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Trial registered on ANZCTR
Registration number
ACTRN12612000907842
Ethics application status
Approved
Date submitted
24/08/2012
Date registered
27/08/2012
Date last updated
1/08/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Effects of protein on gut hormones and motility, and appetite and energy intake in undernourished compared with healthy older individuals
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Scientific title
Effects of intraduodenal protein, on energy intake, appetite, antropyloroduodenal motility, amino acids, hormones and glucose in undernourished compared with healthy older individuals
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Secondary ID [1]
281086
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Malnutrition in older people
287239
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Condition category
Condition code
Diet and Nutrition
287563
287563
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0
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Other diet and nutrition disorders
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Oral and Gastrointestinal
287564
287564
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0
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Normal oral and gastrointestinal development and function
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
A single 60 minute intraduodenal infusion at 4mL/min of
i) 0 kcal/min (saline control)
ii) 1.5 kcal/min (Whey Protein Hydrolysate)
in 12 undernourished and 12 'healthy' older subjects
Appetite sensation questionnaires in the form of a Visual Analogue Scale (VAS), blood samples.
A standard buffet meal will be provided at the end of the 60 minute infusion from which the volunteer has 30 minutes to eat until comfortably full. The buffet meal consists of 300ml orange juice, 600ml water, 375ml iced coffee, 4 slices white bread, 4 slices brown bread, 100g deli leg ham, 100g virginian chicken, 4 slices cheese, 100g tomato, 100g cucumber, 100g lettuce, 2 portions mayonnaise, 2 portions margarine, 1 medium apple, 1 medium banana, 200g chocolate custard, 150g fruit salad, 200g strawberry yoghurt, and a 14g milky way bar.
Each volunteer will receive one of each infusion solution over 2 study days. Study visits will be seperated by no less than 3 days.
Each study visit will last approximately 3-6 hours.
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Intervention code [1]
285538
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Treatment: Other
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Intervention code [2]
285553
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Prevention
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Comparator / control treatment
Volunteers will act as their own control via administration of a single 0kcal/min intraduodenal infusion of saline solution, delivered at a rate of 4mL/min for 60 minutes, to enable comparison to nutrient containing infusion.
Undernourished older people will be compared to 'healthy' older people.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Antropyloroduodenal motility (antropyloroduodenal pressures; number of antral, duodenal and isolated pyloric pressure waves; basal pyloric pressure) assessed by Manometry.
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Assessment method [1]
287816
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Timepoint [1]
287816
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Intubation occurs on subject arrival.
At t= -15 until 0, a baseline of the antropyloroduodenal (APD) motility is recorded.
Infusion starts at t=0 until t=60 minutes. APD motility is assessed continuously for the duration of the infusion (t=0-60 minutes).
Subject is extubated at t=60 minutes.
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Primary outcome [2]
287817
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Plasma concentrations of gut hormones (cholecyctokinin (CKK), glucagon-like peptide-1 (GLP-1), peptide YY (PYY), gastric inhibitory polypeptide (GIP), ghrelin, glucagon and insulin), glucose and amino acids.
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Assessment method [2]
287817
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Timepoint [2]
287817
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Blood samples are taken at t= 0, 15, 30, 45 and 60 minutes.
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Primary outcome [3]
287818
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Macronutrient and total energy intake of standard buffet meal are determined using Foodworks Software.
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Assessment method [3]
287818
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Timepoint [3]
287818
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Buffet meal will be presented at the end of the infusion and after extubation (t=60). The subject will be allowed to freely consume food for 30 minutes until comfortably full (until t=90).
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Secondary outcome [1]
298878
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Appetite sensations using a Visual Analogue Scale (VAS) (nausea, hunger, fullness, desire to eat, thirst).
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Assessment method [1]
298878
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Timepoint [1]
298878
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VAS questionnaires are given at t= 0, 15, 30, 45, 60 and 90 minutes.
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Secondary outcome [2]
298879
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Blood pressure and heart rate are determined using an automatic sphygmomanometer.
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Assessment method [2]
298879
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Timepoint [2]
298879
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Blood pressure and heart rate are measured at t= 0, 15, 30, 45, 60 and 90 minutes.
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Eligibility
Key inclusion criteria
Undernourished older people:
at risk of malnourishment + malnourishment defined by a well validated, widely used, screening tool that is associated with poor outcomes in older people: the Mini Nutritional Assessment (MNA) with a score <24 out of 30
and, at least one of: self-reported weight loss in the previous 3 months, or a Body Mass Index (BMI) <22 kg/m2
'Healthy' older people:
BMI: 20-30 kg/m2
Weight stable (<5% fluctuation in body weight in previous 3 months).
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Minimum age
65
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Significant gastrointestinal symptoms, disease, or surgery.
Current gallbladder or pancreatic disease; diabetes mellitus; epilepsy; cardiovasculr or respiratory diseases; any other illnesses as assessed by the investigator (including chronic illnesses not explicitly listed above).
Impaired cognitive function.
Depression.
Use of prescribed or non-prescribed medications (including vitamins and herbal supplements) which may effect gastrointestinal function or appetite.
Lactose intolerant or other food allergies; intolerance or allergy to paracetomol.
Individuals with low ferritin levels or who have donated blood in the 12 weeks prior to taking part in the study.
Current intake of >2 standard drinks on >5 days per week.
Current smokers of cigarettes/cigars/marijuana.
Current intake of any illicit substance.
Experience claustrophobia in confined spaces.
Unable to tolerate nasogastrointestinal tube, or to comprehend study protocol.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Volunteers are asked to visit the clinic for a screening visit. A series of screening questionnaires are answered by the volunteer, and a blood sample is taken for determination of ferritin levels. Eligibility is determined based on the inclusion/exclusion criteria. A signed informed consent form is obtained and study dates are established. Eligible volunteers are assigned a subject number and randomised into a treatment for each study visit using a randomisation table created on an excel spreadsheet. Randomisation involves contacting the holder of the randomisation table (study assistant) to inform them of the subjects details and study dates. The unblinded study assistant is therefore responsible for allocating a random treatment to the subject and preparing the solution for infusion on each study day.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
The randomisation table was created using Microsoft Office Excel.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Withdrawn
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Reason for early stopping/withdrawal
Lack of funding/staff/facilities
Participant recruitment difficulties
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Date of first participant enrolment
Anticipated
10/09/2012
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
24
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
SA
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Funding & Sponsors
Funding source category [1]
285871
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Government body
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Name [1]
285871
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National Health and Medical Research Council Grant
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Address [1]
285871
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Level 1 16 Marcus Clarke Street
Canberra ACT 2601
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Country [1]
285871
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Australia
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Primary sponsor type
Individual
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Name
Dr Stijn Soenen
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Address
Level 6 Eleanor Harrald Building,
Frome Road,
Adelaide, SA 5000
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Country
Australia
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Secondary sponsor category [1]
284695
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University
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Name [1]
284695
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University of Adelaide
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Address [1]
284695
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North Terrace
Adelaide, SA 5005
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Country [1]
284695
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Australia
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Secondary sponsor category [2]
284696
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Hospital
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Name [2]
284696
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Royal Adelaide Hospital
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Address [2]
284696
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North Terrace
Adelaide, SA 5005
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Country [2]
284696
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
287899
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Royal Adelaide Hospital Research Ethics Committee
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Ethics committee address [1]
287899
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Level 3, Hanson Institute, North Terrace Adelaide, South Australia, 5000
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Ethics committee country [1]
287899
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Australia
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Date submitted for ethics approval [1]
287899
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Approval date [1]
287899
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01/06/2012
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Ethics approval number [1]
287899
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120601
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Summary
Brief summary
Ageing is associated with a physiological reduction of appetite and energy intake, which has been called the “anorexia of ageing”. Dietary supplementation with liquid protein preparations is now used frequently to increase energy and protein intake in older adults in both institutionalized and community-dwelling populations. Although the latter would appear a logical approach, evidence for success of increased energy intake in older individuals is limited. There is consensus that nutrient stimuli in the gastrointestinal (GI) tract, especially in the small intestine, play a major role in the regulation of appetite and energy intake via modulation of GI motility and hormone release. Increasing our knowledge of how protein affects GI motility and hormone release is of increasing relevance in healthy and undernourished older individuals. In addition to the effects of healthy ageing, there is evidence of differences between undernourished and well-nourished older people, which may potentially result from being undernourished and/or contribute to the undernourished state. Urgent investigation is warranted to determine the effects of oral protein intake, so that protein can be incorporated into their diet to assist in sparing muscle mass without reducing their appetite. The study aims to characterise in older individuals, the effect of undernutrition on energy intake, appetite, antropyloroduodenal motility, plasma concentrations of amino acids, hormones (i.e. CCK, PYY, ghrelin, GLP-1, GIP, glucagon and insulin) and glucose after intraduodenal protein infusion.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
34613
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Dr Stijn Soenen
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Address
34613
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Adelaide Health & Medical Sciences Building (AHMS), level 5
Cnr North Tce & George St
Adelaide, SA, 5000
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Country
34613
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Australia
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Phone
34613
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+61 8 8313 3638
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Fax
34613
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Email
34613
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[email protected]
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Contact person for public queries
Name
17860
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Dr Stijn Soenen
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Address
17860
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Adelaide Health & Medical Sciences Building (AHMS), level 5
Cnr North Tce & George St
Adelaide, SA, 5000
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Country
17860
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Australia
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Phone
17860
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+61 8 8313 3638
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Fax
17860
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+61 8 8313 7794
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Email
17860
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[email protected]
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Contact person for scientific queries
Name
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Dr Stijn Soenen
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Address
8788
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Adelaide Health & Medical Sciences Building (AHMS), level 5
Cnr North Tce & George St
Adelaide, SA, 5000
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Country
8788
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Australia
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Phone
8788
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+61 8 8313 3638
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Fax
8788
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+61 8 8313 7794
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Email
8788
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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