Today's Date
Today Y-M-D
Current Time* must provide value
Now H:M
Full Name* must provide value
Phone Number* must provide value
Email Address* must provide value
Address* must provide value
Zipcode* must provide value
Birthdate* must provide value
Y-M-D
Age View equation
Gender* must provide value
Male
Female
Other
Ethnicity* must provide value
White
Hispanic or Latino, White
Hispanic or Latino, Non-White
Black or African American
Native American or American Indian
Asian / Pacific Islander
South Asian
Other
White
Hispanic or Latino, White
Hispanic or Latino, Non-White
Black or African American
Native American or American Indian
Asian / Pacific Islander
South Asian
Other
Specify Ethnicity
Are you currently employed or self-employed?* must provide value
Yes
No
How many hours per week do you currently work?
If you work multiple jobs, please indicate the cumulative number of hours per week.* must provide value
hours per week
Are you currently a student? No
Yes, full-time graduate student
Yes, part-time graduate student
Yes, full-time undergraduate student
Yes, part-time undergraduate student
No
Yes, full-time graduate student
Yes, part-time graduate student
Yes, full-time undergraduate student
Yes, part-time undergraduate student
Are you currently on a vacation or break?* must provide value
Yes
No
How long have you been on vacation so far?
In the past 2 weeks, have you used melatonin to help with your sleep?* must provide value
Yes
No
Are you able to be off melatonin for two weeks prior to taking part in the study?* must provide value
Yes
No
You have indicated that you use an inhaled or topical glucocorticoid. How often do you use it?
You have indicated that you use opioids. How often do you use it and for how long have you been using it?
You have indicated that you use an amphetamine. How often do you use it and for how long have you been using it?
Do you currently use Tranquilizers (such as Benzodiazipines)* must provide value
Yes
No
How many times per week do you use Tranquilizers (such as Benzodiazipines)?* must provide value
per week
Do you currently use nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen?* must provide value
Yes
No
How many times do you usually use nonsteroidal anti-inflammatory drugs (NSAIDs) (such as aspirin or ibuprofen) per week?* must provide value
per week
Are you allergic to heparin?* must provide value
Yes
No
Are you allergic to any other medication?* must provide value
Yes
No
Please list other medication(s) or food(s) you are allergic to.* must provide value
Are you on any other prescribed medication(s)?* must provide value
Yes
No
Please list the name(s) of other prescribed medication(s).* must provide value
Have you changed your medication regimen in the past 2 months? Yes
No
Please explain the recent change to your medication regime. * must provide value
Do you have any medical condition(s) or problems?* must provide value
Yes
No
Please select all medical condition(s) you currently have.* must provide value
Diabetes
Heart disease
Hypertension (high blood pressure)
Cancer (any)
HIV/AIDs
Chronic Obstructive Pulmonary Disease (COPD)
Alzheimer's
Arthritis
Osteoporosis
Sleep Apnea
Hypothyroidism
Other
Diabetes
Heart disease
Hypertension (high blood pressure)
Cancer (any)
HIV/AIDs
Chronic Obstructive Pulmonary Disease (COPD)
Alzheimer's
Arthritis
Osteoporosis
Sleep Apnea
Hypothyroidism
Other
You have indicated that you have sleep apnea. Are you currently undergoing treatment for sleep apnea (i.e. CPAP)? Yes
No
Please describe other medical condition(s).* must provide value
Do you have a preference for a clinical site? Brigham and Women's Hospital (Longwood Medical area)
Massachusetts General Hospital (West End, Boston)
No Preference
Brigham and Women's Hospital (Longwood Medical area)
Massachusetts General Hospital (West End, Boston)
No Preference
Do you have a site preference for your consent visit (visit 1)? Virtual eConsent (via secure Zoom)
Brigham and Women's Hospital (Longwood Medical area)
Massachusetts General Hospital (West End, Boston)
No Preference
Virtual eConsent (via secure Zoom)
Brigham and Women's Hospital (Longwood Medical area)
Massachusetts General Hospital (West End, Boston)
No Preference
Do you have a site preference for your consent visit (visit 1)? Virtual eConsent (via secure Zoom)
Virtual eConsent (via secure Zoom)
During this time, the study clinical visits (visits 2 and 3) are only running at the Massachusetts General Hospital (MGH; West End, Boston). Are you able to attend visits at MGH?* must provide value
Yes
No
This study involves 3 parts:
1) three visits to Brigham and Women's Hospital research clinic in Longwood (an initial visit lasting 1-2 hours (a weekday anytime between 7am and 5pm), and two study visits, one during the day and one during the night - each lasting 3 hours (may be scheduled on the weekend));
2) two weeks of home activity monitoring (using an actiwatch, an activity monitor like a FitBit) and sleep/ diet logging;
3) completing nine questionnaires (each taking between 1 and 10 minutes to complete).
Your initial visit to the research clinic will include getting your consent for the study and answering any questions you might have about the study. We will also be measuring your height and weight and body composition, and providing you with an actiwatch, an activity monitor like a FitBit, that tracks your activity, light exposure and sleep for two consecutive weeks. We will expect you to wear this monitor the entire duration of these 2 weeks. We will also ask you to fill out a food and sleep diary during these 2 weeks.
You'll be asked to return for two additional study visits. For those visits, you'll have to fast for 8 hours prior to the visits and refrain from travel across time zones. Each visit will involve drinking a glucose (sugar) drink and five small blood draws (2 3/4 tablespoons (40 ml) total per visit) over a 2-hour time period using IV catheter.
One visit will be during the daytime (scheduled a few hours after your typical wake-up time) and one visit will be during the nighttime (scheduled an hour before your typical bedtime). The exact timing of each visit will be specified at a later time. The exact dates will depend on your availability.
We will review the study more thoroughly and you'll also have the opportunity to ask a staff member about the study. At any point during the study, you can drop out if you wish to do so.
You will receive $100 for participating in this study if you complete the study and may be eligible for travel reimbursement. In addition, we will provide you with a free health report on your sleep, physical activity and dietary intake habits as well as your body composition.
Do you agree to this protocol?* must provide value
Yes
No
This study involves 3 parts:
1) three visits to Massachusetts General Hospital's research clinic in West End (an initial visit lasting 1 hour (a weekday anytime between 7am and 5pm or Saturday), and two study visits, one during the day and one during the night - each lasting 3 hours (may be scheduled on the weekend));
2) two weeks of home activity monitoring (using an actiwatch, an activity monitor like a FitBit) and sleep/ diet logging;
3) completing nine questionnaires (each taking between 1 and 10 minutes to complete).
Your initial visit to the research clinic will include getting your consent for the study and answering any questions you might have about the study. We will also be measuring your height and weight and body composition, and providing you with an actiwatch, an activity monitor like a FitBit, that tracks your activity, light exposure and sleep for two consecutive weeks. We will expect you to wear this monitor the entire duration of these 2 weeks. We will also ask you to fill out a food and sleep diary during these 2 weeks.
You'll be asked to return for two additional study visits. For those visits, you'll have to fast for 8 hours prior to the visits and refrain from travel across time zones. Each visit will involve drinking a glucose (sugar) drink and five small blood draws (2 3/4 tablespoons (40 ml) total per visit) over a 2-hour time period using IV catheter.
One visit will be during the daytime (scheduled a few hours after your typical wake-up time) and one visit will be during the nighttime (scheduled an hour before your typical bedtime). The exact timing of each visit will be specified at a later time. The exact dates will depend on your availability.
We will review the study more thoroughly and you'll also have the opportunity to ask a staff member about the study. At any point during the study, you can drop out if you wish to do so.
You will receive $100 for participating in this study if you complete the study and may be eligible for travel reimbursement. In addition, we will provide you with a free health report on your sleep, physical activity and dietary intake habits as well as your body composition.
Do you agree to this protocol?* must provide value
Yes
No
This study involves 3 parts:
1) one consent visit to Brigham and Women's Hospital (30 minutes - 221 Longwood Ave)
2) two visits to Massachusetts General Hospital's research clinic in West End (one during the day and one during the night - each lasting 3 hours (may be scheduled on the weekend));
3) two weeks of home activity monitoring (using an actiwatch, an activity monitor like a FitBit) and sleep/ diet logging;
4) completing nine questionnaires (each taking between 1 and 10 minutes to complete).
Your initial visit to the research clinic will include getting your consent for the study and answering any questions you might have about the study. We will also be providing you with an actiwatch, an activity monitor like a FitBit, that tracks your activity, light exposure and sleep for two consecutive weeks. We will expect you to wear this monitor the entire duration of these 2 weeks. We will also ask you to fill out a food and sleep diary during these 2 weeks.
You'll be asked to return for two additional study visits. For those visits, you'll have to fast for 8 hours prior to the visits and refrain from travel across time zones. Each visit will involve drinking a glucose (sugar) drink and five small blood draws (2 3/4 tablespoons (40 ml) total per visit) over a 2-hour time period using IV catheter.
One visit will be during the daytime (scheduled a few hours after your typical wake-up time) and one visit will be during the nighttime (scheduled an hour before your typical bedtime). The exact timing of each visit will be specified at a later time. The exact dates will depend on your availability.
During your daytime visit, we will also be measuring your height and weight and body composition.
We will review the study more thoroughly and you'll also have the opportunity to ask a staff member about the study. At any point during the study, you can drop out if you wish to do so.
You will receive $100 for participating in this study if you complete the study and may be eligible for travel reimbursement. In addition, we will provide you with a free health report on your sleep, physical activity and dietary intake habits as well as your body composition.
Do you agree to this protocol?* must provide value
Yes
No
This study involves 3 parts:
1) three visits to either Brigham and Women's Hospital research clinic in Longwood or Massachusetts General Hospital research clinic in West End (an initial visit lasting 1-2 hours (a weekday or weekend anytime between 7am and 5pm), and two study visits, one during the day and one during the night - each lasting 3 hours (may be scheduled on the weekend));
2) two weeks of home activity monitoring (using an actiwatch, an activity monitor like a FitBit) and sleep/ diet logging;
3) completing nine questionnaires (each taking between 1 and 10 minutes to complete).
Your initial visit to the research clinic will include getting your consent for the study and answering any questions you might have about the study. We will also be measuring your height and weight and body composition, and providing you with an actiwatch, an activity monitor like a FitBit, that tracks your activity, light exposure and sleep for two consecutive weeks. We will expect you to wear this monitor the entire duration of these 2 weeks. We will also ask you to fill out a food and sleep diary during these 2 weeks.
You'll be asked to return for two additional study visits. For those visits, you'll have to fast for 8 hours prior to the visits and refrain from travel across time zones. Each visit will involve drinking a glucose (sugar) drink and five small blood draws (2 3/4 tablespoons (40 ml) total per visit) over a 2-hour time period using IV catheter.
One visit will be during the daytime (scheduled a few hours after your typical wake-up time) and one visit will be during the nighttime (scheduled an hour before your typical bedtime). The exact timing of each visit will be specified at a later time. The exact dates will depend on your availability.
We will review the study more thoroughly and you'll also have the opportunity to ask a staff member about the study. At any point during the study, you can drop out if you wish to do so.
You will receive $100 for participating in this study if you complete the study and may be eligible for travel reimbursement. In addition, we will provide you with a free health report on your sleep, physical activity and dietary intake habits as well as your body composition.
Do you agree to this protocol?* must provide value
Yes
No
During the study test, we will use an IV catheter for blood draws. The IV catheter may contain a very small dose of heparin (common drug) to prevent the catheter from clogging up with blood.
Do you have any questions/concerns regarding heparin?* must provide value
Yes
No
Heparin question/concern* must provide value
Are you currently pregnant?* must provide value
Yes
No
Have you had your menopause (periods stopped)?* must provide value
Yes
No
What is the date of your last menstrual period?
Today Y-M-D Y-M-D
How old were you when your periods stopped?* must provide value
Have you ever taken the contraceptive pills (birth control)?* must provide value
Yes, and I'm currently taking it
Yes, but in the past
Never
Yes, and I'm currently taking it
Yes, but in the past
Never
Have you had bariatric surgery in the past or have a bariatric surgery scheduled within the next 2 months?* must provide value
Yes
No
Have you ever been diagnosed with a psychiatric illness, such as schizophrenia or bipolar affective disorder?* must provide value
Yes
No
Please indicate diagnosed psychiatric illness.* must provide value
Are you blind? * must provide value
Yes
No
During the past year, how many alcoholic drinks [glass/bottle/can (12oz of beer; 4oz glass of wine, 1oz drink or shot of liquor] did you usually drink in a typical week?* must provide value
None, or less than 1 per month
1-3 per month
1 per week
2-4 per week
5-6 per week
1-2 per day
3-4 per day
5-6 per day
More than 6 per day
None, or less than 1 per month
1-3 per month
1 per week
2-4 per week
5-6 per week
1-2 per day
3-4 per day
5-6 per day
More than 6 per day
Do you currently have a diagnosed eating disorder, such as anorexia, binge eating, or bulimia?* must provide value
Yes
No
Do you currently work any night shifts?* must provide value
Yes
No
Have you EVER worked any night shifts?* must provide value
Yes
No
What was the typical START time for your night shift?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
What was the typical END time for your night shift?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
Have you worked these night shifts for 1 year or longer?* must provide value
Yes
No
How many YEARS have you worked these night shifts for?
(enter 0 if less than one year)* must provide value
year(s)
Roughly how many MONTHS have you been working these night shifts this past year?* must provide value
month(s)
Have you worked ANY night shifts in the past 2 years?* must provide value
Yes
No
What year did you stop working those night shifts?
year
What is the typical START time for your work shift?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
What is the typical END time for your work shift?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
Do you typically work at least 3 night shifts or more within a month?* must provide value
Yes
No
What is the typical START time for your night shifts?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
What is the typical END time for your night shifts?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
Have you been working this schedule for at least 1 year or more?* must provide value
Yes
No
Roughly how many months have you been working these night shifts if less than a year?* must provide value
month(s)
You have indicated that you are on a break or vacation, what time do you go to bed and try to fall asleep while on break/vacation? 12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
You have indicated that you are on a break or vacation, what time do you finally wake up on while on break/vacation?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
What time do you go to bed and try to fall asleep on work days (typically weekdays)?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
What time do you finally wake up on work days (typically weekdays)?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
What time do you go to bed and try to fall asleep on non-work days (typically weekends)?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
What time do you wake up on non-work days (typically weekends)?* must provide value
12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM
How would you like to receive your communications?
The Partners standard is to send email securely. This requires you to initially set up and activate an account with a password. You can then use the password to access secure emails sent to you from Partners HealthCare.
If you prefer, we can send you "unencrypted" email that is not secure and could result in the unauthorized use or disclosure of your information. If you want to receive communications by unencrypted email despite these risks, Partners HealthCare will not be held responsible. Your preference to receive unencrypted email will apply to emails sent from this research group/study only. Unencrypted
Encrypted
Preferred methods of contact* must provide value
Email
Text Message
Phone call
Email
Text Message
Phone call
Preferred day and time for phone call* must provide value
If eligible, please describe your general availability/preference for participation in this 2-week study (including general months/dates), and preferred date/time for an initial visit (1-2 hours; Brigham and Women's Hospital has to be a weekday and may start between 7.30am and 3pm, Massachusetts General Hospital can be a weekday, or Saturday, between 8am and 3pm).* must provide value
Are you currently in, or planning to join another research study during your 2-week enrollment in The SHIFT Study? Yes
No
Can you please describe all other studies you are currently participating in, or plan to join during this time, include name, study description, etc...?
How did you hear about the study? Clinical Trials/Rally at Partners
RSVP for Health
Partners Biobank
Craigslist
Flyer at work
ResearchMatch
Gym
SUGAR-MGH or SIGMA Study
Sleep or Melatonin Study at Brigham and Women's Hospital
Another study I completed at Mass General or Brigham and Women's Hospital
Friend, Family, or Colleague
Other Website
Other
Recruitment Table
Clinical Trials/Rally at Partners
RSVP for Health
Partners Biobank
Craigslist
Flyer at work
ResearchMatch
Gym
SUGAR-MGH or SIGMA Study
Sleep or Melatonin Study at Brigham and Women's Hospital
Another study I completed at Mass General or Brigham and Women's Hospital
Friend, Family, or Colleague
Other Website
Other
Recruitment Table
Do you want to be contacted about any future studies from MGH's Center for Genomic Medicine?* must provide value
Yes
No
Any information asked during this screening will be securely stored in the Center for Genomic Medicine database.
Do you give us permission to enter your information into our database?* must provide value
Yes
No