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Heuvelman H, Davies NM, Ben-Shlomo Y, Emond A, Evans J, Gunnell D, Liebling R, Morris R, Payne R, Storey C, Viner M, Rai D. Antidepressants in pregnancy: applying causal epidemiological methods to understand service-use outcomes in women and long-term neurodevelopmental outcomes in exposed children. Health Technol Assess 2023; 27:1-83. [PMID: 37842916 DOI: 10.3310/aqtf4490] [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] [Indexed: 10/17/2023] Open
Abstract
Background Antidepressants are commonly prescribed during pregnancy, despite a lack of evidence from randomised trials on the benefits or risks. Some studies have reported associations of antidepressants during pregnancy with adverse offspring neurodevelopment, but whether or not such associations are causal is unclear. Objectives To study the associations of antidepressants for depression in pregnancy with outcomes using multiple methods to strengthen causal inference. Design This was an observational cohort design using multiple methods to strengthen causal inference, including multivariable regression, propensity score matching, instrumental variable analysis, negative control exposures, comparison across indications and exposure discordant pregnancies analysis. Setting This took place in UK general practice. Participants Participants were pregnant women with depression. Interventions The interventions were initiation of antidepressants in pregnancy compared with no initiation, and continuation of antidepressants in pregnancy compared with discontinuation. Main outcome measures The maternal outcome measures were the use of primary care and secondary mental health services during pregnancy, and during four 6-month follow-up periods up to 24 months after pregnancy, and antidepressant prescription status 24 months following pregnancy. The child outcome measures were diagnosis of autism, diagnosis of attention deficit hyperactivity disorder and intellectual disability. Data sources UK Clinical Practice Research Datalink. Results Data on 80,103 pregnancies were used to study maternal primary care outcomes and were linked to 34,274 children with at least 4-year follow-up for neurodevelopmental outcomes. Women who initiated or continued antidepressants during pregnancy were more likely to have contact with primary and secondary health-care services during and after pregnancy and more likely to be prescribed an antidepressant 2 years following the end of pregnancy than women who did not initiate or continue antidepressants during pregnancy (odds ratioinitiation 2.16, 95% confidence interval 1.95 to 2.39; odds ratiocontinuation 2.40, 95% confidence interval 2.27 to 2.53). There was little evidence for any substantial association with autism (odds ratiomultivariableregression 1.10, 95% confidence interval 0.90 to 1.35; odds ratiopropensityscore 1.06, 95% confidence interval 0.84 to 1.32), attention deficit hyperactivity disorder (odds ratiomultivariableregression 1.02, 95% confidence interval 0.80 to 1.29; odds ratiopropensityscore 0.97, 95% confidence interval 0.75 to 1.25) or intellectual disability (odds ratiomultivariableregression 0.81, 95% confidence interval 0.55 to 1.19; odds ratiopropensityscore 0.89, 95% confidence interval 0.61 to 1.31) in children of women who continued antidepressants compared with those who discontinued antidepressants. There was inconsistent evidence of an association between initiation of antidepressants in pregnancy and diagnosis of autism in offspring (odds ratiomultivariableregression 1.23, 95% confidence interval 0.85 to 1.78; odds ratiopropensityscore 1.64, 95% confidence interval 1.01 to 2.66) but not attention deficit hyperactivity disorder or intellectual disability; however, but results were imprecise owing to smaller numbers. Limitations Several causal-inference analyses lacked precision owing to limited numbers. In addition, adherence to the prescribed treatment was not measured. Conclusions Women prescribed antidepressants during pregnancy had greater service use during and after pregnancy than those not prescribed antidepressants. The evidence against any substantial association with autism, attention deficit hyperactivity disorder or intellectual disability in the children of women who continued compared with those who discontinued antidepressants in pregnancy is reassuring. Potential association of initiation of antidepressants during pregnancy with offspring autism needs further investigation. Future work Further research on larger samples could increase the robustness and precision of these findings. These methods applied could be a template for future pharmaco-epidemiological investigation of other pregnancy-related prescribing safety concerns. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/80/19) and will be published in full in Health Technology Assessment; Vol. 27, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hein Heuvelman
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Neil M Davies
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Alan Emond
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan Evans
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - David Gunnell
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Rachel Liebling
- Fetal Medicine Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Richard Morris
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Rupert Payne
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Dheeraj Rai
- Department of Population Health Sciences, University of Bristol, Bristol, UK
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Stevenson F, Hamilton S, Pinfold V, Walker C, Dare CRJ, Kaur H, Lambley R, Szymczynska P, Nicolls V, Petersen I. Decisions about the use of psychotropic medication during pregnancy: a qualitative study. BMJ Open 2016; 6:e010130. [PMID: 26817641 PMCID: PMC4735167 DOI: 10.1136/bmjopen-2015-010130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To understand the perspectives of women with severe mental illness concerning the use of psychotropic medicines while pregnant. DESIGN Interviews conducted by female peer researchers with personal experience of making or considering decisions about using psychotropic medicines in pregnancy, supported by professional researchers. PARTICIPANTS 12 women who had had a baby in the past 5 years and had taken antipsychotics or mood-stabilisers for severe mental illness within the 12-month period immediately prior to that pregnancy. Recruitment to the study was via peer networks and the women interviewed came from different regions of England. SETTING Interviews were arranged in places where women felt comfortable and that accommodated their childcare needs including their home, local library and the research office. RESULTS The views expressed demonstrated complex attempts to engage with decision-making about the use of psychotropic medicines in pregnancy. In nearly all cases, the women expressed the view that healthcare professionals had access to limited information leaving women to rely on experiential and common sense evidence when making decisions about medicine taking during pregnancy. CONCLUSIONS The findings complement existing work using electronic health records by providing explanations for the discontinuation of psychotropic medicines in pregnancy. Further work is necessary to understand health professionals' perspectives on the provision of services and care to women with severe mental illness during pregnancy.
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Affiliation(s)
- Fiona Stevenson
- Department of Primary Care and Population Health, UCL, London, UK
| | | | | | | | | | | | | | - Paulina Szymczynska
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | | | - Irene Petersen
- Department of Primary Care and Population Health, UCL, London, UK
- Department of Clinical Epidemiology, Aarhus, Denmark
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Rader T, Pardo Pardo J, Stacey D, Ghogomu E, Maxwell LJ, Welch VA, Singh JA, Buchbinder R, Légaré F, Santesso N, Toupin April K, O'Connor AM, Wells GA, Winzenberg TM, Johnston R, Tugwell P. Update of strategies to translate evidence from cochrane musculoskeletal group systematic reviews for use by various audiences. J Rheumatol 2013; 41:206-15. [PMID: 24293571 DOI: 10.3899/jrheum.121307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
For rheumatology research to have a real influence on health and well-being, evidence must be tailored to inform the decisions of various audiences. The Cochrane Musculoskeletal Group (CMSG), one of 53 groups of the not-for-profit international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. While systematic reviews provided by the CMSG fill a major gap in meeting the need for high-quality evidence syntheses, our work does not end at the completion of a review. The term "knowledge translation" (KT) refers to the activities involved in bringing research evidence to various audiences in a useful form so it can be used to support decision making and improve practices. Systematic reviews give careful consideration to research methods and analysis. Because the review is often long and detailed, the clinically relevant results may not be apparent or in the optimal form for use by patients and their healthcare practitioners. This paper describes 10 formats, many of them new, for ways that evidence from Cochrane Reviews can be translated with the intention of meeting the needs of various audiences, including patients and their families, practitioners, policy makers, the press, and members of the public (the "5 Ps"). Current and future knowledge tools include summary of findings tables, patient decision aids, plain language summaries, press releases, clinical scenarios in general medical journals, frequently asked questions (Cochrane Clinical Answers), podcasts, Twitter messages, Journal Club materials, and the use of storytelling and narratives to support continuing medical education. Future plans are outlined to explore ways of improving the influence and usefulness of systematic reviews by providing results in formats suitable to our varied audiences.
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Affiliation(s)
- Tamara Rader
- From the Cochrane Musculoskeletal Group (CMSG), Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
The present experiment tests the hypothesis that a secondary reinforcer associated with high effort would be preferred to the same secondary reinforcer with low effort. Preference was measured by (a) S's choice in a T-maze and (b) time spent in the presence of the secondary reinforcet. Each of 40 animals experienced both high and low effort conditions associated with either a vertical or a horizontal striped area. Half of the Ss experienced high effort with vertical and low effort with horizontal stripes. The other half experienced high effort with horizontal and low effort with vertical stripes. Results demonstrated that effort is effective in influencing the value of a secondary reinforcer.
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Abstract
It was hypothesized that certain personality variables would be related to decision making in a guessing experiment. A stimulus set of 100 3- × 5-in. unlined filing cards, 75 of which contained circles and 25 of which were blank, was presented twice to each of 56 undergraduate Ss. The cards were in a random order and Ss were asked to guess whether a circle or a blank would be the forthcoming event. Their predictions on the second session's presentations were quantified in terms of the likelihood of false positive errors and hit rate over false alarm rate. Independently of the behavioral task, all Ss completed two personality inventories designed to assess need for approval and a dimension of internal vs external control of reinforcement. Scholastic Aptitude Test scores and Ss' estimates of the number of circles present in the stimulus set were incorporated as control variables. Results clearly show the effect of personality differences on guessing behavior. Subsequent related studies for psychophysics and judgmental responses were suggested.
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MYERS JL, FORT JG, KATZ L, SUYDAM MM. DIFFERENTIAL MONETARY GAINS AND LOSSES AND EVENT PROBABILITY IN A TWO-CHOICE SITUATION. ACTA ACUST UNITED AC 1996; 66:521-2. [PMID: 14082008 DOI: 10.1037/h0041958] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Operant responses of human subjects were conditioned according to a variable-interval schedule of positive reinforcement. A brief noise was delivered as punishment for each of the responses. The noise suppressed the punished responses more when an alternative unpunished response was concurrently available than when only a single punished response was available. This finding extends the generality of a previous study that had used a period of extinction rather than the brief noise as the punishing stimulus.
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HOAR JR, MEEK EE. THE SEMANTIC DIFFERENTIAL AS A MEASURE OF SUBLIMINAL MESSAGE EFFECTS. J Psychol 1965; 60:165-9. [PMID: 14326182 DOI: 10.1080/00223980.1965.10544764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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SLOVIC P, LICHTENSTEIN S, EDWARDS W. BOREDOM-INDUCED CHANGES IN PREFERENCES AMONG BETS. Am J Psychol 1965; 78:208-17. [PMID: 14290749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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BRODY N. THE EFFECT OF COMMITMENT TO CORRECT AND INCORRECT DECISIONS ON CONFIDENCE IN A SEQUENTIAL DECISION-TASK. Am J Psychol 1965; 78:251-6. [PMID: 14290754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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EDWARDS W, SLOVIC P. SEEKING INFORMATION TO REDUCE THE RISK OF DECISIONS. Am J Psychol 1965; 78:188-97. [PMID: 14290747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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VAN NAERSSENR, VAN BEAUMONT. [EXPERIENCES WITH INDICATIONS OF CERTAINTY IN OBJECTIVE TESTS]. Ned Tijdschr Psychol 1965; 20:308-15. [PMID: 14343966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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GERJUOY IR, GERJUOY H. BINARY-CHOICE SEQUENCES OF RETARDATES, NORMAL CHILDREN, AND COLLEGE STUDENTS UNDER RANDOM- AND PATTERN-SET INSTRUCTIONS. Am J Ment Defic 1965; 69:854-9. [PMID: 14287822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SCHUM DA, GOLDSTEIN IL, SOUTHARD JF. THE INFLUENCE OF EXPERIENCE AND INPUT INFORMATION FIDELITY UPON POSTERIOR PROBABILITY ESTIMATION IN A SIMULATED THREAT-DIAGNOSIS SYSTEM. AMRL-TR-65-25. AMRL TR 1965:1-71. [PMID: 14309546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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Rita M. THE CASE FOR A DYNAMIC DECISION-MAKING SYSTEM. Hosp Top 1965; 43:58-61. [PMID: 14258894 DOI: 10.1080/00185868.1965.9955160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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LEIK RK. TYPE OF GROUP AND THE PROBABILITY OF INITIATING ACTS. Sociometry 1965; 28:57-65. [PMID: 14255843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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CAILLE. [MILITARY IMPLICATIONS OF RESEARCH CONCERNING VIGILANCE AND DECISION MAKING]. Rev Corps Sante Armees Terre Mer Air 1965; 6:63-92. [PMID: 14306396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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FREEMAN JR, SMALLEY HE. DETERMINANTS OF HOSPITAL SUPPLY DECISIONS: AN EXPLORATORY STUDY. Nurs Res 1965; 14:244-53. [PMID: 14346008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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RIM Y. DOMINANT INTERESTS AND RISKS. Arch Psicol Neurol Psichiatr 1965; 26:17-25. [PMID: 14304027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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TUNE GS. THE NONINDEPENDENCE OF RESPONSES TO A TWO-CHOICE SITUATION. J Gen Psychol 1965; 72:173-8. [PMID: 14253501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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STRASSER S. [PROBLEMS CONCERNING THE CONCEPT OF INTENTIONALITY]. Ned Tijdschr Psychol 1965; 20:1-20. [PMID: 14299848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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HOMZIE MJ, WEISS G. UCS INTENSITY AND THE ASSOCIATIVE STRENGTH OF THE EYELID CR WITH A MASKED CONDITIONING PROCEDURE. J Exp Psychol 1965; 69:101-3. [PMID: 14256240 DOI: 10.1037/h0021577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SPIGEL IM. LIFT REACTION TIME AND TOPOGRAPHIC COMPATIBILITY OF THE S-R FIELD. J Gen Psychol 1965; 72:165-72. [PMID: 14253500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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THURNER F. [ON THE DIFFICULTIES OF DECISION IN SELF-JUDGMENTS. A PERFORMANCE ASPECT IN PERSONALITY QUESTIONNAIRES]. Z Exp Angew Psychol 1965; 12:161-71. [PMID: 14276506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SPALTRO E. AN ANALYSIS OF RISK TAKING BEHAVIOR. Arch Psicol Neurol Psichiatr 1965; 26:7-16. [PMID: 14304030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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WALTER WG. SLOW POTENTIAL WAVES IN THE HUMAN BRAIN ASSOCIATED WITH EXPECTANCY, ATTENTION AND DECISION. Arch Psychiatr Nervenkr 1964; 206:309-22. [PMID: 14345314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SHUFORD EH. CORTEX: A COMPUTER-BASED SYSTEM FOR AIDING DECISION MAKING. ESD-TDR-64-677. Tech Doc Rep U S Air Force Syst Command Electron Syst Div 1964; 10:1-34. [PMID: 14262974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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WATKINS WH, FEEHRER CE. INVESTIGATIONS OF ACOUSTIC EFFECTS UPON VISUAL SIGNAL DETECTION. ESD-TR-64-557. Tech Doc Rep U S Air Force Syst Command Electron Syst Div 1964; 27:1-22. [PMID: 14282783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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GRATCH G. AN EXPLORATORY STUDY OF THE RELATION OF DEPENDENCE UPON ADULT APPROVAL AND AGE TO CHILDREN'S RISK TAKING. Child Dev 1964; 35:1155-67. [PMID: 14251362 DOI: 10.1111/j.1467-8624.1964.tb05256.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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GIBSON RS, NICOL EH. THE MODIFIABILITY OF DECISIONS MADE IN A CHANGING ENVIRONMENT. ESD-TR-64-657. Tech Doc Rep U S Air Force Syst Command Electron Syst Div 1964; 10:1-29. [PMID: 14262972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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