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ANIMAL USE PROPOSAL
(in accordance with the Valdosta State University Policy on Humane Care and Use of Laboratory Animals)
Final Use Category Assigned (circle): B C D E AUP No. _____________________
IACUC Approval Signature: __________________________________________________
Date of Approval: ___________________________________________________________
IACUC Reviewer: ___________________________________________________________
This form has been developed to facilitate the review of requests to use animals for specific research, teaching, or biological testing projects. The review process has been designed to communicate methods and materials for using animals through administrative officials and attending veterinarians to the Institutional Animal Care and Use Committee (IACUC). This process will help assure that provisions are made for compliance with the Animal Welfare Act, the Public Health Service Policy on Humane Care and Use of Laboratory Animals (10/00), and the Department of Health and Human Services� 1996 Guide for the Care and Use of Laboratory Animals, HYPERLINK "http://grants.nih.gov.grants/olaw/olaw.htm" http://grants.nih.gov.grants/olaw/olaw.htm. This completed form must be approved by the IACUC before the project or course is initiated and before animals can be procured. Approved AUPs and AUP numbers are valid for up to three years subject to approval of modifications and annual reviews.
Use this form only for NEW AUPs or for those whose 3-year approval for use has expired.
For ANNUAL REVIEWS or MODIFICATIONS to an approved AUP, use the 1-page 揂UP Annual Review or Modification� form. After 3 years a new complete AUP must be submitted and assigned a new AUP number. The number of animals used must be declared annually and their documentation is the responsibility of the Principal Investigator.
MULTIPLE FUNDING AGENCIES: Submit only one AUP for identical procedures, animal species and numbers of animals proposed in grant requests to different funding agencies. Use the same AUP number for each grant application. If funded, submit 揂UP Annual Review or Modification� form with changes from original AUP, such as funding agency, procedures, or number of animals. Unless authorized by a Modification, the number of animals used must not exceed the number authorized on the original approved AUP regardless of the sources of funding.
1. Project or Course Title: FORMTEXT
2. Name of Principal Investigator: FORMTEXT E-mail: FORMTEXT
Title of PI: FORMTEXT Telephone: FORMTEXT
Department: FORMTEXT Bldg./Room: FORMTEXT
Please list all persons from your laboratory who will work with animals and the procedures they will perform:
Name: FORMTEXT Procedures: FORMTEXT
Name: FORMTEXT Procedures: FORMTEXT
Name: FORMTEXT Procedures: FORMTEXT
Name: FORMTEXT Procedures: FORMTEXT
Name: FORMTEXT Procedures: FORMTEXT
3. Source of Funding: FORMTEXT Proposal Deadline: FORMTEXT
Anticipated Starting Date: FORMTEXT Study Completion Date: FORMTEXT
The PI assumes responsibility for compliance with the policies stated above including assuring that the staff are trained and qualified to perform the procedures on animals as indicated in this Animal Use Proposal and assures the Committee that this research does not unnecessarily duplicate previous experiments. The PI must hold 蜜桃影像传媒有限公司网站 faculty status. Students, including post-docs, residents and others 搃n training,� and non-蜜桃影像传媒有限公司网站 employees can only serve as Co-Investigators.
The Attending Veterinarian verifies that the elements of this proposal have been assessed regarding the use of appropriate techniques in utilization of animals and that consultation with the PI will occur as necessary to resolve issues to minimize pain and distress.
Signature of PI: ______________________________________ Date: FORMTEXT
Attending Veterinarian: Date:
Please submit this completed form through the Office of Sponsored Programs and Research Administration: Compliance Coordinator, Suite 3100, Psychology Building, Valdosta State University, Valdosta, GA 31698
Phone: (229) 259-5045 FAX: (229) 245-3853
For all proposals submitted, particularly those related to U.S. PHS or NIH proposals, please complete this item: The Dean, Department Head, or College Review Committee (Please indicate which by underline) concurs with the scientific relevance of conducting this protocol.
Printed Name: Signature:
Will any aspect of the experimental study (course) or animal husbandry be conducted at another institution? FORMCHECKBOX Yes FORMCHECKBOX No
If Yes, where? FORMTEXT
Was the proposal approved by the IACUC of that institution? FORMCHECKBOX Yes FORMCHECKBOX No
7. Abstract of Proposal: Describe succinctly, in lay terms, how the animals will be used and what the contribution from using animals will be, or attach your project abstract. (Text box will expand as necessary)
FORMTEXT
8. Does this proposal include the maintenance of a breeding colony? FORMCHECKBOX Yes FORMCHECKBOX No
9. Animals to be used in this study per year:
Max. No.
Animal Species To be Used Source
(Common name) Per Year* Strain Sex Facility Location**
FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT *For breeding colonies, indicate the maximum number to be maintained in the colony at any time.
Note: Excluding breeding colonies, the number of animals procured and the number of animals used under this AUP must be documented by the investigator each year. By law, this number must not be greater than the maximum approved in this AUP.
**For additional space use bottom of this page or add a page.
10. a) Explain why each species was selected.
FORMTEXT
b) Explain how the numbers needed of each species were determined.
FORMTEXT
11. Indicate non-surgical procedures below and describe on a separate sheet.
a) Specimen collection from live animals:
Type and volume of samples: FORMTEXT
Frequency and duration of collection: FORMTEXT
Method of collection: FORMTEXT
Specimen collection from euthanized animals:
Type: FORMTEXT
Source: FORMTEXT
c) Induction of neoplasia:
Type: FORMTEXT
d) Use of infectious agents (Request approval from Environmental Health Officer)
Name of agent: FORMTEXT
Amount of dose: FORMTEXT Route of administration: FORMTEXT
Biosafety level: FORMTEXT
e) Use of radioisotopes (Request approval from Environmental Health Officer):
Isotope: FORMTEXT
Amount/Dose: FORMTEXT
Route: FORMTEXT
f) Use of carcinogens (Request approval from Environmental Health Office):
Carcinogen: FORMTEXT
Amount/Dose: FORMTEXT
g) Administration of test substances not listed above:
Amount/Dose: FORMTEXT
Route: FORMTEXT
h) Tranquilizers, anesthetics, analgesics or antagonists used in any of the above procedures (specify below):
Species Agent/Conc. Dose (mg/kg) Route
FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT
NOTE: The Institution does not condone any project involving pain without anesthetic/analgesia.
12. Indicate Surgical Procedures:
a) Type of surgical procedure. A complete description should include who will administer and what the pre- and post-operative care will consist of, special post-surgical needs of the animal, the length of time the animal will be kept alive following surgery, and any anticipated complications.
Terminal, i.e. animals will be euthanized under anesthesia when surgery is completed. FORMCHECKBOX Yes FORMCHECKBOX No
NOTE: Describe fully any euthanasia method to be used and the reasons for the selection (list by name of drug, dosage and route of administration). See question 13.
Survival, i.e. animals will recover from anesthesia following surgery. FORMCHECKBOX Yes FORMCHECKBOX No
b) Anesthetic and analgesic agents to be used in surgical procedures:
Species Agent/Conc. Dose (mg/kg) Route
FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT
c) Indicate monitoring and life support systems to be utilized.
FORMCHECKBOX Respiratory rate FORMCHECKBOX Heart rate
FORMCHECKBOX Mucous membrane color FORMCHECKBOX Reflexes
FORMCHECKBOX EKG FORMCHECKBOX Blood gases
FORMCHECKBOX Body Temperature FORMCHECKBOX Blood Pressure
FORMCHECKBOX Other: FORMTEXT
13. Euthanasia procedures:
a) Technique Species
FORMCHECKBOX CO2 inhalation FORMTEXT
FORMCHECKBOX Barbiturate overdose FORMTEXT
FORMCHECKBOX Cervical dislocation FORMTEXT
FORMCHECKBOX Other Methods (Specify) FORMTEXT
Name and title of person performing euthanasia: FORMTEXT
14. If the answer to any of the following questions is Yes, please provide an explanation.
Will any technique be performed which would result in prolonged loss of sensation or paralysis?
FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT
Will any technique be performed which will involve prolonged physical restraint other than routine caging and handling?
FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT
Will any technique be performed which will involve any non-standard husbandry techniques (feedings, watering, housing, environment)?
FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT
d) Will any substance such as Complete Freund s Adjuvant be injected which could cause chronic inflammation and/or pain?
FORMCHECKBOX Yes FORMCHECKBOX No If yes, describe what will be used and the schedule: FORMTEXT
Will animals be subjected to potentially painful procedures for identification, i.e. toe clipping, branding, etc?
FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT
Will it be necessary for live animals to be removed from the immediate care facility?
FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT
Will this experiment involve the study of stress, pain, or abnormal behavior in live animals which cannot be alleviated with drugs because their use would interfere with the research goal?
FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT
h) Will any adverse effects or overt signs of illness be expected?
FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT
Please provide explanations related to question 14. a-h).
15. Place proposed animal research/laboratory use into categories according to potential pain and distress. The Animal Welfare Act requires an annual report to the U.S.D.A. For each species of animal involved please read the attached Animal Use Category definitions and indicate which category; B, C, D, or E applies to this project.
Species Use Category
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�`�.�0>$�#�勪齘�`勪齛$
�����$勚�刲]勚黕刲gd*:Q3R4RdSjS匰哠嶴廠怱烻燬猄玈T�
����$�&�(�2�4�8�:�N�P�R�\�^�`�b�v�蝈劐瓤炔骏湆wgW�j繥h(o�hQD�CJU�j笷h(o�hQD�CJU$jh(o�hQD�CJUmHnHuU�jCFh(o�hQD�CJUh(o�hQD�CJjh(o�hQD�CJUhQD�5丆JOJPJQJhQD�hV�CJhQD�hV�5丆JOJPJQJh躢W5丆JOJPJQJhV�5丆JOJPJQJh*:Q5丅*CJ\乸h3f�! FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT
16. What techniques will be used to minimize potential pain and/or distress (e.g. frequency of observations or euthanasia of sick or moribund animals)?
a) The animals will be observed FORMTEXT times a day or every FORMTEXT hours. Any sick or moribund animals will be treated or euthanized.
b) Other (describe): FORMTEXT
If your study was categorized above as D or E, are there alternatives to the painful procedure?
FORMCHECKBOX Yes FORMCHECKBOX No
If Yes list the alternatives:
FORMTEXT
If alternatives are available but will not be used, justify the procedures used in this proposal.
FORMTEXT
c) If No , describe the methods and source you used to determine there are no alternatives to the procedures in this proposal. For example; Biological Abstracts, Index Medicus, AGRICOLA, Animal Welfare Information Center.
FORMTEXT
If applying for a grant, does the information on this form agree with the animal use section of the grant application? FORMCHECKBOX Yes FORMCHECKBOX No
If this study involves collections or use of animals requiring governmental permits, please provide the name and number of the permit: FORMTEXT
USDA Pain Levels:
USDA Category BUSDA Category CUSDA Category DUSDA Category EBreeding or Holding Colony ProtocolsNo more than momentary or slight pain or distress and no use of pain-relieving drugs, or no pain or distress. For example: euthanatized for tissues; just observed under normal conditions; positive reward projects; routine procedures; injections; and blood sampling.Pain or distress appropriately relieved with anesthetics, analgesics and/or tranquilizer drugs or other methods for relieving pain or distress.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.ExamplesExamplesExamplesHolding or weighing animals in teaching or research activities.
Injections, blood collection or catheter implantation via superficial vessels.
Tattooing animals.
Ear punching of rodents.
Routine physical examinations.
Observation of animal behavior.
Feeding studies, which do not result in clinical health problems.
AVMA approved humane euthanasia procedures.
Routine agricultural husbandry procedures.
Live trapping.
Positive reward projects.Diagnostic procedures such as laparoscopy or needle biopsies.
Non-survival surgical procedures.
Survival surgical procedures.
Post operative pain or distress.
Ocular blood collection in mice.
Terminal cardiac blood collection.
Any post procedural outcome resulting in evident pain, discomfort or distress such as that associated with decreased appetite/ activity level, adverse reactions, to touch, open skin lesions, abscesses, lameness, conjunctivitis, corneal edema and photophobia.
Exposure of blood vessels for catheter implantation.
Exsanguination under anesthesia.
Induced infections or antibody production with appropriate anesthesia and post-op/post-procedure analgesia when necessary.Toxicological or microbiological testing, cancer research or infectious disease research that requires continuation until clinical symptoms are evident or death occurs.
Ocular or skin irritancy testing.
Food or water deprivation beyond that necessary for ordinary pre-surgical preparation.
Application of noxious stimuli such as electrical shock if the animal cannot avoid/escape the stimuli and/or it is severe enough to cause injury or more than momentary pain or distress.
Infliction of burns or trauma.
Prolonged restraint.
Any procedures for which needed analgesics, tranquilizers, sedatives, or anesthetics must be withheld for justifiable study purposes.
Use of paralyzing or immobilizing drugs for restraint.
Exposure to abnormal or extreme environmental conditions.
Psychotic-like behavior suggesting a painful or distressful status.
Euthanasia by procedures not approved by the AVMA.
Guidelines for determining USDA classification in protocols involving tissue collection before/after euthanasia and/or animal perfusion:
If an animal will be euthanatized by an approved physical or chemical method of euthanasia solely for the collection of tissues (after the animal's death), the procedure should be classified as USDA C.
If an animal will be anesthetized so that non-vital tissues can be collected (liver or skin biopsy), and the animal will then be allowed to recover, the procedure should be classified as USDA D (survival surgery).
If an animal will be anesthetized so that non-vital tissues can be collected (liver or skin biopsy, etc.); and the animal will then be euthanatized, the procedure should be classified as USDA D (non-survival surgery). In this scenario, it is necessary to justify why the animal couldn't be euthanatized (USDA category C) rather than anesthetized.
If an animal will be anesthetized so that vital tissues can be collected (heart, both kidneys or lungs, whole liver, etc.), the animal will obviously succumb to the procedure. To determine whether this will be euthanasia or non-survival surgery, we must consider the definition of euthanasia. A critical component of this definition is "rapid unconsciousness followed by loss of cardiac, respiratory and brain function". Based on this definition, procedures which require tissue manipulation or other prolonged techniques prior to the animals death (more than a few minutes) should be classified as non-survival surgery (USDA D). Similarly, if an animal will be anesthetized so that the tissue can be collected in the "freshest" possible state (i.e. heart) and the tissues will be rapidly excised, the procedure should be classified as euthanasia (USDA C). (Note: In this scenario, it is difficult to justify why the animal couldn't be euthanatized rather than anesthetized.)
If an animal will be anesthetized so that it can be chemically perfused, the same "test of time" applies (i.e.: long, technical manipulations should be classified as USDA D; while rapid intravascular injection of the perfusate without other manipulations should be classified as USDA C).
NOTE: Because the USDA classification system is based on the "potential for pain, distress or discomfort," the anesthetic/euthanasia drug dose becomes a critical concern. For example, if a known "euthanasia dose" of pentobarbital will be administered, drug irreversibility is assumed. Thus, once the animal is confirmed to be in an anesthetic plane (toe pinch response, etc.), tissues can be collected/ procedures can be performed without the concern about what the animal will be perceiving. This procedure would then be classified as USDA C. The Committee recommends using a euthanizing dose whenever possible. Other methods may be appropriate with proper scientific justification.
Valdosta State University Animal Use Proposal (AUP)
PAGE
PAGE 7
Rev: 4-1-2009
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