ID

23956

Description

Infection NCT00513526 Registration - AMC-052 Screen Failure Predictor Variables Survey Form - 2958715v1.0 AMC-052 Screen Failure Predictor Variables Survey Form Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=77B9D50C-53A6-8752-E040-BB89AD4320A2

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=77B9D50C-53A6-8752-E040-BB89AD4320A2

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 7/19/17 7/19/17 - Martin Dugas
Uploaded on

July 19, 2017

DOI

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License

Creative Commons BY-NC 3.0
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HIV HPV Vaccine NCT00513526 AMC-052

English

Please provide responses to all questions below. Only data which was previously collected by the research staff should be reported

1 forms  
Verbal Consent
Description

Verbal Consent

Alias
UMLS CUI-1
C0021430
UMLS CUI-2
C1608381
Was verbal consent obtained from the subject
Description

Verbal consent

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16735
NCI Thesaurus ObjectClass-2
C51277
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C79751
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C1608381
Date verbal consent obtained
Description

Verbal consent date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus Property
C25250
NCI Thesaurus ObjectClass
C16735
NCI Thesaurus ObjectClass-2
C51277
NCI Thesaurus Property-2
C79751
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C1608381
UMLS CUI [1,3]
C0011008
Results of the most recent viral load assay
Description

Results of the most recent viral load assay

Alias
UMLS CUI-1
C0376705
CD4+ Count
Description

LaboratoryProcedureCD4-PositiveT-LymphocyteHelper-InducerT-LymphocyteOutcomeCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12537
NCI Thesaurus Property-3
C12538
NCI Thesaurus ValueDomain
C25463
UMLS CUI [1]
C1277776
Lowest CD4+ count ever reported (i.e. nadir CD4)
Description

LaboratoryProcedureCD4+LowestResultCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12537
NCI Thesaurus Property-3
C43517
NCI Thesaurus ValueDomain
C25463
UMLS CUI [1,1]
C1277776
UMLS CUI [1,2]
C1708760
Results of HIV viral load assay
Description

HumanImmunodeficiencyVirusViralLoadAssayPerformedAmount

Data type

text

Alias
NCI Thesaurus ObjectClass
C14219
NCI Thesaurus ObjectClass-2
C51952
NCI Thesaurus ObjectClass-3
C16341
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C25417
UMLS CUI [1]
C1168369
HIV viral load value
Description

HumanImmunodeficiencyVirusViralLoadAssayPerformedValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C14219
NCI Thesaurus ObjectClass-2
C51952
NCI Thesaurus ObjectClass-3
C16341
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C25712
UMLS CUI [1]
C1168369
Method of detection
Description

HumanImmunodeficiencyVirusViralLoadAssayPerformedType

Data type

text

Alias
NCI Thesaurus ObjectClass
C14219
NCI Thesaurus ObjectClass-2
C51952
NCI Thesaurus ObjectClass-3
C16341
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C25284
UMLS CUI [1]
C0449335
Other, specify
Description

HumanImmunodeficiencyVirusViralLoadAssayPerformedSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C14219
NCI Thesaurus ObjectClass-2
C51952
NCI Thesaurus ObjectClass-3
C16341
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C25685
UMLS CUI [1,1]
C0005507
UMLS CUI [1,2]
C0019682
HIV viral load assay type
Description

HIV viral load assay

Data type

text

Alias
NCI Thesaurus ObjectClass
C14219
NCI Thesaurus ObjectClass-2
C51952
NCI Thesaurus ObjectClass-3
C16341
NCI Thesaurus Property
C38000
NCI Thesaurus ValueDomain
C25372
UMLS CUI [1,1]
C0005507
UMLS CUI [1,2]
C0019682
Limits of detection
Description

HumanImmunodeficiencyVirusViralLoadAssayLowerThresholdDetectedNumber

Data type

float

Measurement units
  • Copies/mL
Alias
NCI Thesaurus ObjectClass
C14219
NCI Thesaurus ObjectClass-2
C51952
NCI Thesaurus ObjectClass-3
C16341
NCI Thesaurus Property
C48228
NCI Thesaurus Property-2
C25309
NCI Thesaurus Property-3
C25481
NCI Thesaurus ValueDomain
C25337
UMLS CUI [1]
C2718050
Copies/mL
Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1]
C0947611
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Similar models

Please provide responses to all questions below. Only data which was previously collected by the research staff should be reported

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Verbal Consent
C0021430 (UMLS CUI-1)
C1608381 (UMLS CUI-2)
Verbal consent
Item
Was verbal consent obtained from the subject
boolean
C16735 (NCI Thesaurus ObjectClass)
C51277 (NCI Thesaurus ObjectClass-2)
C25250 (NCI Thesaurus Property)
C79751 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0021430 (UMLS CUI [1,1])
C1608381 (UMLS CUI [1,2])
Verbal consent date
Item
Date verbal consent obtained
date
C25164 (NCI Thesaurus ValueDomain)
C25250 (NCI Thesaurus Property)
C16735 (NCI Thesaurus ObjectClass)
C51277 (NCI Thesaurus ObjectClass-2)
C79751 (NCI Thesaurus Property-2)
C0021430 (UMLS CUI [1,1])
C1608381 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Results of the most recent viral load assay
C0376705 (UMLS CUI-1)
CD4+
Item
CD4+ Count
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C12537 (NCI Thesaurus Property-2)
C12538 (NCI Thesaurus Property-3)
C25463 (NCI Thesaurus ValueDomain)
C1277776 (UMLS CUI [1])
nadir CD4+
Item
Lowest CD4+ count ever reported (i.e. nadir CD4)
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C12537 (NCI Thesaurus Property-2)
C43517 (NCI Thesaurus Property-3)
C25463 (NCI Thesaurus ValueDomain)
C1277776 (UMLS CUI [1,1])
C1708760 (UMLS CUI [1,2])
Item
Results of HIV viral load assay
text
C14219 (NCI Thesaurus ObjectClass)
C51952 (NCI Thesaurus ObjectClass-2)
C16341 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C25417 (NCI Thesaurus ValueDomain)
C1168369 (UMLS CUI [1])
CL.2
Code List
Results of HIV viral load assay
CL Item
Greater Than (>) (Greater than (>))
CL Item
Less Than (Less than (<))
CL Item
Undetectable (Undetectable)
CL Item
) = Equal To (Equal to ()
HIV viral load
Item
HIV viral load value
float
C14219 (NCI Thesaurus ObjectClass)
C51952 (NCI Thesaurus ObjectClass-2)
C16341 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C1168369 (UMLS CUI [1])
Item
Method of detection
text
C14219 (NCI Thesaurus ObjectClass)
C51952 (NCI Thesaurus ObjectClass-2)
C16341 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0449335 (UMLS CUI [1])
CL.3
Code List
Method of detection
CL Item
Roche Amplicor Monitor Assay (Roche Amplicor Monitor Assay)
CL Item
Versant Hiv-1 Rna Assay By Branched Dna (Versant HIV-1 RNA assay by branched DNA)
CL Item
Cobas Ampliprep/taqman Hiv-1 Assay (COBAS AmpliPrep/TAQMAN HIV-1 assay)
CL Item
Abbott Realtime Hiv-1 Assay (Abbott RealTime HIV-1 assay)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
HIV viral load assay
Item
Other, specify
text
C14219 (NCI Thesaurus ObjectClass)
C51952 (NCI Thesaurus ObjectClass-2)
C16341 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C0005507 (UMLS CUI [1,1])
C0019682 (UMLS CUI [1,2])
Item
HIV viral load assay type
text
C14219 (NCI Thesaurus ObjectClass)
C51952 (NCI Thesaurus ObjectClass-2)
C16341 (NCI Thesaurus ObjectClass-3)
C38000 (NCI Thesaurus Property)
C25372 (NCI Thesaurus ValueDomain)
C0005507 (UMLS CUI [1,1])
C0019682 (UMLS CUI [1,2])
CL.4
Code List
HIV viral load assay type
CL Item
Standard (Standard)
CL Item
Ultra (Ultra)
Limits of detection
Item
Limits of detection
float
C14219 (NCI Thesaurus ObjectClass)
C51952 (NCI Thesaurus ObjectClass-2)
C16341 (NCI Thesaurus ObjectClass-3)
C48228 (NCI Thesaurus Property)
C25309 (NCI Thesaurus Property-2)
C25481 (NCI Thesaurus Property-3)
C25337 (NCI Thesaurus ValueDomain)
C2718050 (UMLS CUI [1])
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
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