Carpal Tunnel Syndrome:
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Exclude from Consideration if:
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Case if meets: (1 + 2 + 3 + 4) OR 5
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· had both tingling/numbness and an abnormal nerve study at baseline (met the prevalence case definition, hand specific1)
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1. Numbness/Tingling (N/T) in 2 or more median nerve served digits (thumb, index, middle finger and/or ring finger) for ≥25% of days and/or nights on at least 2 consecutive monthly followups (from monthly follow-up interview). Note: N/T at baseline counts as one of two consecutive followups).
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· has evidence of systemic neuropathy (determined by JJW, censor for all CTS analyses)
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· had prior Carpal Tunnel Release surgery (hand specific1)
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· had prior diagnosis of CTS by a Physician (hand specific1)
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2. Abnormal nerve conduction study consistent with median mononeuropathy at the wrist (from baseline, or semiannual NCS) that was independently interpreted by a blinded, board certified physical medicine and rehabilitation physician (JW).
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· had prior injection for CTS (hand specific)
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· has amputation of second or third digits at MCP or PIP in either hand (censor for all CTS analyses)
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Right Censor if:
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3. Time difference between + (positive) NCS and consecutive N/T followups must occur within 6-months)
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· becomes CTS incident case (hand specific1)
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4. Automatically a case if has surgery for CTS, provided the surgery cause is said to be “work-related” or “unsure”) and review by physician (KTH) suggests CTS.
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· leaves the study permanently (non-case)
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Lateral Epicondylalgia:
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Exclude from Consideration if:
all exclusions are hand specific
1
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Case if meets: (1 + 2 + 3) OR 4
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1) Lateral elbow pain on interview present for ≥ 25% of days since last follow-up (from monthly follow-up interview).
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· met the case definition at baseline
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· had prior lateral elbow surgery
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· had prior elbow surgery of unknown type
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2) “Pain” upon palpation of 1 or more of 6 lateral tender points (from monthly follow-up physical exam).
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· had prior diagnosis of lateral epicondylalgia
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· had prior treatment for lateral epicondylalgia
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3) Automatically a case if have surgery or injection for lateral epicondylalgia, provided the surgery cause is said to be “work-related” or “unsure”) and review by physician (KTH) suggests lateral epicondylalgia.
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· had prior radial nerve pain
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Right Censor if:
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· becomes Lateral Epicondylalgia incident case (hand specific1)
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· suffers an elbow injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· permanently leaves the study (non-case)
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Medial Epicondylalgia:
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Exclude from Consideration if:
all exclusions are hand specific
1
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Case if meets: (1 + 2 + 3) OR 4
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1) Medial elbow pain on interview present for ≥ 25% of days since last follow-up (from monthly follow-up interview).
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· met the case definition at baseline
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· had prior medial elbow surgery
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· had prior elbow surgery of unknown type
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2) “Pain” upon palpation of 1 or more of 2 medial tender points (from monthly follow-up physical exam).
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· had prior ulnar neuropathy or cubital tunnel surgery, OR clinical impression of ulnar neuropathy.
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3) Automatically a case if have surgery or injection for medial epi, provided the surgery cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests medial epicondylalgia.
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· had prior diagnosis of medial epicondylalgia
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· had prior treatment of medial epicondylalgia
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Right Censor if:
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· becomes medial epicondylalgia incident case (hand specific1)
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· suffers an elbow injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· permanently leaves the study (non-case)
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deQuervain’s Tenosynovitis:
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Exclude from Consideration if:
all exclusions are hand specific1
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Case if meets: (1 + 2 + 3 + 4) OR 5
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1. Radial wrist pain for ≥ 25% of days since last follow-up (from monthly follow-up interview).
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· met the case definition at baseline
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· had prior deQuervain’s surgery
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· had prior deQuervain’s treatment (injection)
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2. 1st extensor compartment tenderness (from monthly follow-up physical exam).
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· had prior deQuervain’s diagnosis
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3. Positive Finkelstein test (active) (from monthly follow-up physical exam).
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· has CMC/Wrist/MCP arthritis at baseline (or prior)
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4. Automatically a case if have surgery or injection for deQuervain’s, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests deQuervain’s.
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Right Censor if:
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· becomes deQuervain’s incident case (hand specific1)
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· suffers a wrist injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· develops CMC/Wrist/MCP arthritis (hand specific1, non-case)
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· permanently leaves the study (non-case)
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Extensor Tendinosis (compartments 2-6)
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Exclude from Consideration if:
all exclusions are hand specific
1
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Case if meets: (1 + 2 + 3 + 4) OR 5
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1. Dorsal wrist pain for ≥ 25% of days since last follow-up.
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· met the case definition at baseline
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· had prior wrist extensor tendinosis surgery
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2. 2-6 extensor compartment tenderness.
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· had prior wrist extensor tendinosis treatment (injection)
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3. Positive resisted wrist extension
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· had wrist arthritis at baseline (or prior)
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4. Automatically a case if have surgery or injection for extensor tendinosis, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests extensor tendinosis.
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Right Censor if:
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· becomes wrist extensor tendinosis incident case (hand specific1)
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· suffers a wrist injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· develops wrist arthritis (hand specific1, non-case)
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· permanently leaves the study (non-case)
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Digital Flexor Tendinosis
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Exclude from Consideration if:
all
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Case if meets: (1 + 2 + 3 + 4) OR 5
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exclusions are hand specific
1
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1. Volar wrist pain – from Hand Pain Diagram
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· met the case definition at baseline
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· had prior flexor tendinosis surgery
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2. Digital flexor tendon tenderness (from monthly follow-up physical exam).
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· had prior flexor tendinosis treatment (injection)
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3. No numbness/tingling in digits 1-4 (from monthly follow-up interview).
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· had wrist arthritis at baseline (or prior)
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Right Censor if:
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4. Automatically a case if have surgery or injection for digital flexor tendinosis, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests digital flexor tendinosis
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· becomes flexor tendinosis incident case (hand specific1)
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· suffers a wrist injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· develops wrist arthritis (hand specific1, non-case)
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· permanently leaves the study (non-case)
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Trigger Finger/Trigger Thumb
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Exclude from Consideration if:
all exclusions are hand specific
1
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Case if meets: (1 + 3) OR (2 + 3) OR 4
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1. Pain in the finger (from both monthly follow-up physical exam and interview) AND Focal tenderness over A-1 pulley
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· met the case definition at baseline
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· had prior trigger finger/thumb
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· had prior finger/hand surgery
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2. Demonstrated triggering (from monthly follow-up physical exam OR monthly interview).
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· had prior treatment for trigger finger/thumb (injection)
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· had MCP/finger OA at baseline
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3. Automatically a case if have surgery or injection for trigger finger, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests trigger finger.
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Right Censor if:
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· becomes trigger finger/thumb incident case (hand specific1)
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· suffers a hand/finger injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· permanently leaves the study (non-case)
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Non-Specific Pain
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Exclude from Consideration if:
all exclusions are hand specific
1
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Case if meets: (1 + 3) OR (2 + 3)
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1) Pain in DUE with intensity ≥ 6 for ≥ 25% of days since last follow-up that is NOT associated with a specific disorder.
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· met the case definition for non-specific pain at baseline
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· met the case definition for any specific disorders at baseline
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2) Pain in DUE of any intensity AND taking medication for pain.
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3)
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a. Carpal Tunnel Syndrome
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b. Lateral Epicondylalgia
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c. Medial Epicondylalgia
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d. deQuervain’s
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e. Extensor Tendinosis
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f. Digital Flexor Tendinosis
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g. Trigger Finger/Trigger Thumb
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Right Censor if:
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· becomes a non-specific pain incident case (hand specific1)
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· becomes an incident case for ANY specific disorder
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a. Carpal Tunnel Syndrome
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b. Lateral Epicondylalgia
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c. Medial Epicondylalgia
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d. deQuervain’s
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e. Extensor Tendinosis
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f. Digital Flexor Tendinosis
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g. Trigger Finger/Trigger Thumb
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· suffers a DUE injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· permanently leaves the study (non-case)
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Aggregate Disorders
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Exclusions from Consideration:
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Case if meets: 1
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· Subjects are excluded from becoming a case under specific disorders based on the specific exclusion criteria above. Note: Subjects may still be eligible to become an aggregate disorder case despite being ineligible under certain disorders. (e.g. a subject that is excluded from becoming a case for trigger finger/trigger thumb, DeQuervain’s, and lateral and medial epicondylalgia, may still become a case for CTS, extensor, or digital flexor tendinosis, and is therefore still eligible to become a case for aggregate disorders.)
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2. Meets any of the following case definitions as defined above:
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a. Carpal Tunnel Syndrome
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b. Lateral Epicondylalgia
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c. Medial Epicondylalgia
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d. deQuervain’s
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e. Extensor Tendinosis
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f. Digital Flexor Tendinosis
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g. Trigger Finger/Trigger Thumb
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Note: person level based on development of any of above disorders in either hand.
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· If a subject is not eligible to become a case
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for any of the 7 specific disorders listed to the left, the subject is excluded from aggregate disorders
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Right Censor if:
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· becomes aggregate disorder incident case (hand specific1)
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· suffers a hand/wrist/elbow injury (i.e. accident, fall, etc..) (hand specific1, non-case)
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· permanently leaves the study (non-case)
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