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Trial registered on ANZCTR
Registration number
ACTRN12619001211156p
Ethics application status
Submitted, not yet approved
Date submitted
30/07/2019
Date registered
30/08/2019
Date last updated
30/08/2019
Date data sharing statement initially provided
30/08/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Clinical Utility of Obstructive Sleep Apnoea Physiology in Predicting Response to Treatment
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Scientific title
An Observational Study of the Clinical Utility of Obstructive Sleep Apnoea Physiology in Predicting Response to Treatment
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Secondary ID [1]
297337
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None
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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:
obstructive sleep apnoea
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Condition category
Condition code
Respiratory
310091
310091
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0
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Sleep apnoea
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This intervention study will investigate the effect that making additional physiological information available to clinicians and patients at the time of obstructive sleep apnoea diagnosis has on treatment referral patterns and patient outcomes.
Over the last 5yrs there has been an accumulating body of evidence that understanding an individual patient's physiology can help predict response to treatment for obstructive sleep apnoea. In particular understanding the contribution of loop gain, arousal threshold, upper airway dilator muscle activity and upper airway anatomy. These experimental parameters are not available for clinical use. Our group has developed tools that allow for this information to be made readily available to clinicians at the time of OSA diagnosis.
The aim of this study will be to make measurements of an individual's loop gain, arousal threshold, upper airway dilator muscle activity and upper airway anatomy at the time of obstructive sleep apnoea diagnosis. Our tool allows for these measurements to be made from routinely collected clinical data (sleep study) and thus does not require any additional testing above and beyond standard clinical practice.
The tool that we will employ for the purpose of this study is a bespoke Matlab code that models the respiratory system. We have currently employed this methodology in ober a dozen clinical studies in Australia and the USA. The tool is experimental and not commercially available. We take regular clinical physiological data (sleep study) and feed that data into our MATLAB code which analyzes the signals and outputs the variables mentioned above. This is then output in a report that clinicians can read. The MATLAB code and analysis is made on data collected using standard sleep study setup. No additional instrumentation or equipment is required.
The additional physiological information will be made available at the time of diagnosis and will be kept with the patient's sleep study results (medical records) so that it can be referred back to at any time. The additional physiological information will be kept with the patient's medical record in accordance with usual practice for keeping and maintaining medical records see https://www2.health.vic.gov.au/about/legislation/health-records-act
The first year of the study (observational arm) will be comppared to the second year of the study (interventional arm) to understand how clinicians treatment patterns have changed with the access to additional physiological parameters (treatment modality recommended, number of treatment trials for a given patient, patient ouutcomes including sleepp study results and QOL measures).
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Intervention code [1]
313587
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Diagnosis / Prognosis
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Comparator / control treatment
The first year of the study will be the comparator/control with the additional diagnostic information to be introduced in the second year of the study.
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Control group
Active
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Outcomes
Primary outcome [1]
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The proportion of patients receiving treatment with each of: continuous positive airways pressure, mandibular advancement splint, upper airway surgery and positional therapy.
This outcome will be assessed based on a combination of patient reporting and device metrics (for CPAP users). This outcome is a composite primary outcome.
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Assessment method [1]
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Timepoint [1]
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12 months from treatment initiation
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Primary outcome [2]
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apnoea and hypopnoea index as assessed with a diagnostic sleep study with treatment in situ.
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Assessment method [2]
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Timepoint [2]
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Post treatment initiation, timepoint will very from treatment to treatment but it is anticipated that the treatment assessment sleep study will be performed within 3 months of treatment initiation.
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Primary outcome [3]
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Symptoms of sleepiness as measured by Functional Outcomes of Sleep Questionnaire.
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Assessment method [3]
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Timepoint [3]
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6 and 12 months from the time of treatment initiation.
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Secondary outcome [1]
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Time to definitive treatment as assessed by the period of time from the diagnosis of sleep apnoea to successful treatment (i.e. treatment is efficacious in terms of AHI measurement and patient is compliant with treatment). This outcome will be assessed by calculating the time from diagnosis of sleep apnoea to the measurement of treatment efficacy on a treatment AHI obtained through a sleep study with the treatment in situ and confirmation of patient compliance with treatment.
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Assessment method [1]
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Timepoint [1]
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2 years from study commencement
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Secondary outcome [2]
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Epworth Sleepiness Score
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Assessment method [2]
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Timepoint [2]
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2 years from study commencement
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Eligibility
Key inclusion criteria
Patients who are being investigated for suspected obstructive sleep apnoea through the Monash University Healthy Sleep Clinic
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Minimum age
18
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
• Receiving medication that could affect ventilation (i.e. morphine derivatives, benzodiazepines, theophylline) or muscle control.
• Previous surgical treatment for OSA and/or obesity
• Women who are pregnant or breastfeeding
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Study design
Purpose of the study
Diagnosis
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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)
None
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
None
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
The clinic will run for one year as an observational arm and the second year as an interventional arm. In this way the study design could be considered stepped or sequential.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
No current data exists on the treatment referral patterns and treatment responses for patients seeking treatment for OSA, mainly because the two most efficacious treatments for OSA (CPAP and mandibular advancement splints [MAS]) are not medicare supported treatments. Additionally, there is no current data to inform a sample size calculation of the effect that OSA physiology will have on treatment patterns.
This highlights the urgent need for our observational study which will provide two crucial insights. Firstly, we will understand the usual treatment patterns of best practice treatment of OSA in the Australian context. Secondly, we will be able to determine the impact on these treatment patterns of understanding OSA physiology. These data will inform a future randomised controlled trial in this area by providing data for future sample size calculations.
Primary Outcome: Independent samples t-test (or non-parametric equivalent) will be used to determine if there is a significant difference in the number of patients being referred for each OSA treatment (CPAP, MAS, surgery, positional therapy) between the observational period and the period when physiological information is made available at the time of diagnosis.
Secondary Outcomes: Independent samples t-test (or non-parametric or categorical equivalent) will be used to determine if there is a significant difference in patient outcomes (AHI, ESS, QOL measures) between the observational period and the period when physiological information is made available at the time of diagnosis.
Additional analyses:
We will determine if any of the physiological traits predict worse outcome to treatment overall. This will be done by regressing the physiological parameters on to the treatment outcome variables using multiple regression analysis.
We will determine if the addition of OSA physiology at the time of diagnosis reduces the time to definitive treatment by performing an independent samples t-test on the time to definitive treatment between the observational period and the period when physiological information is made available at the time of diagnosis.
We will determine if any of the physiological traits predict longer time to definitive treatment outcome. This will be done by regressing the physiological parameters on to the time to definitive treatment.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/01/2020
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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
300
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Monash Medical Centre - Clayton campus - Clayton
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Recruitment postcode(s) [1]
25576
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3168 - Clayton
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Recruitment postcode(s) [2]
25577
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3168 - Notting Hill
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Resarch Council
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Address [1]
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GPO box 4121
Canberra
ACT
2601
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Monash Health
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Address
246 Clayton Rd
Clayton
Victoria
3168
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
301653
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Address [1]
301653
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Country [1]
301653
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
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Monash Health HREC
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Ethics committee address [1]
302590
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246 Clayton Rd
Clayton
Victoria
3168
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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27/02/2019
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Approval date [1]
302590
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Ethics approval number [1]
302590
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Summary
Brief summary
Continuous positive airway pressure (CPAP) is the current gold standard treatment for OSA. While efficacious, CPAP is poorly tolerated. Nightly use may be inadequately brief and 50% of patients do not continue CPAP therapy beyond 3 months. Although alternative treatments such as mouth guard devices and surgery exist for CPAP-intolerant patients, individual responses to these treatments are difficult to predict and as such many clinicians and patients are stuck in a trial and error paradigm for these treatments.
Traditionally OSA has been thought to be a disorder of aberrant upper airway anatomy. Recently, it has become clear though that OSA can be caused by both anatomical and non-anatomical pathophysiology. Much of this paradigm change can be attributed to recent developments to the ability to measure this physiology – work that has been carried out by our research team at Monash Health and Monash University. We have developed readily applicable clinical tool that can predict the patient’s response to upper airway surgery and mandibular advancement splint treatments. The tools we have developed are now ready for direct translation to the clinical setting.
In this exciting research project we will run an observation study to assess the impact of making physiological information available to clinicians at the time of OSA diagnosis on the treatment referral patterns and treatment outcomes of OSA patients. We hope that this extra physiological data will be able to predict patient response to CPAP-alternative treatments and give clinicians and patients extra treatment options that are tailored to patients personal physiology.
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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 Simon Joosten
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Address
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Monash Health, Monash Lung and Sleep Department
246 Clayton Rd
Clayton
Victoria
3168
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Country
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Australia
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Phone
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+61 3 95942900
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Fax
90742
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Email
90742
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[email protected]
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Contact person for public queries
Name
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Dr Simon Joosten
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Address
90743
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Monash Health
246 Clayton Rd
Clayton
Victoria
3168
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Country
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Australia
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Phone
90743
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+61 3 95942900
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Fax
90743
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Email
90743
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[email protected]
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Contact person for scientific queries
Name
90744
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Dr Simon Joosten
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Address
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Monash Health
246 Clayton Rd
Clayton
Victoria
3168
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Country
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Australia
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Phone
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+61 3 95942900
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Fax
90744
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Email
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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)?
No
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No/undecided IPD sharing reason/comment
Unidentifiable patient data will be stored for analysis for primary and secondary endpoints.All patient data will be made available to patients and treating clinicians in the intervention phase of the study.
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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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