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Trial registered on ANZCTR
Registration number
ACTRN12621001286831
Ethics application status
Approved
Date submitted
14/06/2021
Date registered
23/09/2021
Date last updated
19/09/2022
Date data sharing statement initially provided
23/09/2021
Type of registration
Prospectively registered
Titles & IDs
Public title
Thoracoscopic Anterior Vertebral Body Tethering For Scoliosis
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Scientific title
Thoracoscopic Anterior Vertebral Body Tethering For Scoliosis: Safety and Efficacy
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Secondary ID [1]
304479
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None
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Universal Trial Number (UTN)
U1111-1250-6452
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Trial acronym
TAVBTS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Idiopathic Scoliosis
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Condition category
Condition code
Surgery
319980
319980
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0
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Surgical techniques
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Musculoskeletal
320707
320707
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0
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Other muscular and skeletal disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Thoracoscopic anterior vertebral body tethering.
All patients who meet eligibility criteria will be given the option of thoracoscopic anterior vertebral body tethering. The intervention will be performed by a Fellowship trained Scoliosis Surgeon. Intraoperative spinal cord monitoring will be utilised. The patient will be positioned in the lateral decubitus position with the convex side up. Surgery will be undertaken through 4-7 thoracoscopic portals. Pleura is dissected off the vertebral bodies and segmental vessels diathermied. Radiographic spinal level check is undertaken prior to placement of bicortical transverse vertebral body screws into each vertebra that requires instrumentation. The tether is connected to the screws and tensioned appropriately. A chest drain is placed prior to layered closure. The intervention will be performed once, with a surgical time of approximately 3 hours.
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Intervention code [1]
320826
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Treatment: Surgery
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Comparator / control treatment
Spinal fusion.
The intervention will be performed by a Fellowship trained Scoliosis Surgeon. Intraoperative spinal cord monitoring will be utilised. The patient will be positioned prone. Surgery will be undertaken through a posterior approach. Radiographic spinal level check is undertaken prior to placement of pedicle screws, or hooks as appropriate. Appropriate correction prior to connection with rods. Layered closure. Surgical time approximately 3 hours.
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Control group
Active
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Outcomes
Primary outcome [1]
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Spinal curve size will be measured from PA (posterior-anterior) scoliosis x-rays.
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Assessment method [1]
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Timepoint [1]
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Preoperative, 6 months, 1, 2, 3 and 4 years post-operative.
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Primary outcome [2]
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Spinal curve correction achieved will be measured from postoperative PA (posterior-anterior) scoliosis x-rays.
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Assessment method [2]
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Timepoint [2]
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6 months postoperative.
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Primary outcome [3]
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Spinal curve progression will be measured from postoperative PA (posterior-anterior) scoliosis x-rays.
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Assessment method [3]
328525
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Timepoint [3]
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1, 2, 3 and 4 years post-operative.
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Secondary outcome [1]
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Operative time.
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Assessment method [1]
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Timepoint [1]
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Intraoperative surgical record.
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Secondary outcome [2]
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Blood loss. This will be estimated from the weight of swabs and volume of blood in the suction.
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Assessment method [2]
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Timepoint [2]
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Estimated intraoperatively.
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Secondary outcome [3]
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Pulmonary function.
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Assessment method [3]
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Timepoint [3]
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Pre- and post-operative spirometry. Post-operative spirometry will be assessed at the 6 month follow-up.
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Secondary outcome [4]
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Number of spinal levels included in construct.
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Assessment method [4]
399328
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Timepoint [4]
399328
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Intraoperative surgical record.
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Secondary outcome [5]
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Length of stay. This will be assessed from hospital records.
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Assessment method [5]
399329
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Timepoint [5]
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This will be calculated once the patient has been discharged from hospital.
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Secondary outcome [6]
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Safety (complications). Intra-operative complications will be recorded by the surgeon. Post-operative complications will be reported by the patient and discussed at each follow-up visit.
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Assessment method [6]
399330
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Timepoint [6]
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Any time point from the initiation of surgery to the completion of the study.
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Eligibility
Key inclusion criteria
Inclusion Criteria:
- Patients treated through CCDHB with a 40-75° flexible idiopathic curve, AND
- Sufficient remaining growth (defined as Risser 0, Sanders stage 2-4).
- Parental consent and patient assent to:
o Procedure
o Follow-up clinical assessment (either in clinic or virtual)
o Follow-up x-rays
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Minimum age
8
Years
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Maximum age
16
Years
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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
- Hyperkyphosis
- Patients who fail to meet indications and inclusion criteria.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
Prospective study assessing safety and efficacy of thoracoscopic anterior vertebral body tethering in skeletally immature patients with progressive scoliosis.
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
N/A. As this is a prospective study of a new technique looking at treatment outcomes, 30 participants are considered sufficient to effectively identify treatment outcomes.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
1/10/2021
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Actual
15/10/2021
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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
30
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Accrual to date
5
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Final
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Recruitment outside Australia
Country [1]
23780
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New Zealand
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State/province [1]
23780
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Address [1]
308839
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Country [1]
308839
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Primary sponsor type
Individual
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Name
Mr. Robert Rowan
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Address
Wellington Regional Hospital
Private Bag 7902
Wellington 6242
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Country
New Zealand
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Secondary sponsor category [1]
309756
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Individual
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Name [1]
309756
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Dr. Matthew Fisk
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Address [1]
309756
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Wellington Regional Hospital
Private Bag 7902
Wellington 6242
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Country [1]
309756
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New Zealand
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
308747
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Central Health and Disability Ethics Committees (HDEC)
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Ethics committee address [1]
308747
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Ministry of Health 133 Molesworth Street PO Box 5013 Wellington 6011
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Ethics committee country [1]
308747
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New Zealand
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Date submitted for ethics approval [1]
308747
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11/03/2021
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Approval date [1]
308747
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10/06/2021
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Ethics approval number [1]
308747
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21/CEN/79
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Summary
Brief summary
Idiopathic Scoliosis is a progressive condition, which presents most commonly in early teenage years. If a curve reaches 50° at skeletal maturity it is likely to progress at a rate of 1° or more per year leading to increased deformity and disability in adult life. For this reason, most people with a curve 50° or more are treated with a spinal fusion to correct deformity and prevent progression. Curves 20-40° (with remaining growth) can be treated effectively with bracing and approximately one in three will avoid spinal fusion. Spinal fusion while effective, is non-physiological and increases stress on non-fused spinal segments. Potential complications include disc degeneration and progressive deformity in unfused segments, and pseudoarthrosis within the fused spine. Growth modulation is a technique used to treat limb deformities in the paediatric population either by surgically damaging the physis or by placing plates across it. A similar technique has been attempted in the spine by placing staples across the discs. This has been largely unsuccessful as the implants aren’t strong enough to prevent the deformity progressing. An alternative technique has been developed involving thoracoscopic placement of anterior vertebral body screws connected by a flexible tether. This relies on the Heuter-Volkmann law; slowing growth by increasing tension on the convexity of the curve, allowing catch up growth on the concave side. This technique has shown promise preventing >70% of patients meeting the criteria for fusion within 5 years. Currently there is a moderately high reoperation rate in these patients due to over correction or progressive deformity. Further information will help guide indications for this procedure and hopefully lower the reoperation rate.
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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
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Mr Robert Rowan
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Address
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Wellington Regional Hospital
Private Bag 7902
Wellington 6242
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Country
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New Zealand
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Phone
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+64 27 286 7336
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Fax
111750
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Email
111750
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[email protected]
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Contact person for public queries
Name
111751
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Robert Rowan
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Address
111751
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Wellington Regional Hospital
Private Bag 7902
Wellington 6242
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Country
111751
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New Zealand
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Phone
111751
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+64 4 385 5999
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Fax
111751
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Email
111751
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[email protected]
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Contact person for scientific queries
Name
111752
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Robert Rowan
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Address
111752
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Wellington Regional Hospital
Private Bag 7902
Wellington 6242
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Country
111752
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New Zealand
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Phone
111752
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+64 4 385 5999
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Fax
111752
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Email
111752
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
De-identified data will be age, gender, and data relating to primary and secondary outcomes, and adverse events.
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When will data be available (start and end dates)?
Data will be available at the completion of the trail and available for the following 10 years.
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Available to whom?
It will be available on a case-by-case basis at the discretion of the principal investigator.
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Available for what types of analyses?
No specific analyses.
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How or where can data be obtained?
Access subject to approval by Principal Investigator (
[email protected]
).
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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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