32.9 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Adult Biospecimen Pick-Up Instrument, Phase 2g

OMB Specification

Adult Biospecimen Pick-Up Instrument

Event Category:	Time-Based
Event:	Birth
Administration:	N/A
Instrument Target:	Biological Mother
Instrument Respondent:	Data Collector
Domain:	Biospecimen
Document Category:	Sample Collection
Method:	Data Collector Administered
Mode (for this instrument*):	In-Person, CAI
OMB Approved Modes:	In-Person, CAI
Estimated Administration Time:	0 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	1.0
MDES Release:	4.0

*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.

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Adult Biospecimen Pick-Up Instrument

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

ADULT BIOSPECIMEN PICK UP 3

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Adult Biospecimen Pick-Up Instrument

GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	DATA TYPE	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100	CHARACTER
UNIT AND PHONE FIELDS	10	CHARACTER
_OTH AND COMMENT FIELDS	255	CHARACTER	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
ALL ID FIELDS	36	CHARACTER
ZIP CODE	5	NUMERIC
ZIP CODE LAST FOUR	4	NUMERIC
CITY	50	CHARACTER
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	NUMERIC CHARACTER	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	NUMERIC	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).

POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.

A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.

ADULT BIOSPECIMEN PICK UP

(TIME_STAMP_ABP_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

DATA COLLECTOR INSTRUCTIONS

• COMPLETE WHEN AN NCS DATA COLLECTOR PICKS UP BIOSPECIMENS FROM MOTHER.

• IF BIOSPECIMENS FROM MULTIPLE MOTHERS ARE PICKED UP AT THE SAME LOCATION IN ONE ATTEMPT, A SEPARATE INSTRUMENT MUST BE COMPLETED FOR EACH MOTHER.

ABP00100/(SPECIMEN_NUM_PU). HOW MANY SPECIMENS ARE BEING PICKED UP?

 

|___|

NUMBER

PROGRAMMER INSTRUCTIONS

• DISPLAY HARD EDIT IF SPECIMEN_NUM_PU > 8.

• LOOP THROUGH SPECIMEN_TYPE, SPECIMEN_SAME_DATE (IF APPLICABLE), ABP01000, ABP02000, SPECIMEN_ID, SPEC_STORED, SPEC_STORAGE_COND, AND SPECIMEN_PICKUP_COND UNTIL NUMBER OF LOOPS = ​SPECIMEN_NUM_PU.

ABP00200/(SPECIMEN_TYPE). WHICH SPECIMEN DID YOU PICK UP?

DATA COLLECTOR INSTRUCTIONS

• IF MORE THAN ONE SPECIMEN COLLECTED, SELECT ONE PER LOOP.

Label	Code	Go To
ADULT URINE	1
ADULT BLOOD - LAVENDER TOP LV10	2
ADULT BLOOD - RED TOP RD15	3
ADULT BLOOD - RED TOP RD10	4
ADULT BLOOD - LAVENDER TOP LV15	5
MOUTH SWAB	6
VAGINAL SWAB	7
RECTAL SWAB	8

PROGRAMMER INSTRUCTIONS

• IF SPECIMEN_NUM_PU = 1 OR IF THIS IS THE FIRST LOOP, GO TO ABP01000.

• OTHERWISE, GO TO SPECIMEN_SAME_DATE.

ABP00300/(SPECIMEN_SAME_DATE). DID YOU PICK UP THIS SPECIMEN AT THE SAME TIME AS {SPECIMEN_TYPE}?

Label	Code	Go To
YES	1	SPECIMEN_ID
NO	2

PROGRAMMER INSTRUCTIONS

• PRELOAD AND DISPLAY THE SPECIMEN_TYPE FROM THE FIRST LOOP:

• IF SPECIMEN_TYPE = 1, DISPLAY "ADULT URINE."

• IF SPECIMEN_TYPE = 2, DISPLAY "ADULT BLOOD - LAVENDER TOP LV10."

• IF SPECIMEN_TYPE = 3, DISPLAY "ADULT BLOOD - RED TOP RD15."

• IF SPECIMEN_TYPE = 4, DISPLAY "ADULT BLOOD - RED TOP RD10."

• IF SPECIMEN_TYPE = 5, DISPLAY "ADULT BLOOD - LAVENDER TOP LV15."

• IF SPECIMEN_TYPE = 6, DISPLAY "MOUTH SWAB."

• IF SPECIMEN_TYPE = 7, DISPLAY "VAGINAL SWAB."

• IF SPECIMEN_TYPE = 8, DISPLAY "RECTAL SWAB."

• IF SPECIMEN_SAME_DATE = 1, SET SPECIMEN_PICKUP_MM, SPECIMEN_PICKUP_DD, SPECIMEN_PICKUP_YYYY, SPECIMEN_PICKUP_TIME, AND SPECIMEN_PICKUP_TIME_UNIT = RESPONSES SELECTED FOR FIRST LOOP.

ABP01000. SPECIMEN PICK-UP DATE:

(SPECIMEN_PICKUP_MM) |___|___|

   M     M

(SPECIMEN_PICKUP_DD) |___|___|

   D     D

(SPECIMEN_PICKUP_YYYY) |2|0|___|___|

 Y Y   Y     Y

ABP02000. SPECIMEN PICK-UP TIME:

(SPECIMEN_PICKUP_TIME) |___|___|:|___|___|

  H     H       M     M

(SPECIMEN_PICKUP_TIME_UNIT)

Label	Code	Go To
AM	1
PM	2

ABP03000/(SPECIMEN_ID). SPECIMEN ID FOR {SPECIMEN TYPE}

|__|__|__|__|__|__|__|__|__|-|__|__|__|__|

PROGRAMMER INSTRUCTIONS

• IF SPECIMEN_TYPE = 1, DISPLAY "ADULT URINE" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH UR01 (AA#######-UR01).

• IF SPECIMEN_TYPE = 2, DISPLAY "ADULT BLOOD LAVENDER TOP LV10" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH LV10 (AA#######-LV10). 

• IF SPECIMEN_TYPE = 3, DISPLAY "ADULT BLOOD RED TOP RD15" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH RD15 (AA#######-RD15). 

• IF SPECIMEN_TYPE = 4, DISPLAY "ADULT BLOOD RED TOP RD10" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH RD10 (AA#######-RD10). 

• IF SPECIMEN_TYPE = 5, DISPLAY "ADULT BLOOD LAVENDER TOP LV15" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH LV15 (AA#######-LV15). 

• IF SPECIMEN_TYPE = 6, DISPLAY "MOUTH SWAB" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH MM10 (AA#######-MM10). 

• IF SPECIMEN_TYPE = 7, DISPLAY "VAGINAL SWAB" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH MV10 (AA#######-MV10). 

• IF SPECIMEN_TYPE = 8, DISPLAY "RECTAL SWAB" AS {SPECIMEN TYPE} AND FORMAT SPECIMEN ID AS TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH MR10 (AA#######-MR10). 

ABP04100/(SPEC_STORED). WAS THE SPECIMEN STORED BEFORE PICK-UP BY NCS STAFF?

Label	Code	Go To
YES	1
NO	2	SPECIMEN_PICKUP_COND

ABP04200/(SPEC_STORAGE_COND). IDENTIFY THE STORAGE CONDITION

Label	Code	Go To
REFRIGERATED	1
FROZEN	2
AMBIENT	3
DON'T KNOW	-2

ABP05000/(SPECIMEN_PICKUP_COND). CONDITION OF SPECIMEN UPON PICK-UP

Label	Code	Go To
PICKED UP OK	1
PICKED UP BROKEN	2
PICKED UP LEAKING	3
PICKED UP AT INCORRECT TEMPERATURE	4
MISSING SPECIMEN ID LABEL	5
SPECIMEN LOST	6
SPECIMEN NOT COLLECTED	7
NOT AVAILABLE	8
NOT APPLICABLE	-7

PROGRAMMER INSTRUCTIONS

• IF NUMBER OF LOOPS = SPECIMEN_NUM_PU, GO TO SPECIMEN_PICKUP_COMMENTS.

• OTHERWISE, GO TO SPECIMEN_TYPE.

ABP06000/(SPECIMEN_PICKUP_COMMENTS). DO YOU HAVE ANY COMMENTS ABOUT PICK-UP?

Label	Code	Go To
YES	1
NO	2	REMAINING_SPECIMEN

ABP07000/(SPECIMEN_PICKUP_COMMENTS_OTH). COMMENTS ABOUT PICK-UP: __________________________________________________________________

ABP08000/(REMAINING_SPECIMEN). ARE THERE ADDITIONAL BIOSPECIMEN SAMPLES THAT NEED TO BE PICKED UP?

Label	Code	Go To
YES	1
NO	2

PROGRAMMER INSTRUCTIONS

• IF REMAINING_SPECIMEN = 1, SET INSTRUMENT_STATUS = 3 AND BEGIN AT ABP00100 WHEN INSTRUMENT OPENED AGAIN.

• OTHERWISE, SET INSTRUMENT_STATUS ​= 4 AND CLOSE OUT OF THE INSTRUMENT COMPLETELY.

(TIME_STAMP_ABP_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP