ESGE MEDTRONIC AI RESEARCH AWARD APPLICATION ESGE MEDTRONIC AI RESEARCH AWARD APPLICATION Personal DetailsTitle*Select a titleDrProfessorName* First name Last name Qualification* Female / Male / Neutral* Female Male Neutral Date of Birth* DD slash MM slash YYYY ESGE membership ID* Place of Employment*Community hospitalAcademic hospitalOther (if other, please specify)Please specify other place of employment* Type of Institution* Contact Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone*Email* Enter Email Confirm Email Application informationFull title*Short title* Number of devices requested for the project* Target date for the study*Official IRB/Ethical approval needed before project starts DD slash MM slash YYYY Information about the research area* impact of AI on quality parameters of colonoscopy differential impact according to endoscopist experience and setting role of AI in training identification of subtle neoplasia in patients at increased risk of cancer AI assisted real time optical diagnosis of the colonic polyps other ( please specify) Please specify other information about the research area* Background of research idea/project (150 words)*Research questions / hypothesis (150 words)*Design / Methods (200 words)*Primary Endpoints (100 words)*Secondary Endpoints (100 words)*Current status of the project (100 words)*Documentation (upload)1. CV of the principal investigators*Please include the CV of the principal investigators in electronic form (one file with CVs of all principal investigators involved, maximum 2 pages each, PDF format, maximum file size: 2 Mb)Accepted file types: pdf, Max. file size: 2 MB.2. Abstract*Please include the abstract including the study title, names of participating investigators with institutions, summary of the proposal (maximum 400 words, PDF format, maximum file size: 2 Mb) Accepted file types: pdf, Max. file size: 2 MB.3. Proposal of the research project*Please include the proposal with aims and hypothesis. This document should also contain all references, images, tables, and illustrations (PDF format, maximum file size: 2 Mb)Accepted file types: pdf, Max. file size: 2 MB.4. Budget*Please include a detailed budget in Euros. Please note that only direct costs may be funded (MS Word, Excel or pdf format, maximum file size: 2Mb) Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.5. Official IRB/Ethical approvalPlease upload if available (PDF format, maximum file size: 2 Mb) Accepted file types: pdf, Max. file size: 2 MB.Be sure to choose the documents to be attached before submitting this form. Large files (greater than 8Mb in size) Should your supporting files be larger than the 8Mb limit, please send them via a cost-free online file transfer service such as wetransfer.com to Maria Izquierdo at mi@hamilton-services.deTerms and ConditionsESGE Privacy Policy* I have read the ESGE Privacy Policy and agree to the terms & conditions.ESGE Medtronic AI Research Award* I have read the ESGE Medtronic AI Research Award terms and conditions and agree to them.Please fill in all fields marked (*).NameThis field is for validation purposes and should be left unchanged.
