Smaller Cortisol Awakening Responses Are Associated with Greater Visual Dependence in Postural Control

Smyth, N., Milani, M., Thorn, L., Flynn, M., Golding, J.F., Evans, P. and Clow, A. 2021. Smaller Cortisol Awakening Responses Are Associated with Greater Visual Dependence in Postural Control. Healthcare. 9 (6) 723. https://doi.org/10.3390/healthcare9060723

TitleSmaller Cortisol Awakening Responses Are Associated with Greater Visual Dependence in Postural Control
TypeJournal article
AuthorsSmyth, N., Milani, M., Thorn, L., Flynn, M., Golding, J.F., Evans, P. and Clow, A.
Abstract

There are known links between the hypothalamic–pituitary–adrenal (HPA) axis and systems responsible for regulating posture. Our aim was to explore directly, for the first time, whether an aspect of circadian HPA axis activity (the cortisol awakening response: CAR) was associated with greater visual dependency in postural control. For measurement of the CAR, electronically monitored saliva samples were collected by participants following morning awakening in their home environment. On the afternoons of the same days, postural sway was measured in the laboratory by exposing participants to static (control) and moving visual stimuli whilst standing still and upright on a force platform. Visual dependence was assessed as the increase in postural sway (path length) during exposure to the moving compared with the static condition. The 44 measurement days were derived from four days for each of eleven healthy participants (mean ± SD age: 51.18 ± 3.3 years). As expected, postural sway was greater when exposed to moving versus static cues. Mixed regression modelling showed that participants with smaller four day average CARs had greater deterioration in postural sway when presented with moving stimuli. These data are the first to document associations between the CAR and visual dependency in postural sway.

Keywordssalivary cortisol
cortisol awakening response
hypothalamic–pituitary–adrenal (HPA) axis
postural control
visual dependency
Article number723
JournalHealthcare
Journal citation9 (6)
ISSN2227-9032
Year2021
PublisherMDPI
Publisher's version
License
CC BY 4.0
File Access Level
Open (open metadata and files)
Digital Object Identifier (DOI)https://doi.org/10.3390/healthcare9060723
PubMed ID34204685
Publication dates
Published12 Jun 2021

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Downey, L.A., Sands, H., Jones, L., Clow, A., Evans, P., Stalder, T. and Parrott, A.C. 2015. Reduced memory skills and increased hair cortisol levels in recent Ecstasy/MDMA users: significant but independent neurocognitive and neurohormonal deficits. Human Psychopharmacology. 30 (3), pp. 199-207. https://doi.org/10.1002/hup.2474

Assessment of the cortisol awakening response: expert consensus guidelines
Stalder, T., Kirschbaum, C., Kudielka, B.M., Adam, E.K., Pruessner, J.C., Wüst, S., Dockray, S., Smyth, N., Evans, P., Hellhammer, D.H., Miller, R., Wetherell, M.A., Lupien, S., Clow, A. and Jens C. Pruessner 2015. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. PNEC (63), pp. 414-432. https://doi.org/10.1016/j.psyneuen.2015.10.010

Detailed time course of the cortisol awakening response in healthy participants
Smyth, N., Thorn, L., Hucklebridge, F., Evans, P. and Clow, A. 2015. Detailed time course of the cortisol awakening response in healthy participants. Psychoneuroendocrinology. 62, pp. 200-203. https://doi.org/10.1016/j.psyneuen.2015.08.011

Post awakening salivary cortisol secretion and trait well-being: The importance of sample timing accuracy
Smyth, N., Thorn, L., Hucklebridge, F., Evans, P. and Clow, A. 2015. Post awakening salivary cortisol secretion and trait well-being: The importance of sample timing accuracy. Psychoneuroendocrinology. 58, pp. 141-151. https://doi.org/10.1016/j.psyneuen.2015.04.019

Anxious attachment style predicts an enhanced cortisol response to group psychosocial stress
Smyth, N., Thorn, L., Oskis, A., Hucklebridge, F., Evans, P. and Clow, A. 2015. Anxious attachment style predicts an enhanced cortisol response to group psychosocial stress. Stress. 18 (2), pp. 143-148. https://doi.org/10.3109/10253890.2015.1021676

The cortisol awakening response predicts same morning executive function: results from a 50-day case study
Law, R., Evans, P., Thorn, L., Hucklebridge, F. and Clow, A. 2015. The cortisol awakening response predicts same morning executive function: results from a 50-day case study. Stress: The International Journal on the Biology of Stress. 18 (6), pp. 616-621. https://doi.org/10.3109/10253890.2015.1076789

Pathophysiology and treatment of motion sickness
Golding, J.F. and Gresty, M.A. 2015. Pathophysiology and treatment of motion sickness. Current Opinion in Neurology. 28, pp. 83-88. https://doi.org/10.1097/WCO.0000000000000163

Motion sickness in migraine and vestibular disorders
Murdin, L., Chamberlain, F., Cheema, S., Arshad, Q., Gresty, M.A., Golding, J.F. and Bronstein, A.M. 2015. Motion sickness in migraine and vestibular disorders. Journal of Neurology, Neurosurgery and Psychiatry. 86 (5), pp. 585-587. https://doi.org/10.1136/jnnp-2014-308331

Are the scope and nature of psychology properly understood? An examination of belief in myths of popular psychology among university students
Swami, V., Thorn, L., Husbands, D., Tran, U.S., Nader, I.W., von Nordheim, L., Pietschnig, J., Stieger, S. and Voracek, M. 2015. Are the scope and nature of psychology properly understood? An examination of belief in myths of popular psychology among university students. in: Columbus, A.M. (ed.) Advances in Psychology Research. Volume 101 Hauppage, NY Nova Science Publishers. pp. 9-32

Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods
Phillips, G., Bottomley, C., Schmidt, E., Tobi, P., Lais, S., Yu, G., Lynch, R., Lock, K., Draper, A., Moore, D., Clow, A., Petticrew, M., Hayes, R. and Renton, A. 2014. Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods . Journal of Epidemiology & Community Health. 68 (7), pp. 606-614. https://doi.org/10.1136/jech-2013-202505

'Visual Vertigo’ and Motion Sickness
Bronstein, A., Golding, J.F. and Gresty, M. 2014. 'Visual Vertigo’ and Motion Sickness. in: Colombo, B. and Teggi, R. (ed.) Free Preview Vestibular Migraine and Related Syndromes Springer. pp. 91-104

Day differences in the cortisol awakening response predict day differences in synaptic plasticity in the brain
Clow, A., Law, R., Evans, P., Vallence, A.M., Hodyl, N.A., Goldsworthy, M.R., Rothwell, J.R. and Ridding, M.C. 2014. Day differences in the cortisol awakening response predict day differences in synaptic plasticity in the brain. Stress. 17 (3), pp. 219-223. https://doi.org/10.3109/10253890.2014.905533

'Visual Vertigo’ and Motion Sickness
Bronstein, A.M., Golding, J.F. and Gresty, M.A. 2014. 'Visual Vertigo’ and Motion Sickness. in: Bruno Colombo and Teggi Roberto (ed.) Vestibular Migraine and Related Syndromes Switzerland Springer. pp. 91-104

Visual Dependency and Dizziness after Vestibular Neuritis
Cousins, S., Cutfield, N.J., Kaski, D., Palla, A., Seemungal, B.M., Golding, J.F., Staab, J.P. and Bronstein, A.M. 2014. Visual Dependency and Dizziness after Vestibular Neuritis. PLoS ONE. 9 (9) e105426. https://doi.org/10.1371/journal.pone.0105426

Longitudinal evaluation of quality of life in 288 patients with Neurofibromatosis 2
Ferner, R.E., Shaw, A., Evans, D.G., McAleer, D., Halliday, D., Parry, A., Raymond F, L., Durie-Gair, J., Hanemann C, O., Hornigold, R., Axon, P.R. and Golding, J.F. 2014. Longitudinal evaluation of quality of life in 288 patients with Neurofibromatosis 2. Journal of Neurology. 26 (5), pp. 936-969. https://doi.org/10.1007/s00415-014-7303-1

Effects of prochlorperazine on vestibular ocular and perceptual responses: a randomised, double-blind, cross-over, placebo-controlled study
Patel, M., Nigmatullina, Y., Seemungal, B., Golding, J.F. and Bronstein, A.M. 2014. Effects of prochlorperazine on vestibular ocular and perceptual responses: a randomised, double-blind, cross-over, placebo-controlled study. Audiology and Neurotology. 19 (2), pp. 91-96. https://doi.org/10.1159/000357028

Salivary cortisol as a biomarker in social science research
Thorn, L., Smyth, N., Hucklebridge, F., Evans, P. and Clow, A. 2013. Salivary cortisol as a biomarker in social science research. Social and Personality Psychology Compass. 7 (9), pp. 605-625. https://doi.org/10.1111/spc3.12057

Delays of 5–15 min between awakening and the start of saliva sampling matter in assessment of the cortisol awakening response
Smyth, N., Clow, A., Thorn, L., Hucklebridge, F. and Evans, P. 2013. Delays of 5–15 min between awakening and the start of saliva sampling matter in assessment of the cortisol awakening response. Psychoneuroendocrinology. 38 (9), pp. 1476-1483. https://doi.org/10.1016/j.psyneuen.2012.12.013

State variation in the cortisol awakening response
Law, R., Hucklebridge, F., Thorn, L., Evans, P. and Clow, A. 2013. State variation in the cortisol awakening response. Stress. 16 (5), pp. 483-492. https://doi.org/10.3109/10253890.2013.817552

Sleep disturbance as part of the neurofibromatosis type 1 phenotype in adults
Leschziner, G., Golding, J.F. and Ferner, R.E. 2013. Sleep disturbance as part of the neurofibromatosis type 1 phenotype in adults. American Journal of Medical Genetics Part A. 161 (6), pp. 1319-1322. https://doi.org/10.1002/ajmg.a.35915

Patterns of adrenal cortisol and DHEA secretion during female adolescence: Implications for psychiatric disorders
Hucklebridge, F., Oskis, A., Loveday, C., Thorn, L. and Clow, A. 2013. Patterns of adrenal cortisol and DHEA secretion during female adolescence: Implications for psychiatric disorders. Giornale Italiano di Ostetricia e Ginecologia. 35 (1), pp. 225-226.

Cortisol secretion in saliva and hair: methodological considerations and relationships with state and trait well-being
Smyth, N. 2013. Cortisol secretion in saliva and hair: methodological considerations and relationships with state and trait well-being. PhD thesis University of Westminster School of Social Sciences, Humanities and Languages https://doi.org/10.34737/8z18y

Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait-anxiety
Paillard, A.C., Quarck, G., Paolino, F., Denise, P., Paolino, M., Golding, J.F. and Ghulyan-Bedikian, V. 2013. Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait-anxiety. Journal of Vestibular Research. 23 (4), pp. 203-209.

Motion sickness and disorientation in vehicles
Golding, J.F. and Gresty, M.A. 2013. Motion sickness and disorientation in vehicles. in: Bronstein, A.M. (ed.) Oxford textbook of vertigo and imbalance Oxford Oxford University Press. pp. 293-306

Vestibular perception following acute unilateral vestibular lesions
Cousins, S., Kaski, D., Cutfield, N., Seemungal, B., Golding, J.F., Gresty, M.A., Glasauer, S. and Bronstein, A.M. 2013. Vestibular perception following acute unilateral vestibular lesions. PLoS ONE. 8 (5) e61862. https://doi.org/10.1371/journal.pone.0061862

Vertigo and dizziness from environmental motion: visual vertigo, motion sickness, and drivers' disorientation
Bronstein, A.M., Golding, J.F. and Gresty, M.A. 2013. Vertigo and dizziness from environmental motion: visual vertigo, motion sickness, and drivers' disorientation. Seminars in Neurology. 33 (3), pp. 219-230.

The cortisol awakening response is related to executive function in older age
Evans, P., Hucklebridge, F., Loveday, C. and Clow, A. 2012. The cortisol awakening response is related to executive function in older age. International Journal of Psychophysiology. 84 (2), pp. 201-204. https://doi.org/10.1016/j.ijpsycho.2012.02.008

Recovery from adolescent anorexia nervosa and associations with diurnal patterns of salivary stress hormones: a case report
Oskis, A., Loveday, C., Hucklebridge, F., Wood, D. and Clow, A. 2012. Recovery from adolescent anorexia nervosa and associations with diurnal patterns of salivary stress hormones: a case report. Case Reports in Psychiatry. 2012, p. 798512. https://doi.org/10.1155/2012/798512

Knowledge of lung cancer symptoms and risk factors in the UK: development of a measure and results from a population-based survey
Simon, A.E., Juszczyk, D., Smyth, N., Power, E., Hiom, S., Peake, M.D. and Wardle, J. 2012. Knowledge of lung cancer symptoms and risk factors in the UK: development of a measure and results from a population-based survey. Thorax. 67 (5), pp. 426-432. https://doi.org/10.1136/thoraxjnl-2011-200898

The reliability of retrieval-induced forgetting
Potts, R., Law, R., Golding, J.F. and Groome, D.H. 2012. The reliability of retrieval-induced forgetting. European Psychologist. 17 (1), pp. 1-10. https://doi.org/10.1027/1016-9040/a000040

Diurnal patterns of salivary cortisol and DHEA in adolescent anorexia nervosa
Oskis, A., Clow, A., Thorn, L., Loveday, C. and Hucklebridge, F. 2012. Diurnal patterns of salivary cortisol and DHEA in adolescent anorexia nervosa. Stress. 15 (6), pp. 601-607. https://doi.org/10.3109/10253890.2012.661493

Differences between the diurnal patterns of salivary cortisol and DHEA in healthy female adolescents
Oskis, A., Clow, A., Thorn, L., Loveday, C. and Hucklebridge, F. 2012. Differences between the diurnal patterns of salivary cortisol and DHEA in healthy female adolescents. Stress. 15 (1), pp. 110-114. https://doi.org/10.3109/10253890.2011.582529

The NFTI-QOL: a disease-specific quality of life questionnaire for neurofibromatosis 2
Hornigold, R.E., Golding, J.F., Leschziner, G., Obholzer, R., Gleeson, M., Thomas, N., Walsh, D., Saeed, S. and Ferner, R.E. 2012. The NFTI-QOL: a disease-specific quality of life questionnaire for neurofibromatosis 2. Journal of Neurological Surgery Part B: Skull Base. 73 (2), pp. 104-111. https://doi.org/10.1055/s-0032-1301396

Empathic and non-empathic routes to visuospatial perspective-taking
Gronholm, P.C., Flynn, M., Edmonds, C.J. and Gardner, M. 2012. Empathic and non-empathic routes to visuospatial perspective-taking. Consciousness and Cognition. 21 (1), pp. 494-500. https://doi.org/10.1016/j.concog.2011.12.004

Cognitive cues and visually induced motion sickness
Golding, J.F., Doolan, K., Achary, A., Tribak, M. and Gresty, M.A. 2012. Cognitive cues and visually induced motion sickness. Aviation, Space, and Environmental Medicine. 83 (5), pp. 477-482.

Differences between diurnal patterns of salivary cortisol and dehydroepiandrosterone in healthy female adolescents
Oskis, A., Clow, A., Thorn, L., Loveday, C. and Hucklebridge, F. 2012. Differences between diurnal patterns of salivary cortisol and dehydroepiandrosterone in healthy female adolescents. Stress. 15 (1), pp. 110-114. https://doi.org/10.3109/10253890.2011.582529

Respiratory vulnerability to vehicle buffeting
Sung, W.L., Kohli, N., Qu’adir, S., Golding, J.F., Bronstein, A.M. and Gresty, M.A. 2011. Respiratory vulnerability to vehicle buffeting. Clinical Autonomic Research. 21 (6), pp. 365-371. https://doi.org/10.1007/s10286-011-0124-8

Seasonal differences in the diurnal pattern of cortisol secretion in healthy participants and those with self-assessed seasonal affective disorder
Thorn, L., Evans, P., Cannon, A., Hucklebridge, F. and Clow, A. 2011. Seasonal differences in the diurnal pattern of cortisol secretion in healthy participants and those with self-assessed seasonal affective disorder. Psychoneuroendocrinology. 36 (6), pp. 816-823. https://doi.org/10.1016/j.psyneuen.2010.11.003

A randomised placebo-controlled trial of oral hydrocortisone for treating tobacco withdrawal symptoms
Ussher, M., Aveyard, P., Reid, F., West, R., Evans, P., Clow, A., Hucklebridge, F., Fuller, J., Ibison, J. and Steptoe, A. 2011. A randomised placebo-controlled trial of oral hydrocortisone for treating tobacco withdrawal symptoms. Psychopharmacology. 216 (1), pp. 43-51. https://doi.org/10.1007/s00213-011-2191-x

Neurofibromatosis 2: a novel risk factor for hypertension?
Hornigold, R.E., Golding, J.F., Ferner, R.E. and Ferner, R.E. 2011. Neurofibromatosis 2: a novel risk factor for hypertension? American Journal of Medical Genetics Part A. 155 (7), pp. 1721-1722. https://doi.org/10.1002/ajmg.a.34035

Associations between the cortisol awakening response and heart rate variability
Stalder, T., Evans, P., Hucklebridge, F. and Clow, A. 2011. Associations between the cortisol awakening response and heart rate variability. Psychoneuroendocrinology. 36 (4), pp. 454-462. https://doi.org/10.1016/j.psyneuen.2010.07.020

The diurnal cortisol cycle and cognitive performance in the healthy old
Evans, P., Fredhoi, C., Loveday, C., Hucklebridge, F., Aitchison, E., Forte, D. and Clow, A. 2011. The diurnal cortisol cycle and cognitive performance in the healthy old. International Journal of Psychophysiology. 79 (3), pp. 371-377. https://doi.org/10.1016/j.ijpsycho.2010.12.006

The effect of smoking nicotine tobacco versus smoking deprivation on motion sickness
Golding, J.F., Prosyanikova, O., Flynn, M. and Gresty, M.A. 2011. The effect of smoking nicotine tobacco versus smoking deprivation on motion sickness. Autonomic Neuroscience: Basic and Clinical. 160 (1-2), pp. 53-58. https://doi.org/10.1016/j.autneu.2010.09.009

Anxious attachment style and salivary cortisol dysregulation in healthy female children and adolescents
Oskis, A., Loveday, C., Hucklebridge, F., Thorn, L. and Clow, A. 2011. Anxious attachment style and salivary cortisol dysregulation in healthy female children and adolescents. Journal of Child Psychology and Psychiatry. 52 (2), pp. 111-118. https://doi.org/10.1111/j.1469-7610.2010.02296.x

Managing motion sickness
Murdin, L., Golding, J.F. and Bronstein, A.M. 2011. Managing motion sickness. BMJ.

Managing motion sickness
Murdin, L., Golding, J.F. and Bronstein, A.M. 2011. Managing motion sickness. British Medical Journal. 343, pp. 1213-1217. https://doi.org/10.1136/bmj.d7430

Off vertical axis rotation motion sickness and field dependence
Cian, C., Ohlmann, T., Ceyte, H., Gresty, M.A. and Golding, J.F. 2011. Off vertical axis rotation motion sickness and field dependence. Aviation, Space, and Environmental Medicine. 82 (10), pp. 959-963.

State associations with the cortisol awakening response in healthy females
Stalder, T., Evans, P., Hucklebridge, F. and Clow, A. 2010. State associations with the cortisol awakening response in healthy females. Psychoneuroendocrinology. 35 (8), pp. 1245-1252. https://doi.org/10.1016/j.psyneuen.2010.02.014

The cortisol awakening response: more than a measure of HPA axis function
Clow, A., Hucklebridge, F., Stalder, T., Evans, P. and Thorn, L. 2010. The cortisol awakening response: more than a measure of HPA axis function. Neuroscience & Biobehavioral Reviews. 35 (1), pp. 97-103. https://doi.org/10.1016/j.neubiorev.2009.12.011

Slalom walking with prism disorientation: impact on verbal and spatial tasks
Green, D.A., Zhu, J.L., Shah, A., Golding, J.F. and Gresty, M.A. 2010. Slalom walking with prism disorientation: impact on verbal and spatial tasks. Aviation, Space, and Environmental Medicine. 81 (8), pp. 728-734. https://doi.org/10.3357/ASEM.2732.2010

Humor attenuates the cortisol awakening response in healthy older men
Lai, J.C.L., Chong, A.M.L., Siu, O.T., Evans, P., Chan, C.L.W. and Ho, R.T.H. 2010. Humor attenuates the cortisol awakening response in healthy older men. Biological Psychology. 84 (2), pp. 375-380. https://doi.org/10.1016/j.biopsycho.2010.03.012

Associations between psychosocial state variables and the cortisol awakening response in a single case study
Stalder, T., Evans, P., Hucklebridge, F. and Clow, A. 2010. Associations between psychosocial state variables and the cortisol awakening response in a single case study. Psychoneuroendocrinology. 35 (2), pp. 209-214. https://doi.org/10.1016/j.psyneuen.2009.06.006

The social impact of dizziness in London and Siena
Bronstein, A.M., Golding, J.F., Gresty, M.A., Mandalà, M., Nuti, D., Shetye, A. and Silove, Y. 2010. The social impact of dizziness in London and Siena. Journal of Neurology. 257 (2), pp. 183-190. https://doi.org/10.1007/s00415-009-5287-z

The cortisol awakening response in context
Clow, A., Hucklebridge, F. and Thorn, L. 2010. The cortisol awakening response in context. International Review of Neurobiology. 93, pp. 153-175.

Effect of temporal relationship between respiration and body motion on motion sickness
Denise, P., Vouriot, A., Normand, H., Golding, J.F. and Gresty, M.A. 2009. Effect of temporal relationship between respiration and body motion on motion sickness. Autonomic Neuroscience. 151 (2), pp. 142-146. https://doi.org/10.1016/j.autneu.2009.06.007

Students who self-harm: coping style, rumination and alexithymia
Borrill, J., Fox, P., Flynn, M. and Roger, D. 2009. Students who self-harm: coping style, rumination and alexithymia. Counselling Psychology Quarterly. 22 (4), pp. 361-372. https://doi.org/10.1080/09515070903334607

Can illusory deviant stimuli be used as attentional distractors to record vMMN in a passive three stimulus oddball paradigm?
Flynn, M., Liasis, A., Gardner, M., Boyd, S. and Towell, A. 2009. Can illusory deviant stimuli be used as attentional distractors to record vMMN in a passive three stimulus oddball paradigm? Experimental Brain Research. 197 (2), pp. 153-161. https://doi.org/10.1007/s00221-009-1901-7

Off-vertical axis rotation of the visual field and nauseogenicity
Golding, J.F., Arun, S., Wortley, E., Wotton-Hamrioui, K., Cousins, S. and Gresty, M.A. 2009. Off-vertical axis rotation of the visual field and nauseogenicity. Aviation, Space, and Environmental Medicine. 80 (6), pp. 516-521. https://doi.org/10.3357/ASEM.2433.2009

Use of a single case study design to examine state variation in the cortisol awakening response: relationship with time of awakening
Stalder, T., Hucklebridge, F., Evans, P. and Clow, A. 2009. Use of a single case study design to examine state variation in the cortisol awakening response: relationship with time of awakening. Psychoneuroendocrinology. 34 (4), pp. 607-614. https://doi.org/10.1016/j.psyneuen.2008.10.023

Impact of vertigo and spatial disorientation on concurrent cognitive tasks
Gresty, M.A. and Golding, J.F. 2009. Impact of vertigo and spatial disorientation on concurrent cognitive tasks. Annals of the New York Academy of Sciences. 1164, pp. 263-267. https://doi.org/10.1111/j.1749-6632.2008.03744.x

The cortisol awakening response, seasonality, stress and arousal: a study of trait and state influences
Thorn, L., Hucklebridge, F., Evans, P. and Clow, A. 2009. The cortisol awakening response, seasonality, stress and arousal: a study of trait and state influences. Psychoneuroendocrinology. 34 (3), pp. 299-306. https://doi.org/10.1016/j.psyneuen.2008.11.005

Diurnal patterns of salivary cortisol across the adolescent period in healthy females
Oskis, A., Loveday, C., Hucklebridge, F., Thorn, L. and Clow, A. 2009. Diurnal patterns of salivary cortisol across the adolescent period in healthy females. Psychoneuroendocrinology. 34 (3), pp. 307-316. https://doi.org/10.1016/j.psyneuen.2008.09.009

Practice Nurses' views of their role in the management of Chronic Fatigue Syndrome/Myalagic Encephalitis: a qualitative study
Chew-Graham, C., Dixon, R., Shaw, J.W., Smyth, N., Lovell, K. and Peters, S. 2009. Practice Nurses' views of their role in the management of Chronic Fatigue Syndrome/Myalagic Encephalitis: a qualitative study. BMC Nursing. 8 (2). https://doi.org/10.1186/1472-6955-8-2

Adaptation of ventilation to 'buffeting' in vehicles
Green, D.A., Golding, J.F., Mandip, A., Faldon, M.C., Murphy, K.G., Bronstein, A.M. and Gresty, M.A. 2008. Adaptation of ventilation to 'buffeting' in vehicles. Clinical Autonomic Research. 18 (6), pp. 346-351. https://doi.org/10.1007/s10286-008-0491-y

Nauseogenicity of off-vertical axis rotation vs. equivalent visual motion
Bijveld, M.M.C., Bronstein, A.M., Golding, J.F. and Gresty, M.A. 2008. Nauseogenicity of off-vertical axis rotation vs. equivalent visual motion. Aviation, Space, and Environmental Medicine. 79 (7), pp. 661-665. https://doi.org/10.3357/ASEM.2241.2008

Caregiving is associated with low secretion rates of immunoglobulin A in saliva
Gallagher, S., Phillips, A.C., Evans, P., Der, G., Hunt, K. and Carroll, D. 2008. Caregiving is associated with low secretion rates of immunoglobulin A in saliva. Brain, Behavior, and Immunity. 22 (4), pp. 565-572. https://doi.org/10.1016/j.bbi.2007.11.007

Cognitive impairment by spatial disorientation
Gresty, M.A., Golding, J.F., Le, H. and Nightingale, K. 2008. Cognitive impairment by spatial disorientation. Aviation, Space, and Environmental Medicine. 79 (2), pp. 105-111. https://doi.org/10.3357/ASEM.2143.2008

[18F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a diagnostic tool for neurofibromatosis 1 (NF1) associated malignant peripheral nerve sheath tumours (MPNSTs): a long-term clinical study
Ferner, R.E., Golding, J.F., Smith, M., Calonje, E., Jan, W., Sanjayanathan, V. and O'Doherty, M. 2008. [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a diagnostic tool for neurofibromatosis 1 (NF1) associated malignant peripheral nerve sheath tumours (MPNSTs): a long-term clinical study. Annals of Oncology. 19 (2), pp. 390-394. https://doi.org/10.1093/annonc/mdm450

Cortisol secretory activity in older people in relation to positive and negative well-being
Evans, P., Forte, D., Jacobs, C., Fredhoi, C., Aitchison, E., Hucklebridge, F. and Clow, A. 2007. Cortisol secretory activity in older people in relation to positive and negative well-being. Psychoneuroendocrinology. 32 (8-10), pp. 922-930. https://doi.org/10.1016/j.psyneuen.2007.06.017

Cognitive performance in light current users and ex-users of ecstasy (MDMA) and controls
Golding, J.F., Groome, D.H., Rycroft, N. and Denton, Z. 2007. Cognitive performance in light current users and ex-users of ecstasy (MDMA) and controls. American Journal of Drug and Alcohol Abuse. 33 (2), pp. 301-307. https://doi.org/10.1080/00952990601175052

Genetic influences on motion sickness susceptibility in adult women: a classical twin study
Reavley, C.M., Golding, J.F., Cherkas, L.F., Spector, T.D. and MacGregor, A.J. 2006. Genetic influences on motion sickness susceptibility in adult women: a classical twin study. Aviation, Space, and Environmental Medicine. 77 (11), pp. 1148-1152.

Motion sickness susceptibility
Golding, J.F. 2006. Motion sickness susceptibility. Autonomic Neuroscience. 129 (1-2), pp. 67-76. https://doi.org/10.1016/j.autneu.2006.07.019

Increasing cognitive load with increasing balance challenge: recipe for catastrophe
Barra, J., Bray, A., Vishal, S., Golding, J.F. and Gresty, M.A. 2006. Increasing cognitive load with increasing balance challenge: recipe for catastrophe. Experimental Brain Research. 174 (4), pp. 734-745. https://doi.org/10.1007/s00221-006-0519-2

Suspected non-adherence and weekend versus week day differences in the awakening cortisol response
Thorn, L., Hucklebridge, F., Evans, P. and Clow, A. 2006. Suspected non-adherence and weekend versus week day differences in the awakening cortisol response. Psychoneuroendocrinology. 31 (8), pp. 1009-1018. https://doi.org/10.1016/j.psyneuen.2006.05.012

P36.42 Identification of a pre-attentive visual discrimination response
Flynn, M., Liasis, A., Gardner, M. and Towell, A. 2006. P36.42 Identification of a pre-attentive visual discrimination response. Clinical Neurophysiology. 117 (Supplement 1), p. 194. https://doi.org/10.1016/j.clinph.2006.06.651

Tachypnea and hypocapnia are induced by 'buffeting' in vehicles
Green, D.A., Bray, A., Golding, J.F., Bronstein, A.M. and Gresty, M.A. 2006. Tachypnea and hypocapnia are induced by 'buffeting' in vehicles. Clinical Autonomic Research. 16 (4), pp. 281-285. https://doi.org/10.1007/s10286-006-0360-5

Predicting individual differences in motion sickness susceptibility by questionnaire
Golding, J.F. 2006. Predicting individual differences in motion sickness susceptibility by questionnaire. Personality and Individual Differences. 41 (2), pp. 237-248. https://doi.org/10.1016/j.paid.2006.01.012

Reduction in cortisol after smoking cessation among users of nicotine patches
Ussher, M., West, R., Evans, P., Steptoe, A., McEwen, A., Clow, A. and Hucklebridge, F. 2006. Reduction in cortisol after smoking cessation among users of nicotine patches. Psychosomatic Medicine. 68 (2), pp. 299-306. https://doi.org/10.1016/j.psyneuen.2004.04.007

'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers
Louka, P., Maguire, M., Evans, P. and Worrell, M. 2006. 'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers. Journal of Health Psychology. 11 (3), pp. 441-451. https://doi.org/10.1177/1359105306063317

Post-awakening cortisol secretion during basic military training
Clow, A., Edwards, S., Owen, G., Evans, G., Evans, P., Hucklebridge, F. and Casey, A. 2006. Post-awakening cortisol secretion during basic military training. International Journal of Psychophysiology. 60 (1), pp. 88-94. https://doi.org/10.1016/j.ijpsycho.2005.05.007

Stressful life events are associated with low secretion rates of immunoglobulin A in saliva in the middle aged and elderly
Phillips, A.C., Carroll, D., Evans, P., Bosch, J.A., Clow, A., Hucklebridge, F. and Der, G. 2006. Stressful life events are associated with low secretion rates of immunoglobulin A in saliva in the middle aged and elderly. Brain, Behavior, and Immunity. 20 (2), pp. 191-197. https://doi.org/10.1016/j.bbi.2005.06.006

Salivary cortisol, stress and arousal following five weeks training in kinesthetic meditation to undergraduate students
Bullen, V., Fredhoi, C., Bloom, W., Povey, J., Hucklebridge, F., Evans, P. and Clow, A. 2006. Salivary cortisol, stress and arousal following five weeks training in kinesthetic meditation to undergraduate students. Journal of Holistic Healthcare. 3 (3), pp. 34-38.

Optimism, positive affectivity, and salivary cortisol
Lai, J.C.L., Evans, P., Ng, S.H., Chong, A.M.L., Siu, O.T., Chan, C.L.W., Ho, S.M.Y., Ho, R.T.H., Chan, P. and Chan, C.C. 2005. Optimism, positive affectivity, and salivary cortisol. British Journal of Health Psychology. 10 (4), pp. 467-484. https://doi.org/10.1348/135910705X26083

Motion sickness susceptibility fluctuates through the menstrual cycle
Golding, J.F., Kadzere, P. and Gresty, M.A. 2005. Motion sickness susceptibility fluctuates through the menstrual cycle. Aviation, Space, and Environmental Medicine. 76 (10), pp. 970-973.

Can tamoxifen relieve motion sickness?
Gianni, M.C., Golding, J.F. and Goldhirsch, A. 2005. Can tamoxifen relieve motion sickness? Annals of Oncology. 16 (10), pp. 1713-1714. https://doi.org/10.1093/annonc/mdi304

Motion sickness
Golding, J.F. and Gresty, M.A. 2005. Motion sickness. Current Opinion in Neurology. 18 (1), pp. 29-34.

The brain-sex theory of occupational choice: a counterexample
Esgate, A. and Flynn, M. 2005. The brain-sex theory of occupational choice: a counterexample. Perceptual and Motor Skills. 100 (1), pp. 25-37.

Effect of a novel motion desensitization training regime and controlled breathing on habituation to motion sickness
Yen Pik Sang, F., Billar, J., Gresty, M.A. and Golding, J.F. 2005. Effect of a novel motion desensitization training regime and controlled breathing on habituation to motion sickness. Perceptual and Motor Skills. 18 (1), pp. 29-34.

The diurnal patterns of the adrenal steroids cortisol and dehydroepiandrosterone (DHEA) in relation to awakening
Hucklebridge, F., Hussain, T., Evans, P. and Clow, A. 2005. The diurnal patterns of the adrenal steroids cortisol and dehydroepiandrosterone (DHEA) in relation to awakening. Psychoneuroendocrinology. 30 (1), pp. 51-57. https://doi.org/10.1016/j.psyneuen.2004.04.007

Acute reduction in secretory immunoglobulin A following smoking cessation
Ussher, M., West, R., Evans, P., Steptoe, A., McEwen, A., Clow, A. and Hucklebridge, F. 2004. Acute reduction in secretory immunoglobulin A following smoking cessation. Psychoneuroendocrinology. 29 (10), pp. 1335-1340. https://doi.org/10.1016/j.psyneuen.2004.04.004

The effect of dawn simulation on the cortisol response to awakening in healthy participants
Thorn, L., Hucklebridge, F., Esgate, A., Evans, P. and Clow, A. 2004. The effect of dawn simulation on the cortisol response to awakening in healthy participants. Psychoneuroendocrinology. 29 (7), pp. 925-930. https://doi.org/10.1016/j.psyneuen.2003.08.005

Perceived control, locus of control and preparatory information: effects on the perception of an acute pain stimulus
Williams, D., Golding, J.F., Phillips, K. and Towell, A. 2004. Perceived control, locus of control and preparatory information: effects on the perception of an acute pain stimulus. Personality and Individual Differences. 36 (7), pp. 1681-1691. https://doi.org/10.1016/j.paid.2003.07.009

The awakening cortisol response: methodological issues and significance
Clow, A., Thorn, L., Evans, P. and Hucklebridge, F. 2004. The awakening cortisol response: methodological issues and significance. Stress. 7 (1), pp. 29-37. https://doi.org/10.1080/10253890410001667205

We are most aware of our place in the world when about to fall
Bray, A., Subanandan, A., Isableu, B., Ohlmann, T., Golding, J.F. and Gresty, M.A. 2004. We are most aware of our place in the world when about to fall. Current Biology. 14 (15), pp. R609-R610. https://doi.org/10.1016/j.cub.2004.07.040

Suppression of sickness by controlled breathing during mildly nauseogenic motion
Yen Pik Sang, F., Golding, J.F. and Gresty, M.A. 2003. Suppression of sickness by controlled breathing during mildly nauseogenic motion. Aviation, Space, and Environmental Medicine. 74 (9), pp. 998-1002.

Effect of breathing supplemental oxygen on motion sickness in healthy adults
Ziavra, N., Yen Pik Sang, F., Golding, J.F., Bronstein, A.M. and Gresty, M.A. 2003. Effect of breathing supplemental oxygen on motion sickness in healthy adults. Mayo Clinic Proceedings. 78 (5), pp. 574-578.

Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress
Edwards, S., Hucklebridge, F., Clow, A. and Evans, P. 2003. Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress. Psychosomatic Medicine. 65 (2), pp. 320-327. https://doi.org/10.1097/01.PSY.0000033123.70631.8E

Behavioral methods of alleviating motion sickness: effectiveness of controlled breathing and a music audiotape
Yen Pik Sang, F., Billar, J., Golding, J.F. and Gresty, M.A. 2003. Behavioral methods of alleviating motion sickness: effectiveness of controlled breathing and a music audiotape. Journal of Travel Medicine. 10 (2), pp. 108-112.

Impairment of spatial cognitive function with preservation of verbal performance during spatial disorientation
Gresty, M.A., Waters, S., Bray, A., Bunday, K. and Golding, J.F. 2003. Impairment of spatial cognitive function with preservation of verbal performance during spatial disorientation. Current Biology. 13 (21), pp. R829-R830. https://doi.org/10.1016/j.cub.2003.10.013

Motion sickness and tilts of the inertial force environment: active suspension systems vs. active passengers
Golding, J.F., Bles, W., Bos, E., Haynes, T. and Gresty, M.A. 2003. Motion sickness and tilts of the inertial force environment: active suspension systems vs. active passengers. Aviation, Space, and Environmental Medicine. 74 (3), pp. 220-227.

An investigation into asymmetrical cortical regulation of salivary S-IgA in conscious man using transcranial magnetic stimulation
Clow, A., Lambert, S., Evans, P., Hucklebridge, F. and Higuchi, K. 2003. An investigation into asymmetrical cortical regulation of salivary S-IgA in conscious man using transcranial magnetic stimulation. International Journal of Psychophysiology. 47 (1), pp. 57-64. https://doi.org/10.1016/S0167-8760(02)00093-4

The awakening cortisol response: no evidence for an influence of body posture
Hucklebridge, F., Mellins, J., Evans, P. and Clow, A. 2002. The awakening cortisol response: no evidence for an influence of body posture. Life Sciences. 71 (6), pp. 639-646. https://doi.org/10.1016/S0024-3205(02)01726-5

Ultrasound measures of bone and the diurnal free cortisol cycle: a positive association with the awakening cortisol response in healthy premenopausal women
Brooke-Wavell, K., Clow, A., Ghazi-Noori, S., Evans, P. and Hucklebridge, F. 2002. Ultrasound measures of bone and the diurnal free cortisol cycle: a positive association with the awakening cortisol response in healthy premenopausal women. Calcified Tissue International. 70 (6), pp. 463-468. https://doi.org/10.1007/s00223-001-2085-8

Low frequency noise enhances cortisol among noise sensitive subjects during work performance
Persson Waye, K., Bengtsson, J., Rylander, R., Hucklebridge, F., Evans, P. and Clow, A. 2002. Low frequency noise enhances cortisol among noise sensitive subjects during work performance. Life Sciences. 70 (7), pp. 745-758. https://doi.org/10.1016/S0024-3205(01)01450-3

Association between time of awakening and diurnal cortisol secretory activity
Edwards, S., Evans, P., Hucklebridge, F. and Clow, A. 2001. Association between time of awakening and diurnal cortisol secretory activity. Psychoneuroendocrinology. 26 (6), pp. 613-622. https://doi.org/10.1016/S0306-4530(01)00015-4

A motion sickness maximum around the 0.2 Hz frequency range of horizontal translational oscillation
Golding, J.F., Mueller, A.G. and Gresty, M.A. 2001. A motion sickness maximum around the 0.2 Hz frequency range of horizontal translational oscillation. Aviation, Space, and Environmental Medicine. 72 (3), pp. 188-192.

Exploration of the awakening cortisol response in relation to diurnal cortisol secretory activity
Edwards, S., Clow, A., Evans, P. and Hucklebridge, F. 2001. Exploration of the awakening cortisol response in relation to diurnal cortisol secretory activity. Life Sciences. 68 (18), pp. 2093-2103. https://doi.org/10.1016/S0024-3205(01)00996-1

Modulation of secretory immunoglobulin A in saliva; response to manipulation of mood
Hucklebridge, F., Lambert, S., Clow, A., Warburton, D.M., Evans, P. and Sherwood, N. 2000. Modulation of secretory immunoglobulin A in saliva; response to manipulation of mood. Biological Psychology. 53 (1), pp. 25-35. https://doi.org/10.1016/S0301-0511(00)00040-5

The cortisol response to normal and nocturnal awakening
Hucklebridge, F., Clow, A., Rahman, H. and Evans, P. 2000. The cortisol response to normal and nocturnal awakening. Journal of Psychophysiology. 14 (1), pp. 24-28. https://doi.org/10.1027//0269-8803.14.1.24

Mind, immunity and health: the science of psychoneuroimmunology
Evans, P., Hucklebridge, F. and Clow, A. 2000. Mind, immunity and health: the science of psychoneuroimmunology. London Free Association.

Endogenous monoamine oxidase inhibitory activity and HPA activation in the pig
Clow, A., Vellucci, S.V., Parrott, R.F., Hucklebridge, F., Sen, S. and Evans, P. 1999. Endogenous monoamine oxidase inhibitory activity and HPA activation in the pig. Life Sciences. 66 (1), pp. 35-41. https://doi.org/10.1016/S0024-3205(99)00559-7

The awakening cortisol response and blood glucose levels
Hucklebridge, F., Clow, A., Abeyguneratne, T., Huezo-Diaz, P. and Evans, P. 1999. The awakening cortisol response and blood glucose levels. Life Sciences. 64 (11), pp. 931-937. https://doi.org/10.1016/S0024-3205(99)00019-3

The relationship between salivary secretory immunoglobulin A and cortisol: neuroendocrine response to awakening and the diurnal cycle
Hucklebridge, F., Clow, A. and Evans, P. 1998. The relationship between salivary secretory immunoglobulin A and cortisol: neuroendocrine response to awakening and the diurnal cycle. International Journal of Psychophysiology. 31 (1), pp. 69-76. https://doi.org/10.1016/S0167-8760(98)00042-7

Mind-body influences on immunity: lateralised control, stress, individual differences, and prophylaxis
Gruzelier, J., Clow, A., Evans, P., Lazar, I. and Walker, L. 1998. Mind-body influences on immunity: lateralised control, stress, individual differences, and prophylaxis. Annals of the New York Academy of Sciences. 851, pp. 487-494. https://doi.org/10.1111/j.1749-6632.1998.tb09027.x

The relationship between circadian patterns of salivary cortisol and endogenous inhibitor of monoamine oxidase A
Hucklebridge, F., Sen, S., Evans, P. and Clow, A. 1998. The relationship between circadian patterns of salivary cortisol and endogenous inhibitor of monoamine oxidase A. Life Sciences. 62 (25), pp. 2321-2328. https://doi.org/10.1016/S0024-3205(98)00213-6

Secretory immunoglobulin A and cardiovascular responses to mental arithmetic and cold pressor
Willemsen, G., Ring, C., Evans, P. and Clow, A. 1998. Secretory immunoglobulin A and cardiovascular responses to mental arithmetic and cold pressor. Psychophysiology. 35 (3), pp. 252-259. https://doi.org/10.1111/1469-8986.3530252

Regional and molecular separation of the four bioactivities of ‘tribulin’
Hucklebridge, F., Doyle, A., Pang, F.Y., Adlard, M., Evans, P. and Clow, A. 1998. Regional and molecular separation of the four bioactivities of ‘tribulin’. Neuroscience Letters. 240 (1), pp. 29-32. https://doi.org/10.1016/S0304-3940(97)00916-6

The role and regulation of monoamines in stress
Clow, A., Hucklebridge, F. and Evans, P. 1998. The role and regulation of monoamines in stress. in: Levi, A., Grauer, E., Ben-Nathan, D. and de Kloet, E.R. (ed.) New frontiers in stress research: modulation of brain function Amsterdam Harwood Academic. pp. 21-31

The cortisol response to psychological challenge is preceded by a rise in endogenous inhibitor of monoamine oxidase.
Clow, A., Patel, S., Najafi, M., Evans, P. and Hucklebridge, F. 1997. The cortisol response to psychological challenge is preceded by a rise in endogenous inhibitor of monoamine oxidase. Life Sciences. 61 (5), pp. 567-575. https://doi.org/10.1016/S0024-3205(97)00416-5

Endogenous monoamine oxidase A inhibitory activity (tribulin), measured in saliva, is related to cardiovascular reactivity in normal individuals
Clow, A., Doyle, A., Hucklebridge, F., Carroll, D., Ring, C., Shrimpton, J., Willemsen, G. and Evans, P. 1997. Endogenous monoamine oxidase A inhibitory activity (tribulin), measured in saliva, is related to cardiovascular reactivity in normal individuals. Journal of Neural Transmission (supplement). 52, pp. 77-83.

Modulation of secretory immunoglobulin A in saliva in relation to an acute episode of stress and arousal
Bristow, M., Hucklebridge, F., Clow, A. and Evans, P. 1997. Modulation of secretory immunoglobulin A in saliva in relation to an acute episode of stress and arousal. Journal of Psychophysiology. 11 (3), pp. 248-255.

Positive but not negative life events predict vulnerability to upper respiratory illness
Evans, P., Doyle, A., Hucklebridge, F. and Clow, A. 1996. Positive but not negative life events predict vulnerability to upper respiratory illness. British Journal of Health Psychology. 1 (4), pp. 339-348. https://doi.org/10.1111/j.2044-8287.1996.tb00514.x

Salivary monoamine oxidase A and B inhibitory activities correlate with stress
Doyle, A., Hucklebridge, F., Evans, P. and Clow, A. 1996. Salivary monoamine oxidase A and B inhibitory activities correlate with stress. Life Sciences. 59 (16), pp. 1357-1362. https://doi.org/10.1016/0024-3205(96)00461-4

Urinary output of endogenous monoamine oxidase inhibitory activity is related to everyday stress
Doyle, A., Hucklebridge, F., Evans, P. and Clow, A. 1996. Urinary output of endogenous monoamine oxidase inhibitory activity is related to everyday stress. Life Sciences. 58 (20), pp. 1723-1730. https://doi.org/10.1016/0024-3205(96)00153-1

Tribulin and stress in normal individuals
Doyle, A., Pang, F.Y., Hucklebridge, F., Evans, P. and Clow, A. 1996. Tribulin and stress in normal individuals. in: McCarty, R., Aguilera, G., Sabban, E. and Kvetnansky, R. (ed.) Stress: molecular genetic and neurobiological advances Amsterdam Harwood Academic.

Urinary cortisol and endogenous monoamine oxidase inhibitor(s), but not isatin, are raised in anticipation of stress and/or arousal in normal individuals
Doyle, A., Pang, F.Y., Bristow, M., Hucklebridge, F., Evans, P. and Clow, A. 1996. Urinary cortisol and endogenous monoamine oxidase inhibitor(s), but not isatin, are raised in anticipation of stress and/or arousal in normal individuals. Stress Medicine. 12 (1), pp. 43-49. https://doi.org/10.1002/(SICI)1099-1700(199601)12:1<43::AID-SMI677>3.0.CO;2-4

Secretory immunoglobulin A as convenient biomarker in health survey work
Evans, P., Hucklebridge, F., Clow, A. and Doyle, A. 1995. Secretory immunoglobulin A as convenient biomarker in health survey work. in: Rodriguez-Martin, J. (ed.) Health psychology and quality of life research: Proceedings of the 8th Annual Conference of the European Health Psychology Society Alicante University of Alicante.

Stress, arousal, Cortisol and secretory immunoglobulin A in students undergoing assessment
Evans, P., Bristow, M., Hucklebridge, F., Clow, A. and Pang, F.Y. 1994. Stress, arousal, Cortisol and secretory immunoglobulin A in students undergoing assessment. British Journal of Clinical Psychology. 33 (4), pp. 575-576. https://doi.org/10.1111/j.2044-8260.1994.tb01154.x

Dysphoria and immune status in postpartum women
Hucklebridge, F., Smith, M.D., Clow, A., Evans, P., Glover, V., Taylor, A., Adams, D. and Lydyard, P.M. 1994. Dysphoria and immune status in postpartum women. Biological Psychology. 37 (3), pp. 199-206. https://doi.org/10.1016/0301-0511(94)90002-7

The relationship between secretory immunity, mood and life-events
Evans, P., Bristow, M., Hucklebridge, F., Clow, A. and Walters, N. 1993. The relationship between secretory immunity, mood and life-events. British Journal of Clinical Psychology. 32 (2), pp. 227-236. https://doi.org/10.1111/j.2044-8260.1993.tb01050.x

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