Pediatric Sepsis Data CoLaboratory Membership Application

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

5QVMVwSFpCHuLXqx3C6Q8WyYxD9WbyZYX89n6SHTBhf

Thank you for your interest in joining the Peditaric Sepsis Data CoLaboratory (Sepsis CoLab). Please complete the membership application below.

Given name

* must provide value

Surname

* must provide value

Salutation

* must provide value

Zip code

City/Region

* must provide value

Country

* must provide value

Institution

* must provide value

Profession

* must provide value

9.1

Please specify:

* must provide value

10.

What WFPICCS member organizations are you affiliated with (if any)? (Select all that apply)

* must provide value

AAP - American Academy of Pediatrics

ACCCN - Australian College of Critical Care Nurses

ACOPE - Asociacion Costarricense de Pediatria - Capitulo: Medicina Critica y Cuidados Intensivos

AEPC - Association for European Paediatric Cardiology (Working Group on Paediatric Cardiac Intensive Care)

African Paediatric Critical Care Association

AMIB - Associacao de Medicina Intensiva Brasileira - Departamento de Pediatria

AMIETIP - Academy of Medical and Nursing Emergency and Pediatric Intensive Care

AMTIP - Asociacion Mexicana de terapia Intensiva Pediatrica, AC

ANZICS - Australian and New Zealand Intensive Care Society

Asociacion Colombiana de medicina Critica y Cuidado Intensivo

Asociacion de terapia Intensiva Pediatrica de Centroamerica y El Caribe

CACCN - Canadian Association of Critical Care Nurses

CCAC - Cameroon Critical Care Nurses Association

CCSSA - Critical Care Society of Southern Africa

CEM - The Assembly of Pediatric Emergency and Intensive Care of Chinese Pediatric Society

CPPC - College of Pediatric Critical Care (India)

EPNMS - Emirates Pediatric Neonatal Medical Society

ESNPC - The Egyptian Society for Neonatal and Preterm Care

ESPIC - The Egyptian Society of Pediatric Intensive Care

ESPNIC - European Society Pediatric and Neonatal Intensive Care

GFRUP - Groupe Francophone de Reanimation et Urgences Pediatriques

IAP - Intensive Care Chapter of Indian Academy of Pediatrics

IPACCS - Irish Paediatric Anaesthesia and Critical Care Society

IPS - Indonesian Pediatric Society (Pediatric Emergency and Intensive Care Working Group (PEIC WG)

IPSS - International Pediatric Simulation Society

ISCCM - Pediatric Section of the Indian Society of Critical Care Medicine

JSPICC - Japanese Society of Pediatric Critical Care

KSPCCM - Korean Society of Pediatric Critical Care Medicine

MSIC - Malaysian Society of Intensive Care

NZCCCN - New Zealand College of Critical Care Nurses

PCICS - Pediatric Cardiac Intensive Care Society

Pediatric Chapter of the Saudi Critical Care Society

PICS - The Paediatric Intensive Care Society

Portuguese Society of Paediatrics- Intensive Care Chapter

PSG - Pediatric Society of Ghana

SARNePI - Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care

SATI - Sociedad Argentina de Terapia Intensiva

SBP - Sociedade Brasileira de Pediatria - Departamento de Terapia Intensiva

SCCM - Society of Critical Care Medicine

SECIP - Sociedad Chilena de Cuidado Intensivo Pediatrico

SECIP - Sociedad Espanola de Cuidados Intesivos Pediatricos

SIAATIP - Italian Society of Anesthesia, Analgesia and Pediatric Intensive Care

SLACIP - Sociedad Latino Americana Cuidados Intensivos Pediatricos

Sociedad Ecuatoriana de Cuidado Intensivo Pediatrico

Sociedad Paraguaya de Cuidados Intensivo Pediatricos y Neonatales

Society of Intensive Care Medicine (Singapore)

SPCCMP -Society of Pediatric Critical Care Medicine Philippines

SPEICM - Society of Pediatric Emergency and Intensive Care Medicine (Turkey)

Sri Lankan Society for Critical Care and Emergency Medicine

SUNPI - Sociedad Uruguayade Neonatologia y Pediatria Intensiva

SVMC - Sociedad Venezolana de Medicina Critica

TPRC - Thai Pediatric Respiratory and Critical Care Society

TSPICCM -Taiwan Society of Pediatric Intensive and Critical Care Medicine

I AM NOT AFFILIATED WITH ANY OF THE LISTED SOCIETIES/ASSOCIATIONS

10.1

What is the name of your organization? (if applicable)

11.

What are your research interests, particularly those in which you are hoping to collaborate with the CoLab?

* must provide value

Expand

12.

What motivated you to join the Pedatric Sepsis Data CoLab?

* must provide value

Expand

13.

How did you hear about us?

* must provide value

13.1

Please specify:

* must provide value

14.

Have you created a Scholars Portal Dataverse account?

* must provide value

Yes

reset

Please create an account Here

(1 min. application form)

15.

Scholars Portal Dataverse username:

* must provide value

Forgot your Dataverse username? Click the link below for 2-step instructions on how to retrieve it.

Attachment:Retrieve Dataverse username.jpg

Mute Dataverse Notifications:

Dataverse sends automated email notifications every time a change is made to the database. Some members find the frequency of notifications overwhelming. We advise that you mute Dataverse notifications by following these steps:

1. Log in to your Dataverse Account
2. Select your name in the top right corner
3. Select "notifications" from the drop down menu
4. Select "notification settings"
5. Unselect all available notifications
6. Select "Save changes"

The Sepsis CoLab keeps members updated on new resources available in our Dataverse via quarterly newsletters. This ensures members receive only essential updates, promoting a more efficient and focused experience within the CoLab.

As a member of the Pediatric Sepsis Data CoLaboratory, you must agree to our Memorandum of Understanding. Please review the attached form.

Attachment:Pediatric Sepsis CoLaboratory Memorandum of Understanding.08.07.2020.pdf

16.

* must provide value

I agree to the Memorandum of Understanding.

reset

17.

Date of agreement:

* must provide value

M-D-Y

18.

* must provide value

I confirm that the information given in this form is true, complete and accurate.

reset

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.