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Stafford L, Munns L, Crossland AE, Kirk E, Preston CEJ. Bonding with bump: Interoceptive sensibility moderates the relationship between pregnancy body satisfaction and antenatal attachment. Midwifery 2024; 131:103940. [PMID: 38335693 DOI: 10.1016/j.midw.2024.103940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/19/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
PROBLEM There is limited understanding and contradictory results regarding the contribution of the pregnant bodily experience to antenatal attachment. BACKGROUND Antenatal attachment is an important aspect of pregnancy, which has been linked with positive maternal and infant outcomes. Given the profound physical process of pregnancy, it is likely that bodily experience is implicated in antenatal attachment, with research supporting the involvement of pregnancy body (dis)satisfaction. However, previous research reveals conflicting results and has only focused on exteroceptive bodily experience (appearance) rather than internal physiological sensations (interoception). AIM To examine the relative contributions of both external and internal bodily experience in antenatal attachment. METHODS This cross-sectional study collected online survey data from 159 pregnant participants with measures capturing interoceptive sensibility (subjective experience of interoception), pregnancy body dissatisfaction and antenatal attachment. FINDINGS We replicated previous findings that pregnancy body dissatisfaction is related to antenatal attachment. However, the relationship between pregnancy body dissatisfaction and antenatal attachment was moderated by worry about interoceptive signals. The interoceptive construct of body trust was most strongly associated with antenatal attachment. DISCUSSION The results suggest that interoception is important for antenatal attachment, particularly feelings of body trust. Moreover, for individuals who were less worried about bodily sensations, high levels of body dissatisfaction were associated with low attachment scores, whilst for those who were more concerned about these sensations, the relationship between body dissatisfaction and antenatal attachment was mitigated. CONCLUSION The results suggest that focusing on internal sensations may be a protective strategy against pregnancy body dissatisfaction to strengthen maternal bonds.
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Affiliation(s)
- Lucy Stafford
- Department of Psychology, University of York, York, United Kingdom
| | - Lydia Munns
- Department of Psychology, University of York, York, United Kingdom
| | - Anna E Crossland
- Department of Psychology, University of York, York, United Kingdom
| | - Elizabeth Kirk
- Department of Psychology, Anglia Ruskin University, Cambridge, United Kingdom
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Salzer EB, Meireles JFF, Kirk E, Preston CEJ, Vasconcelos E Sá D, Neves CM. Body understanding measure for pregnancy scale (BUMPs): Cross-cultural adaptation and psychometric properties among Brazilian pregnant women. Body Image 2024; 49:101689. [PMID: 38522365 DOI: 10.1016/j.bodyim.2024.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024]
Abstract
The Body Understanding Measure for Pregnancy Scale (BUMPs) is a scale developed and validated for British pregnant women to assess body satisfaction during pregnancy. The aim of this study was to perform a cross-cultural adaptation and verify the psychometric properties of BUMPs for Brazilian adult pregnant women. The cross-cultural adaptation was performed using translation, back-translation, expert committee, expert analysis, and pre-testing, which showed easy comprehension by pregnant women. Psychometric analyses were evaluated in a sample of 618 pregnant women (31.08 ± 4.94 years old). Exploratory and confirmatory factor analyses resulted in 19 items and three factors, with satisfactory fit indices. BUMPs presented an invariant measurement across white vs. nonwhite women and across the three gestational trimesters. BUMPs showed good indicators of convergent, internal consistency, and test-retest reproducibility validity. It was concluded that the Brazilian version of BUMPs has adequate psychometric properties for Brazilian pregnant women, being an excellent instrument for analyzing body satisfaction in this population, facilitating additional investigations into these constructs.
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Affiliation(s)
- Eduardo Borba Salzer
- Federal University of Juiz de Fora, Faculty of Physical Education and Sports, Juiz de Fora, Brazil
| | | | | | | | | | - Clara Mockdece Neves
- Federal University of Juiz de Fora, Faculty of Physical Education and Sports, Juiz de Fora, Brazil.
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Kyriacou C, Ledger A, Bobdiwala S, Ayim F, Kirk E, Abughazza O, Guha S, Vathanan V, Gould D, Timmerman D, Van Calster B, Bourne T. Updating M6 pregnancy of unknown location risk-prediction model including evaluation of clinical factors. Ultrasound Obstet Gynecol 2024; 63:408-418. [PMID: 37842861 DOI: 10.1002/uog.27515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/19/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Ectopic pregnancy (EP) is a major high-risk outcome following a pregnancy of unknown location (PUL) classification. Biochemical markers are used to triage PUL as high vs low risk to guide appropriate follow-up. The M6 model is currently the best risk-prediction model. We aimed to update the M6 model and evaluate whether performance can be improved by including clinical factors. METHODS This prospective cohort study recruited consecutive PUL between January 2015 and January 2017 at eight units (Phase 1), with two centers continuing recruitment between January 2017 and March 2021 (Phase 2). Serum samples were collected routinely and sent for β-human chorionic gonadotropin (β-hCG) and progesterone measurement. Clinical factors recorded were maternal age, pain score, bleeding score and history of EP. Based on transvaginal ultrasonography and/or biochemical confirmation during follow-up, PUL were classified subsequently as failed PUL (FPUL), intrauterine pregnancy (IUP) or EP (including persistent PUL (PPUL)). The M6 models with (M6P ) and without (M6NP ) progesterone were refitted and extended with clinical factors. Model validation was performed using internal-external cross-validation (IECV) (Phase 1) and temporal external validation (EV) (Phase 2). Missing values were handled using multiple imputation. RESULTS Overall, 5473 PUL were recruited over both phases. A total of 709 PUL were excluded because maternal age was < 16 years or initial β-hCG was ≤ 25 IU/L, leaving 4764 (87%) PUL for analysis (2894 in Phase 1 and 1870 in Phase 2). For the refitted M6P model, the area under the receiver-operating-characteristics curve (AUC) for EP/PPUL vs IUP/FPUL was 0.89 for IECV and 0.84-0.88 for EV, with respective sensitivities of 94% and 92-93%. For the refitted M6NP model, the AUCs were 0.85 for IECV and 0.82-0.86 for EV, with respective sensitivities of 92% and 93-94%. Calibration performance was good overall, but with heterogeneity between centers. Net Benefit confirmed clinical utility. The change in AUC when M6P was extended to include maternal age, bleeding score and history of EP was between -0.02 and 0.01, depending on center and phase. The corresponding change in AUC when M6NP was extended was between -0.01 and 0.03. At the 5% threshold to define high risk of EP/PPUL, extending M6P altered sensitivity by -0.02 to -0.01, specificity by 0.03 to 0.04 and Net Benefit by -0.005 to 0.006. Extending M6NP altered sensitivity by -0.03 to -0.01, specificity by 0.05 to 0.07 and Net Benefit by -0.005 to 0.006. CONCLUSIONS The updated M6 model offers accurate diagnostic performance, with excellent sensitivity for EP. Adding clinical factors to the model improved performance in some centers, especially when progesterone levels were not suitable or unavailable. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Kyriacou
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - A Ledger
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - F Ayim
- Department of Gynaecology, Hillingdon Hospital NHS Trust, London, UK
| | - E Kirk
- Department of Gynaecology, Royal Free NHS Foundation Trust, London, UK
| | - O Abughazza
- Department of Gynaecology, Royal Surrey County Hospital, Guildford, UK
| | - S Guha
- Department of Gynaecology, Chelsea and Westminster NHS Trust, London, UK
| | - V Vathanan
- Department of Gynaecology, Wexham Park Hospital, London, UK
| | - D Gould
- Department of Gynaecology, St Mary's Hospital, London, UK
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Gynecology, University Hospital Leuven, Leuven, Belgium
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - T Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Gynecology, University Hospital Leuven, Leuven, Belgium
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Crossland AE, Munns L, Kirk E, Preston CEJ. Comparing body image dissatisfaction between pregnant women and non-pregnant women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:709. [PMID: 37794358 PMCID: PMC10548696 DOI: 10.1186/s12884-023-05930-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/16/2023] [Indexed: 10/06/2023] Open
Abstract
Body image dissatisfaction refers to negative thoughts and feelings individuals have towards their own body appearance and this is thought to be affected by the physiological changes that occur during pregnancy. There are two main conflicting theories as to the effect pregnancy has on body image dissatisfaction: 1) Pregnancy related changes are in direct conflict with social ideas of female beauty (e.g. weight gain) and so increase body image dissatisfaction; 2) Due to changes in expectations of bodily appearance during pregnancy, women are liberated from social ideals at this time and thus body image dissatisfaction would decrease. This study aimed to assess these theories by synthesising the current literature. Six databases were searched, and 2,017 study abstracts were screened based on strict inclusion and exclusion criteria. Following screening and quality assessment by two blind reviewers, 17 studies (comprising 17 effect sizes) were subject to full review and meta-analysis following PRISMA guidelines. These studies included cross-sectional, longitudinal and retrospective designs. Results varied with some studies showing women to feel more positive about their body during pregnancy, others showing a more negative body experience and yet others showing no statistical difference. Overall the analysis showed no statistical difference in body image dissatisfaction between pregnant women and non-pregnant women (p = 0.39). Any changes that do occur are heterogeneous and likely to be largely dependent on the individual experience as well as moderator variables and other factors such as differences in methodology of research studies. Studies in this field of research would benefit from more explicit and complete reporting of data and key variables, in order to allow early intervention for women who display body image dissatisfaction in pregnancy.
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Affiliation(s)
| | - Lydia Munns
- Department of Psychology, University of York, Heslington, YO10 5DD, UK
| | - Elizabeth Kirk
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, CB1 1PT, UK
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Crossland A, Kirk E, Preston C. Interoceptive sensibility and body satisfaction in pregnant and non-pregnant women with and without children. Sci Rep 2022; 12:16138. [PMID: 36168024 PMCID: PMC9515153 DOI: 10.1038/s41598-022-20181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Pregnancy is a time of great physical and psychological change. As well as prominent changes in the external appearance of the body, such as the baby bump, there are also substantial changes taking place within the body. Our awareness of, and attention towards, internal bodily signals (interoception) is thought to have a direct impact on how we feel about our bodies. Therefore, understanding how our experience of these interoceptive signals might change during pregnancy may have important implications for maternal wellbeing. This study examined body satisfaction and interoceptive sensibility (subjective experience of interoception) in pregnant and non-pregnant women with and without children. Feelings towards pregnancy-specific changes in body satisfaction and interoceptive sensibility were also examined in women in their first pregnancy (primigravida) and subsequent pregnancies (multigravida). It was found that pregnancy did not directly impact levels of body satisfaction, instead pregnant and non-pregnant women with children reported less satisfaction with their bodies compared to those without children. Primigravida women were more satisfied with the appearance of pregnancy specific bodily changes compared to multigravida women. Interestingly, these differences in body satisfaction in those with children (pregnant and non-pregnant) were mediated by the extent to which women trusted their bodies (measure of interoceptive sensibility). All other pregnancy related changes in interoceptive sensibility and body satisfaction were either non-significant or had small effect sizes. These results may suggest body trust as an important factor to support during the transition to parenthood in order to improve body satisfaction in mothers.
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Preston C, Kirk E. Exploring the development of high-level contributions to body representation using the rubber hand illusion and the monkey hand illusion. J Exp Child Psychol 2022; 223:105477. [PMID: 35753196 DOI: 10.1016/j.jecp.2022.105477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
Abstract
During development our body undergoes significant changes, yet we are able to maintain a coherent experience of our body and sense of self. Bodily experience is thought to comprise integration of multisensory signals (vision, touch, and proprioception) constrained by top-down knowledge of body appearance. Evidence from developmental studies suggests that low-level multisensory integration develops throughout childhood, reaching adult levels by 10 years of age. However, how high-level cognitive knowledge changes during childhood to constrain our multisensory body experience is unknown. This study describes four experiments examining high-level contributions to the bodily experience in children compared with adults using the rubber hand illusion and a monkey hand illusion. We found that children (5-17 years of age) exhibited more flexible body representations, showing stronger illusions for small and fantastical (monkey) fake hands compared with adults. Conversely, using a task indirectly capturing changes in hand size, we found that children and adults demonstrated statistically equivalent increases and decreases in hand size following illusions over large and small hands, respectively. Interestingly, at baseline children showed a bias in reporting larger hand size judgments that decreased with age. Finally, we did not find a relationship between individual differences in fantasy proneness and illusion strength for a fantastical (monkey) hand for children or adults, suggesting that developmental changes of top-down constraints are not purely driven by more diffuse boundaries between imagination and reality. These data suggest that high-level constraints acting on our multisensory body experience change during development, allowing children a more flexible bodily experience compared with adults.
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Affiliation(s)
- Catherine Preston
- Department of Psychology, University of York, Heslington, York YO10 5DD, UK.
| | - Elizabeth Kirk
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge CB1 1PT, UK
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Floberg J, Kirk E, Harris C. Stress and Eating Behaviors of Dietitians Amidst the COVID-19 Pandemic. Curr Dev Nutr 2022. [PMCID: PMC9193380 DOI: 10.1093/cdn/nzac048.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives To determine the relationships between stress experienced by registered dietitians, eating competence, and risk for orthorexia nervosa amid the backdrop of COVID-19. Methods A cross-sectional study was used to compare Perceived Stress Scale, ORTO-15 Questionnaire, and Satter Eating Competence Inventory 2.0 scores computed from participant responses to understand how prevalence of stress, risk for orthorexia nervosa, and eating competence in registered dietitians relate to one another. Independent sample t-tests, Pearson's correlation coefficient, and two-way ANOVA were used to compare scores. A random sample of 5,000 registered dietitians in the United States were invited to complete an online survey; 155 responses were received. Results Scores for the final sample (N = 83) suggested 63.9% had high stress, 61.4% were at risk for orthorexia nervosa, and 80.7% were eating competent. Statistical analysis revealed a negative association between stress and eating competence, but no relationship between stress and orthorexia nervosa risk. Risk for orthorexia nervosa and eating competence were positively associated. Conclusions Further exploration of the relationship between stress and eating competence in registered dietitians may offer insight into addressing stress in the dietetics profession. The positive association between orthorexia nervosa risk and eating competence may imply the presence of healthy orthorexia, or a non-pathological focus on eating healthfully, in registered dietitians. Funding Sources This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Jurkovic D, Tellum T, Kirk E. Cesarean scar pregnancy IS an ectopic pregnancy. Ultrasound Obstet Gynecol 2022; 59:831-832. [PMID: 35642911 DOI: 10.1002/uog.24921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 05/27/2023]
Affiliation(s)
- D Jurkovic
- Institute for Women's Health, University College Hospital, London, UK
| | - T Tellum
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - E Kirk
- Early Pregnancy and Emergency Gynaecology Unit, Royal Free London NHS Foundation Trust, London, UK
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Kirk E, Donnelly S, Furman R, Warmington M, Glanville J, Eggleston A. The relationship between infant pointing and language development: A meta-analytic review. Developmental Review 2022. [DOI: 10.1016/j.dr.2022.101023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bourne T, Kyriacou C, Coomarasamy A, Al‐Memar M, Leonardi M, Kirk E, Landolfo C, Blanchette‐Porter M, Small R, Condous G, Timmerman D. ISUOG Consensus Statement on rationalization of early-pregnancy care and provision of ultrasonography in context of SARS-CoV-2. Ultrasound Obstet Gynecol 2020; 55:871-878. [PMID: 32267981 PMCID: PMC7262213 DOI: 10.1002/uog.22046] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- T. Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial CollegeLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
- KU LeuvenDepartment of Development and RegenerationLeuvenBelgium
| | - C. Kyriacou
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial CollegeLondonUK
| | - A. Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of BirminghamBirminghamUK
| | - M. Al‐Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial CollegeLondonUK
| | - M. Leonardi
- Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, Sydney Medical School Nepean, University of Sydney Nepean HospitalPenrith, SydneyAustralia
| | - E. Kirk
- Early Pregnancy and Acute Gynaecology Unit, Royal Free NHS Foundation TrustLondonUK
| | - C. Landolfo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità PubblicaRomeItaly
| | - M. Blanchette‐Porter
- Larner College of Medicine at University of Vermont ObstetricsGynecology, and Reproductive Sciences Division, Reproductive Medicine and Infertility BurlingtonVermontUSA
| | - R. Small
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation TrustBordesley Green East, BirminghamUK
| | - G. Condous
- Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, Sydney Medical School Nepean, University of Sydney Nepean HospitalPenrith, SydneyAustralia
| | - D. Timmerman
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
- KU LeuvenDepartment of Development and RegenerationLeuvenBelgium
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Ueland K, Harris C, Kloubec J, Kirk E. How Diet Impacts Performance in Rock Climbers: A Pilot Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa066_024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
This observational, cross-sectional, pilot study was conducted to establish a nutritional profile among experienced climbers, both non-elite and elite, and to evaluate factors that influence time to exhaustion while climbing to volitional failure.
Methods
Elite (n = 10) and non-elite (n = 5) climbers, aged 18–45 years participated in the following: (1) nutritional analysis - 3-day food record and 24-hour dietary recall were analyzed using Food Processor and compared to government daily recommended intake; (2) climbing trial - after completing a climbing-related questionnaire and measuring anthropometric characteristics and hand grip strength, participants climbed a moderately difficult pre-set indoor route continuously until reaching volitional exhaustion.
Results
The major findings were significant differences for total climbing time between non-elite and elite climbers (t(13) = −2.6, p = 0.02). Additionally, protein intake from 24 hour recall (n = 15, rS = −0.53, p = 0.04) and total % water intake (n = 15, rS = −0.60, p = 0.02) were negatively correlated with climbing time.
Conclusions
These results indicate that a longer climbing time to exhaustion is related to self-reported climbing ability. In contrast, the negative association between protein intake and climbing time, suggest that carbohydrate intake may play a more important role in climbing performance than protein intake. In addition the negative association between total % water and climbing suggest that the more hydrated a person is going into a climb, the longer they can sustain a climb.
Funding Sources
This research was supported by Grant Award BUCSR-Y3–010 from the Bastyr University Center for Student Research.
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Illingworth B, Stocking K, Showell M, Kirk E, Duffy J. Evaluation of treatments for Bartholin's cyst or abscess: a systematic review. BJOG 2020; 127:671-678. [PMID: 31876985 DOI: 10.1111/1471-0528.16079] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND No consensus on the management of symptomatic cysts or abscesses of the Bartholin's gland exists. OBJECTIVES To assess the effectiveness and safety of surgical interventions for a symptomatic Bartholin's cyst or abscess. SEARCH STRATEGY We searched bibliographical databases from inception to April 2019. SELECTION CRITERIA Randomised trials evaluating a surgical intervention for the treatment of a symptomatic Bartholin's cyst or abscess. DATA COLLECTION AND ANALYSIS Eight trials, reporting data from 699 women, were included. Study characteristics and methodological quality were recorded for each trial. Summary estimates were calculated using random-effects methods. MAIN RESULTS When considering the recurrence of a symptomatic Bartholin's cyst or abscess, the evidence was consistent with notable effects in either direction (risk ratio [RR] 0.76; 95% confidence interval [CI] 0.41-1.40) when comparing marsupialisation with incision, drainage and insertion of a Word catheter. Limited inference could be made when comparing marsupialisation with incision, drainage and silver nitrate insertion (RR 1.00; 95% CI 0.57-1.75), and incision, drainage and cavity closure (RR 0.25; 95% CI 0.01-4.89). There was limited reporting of secondary outcomes, including haematoma, infectious morbidity and persistent dyspareunia. CONCLUSIONS Current randomised trial evidence does not support the use of any single surgical intervention for the treatment of a symptomatic cyst or abscess of the Bartholin's gland. PROSPECTIVE REGISTRATION PROSPERO: International Prospective Register of Systematic Reviews; CRD42018088553. TWEETABLE ABSTRACT Further research is needed to identify an effective treatment for #Bartholin's cyst or abscess. @jamesmnduffy.
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Affiliation(s)
- Bjg Illingworth
- North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - K Stocking
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - M Showell
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - E Kirk
- Department of Obstetrics and Gynaecology, Royal Free London NHS Trust, London, UK
| | - Jmn Duffy
- Institute for Women's Health, University College London, London, UK.,Barking, Havering and Redbridge University Hospitals NHS Trust, Essex, UK
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Bobdiwala S, Christodoulou E, Farren J, Mitchell-Jones N, Kyriacou C, Al-Memar M, Ayim F, Chohan B, Kirk E, Abughazza O, Guruwadahyarhalli B, Guha S, Vathanan V, Bottomley C, Gould D, Stalder C, Timmerman D, van Calster B, Bourne T. Triaging women with pregnancy of unknown location using two-step protocol including M6 model: clinical implementation study. Ultrasound Obstet Gynecol 2020; 55:105-114. [PMID: 31385381 DOI: 10.1002/uog.20420] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The M6 risk-prediction model was published as part of a two-step protocol using an initial progesterone level of ≤ 2 nmol/L to identify probable failing pregnancies (Step 1) followed by the M6 model (Step 2). The M6 model has been shown to have good triage performance for stratifying women with a pregnancy of unknown location (PUL) as being at low or high risk of harboring an ectopic pregnancy (EP). This study validated the triage performance of the two-step protocol in clinical practice by evaluating the number of protocol-related adverse events and how effectively patients were triaged. METHODS This was a prospective multicenter interventional study of 3272 women with a PUL, carried out between January 2015 and January 2017 in four district general hospitals and four university teaching hospitals in the UK. The final pregnancy outcome was defined as: a failed PUL (FPUL), an intrauterine pregnancy (IUP) or an EP (including persistent PUL (PPUL)). FPUL and IUP were grouped as low-risk and EP/PPUL as high-risk PUL. Serum progesterone and human chorionic gonadotropin (hCG) levels were measured at presentation in all patients. If the initial progesterone level was ≤ 2 nmol/L, patients were discharged and were asked to have a follow-up urine pregnancy test in 2 weeks to confirm a negative result. If the progesterone level was > 2 nmol/L or a measurement had not been taken, hCG level was measured again at 48 h and results were entered into the M6 model. Patients were managed according to the outcome predicted by the protocol. Those classified as 'low risk, probable FPUL' were advised to perform a urine pregnancy test in 2 weeks and those classified as 'low risk, probable IUP' were invited for a scan a week later. When a woman with a PUL was classified as high risk (i.e. risk of EP ≥ 5%) she was reviewed clinically within 48 h. One center used a progesterone cut-off of ≤ 10 nmol/L and its data were analyzed separately. If the recommended management protocol was not adhered to, this was recorded as a protocol deviation and classified as: unscheduled visit for clinician reason, unscheduled visit for patient reason or incorrect timing of blood test or ultrasound scan. The classifications outlined in the UK Good Clinical Practice (GCP) guidelines were used to evaluate the incidence of adverse events. Data were analyzed using descriptive statistics. RESULTS Of the 3272 women with a PUL, 2625 were included in the final analysis (317 met the exclusion criteria or were lost to follow-up, while 330 were evaluated using a progesterone cut-off of ≤ 10 nmol/L). Initial progesterone results were available for 2392 (91.1%) patients. In Step 1, 407 (15.5%) patients were classified as low risk (progesterone ≤ 2 nmol/L), of whom seven (1.7%) were ultimately diagnosed with an EP. In 279 of the remaining 2218 women with a PUL, the M6 model was not applied owing to protocol deviation or because the outcome was already known (usually on the basis of an ultrasound scan) before a second hCG reading was taken; of these patients, 30 were diagnosed with an EP. In Step 2, 1038 women with a PUL were classified as low risk, of whom eight (0.8%) had a final outcome of EP. Of 901 women classified as high risk at Step 2, 275 (30.5%) had an EP. Therefore, 275/320 (85.9%) EPs were correctly classified as high risk. Overall, 1445/2625 PUL (55.0%) were classified as low risk, of which 15 (1.0%) were EP. None of these cases resulted in a ruptured EP or significant clinical harm. Sixty-two women participating in the study had an adverse event, but no woman had a serious adverse event as defined in the UK GCP guidelines. CONCLUSIONS This study has shown that the two-step protocol incorporating the M6 model effectively triaged the majority of women with a PUL as being at low risk of an EP, minimizing the follow-up required for these patients after just two visits. There were few misclassified EPs and none of these women came to significant clinical harm or suffered a serious adverse clinical event. The two-step protocol incorporating the M6 model is an effective and clinically safe way of rationalizing the management of women with a PUL. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - E Christodoulou
- KU Leuven, Department of Development & Regeneration, Leuven, Belgium
| | | | | | - C Kyriacou
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - M Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - F Ayim
- Hillingdon Hospital, London, UK
| | - B Chohan
- Wexham Park Hospital, Slough, UK
| | - E Kirk
- Royal Free NHS Foundation Trust, London, UK
| | | | | | - S Guha
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - C Bottomley
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - D Gould
- St Marys' Hospital, London, UK
| | - C Stalder
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - D Timmerman
- KU Leuven, Department of Development & Regeneration, Leuven, Belgium
- University Hospital Leuven, Leuven, Belgium
| | - B van Calster
- KU Leuven, Department of Development & Regeneration, Leuven, Belgium
- Leiden University Medical Centre, Leiden, The Netherlands
| | - T Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- KU Leuven, Department of Development & Regeneration, Leuven, Belgium
- University Hospital Leuven, Leuven, Belgium
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Kirk E, Preston C. Development and validation of the Body Understanding Measure for Pregnancy Scale (BUMPS) and its role in antenatal attachment. Psychol Assess 2019; 31:1092-1106. [PMID: 31120297 DOI: 10.1037/pas0000736] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pregnancy is a unique period in a woman's life during which her body undergoes rapid and dramatic change. Many of these changes are in direct conflict to social ideals of female body appearance, such as increases in body size and weight. Existing research that has examined body satisfaction in pregnancy is limited by the use of measures that are not designed for pregnancy, yielding biased results. Two studies have attempted to develop measures for pregnancy but have used suboptimal sample sizes and/or have not fully validated the measure with independent samples. We seek to address these limitations in the current study and report the development and validation of the newly developed Body Understanding Measure for Pregnancy scale (BUMPs) in 613 pregnant women across two independent samples. Exploratory factor analysis revealed three factors; satisfaction with appearing pregnant, weight gain concerns, and physical burdens of pregnancy, which were confirmed with confirmatory factor analysis. Multiple Indicators Multiple Causes (MIMIC) modeling indicated the scale is appropriate for women in all three trimesters of pregnancy. Evidence of internal reliability, test-retest reliability and convergent validity provide excellent psychometric support. We further demonstrated construct validity by supporting 3 hypotheses, finding that more positive body satisfaction in pregnancy was related to: (a) better relationship quality; (b) lower depression and anxiety; (c) higher levels of interoception, specifically body listening, and body trusting. Additionally, we present evidence that BUMPs score was the strongest predictor of antenatal attachment when compared against depression, anxiety, gestational age, and relationship satisfaction. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Elizabeth Kirk
- School of Psychology and Sports Science, Anglia Ruskin University
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Crucianelli L, Wheatley L, Filippetti ML, Jenkinson PM, Kirk E, Fotopoulou AK. The mindedness of maternal touch: An investigation of maternal mind-mindedness and mother-infant touch interactions. Dev Cogn Neurosci 2019; 35:47-56. [PMID: 29402735 PMCID: PMC6347578 DOI: 10.1016/j.dcn.2018.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 01/18/2018] [Accepted: 01/28/2018] [Indexed: 01/12/2023] Open
Abstract
Increasing evidence shows that maternal touch may promote emotion regulation in infants, however less is known about how parental higher-order social cognition abilities are translated into tactile, affect-regulatory behaviours towards their infants. During 10 min book-reading, mother-infant sessions when infants were 12 months old (N = 45), we investigated maternal mind-mindedness (MM), the social cognitive ability to understand an infant's mental state, by coding the contingency of maternal verbal statements towards the infants' needs and desires. We also rated spontaneous tactile interactions in terms of their emotional contingency. We found that frequent non-attuned mind-related comments were associated with touch behaviours that were not contingent with the infant's emotions; ultimately discouraging affective tactile responses from the infant. However, comments that were more appropriate to infant's mental states did not necessarily predict more emotionally-contingent tactile behaviours. These findings suggest that when parental high-order social cognitive abilities are compromised, they are also likely to translate into inappropriate, tactile attempts to regulate infant's emotions.
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Affiliation(s)
- Laura Crucianelli
- Division of Psychology and Language Sciences, University College London, London, UK.
| | - Lisa Wheatley
- Faculty of Education, University of Cambridge, Cambridge, UK
| | | | - Paul M Jenkinson
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Kent M, Scott S, Lambert S, Kirk E, Terhune-Cotter B, Thompson B, Neal S, Dozier B, Bardi M, Lambert K. Contingency Training Alters Neurobiological Components of Emotional Resilience in Male and Female Rats. Neuroscience 2018; 386:121-136. [PMID: 29928950 PMCID: PMC8112904 DOI: 10.1016/j.neuroscience.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
Prior research with a rat model of behavioral therapy [i.e., effort-based reward (EBR) contingency training] suggests that strengthened associations between physical effort and desired outcomes enhance neurobiological indices of resilience. In the current study, male and female Long-Evans rats were exposed to either six weeks of EBR training or noncontingent training prior to 10 days of exposure to chronic unpredictable stress (CUS). Subsequently, all animals were exposed to a problem-solving task and then trained in a spatial learning/foraging task, the Dry Land Maze (DLM). Following habituation training and test trials, rats were assessed in a probe trial that generated a prediction error (cognitive uncertainty). Results indicated that, during CUS exposure, contingency-training enhanced dehydroepiandrosterone/corticosterone ratios (consistent with healthier stress responses), especially in male rats. Additionally, contingency training increased exploratory behaviors in the probe trial as well as differentially influenced on-task problem-solving performance in males and females. Following the probe trial, brains were exposed to histological analyses to determine the effects of sex and contingency training on various neurobiological markers. Contingency training decreased BDNF-immunoreactivity (ir) in the hippocampus CA1 and lateral habenula, implicating differential neuroplasticity responses in the training groups. Further, coordinated fos-ir activation in areas associated with emotional resilience (i.e., motivation-regulation) was observed in contingent-trained animals. In sum, the current findings confirm that behavioral training is associated with neurobiological markers of emotional resilience; however, further assessments are necessary to more accurately determine the therapeutic potential for the EBR contingency training model.
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Affiliation(s)
- M Kent
- Department of Psychology, Neuroscience Concentration, University of Richmond, Richmond, VA 23173, United States
| | - S Scott
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - S Lambert
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - E Kirk
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - B Terhune-Cotter
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - B Thompson
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - S Neal
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - B Dozier
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - M Bardi
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - K Lambert
- Department of Psychology, Neuroscience Concentration, University of Richmond, Richmond, VA 23173, United States.
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Troester MA, Sun X, Allott EH, Kit CK, Thorne L, Mathews M, Cohen SM, Geradts J, Kirk E, Li Y, Hu Z, Robinson W, Hoadley KA, Reeder-Hayes K, Earp S, Olshan AF, Carey LA, Perou CM. Abstract PD8-01: Race and age differences in PAM50 biomarker status in the Carolina breast cancer study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd8-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: African American breast cancer patients have lower relative frequency of hormone receptor (HR)-positive/HER2-negative disease and higher subtype-specific mortality. However, few population-based studies have RNA-based subtyping data, and racial differences in the biology of HR-positive/HER2-negative tumors are not well understood.
Methods: Using data and biospecimens from the Carolina Breast Cancer Study (CBCS) Phase 3 (2008-2013), we classified approximately 1,000 invasive breast cancers according to PAM50 subtype and two risk of recurrence scores (ROR-P and ROR-PT). Relative frequency of Luminal A, Luminal B, Her2-enriched, and Basal-like subtypes and ROR scores (low/medium/high) were compared by race (blacks vs. whites) and age (≤50 years vs. >50 years), overall and among HR-positive/HER2-negative cases.
Results: Black women of all ages had significantly higher relative frequency of Basal-like breast cancer (36 and 31% in blacks vs. 18 and 15% in whites; younger and older, respectively) and lower frequency of Luminal A breast cancer (26 and 34% in blacks vs. 43 and 52% in whites; younger and older, respectively). Frequency of Luminal B and HER2-enriched breast cancer did not vary by race or age. Among clinically HR-positive, HER2-negative cases, Luminal A subtype comprised only half of the cases among black women, and was significantly less common than among white women (51% vs 60% in whites, p<0.05). Black women with HR-positive/HER2-negative disease also had significantly higher ROR scores (ROR-P medium or high 82% vs. 66% in whites, p=0.01; ROR-PT medium or high 85% vs. 69% in whites, p<0.01).
Conclusions: Multi-gene assays highlight disparities in frequency of aggressive, poorer prognosis tumor subtypes and implicate differences in tumor biology as an important contributor to mortality disparities among HR-positive/HER2-negative patients.
Citation Format: Troester MA, Sun X, Allott EH, Kit C-K, Thorne L, Mathews M, Cohen SM, Geradts J, Kirk E, Li Y, Hu Z, Robinson W, Hoadley KA, Reeder-Hayes K, Earp S, Olshan AF, Carey LA, Perou CM. Race and age differences in PAM50 biomarker status in the Carolina breast cancer study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD8-01.
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Affiliation(s)
- MA Troester
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - X Sun
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - EH Allott
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - C-K Kit
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - L Thorne
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - M Mathews
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - SM Cohen
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - J Geradts
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - E Kirk
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - Y Li
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - Z Hu
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - W Robinson
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - KA Hoadley
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - K Reeder-Hayes
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - S Earp
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - AF Olshan
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - LA Carey
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - CM Perou
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
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Abstract
Gestures help people think and can help problem solvers generate new ideas. We conducted two experiments exploring the self-oriented function of gesture in a novel domain: creative thinking. In Experiment 1, we explored the relationship between children's spontaneous gesture production and their ability to generate novel uses for everyday items (alternative-uses task). There was a significant correlation between children's creative fluency and their gesture production, and the majority of children's gestures depicted an action on the target object. Restricting children from gesturing did not significantly reduce their fluency, however. In Experiment 2, we encouraged children to gesture, and this significantly boosted their generation of creative ideas. These findings demonstrate that gestures serve an important self-oriented function and can assist creative thinking.
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Affiliation(s)
| | - Carine Lewis
- 2 Department of Psychology, University of Hertfordshire
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Finizio S, Wintz S, Kirk E, Raabe J. In situ membrane bending setup for strain-dependent scanning transmission x-ray microscopy investigations. Rev Sci Instrum 2016; 87:123703. [PMID: 28040922 DOI: 10.1063/1.4971849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present a setup that allows for the in situ generation of tensile strains by bending x-ray transparent Si3N4 membranes with the application of a pressure difference between the two sides of the membrane, enabling the possibility to employ high resolution space- and time-resolved scanning transmission x-ray microscopy for the investigation of the magneto-elastic coupling.
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Affiliation(s)
- S Finizio
- Paul Scherrer Institut, Villigen, CH-5232, Switzerland
| | - S Wintz
- Paul Scherrer Institut, Villigen, CH-5232, Switzerland
| | - E Kirk
- Paul Scherrer Institut, Villigen, CH-5232, Switzerland
| | - J Raabe
- Paul Scherrer Institut, Villigen, CH-5232, Switzerland
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Van Calster B, Bobdiwala S, Guha S, Van Hoorde K, Al-Memar M, Harvey R, Farren J, Kirk E, Condous G, Sur S, Stalder C, Timmerman D, Bourne T. Managing pregnancy of unknown location based on initial serum progesterone and serial serum hCG levels: development and validation of a two-step triage protocol. Ultrasound Obstet Gynecol 2016; 48:642-649. [PMID: 26776599 DOI: 10.1002/uog.15864] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES A uniform rationalized management protocol for pregnancies of unknown location (PUL) is lacking. We developed a two-step triage protocol to select PUL at high risk of ectopic pregnancy (EP), based on serum progesterone level at presentation (step 1) and the serum human chorionic gonadotropin (hCG) ratio, defined as the ratio of hCG at 48 h to hCG at presentation (step 2). METHODS This was a cohort study of 2753 PUL (301 EP), involving a secondary analysis of prospectively and consecutively collected PUL data from two London-based university teaching hospitals. Using a chronological split we used 1449 PUL for development and 1304 for validation. We aimed to assign PUL as low risk with high confidence (high negative predictive value (NPV)) while classifying most EP as high risk (high sensitivity). The first triage step assigned PUL as low risk using a threshold of serum progesterone at presentation. The remaining PUL were triaged using a novel logistic regression risk model based on hCG ratio and initial serum progesterone (second step), defining low risk as an estimated EP risk of < 5%. RESULTS On validation, initial serum progesterone ≤ 2 nmol/L (step 1) classified 16.1% PUL as low risk. Second-step classification with the risk model selected an additional 46.0% of all PUL as low risk. Overall, the two-step protocol classified 62.1% of PUL as low risk, with an NPV of 98.6% and a sensitivity of 92.0%. When the risk model was used in isolation (i.e. without the first step), 60.5% of PUL were classified as low risk with 99.1% NPV and 94.9% sensitivity. CONCLUSION PUL can be classified efficiently into being either high or low risk for complications using a two-step protocol involving initial progesterone and hCG levels and the hCG ratio. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B Van Calster
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - S Guha
- West Middlesex Hospital, Isleworth, Middlesex, UK
| | | | - M Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - R Harvey
- Charing Cross Oncology Laboratory and Trophoblastic Disease Center, Charing Cross Hospital, London, UK
| | - J Farren
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - E Kirk
- North Middlesex Hospital, London, UK
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, NSW, Australia
| | - S Sur
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - C Stalder
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Bourne
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Kirk E, Pine K, Wheatley L, Howlett N, Schulz J, Fletcher BC. A longitudinal investigation of the relationship between maternal mind-mindedness and theory of mind. Br J Dev Psychol 2015. [DOI: 10.1111/bjdp.12104] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kirk E, Strong J, Burgess-Limerick R. Developing computer competencies for eWorkers within call centres. Work 2014; 46:283-95. [PMID: 23324699 DOI: 10.3233/wor-121533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
High rates of work related musculoskeletal discomfort (WRMSD) associated with long-hours of computer work are considered a significant occupational health problem. However, to date few training programs aim to develop the multidisciplinary skills required for self-management of WRMSD risk factors. This paper seeks to provide a background to, and illustrate the significance of, this issue. Management strategies, training elements and methods recommended within the literature to build the required work skills for increased self-management of WRMSD are discussed. The inclusion of two case studies investigating the impact of training methods on levels of WRMSD illustrates how the application of new training strategies may improve WRMSD outcomes. The first case-study trialling a pre-existing office ergonomic checklist revealed training improved knowledge and awareness, but failed to change work behaviours or effect levels of WRMSD. The second case study investigated the impact of training providing additional knowledge and demonstrating 'how-to' apply recommendations at the workstation. Outcomes of this skill-based program included the collaborative development of training elements, increased trainee engagement, and a significant reduction in reported levels of WRMSD. These findings suggest training designed to develop multidisciplinary work skills or competencies may be a strategy for the management of occupational musculoskeletal discomfort amongst computer operators.
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Affiliation(s)
- Elizabeth Kirk
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia Campus, Brisbane, Australia
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Wang L, Kirk E, Wäckerlin C, Schneider CW, Hojeij M, Gobrecht J, Ekinci Y. Nearly amorphous Mo-N gratings for ultimate resolution in extreme ultraviolet interference lithography. Nanotechnology 2014; 25:235305. [PMID: 24850475 DOI: 10.1088/0957-4484/25/23/235305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present fabrication and characterization of high-resolution and nearly amorphous Mo1 - xNx transmission gratings and their use as masks for extreme ultraviolet (EUV) interference lithography. During sputter deposition of Mo, nitrogen is incorporated into the film by addition of N2 to the Ar sputter gas, leading to suppression of Mo grain growth and resulting in smooth and homogeneous thin films with a negligible grain size. The obtained Mo0.8N0.2 thin films, as determined by x-ray photoelectron spectroscopy, are characterized to be nearly amorphous using x-ray diffraction. We demonstrate a greatly reduced Mo0.8N0.2 grating line edge roughness compared with pure Mo grating structures after e-beam lithography and plasma dry etching. The amorphous Mo0.8N0.2 thin films retain, to a large extent, the benefits of Mo as a phase grating material for EUV wavelengths, providing great advantages for fabrication of highly efficient diffraction gratings with extremely low roughness. Using these grating masks, well-resolved dense lines down to 8 nm half-pitch are fabricated with EUV interference lithography.
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Affiliation(s)
- L Wang
- Laboratory for Micro- and Nanotechnology, Paul Scherrer Institute, CH-5232 Villigen PSI, Switzerland
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Guha S, Ayim F, Ludlow J, Sayasneh A, Condous G, Kirk E, Stalder C, Timmerman D, Bourne T, Van Calster B. Triaging pregnancies of unknown location: the performance of protocols based on single serum progesterone or repeated serum hCG levels. Hum Reprod 2014; 29:938-45. [DOI: 10.1093/humrep/deu045] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Kirk E, Marjaneh MM, Thomson P, Doan T, Martin I, Moran C, Harvey R. Use of a murine Advanced Intercross Line combined with whole genome sequencing and transcriptome analysis confirms previously discovered QTL and identifies candidate genetic loci for cardiac atrial septal morphology. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update 2013; 20:250-61. [DOI: 10.1093/humupd/dmt047] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Mahana C, Chen J, Kirk E, Ruiz C. Sugar Consumption in Women: Relationship to Life Satisfaction and Mood. J Acad Nutr Diet 2013. [DOI: 10.1016/j.jand.2013.06.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Calster B, Abdallah Y, Guha S, Kirk E, Van Hoorde K, Condous G, Preisler J, Hoo W, Stalder C, Bottomley C, Timmerman D, Bourne T. Rationalizing the management of pregnancies of unknown location: temporal and external validation of a risk prediction model on 1962 pregnancies. Hum Reprod 2013; 28:609-16. [DOI: 10.1093/humrep/des440] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Kirk E, Howlett N, Pine KJ, Fletcher BC. To Sign or Not to Sign? The Impact of Encouraging Infants to Gesture on Infant Language and Maternal Mind-Mindedness. Child Dev 2012; 84:574-90. [DOI: 10.1111/j.1467-8624.2012.01874.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Karen J. Pine
- University of Hertfordshire and Istanbul Bilgi University
| | - Ben C Fletcher
- University of Hertfordshire and Istanbul Bilgi University
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Etemadinejad H, Kirk E, Kloubec J, Koutoubi S. Knowledge, Awareness of Diabetes Mellitus, and Weight Change Among Iranian Adults Living in the United States. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1010.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Elizabeth Kirk
- Nutrition and Exercise ScienceBastyr UniversityKenmoreWA
| | - June Kloubec
- Nutrition and Exercise ScienceBastyr UniversityKenmoreWA
| | - Samer Koutoubi
- Nutrition and Exercise ScienceBastyr UniversityKenmoreWA
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Abdallah Y, Daemen A, Kirk E, Pexsters A, Naji O, Stalder C, Gould D, Ahmed S, Guha S, Syed S, Bottomley C, Timmerman D, Bourne T. Limitations of current definitions of miscarriage using mean gestational sac diameter and crown-rump length measurements: a multicenter observational study. Ultrasound Obstet Gynecol 2011; 38:497-502. [PMID: 21997898 DOI: 10.1002/uog.10109] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES There is significant variation in cut-off values for mean gestational sac diameter (MSD) and embryo crown-rump length (CRL) used to define miscarriage, values suggested in the literature ranging from 13 to 25 mm for MSD and from 3 to 8 mm for CRL. We aimed to define the false-positive rate (FPR) for the diagnosis of miscarriage associated with different CRL and MSD measurements with or without a yolk sac in a large study population of patients attending early pregnancy clinics. We also aimed to define cut-off values for CRL and MSD that, on the basis of a single measurement, can definitively diagnose a miscarriage and so exclude possible inadvertent termination of pregnancy. METHODS This was an observational cross-sectional study. Data were collected prospectively according to a predefined protocol. Intrauterine pregnancy of uncertain viability (IPUV) was defined as an empty gestational sac or sac with a yolk sac but no embryo seen with MSD < 20 or < 30 mm or an embryo with an absent heartbeat and CRL < 6 mm or < 8 mm. We recruited to the study 1060 consecutive women with IPUV. The endpoint was presence or absence of a viable pregnancy at the time of first-trimester screening ultrasonography between 11 and 14 weeks. The sensitivity, specificity, positive and negative predictive values were calculated for potential cut-off values to define miscarriage from MSD 8 to 30 mm with or without a yolk sac and from CRL 3 to 8 mm. RESULTS Of the 1060 women with a diagnosis of IPUV, 473 remained viable and 587 were non-viable by the time of the 11-14-week scan. In the absence of both embryo and yolk sac, the FPR for miscarriage was 4.4% when an MSD cut-off of 16 mm was used and 0.5% for a cut-off of 20 mm. There were no false-positive test results for miscarriage when a cut-off of MSD ≥ 21 mm was used. If a yolk sac was present but an embryo was not, the FPR for miscarriage was 2.6% for an MSD cut-off of 16 mm and 0.4% for a cut-off of 20 mm, with no false-positive results when a cut-off of MSD ≥ 21 mm was used. When an embryo was visible with an absent heartbeat, using a CRL cut-off of 4 mm the FPR for miscarriage was 8.3%, and for a CRL cut-off of 5 mm it was also 8.3%. There were no false-positive results using a CRL cut-off of ≥ 5.3 mm. CONCLUSIONS These data show that some current definitions used to diagnose miscarriage are potentially unsafe. Current national guidelines should be reviewed to avoid inadvertent termination of wanted pregnancies. An MSD cut-off of > 25 mm and a CRL cut-off of > 7 mm could be introduced to minimize the risk of a false-positive diagnosis of miscarriage.
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Affiliation(s)
- Y Abdallah
- Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK.
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Abdallah Y, Daemen A, Guha S, Syed S, Naji O, Pexsters A, Kirk E, Stalder C, Gould D, Ahmed S, Bottomley C, Timmerman D, Bourne T. Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study. Ultrasound Obstet Gynecol 2011; 38:503-509. [PMID: 21858883 DOI: 10.1002/uog.10075] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES We studied changes in mean gestational sac diameter (MSD) and embryonic crown-rump length (CRL) in intrauterine pregnancies of uncertain viability (IPUVs). We aimed to establish cut-off values for MSD and CRL growth that could be definitively associated with either viability or miscarriage, and to establish the relationship between growth in MSD and appearance of embryonic structures in the gestational sac. METHODS One thousand and sixty consecutive IPUVs were recruited prospectively from four London University hospitals: 462 with no yolk sac or embryo, 419 with a yolk sac but no embryo, and 179 with an embryo but no heartbeat visible. IPUV was defined as an empty gestational sac with or without a yolk sac but no embryo seen with MSD < 20 or < 30 mm (depending on center) or an embryo with no heartbeat and CRL < 6 mm or < 8 mm (depending on center). Scans were repeated 7-14 days later. The endpoint was viability at first-trimester screening ultrasonography between 11 and 14 weeks. Change in MSD and CRL between the first and second scans of each pregnancy was compared with respect to viability and appearance of embryonic structures using the two-sample t-test. RESULTS The study included 359 pregnancies in which a gestational sac with or without embryo was identified at the follow-up scan 7-14 days later. Of these, 192 were viable and 167 non-viable at the 11-14-week scan. MSD growth was significantly higher in viable than non-viable pregnancies (mean 1.003 vs. 0.503 mm/day; P < 0.001, 95% CI of difference 0.403-0.596). A difference in CRL growth was found between the two groups (mean 0.673 vs. 0.148 mm/day; P < 0.001, 95% CI of difference 0.345-0.703). MSD growth of 0.6 mm/day was associated with a specificity for diagnosing miscarriage of 90.1%, a sensitivity of 61.7% and 19 false-positive test results. A cut-off of CRL growth rate of 0.2 mm/day gave a sensitivity of 76.3% and there were no false-positive test results for miscarriage. On repeat scan the failure of either a yolk sac or embryo to be visualized was always associated with miscarriage. CONCLUSION There is an overlap in MSD growth rates between viable and non-viable IPUV. No cut-off exists for MSD growth below which a viable pregnancy could be safely excluded. A cut-off value for CRL growth of 0.2 mm/day was always associated with miscarriage. These data suggest that criteria to diagnose miscarriage based on growth in MSD and CRL are potentially unsafe. However, finding an empty gestational sac on two scans more than 7 days apart is highly likely to indicate miscarriage, irrespective of growth.
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Affiliation(s)
- Y Abdallah
- Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, Hammersmith Campus, London, UK.
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Lehna C, Ramos P, Myers J, Coffey R, Kirk E. A web-based educational module increases burn prevention knowledge over time. Burns 2011; 37:1255-8. [DOI: 10.1016/j.burns.2011.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/07/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
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Bottomley C, Van Belle V, Pexsters A, Papageorghiou AT, Mukri F, Kirk E, Van Huffel S, Timmerman D, Bourne T. A model and scoring system to predict outcome of intrauterine pregnancies of uncertain viability. Ultrasound Obstet Gynecol 2011; 37:588-595. [PMID: 21520315 DOI: 10.1002/uog.9007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To define the incidence and outcome of intrauterine pregnancy of uncertain viability (PUV) and to develop and assess the performance of a model and a scoring system to predict ongoing viability. METHODS Of 1881 consecutive women undergoing transvaginal ultrasonography, a cohort of 493 women with an empty gestational sac < 20 mm in mean diameter, gestational sac < 25 mm in mean diameter and containing yolk sac only or an embryonic pole < 6 mm in maximum length and without visible heart activity were followed until the end of the first trimester. Women with multiple pregnancies or who underwent termination of pregnancy were excluded. Outcome measures were pregnancy viability at initial 7-14-day follow-up and first-trimester viability at 11-14 weeks. The data were split randomly into two sets (two-thirds and one-third, respectively) in order to first develop and then test a mathematical model and a 'simple' model in the prediction of viability at each outcome point, based on maternal demographics, ultrasound features and symptoms. The performance of each system was assessed by receiver-operating characteristics (ROC) curve analysis and calibration plots on a test dataset. RESULTS The incidence of PUV in this population was 29.2% (549/1881). Of the 493 pregnancies with initial (7-14 days) follow-up available, 307 (62.3%) were viable at this time and of the 444 pregnancies with follow-up at the end of the first trimester, 225 (50.7%) were still viable. Initial (7-14-day) viability was predicted by the model with an area under the ROC curve (AUC) of 0.837 (95% CI, 0.791-0.884) in the training dataset and 0.821 (95% CI, 0.756-0.885) in the test dataset. First-trimester (11-14-week) viability was predicted by the model with an AUC of 0.788 (95% CI, 0.734-0.842) in the training dataset and 0.774 (95% CI, 0.701-0.848) in the test dataset. The scoring system performed slightly worse than did the model, but had the advantage of being easily applicable. CONCLUSIONS When early pregnancy viability cannot be established immediately with ultrasound, use of either a logistic regression model or a scoring system allows an individualized prediction of first-trimester outcome.
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Affiliation(s)
- C Bottomley
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital London, London, UK.
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Kirk E, Pine KJ, Ryder N. I hear what you say but I see what you mean: The role of gestures in children's pragmatic comprehension. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/01690961003752348] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Moody B, Haslauer CM, Kirk E, Kannan A, Loboa EG, McCarty GS. In situ monitoring of adipogenesis with human-adipose-derived stem cells using surface-enhanced Raman spectroscopy. Appl Spectrosc 2010; 64:1227-1233. [PMID: 21073790 DOI: 10.1366/000370210793335106] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Methods capable of nondestructively collecting high-quality, real-time chemical information from living human stem cells are of increasing importance given the escalating relevance of stem cells in therapeutic and regenerative medicines. Raman spectroscopy is one such technique that can nondestructively collect real-time chemical information. Living cells uptake gold nanoparticles and transport these particles through an endosomal pathway. Once inside the endosome, nanoparticles aggregate into clusters that give rise to large spectroscopic enhancements that can be used to elucidate local chemical environments through the use of surface-enhanced Raman spectroscopy. This report uses 40-nm colloidal gold nanoparticles to create volumes of surface-enhanced Raman scattering (SERS) within living human-adipose-derived adult stem cells enabling molecular information to be monitored. We exploit this method to spectroscopically observe chemical changes that occur during the adipogenic differentiation of human-adipose-derived stem cells over a period of 22 days. It is shown that intracellular SERS is able to detect the production of lipids as little as one day after the onset of adipogenesis and that a complex interplay between lipids, proteins, and chemical messengers can be observed shortly thereafter. After 22 days of differentiation, the cells show visible and spectroscopic indications of completed adipogenesis yet still share spectral features common to the progenitor stem cells.
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Affiliation(s)
- Benjamin Moody
- University of North Carolina, Chapel Hill and North Carolina State University, Joint Department of Biomedical Engineering, Raleigh, North Carolina 27695, USA
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Abstract
Depression is a major public health problem for older women. Medications do not always decrease depression. Therefore, there is a need to research alternative approaches to dealing with depression in this age group. Structured reminiscence has been suggested as a cognitive behaviour approach for dealing with depression in older women. However, the research is limited. This article presents a research study using a structured reminiscence protocol to decrease depression in older women. This study found significant positive results. First, structured reminiscence decreases depression levels of women 60 years and older residing in assisted living facilities when offered twice weekly for 6-week duration to document significant improvement in depression scores. Second, engagement in reminiscence must occur longer than 3 weeks to measure a significant improvement in depression scores. The study also recommends screening of all older women admitted to assisted living facilities for depression on admission and offering education to nurses working with older adults to educate them on the positive effects of structured reminiscence group interventions.
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Affiliation(s)
- C K Stinson
- Lamar University School of Nursing, Beaumont, TX 77710, USA.
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Howlett N, Kirk E, Pine KJ. Does ‘Wanting the Best’ create more stress? The link between baby sign classes and maternal anxiety. Inf Child Develop 2010. [DOI: 10.1002/icd.705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barnhart KT, Sammel MD, Appleby D, Rausch M, Molinaro T, Van Calster B, Kirk E, Condous G, Van Huffel S, Timmerman D, Bourne T. Does a prediction model for pregnancy of unknown location developed in the UK validate on a US population? Hum Reprod 2010; 25:2434-40. [PMID: 20716562 DOI: 10.1093/humrep/deq217] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A logistic regression model (M4) was developed in the UK to predict the outcome for women with a pregnancy of unknown location (PUL) based on the initial two human chorionic gonadotrophin (hCG) values, 48 h apart. The purpose of this paper was to assess the utility of this model to predict the outcome for a woman (PUL) in a US population. METHODS Diagnostic variables included log-transformed serum hCG average of two measurements, and linear and quadratic hCG ratios. Outcomes modeled were failing PUL, intrauterine pregnancy (IUP) and ectopic pregnancy (EP). This model was applied to a US cohort of 604 women presenting with symptomatic first-trimester pregnancies, who were followed until a definitive diagnosis was made. The model was applied before and after correcting for differences in terminology and diagnostic criteria. RESULTS When retrospectively applied to the adjusted US population, the M4 model demonstrated lower areas under the curve compared with the UK population, 0.898 versus 0.988 for failing PUL/spontaneous miscarriage, 0.915 versus 0.981 for IUP and 0.831 versus 0.904 for EP. Whereas the model had 80% sensitivity for EP using UK data, this decreased to 49% for the US data, with similar specificities. Performance only improved slightly (55% sensitivity) when the US population was adjusted to better match the UK diagnostic criteria. CONCLUSIONS A logistic regression model based on two hCG values performed with modest decreases in predictive ability in a US cohort for women at risk for EP compared with the original UK population. However, the sensitivity for EP was too low for the model to be used in clinical practice in its present form. Our data illustrate the difficulties of applying algorithms from one center to another, where the definitions of pathology may differ.
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Affiliation(s)
- K T Barnhart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA 19104, USA.
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Bignardi T, Condous G, Kirk E, Van Calster B, Van Huffel S, Timmerman D, Bourne T. Viability of intrauterine pregnancy in women with pregnancy of unknown location: prediction using human chorionic gonadotropin ratio vs. progesterone. Ultrasound Obstet Gynecol 2010; 35:656-661. [PMID: 20503230 DOI: 10.1002/uog.7669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To find the best predictor of the viability of intrauterine pregnancies of uncertain viability (IPUVs). An IPUV is defined as an empty intrauterine gestational sac measuring less than 20 mm in diameter or an intrauterine gestational sac containing a fetal pole with a crown-rump length (CRL) of less than 6 mm with no fetal cardiac activity. METHODS This was a prospective observational study comparing the following two markers for the prediction of viability in IPUVs: human chorionic gonadotropin (hCG) ratio (hCG 48 h : hCG 0 h); and serum progesterone at first presentation. All women classified with a pregnancy of unknown location (PUL) were followed up until final diagnosis: failing PUL, viable or non-viable intrauterine pregnancy (IUP), or ectopic pregnancy. Those PULs found to have an IPUV at follow-up transvaginal ultrasound scan (TVS) were included in the final analysis. Receiver-operating characteristics (ROC) curves were used to compare the performance of the hCG ratio and progesterone. Using logistic regression, the added value of combining both variables over single-variable prediction was also evaluated. Missing values were imputed using multiple imputation. RESULTS In total, 12 572 consecutive first-trimester women were scanned. Of these, 1003 (8%) women were classified as having PULs at first scan; 379 (37.8%) PULs were confirmed as IPUVs at follow-up scan, with 82.6% (276/334) found to be viable IUPs and 17.4% (58/334) non-viable IUPs on a second follow-up scan. Forty-five PULs were lost to follow-up. For prediction of viability in IPUVs, the area under the ROC curve (AUC) for the hCG ratio was 0.756 (95% CI, 0.686-0.826) whilst that for progesterone was 0.678 (95% CI, 0.603-0.753). The difference in AUC was 0.078 (95% CI, 0.014-0.169, P = 0.098), suggesting that the hCG ratio was at least as good as initial progesterone. Furthermore, there was no clear threshold for initial progesterone, whilst for hCG a ratio of 2 was suggested (sensitivity 78%, specificity 67%). Logistic regression modeling demonstrated that progesterone did not improve the discriminatory power of the hCG ratio (AUC = 0.758). CONCLUSIONS The hCG ratio may be preferred to single measurements of progesterone to predict the viability of IPUVs in the PUL population.
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Affiliation(s)
- T Bignardi
- Acute Gynaecology, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, Australia.
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Abstract
Contact centres are vehicles for a rapidly growing group of knowledge workers, or eWorkers. Using computers and high-speed telecommunications connections as work tools, these employees spend long hours performing mentally demanding work while maintaining static, physically stressful, seated positions. The complex interplay between job demands, work environment, and individual differences combine to produce high levels of physical discomfort among eWorkers. This paper discusses a new view that has emerged, one that focuses on the management rather than the elimination of work related upper limb disorders (WRULD) and computer vision syndrome (CVS) issues that are prevalent among eWorkers. It also reviews a cultural shift among practitioners and business that moves towards a consultative process and the sharing of knowledge among all stakeholders. The controlled work conditions and large single location workforce found within contact centres provide the opportunity to understand the personal and industry cost of eWork injuries and the ability to develop and review new multifaceted interventions. Advances in training and workplace design aimed at decreasing discomfort and injury and reducing the associated economic burden may then be adapted for all eWorkforce groups.
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Affiliation(s)
- Elizabeth Kirk
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Abstract
OBJECTIVES To assess whether early fetal growth restriction in a twin, expressed as the intertwin discrepancy in crown-rump length (CRL) between two viable twins at 7 + 0 to 9 + 6 weeks' gestation, is predictive of subsequent single fetal loss. METHODS This was a retrospective analysis of data collected prospectively over 3 years. Women attending an early pregnancy unit underwent a transvaginal ultrasound examination. In women with a viable twin pregnancy between 7 + 0 and 9 + 6 weeks of gestation, the CRL ratio between the two embryos was calculated. Women were followed up and the intertwin discrepancy in CRL at the 7 + 0 to 9 + 6-week scan was compared between cases in which there was spontaneous reduction to a singleton and those in which both twins remained viable at the 11-14-week scan. RESULTS There were 77 women included in the study and nine (12%) of these had a single fetal loss. Pregnancies with subsequent single fetal loss were more likely to have a larger median CRL discrepancy (42.0%; interquartile range (IQR), 23.8-64.3%) than were those which retained two viable fetuses (6.1%; IQR, 2.2-12.5%) (P < 0.0001). The median CRL discrepancy in subsequently viable monochorionic diamniotic twins (10.9%; IQR, 1.9-17.5%) was no different from that in dichorionic diamniotic twin pregnancies (5.9%; IQR, 2.1-12.3%) (P = 0.305). Regardless of chorionicity, there was a relationship between increasing CRL discrepancy and single fetal loss; the likelihood of a subsequently viable twin pregnancy was 97% if the discrepancy was < 20%, while if the discrepancy was > 60% there were no cases of both twins remaining viable (P < 0.0001). Receiver-operating characteristics curve analysis of CRL discrepancy in predicting single fetal loss gave an area under the curve of 0.93, with an optimum cut-off point of 16.9% discrepancy (sensitivity, 88.9%; 95% CI, 51.8-99.7; and specificity, 86.7%; 95% CI, 76.3-93.8). CONCLUSION There is a significant relationship between CRL discrepancy at 7 + 0 to 9 + 6 weeks and the likelihood of subsequent single intrauterine fetal loss. This suggests that spontaneous fetal demise of one twin may be preceded by growth restriction in the first trimester.
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Affiliation(s)
- S A Bora
- Department of Obstetrics & Gynaecology, St George's, University of London, London, UK
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Kirk E, Papageorghiou AT, Van Calster B, Condous G, Cowans N, Van Huffel S, Timmerman D, Spencer K, Bourne T. The use of serum inhibin A and activin A levels in predicting the outcome of 'pregnancies of unknown location'. Hum Reprod 2009; 24:2451-6. [DOI: 10.1093/humrep/dep066] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bottomley C, Van Belle V, Mukri F, Kirk E, Van Huffel S, Timmerman D, Bourne T. The optimal timing of an ultrasound scan to assess the location and viability of an early pregnancy. Hum Reprod 2009; 24:1811-7. [DOI: 10.1093/humrep/dep084] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bottomley C, Daemen A, Mukri F, Papageorghiou AT, Kirk E, Pexsters A, De Moor B, Timmerman D, Bourne T. Assessing first trimester growth: the influence of ethnic background and maternal age. Hum Reprod 2009; 24:284-90. [DOI: 10.1093/humrep/den389] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bottomley C, Daemen A, Mukri F, Papageorghiou AT, Kirk E, Pexsters A, De Moor B, Timmerman D, Bourne T. Functional linear discriminant analysis: a new longitudinal approach to the assessment of embryonic growth. Hum Reprod 2008; 24:278-83. [PMID: 18978027 DOI: 10.1093/humrep/den382] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Functional linear discriminant analysis (FLDA) is a new growth assessment technique using serial measurements to discriminate between normal and abnormal fetal growth. We used FLDA to assess and compare growth in live pregnancies destined to miscarry with those remaining viable. METHODS This was a prospective cohort study of women with ultrasound scans on at least two separate occasions showing live pregnancies. Serial crown-rump length (CRL), mean gestational sac diameter and mean yolk sac diameter measurements were recorded. The ability of FLDA to predict subsequent miscarriage was compared with that of a single CRL measurement. RESULTS Of 521 included pregnancies, 493 (94.6%) remained viable at 14 weeks and 28 (5.4%) miscarried. The CRL growth rate was significantly lower in those that miscarried (one-sample t-test, P = 2.638E-22). The sensitivity of FLDA in predicting miscarriage from serial CRL measurements was 60.7% and specificity was 93.1% [positive predictive value (PPV) 33.3%, negative predictive value (NPV) 97.7%]. This was significantly better for predicting miscarriage than a single CRL observation of more than 2SD below that expected (sensitivity 53.6%, specificity 72.2%, PPV 9.9%, NPV 96.5%). CONCLUSIONS FLDA discriminates between normal and abnormal growth to predict miscarriage with high specificity. FLDA predicts miscarriage better than a single observation of a small CRL.
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Affiliation(s)
- C Bottomley
- Early Pregnancy and Gynaecology Ultrasound Unit, Department of Obstetrics and Gynaecology, St George's University of London, Third Floor Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK.
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Bora SA, Papageorghiou AT, Bottomley C, Kirk E, Bourne T. Reliability of transvaginal ultrasonography at 7-9 weeks' gestation in the determination of chorionicity and amnionicity in twin pregnancies. Ultrasound Obstet Gynecol 2008; 32:618-621. [PMID: 18677702 DOI: 10.1002/uog.6133] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess the agreement in the diagnosis of chorionicity and amnionicity between transvaginal ultrasound examination at 7-9 weeks' gestation and at the 11-14-week transabdominal scan. METHODS This was a retrospective analysis of prospectively collected data of twin pregnancies over a 3-year period. Chorionicity and amnionicity were assessed in women with viable twin pregnancies who underwent a transvaginal ultrasound scan at between 7 and 9 weeks' gestation. These findings were compared with the diagnoses of chorionicity and amnionicity at the subsequent 11-14-week scan in these women. RESULTS Chorionicity and amnionicity were documented in 67 viable twin pregnancies at both 7-9 and 11-14 weeks' gestation. There was agreement in the chorionicity and amnionicity reported at each of the two scans in 65 out of 67 (97%) cases. Of the dichorionic-diamniotic (DCDA) pregnancies reported at 7-9 weeks, 53 out of 54 (98%) were confirmed at the 11-14-week scan and one (2%) was found to be monochorionic-diamniotic (MCDA). However, at birth these twins were of different sex, confirming DCDA twins as initially diagnosed at 7-9 weeks. Of the 12 pregnancies diagnosed as MCDA at 7-9 weeks, all were found to be MCDA at the 11-14-week scan. There was one monochorionic-monoamniotic (MCMA) pregnancy diagnosed at 7-9 weeks that was subsequently found to be MCDA at the 11-14-week scan. CONCLUSION Transvaginal ultrasound examination at 7-9 weeks' gestation shows very high agreement with the 11-14-week scan in the diagnosis of chorionicity and amnionicity in twin pregnancies, suggesting that it provides a similar level of accuracy. Accuracy may be higher for DC twins than MC twins, which may relate to the gestational age at which the sonographic appearance of the amniotic sac develops.
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Affiliation(s)
- S A Bora
- Early Pregnancy and Gynaecological Ultrasound Unit, St George's, University of London, London, UK.
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Mukri F, Bourne T, Bottomley C, Schoeb C, Kirk E, Papageorghiou AT. Evidence of early first-trimester growth restriction in pregnancies that subsequently end in miscarriage. BJOG 2008; 115:1273-8. [PMID: 18715413 DOI: 10.1111/j.1471-0528.2008.01833.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether viable early pregnancies that subsequently end in miscarriage exhibit evidence of first-trimester growth restriction. DESIGN Prospective cohort study. SETTING Early pregnancy unit (EPU) of a teaching hospital. POPULATION Women attending EPU between 5 and 10 weeks of gestation. METHODS Women with spontaneously conceived intrauterine, viable singleton pregnancies with certain last menstrual period and regular cycles were included. The deviation between the observed and expected crown-rump length (CRL) for gestation was calculated and expressed as a z score. Pregnancies were followed up until the 11-14 week scan, and the deviation between those that remained viable and miscarried subsequently was calculated. MAIN OUTCOME MEASURES Viability at 11-14 week scan. RESULTS Over 6 months, 316 women met the inclusion criteria. Twenty-four (7.4%) women were excluded. Of the remaining 292, the pregnancy remained viable in 251 (86%) and 41 (14%) suffered a miscarriage. At the first transvaginal ultrasound, the z score of the mean measured CRL for pregnancies that remained viable was -0.82, SD 1.46, while in pregnancies that subsequently miscarried the z score was -2.42 and the CRL was significantly smaller, SD 1.31 (P < 0.0001). In the latter group, the initial CRL was below the expected mean for gestational age in all women, while in 61% (25/41), the CRL was at least 2 SDs below the expected mean. CONCLUSIONS CRL was significantly smaller in pregnancies that subsequently ended in miscarriage. This suggests that early first-trimester growth restriction is associated with subsequent intrauterine death.
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Affiliation(s)
- F Mukri
- Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital, London, UK.
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Bignardi T, Condous G, Alhamdan D, Kirk E, Van Calster B, Van Huffel S, Timmerman D, Bourne T. The hCG ratio can predict the ultimate viability of the intrauterine pregnancies of uncertain viability in the pregnancy of unknown location population. Hum Reprod 2008; 23:1964-7. [DOI: 10.1093/humrep/den221] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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