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 U.S. 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:

RUNSA Screening

Thank you for your interest in the RUNSA Study. You can complete the short (less than 2 minutes) questionnaire to see if you may be eligible to participate in the research study.

Or you can contact Mariah Jackson, (402) 836-9892 mariah.jackson@unmc.edu

IRB# 0590-22-EP

This is a screening survey to see if you are eligible for the RUNSA research project that will involve diet information surveys and urine collection. This survey is completely voluntary, you can change your mind and stop at any time. Anytime you share information online there are risks. We're using a secure system to collect this data, but we can't completely eliminate this risk. We collect personally identifying information for the research in order to be able to contact you. This data will be stored in a secure online server. This survey has been IRB approved. It should take about 2 minutes to complete.

I agree and would like to take the survey

I do not wish to take the survey

reset

First Name

Last Name

* must provide value

Phone Number with area code

* must provide value

Are you 19 years of age or older?

Yes

reset

Have you received medical diagnosis of a stroke (cerebrovascular accident (CVA) of any form)?

Yes

reset

Have you been discharged to your home environment after completing any necessary rehabilitation (such as physical therapy, occupational therapy, or speech therapy etc.) for a stroke?
Independent living communities or similar are acceptable.

Yes

reset

Are you currently pregnant?

Yes

reset

Do you live in rural to semi-rural region of Nebraska as defined by US Census (< 49,999 population of community)?

Yes

reset

Please list your city of residence

Do you have access to the internet through a computer, tablet or cell phone?

(This is used for email, online questionnaires, remote consent process.)

Yes

reset

Are you able to make decisions for yourself and provide informed consent?

Select YES if you do not require a Legally Authorized Representative or LAR.

Select NO if you do require a Legally Authorized Representative or LAR.

Yes

reset

Are you able to engage in all of the following independently or with the assistance of a caregiver?

Provide 3 urine samples (Toilet hats will be provided to assist in hands-free urine collection)
Fill out diet history information
Transport urine samples to a FedEx location

Yes

reset

Which task(s) do you anticipate not being able to complete independently or with assistance from a caregiver? Select all that apply.

Urine collection

Diet history

Transportation to FedEx location

Do you have any other comments or questions?

Expand

Your answers to the survey questions indicate you are not eligible to participate in the research study. You may submit the survey now.
If you think this is a mistake or have questions, please call 402-836-9892 or email mariah.jackson@unmc.edu.

Your answers indicate you may be eligible to participate in the RUNSA study. Please submit your survey and a member of the research team will be in contact with you soon.

If you have any questions, please email mariah.jackson@unmc.edu.

Contacted Subject

M-D-Y

Participating

Yes

reset

Coordinator Notes

Expand

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.