45 and Up Research Expression of Interest and Application Form Please use this form for expressions of interest and project applications to use the 45 and Up Study data. You only need to fill out the Sections of the form relevant to the status of your project. As your project develops, you may revisit this form and fill out additional Sections as required.

Sections of the Form

1. Expression of Interest / Project Application: fill out this Section with as much information as you have availableat this time, indicating whether you are at the Expression of Interest (EOI) or Application stage. An indicative quotewill be sent to you if the EOI or application is approved.

2. Researcher Information: this section must be completed for a Project Application. Fill out this Section for everyresearcher on the Project, whether they will be accessing data or not. Please be advised that access to 45 and Updata is only available within the Secure Unified Research Environment (SURE), more information on SURE can befound at https://www.saxinstitute.org.au/our-work/sure/

3. 45 and Up Study Variable Checklist: this section must be completed for a Project Application and where you haverequested to access 45 and Up Baseline, Follow-up and/or SEEF datasets.

4. MBS and PBS Variable Checklist: this section must be completed for a Project Application and where you haverequested access to MBS and/or PBS datasets.

5. Contracting and Invoicing details: this section must be completed for a Project Application.6. Declaration: this section must be signed for a Project Application.

Instructions

Submitting an EOI Complete Section 1 of this form and return via email along with any supporting documents. Complete an EOI if your

project does not yet have funding and a research protocol. We will endeavour to review your submission and provide an outcome within 14 days.

Submitting a Project Application Complete all Sections of this form and return via email along with any supporting documents. You can add to your

existing EOI form for a Project Application if you have previously submitted an EOI for the same project. Pleaseensure that you update the information in Section 1 with any changes.

We will endeavour to review your submission and provide an outcome within 14 days. Sub-study applications maytake longer and we will inform you of the expected timeframe following receipt of your application.

Due to the complex nature of sub-studies, please contact the 45 and Up Study Coordinating Centre before submitting an EOI or application for sub-studies. 

Once a Project Application has been approved by the Institute, access to the Data and the Project Workspace by a Researcher is also conditional on the completion and return of a Researcher Deed Poll.

For more information Additional information can be found on our website or by contacting us directly: Website: https://www.saxinstitute.org.au/our-work/45-up-study/ 45 and Up Coordinating Centre: 45andUp.research@saxinstitute.org.au Phone: 02 9188 9500

How to submit To submit your EOI or application form, please click on the Submit button below. 

Glossary Term Definition Chief Investigator The primary Chief Investigator on the Study in accordance with Ethics

approval. The Chief Investigator has overall responsibility for the project and has the authority to sign-off on instructions regarding the project with 45 and Up Study.

Curator A named individual nominated by the Chief Investigator responsible for curating (reviewing and approving) all incoming and outgoing data flow and files on the SURE Workspace. The Curator is also responsible for ensuring that any information entering the Workspace complies with Ethics and Data Custodian approvals.

Contact Person A nominated individual to interact with 45 and Up Study or SURE regarding the project. The contact person may provide instructions regarding the project with sign-off from the Chief Investigator.

Researcher Any investigator who will be accessing and/or analysing data from the 45 and Up Study as part of the research project.

Sub-Study A sub-study involves re-contacting a smaller group of 45 and Up participants to provide additional information, test an intervention or collect biospecimens that relate to one or more specific areas of research.

1. Expression of Interest / Project ApplicationPlease indicate whether your project is at Expression of Interest (EOI) or Project Application stage

Expression of Interest. Complete sections 1.1, 1.2 and 1.3. Project Application. Complete ALL sections in this form.

Select Expression of Interest if your project does not yet have funding or a research protocol. If the project is sufficiently advanced to have both of these, select Project Application.

1.1 Project Information All fields are mandatory in this section

Project Information 

Project Title (in full): Project duration (years): Is funding confirmed?: If No, when is funding expected to be received?: Funding source (Funder, Amount, Grant ID):

Chief Investigator Name of Chief Investigator: Organisation: Email: Contact Number:

Contact Person If you wish to nominate a contact person for this project, please provide the following details. Full Name: Organisation: Contact Number: Email: 

Researchers 

No. of researchers in this project: No. of researchers to access unit record data in SURE: Estimated data access period: FROM: TO: Please indicate the data retention period following closure of workspace:

Collaborative Partners No. of non-researchers in this project if applicable ( e.g. 1 policy maker, 2 consumers):

List the organisations collaborating in this project:

1.2 About your research Fill in the fields with as much detail as possible. You may return to this form later as more information becomes available or attach additional pages as Annexures if there is insufficient space on this form.

Summary of Proposed Research Please include the research aims and objectives and context

Research Plan Please include the overall research design, key study variables, outcome of interest, key milestones and timeframes

Expected Research Output Please describe the expected research outputs from this Project (be specific and list the expected outputs, e.g. scientific publications, plain language summary, reports, evidence brief, educational/training material, products/tools)

Expected impact Please describe the expected impact from this Project (e.g. influence new or revise guidelines, inform change in policy, reduce mortality, improve risk behaviour, build research capacity in non-academic sectors) and whether there are planned actions or pathways to achieve impact (e.g. project commissioned by government and/or other non-research bodies, links with policy makers/organisations, links with clinicians/consumers/advocacy groups, membership of guideline development group). Be specific when describing expected impact and planned actions.

The Sax Institute’s mission is to drive the use of research in health policy, programs and services.

For Project Applications: the Sax Institute may follow up with project applications to further discuss the impact planning of your project.

For EOIs: Would you like for us to contact you to further discuss research impact planning for your project?

Supporting Documents

Do you have a copy of: Final protocol: Ethics Approval:

If yes, please attach a copy with this submission. If no, please email this to us once it becomes available.

1.3 Requested Datasets Please select the datasets requested for this project. You may return to this form later as more information becomes available.

45 and Up Study Questionnaires (refer to https://www.saxinstitute.org.au/our-work/45-up-study/for-researchers/ for more information)

Baseline (2006 – 2009) SEEF (2010) Follow-up (2012 – 2015) Follow-up (2018 – 2020)

Please nominate the variables required in Section 4 of this form if completing a project application.

Geocoded data for each questionnaire is available. Broad Geographical variables at SA2 and above can be requested in Section 3. Please contact the 45 and Up Coordinating Centre if you require access to Geocoded data at SA1 level and below. Do you require geocoded data at SA1 or below?

Datasets linked to 45 and Study Medicare Benefits Schedule (MBS) Pharmaceutical Benefits Scheme (PBS)

If MBS and/or PBS is selected, please nominate the variables required in Section 4 of this application.

CHeReL Linkages (refer to http://www.cherel.org.au/ for more information and relevant costs payable directly to CHeReL) Admitted Patients Data Collection (APDC) Emergency Department Data Collection (EDDC) Central Cancer Registry RBDM death registrations Notifiable Conditions Information Management System Cause of Death Unit Record File Mental Health Ambulatory Data Collection NSW Pap Test Registry NSW Ambulance BreastScreen NSW Other. Please specify:

Other Linkages requested

Other study datasets that will be stored in the SURE workspace

End here if this is an Expression of Interest Application

PROCEED TO SECTIONS 2, 3, 4, 5 and 6 IF THIS IS A PROJECT APPLICATION

2. Researcher informationPlease complete the following table with information about all the Researchers on this Project

Name of Researcher

Institution and Department

Position Email Contact Number

Will this researcher be

accessing data?**

You may use the CI’s details by marking ‘as per CI’ **For all researchers that have ticked ‘Yes’ to data access, Section 2.1 must also be completed.

2.1 Researchers Requiring Data Access Please complete a form for each researcher requiring data access.

Full Name and Title

Position

Is the researcher Early Career Researcher PhD student Master student Other student

Please complete the following: Supervisor and Organisation: Area of study: Funding source: Type of post:

Position on research study

Postal Address*

Mobile number Required for one time password and soft token authentication for SURE access Will this researcher be curating the SURE workspace? Is the researcher registered as part of another SURE project? SURE Virtual Machine type More info can be found at: https://www.saxinstitute.org.au/our-work/sure/using-sure/

Standard (with SAS, Stata or SPSS) Standard (without SAS, Stata or SPSS) Power (with SAS, Stata or SPSS) Power (without SAS, Stata or SPSS) Supervisory

Statistical analysis software requirements: Optional software available is listed athttp://www.saxinstitute.org.au/our-work/sure/frequently-asked-questions/ 

Other information

*To use CI’s details, note ‘as per CI’

3. 45 and Up Study Variable ChecklistPlease complete this section if you have selected any of the following datasets:

45 and Up Study Baseline (2006-2009) Social, Economic and Environmental Factors (SEEF - 2010) questionnaires Follow-up (2012-2015) Follow-up (2018-2020)

Please include a brief written justification for each group of questionnaire items requested. For medical conditions, choose either by topic groups (e.g. family histories, medical conditions, treatments and operations) or by disease groups (e.g. cancers, CVD, Parkinson ’s disease, musculoskeletal diseases, precursors for CVD and diabetes, mental health and respiratory diseases).

Access the questionnaires, data dictionaries and questions in each item group by clicking on the text.

Select dataset format: SAS SPSS Stata

Variable Group Justification

Age and gender

Broad level Geography#

Qualification and Employment

Cultural Background (baseline only)

Relationships

Health Cover

Aboriginality^ (baseline only)

Household

Housing Details

Height, Weight & BMI

Smoking & Alcohol

Physical Activity / Inactivity

Diet / Nutrition

Fertility

Psychological Health

Personal Care

Carer

Variable Group Justification

Self-rated Health

Physical Functioning

Pain (SEEF & follow-up only)

Injuries & Falls

Sun Protection Behaviour

(baseline and follow-up only)

Social Support

Religion/Beliefs (SEEF only)

Retirement

Health Service Access (SEEF only)

Managing Own Health Care

(SEEF only)

Cancer Screening

Neighbourhood (SEEF only)

Drinking Water (SEEF only)

Vaccination (follow-up only)

Transportation

(SEEF and follow-up only)

Blood Donor/Transfusion

(follow-up only)

Family Histories

(follow-up only)

Hormone Therapy

Medical Conditions Overall

Treatments Overall

Operations Overall

Medications

Cancers

Cardiovascular Disease

Diabetes

Parkinson’s Disease

Musculoskeletal

Variable Group Justification

~ Includes geography variables at SA2 level and higher. For geography at SA1 and below, please contact the 45 and Up Coordinating Centre.

^ Additional ethics approval is required when Aboriginality used as the focus of research and/or any results will be presented by Aboriginality. However, additional Ethics approval is not required when the Aboriginality variable is to be used only as a predictor to adjust models.

Further information on 45 and Up Study Questionnaire Variables can be found at https://www.saxinstitute.org.au/wp-content/uploads/45-and-Up-Study-Questionnaire-Variables-1.pdf

Precursors for CVD

Mental Health

Respiratory Diseases

COVID-19 (2020) Variables

Additional Variables* (Sponsored questions)

Justification Specify variables

* Additional questions are sponsored by external organisations to address their research interests. This data is available to all researchers.For additional variables and the years they are available, please refer to https://www.saxinstitute.org.au/wp-content/uploads/45-and-Up-Study-Questionnaire-Variables-1.pdf

4. MBS and PBS Variable ChecklistPlease complete this section if you have selected the MBS or PBS datasets. MBS and PBS data do not form part of any participant record stored in the 45 and Up Study questionnaire data collection and the 45 and Up Study Coordinating Centre can perform linkage of these datasets.

Please consult the data dictionary for more information about the MBS and PBS items: https://www.saxinstitute.org.au/wp-content/uploads/MBS-Data-Dictionary-January-2017.pdf https://www.saxinstitute.org.au/wp-content/uploads/PBS-Data-Dictionary-January-2017.pdf

Medical Benefits Schedule (MBS) Variables

Variable Justification

Date of Service

Date of Processing

MBS Item Description

MBS Item Number

Provider Charge

Schedule Fee

Benefit Paid

Patient Out of Pocket

Bill Type

Scrambled Rendering Provider Number

Scrambled Ordering Provider Number

Date of Referral

Hospital Indicator

Provider Specialty

Item Category

Rendering Provider Postcode

Ordering Provider Postcode

Pharmaceutical Benefits Schedule (PBS) Variables

Variable Justification

Date of Supply

Date of Prescribing

PBS Item Code

PBS Item Description

Patient Category

Patient Contribution

Net Benefit

Scrambled Prescriber Number

Form Category

Gross Price

Prescriber Specialty

Quantity Supplied

ATC Code

Pharmacy Postcode

5. Contracting and Invoicing Details

6. DeclarationThis section must signed for a Project Application.

Signature of Chief Investigator

_________________________________________________ __________________________________ Signature Date

Contract sign off authority [Title, Name]:

Organisation:

ABN:

Address:

Email: Contact Number:

You may nominate an invoice recipient by providing their details below. If left blank, the invoice will be sent to the nominated contact person.

Recipient Name: Email: Contact Number: 

Please sign by drawing or inserting an image of your signature