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Trial record 8 of 729 for:    Anti-Infective Agents AND Antibiotics, Antitubercular AND culture

Rapid Identification and Phenotypic Susceptibility Testing for Gram-Negative Bacteremia (RAPIDS-GN)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03218397
Recruitment Status : Completed
First Posted : July 14, 2017
Results First Posted : November 26, 2019
Last Update Posted : November 26, 2019
Sponsor:
Collaborators:
National Institute of Allergy and Infectious Diseases (NIAID)
Vanderbilt University
Information provided by (Responsible Party):
Duke University

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: Single (Care Provider);   Primary Purpose: Diagnostic
Condition Gram-negative Bacteremia
Interventions Device: Accelerate PhenoTest™ BC Kit
Device: Standard Culture and AST
Enrollment 500
Recruitment Details  
Pre-assignment Details  
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship. Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Period Title: Overall Study
Started 249 251
Completed 226 222
Not Completed 23 29
Reason Not Completed
Prior positive blood culture             8             13
Comfort care             8             5
Comfort care and positive blood culture             1             0
Comfort care and mixed culture             0             1
Mixed culture             2             2
Inaccessible hospital records             2             5
No gram-negative bacilli (GNB)             0             2
Randomized during laboratory off hours             2             1
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST Total
Hide Arm/Group Description Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship. Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing. Total of all reporting groups
Overall Number of Baseline Participants 226 222 448
Hide Baseline Analysis Population Description
Subjects who completed the study.
Age, Continuous  
Mean (Standard Deviation)
Unit of measure:  Years
Number Analyzed 226 participants 222 participants 448 participants
65.8  (18.3) 62.2  (20.3) 64.0  (19.4)
Sex/Gender, Customized  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 226 participants 222 participants 448 participants
Male
130
  57.5%
122
  55.0%
252
  56.3%
Female
95
  42.0%
100
  45.0%
195
  43.5%
Unknown
1
   0.4%
0
   0.0%
1
   0.2%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 226 participants 222 participants 448 participants
Hispanic or Latino
13
   5.8%
16
   7.2%
29
   6.5%
Not Hispanic or Latino
202
  89.4%
191
  86.0%
393
  87.7%
Unknown or Not Reported
11
   4.9%
15
   6.8%
26
   5.8%
Race (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 226 participants 222 participants 448 participants
American Indian or Alaska Native
1
   0.4%
1
   0.5%
2
   0.4%
Asian
10
   4.4%
8
   3.6%
18
   4.0%
Native Hawaiian or Other Pacific Islander
0
   0.0%
2
   0.9%
2
   0.4%
Black or African American
9
   4.0%
8
   3.6%
17
   3.8%
White
183
  81.0%
176
  79.3%
359
  80.1%
More than one race
2
   0.9%
1
   0.5%
3
   0.7%
Unknown or Not Reported
21
   9.3%
26
  11.7%
47
  10.5%
Region of Enrollment  
Measure Type: Count of Participants
Unit of measure:  Participants
United States Number Analyzed 226 participants 222 participants 448 participants
226
 100.0%
222
 100.0%
448
 100.0%
1.Primary Outcome
Title Hours to First Antibiotic Modification
Hide Description Mean hours until first modification of antibiotic therapy within 72 hours post randomization
Time Frame 72 hours after randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Mean (Standard Deviation)
Unit of Measure: hours
24.7  (24.6) 19.0  (22.9)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.013
Comments alpha = 0.05
Method t-test, 2 sided
Comments [Not Specified]
Method of Estimation Estimation Parameter Difference in means
Estimated Value 5.6
Confidence Interval (2-Sided) 95%
1.2 to 10
Estimation Comments Difference in mean hours to first antibiotic modification (Standard Blood Culture and AST minus Rapid Organism Identification and AST)
2.Secondary Outcome
Title Subjects Who Experienced Mortality Within 30 Days of Randomization
Hide Description Subjects who experienced mortality within 30 days of randomization
Time Frame Within 30 days of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Measure Type: Count of Participants
Unit of Measure: Participants
Dead within 30 days
18
   8.0%
25
  11.3%
Not dead within 30 days
206
  91.2%
197
  88.7%
Unknown
2
   0.9%
0
   0.0%
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.265
Comments alpha = 0.05
Method Fisher Exact
Comments [Not Specified]
3.Secondary Outcome
Title Length of Stay in the Hospital
Hide Description Length of stay in the hospital after randomization, up to 30 days, for patients alive at 30 days. Length of stay will be date of discharge minus date of randomization.
Time Frame Within 30 days of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who were alive at 30 days.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 208 197
Mean (Standard Deviation)
Unit of Measure: days
8.2  (8.7) 9.8  (9.8)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.093
Comments alpha = 0.05
Method t-test, 2 sided
Comments T-test for the difference in mean length of stay (days) between treatment arms among subjects alive at 30 days.
4.Secondary Outcome
Title ICU Status Through 72 Hours Post-randomization
Hide Description ICU status through 72 hours post-randomization
Time Frame Within 72 hours of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Measure Type: Count of Participants
Unit of Measure: Participants
In ICU < 72 hours after randomization
33
  14.6%
55
  24.8%
In ICU for >= 72 hours after randomization
34
  15.0%
37
  16.7%
Not in ICU
159
  70.4%
130
  58.6%
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.014
Comments alpha = 0.05
Method Fisher Exact
Comments [Not Specified]
5.Secondary Outcome
Title Time to First Antibiotic Escalation
Hide Description Mean hours to first antibiotic escalation within 72 hours from randomization, where escalation is defined as changing to a broader spectrum antibiotic, addition of one or more antibiotics, or conversion of oral to intravenous route.
Time Frame Within 72 hours of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Mean (Standard Deviation)
Unit of Measure: hours
52.7  (28.8) 45.2  (31.4)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.009
Comments alpha = 0.05
Method t-test, 2 sided
Comments [Not Specified]
Method of Estimation Estimation Parameter Difference in means
Estimated Value 7.5
Confidence Interval (2-Sided) 95%
1.9 to 13.1
Estimation Comments Difference in mean hours to first antibiotic escalation (Standard Blood Culture and AST minus Rapid Organism Identification and AST)
6.Secondary Outcome
Title Time to First Gram-negative Antibiotic Escalation
Hide Description Mean hours to first gram-negative antibiotic escalation within 72 hours from randomization, where escalation is defined as changing to a broader spectrum antibiotic, addition of one or more antibiotics, or conversion of oral to intravenous route.
Time Frame Within 72 hours of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Mean (Standard Deviation)
Unit of Measure: hours
53.9  (28.4) 47.5  (31.2)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.022
Comments alpha = 0.05
Method t-test, 2 sided
Comments [Not Specified]
Method of Estimation Estimation Parameter Difference in means
Estimated Value 6.5
Confidence Interval (2-Sided) 95%
0.9 to 12.0
Estimation Comments Difference in mean hours to first gram-negative antibiotic escalation (Standard Blood Culture and AST minus Rapid Organism Identification and AST)
7.Secondary Outcome
Title Time to First Gram-positive Antibiotic Escalation
Hide Description Mean hours to first gram-positive antibiotic escalation within 72 hours from randomization, where escalation is defined as changing to a broader spectrum antibiotic, addition of one or more antibiotics, or conversion of oral to intravenous route.
Time Frame Within 72 hours of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Mean (Standard Deviation)
Unit of Measure: hours
70.5  (9.5) 69.7  (11.3)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.46
Comments alpha = 0.05
Method t-test, 2 sided
Comments [Not Specified]
Method of Estimation Estimation Parameter Difference in means
Estimated Value 0.7
Confidence Interval (2-Sided) 95%
-1.2 to 2.7
Estimation Comments Difference in mean hours to first gram-positive antibiotic escalation (Standard Blood Culture and AST minus Rapid Organism Identification and AST)
8.Secondary Outcome
Title Time to First Antibiotic De-escalation
Hide Description Mean hours to first antibiotic de-escalation within 72 hours from randomization, where de-escalation is defined as changing to a narrower spectrum antibiotic, cessation of one or more antibiotics, or changing from an intravenous to oral route of appropriate drug.
Time Frame Within 72 hours of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Mean (Standard Deviation)
Unit of Measure: hours
44.2  (26.2) 39.6  (28.0)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.074
Comments alpha = 0.05
Method t-test, 2 sided
Comments [Not Specified]
Method of Estimation Estimation Parameter Difference in means
Estimated Value 4.6
Confidence Interval (2-Sided) 95%
-0.4 to 9.6
Estimation Comments Difference in mean hours to first antibiotic de-escalation (Standard Blood Culture and AST minus Rapid Organism Identification and AST)
9.Secondary Outcome
Title Time to First Gram-negative Antibiotic De-escalation
Hide Description Mean hours to first gram-negative antibiotic de-escalation within 72 hours from randomization, where de-escalation is defined as changing to a narrower spectrum antibiotic, cessation of one or more antibiotics, or changing from an intravenous to oral route of appropriate drug.
Time Frame Within 72 hours of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Mean (Standard Deviation)
Unit of Measure: hours
55.8  (23.5) 49.3  (27.8)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.008
Comments alpha = 0.05
Method t-test, 2 sided
Comments [Not Specified]
Method of Estimation Estimation Parameter Difference in means
Estimated Value 6.5
Confidence Interval (2-Sided) 95%
1.7 to 11.2
Estimation Comments Difference in mean hours to first gram-negative antibiotic de-escalation (Standard Blood Culture and AST minus Rapid Organism Identification and AST)
10.Secondary Outcome
Title Time to First Gram-positive Antibiotic De-escalation
Hide Description Mean hours to first gram-positive antibiotic de-escalation within 72 hours from randomization, where de-escalation is defined as changing to a narrower spectrum antibiotic, cessation of one or more antibiotics, or changing from an intravenous to oral route of appropriate drug.
Time Frame Within 72 hours of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Mean (Standard Deviation)
Unit of Measure: hours
60.4  (22.6) 62.2  (21.3)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Standard Blood Culture and AST, Rapid Organism Identification and AST
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.37
Comments alpha = 0.05
Method t-test, 2 sided
Comments [Not Specified]
Method of Estimation Estimation Parameter Difference in means
Estimated Value -1.9
Confidence Interval (2-Sided) 95%
-5.9 to 2.2
Estimation Comments Difference in mean hours to first gram-positive antibiotic de-escalation (Standard Blood Culture and AST minus Rapid Organism Identification and AST)
11.Secondary Outcome
Title Number of Hospital-onset Clostridium Difficile Infections
Hide Description Acquisition of hospital-onset Clostridium difficile within 30 days, as defined by the National Healthcare Safety Network (NHSN), normalized to 10,000 patient-days.
Time Frame Within 30 days of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Measure Type: Number
Number (95% Confidence Interval)
Unit of Measure: Infections per 10,000 patient-days
26.8
(11.2 to 64.4)
27.5
(12.4 to 61.3)
12.Secondary Outcome
Title Number of New Hospital-acquired Infections (HAIs) and/or Multidrug Resistant Organisms (MDROs), Normalized to 10,000 Patient-days.
Hide Description

Acquisition of new hospital-acquired infections (HAIs) and/or multidrug resistant organisms (MDROs) within 30 days during index hospitalization identified on routine clinical or surveillance samples.

Cultures that will be tracked include the following, from any specimen source, unless otherwise indicated:

  • Methicillin-resistant Staphylococcus aureus
  • Vancomycin-resistant Enterococcus
  • 3rd generation cephalosporin non-susceptible Enterobacteriaceae
  • Carbapenem-resistant Enterobacteriaceae, as defined by the Centers for Disease Control and Prevention (CDC): resistant to imipenem, meropenem, doripenem, or ertapenem OR documentation that the isolate possesses a carbapenemase
  • Multidrug-resistant Pseudomonas aeruginosa (resistant to aminoglycosides, cephalosporins, fluoroquinolones, and carbapenems)
  • Carbapenem-resistant Acinetobacter
  • Candida species (isolated from blood cultures only)
Time Frame Within 30 days of randomization
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects who completed the study.
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description:
Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship.
Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
Overall Number of Participants Analyzed 226 222
Measure Type: Number
Number (95% Confidence Interval)
Unit of Measure: Infections per 10,000 patient-days
123.3
(82.0 to 185.6)
105.5
(70.1 to 158.8)
Time Frame 30 days from randomization
Adverse Event Reporting Description With the exception of mortality, adverse events were not collected.
 
Arm/Group Title Standard Blood Culture and AST Rapid Organism Identification and AST
Hide Arm/Group Description Standard blood culture and antimicrobial susceptibility testing (AST), and antimicrobial stewardship. Rapid organism identification and AST using the Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System (AXDX), and antimicrobial stewardship. The blood sample will also undergo standard culture and AST in addition to the rapid testing.
All-Cause Mortality
Standard Blood Culture and AST Rapid Organism Identification and AST
Affected / at Risk (%) Affected / at Risk (%)
Total   18/226 (7.96%)   25/222 (11.26%) 
Hide Serious Adverse Events
Standard Blood Culture and AST Rapid Organism Identification and AST
Affected / at Risk (%) Affected / at Risk (%)
Total   0/0   0/0 
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 0%
Standard Blood Culture and AST Rapid Organism Identification and AST
Affected / at Risk (%) Affected / at Risk (%)
Total   0/0   0/0 
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: Vance Fowler, MD, MHS
Organization: Duke University
Phone: 919-613-5678
EMail: vance.fowler@duke.edu
Layout table for additonal information
Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT03218397    
Other Study ID Numbers: Pro00075768
5UM1AI104681 ( U.S. NIH Grant/Contract )
First Submitted: July 11, 2017
First Posted: July 14, 2017
Results First Submitted: October 17, 2019
Results First Posted: November 26, 2019
Last Update Posted: November 26, 2019