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Ad6sU7WMT3UjbAiqqwV2NgwAKtCiMtsUaLeU5tI4H3XdQM7DknsnPB2ybxnQrvSTWuWncBy8XogIYiAhUdvz33cKFeqfCcy95g

Metabolism and Bioenergetics Core Request

Please provide the information requested below. Once completed, a member of the Metabolism and Bioenergetics Core will contact you to discuss your request in more detail and provide pricing information.

Please be aware that upon approval of your request, you must provide a complete list of samples to be analyzed per analyte requested (if samples vary per analyte). A template for the complete list of samples will be provided upon approval of your request along with specific instructions for analysis (if applicable).

You may contact Matthew Cotter at cotterm@archildrens.org with any questions regarding the form.

Date of Request

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M-D-Y

Requester Name

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Email Address

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Phone

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Job Title

Institutional Affiliation

* must provide value

Mailing Address

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Project Name

Preferred Date of Analysis Completion

M-D-Y

Final Deadline for Analysis Completion

M-D-Y

Samples Should Be:

discarded after analysis

returned to requester after analysis

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Are you currently a funded investigator or applicant to the (CCOP) COBRE?

Yes No

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Is this Project Funded by the Center for Childhood Obesity Prevention (CCOP) COBRE Grant?

Yes No

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Please select CCOP project type

Research Project Leader (RPL - Formally "Primary")

Pilot Project

Seed Project (Formally "Affiliated")

Feasibility

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Funding Agency

Grant Number (if already awarded)

Roll

Amount

Name of Billing Contact

Billing Contact Mailing Address

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Billing Contact Phone

Billing Contact Email Address

You may only select services for which you have IRB/IACUC approval

Oroboros Analysis Type Requested

Cells

Tissue

Cells Oroboros Method/Protocol

Respirometry Protocol (RP) 1

RP 2

Other

Please Specify

Type of Cells for RP 1

Type of Cells for RP 2

Type of Cells for Other Protocol

Number of Samples for Cells Oroboros

Tissue Oroboros Method/Analyte

Respirometry Protocol (RP) 1

RP 2

Other

Please Specify

Type of Tissue for RP 1

Type of Tissue for RP 2

Type of Tissue for Other Protocol

Number of Samples for Tissue Oroboros

Clinical Analyzer Analysis Type Requested

Basic Metabolic Panel (BMP)

Comprehensive Metabolic Panel (CMP)

Individual Tests

Type(s) of Samples for BMP

Serum

Plasma

Urine

Saliva

Stool

Breath

Number of Samples for BMP Analytes

Type(s) of Samples for CMP

Serum

Plasma

Urine

Saliva

Stool

Breath

Number of Samples for CMP Analytes

Individual test method/analyte

Glucose

Calcium

Sodium

Potassium

Carbon Dioxide (CO2)

Chloride

Blood Urea Nitrogen (BUN)

Creatinine

Albumin

Total Protein

Alkaline Phosphatase (ALP)

Alanine Transaminase (ALT)

Aspartate Transaminase (AST)

Bilirubin

Triglycerides

Total Cholesterol

High-Density Lipoprotein (HDL)

Low-Density Lipoprotein (LDL)

Glycerol

C-Reactive Protein (CRP) Full Range (0.3-160 mg/l)

Other

Please specify

Type(s) of Samples for Individual Tests

Serum

Plasma

Urine

Saliva

Stool

Breath

If more than one type of sample was selected above, please specify which types of samples will be used for each selected analysis

Number of Samples for Individual Analytes

ELISA Analysis Type Requested

Spectrophotometer

MSD

Milliplex MAP

Spectrophotometer Method/Analyte

Insulin

Adiponectin

Leptin

Other

Please Specify

Type(s) of Samples for Insulin

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Adiponectin

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Leptin

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Other

Serum

Plasma

Urine

Saliva

Stool

Breath

Number of Samples for Spectrophotometer Analyte(s)

MSD Method/Analyte

Insulin

Other

Please Specify

Type(s) of Samples for Insulin

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Other

Serum

Plasma

Urine

Saliva

Stool

Breath

Number of Samples for MSD Analyte(s)

Milliplex MAP Method/Analyte

Human Cytokine/Chemokine

Other

Please Specify

Type(s) of Samples for Human Cyokine/Chemokine

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Other

Serum

Plasma

Urine

Saliva

Stool

Breath

Number of Samples for Milliplex MAP Analyte(s)

GC/MS Analysis Type Requested

Quantification

Enrichment

Quantification Method/Analyte

Amino Acids

Fatty Acid Methyl Esters

Other

Please specify

Type(s) of Samples for Amino Acids

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Fatty Acid Methyl Esters

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Other Analyte

Serum

Plasma

Urine

Saliva

Stool

Breath

Number of Samples for Quantification Analyte(s)

Enrichment Method/Analyte

Creatine

Leucine

Phenylalanine

Urea

Palmitate

Other

Please specify

Type(s) of Samples for Creatine

Serum

Plasma

Urine

Saliva

Stool

Breath

Enrichment Tracer for Creatine

Type(s) of Samples for Leucine

Serum

Plasma

Urine

Saliva

Stool

Breath

Enrichment Tracer for Leucine

Type(s) of Samples for Phenylalanine

Serum

Plasma

Urine

Saliva

Stool

Breath

Enrichment Tracer for Phenylalanine

Type(s) of Samples for Urea

Serum

Plasma

Urine

Saliva

Stool

Breath

Enrichment Tracer for Urea

Type(s) of Samples for Palmitate

Serum

Plasma

Urine

Saliva

Stool

Breath

Enrichment Tracer for Palmitate

Type(s) of Samples for Other

Serum

Plasma

Urine

Saliva

Stool

Breath

Enrichment Tracer for Other

Number of Samples for Enrichment Analyte(s)

IRMS Analysis Type Requested

Enrichment

Elemental analysis (quantification)

IRMS Enrichment Method/Analyte

Deuterium Oxied (D20)

Doubly Labeled Water (H2180)

Breath CO2

13C-Labeled Compound

15N-Labeled Compound

2H-Labeled Compound

18O-Labeled Compound

Type(s) of Samples for Deuterium Oxide

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Doubly Labeled Water

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Breath CO2

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for 13C-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for 15N-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for 2H-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for 18O-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Brief Description of IRMS Enrichment Study

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Number of Samples for IRMS Enrichment Analyte(s)

IRMS Elemental Analysis Method/Analyte

13C-labeled compound

15N-labeled compound

2H-labeled compound

18O-labeled compound

Deuterium Oxide (D2O)

Doubly Labeled Water (H218O)

Type(s) of Samples for 13C-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for 15N-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for 2H-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for 18O-Labeled Compound

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Deuterium Oxide

Serum

Plasma

Urine

Saliva

Stool

Breath

Type(s) of Samples for Doubly Labeled Water

Serum

Plasma

Urine

Saliva

Stool

Breath

Brief Description of IRMS Elemental Study

Expand

Number of Samples for IRMS Elemental Analyte(s)

Notes

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I certify that the analyses requested have IRB/IACUC approval.

The Metabolism Core facility is supported by the Arkansas Children's Research Institute.

For publications and presentations using data generated from this core, I agree to add the following acknowledgment:

"Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 5P20GM109096. Additional services were provided by the Center for Childhood Obesity Prevention Metabolism Core under Award Number 5P2GM109096, Sub #5995. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health"

Note: Failure to acknowledge this grant may limit access to this core in the future.

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I agree

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