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Trial registered on ANZCTR
Registration number
ACTRN12614000971639
Ethics application status
Approved
Date submitted
3/09/2014
Date registered
10/09/2014
Date last updated
10/09/2014
Type of registration
Prospectively registered
Titles & IDs
Public title
Emotional writing and wound healing
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Scientific title
Emotional disclosure writing in healthy university students and how it effects wound healing
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Secondary ID [1]
285279
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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:
Wound healing
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Condition category
Condition code
Inflammatory and Immune System
293238
293238
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0
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Normal development and function of the immune system
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Mental Health
293269
293269
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0
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Studies of normal psychology, cognitive function and behaviour
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Skin
293270
293270
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0
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Normal skin development and function
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Emotional disclosure writing
Participants who complete the intervention will be asked on 3 consecutive days. On each day they will write for 20 minutes about a traumatic or upsetting experience in their life. They will be instructed to delve (dig deep) into their deepest emotions and thoughts. This will be administered online. Participants will be sent a secure link each day to compete in their own time. The task will not be supervised. The writing will be stored on the researchers computer under the participants ID code and will only be shared with the study supervisors. Participants will receive a 4mm punch biopsy wound either 14 days after the first writing session or will start the task the day after the 4mm punch biopsy (in order to see whether the timing of the intervention matters). The biopsy will be performed by a registered dermatologist at the clinical research center in campus. To perform the biopsy, the skin on the upper arm will be marked and cleaned, then anaesthetised. A punch biopsy will be performed and the skin samples will be stored and transported to the lab for analysis.
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Intervention code [1]
290169
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Other interventions
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Comparator / control treatment
Time management writing
Participants who complete the intervention will be asked on 3 consecutive days. On each day they will write for 20 minutes about how they spend their time. They will be instructed to be as objective and descriptive as possible (i.e. just the facts, no emotions, no opinions, no feelings). They will be asked to concentrate on the specific details of their activities, even when referring to everyday tasks. On the first day they will write about the past 7 days, on the second day they will write about the past 24 hours and the third day they will write about their plans for the next 7 days. Participants will be sent a secure link each day to compete in their own time. The task will not be supervised. The writing will be stored on the researchers computer under the participants ID code and will only be shared with the study supervisors. Participants will receive a 4mm punch biopsy wound either 14 days after the first writing session or will start the task the day after the 4mm punch biopsy (in order to see whether the timing of the intervention matters). The biopsy will be performed by a registered dermatologist at the clinical research center in campus. To perform the biopsy, the skin on the upper arm will be marked and cleaned, then anaesthetised. A punch biopsy will be performed and the skin samples will be stored and transported to the lab for analysis.
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Control group
Active
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Outcomes
Primary outcome [1]
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Speed of healing of a 4mm biopsy wound as indicated by photographs and immunological and histological analyses. The 1st biopsy will be embedded in paraffin and immunohistology will be performed to identify CD1a, HLA-DR, CD-68.
The 2nd biopsy will be 5mm and will be taken 14 days after the initial biopsy at the same site. This biopsy will be split into two – half with be snap frozen and half will be embedded in paraffin.
The snap frozen will be analyzed for
1. Cytokines – IL1, IL6, TNFalpha
2. Collagen – type I/III collagens, glycosaminoglycans and collagen crosslinking, PICP (collagen synthesis), MMP9 (inflammation) MMP2 (collagen remodelling)
The section embedded in paraffin will be analyzed for immunohistology (CD1a to identify Langarhan cells; HLA-DR for immune cell activation; CD-68 to identify macrophages)
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Assessment method [1]
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Timepoint [1]
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14 days after the 4mm initial biopsy a 5mm biopsy will be taken at the same site
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Secondary outcome [1]
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Mood-Affect Valuation Index; AVI
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Assessment method [1]
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Timepoint [1]
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14 days after the initial biopsy
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Secondary outcome [2]
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Mood- Life Orientation Test; LOT
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Assessment method [2]
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Timepoint [2]
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14 days after initial biopsy
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Secondary outcome [3]
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Perceived Stress-Perceived Stress Scale
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Assessment method [3]
310381
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Timepoint [3]
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14 days after the initial biopsy
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Secondary outcome [4]
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Social support- Medical Outcomes Study: Social Support Survey Instrument
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Assessment method [4]
310382
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Timepoint [4]
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14 days after the initial biopsy
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Secondary outcome [5]
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Depression -General Health Questionnaire
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Assessment method [5]
310383
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Timepoint [5]
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14 days after the initial biopsy
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Secondary outcome [6]
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Sleep- Pittsburgh Sleep Quality Index
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Assessment method [6]
310384
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Timepoint [6]
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14 days after the initial biopsy
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Eligibility
Key inclusion criteria
Aged between 18 and 55, able to read and write in English, non smoker
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Minimum age
18
Years
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Maximum age
55
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Exclusion criteria will include people with current inflammatory skin disease and chronic illness and people with immunological-related health problems or people taking medication that affect immune functioning. Additionally participants allergic to lignocaine (or any other local anaesthetic) will be excluded because this will be used to locally anaesthetize the tissue before performing the punch biopsy procedure.
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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)
Participants will be recruited from the University of Auckland through an advertisement flyer promoted through social media, the University of Auckland’s junk email address book, in public areas at the university’s campuses, from emails sent by course coordinators to the university’s students, and student notice boards throughout the Auckland University campus’.
Interested participants will be screened for eligibility using inclusion/exclusion criteria. Upon verbally consenting the researcher will look at a randomized list created through random.org to allocate the participant to one of four groups. The researcher would ask a colleague to put the participants code on a sealed envelope and the group allocation inside. When the researcher contacts them and determines they are eligible she will open the envelope to reveal the group.
Participants will then be sent a link to go online and complete consent and a baseline questionnaire. Depending on whether they receive the intervention before or after the initial biopsy they will also be given the control or intervention instructions for the writing task.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A randomized list will be generated used the website random.org. This will allocate participants to one of four conditions: emotional writing before initial biopsy, control writing before initial biopsy, emotional writing after initial biopsy or control writing after initial biopsy
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Factorial
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
A power calculation based on Koshwanez et al. (2013) was conducted using a medium effect size. With power set at .80 and a two tailed significant level of a = .05; the total sample size required for an ANCOVA analysis with 4 groups was calculated to be 128 (32 per group). 140 participants will be recruited in total (35 per group) to allow for attrition.
Analysis will be conducted on immunological and histological outcomes using an ANOVA
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
15/09/2014
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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
140
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
6334
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New Zealand
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State/province [1]
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Auckland
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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The University of Auckland
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Address [1]
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The University of Auckland
Private Bag 92019
Auckland 1142
New Zealand
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Country [1]
289903
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New Zealand
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Primary sponsor type
University
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Name
University of Auckland
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Address
The University of Auckland
Private Bag 92019
Auckland 1142
New Zealand
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
288592
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Country [1]
288592
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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The University of Auckland Human Ethics Committee
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Ethics committee address [1]
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The University of Auckland Private Bag 92019 Auckland 1142 New Zealand
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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29/07/2014
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Approval date [1]
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16/08/2014
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Ethics approval number [1]
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012656
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Summary
Brief summary
Research has found that stress has a negative impact on wound healing (Ebrecht et al., 2004; Marucha, Kiecolt-Glaser & Favagehi, 1998). A meta-analysis of research conducted by Walburn and colleagues (2009) found that stress impacted the healing both acute and chronic wounds as well as experimentally inflicted wounds, such as punch biopsy and tape stripping. The research cites a high effect size (r=0.42) and emphasises that a focus should now shift to determining why stress detrimentally effects healing. Research is now looking at stress reduction interventions to help promote faster healing. At present only a few studies have measured the relationship between stress reduction techniques and wound healing (Broadbent et al. 2012; Emery, Hextall, Kirtley, Taylor, Dyson & Weinman, 2005). If such interventions can be proven to have a positive effect there are very important implications for clinical and surgical populations. Emotional writing is one intervention that researchers are currently trialling to investigate the stress-reducing effects on wound healing. The intervention involves participants writing about a traumatic or upsetting event over three consecutive days for 20 minutes per session. The intervention is not only easy to administer but also very cost effective. Emotional writing has been found to have a number of positive effects on mood and well-being for different populations. For example, Smyth (1998) conducted a review of 13 studies reporting benefits in physical health, psychological well-being, physiological functioning, and general functioning. Furthermore, emotional disclosure has been linked to decreased pain, better mood and shorter hospital stays in surgical patients (Francis & Pennebaker, 1992; Greenberg & Stone, 1992). The benefits of emotional writing are not fully understood but it is thought that writing about traumatic events or upsetting emotions can help process the event or issue, which can decrease the stress and prevent rumination (Pennebaker, 1997). Two studies to date have found that emotional writing has an impact on wound healing. Weinman, Ebrecht, Scott, Walburn and Dyson (2008) conducted a randomised control trial with young men who received punch biopsy wounds. They found that those who completed emotional writing healed significantly faster than the control group. More recently Koschwanez et al., (2013) found a similar effect with older adults. Those assigned to write expressively, rather than about daily life events, had a greater proportion of fully healed wounds at day 11 after receiving a standardized biopsy. Despite the amount of research that has been done looking at the effects of emotional disclosure there is still more research to be conducted to ensure that the intervention has the best effect. In the two studies previously discussed (Koschwanez et al., 2013; Weinman et al., 2008), the intervention was administered prior to wounding. The research aims to understand if the timing can play a role in improving wound healing. Timing may be a very important factor in understanding exactly how the emotional disclosure intervention works and may be particularly relevant for injured populations, for whom which this intervention may be particularly helpful and may be more practical to administer after the injury or post-surgery.
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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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Dr Elizabeth Broadbent
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Address
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AUCKLAND HOSPITAL
Level 1, Room 599-12003
PARK RD
Auckland 1023
GRAFTON
New Zealand
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Country
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New Zealand
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Phone
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+64 (0) 9 923 6756
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Fax
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Email
51186
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[email protected]
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Contact person for public queries
Name
51187
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Elizabeth Broadbent
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Address
51187
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AUCKLAND HOSPITAL
Level 1, Room 599-12003
PARK RD
Auckland 1023
GRAFTON
New Zealand
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Country
51187
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New Zealand
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Phone
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+64 (0) 9 923 6756
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Elizabeth Broadbent
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Address
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AUCKLAND HOSPITAL
Level 1, Room 599-12003
PARK RD
Auckland 1023
GRAFTON
New Zealand
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Country
51188
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New Zealand
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Phone
51188
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+64 (0) 9 923 6756
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Fax
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Email
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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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