Animal Owner Informed Consent Use of animals for research INFORMATION SHEET Use of As the owner or duly authorized agent for the owner you have been asked to have your animal participate in a research study. Your informed consent is required prior to this use. Please read this document and accompanying Consent Form carefully and feel free to ask any questions you might have. Animal Project Title: Investigate Effects of Caffeine on Alcohol Consumption and Nicotine Self- Administration in Rats. AEC Approval No: Approval penod Dates: 25/11/2013 Chief Investigator Name: Amir H. Rezvani*, Hannah G.
Sexton, Faculty/School: Department of Psychiatry and Behavioral Sciences , Duke University Medical Centre, Durham, North Carolina Contact Details 919-668-1880; Fax: 919-681-3416; E-mail: [email protected] edu Person Responsible for the animal(s) during the Research Study: Amir H. Rezvani*, Hannah G. SextonJoshua Johnson, Cori Wells, Karen Gordon, Edward D. Levin Contact Details Location where animal participation/research study occurs Durham, North Carolina Aims and Benefits of the Research Study: To study more about The Effect of Nicotine on Ethanol Intravenous and its relation to
Self-Administration, Duration of animal participation Description of animal procedures to be carried out Male and Female rats Possible discomfort, risks and complications and steps taken to minimise risks. There is no risk; the rats will not die after inducing drugs. Possible benefits to the animal None Voluntary Participation: The participation of your animal is voluntary, and you may withdraw your animal(s) for any reason at any time. If you do not wish to participate you do not have to provide any reason for your decision.
Refusal to participate or withdrawal will in no ay affect the care to which animal participants are otherwise entitled. If you withdraw, any data collected about your animal will be retained for analysis. Unforseen Risks: Unforseen risks might arise at any time during the research study. The research investigators will promptly inform owners of all animals participating in the study of any new information that may affect their willingness to participate.
Termination of Participation by Chief Investigator: The research investigators have the right to terminate the research study for any and all participants at any time and for any reason. Financial Implications: There will be no cost to you for the participation of your animal in the research study. You will not be charged for any of the procedures performed solely for the studys purposes. You will receive no reimbursement for the participation of your animal in the research study.
All unrelated costs for diagnosis, management and treatment of your animal are your responsibility (relates to veterinary studies). The University of Adelaide does not provide compensation or therapy for any injuries or losses that may occur as a result of participation. If the animal is insured you are advised to notify the insurer of involvement in a research project. Questions: 1 . If you have any questions or concerns relating to the practical aspects of the research study please feel free to ask at any point.
You are free to contact the research personnel – Chief Investigator and the Responsible Person – using the contact details provided above. 2. This research study has been approved by the University of Adelaide Animal Ethics with the Animal Ethics Committee you may contact either of the following AEC contact ersonnel: Animal Welfare Officer: Animal Ethics Committee Secretary: Dr Denise Noonan Ph: (08) 8303 4107 Mobile: 0421 615 147 Email: denise. [email protected] edu. au C/- Office of the DV-C & V-P (Research), The University of Adelaide SA 5005 Mrs Helen Malby Ph: (08) 8303 4014 Email: helen. [email protected] edu. au C/- Research Ethics & Compliance Unit, The University of Adelaide SA 5005 CONSENT FORM – FOR ANIMAL PARTICIPATION IN RESEARCH Name & Identification of animal(s) Name: none Species: Rats Breed: Sprague-Dawley adolescent and adult Sex: Male and Female . l, Hannah G. Sexton certify that I am at least 18 years of age and am the owner (or duly authorised representative of the owner) of the above animal(s) and that the animal(s) are free of any lien or claim by any other person or persons. 2.
I acknowledge that I have read the attached Information sheet for the research project entitled: Effects of Caffeine on Alcohol Consumption and Nicotine Self- Administration in Rats. and have had the participation of my animal(s) in the research study fully explained to me by the research investigator: Amir H. Rezvani*, Hannah G. SextonJoshua Johnson, Cori Wells, Karen Gordon, Edward D. Levin 3. My consent is freely given. I have had the opportunity to ask questions and discuss any aspects of the participation with the research investigator.
I understand that some risk always exists when animal handling and animal procedures are performed. I understand that the participation of my animal(s) is voluntary, and I may withdraw my animal(s) for any reason at any time. I understand that this research participation will involve leaving my animal(s) in the care of suitably trained nd authorised staff of the Department of Psychiatry and Behavioural Sciences, Duke University Medical Centre, Durham, North Carolina. 4.
I understand that the research investigator(s) will inform me of any new risks that 5. I am aware that this project has current approval by the University of Adelaide Animal Ethics Committee. 6. I understand that all private data pertaining to me and my animal(s) will be treated in strict confidence. 7. I am aware that I should retain a copy of this Consent Form and attached Information sheet. Consenting owner/authorised agent name: Agent Contact details: Telephone:……………………………………….. xplanation. Witness’s name: Signature: Date Owner/ Address: Witness Declaration: I have described to the animal owner/authorised agent the nature of the animal(s) participation in the research study. In my opinion he/she understood the Signature: … ….. …………………………………………….. Date Original of consent form to be retained by the Chief Investigator Copy to be given to the consenting owner/agent Copy to be kept in the animal’s record (if applicable)