ࡱ> x{uvwi Ybjbj.. DbDbhPv v 8>*T?~t"(###%V$&$H&V?X?X?X?X?X?X?$AMD|?\&%@%\&\&|?##t?,,,,\&##V?,\&V?,,H7h8# Q_&j7B??<?7DT'PD 88D 98\&\&,\&\&\&\&\&|?|?)b\&\&\&?\&\&\&\&D\&\&\&\&\&\&\&\&\&v B : Animal Care and Use Committee For Administration Use Only Protocol No.Date Received:Committee Meeting Date:RESEARCH PROTOCOL New Application Form (Field Studies)  The use of animals for research is a privilege. Before a protocol to use animals in a research project is approved, the researcher must show that the use of animals is justified, that the project has merit, and that the procedures to which the animals will be subjected will be carried out humanely and in accordance with CCAC standards. Approved protocols will be valid for a period of 1 year and may be renewed (with minor revisions if required) in years 2, 3 and 4 with re-application in year 5. Please submit a signed original of the completed application to the Animal Care and Use Committee, Office of Research, 3333 University Way, Prince George BC, V2N 4Z9, and an electronic version to  HYPERLINK "mailto:acuc@unbc.ca" acuc@unbc.ca. 1. GENERAL INFORMATION Project Title:Has this protocol been approved before?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please provide previous protocol number: Is this a collaborative project with another CCAC-certified institution?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please attach copies of the application and approval letter from the other institution.Principal Investigator Department/ProgramPosition/RankApplication DatePhone/Fax:EmailProposed Start Date for Current ApplicationProposed End Date for This ApplicationFinal End Date of ProjectMulti-Year Project ____/____ (Indicate the year this application relates to) yr /of/ yrLocation where study will take place: CCAC Category of Invasiveness:  FORMCHECKBOX  A  FORMCHECKBOX  B  FORMCHECKBOX  C  FORMCHECKBOX  D  FORMCHECKBOX  E (see Definitions in Section 16 of this document for details)  CCAC Purpose of Animal Use (PAUs):  FORMCHECKBOX  0  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5 (see Definitions in Section 16 of this document for details)  Declaration: I, the undersigned, will ensure that all animals used in this project will be treated and cared for in accordance with the policies and guidelines of the Canadian Council on Animal Care and the requirements of the relevant international, federal, provincial and municipal legislation. I accept responsibility for keeping the information in this application current and accurate and for notifying the Animal Care and Use Committee of any deviations from this proposal. ______________________________________________ ________________________________ Principal Investigator Signature Date 2. FUNDING AND PEER REVIEW Funding:  FORMCHECKBOX  Internal  FORMCHECKBOX  External Agency Name:Complete Grant Title:Status:  FORMCHECKBOX  Awarded  FORMCHECKBOX  Pending Form of Funding:  FORMCHECKBOX  Grant  FORMCHECKBOX  Contract  FORMCHECKBOX  Other (Specify):Has this proposal for funding received peer review?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf No (above), contact  HYPERLINK "mailto:acuc@unbc.ca" acuc@unbc.ca to request peer review prior to submission.If Yes (above), which agency reviewed this proposal?If available, please provide Fund and Org number.  3. KEY WORD DESCRIPTION PLEASE CHECK ALL THAT APPLY GeneralProceduresAgentsSurgical  FORMCHECKBOX  Acute  FORMCHECKBOX  Behavioural Study  FORMCHECKBOX  Breeding  FORMCHECKBOX  Cell Cultures  FORMCHECKBOX  Chronic  FORMCHECKBOX  Environmental Protection  FORMCHECKBOX  Pilot Study  FORMCHECKBOX  Reinforcement/Motivation  FORMCHECKBOX  Scales/Fin/Feathers/Hair  FORMCHECKBOX  Collection of Feces  FORMCHECKBOX  Tissue/organ Collection  FORMCHECKBOX  Transgenic Animal  FORMCHECKBOX  Observational  FORMCHECKBOX  Wild Animals  FORMCHECKBOX  Other (please specify):   FORMCHECKBOX  Blood Sampling  FORMCHECKBOX  Euthanasia  FORMCHECKBOX  Food Deprivation  FORMCHECKBOX  Gavaging  FORMCHECKBOX  Identification/Marking  FORMCHECKBOX  Injections  FORMCHECKBOX IP  FORMCHECKBOX IV  FORMCHECKBOX IM  FORMCHECKBOX SQ  FORMCHECKBOX  Physical Restraint  FORMCHECKBOX  Special Diet  FORMCHECKBOX  Trapping/Netting  FORMCHECKBOX  Water Restriction  FORMCHECKBOX  Other (Please specify):   FORMCHECKBOX  Anaesthetics  FORMCHECKBOX  Bio-Hazardous  FORMCHECKBOX  Carcinogens  FORMCHECKBOX  Chemical  FORMCHECKBOX  Infectious  FORMCHECKBOX  Immunogenic  FORMCHECKBOX  Inflammatory  FORMCHECKBOX  Other (Please specify):  FORMCHECKBOX Cannulation  FORMCHECKBOX  Major  FORMCHECKBOX  Minor  FORMCHECKBOX  Multiple  FORMCHECKBOX  Survival  FORMCHECKBOX  Terminal  FORMCHECKBOX  Other (Please specify): 4. Description of Proposed Research (Lay Summary) In lay terms provide a brief description of the research objectives and the procedures to be used. Use language that a non-scientist can understand. Maximum 250 words.  5. Participants directly involved in the care and use of animals in this project NamePositionResponsibilitiesContact Completion  FORMCHECKBOX  mandatory Animal Training course  FORMCHECKBOX  Surgery and Anesthesia course, if applicable  FORMCHECKBOX  mandatory Medical Surveillance Questionnaire  FORMCHECKBOX  mandatory Animal Training course  FORMCHECKBOX  Surgery and Anesthesia course, if applicable  FORMCHECKBOX  mandatory Medical Surveillance Questionnaire   FORMCHECKBOX  mandatory Animal Training course  FORMCHECKBOX  Surgery and Anesthesia course, if applicable  FORMCHECKBOX  mandatory Medical Surveillance Questionnaire  FORMCHECKBOX  mandatory Animal Training course  FORMCHECKBOX  Surgery and Anesthesia course, if applicable  FORMCHECKBOX  mandatory Medical Surveillance QuestionnaireDescribe additional training that each participant has received or will receive. Indicate the source of this training.  6. ANIMAL INFORMATION - Identify the total number of each species of animal to be used in this project. SpeciesLocationAnimal Total / YearHousing (if used)  7. PERMITS It is the responsibility of the investigator to obtain all necessary permits for work with wild animals. Please provide the name of the agency issuing all necessary permits, permit numbers, and copies of permits.  8. REPLACEMENT, REDUCTION AND REFINEMENT Those using animals should employ the most humane methods on the smallest number of animals to obtain valid information. Justify the proposed numbers of animals. Use of statistical arguments if necessary. Provide rationale for the choice of species. Non-animal alternatives should be used whenever possible. Explain briefly why any available non-animal alternatives are not suitable for meeting the objectives of this study.  9. DESCRIPTION OF PROCEDURES INVOLVING ANIMALS State the specific scientific objective and potential benefits of the proposed work. Detail all procedures (both experimental and observational) while working in the field with animals, including how they will be monitored. Identify what actions will be made to limit pain and/or stress of the animals. Attach additional pages as necessary. Use simple language, and do not excerpt pages from grant applications. Describe any potential ecological disruption this study may cause.  10. PROJECTS INVOLVING HANDLING/CAPTURE OF WILDLIFE Procedures involving the capture, handling and release of wild animals are of special concern because such procedures may result in elevated levels of stress in captured animals. The necessity for capture, handling, administration of chemicals, placement of marks, and/or attachment of tags must be clearly established. Detailed descriptions of pursuit, capture, handling and chemical restraint procedures, and explanations of their appropriateness, are essential. Clearly state the criteria used to assess suitability for release. Describe any personal hazards that may be encountered in the field (e.g. animal bites, rabies).  FORMCHECKBOX  N/A No animals are to be captured/restrained Proceed to Next Section Method of capture/restraint - provide details of the type of restraint chosen, the time and frequency for checking traps, chase times, immobilization agent used for chemical restraint, duration of captivity, potential for injury/mortality, monitoring frequency of cages or traps and monitoring of animal during captivity and release. Provide details of marking, tagging or banding describe the weight of the equipment and the impact on the animal including potential long-term effects. Also, if equipment is to be removed in the future please provide details.  FORMCHECKBOX  N/A Will you be housing animals in the field or transporting them from the capture area? Include details of pens, enclosures, duration and nutrition.  FORMCHECKBOX  N/A Do you anticipate capturing non-target species? If yes, what is the potential for injury/mortality? What precautions will be taken to avoid capturing vulnerable animals and what action will be taken if these animals are captured?  11. AGENTS TO BE ADMINISTERED TO ANIMALS Indicate all agents to be administered for each species. Indicate hazardous agents with ** and complete section 13.  FORMCHECKBOX  N/A SpeciesAgent/DrugPurposeRoute (SQ, IM, etc)Dosage (e.g. mg/kg)Amount (e.g. mL)Frequency 12. SAMPLES TO BE TAKEN FROM ANIMALS Indicate all samples to be taken for each species  FORMCHECKBOX  N/A SpeciesType of SampleSiteAmountProcedureFrequency 13. HAZARDOUS MATERIALS  FORMCHECKBOX  No hazardous materials will be used in this study (Go to Section 14) Indicate which of the following will be used in animals (**complete details must be listed in Section 11, marked as **)  FORMCHECKBOX  Infectious agents (includes vectors)  FORMCHECKBOX  Toxic chemicals  FORMCHECKBOX  Radioisotopes  FORMCHECKBOX  Carcinogens  FORMCHECKBOX  Other (please specify): Has the use of hazardous materials been reviewed by the Laboratory Safety Committee?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoDescribe potential health risk(s) to humans or animals. Indicate duration of the effects of the agent. Describe measures that will be used to reduce risk to the environment, the project and personnel.  14. PAIN, DISTRESS, ENDPOINTS AND EUTHANASIA Identify any pain or distress likely to be associated with the procedures or manipulations, and describe how it will be alleviated or minimized. If animals encounter unanticipated pain and/or distress, what criteria will be used to terminate the procedure/study and possibly euthanize the animal(s)? Endpoints are clear criteria to define the point at which humane intervention must be implemented to prevent or relieve unnecessary pain and/or distress. Should the experimental animal acquire experimentally-induced disease, illness or life-threatening condition, select the endpoint(s) of the experiment for the animal. If euthanasia is necessary upon termination of the study, or where pain and/or distress exceeds the threshold, specify the method of euthanasia. Acceptable methods of Euthanasia: Please specify the method of euthanasia.  FORMCHECKBOX  Injection of diluted/buffered barbiturate*  FORMCHECKBOX  Exsanguination with anesthesia  FORMCHECKBOX  Decapitation with anesthesia, list agent/dose/route*  FORMCHECKBOX  Maceration (for fish less than 2cm in length)  FORMCHECKBOX  Cervical dislocation with anesthesia, list agent/dose/route *  FORMCHECKBOX  Overdose of inhalant anesthetics with C02  FORMCHECKBOX  Immersion or injection of buffered TMS/MS222 (Fish/Frogs)  FORMCHECKBOX  Clove oil (Fish)  FORMCHECKBOX  Other (please specify): *List agent/dose/route: Conditionally Acceptable Methods: Please specify the method of euthanasia  FORMCHECKBOX  Decapitation without anesthesia  FORMCHECKBOX  Cervical dislocation without anesthesia  FORMCHECKBOX  C02 only (Rodents)  FORMCHECKBOX Concussion (Fish)  FORMCHECKBOX  Other (please specify):The use of any Conditionally Acceptable Method must be justified. Please explain the reason why this method of euthanasia is required: If an animal needs to be euthanized in the field, how will the carcass be disposed of? What is the intended fate of the animals used in the study:  FORMCHECKBOX  Nothing, observations only  FORMCHECKBOX  Released, at or near capture site  FORMCHECKBOX  Released, at other location  FORMCHECKBOX  Euthanized  FORMCHECKBOX  Other _________________________________________________________  15. Emergency PlAN Provide the contact information of a veterinarian(s) when consultation may be necessary.Name of Contact and addressPhone Number 16. DEFINITIONS Description of Purpose of Animal Use (PAUs) 0: Breeding Colony/Stock Animals held in breeding colonies (e.g., fish, rodents) that have not been assigned to a particular research or teaching protocol. 1: Fundamental Nature Studies Studies of a fundamental nature in sciences relating to essential structure or function (e.g., biology. psycho-biochemistry, pharmacology, physiology, etc.). Possible examples are studies designed to understand: the cellular and/or molecular basis of inflammatory reactions or basic physiological or biochemical reactions; one of the various roles played by a hormone or other compound in mammals; the behavior of species; the population dynamics of various species. 2: Medical Purposes - Studies for medical purposes, including veterinary medicine, that relate to human or animal diseases. These are studies carried out to better understand a specific disease or disorder and to possibly find therapies for it. Possible examples: development of a mouse model for a specific type of cancer or other disease; studies to determine which antibodies are the most likely to contribute positively to the therapy of a specific type of cancer; studies to determine which molecule within a particular class of compounds is the most likely to contribute to maintaining stable blood glucose levels in an animal model of diabetes. 3: Regulatory Testing - Studies for regulatory testing of products for the protection of humans, animals, or the environment. Possible examples: safety testing, regulatory toxicology, vaccine efficacy trials and testing of new therapeutic compounds. 4: Development of Products - Studies for the development of products or appliances for human or veterinary medicine. These are studies that investigate potential therapies (as determined following studies of PAU 2) for humans or animals, before regulatory testing. PAU 3 is carried out on the most promising therapies. Possible examples include studies undertaken to: investigate the role and effects of a specific drug or immunotherapy candidate for cancer; develop physical devices to assist heart function; develop artificial organs. 5: Education and training Education and training of individuals in post-secondary institutions or facilities. These are teaching or training programs where animals are used to introduce students to scientific work and teach manual skills and techniques. Category of Invasiveness* Category of Invasiveness* *(Excerpt from the CCAC guidelines on: the care and use of wildlife (2003) A: Experiments on most invertebrates or on live isolates. Possible examples: the use of tissue culture and tissues obtained at necropsy; the use of eggs, protozoa or other single-celled organisms; experiments involving containment, incision or other invasive procedures on metazoa; and studies in which the animals are observed without any disturbance to them. B: Experiments which cause little or no discomfort or stress. Possible examples: Observational studies in which there is some disturbance to the animals but not to the point that the same individuals are repeatedly observed so as to habituate or otherwise modify their behavior; census or other surveys which disturb animals but which do not involve capture or marking individuals; non-invasive studies on animals that have been habituated to captivity; short periods of food and/water deprivation equivalent to periods of abstinence in nature. C Experiments which cause minor stress or pain of short duration. Possible examples: capture, using methods with little or no potential to cause injury, and marking of animals for immediate release; long-term observational studies on free-ranging animals where the behavior of individuals may be altered by repeated contact; brief restraint for blood or tissue sampling; short periods of restraint beyond that for simple observation or examination, but consistent with minimal distress; short periods of food and/water deprivation which exceed periods of abstinence in nature; exposure to non-lethal levels of drugs or chemicals; low-velocity darting and slow-injection darts with immobilization chemicals. Such procedures should not cause significant changes in the animals appearance, in physiological variables (such as respiratory or cardiac rate, or fecal or urinary output), in social responses or inability to survive. Note: During or after Category C studies, animals must not show self-mutilation, anorexia, dehydration, hyperactivity, increased recumbency or dormancy, increased vocalization, aggressive-defensive behavior, or demonstrate social withdrawal and self-isolation. D: Experiments which cause moderate to severe distress or discomfort. Possible examples: Capture, using methods that have the potential to cause injury (e.g. high-velocity darting and rapid injection darts with immobilization chemicals, net gunning, etc.); maintenance of wild-caught animals in captivity; translocation of wildlife to new habitats; major surgical procedures conducted under general anesthesia, with subsequent recovery; prolonged (several hours or more) periods of physical restraint; induction of behavioural stresses such as maternal deprivation, aggression, predator-prey interactions; procedures which cause severe, persistent or irreversible disruption of sensorimotor organization. Other examples in captive animals include: induction of anatomical and physiological abnormalities that will result in pain or distress; the exposure of an animal to noxious stimuli from which escape is impossible; the production of radiation sickness; exposure to drugs or chemicals at levels that impair physiological systems. Note: Experiments described in this paragraph are considered to be Category E if performed on wildlife immediately prior to release. E: Procedures which cause severe pain near, at, or above the pain tolerance threshold of an unanesthetized conscious animal. This Category of Invasiveness is not necessarily confined to surgical procedures, but may include exposure to noxious stimuli or agents whose effects are unknown; exposure to drugs or chemicals at levels that (may) markedly impair physiological systems and which cause death, severe pain, or extreme distress; behavioural studies where the effects and degree of distress are not known; environmental deprivation that has the potential to seriously jeopardize an animals well-being; use of muscle relaxants or paralytic drugs without anesthetics; burn or trauma infliction on unanesthetized animals; a method of euthanasia not approved by the CCAC; any procedures (e.g., the injection of noxious agents or the induction of severe stress or shock) that will result in pain which approaches the pain tolerance threshold and cannot be relieved by analgesia (e.g., removal of teeth without analgesia; or when toxicity testing and experimentally-induced infectious disease studies have death as the endpoint). Capture methods with a high potential of causing severe injury that could result in severe chronic pain and/or death (e.g. leghold traps).     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