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Trial registered on ANZCTR
Registration number
ACTRN12625000418471
Ethics application status
Approved
Date submitted
16/04/2025
Date registered
7/05/2025
Date last updated
29/05/2025
Date data sharing statement initially provided
7/05/2025
Type of registration
Prospectively registered
Titles & IDs
Public title
CORI Robotics and Sensor-based Inertial Measurement Unit in Unicompartmental (Partial) Knee Arthroplasty
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Scientific title
A Prospective Interventional Study of REAL INTELLIGENCE™ CORI™ and Sensor-Based Inertial Measurement Unit (IMU) in Unicompartmental Knee Arthroplasty (UKA) patients
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Secondary ID [1]
314221
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Nil known
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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:
Knee osteoarthritis
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Condition category
Condition code
Musculoskeletal
333543
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0
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Osteoarthritis
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Surgery
333615
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0
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Surgical techniques
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a prospective, non-randomised, non-blinded, longitudinal study of early clinical outcomes of patients with osteoarthritis of the knee who are eligible for unicompartmental (partial) knee arthroplasty (UKA). The most suitable intervention for the patient will be chosen at physician discretion.
Participants in the intervention group will undergo UKA procedure with the robotic REAL INTELLIGENCE™ CORI™ unit performed by consultant orthopaedic surgeons. The CORI unit will be used in surgery and involves the use of bony landmarks and computer navigation trackers to more accurately work out alignment of bony cuts aiding better positioning of the implant over not using it. The approximate duration of a UKA procedure is 90 minutes. The robotic navigation technique is expected to add approximately 10 minutes to the procedure, therefore the total time of the operation will be approximately 100 minutes.
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Intervention code [1]
330880
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Treatment: Surgery
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Comparator / control treatment
Participants in the comparator group will undergo conventional, non-robotic UKA procedure per the investigators’ preferred procedure. The surgery will be performed by consultant orthopaedic surgeons. The approximate duration of a UKA procedure is 90 minutes.
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Control group
Active
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Outcomes
Primary outcome [1]
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Complications in the early post-operative period (3 months following surgery)
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Assessment method [1]
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Between-group comparisons of any post-operative complications recorded in patient medical records in the 3 months following surgery (includes inpatient stay, or subsequent re-presentation at hospital)
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Timepoint [1]
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All complications up to 3 months following surgery. Complications will be assessed at 3 months following surgery to ensure complete capture.
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Primary outcome [2]
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Gait analysis
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Assessment method [2]
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Composite sensor-based Inertial Measurement Unit (IMU) metrics (knee flexion, impact load asymmetry, spatio-temporal gait)
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Timepoint [2]
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Pre-operative (up to 90 days prior to surgery), post-surgery at Week 1, Week 2, Week 3, Week 4, and Week 6
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Secondary outcome [1]
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Post-operative limb alignment
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Assessment method [1]
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Hip-knee-ankle (HKA) angles measured using radiographic assessment at 6 weeks.
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Timepoint [1]
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6 weeks post-surgery
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Secondary outcome [2]
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Oxford knee Score
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Assessment method [2]
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The Oxford Knee Score (OKS) is a Patient Reported Outcome questionnaire that was developed to assess perceived function and pain answered on a Likert scale. Responses to each question ranges from 0-4 with a range of a possible overall score from 0-48. A score of 0 is the worst possible outcome while a score of 48 is the best possible outcome.
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Timepoint [2]
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Pre-operative (up to 90 days prior to surgery), 3 months post-surgery
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Secondary outcome [3]
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Forgotten Joint Score (FJS-12)
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Assessment method [3]
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The Forgotten Joint Score (FJS) comprises measures for the assessment of joint-specific patient reported outcomes. Participants are asked to rate their awareness of their knee arthroplasty in 12 questions with a five point Likert response format: "Never", "almost never", "seldom", "sometimes" and "mostly". The item scores are summed and linearly transformed in a 0 to 100 scale with a high value reflecting the ability of the subject to forget about the replaced knee joint during the activities of daily living (i.e., a higher score is a better outcome).
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Timepoint [3]
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3 months post-surgery
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Secondary outcome [4]
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EuroQol 5 Dimensions (EQ-5D-5L)
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Assessment method [4]
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The EQ-5D-5L score consists of two parts: a descriptive system and a visual analogue scale (VAS). The descriptive system (i.e., index score) is used to describe the participant's health state and consists of five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels to choose the most appropriate answer: no problems, slight problems, moderate problems, severe problems and extreme problems. The participant is asked to indicate their health state by marking the most appropriate statement in each of the five areas. The EQ-5D-5L Index Score was based on a scale of 0 to 1, with higher index values indicating better health and lower index values indicating worse health.
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Timepoint [4]
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Pre-operative (up to 90 days prior to surgery), 3 months post-surgery
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Secondary outcome [5]
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Pain Visual Analogue Scale (VAS)
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Assessment method [5]
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The Pain VAS scale consists of 2 sub-scales measuring pain at rest and pain with movement, with a range of 0 to 100, with a higher score indicating higher level of pain.
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Timepoint [5]
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Pre-operative (up to 90 days prior to surgery), 3 months post-surgery
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Secondary outcome [6]
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Satisfaction
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Assessment method [6]
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Participants will be asked to rate their satisfaction with the procedure using a 5 point Likert scale.
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Timepoint [6]
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3 months post-surgery
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Secondary outcome [7]
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Surgical time
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Assessment method [7]
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Operating time of each surgery from patient surgical records
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Timepoint [7]
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Intraoperative
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Eligibility
Key inclusion criteria
• Patient is deemed appropriate for a unicompartmental knee replacement.
• Patients are deemed skeletally mature (>18 years of age)
• The patient has a primary diagnosis of osteoarthritis (OA), avascular necrosis, functional deformity or fractures that are unmanageable using other techniques.
• The patient has intact collateral ligaments.
• The patient has signed the study specific, ethics-approved, Informed Consent document.
• The patient is willing and able to comply with the specified pre-operative and post-operative clinical and radiographic evaluations.
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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
• The patient is receiving UKA as a revision for a previously failed surgery, or need for complex implants, or any other implant than a standard UKA (e.g. stems, augments, osteotomy, or custom made devices).
• The patient is undergoing simultaneous bilateral knee arthroplasty.
• The patient has been diagnosed as having an active infection.
• The patient is morbidly obese (BMI greater than or equal to 41).
• Patient, in the opinion of the Investigators, has a cognitive, emotional, neurological or neuromuscular condition that would pre-empt their ability or willingness to participate in the study, or may interfere with UKA survival or outcome.
• Patient does not meet the indication, or is contraindicated, for UKA according to the knee system’s Instructions for Use (IFU).
• Patient is pregnant or breastfeeding at time of surgery.
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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
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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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
Sample size justification:
This study will follow 100 consenting participants undergoing 50 robotic assisted and 50 conventional UKA. The sample size was calculated using pilot data conducted by the study group for a TKA population (average impact asymmetry 8% vs 13.6% for RA-TKA and conventional TKA groups, respectively), and was powered to 0.80 to detect an alpha significance level of 0.05 with a pooled SD of 0.09 requiring a minimum sample of 42 individuals in each group. The final sample size was calculated to account for 10% drop out (expected rate of drop out from previous similar studies).
Statistical analysis plan:
The primary outcome data gathered from patients in each study group will be pooled and summarized. For the primary objective, a two-way analysis of variance (ANOVA) will be performed to determine differences between robotic-assisted and conventional UKA groups. A partial least squares regression analysis will be used to correlate sensor and oxford knee scoring metrics. Group wise comparisons and post-hoc analyses will be performed using non-parametric statistical methods following ANOVA testing. Independent two-sample t-test or Wilcoxon non-parametric rank-sum test will be used to compare the OKS, FJS, EQ-5D, VAS Pain and Satisfaction and scores between the robotic and conventional groups at all available visits.
For the secondary objectives, independent two-sample t-test or Wilcoxon non-parametric rank-sum test will be used to compare differences in length of stay, and chi-squared analyses will be used to compare proportional differences in complications. Learning curves will be analysed using a Cumulative Summation (CUSUM) method.
Adverse events will be tabulated separately and reviewed for any commonalities. Any revision surgery data from the study will be compared to the revision rates reported in the New Zealand Joint Registry report.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
15/05/2025
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Actual
15/05/2025
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Date of last participant enrolment
Anticipated
15/05/2027
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Actual
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Date of last data collection
Anticipated
15/08/2027
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Actual
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Sample size
Target
100
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Accrual to date
2
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Final
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Recruitment outside Australia
Country [1]
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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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Commercial sector/Industry
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Name [1]
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Smith & Nephew Pty Ltd
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Address [1]
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Country [1]
318738
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Australia
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Primary sponsor type
University
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Name
University of Auckland
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Address
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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]
321174
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Address [1]
321174
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Country [1]
321174
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
317351
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Northern B Health and Disability Ethics Committee
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Ethics committee address [1]
317351
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https://ethics.health.govt.nz/about/northern-b-health-and-disability-ethics-committee/
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Ethics committee country [1]
317351
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New Zealand
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Date submitted for ethics approval [1]
317351
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02/10/2024
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Approval date [1]
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17/03/2025
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Ethics approval number [1]
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2025 EXP 20846
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Summary
Brief summary
Total knee arthroplasty (TKA) is a highly successful surgical treatment for patients with end-stage osteoarthritis. Unicompartmental knee arthroplasty (UKA) is an alternative option if patients have single-compartment isolated osteoarthritis. UKA is less invasive and can have benefits over TKA, including lower rates of post-operative mortality and readmissions, shorter length of stay, increased range of motion (ROM), and physiologically more normal gait. Despite potential benefits, there is low usage associated with a higher technical demand and an increased risk of revision surgery. Therefore, technology or techniques that could improve outcomes and reduce the risk of UKA revision are important. The primary objective of this study is to compare surgical and post-surgical outcomes of robotic (CORI system) vs. conventional (non-robotic) UKA in the early post-operative period using wearable Sensor-Based Inertial Measurement Unit (IMU) technology and PROMs.
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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 A. Paul Monk
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Address
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University of Auckland, 8 Park Road, Grafton, Auckland 1023
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Country
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New Zealand
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Phone
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+64 9 4868900 43748
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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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Mei Lin Tay
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Address
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University of Auckland, 8 Park Road, Grafton, Auckland 1023
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Country
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New Zealand
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Phone
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+64 9 4868900 43748
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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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A. Paul Monk
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Address
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University of Auckland, 8 Park Road, Grafton, Auckland 1023
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Country
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New Zealand
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Phone
140772
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+64 9 4868900 43748
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Fax
140772
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Email
140772
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[email protected]
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Data sharing statement
Will the study consider sharing individual participant data?
No
No IPD sharing reason/comment:
Individual participant data will not be shared for privacy and confidentiality purposes.
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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