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Acknowledging that the aggregation of complications into a single state may sacrifice granularity and potentially introduce structural bias, we adopted the three-state framework but implemented a key refinement to enhance its clinical plausibility
Lancet 392 , 7587 (2018)
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it is banned at all times, in and out of competition, for athletes subject to anti-doping codes, and is not classified under S2 (Peptide Hormones, Growth Factors, and Related Substances), which is reserved for specifically defined peptide hormones and growth factors such as hGH and EPO
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