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1 |
[record_id] |
Record ID |
text |
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2 |
[participant_id_sniffing_test] |
Participant id
प्रतिभागी आईडी
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text |
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3 |
[particippant_name_sniffing_test] |
Participant name
प्रतिभागी का नाम
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text |
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4 |
[date] |
Date: __ __ / __ __ / __ __ __ __
तारीख: __ __ / __ __ / __ __ __ __
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text (date_dmy) |
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5 |
[date_4] |
Occupation: ________________________
पेशा: ________________________
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text |
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6 |
[date_5] |
Smoker: Yes/No
धूम्रपान करने वाला: हाँ/नहीं
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yesno |
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7 |
[date_6] |
The patient judges his/her own olfactory sensitivity as:
रोगी अपनी घ्राण संवेदनशीलता का आकलन इस प्रकार करता है:
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dropdown| 1 | Normal | | 2 | Decreased | | 3 | Increased |
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8 |
[value_of_turning_point_1_o_1] |
Section Header: Evaluation Threshold TestBilateral test मूल्यांकन सीमा परीक्षणद्विपक्षीय परीक्षण Dilution 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Evaluation Threshold TestBilateral test
Value of Turning point 1 of threshold test
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text |
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9 |
[value_of_turning_point_1_o_2] |
Value of Turning point 2 of threshold test |
text |
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10 |
[value_of_turning_point_1_o_3] |
Value of Turning point 3 of threshold test |
text |
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11 |
[value_of_turning_point_1_o_4] |
Value of Turning point 4 of threshold test |
text |
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12 |
[value_of_turning_point_1_o_5] |
Value of Turning point 5 of threshold test |
text |
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13 |
[value_of_turning_point_1_o_6] |
Value of Turning point 6 of threshold test |
text |
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14 |
[value_of_turning_point_1_o_7] |
Value of Turning point 7 of threshold test |
text |
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15 |
[average_score] |
SCORE=(AVERAGE OF 4 TO 7) |
calc Calculation: ([value_of_turning_point_1_o_4] + [value_of_turning_point_1_o_5] + [value_of_turning_point_1_o_6] + [value_of_turning_point_1_o_7]) / 4 |
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16 |
[pen_1] |
Section Header: Discrimination test
Pen 1
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radio (Matrix) |
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17 |
[pen_2] |
Pen 2 |
radio (Matrix) |
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18 |
[pen_3] |
Pen 3 |
radio (Matrix) |
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19 |
[pen_4] |
Pen 4 |
radio (Matrix) |
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20 |
[pen_5] |
Pen 5 |
radio (Matrix) |
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21 |
[pen_6] |
Pen 6 |
radio (Matrix) |
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22 |
[pen_7] |
Pen 7 |
radio (Matrix) |
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23 |
[pen_8] |
Pen 8 |
radio (Matrix) |
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24 |
[pen_9] |
Pen 9 |
radio (Matrix) |
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25 |
[pen_10] |
Pen 10 |
radio (Matrix) |
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26 |
[pen_11] |
Pen 11 |
radio (Matrix) |
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27 |
[pen_12] |
Pen 12 |
radio (Matrix) |
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28 |
[pen_13] |
Pen 13 |
radio (Matrix) |
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29 |
[pen_14] |
Pen 14 |
radio (Matrix) |
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30 |
[pen_15] |
Pen 15 |
radio (Matrix) |
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31 |
[pen_16] |
Pen 16 |
radio (Matrix) |
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32 |
[green_count] |
Number of Green Responses |
calc Calculation: if([pen_1] = 2, 1, 0) +
if([pen_2] = 2, 1, 0) +
if([pen_3] = 2, 1, 0) +
if([pen_4] = 2, 1, 0) +
if([pen_5] = 2, 1, 0) +
if([pen_6] = 2, 1, 0) +
if([pen_7] = 2, 1, 0) +
if([pen_8] = 2, 1, 0) +
if([pen_9] = 2, 1, 0) +
if([pen_10] = 2, 1, 0) +
if([pen_11] = 2, 1, 0) +
if([pen_12] = 2, 1, 0) +
if([pen_13] = 2, 1, 0) +
if([pen_14] = 2, 1, 0) +
if([pen_15] = 2, 1, 0) +
if([pen_16] = 2, 1, 0)
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33 |
[identification_q1] |
Section Header: Identification Test
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radio| 1 | Orange | | 2 | strawberry | | 3 | blackberry | | 4 | Pineapple |
Question number: Pen1 |
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34 |
[are_you_familiar_with_this] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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35 |
[identification_q2] |
|
radio| 1 | smoke | | 2 | leather | | 3 | glue | | 4 | grass |
Question number: Pen2 |
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36 |
[identification_q17] |
Indian Odor |
radio| 1 | smoke | | 2 | leather | | 3 | glue | | 4 | grass |
Question number: Pen2 |
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37 |
[are_you_familiar_with_this_2] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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38 |
[are_you_familiar_with_this_5] |
Are you familiar with this indian odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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39 |
[identification_q3] |
|
radio| 1 | honey | | 2 | chocolate | | 3 | vanilla | | 4 | cinnamon |
Question number: Pen 3 |
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40 |
[identification_q18] |
Indian odor |
radio| 1 | honey | | 2 | chocolate | | 3 | vanilla | | 4 | cinnamon |
Question number: Pen 3 |
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41 |
[are_you_familiar_with_this_3] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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42 |
[are_you_familiar_with_this_6] |
Are you familiar with this Indian odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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43 |
[identification_q4] |
|
radio| 1 | chive | | 2 | fir | | 3 | peppermint | | 4 | onion |
Question number: Pen 4 |
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44 |
[are_you_familiar_with_this_4] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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45 |
[identification_q5] |
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radio| 1 | coconut | | 2 | walnut | | 3 | banana | | 4 | cherry |
Question number: Pen 5 |
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46 |
[are_you_familiar_with_this5] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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47 |
[identification_q6] |
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radio| 1 | peach | | 2 | apple | | 3 | lemon | | 4 | grapefruit |
Question number: Pen 6 |
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48 |
[are_you_familiar_with_this6] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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49 |
[identification_q7] |
|
radio| 1 | liquorice | | 2 | wine gums | | 3 | spearmint | | 4 | cookies |
Question number: Pen 7 |
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50 |
[identification_q19] |
Indian Odor |
radio| 1 | liquorice | | 2 | wine gums | | 3 | spearmint | | 4 | cookies |
Question number: Pen 7 |
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51 |
[are_you_familiar_with_this_7] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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52 |
[are_you_familiar_with_this_17] |
Are you familiar with this Indian odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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53 |
[identification_q8] |
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radio| 1 | mustard | | 2 | menthol | | 3 | rubber | | 4 | turpentine |
Question number: Pen 8 |
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54 |
[identification_q20] |
Indian |
radio| 1 | mustard | | 2 | menthol | | 3 | rubber | | 4 | turpentine |
Question number: Pen 8 |
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55 |
[are_you_familiar_with_this_8] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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56 |
[are_you_familiar_with_this_18] |
Are you familiar with this Indian odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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57 |
[identification_q9] |
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radio| 1 | onion | | 2 | garlic | | 3 | rubber | | 4 | turpentine |
Question number: Pen 9 |
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58 |
[are_you_familiar_with_this_9] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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59 |
[identification_q10] |
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radio| 1 | smoke | | 2 | coffee | | 3 | wine | | 4 | turpentine |
Question number: Pen 10 |
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60 |
[are_you_familiar_with_this_10] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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61 |
[identification_q11] |
|
radio| 1 | mustard | | 2 | menthol | | 3 | rubber | | 4 | apple |
Question number: Pen 11 |
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62 |
[are_you_familiar_with_this_11] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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63 |
[identification_q12] |
|
radio| 1 | clove | | 2 | menthol | | 3 | rubber | | 4 | turpentine |
Question number: Pen 12 |
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64 |
[identification_q21] |
Indian odor |
radio| 1 | clove | | 2 | menthol | | 3 | rubber | | 4 | turpentine |
Question number: Pen 12 |
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65 |
[are_you_familiar_with_this_12] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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66 |
[are_you_familiar_with_this_19] |
Are you familiar with this Indian odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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67 |
[identification_q13] |
|
radio| 1 | pear | | 2 | plum | | 3 | peach | | 4 | pineapple |
Question number: Pen 13 |
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68 |
[are_you_familiar_with_this_13] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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69 |
[identification_q14] |
|
radio| 1 | camomile | | 2 | rose | | 3 | raspberry | | 4 | cherry |
Question number: Pen 14 |
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70 |
[are_you_familiar_with_this_14] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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71 |
[identification_q15] |
|
radio Question number: Pen 15 |
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72 |
[identification_q22] |
Indian odor |
radio Question number: Pen 15 |
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73 |
[are_you_familiar_with_this_15] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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74 |
[are_you_familiar_with_this_20] |
Are you familiar with this Indian odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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75 |
[identification_q16] |
|
radio Question number: Pen 16 |
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76 |
[identification_q23] |
Indian Odor |
radio Question number: Pen 16 |
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77 |
[are_you_familiar_with_this_16] |
Are you familiar with this odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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78 |
[are_you_familiar_with_this_21] |
Are you familiar with this Indian odor?
क्या आप इस गंध से परिचित हैं?
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yesno |
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79 |
[olfactrory_score] |
Olfactory score: |
calc Calculation: (sum( if([identification_q1]='1',1,0), if([identification_q2]='2',1,0), if([identification_q5]='3',1,0), if([identification_q8]='4',1,0), if([identification_q10]='2',1,0), if([identification_q11]='4',1,0), if([identification_q13]='4',1,0), if([identification_q14]='2',1,0) )) |
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80 |
[trigeminal_score] |
Trigeminal score |
calc Calculation: (sum( if([identification_q3]='4',1,0), if([identification_q4]='3',1,0), if([identification_q6]='3',1,0), if([identification_q7]='1',1,0), if([identification_q9]='2',1,0), if([identification_q12]='1',1,0), if([identification_q15]='1',1,0), if([identification_q16]='3',1,0) )) |
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81 |
[total_correct_answers] |
Total Correct Answers |
calc Calculation: (sum(
if([identification_q1]='1',1,0),
if([identification_q2]='2',1,0),
if([identification_q17]='2',1,0),
if([identification_q3]='4',1,0),
if([identification_q18]='4',1,0),
if([identification_q4]='3',1,0),
if([identification_q5]='3',1,0),
if([identification_q6]='3',1,0),
if([identification_q7]='1',1,0),
if([identification_q19]='1',1,0),
if([identification_q8]='4',1,0),
if([identification_q20]='4',1,0),
if([identification_q9]='2',1,0),
if([identification_q10]='2',1,0),
if([identification_q11]='4',1,0),
if([identification_q12]='1',1,0),
if([identification_q21]='1',1,0),
if([identification_q13]='4',1,0),
if([identification_q14]='2',1,0),
if([identification_q15]='1',1,0),
if([identification_q22]='1',1,0),
if([identification_q16]='3',1,0),
if([identification_q23]='3',1,0)
))
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82 |
[total_tdi_score] |
Total TDI score |
calc Calculation: [average_score] + [green_count] + [total_correct_answers] |
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83 |
[sniffing_sticks_complete] |
Section Header: Form Status
Complete?
|
dropdown| 0 | Incomplete | | 1 | Unverified | | 2 | Complete |
|