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Trial registered on ANZCTR
Registration number
ACTRN12623000646640
Ethics application status
Approved
Date submitted
22/03/2022
Date registered
15/06/2023
Date last updated
15/06/2023
Date data sharing statement initially provided
15/06/2023
Type of registration
Retrospectively registered
Titles & IDs
Public title
IMAGENDO: Diagnosing Endometriosis with Imaging and Artificial Intelligence
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Scientific title
Non-invasive endometriosis diagnosis in women using machine learning
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Secondary ID [1]
305284
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PHRDI000014
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Universal Trial Number (UTN)
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Trial acronym
IMAGENDO
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
endometriosis
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Condition category
Condition code
Reproductive Health and Childbirth
321131
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0
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Other reproductive health and childbirth disorders
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
There are two study arms:
Stage 1 - retrospective study - Women who have had an MRI or MRI and TV-US in the last 5 years will be contacted directly by mail by administration staff from our partner radiology and ultrasound clinics (including Benson Radiology, Specialist Imaging Partners, OmniGynaecare, O &G ) to obtain consent for these images and to follow up on any operation notes to confirm diagnosis. It is anticipated that it will take approximately 25 – 35 mins for the participant to complete their baseline data collection. Baseline data collection includes date of birth, height and weight, any previous surgery, any previous diagnostic imaging, Treating Specialist Doctor / Gynaecologist, Surgeon name and Hospital. Images and operation notes are de identified by admin staff from the clinic before being sent to the computer analysts. Participants will only need to read information and provide consent, and supply baseline information including date of birth, height and weight, any previous surgery, any previous diagnostic imaging, Treating Specialist Doctor / Gynaecologist, Surgeon name and Hospital. Once imaging and operation notes are received there will be no further observation. Images and medical history details will be entered into a machine learning algorithm designed specifically for this study. We will then compare the results from the algorithm to the documented diagnosis.
Stage 2: After being identified as eligible for the study, if they haven’t already had one, women will be invited to undertake a transvaginal endometriosis ultrasound scan and/or an MRI at one of the imaging partners. These scans take less than an hour to complete. They will then attend a follow up interview with their Gynaecologist at least one week prior to their surgery, for 15 minutes who will explain the findings of the scans. They will also attend a review appointment within one month after their surgery with their Gynaecologist. Operation notes will be accessed by the study team after surgery.
When consenting for the study, women will also be asked if they are willing to have their contact details including their name, date of birth, address, phone number, email address and treating specialist doctor entered on a secure electronic database and be contacted about future research questions that might arise from this project.
It is anticipated that it will take approximately 25 – 35 mins for the participant to complete their baseline data collection. Baseline data collection includes date of birth, height and weight, any previous surgery, any previous diagnostic imaging, Treating Specialist Doctor / Gynaecologist, Surgeon name and Hospital. The observation period will end at the follow up review appointment post surgery.
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Intervention code [1]
321689
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Diagnosis / Prognosis
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Comparator / control treatment
Laporascopic surgery will be used as a comparison for both Stage 1 and Stage 2. Surgical notes will be obtained directly from surgical clinics. No active involvement from participants will be required post surgery. The oveerall duration of observation for patients will be from imaging diagnosis until surgical notes are obtained.
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Control group
Active
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Outcomes
Primary outcome [1]
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Diagnostic Test Accuracy for Stage 1:
Machine Learning algorithm (Transvaginal Ultrasound & MRI) compared with laparoscopic surgery for endometriosis - Composite sensitivities, specificities, diagnostic accuracy, PPV, NPV and the AUC will be calculated
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Assessment method [1]
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Timepoint [1]
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6 months after participant enrolment in study
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Primary outcome [2]
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Diagnostic Test Accuracy for Stage 2:
Machine Learning algorithm (Transvaginal Ultrasound & MRI) compared with laparoscopic surgery for endometriosis - Composite Sensitivities, specificities, diagnostic accuracy, PPV, NPV and the AUC will be calculated
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Assessment method [2]
334123
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Timepoint [2]
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2 years after participant enrolment in study
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Secondary outcome [1]
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Time elapsed between imaging and surgery - sugical data will be requested directly from surgeons after patient consent.
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Assessment method [1]
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Timepoint [1]
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2 years after patient enrolment
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Eligibility
Key inclusion criteria
Women with symptoms of endometriosis including:
o Period paid
o Other chronic pelvic pain
o Fatigue
o Dysmenorrhoea,
o Dyspareunia,
o Difficulty conceiving
• Women do not need to have regular menstrual cycles, and can be taking oral contraceptive or have a Mirena in place
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Minimum age
18
Years
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Maximum age
45
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
• Women with cancer
• Women with bowel conditions such as Crohn’s Disease or Ulcerative Colitis
• Postmenopausal women
• Women with an intellectual disability/inability to give informed consent
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Study design
Purpose
Screening
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Duration
Cross-sectional
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Selection
Defined population
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Timing
Both
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Statistical methods / analysis
As Machine learning is dependant on obtaining as mcuh data as possible, we have not coalbulated a sample size.
Composite Sensitivities, specificities, diagnostic accuracy, PPV, NPV and the AUC will be calculated
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
5/11/2020
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Date of last participant enrolment
Anticipated
30/06/2024
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Actual
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Date of last data collection
Anticipated
30/06/2025
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Actual
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Sample size
Target
1000
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Accrual to date
350
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Final
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC
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Recruitment outside Australia
Country [1]
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Canada
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State/province [1]
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Ontario
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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Australian Gynaecological Endoscopy Society (AGES)
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Address [1]
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YRD Event Management
PO Box 717 Indooroopilly
QLD 4068 AUSTRALIA
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Country [1]
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Australia
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Funding source category [2]
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Charities/Societies/Foundations
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Name [2]
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Endometriosis Australia
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Address [2]
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C/O Weston Woodley & Robertson
PO Box 1070 North Sydney
NSW 2059 Australia
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Country [2]
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Australia
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Funding source category [3]
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Government body
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Name [3]
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Australian Government (MRFF 2020 Primary Health Care Research Data Infrastructure Grant)
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Address [3]
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Department of Industry, Science, Energy and Resources
10 Binara Street
CANBERRA ACT 2600
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Country [3]
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Australia
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Funding source category [4]
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Charities/Societies/Foundations
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Name [4]
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Australasian Society of Ultrasound in Medicine
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Address [4]
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Suite 3.01, 9 Help St
Chatswood NSW 2067 Australia
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Country [4]
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Australia
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Primary sponsor type
University
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Name
Robinson Research Institute, University of Adelaide
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Address
Norwich House
Ground Floor, 55 King William Rd
North Adelaide SA, 5006
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Country
Australia
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Secondary sponsor category [1]
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University
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Name [1]
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Australian Institute of Machine Learning, University of Adelaide
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Address [1]
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Corner Frome Road and, North Terrace, Adelaide SA 5000
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Country [1]
312405
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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University of Adelaide Human Research Ethics Committee
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Ethics committee address [1]
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Office of Research Ethics, Compliance and Integrity The University of Adelaide Level 4, Rundle Mall Plaze 50 Rundle Mall Adelaide SA 5000 Australia
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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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15/08/2019
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Approval date [1]
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23/04/2020
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Ethics approval number [1]
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H-2020-051
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Summary
Brief summary
Endometriosis is a chronic, inflammatory condition which can lead to chronic pelvic pain and infertility. There is no cure for this condition and the gold standard for diagnosis is laparoscopy (keyhole surgery) which is costly, has long wait times and is associated with risks. This study (Imagendo) will use artificial intelligence to create a diagnostic algorithm by analysing ultrasound and MRI endometriosis scans, providing general practitioners with an earlier, easily accessed, non-invasive, diagnosis of endometriosis.
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Trial website
www.imagendo.org.au
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Trial related presentations / publications
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Public notes
Presentations: 2023: Australian Society for Ultrasound in Medicine (ASUM): Sydney, Avery J et al. (Invited speaker) Enhancing the detection of Pouch of Douglas obliteration for endometriosis diagnosis with Artificial Intelligence, using magnetic resonance imaging and unpaired endometriosis ultrasounds. 2023: 12th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2023) Adelaide. Avery J et al (Oral) EXTRAPOLATING ENDOMETRIOSIS DIAGNOSIS USING IMAGING AND MACHINE LEARNING: THE IMAGENDO PROJECT 2023: 20th IEEE International Symposium on Biomedical Imaging (ISBI): Colombia: Zhang Y, et al. (Oral) “Distilling Missing Modality Knowledge from Ultrasound for Endometriosis Diagnosis with Magnetic Resonance Images”. Winner: best Oral Presentation 2023: World Congress on Endometriosis (WCE), Zhang Y, Avery JC (Presenter), et al Oral: A multimodal AI analysis of endometriosis imaging markers”. Posters: Deslandes A, et al A quantitative grading system for the assessment TVUS image quality 2023: ARGANZ Adelaide, White S, et al (Poster) Development and validation of a machine learning system for automated routine 2-dimensional morphometric measurements on female pelvic MRI 2023: Computer Vision and Pattern Recognition Conference (CVPR 2023) Wang H, et al. (Oral) "Multi-modal Learning with Missing Modality via Shared-Specific Feature Modeling". 45th IEEE Engineering in Medicine and Biology Society, (EMBC 23) Sydeney, Butler D, et al.(Oral) “The Effectiveness of Self-supervised Pre-training for Multi-modal Endometriosis Classification” 2022: RANZCOG Meeting Gold Coast, Avery J et al IMAGENDO – non-invasive diagnosis of endometriosis using machine learning 11th Congress of the Asia Pacific Initiative on Reproduction ASPIRE: Warner R, Avery J et al (Oral) Associations between environmental exposures in the middle east area of operations and reproductive outcomes in Australian defence force veterans 2022: RCOG – BSGI Meeting Hull L, Avery J et al. Oral and Poster IMAGENDO: Combining ultrasound and magnetic resonance imaging using artificial intelligence to reduce diagnostic delay. (Virtual) London. 2022: Australian Society for Ultrasound in Medicine (ASUM) Meeting Adelaide Avery J. (Poster) Imagendo® – Non-Invasive diagnosis of endometriosis using machine learning. (Oral) 2022: European Conference on Computer Vision. Uncertainty-aware Multi-modal Learning via Cross-modal Random Network Prediction Wang, H. Avery J, et al. Uncertainty-Aware Multi-modal Learning via Cross-Modal Random Network Prediction. 2021: World Congress on Endometriosis (WCE) Maicas G, Avery J et al (Oral) Artificial Intelligence for Sliding Sign Detection to Diagnose Endometriosis. 2020: ISUOG Virtual World Congress Leonardi M, Avery J, et al (Poster) Machine learning to diagnose rectouterine pouch obliteration with the sliding sign on transvaginal ultrasound. 2020 UOG 56(S1) Publications: Butler D, Wang H, Zhang Y, To MS, Avery JC, Hull ML, Carneiro G. The Effectiveness of Self-supervised Pre-training for Multi-modal Endometriosis Classification, Proceedings of the 45th IEEE Engineering in Medicine and Biology Society, 2023 In Press. H Wang, Y Chen, C Ma, AVERY J, L Hull, G Carneiro Multi-Modal Learning With Missing Modality via Shared-Specific Feature Modelling. - Proceedings of the IEEE/CVF Conference on Computer Vision and Pattern Recognition. pp15878-15887 2023 Zhang Y, Wang H, Avery J, et al. “Distilling Missing Modality Knowledge from Ultrasound for Endometriosis Diagnosis with Magnetic Resonance Images”. Proceedings of 20th IEEE International Symposium on Biomedical Imaging (ISBI). In Press. https://ieeexplore.ieee.org/xpl/conhome/1000080/all-proceedings Wang H, Zhang J, Chen Y, Ma C, AVERY J, Hull L, Carneiro G, Uncertainty-Aware Multi-modal Learning via Cross-Modal Random Network Prediction. Computer Vision–ECCV 2022: 17th European Conference, Tel Aviv, Israel, October 23–27, 2022, Proceedings, Part XXXVII, Pp 200-217 Leonardi M, Macais G, Avery J, Panuccio C. Carneiro G, Hull ML, Condous G. Machine learning to diagnose rectouterine pouch obliteration with the sliding sign on transvaginal ultrasound. ISUOG Virtual World Congress 2020 Ultrasound in Obstetrics and Gynecology 56(S1) doi: 10.1002/uog.23327 Maicas G, Leonardi M, Avery J, Panuccio C, Carneiro G, Hull ML, Condous G. Deep learning to diagnose pouch of Douglas obliteration with ultrasound sliding sign. Reprod Fertil. 2021 Aug 25;2(4):236-243. doi: 10.1530/RAF-21-0031. eCollection 2021 Dec.
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Contacts
Principal investigator
Name
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Prof Mary Louise Hull
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Address
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Robinson Research Institute
Ground Floor, 55 King William Rd
North Adelaide SA 5006
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Country
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Australia
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Phone
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+61403933312
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Jodie C Avery
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Address
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Robinson Research Institute
Ground Floor, 55 King William Rd
North Adelaide SA 5006
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Country
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Australia
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Phone
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+61410519941
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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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Jodie C Avery
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Address
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Robinson Research Institute
Ground Floor, 55 King William Rd
North Adelaide SA 5006
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Country
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Australia
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Phone
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+61410519941
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Fax
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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
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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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