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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Institutional Affiliation
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Preferred Date of Analysis Completion
Today M-D-Y
Final Deadline for Analysis Completion
Today M-D-Y
discarded after analysis
returned to requester after analysis
Are you currently a funded investigator or applicant to the (CCOP) COBRE?
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Is this Project Funded by the Center for Childhood Obesity Prevention (CCOP) COBRE Grant?
Yes No
Please select CCOP project type
Research Project Leader (RPL - Formally "Primary")
Pilot Project
Seed Project (Formally "Affiliated")
Feasibility
Grant Number (if already awarded)
PI Co-I Other
Billing Contact Mailing Address
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
Type of Cells for Other Protocol
Number of Samples for Cells Oroboros
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
Tissue Oroboros Method/Analyte
Respirometry Protocol (RP) 1
RP 2
Other
Type of Tissue for Other Protocol
Number of Samples for Tissue Oroboros
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
Clinical Analyzer Analysis Type Requested
Basic Metabolic Panel (BMP)
Comprehensive Metabolic Panel (CMP)
Individual Tests
BMP includes Glucose, Calcium, Sodium, Potassium, CO2, & Creatinine. CMP includes everything in BMP plus Albumin, Total Protein, Alkaline Phosphatase, Alanine Transaminase, Aspartate Transaminase & Bilirubin
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
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
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
ELISA Analysis Type Requested
Spectrophotometer
MSD
Milliplex MAP
Spectrophotometer Method/Analyte
Insulin
Adiponectin
Leptin
Other
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)
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
Insulin
Other
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)
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
Milliplex MAP Method/Analyte
Human Cytokine/Chemokine
Other
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)
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
GC/MS Analysis Type Requested
Quantification
Enrichment
Quantification Method/Analyte
Amino Acids
Fatty Acid Methyl Esters
Other
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)
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
Enrichment Method/Analyte
Creatine
Leucine
Phenylalanine
Urea
Palmitate
Other
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)
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
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
Number of Samples for IRMS Enrichment Analyte(s)
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
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
Number of Samples for IRMS Elemental Analyte(s)
If you have a different number of samples for different analytes, please enter the most common number here, then specify additional numbers for other analyte types in the notes section below
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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