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Please complete the information as it applies to your proposal. Use “Not Applicable” where the requested information does not apply to your proposal.  \nPlease note you can save your proposal any time. A field is required if marked with *  \nSponsor Information  \nSponsor: This is the external entity (e.g. , external investigator, healthcare institution, medical network, academic research organisation) who is accountable for all aspects of the study, including compliance with all applicable ethical codes, laws and regulations that governs the research tobe conducted, regardless of whether GSK is fully or partially funding the study.  \n* Is the Sponsor an individual or an institution?  \nSponsor choices are: Individual / Institution * Name of the Sponsor:  \nSponsor Institution Type:  \nInstitution Type choices are: Company / Cooperative Group / Hospital / Physician Network / Private Practice / University of Academic Center * Sponsor Address:  \n* Country:  \n* Sponsor email Address:  \n* Sponsor phone number:  \n* Is the Principal Investigator contact different from the Sponsor? Yes / No  \nIf yes:  \n* Name of the Principal Investigator  \n* Principal Investigator email address  \n* Principal Investigator phone number  \n* Institution Type  \nInstitution Type choices are: Company / Cooperative Group / Hospital / Physician Network / Private Practice / University of Academic Center  \n* Institution Name  \n* Address  \n* Do you have other key personnel participating in the study? Yes / No  \nIf yes:  \n\n| Title | * Name | * Phone | * Email | Affiliation |\n| --- | --- | --- | --- | --- |\n| e.g.: Project Manager |  |  |  |  |\n| e.g.: Co-Investigator |  |  |  |  |\n| e.g.: Study Coordinator |  |  |  |  |\n| e.g.: Other |  |  |  |  |\n\n(*) required  \n* Are you working with any Cooperative Group, Research Consortium and/or Physician Network? Yes / No  \n* If yes:  \n* Please specify name(s):  \n* Have you been in contact with any GSK employees with regards to this submission? Yes / No  \n* If yes:  \n* Please specify name(s):  \nHow did you hear about the GSK Supported Studies Program?  \nChoices are: Congress / GSK Medical Contact / Medical Journal / Website / Other. If Other:  \nPlease specify:  \n|  |\n| --- |\n| Support Requested\u003Cbr>GSK does not provide support for sponsor pay, incentive to join the study.\u003Cbr>* Please indicate which therapeutic area you would like this to be directed:\u003Cbr>Global Health – Africa Open Lab\u003Cbr>Please note: The Africa Open Lab Project is open only to countries in sub-Saharan Africa.\u003Cbr>* Disease\u003Cbr>\u003Cbr>Disease choices are: Antimicrobial resistance (AMR) linked to bacterial infections/ Enteric infections/ Malaria/ Tuberculosis/ / Other If Other:\u003Cbr>* Please specify:\u003Cbr>\u003Cbr>* Supported Study type:\u003Cbr>Human Subject Research applies to research that uses human individual data or human biological materials to evaluate use of a product or a technology in, or by, humans, or to answer a human health-related scientific question\u003Cbr>Select one: HSR / Other\u003Cbr>\u003Cbr>If Other:\u003Cbr>* Please specify: |\n\nIf HSR:  \n* Study Phase  \nChoices are: Non-Interventional / Pilot / Phase I / Phase I/II / Phase II / Phase II/ III / Phase III / Phase IIIb / Phase IV / N/A * Is monetary support required?  \nYes / No  \nIf monetary support is requested/ please complete the table below:  \n\n| Materials and consumables |  |\n| --- | --- |\n| Equipment |  |\n| Field Work |  |\n| Travel and subsistence |  |\n| Research Assistance |  |\n| Training |  |\n| Other-specify |  |\n| Other-specify |  |\n| *Total |  |\n\nAmount in GBP  \n(Please note the total sum is automatically calculated on the online form, as the amounts are being entered)  \n* Any othe","cbCaiqBPt0AcFu96","https://ap.wps.com/l/cbCaiqBPt0AcFu96","pdf",307870,18,"English","# Sponsor Information\n## Support Requested\n## Scientific Context\n### Estimated study start date\n### Estimated study completion date\n### Scientific Rationale\n### Research Question\n### Primary Objectives\n### Key Secondary Objectives\n### Inclusion Criteria\n## Exclusion Criteria","[{\"question\":\"提交概念阶段提案需要填写哪些最低信息？\",\"answer\":\"需提供赞助方信息、研究主要联系人（如适用）、合作网络与沟通情况、所请求的支持类型与治疗领域/疾病/研究类型、以及科学背景相关字段；带*的字段为必填，并可在模板中填写或提交其他可用的提案文件。\"},{\"question\":\"Africa Open Lab项目对国家范围有什么要求？\",\"answer\":\"Africa Open Lab项目仅对撒哈拉以南非洲国家开放，因此提交时需选择研究开展国家并确保符合该范围要求。\"},{\"question\":\"表单中的科学背景（Scientific Context）包含哪些核心内容？\",\"answer\":\"科学背景需要填写预计研究开始与完成时间、科学依据（Scientific Rationale）、研究问题（Research Question）、主要目标（Primary Objectives）、关键次要目标（Key Secondary Objectives）、以及纳入与排除标准（Inclusion/Exclusion Criteria）等。\"}]","Concept Stage Submission Form Template - Africa Open Lab 2023-2024 | PDF",1789850305,6,{"code":4,"msg":82,"data":100},[101,105,110,115,120,125,128,132,137],{"id":55,"doc_module":22,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},"Presentations",90,"presentations",{"id":106,"doc_module":22,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},12,"Resumes",80,"resumes",{"id":111,"doc_module":22,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},14,"Invoices",70,"invoices",{"id":116,"doc_module":22,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},15,"Posters",60,"posters",{"id":121,"doc_module":22,"doc_module_name":25,"category_name":122,"show_sort_weight":123,"slug":124},16,"Social Media",50,"social-media",{"id":86,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":126,"slug":127},40,"forms",{"id":92,"doc_module":22,"doc_module_name":25,"category_name":129,"show_sort_weight":130,"slug":131},"Letters",30,"letters",{"id":133,"doc_module":22,"doc_module_name":25,"category_name":134,"show_sort_weight":135,"slug":136},21,"Paper Templates",5,"papers-templates",{"id":138,"doc_module":22,"doc_module_name":25,"category_name":139,"show_sort_weight":4,"slug":140},158,"General","general-158"]