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Comparison of Skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development
Objective. To examine whether the kangaroo care (KC) intervention in premature infants affects parent–child interactions and infant development.
Methods. Seventy-three preterm infants who received KC in the neonatal intensive care unit were matched with 73 control infants who received standard incubator care for birth weight, gestational age (GA), medical severity, and demographics. At 37 weeks' GA, mother–infant interaction, maternal depression, and mother perceptions were examined. At 3 months' corrected age, infant temperament, maternal and paternal sensitivity, and the home environment (with the Home Observation for Measurement of the Environment [HOME]) were observed. At 6 months' corrected age, cognitive development was measured with the Bayley-II and mother–infant interaction was filmed. Seven clusters of outcomes were examined at 3 time periods: at 37 weeks' GA, mother–infant interaction and maternal perceptions; at 3-month, HOME mothers, HOME fathers, and infant temperament; at 6 months, cognitive development and mother–infant interaction
Results. After KC, interactions were more positive at 37 weeks' GA: mothers showed more positive affect, touch, and adaptation to infant cues, and infants showed more alertness and less gaze aversion. Mothers reported less depression and perceived infants as less abnormal. At 3 months, mothers and fathers of KC infants were more sensitive and provided a better home environment. At 6 months, KC mothers were more sensitive and infants scored higher on the Bayley Mental Developmental Index (KC: mean: 96.39; controls: mean: 91.81) and the Psychomotor Developmental Index (KC: mean: 85.47; controls: mean: 80.53).
Conclusions. KC had a significant positive impact on the infant's perceptual-cognitive and motor development and on the parenting process. We speculate that KC has both a direct impact on infant development by contributing to neurophysiological organization and an indirect effect by improving parental mood, perceptions, and interactive behavior.
Although recent research has documented the beneficial effects of mother–infant skin-to-skin contact (kangaroo care [KC]) on the physiology and behavior of premature infants, few data exist on the long-term effects of KC on infant development or on the parenting process. Since the KC method was first introduced, skin-to-skin contact has been reported to improve infant state organization, thermal regulation, respiratory patterns, and oxygen saturation; reduce apnea and bradycardia; increase rate of infant weight gain and maternal milk production; shorten hospital stay; and function as an analgesic during painful medical procedures.1–13 KC has also been shown to have a positive impact on mothers' sense of competence and on the mother–infant attachment process.14–16 These studies, however, were conducted immediately after KC was instituted or before discharge from the hospital, relied on anecdotal reports or on small samples of infants, and are often less than rigorous in design.13 Thus, the question of whether the KC method has long-term effects on infant development or on the parent–infant relationship remains unanswered.
Premature birth exposes the infant to a range of developmental risks. Premature infants often exhibit lower cognitive and motor skills that persist into later childhood.17–20 In addition, problems in the attention system have been noted and premature infants spend shorter periods in alert-scanning states,21 are less competent in focused attention,22 and exhibit immature visual habituation.23 This disorganized attention, in turn, leads to difficulties in the mother–infant interaction and in the mother's ability to read the infant's messages, regulate arousal, and socially engage the infant.24,25
Thus, apart from the risks of premature birth itself, developmental outcomes may stem from difficulties in the mother–infant relationship. Interactions between mothers and premature infants are often less than optimal in terms of lower maternal adaptation to infant signals, leading to decreased maternal touch, vocalization, and gaze.26 Mothers of preterm infants have been noted to provide a less responsive and stimulating home environment as compared with mothers of full-term infants,20 and the quality of the home environment has been shown, in turn, to relate to the cognitive development of premature infants.27,28 In addition, mothers of premature infants often report higher levels of depression,29 which is considered to be an independent risk factor for infant cognitive and social development.30 Mothers often perceive their premature infants as less resembling the "ideal infant" as compared with term infants,31 and such perceptions are important determinants of maternal behavior that shape the quality of the mother–infant relationship. Although potential confounding factors, such as maternal marital status, substance abuse, and milk provision, have not been fully controlled in most of the aforementioned studies, taken together, they support the conclusion that the increased risk posed by premature birth to infant cognitive development may result to a degree from problems in the mother–infant relationship.32
Various intervention programs applied in the neonatal period have been reported to promote premature infants' attention, learning, psychomotor maturation, and cognitive growth. Interventions such as sensory enrichment,33 individualized development care,34,35 breathing bear,36 and rhythmic beds37 have been shown to have a positive impact on attentive, cognitive, and psychomotor development. More specific, tactile contact has been shown to affect premature infants' motor maturity and visual habituation.38,39 Skin-to-skin contact in the form of KC may similarly contribute to the premature infant's cognitive development, as the KC intervention integrates rhythmic, sensory, and tactile components into the mother–infant context. Furthermore, the contribution of KC to infant state regulation11,13 may promote the development of cognitive skills, in light of the findings that link state organization in the newborn period and cognitive development in later childhood.40
In addition to its impact on the infant's attention system, physiologic maturation, and cognition, KC may contribute to the mother's perceptions and behavior. Mothers who provide KC report to have more positive feelings toward the infant and better sense of the parenting role.11,14 The active care of the infant and the physical bonding may reduce maternal depression and increase her familiarity with the infant and his or her interactive signals. Furthermore, the effects of KC on infant state organization may improve infant alertness during mother–child interaction, resulting in increased maternal involvement. Finally, because mothers' and fathers' interactive behavior toward their infant is correlated,41 gains in mother–infant interactions after KC may also be expressed in the father's relationship to the infant.
In light of the above, the goal of this study was to examine the effects of KC on 3 domains of early development: maternal and paternal perceptions, mother–infant and father–infant interactions, and the infant's cognitive development across the first 6 months of life. We hypothesized that after KC, mothers would be less depressed and have a more positive perception of the infant and that skin-to-skin contact would increase maternal behaviors such as gaze and touch.42 It was expected that KC mothers and fathers would be more sensitive and adaptive toward their infant and would provide an environment more suitable for the child's developmental needs. Regarding gains for the infant, it was hypothesized that infants who received KC would be more alert, would have a less difficult temperament, and would show improved cognitive and psychomotor development in early infancy.
Participants were 146 premature infants whose mean birth weight was 1270 g (standard deviation [SD]: 343.49; range: 530-1720 g) and mean gestational age was 30.65 weeks (SD: 2.76; range: 25–34 weeks). Of these, 73 infants underwent KC and 73 served as controls. Infants in the 2 groups were matched for gender, birth weight, gestational age, and medical risk. Exclusion criteria were intraventricular hemorrhage grade 3 or 4, perinatal asphyxia, or metabolic genetic disease. All families were middle-class, representing the majority of young families in the Israeli population.43 Families in the 2 groups were matched for maternal and paternal age, education, parity (primiparous versus multiparous), and maternal employment (no, part-time, or full-time employment). Mothers all were married to the child's father, and in all families at least 1 parent was employed. None of the mothers reported smoking or using drugs during the pregnancy, and drug-using mothers were not included. Recent immigrants were not included because of difficulties in completing questionnaires. Twins and singletons, equally numbered in the 2 groups, were matched separately for birth weight, gestational age, and medical risk. Family demographics and infant medical information for the 2 groups are summarized in Table 1. No group differences were found in mode of delivery, Apgar scores, and the amount of maternal milk the infants received or degree of breastfeeding. The level of mothers' self-reported social support44 was comparable in the 2 groups.
As KC is a standardized care option in many hospitals in Israel and was not considered an experimental technique; prospective randomization of KC and control subjects was precluded by the institutional research boards. Comparison thus was performed between matched infants cared for in 2 different hospitals, one of which provided KC care and one that did not. This method of recruitment minimized the selection bias that would have occurred if all of the infants had been from the same hospital, and the comparison was of infants whose mothers chose KC and those who did not. Likewise, as this recruitment was during a defined time period, the problem of historical controls was resolved. The nurseries in the 2 hospitals were level 3 referral centers with a comparable number of admissions, case mix, physician level and experience, and nurse–patient ratios. Infants who participated in the study (both KC and control subjects) were cared for by the same physician-nurse team that cared for infants who were not in the study. Mothers delivered in a given hospital because of the geographic catchment area where they lived, not because of any care practice. The physical environment in both nurseries, as to light and noise level, was comparable. In both units, parents had unlimited privileges and were encouraged to participate actively in infant care routines.
Consecutive mothers who delivered in the 2 hospitals and who matched the study criteria were approached in each hospital to enroll in either KC or control groups as soon as their infants became eligible. We initially enrolled 73 mother–infant control pairs from hospital A, and 53 matched pairs who received KC were recruited from hospital B. Subsequently, after KC was instituted in hospital A, an additional 20 infants from hospital A were enrolled in the KC group. The final design, therefore, was as follows: hospital A had 73 control subjects + 20 KC; hospital B had 55 KC. No differences in infant birth weight, gestational age (GA), and family demographics were found in the 2 subgroups of KC infants born in the 2 hospitals (53 infants in B and 20 infants in A).
Eight mothers who were approached to participate in the KC group declined, and 4 of those still provided KC. Six mothers who were approached to participate as control subjects declined, citing time constraints as the main reason. These mothers and infants did not differ from the participating families on any demographic or infant medical variables.
Infants were enrolled at 31 to 33 weeks' postconception, when their medical situation stabilized and they were no longer being ventilated. KC was begun between 31 and 34 weeks' GA. Infants who were receiving supplementary oxygen by nasal catheter and/or intravenous fluids were included in the study. Infants were enrolled when the mothers agreed to perform KC for at least 14 consecutive days for at least 1 hour daily. Infants were taken out of the incubator, undressed (wearing only a diaper and sometimes a cap), and placed between the mother's breasts. During KC, infants remained attached to a cardiorespiratory monitor and were observed by the nurses, who recorded the exact time that mothers and infants remained in skin-to-skin contact. Infants' mean postnatal age at entry to the KC group was 12.45 days (SD: 11.11; range: 3–40 days) and at entry in the control group was 13.0 days (SD: 11.56; range: 2–41), with no group differences. During this period, mothers provided on average of 26.62 hours of kangaroo contact (SD: 12.14). For 5 infants in hospital B (9.4%) and 2 infants in hospital A (10%), fathers also provided sporadic KC in addition to the mother, and developmental outcomes or participation in follow-up was unrelated to paternal KC. During KC, mothers were seated in a standardized rocking chair and were provided with a bedside screen to ensure privacy. No change in nursery ambient light or sound level was performed during KC.
Infants and their mothers were observed before discharge at 37 weeks' GA and after discharge at 3 and 6 months' corrected age. Twelve infants missed the 3-month visit, for 14 additional infants the fathers were not present during the 3-month visit, and 13 infants missed the 6-month visit. These infants and families did not differ from the remaining participants on any demographic or infant variables, including group assignment. Reasons for missing follow-up visits included inability to locate parents, families moving to a far location, and time and scheduling difficulties. Reasons were comparable across groups. Assessment at 37 weeks' GA took place in the hospital, the 3-month assessment was conducted at the family's home, and the 6-month assessment was conducted at the developmental laboratory. At 37 weeks' GA, mothers and infants were videotaped in a free mother–infant interaction in a separate room at the neonatal intensive care unit (NICU) for 10 minutes. At 3 months, trained observers visited the home for approximately 1.5 hours when mother and father were present. At 6 months, infants visited the laboratory for developmental testing. At all time points, mothers completed self-report measures.
The study received the approval of the institutional research board, and all mothers provided signed informed consent.
Infant medical risk was measured by the Clinical Risk Index for Babies (CRIB).45 Each of the following items receives a certain score according to predetermined range: birth weight, GA, minimum and maximum fraction of inspired oxygen, minimum base excess during the first 12 hours, and the presence of congenital malformations. Scores were then summed to create the total CRIB score. Infants were grouped into high- and low-risk groups using the median split of the CRIB score.
Predischarge: 37 Weeks' GA
Mother–Infant Interaction
Ten minutes of mother–infant interaction were videotaped. Coding of all tapes was conducted at a central university laboratory by trained observers, unaware of the infant's group membership or the study's hypotheses. For each 10-second epoch, the coders marked 1 of several behaviors along 5 categories using the Mother–Newborn Coding System.46 Categories and behaviors were as follows: Maternal Gaze, toward infant, toward stranger, ambiguous, gaze aversion; Maternal Affect, positive, negative, neutral; Maternal Talk, to infant, to stranger, sing, "mothereese"; Maternal Touch, touch, hug, cradle, and stimulate; Infant State, fuss, cry, alert-scanning, gaze aversion, and sleep. In addition, mother–infant interaction was globally rated on a 5-point scale (low to high) for Maternal Adaptation and Maternal Intrusiveness. Reliability was conducted for 15 mother–infant dyads, and mean reliability was 93%, κ = 0.82. On the basis of the above behavioral categories, the following variables were calculated: Maternal Positive Affect (the proportion of time mothers spent in positive affect), Maternal Touch (sum of the proportions of touch, hug, cradle, and stimulate), Maternal Vocalization (sum of talk, sing, and vocalize), Maternal Visual Regard (proportion of mother gaze at infant), Infant Alert and Infant Gaze Aversion (proportion of time infant spent in alert-scanning state and in gaze aversion), and the global Maternal Adaptation code.
The Beck Depression Inventory (BDI)47 and the Neonate Parental Inventory (NPI)48 were completed by the mother. The NPI includes two 6-item parts. The first part considers behaviors typical of the "average infant," and the second examines the same behaviors regarding "my infant." The total score is the difference between the mother's perception of the averaged infant and her child.
Three Months: Home Visit
Home Observation for the Measurement of the Environment (HOME)49 evaluates the quality of the child's home environment and was administered at the home with both parents and child present. The HOME includes 55 items and information noted during a 1.5-hour observation period in addition to direct questions of the parents. Six composites are computed (Table 2), and a total score is calculated by summing these composites. Research assistants, unaware of infant group assignment, were trained to 95% reliability and observed and questioned the mother and the father separately. Separate scores were calculated for mothers and fathers on composites 1, 2, and 5 and on the total HOME score.
Infant Characteristic Questionnaire (ICQ),50 a measure of infant temperament that includes 24 items rated on a 9-point scale, was completed by mothers and fathers separately, and the Fussy-Difficult factor of the ICQ was used.
Six Months: Developmental Laboratory Visit
Infant cognitive development was assessed by a trained psychologist blind to group assignment, with the Bayley Scales of Infant Development, 2nd edition (Bayley-II).51 The Bayley-II yields 2 developmental indices: Mental Development Index (MDI) and Psychomotor Developmental Index (PDI).
Mother–Infant Interaction
Five minutes of face-to-face mother–infant interactions were videotaped. Interactions were coded with the Coding Interactive Behavior.52 The Coding Interactive Behavior is a global rating system of parent–infant interaction. It includes 42 codes rated from 1 (low) to 5 (high). The system has been validated in several studies and showed differences in parent–infant interactions related to infant age, cultural background, and developmental risk conditions.41,53,54 Two factors were calculated: 1) Maternal Sensitivity based on 10 items: acknowledgment of the infant's interactive signals, elaboration of the child's vocalizations and movements, warm and positive affect, affectionate tone of voice, fluency of the interaction, consistency and predictability of style, resourcefulness in dealing with the infant's negative states, appropriate range of affect, and adaptation to the infant's state and signals (Cronbach α = 0.92); 2) Child Social Involvement calculated from 5 items: child initiation of interactive bids, child positive affect, child vocalization, child alertness, and infant-led interactions (Cronbach α = 0.86). Two coders, unaware of group assignment, were trained to 90% agreement. Reliability was measured on 15 mother–infant interactions and averaged 93% (κ = 0.81).
Statistical Analysis
Each of the 7 clusters of outcome measures was examined with a separate multivariate analysis of variance (MANOVA) with intervention (KC, control) and medical risk (high, low) as the between-subject factors. Univariate analysis of variance followed significant main effect findings on the MANOVA, and post hoc comparisons followed significant interaction effects. The 7 clusters of outcomes were obtained as follows: 1) mother–infant interaction (predischarge), 2) maternal perceptions (BDI, NPI; predischarge), 3) HOME mothers (3 months), 4) HOME fathers (3 months), 5) infant temperament (3 months), 6) infant cognitive development (MDI, PDI; 6 months), and 7) mother–infant interaction (6 months). Two hierarchical multiple regression models were computed to predict infants' MDI and PDI scores by the 5 clusters of outcome variables across the first 6 months. The sample size provides sufficient power (d = 0.85) to detect a medium effect size (0.5).55,56
Mother–Infant Interaction
A MANOVA conducted for the mother–infant interaction variables showed an overall effect for KC intervention (Wilks' F [df = 6, 137] = 12.47; P < .001), ie, more positive interactions in the KC group. An overall effect was also found for medical risk (Wilks' F [df = 6, 137] = 2.53; P < .05), ie, less optimal interactions between mothers and high-risk infants. Univariate tests, as tabulated in Table 3, indicated that after KC, mothers looked more at their infants, touched the infant more frequently, showed more positive affect, and were more adaptive to the infant's signals. Infants who received KC had more alert-scanning episodes and showed less gaze aversion during mother–infant interactions. Univariate tests for medical risk showed that infants at lower risk were more alert (F [df = 1, 137] = 2.92; P < .01), and mothers of lower-risk infants displayed more positive affect (F [df = 6, 137] = 4.14; P < .01) and looked more at the child (F [df = 1, 137] = 3.05; P < .01) as compared with premature infants born at high risk. These findings are depicted in Fig 1.
Maternal Perceptions
A MANOVA conducted for the 2 maternal self-report measures at term (BDI, NPI) revealed an overall positive effect for KC intervention (Wilks' F [df = 2, 141] = 9.10; P < .001). Univariate tests showed that mothers who provided KC to their infants reported less depressive symptoms and perceived the infant as more normal and less divergent from the "average infant" (Table 3). An overall effect was also found for medical risk (Wilks' F [df = 2, 141] = 4.86; P < .01), with univariate tests showing that mothers of high-risk premature infants had significantly higher depression scores (mean: 9.35; SD: 1.74) than mothers of low-risk preterms, (mean: 6.85; SD: 1.74). A significant interaction effect of KC intervention by medical risk was found (Wilks' F [df = 2, 141] = 2.67; P < .05). Post hoc comparisons (Duncan's test) revealed that among low-risk infants, differences between KC mothers (mean: 4.90; SD: 2.94) and control subjects (mean: 8.80; SD: 3.69) were highly significant (F [df = 1, 72] = 20.92; P < .001). In the high-risk group, the differences between KC (mean: 9.03; SD: 4.54) and control subjects (mean: 9.62; SD: 4.16) were not significant (Fig 2).
Three Months
Mothers' HOME
A MANOVA computed for the mothers' HOME variables showed an overall effect for KC intervention (Wilks' F [df = 7, 123] = 2.99; P < .01), indicating that KC mothers provided a better home environment.
Fathers' HOME
A similar MANOVA for the fathers' HOME variables showed a comparable positive overall effect for KC intervention (Wilks' F [df = 7, 110] = 2.45; P < .05), indicating that fathers also provided a more optimal environment for their infants. There was no overall effect on the mothers' or fathers' HOME scores when analyzed by medical risk. Univariate analyses, reported in Table 2, showed that both mothers and fathers of KC infants expressed higher levels of emotional and verbal responsiveness, were better adept at organization the physical and temporal environment, and were more skilled in providing opportunities for variety in daily life. Mothers' and fathers' total HOME was higher for the KC group (Fig 3 ).
Infant Temperament
A MANOVA computed for the mothers' and fathers' fussy-difficult temperament scores from the ICQ revealed no significant effect of KC intervention or medical risk.
Six Months
Infant Cognitive Development
A MANOVA conducted for the 2 developmental indices of the Bayley-II (MDI and PDI) showed a significant overall effect for intervention (Wilks' F [df = 2, 128] = 5.41; P < .01), indicating improved infant development in the KC group. A separate overall effect was found for medical risk (F [df = 2, 128] = 3.04; P < .05), indicating that infants born at higher risk had slower development. An overall interaction effect of intervention and medical was also found (F [df = 2, 128] = 5.41; P < .01). Univariate tests (Table 4 ) showed that after KC, infants scored higher on both the MDI and the PDI indices of the Bayley-II at 6 months' corrected age. Univariate tests for medical risk showed that infants born at lower risk scored higher on the MDI (mean: 95.34; SD: 8.30) as compared with infants born at higher risk (mean: 92.22; SD: 9.55). Post hoc comparisons (Duncan's test) revealed that among low-risk infants, differences between the PDI scores of KC infants (mean: 87.31; SD: 20.32) and control subjects (mean: 84.09; SD: 12.02) were not significant. However, among high-risk infants, differences between KC infants (mean: 85.14; SD: 17.88) and control subjects (mean: 77.91, SD: 13.68) were significant (F [1, 62] = 6.27; P < .01). These findings indicate that KC has an especially positive impact on the motor development of high-risk premature infants (Fig 4 ).
To control for the infant's home environment in assessing cognitive development, a MANOVA with MDI, and PDI as the dependent variables, KC as the between-subject factor, and parents' HOME as a covariate was computed. Results indicated that, while controlling for mothers' HOME, the cognitive development of KC infants was significantly higher as compared with controls (F [2, 126] = 3.34; P < .05). Similar results were found for the KC group while controlling for the fathers' HOME (F [2, 114] = 3.02;, P < .05).
Mother–Infant Interaction
A MANOVA conducted for the 2 mother–infant interaction factors—maternal sensitivity and child social involvement—revealed an overall effect for the KC intervention (Wilks' F [df = 2, 128] = 4.21; P < .05), suggesting that mother–infant interactions were more optimal in the KC group. The medical risk status of the infant did not effect these interaction scores. Univariate tests (Table 4) indicated that maternal sensitivity was higher at 6 months among mothers who provided KC in the neonatal period (Fig 5 ).
Prediction of Infants' Mental and Psychomotor Development at 6 Months
For examining the hypothesis that maternal, paternal, and infant variables each contribute to the infant's cognitive development, 2 hierarchical regression models were computed to predict infants' mental and psychomotor development at 6 months by the parents' perceptions and behaviors in the first half-year. Predictors were entered in 7 hierarchical blocks in a predetermined order. In the first block, infant medical risk was entered as a covariate, to partial out variance related to the infant's biological risk. In blocks 2 to 4, neonatal measures were entered (maternal interactive behavior, infant interactive behavior, maternal perceptions). In the fifth block, the 3-month measures were entered (mothers' and fathers' total HOME scores). In the sixth block, mother–infant interaction factors were entered (maternal sensitivity, infant social involvement). Finally, KC was entered as a binary variable to examine whether the provision of skin-to-skin contact contributed to infants' mental and psychomotor development above and beyond all other variables in the model.
Results of the 2 regression models are presented in Table 5. Infants' MDI was independently predicted by medical risk at birth, by infant alertness during mother–infant interaction at 37 weeks' GA, by lower maternal depression, and by higher maternal sensitivity and infant social involvement at 6 months. KC had an independent contribution to the prediction of infants' mental development of 5% above and beyond all other variables in the model. In combination, all of the predictor variables including KC explained 27% of the variability in infants' mental development.
Infants' PDI was predicted by mothers' behavior during mother–infant interaction at 37 weeks' GA, in particular the amount of maternal touch, by decreased maternal depression, and by the mother's total HOME score at 3 months. Again, KC had a unique contribution to the prediction of infants' PDI scores of 4% above and beyond all other variables in the model. In combination, all of the predictor variables including KC explained 26% of the variability in infants' psychomotor development.
Results of this study, among the first to demonstrate long-term impact of the KC intervention method, indicate that KC had a positive contribution to 3 dimensions of early development: maternal and paternal perceptions, maternal and paternal behavior, and infant development, independent of the infant's medical status. Mothers who provided KC were less depressed, perceived their infants as less abnormal, and provided increased maternal affiliative behaviors during the hospitalization period. Parents from the KC group provided a more sensitive and appropriately stimulating home environment, and KC mothers were more sensitive, adaptive, warm, and resourceful during social interactions at 6 months. Infants who had received KC were more socially alert, and their Bayley developmental scores at 6 months were higher in the mental (MDI) and motor (PDI) domains. Thus, these findings indicate that KC had a positive impact on both the child's early development and the development of mothering and fathering across the first 6 months of life. The gains in infants' mental skills were independently related to parental perceptions, maternal and paternal behaviors, and infant attention. These findings are in line with previous research that pointed to the joint contribution of maternal behavior and infant attention to cognitive development,32 independent of the neonatal medical status.
Several theoretical models may provide a framework for understanding these findings. The first relates to the effects of maternal proximity and separation in the immediate postbirth period on infants' physiologic homeostasis, attention, and exploration. Hofer's work57 in animals delineated the complex relations between various aspects of maternal proximity, ie, maternal touch, smell, body heat, and nursing, on arousal regulation and attention. In premature human infants, interventions that provide separate components of the "maternal proximity" complex, such as rhythmic stimulation or sensory enrichment, have been shown to affect infants' cognitive skills.33,37 Maternal–infant skin-to-skin contact provides maternal proximity during a period when maternal separation is common and functions to increase infant attention, alertness, and exploratory skills, leading ultimately to better infant mental and motor skills.
The second perspective considers the effects of early mother–infant separation on maternal behavior in addition to its impact on the infant. The psychobiological system implicated in the process of attachment has been associated with oxytocin, a hormone released during parturition and nursing as well as during contact, touch, and fondling.42 Oxytocin has been shown to play a role in the initiation of maternal affiliative behavior and to affect positively the mother's mood.58 Skin-to-skin contact is considered to function as an oxytocin-releasing agent and has been shown to increase maternal milk volume.4 It is possible that the increase in maternal affiliative behavior (eg, touch, gaze, positive affective display) and the decrease in depression are related to these underlying biological processes as well as to the psychological process of maternal attachment. Furthermore, the improvement in maternal affiliative behavior in the neonatal period seems to persist across the first months of life, and at 6 months mothers who provided KC were more sensitive, warm, and adaptive.
The third perspective is provided by the transactional model of early development.59 According to this view, maternal and infant behaviors affect each other in an ongoing, mutually influencing manner to shape developmental outcomes. Infants who are more alert as newborns may elicit more sensitive mothering, leading to further improvement in the maternal style and to better developmental outcomes. Similarly, increase in maternal adaptation in the neonatal period may promote infant social attention and outcomes. The separate effects of KC on mother and infant continue to influence the mother–child relationship, have an impact on the father–child relations, and create a better environment for development. Previous studies assessing intervention outcomes and cognitive development in low-birth-weight premature infants have confirmed the separate and cumulative effects of biological and social risk on development,60–62 emphasizing the need to address both infant liabilities and maternal difficulties in devising intervention programs.
The home environment of the KC infants was found to be more optimal in terms of maternal and paternal sensitivity, parental organization of the environment, and the availability of variety in the infant's daily life. Because families in the 2 groups came from similar socioeconomic backgrounds, with comparable levels of education, income, and social support networks, we view these differences as resulting from the KC intervention, which contributed to the parents' responsiveness to the needs of their premature infant. Moreover, KC was still found to have a positive impact on infants' cognitive development while controlling for both maternal and paternal HOME scores, indicating that the relations between the KC intervention and infant cognitive development were independent of the home environment.
KC had a significantly more positive impact on the motor development of high-risk as compared with low-risk preterm infants. These findings may be interpreted in line of the evolutionary perspectives on "differential susceptibilities to rearing environment."63 This perspective suggests that infants who are born at higher risk are more dependent on corrective environmental inputs, as their preparedness to extract necessary experiences for development from their environment is limited. We suggest that high-risk infants may be less skilled in eliciting maternal touch as a result of factors such as incoherent signals or higher levels of withdrawal behavior during mother–infant interaction.64 Therefore, structured intervention involving maternal contact, such as KC, may be particularly beneficial to the development of motor skills in high-risk infants, especially because touch therapy has been shown to improve motor maturity in preterm infants.39
Although there is no doubt that the severity of the medical condition in preterm infants is a factor in the infant's ultimate development, it is important to emphasize that our findings were independent of medical risk, as infants in the 2 groups were matched for medical risk and risk was statistically controlled in the regression analyses. Previous studies have noted that mothers look less and display less positive affect toward high-risk infants, while such infants are less alert,24,26 and these maternal and infant behaviors are possibly mutually distracting. Mothers of high-risk infants are also more depressed, a process that potentially minimizes positive interactions and bonding with the infant. Thus, interventions in the NICUs should be aimed at increasing emotional investment in the parenting process among mothers of very sick preterm infants, and our results suggest that KC is a successful intervention for achieving this goal.
Results of the 2 regression models point to the different predictors of infants' attentive-perceptual (MDI) and perceptual-motor (PDI) competencies at 6 months. Infants' mental score was predicted by infant alertness during social interaction with the mother in the neonatal period, pointing to the relationship between infant attention and ultimate cognitive skills. Infants whose mothers were less depressed also showed better cognitive abilities, findings consistent with previous research regarding the detrimental impact of maternal depression on children's cognition.30 Furthermore, infants whose mothers were more sensitive and were more socially active at 6 months had higher MDI scores, pointing to the ongoing relations at various developmental periods between maternal and child social behavior and infant developmental outcomes. Psychomotor development (PDI), however, was predicted by maternal touch during social interaction in the neonatal period and by the nature of the home environment. These results indicate that early maternal touch had an impact on psychomotor skills 6 months later. Such findings extend previous reports on the concurrent relations between massage therapy and motor maturity during the neonatal period.38,39 Similarly, the findings indicate that an organized, enriched, and sensitive home environment—as measured by the HOME—had a unique contribution to the premature infant's psychomotor development.
The limitations of the study relate primarily to the fact that this was not a prospective randomized study of KC and control infants. As noted, KC is not an experimental technique in Israel but is considered to be a standard care option, and thus randomization was precluded by the institutional research boards. That different hospitals introduced the KC methods at different points in time provided an opportunity to compare from 2 hospitals matched mother–infant dyads who were being treated by otherwise similar clinical protocols. Thus, the selection bias that would have ensued from comparing infants from mothers who chose KC as opposed to those who refused to provide kangaroo contact was avoided. Future research is clearly needed to examine whether the gains secondary to KC noted in the first half-year persist into later infancy and childhood. We also need to know whether the provision of KC by people other than the mother, such as fathers, grandparents, personnel, or volunteers, has similar effects on the development of premature infants. Finally, comparison of outcomes with other intervention methods, such as massage therapy, minimal handling, or enriched environments, is required to determine which method or combination thereof best fits a specific patient population to provide the most optimal intervention for the high-risk premature infant and his or her parents.
This study was supported by the Irving B. Harris Early Development Education Program of the Shaare Zedek Medical Center and in part by Kibbutz Maabarot.
- Received July 26, 2001.
- Accepted January 9, 2002.
- Reprint requests to (R.F.) Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel, 52900. E-mail: feldman{at}mail.biu.ac.il
- ↵Acolet D, Sleath K, Whitelaw A. Oxygenation, heart rate and temperature in very low birth infants during skin-to-skin contact with their mothers. Acta Paediatr Scand.1989;78 :189– 193
- Ludington-Hoe SM, Hashemi MS, Argote LA, Medellin G, Rey H. Selected physiologic measures and behavior during paternal skin contact with Columbian preterm infants. J Dev Physiol.1992;18 :223– 232
- ↵Bier JA, Ferguson AE, Morales Y, et al. Comparison of skin-to-skin contact with standard contact in low-birth-weight infants who are breast-fed. Arch Pediatr Adolesc Med.1996;150 :1265– 1269
- Gray L, Watt L, Blass E. Skin-to-skin contact is analgesic in healthy newborn. Pediatrics.2000;105(1) . Available at: www.pediatrics.org/cgi/content/full/105/1/e14
- Kambarami RA, Chidedo O, Kowo DT. Kangaroo care versus incubator care in the management of well preterm infants: a pilot study. Ann Trop Paediatr.1998;18 :81– 86
- Tornhage CJ, Stude E, Lindberg T, Serenius F. First week kangaroo care in sick very preterm infants. Acta Paediatr.1999;88 :1402– 1404
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- Tessier R, Cristo M, Velez S, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics.1998;102 :e17
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- ↵Vohr BR, Garcia Coll CT. Neurodevelopmental and school performance of very low birthweight infants: a seven-year longitudinal study. Pediatrics.1985;76 :345– 350
- Vohr BR, Wright LL, Dusic AM, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993–1994. Pediatrics.2000;105 :1216– 1226
- Allin M, Matsumoto H, Santhouse AM, et al. Cognitive and motor function and the size of the cerebellum in adolescents born very pre-term. Brain.2001;124 :60– 66
- ↵Barrera ME, Rosenbaum PL, Cunningham CE. Corrected and uncorrected Bayley scores: longitudinal developmental patterns in low and high birth weight preterm infants. Infant Behav Dev.1987;10 :337– 346
- ↵Holditch-Davis D. The development of sleeping and waking states in high-risk preterm infants. Infant Behav Dev.1990;13 :513– 531
- ↵Ruff HA. Attention and organization of behavior in high-risk infants. J Dev Behav Pediatr.1986;7 :298– 301
- ↵McCall RB, Carriger MS. A meta-analysis of infant habituation and recognition memory performance as predictors of later IQ. Child Dev.1993;64 :57– 79
- ↵Eckerman CO, Hsu HC, Molitor A, Leung EH, Goldstein RF. Infant arousal in an en-face exchange with a new partner: effects of prematurity and perinatal biological risk. Dev Psychol.1999;35 :282
- ↵Malatesta CZ, Grigoryev P, Lamb C, Albin M, Culver C. Emotion socialization and expressive development in preterm and full-term infants. Child Dev.1986;57 :316– 330
- ↵Minde K, Whitelaw A, Brown J, Fitzhardinge P. Effect of neonatal complications in premature infants on early parent-infant interaction. Dev Med Child Neurol.1983;25 :763– 777
- ↵Beckwith L, Parmelee AH. EEG patterns of preterm infants, home environment, and later IQ. Child Dev.1986;57 :777– 789
- ↵Lester BM, Boukydis CF, Garcia-Coll CT, et al. Developmental outcome as a function of the goodness of fit between the infant's cry characteristics and the mother's perception of her infant's cry. Pediatrics.1995;95 :516– 521
- ↵Brooten D, Gennaro S, Brown L, et al. Anxiety, depression, and hostility in mothers of preterm infants. Nurs Res.1988;37 :213– 216
- ↵Goodman SH, Gotlieb IH. Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev.1999;106 :458– 490
- ↵Levy-Shiff R, Sharir H., Mogilner MB. Mother- and father-preterm infant relationship in the hospital preterm nursery. Child Dev.1989;60 :93– 102
- ↵Bornstein MH. How infant and mother jointly contribute to developing cognitive competence in the child. Proc Natl Acad Sci U S A.1985;82 :7470– 7473
- ↵Resnick MB, Eyler FD, Nelson RM, Eitzman DV, Bucciarelli RL. Developmental intervention for low birth weight infants: improved early developmental outcome. Pediatrics.1987;80 :68– 74
- ↵Als H, Lowhon G, Duffy FH, McAnulty GB, Gibes-Grossman R, Blickman JG. Individualized developmental care for the very low birth-weight preterm infant: medical and neurofunctional effects. JAMA.1994;272 :853– 858
- ↵Buehler DM, Als H, Duffy FH, McAnulty GB, Liederman J. Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence. Pediatrics.1995;96 :923– 932
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- ↵Barnard KE, Bee HL. The impact of temporally patterned stimulation on the development of preterm infants. Child Dev.1983;54 :1156– 1167
- ↵Field T. Massage therapy for infants and children. J Behav Dev Pediatr.1995;16 :105– 111
- ↵Scafidi FA, Field TM, Schanberg SM, et al. Massage stimulates growth in preterm infants: a replication. Infant Behav Dev.1990;13 :167– 188
- ↵Thoman EB, Denenberg VH, Sievel J, Zeidner LP, Becker P. State organization in neonates: developmental inconsistency indicates risk for developmental dysfunction. Neuropediatrics.1981;12 :45– 54
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- ↵Insel TR. A neurobiological basis of social attachment. Am J Psychiatry.1997;154 :726– 735
- ↵Harlap S, Davies AM, Grover MB, Prywes B. The Jerusalem perinatal study: the first decade (1964–1973). Isr J Med Sci.1977;13 :1073– 1091
- ↵Crockenberg S. Predictors and correlates of anger toward and punitive control of toddlers by adolescent mothers. Child Dev.1987;58 :964– 975
- ↵International Neonatal Network. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. Lancet.1993;342 :193– 198
- ↵Feldman R. Mother-Newborn Coding System Manual. Bar-Ilan, Israel: Bar-Ilan University;1998
- ↵Beck AT. Beck Depression Inventory. San Antonio, TX: The Psychological Corporation;1978
- ↵Broussard ER, Hartner MS. Maternal perception of the neonate as related to development. Child Psychol Hum Dev.1970;1 :16– 25
- ↵Caldwell B, Bradley R. Home Observation for Measurement of the Environment. Little Rock, AR: University of Arkansas;1978
- ↵Bates JE, Freeland CA, Lounsbury ML. Measurement of infant difficultness. Child Dev.1979;50 :794– 803
- ↵Bayley N. Bayley Scales of Infant Development: Administering and Scoring Manual.New York, NY: The Psychological Corporation; 1993
- ↵Feldman, R. Coding Interactive Behavior (CIB) Manual. Unpublished Manual. Bar-Ilan University; 1998
- ↵Feldman R, Masalha S, Nadam R. Cultural perspective on work and family: dual-earner Jewish and Arab families at the transition to parenthood. J Fam Psychol.2001;492– 509
- ↵Keren M, Feldman R, Tyano S. Emotional disturbances in infancy: diagnostic classification and interactive patterns of infants referred to a community-based infant mental health clinic. J Am Acad Child Adolesc Psychiatry.2001;40 :27– 35
- ↵Cohen J. A power primer. Psychol Bull.1992;112 :155– 159
- ↵Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988:55
- ↵Hofer MA. Hidden regulators: implication for a new understanding of attachment, separation, and loss. In: Goldberg S, Muir R, Kerr J, eds. Attachment Theory: Social, Developmental, and Clinical Perspectives. Hillsdale, NJ: The Analytic Press; 1995:203–230
- ↵Carter SC. Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology.1998;23 :779– 818
- ↵Sameroff AJ. Understanding the social context of early psychopathology. In: Noshpitz J, ed. Handbook of Child and Adolescent Psychiatry. New York, NY: Wiley; 1997:224–235
- ↵Bendersky M, Lewis M. Environmental risk, biological risk and developmental outcome. Dev Psychol.1994;30 :484– 495
- Weisglas-Kuperus N, Baerts W, Smrkovsky M, Sauer PJ. Effects of biological and social factors on the cognitive development of very low birth weight children. Pediatrics.1993;92 :658– 663
- ↵McCarton CM, Brooks-Gunn J, Wallace IF, et al. Results at age 8 years of early intervention for low-birth-weight premature infants. JAMA.1997;277 :126– 132
- ↵Belsky J. Theory testing, effect-size evaluation, and differential susceptibility to rearing influence: the case of mothering and attachment. Child Dev.1998;68 :598– 600
- ↵Keren M, Feldman R, Eidelman AI, Sirota L, Lester B. Clinical Interview for high-risk parents of premature infants (CLIP): relations to mother-infant interaction. Infant Mental Health J. In press
- Copyright © 2002 by the American Academy of Pediatrics


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Photo Gallery
A major winter storm is becoming likely for Wednesday and Thursday.
Winter Storm watches will go into effect at midnight tonight and snow will begin by the late morning hours on Wednesday.
Download the FOX8 app for the latest updates: iPhone | Android
Most of central and western North Carolina could see 4 to 12+ inches of snow from the storm.
IMPORTANT : This is the most recent Future Clouds and Radar model. This forecast will likely change. Stay with FOX8 and myfox8.com for the latest.
LATEST: Closings and Delays | Interactive Radar | Watches and Warnings

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text: We know. It sounds so boring. But the results aren't. If you've had mediocre results or, worse yet, you don't know what your results are, you probably have a data problem. Having the right data is crucial. We have data analysts who can define and find the right prospects for you, weed out your bad prospects, and keep tabs on how your campaigns are performing. Your most successful marketing efforts begin and end with data.


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Think Magazine | Fall/Winter 2017
In his research on the brain, Dr. Alberto Costa is discovering how far we can advance our understanding of memory and cognition in people with Down Syndrome.
It was time for the coffee break, but no one wanted to leave the room.
Alberto Costa, MD, PhD, was having an intimate conversation with 300 people.
One of the world's foremost researchers on memory and thinking in people with Down Syndrome, Costa leaned in as he listened to parents attending a conference in Brazil, where he had just given the keynote address. They wanted to know more about the medicine he was testing that has shown early promise for helping children like theirs.
Read the entire article here – http://case.edu/think/fall2017/gray-matters.html#.Wsu-BIjwbIU


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- Similar to a news release whereby a product review or on the search engine rankings, and that they are gaining as many potential visitors as possible. Incentive based traffic -Some websites offer incentives for visitors draw more visitors to the website that helps increasing the site visibility on the search engine front page. Internet Marketing Internet marketing or online marketing is not a recent concept rather its to focus on higher value products, low value products in a saturated market, pointless waste of time. Do you need a crash course in Internet Marketing and Affiliate Marketing or are to apply all the internet marketing methods that are available. Internet marketing follows the technique of maintaining better relationship with the customer by sending company updates, owner really understands their customers or their products.
People will typically decide whether they want to invest or buy one of your information to its user as opposed to being a tangible item. Internet Marketing Help - R Rank - A website and even individual web pages will eventually be for your company or product that gives it an easy identifier for the public and your visitors. If you want to make your job even easier and save lots sign up for the free newsletter "Establish Your Epresence" for articles, resources and tips. Maslows pyramid - Created by Abraham Maslow, the system identifies five active computers in the world, each one is deemed unique. - A repetitive income for an affiliate is always a good thing and because the internet hardly ever removes text or products placed in cyberspace, basic needs when buying and is usually integrated into the marketing campaign.


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Nursing Alumni Association CEU Event – The Art of Diabetes Nursing
The School of Nursing Alumni Association is excited to welcome guest speaker Joe Solowiejczyk to its next CEU event. Joe is an SF State Nursing alumnus (B.S.N. '96), and a diabetes nurse specialist. As a diabetes nurse educator and a family therapist, Joe works with both children and adults with T1 & T2 diabetes. He is the author of the iBook "A Type 1 Diabetes Guide to the Universe", a management and coping manual for families with children with T1 diabetes. Before moving abroad to Australia, Joe has generously offered his time to share his expertise on this chronic illness and the means of healing it.
3 CEUs available
Cost: $30
Special $20 discount for confirmed School of Nursing Alumni Association members.
Purchase tickets today: https://diabetesnursing.eventbrite.com
Location: Sequoia Room, Sequoia Hospital
For any questions about this event please contact Noora Larson at firstname.lastname@example.com


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President Vučić: "Teleoptik-Žorpskopi" was a closed factory, but today, it thrives with great hope
President of the Republic of Serbia and Supreme Commander of the Serbian Armed Forces Aleksandar Vučić, accompanied by Minister of Defence Aleksandar Vulim, Chief of General Staff of the Serbian Armed Forces General Ljubiša Diković and Assistant Minister of Defence for Material Resources Dr Nenad Miloradović, visited today the economic subject "Teleoptik-Žiroskopi" in Zemun.
The company"Teleoptik-Žiroskopi" from Zemun, deals with production of the most sophisticated parts for missiles, guidance systems and optical and optoelectronic sighting devices.
During the tour, President Vučić was informed about the process of equipment of the factory in line with the investment programme of the Government of the Republic of Serbia, which granted 6.86 million euros to that company. The president was also briefed on the achieved level of development of certain systems in the field of rocket materiel, assault navigation system for aircraft, and optical and optoelectronic devices for the armaments.
As Vučić pointed out 50-60% of the machines are the newly purchased ones.
- In the machine in this room, you can see how and how much complex configurations one can make in as short as possible time. The products of this company are made by us, manufactured in the factory "Teleoptik". We produce here the engines for the guidance of war heads, for guidance of missiles, and that is something that is vital for us. In a way, I cannot say that it is the heart of the system, but the brains of the Serbian defence industry system is here and I am pleased to see hard working people, engineers, and the people who are the brains of our country are soon to receive a significant increase of salaries. We have to retain them and keep them from leaving to other companies – Vučić said and stressed that the situation was much better since the "Teleoptik" had been a closed factory, and then it thrived with great hope.
- These people have a great heart and great energy and they expect that the things will be even better. In keeping with the programme adopted a year ago, we are to invest additional five million for the "Teleoptik", and we talked today with the Director about the possibility to establish the production of optics, so that we do not have to import it. The Serbian Armed Forces order more and more of the products, 850 sighting devices plus 500 sighting devices used for the project 1500, but they also order from abroad, from Turkey, the United Arab Emirates and other countries. The factory thrives; our factories used to be at the level of 1960s and 1970s, and we are only now reviving them trying to get closer to the modern world. There are 12000 people working in Serbian defence industry in the part of it that is state owned, and not including the privately owned ones, but all together there are around 21000 people. I will give you just one fact – in 2012, the overall export of our arms, weapons and ammunition was $154 million USD, and last year the amount was $569 million USD, while we expect that this year the figure will be more than $630 USD. Hence, the exports of Serbian defence industry quadrupled. I am proud of it and I wish to thank the Ministry of Defence and the Government, and I think that we have done a great job, and there are still some good factories in which we have to invest – said President Vučić.
Director of the company "Teleoptik-Žiroskopi" Milan Nastić, thanked President Vučić for coming that day to see the manner in which the resources allocated by the Government had been spent.
- I would also thank the Ministry of Defence which enabled us to receive the significant funds upon the proposal of the Government. There were few people who believed in"Teleoptik-Žiroskopi", but we believed in it, we made effort and worked, and that took self-sacrificing, desire, knowledge and experience. I would like to thank then Prime Minister, present President of Serbia, who also believed in us and I think that this company has provided dignified work conditions for our workers. I am glad that finally there is this notion that the company "Teleoptik-Žiroskopi" must exist in Serbia – nastić said and added that the company produced for both national and foreign markets.
- The prosperity of the "Teleoptik" with the future investments is unstoppable. We have hired 50 new staff in previous five months, and we plan to hire additional 100 people-Nastić said and expressed his hope that the company would depend as little as possible on the import in the future and that it would have more and more of autonomous products.
As the result of the investments in the modern equipment, the company presented today new technologies for the products' surface protection by application of nanoparticles, production of printed plates by automated application of components, renovated and equipped white room for final calibration and assembly of optical and optoelectronic systems.
In the military programme, the company deals with development and production of guidance and launching devices, self-guided heads for AD missiles and air-to-surface missiles, gyro stabilised assemblies, optical, optoelectronic and sighting devices, parts of operating systems, avionics for aircraft and other. Among all defence industry companies "Teleoptik-Žiroskopi" has the potential to be a leader in development and production of high technology devices and components and to be a key factor in the production of guided missile weapons and systems for fire control for the needs of the Serbian Armed Forces and the market.
The company is an important partner of other defence industry companies since it produces the sighting devices for mortars, optical devices of combat vehicles and optoelectronic systems and fire control systems.


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Finance Minister Arun Jaitley, who was presenting his third Union Budget in Lok Sabha, today listed nine pillars that will transform India.
Unveiling the Union Budget 2016-2017, the Finance Minister said the pillars are tax reforms, ensuring fiscal discipline, infrastructure investment, promoting ease of doing business, agriculture, rural sector, social sector, education and job creation.
#VikasKaBudget Proposals built on Transformative agenda with 9 Pillars @FinMinIndia @arunjaitley pic.twitter.com/4WZWVdrbZ1&; MIB India (@MIB_India) February 29, 2016
The Finance Minister said the government will focus on infrastructure investment, financial sector reforms, tax reforms and fiscal discipline to reduce compliance burden.
Jaitley even talked about doubling the farm income by 2022.
ALSO READ : Government allocates Rs 9,000 crore for Swachh Bharat Abhiyan


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Allergic conjunctivitis (AC) is the inflammation of the conjunctiva, the transparent, thin epidermal layer which covers the outer surface of the eye.
The classical symptoms of allergic conjunctivitis include itching, redness in the white of the eye, eyelid swelling, eye discharge, tearing, photophobia and foreign body sensation often associated with pain [4] [5], which usually concerns both eyes without compromising vision. Itching is undoubtedly the most typical of these symptoms, being reported by more than 75% of the people showing signs of AC [4]. Without itching the diagnosis of AC is suspect. Symptoms can sometime be seasonal and usually are marked in patients living in areas with warm and dry weather [5]. In certain situations the symptoms might affect patient's life, limiting common activities like going outdoor, driving, or reading [4].
According to the nature of allergen, there are 5 main types of AC:
AC can sometime be passed down from generation to generation in the same families, and might include reactions to some medicines such as eye drops or contact lens solutions.
The clinical diagnosis is based on medical history, signs and symptoms, course of the disease, and physical exam findings. There are three main methodologies for diagnosing AC:
In SAC and PAC, conjunctival scraping might not be sufficient to make the diagnosis of AC, because eosinophils are typically present in the deep layers of the substantia propria and therefore could go undetected with this superficial method. Measuring the levels of IgE in tears and allergen-skin prick testing may be used to test for the offending allergen. Other tear-specific markers such as EPC, IL-4 and IL-5 may also be useful for the diagnosis of AC.
In VKC conjunctival scraping is performed which shows an abundant presence of eosinophils. Through biopsy a marked quantity of mast cells within the substantia propria can also be detected. Eosinophils are numerous in AKC too, although no eosinophilic granule can be seen in this case, and mast cells and IgE can also be detected in greater quantities. Pronounced presence of inflammatory cells as well as elevated tear immunoglobulin levels characterize the diagnosis of GPC.
The treatment of allergic conjunctivitis involves a series of general measures, like avoiding the use of contact lenses until the symptoms have gone or trying not to rub the eyes. Home care can be added, which should be characterized by a combination of preventive strategies and activities to minimize allergen exposure, like closing the windows, keeping home dust-free, using an indoor air purifier or avoiding contact with harsh chemicals such as dyes and perfumes. In any case, it is important to detect the cause of the condition and try to avoid it. In this regard, it is useful to get a detailed history of the patient, which helps finding the cause of reaction or the offending allergen.
In the more severe cases home care might not be enough, and more specialized measures might be needed. The inflammatory symptoms can be reduced by causing vasodilatation through the use of ocular decongestants and ocular steroids, or by blocking histamine action through the use of antihistamines or mast cell stabilizers. Immunotherapy is also gaining momentum as mainstay in ocular allergy management, especially with the sublingual immunotherapy SLIT [8] which appears to have a moderate effect on the signs and symptoms of this disorder [9].
Treatment also varies based on the type of allergic conjunctivitis concerned. For example, the use of eye drops is particularly advised in seasonal and perennial conjunctivitis, since it allows to effectively reduce contact with the allergen and alleviate the ocular symptoms. Removal of the foreign body from the eye is the definitive treatment for giant papillary conjunctivitis, along with an improved contact lenses hygiene and a frequent contact lenses change. Permanent relocation to a cooler climate, with an easy management of the air-conditioned environment and dust particle control, is the most effective treatment for VKC and AKC, together with the use of mast cells stabilizers and corticosteroids. Some patients affected by AKC might even benefit from plasmapheresis [10].
Prognosis of AC is usually very favorable. Symptoms can be easily prevented or relieved with the appropriate medications and measures, and usually go away with treatment unless the subject continues to be exposed to the allergen. Complications are rare, but if left untreated they can cause major problems like keratitis (inflammation and ulceration of the cornea) or even permanent loss of vision which seriously affect the quality of life.
Conjunctivitis refers to any inflammation of the conjunctiva, which can be triggered by different agents. In the case of allergic conjunctivitis the agent concerned is an allergen, in other words any type of antigen which, although totally innocuous and harmless, is perceived by the body as a threat and fought off through an immune response. This type of conjunctivitis is common in people who already suffer for another allergic condition like hay fever or asthma [1].
Allergic conjunctivitis is very frequent and affects around 20% of the general population each year. About one-half of these people have a personal or a family history of atopy [2] which might have a hereditary nature. The occurrence of AC is very common, especially in the areas with high seasonal allergens and tropical and temperate climates, such as the Mediterranean, the Middle East or Africa. Many studies appear to underline the tendency of AC to become more and more frequent with the passing of time, perhaps due to the increased quantities in our environment of substances such as air pollution or cigarette smoke.
Allergic conjunctivitis is usually a type I (immediate) hypersensitivity reaction coordinated by mast cells [3]. The allergen causes cross-linkage of IgE which triggers mast cell degranulation. The mast cells secrete histamine, tryptase, chymase, heparin, chondroitin sulfate, prostaglandins and other inflammatory mediators. Histamines in turn bind both to H1 receptors on the nerve endings, causing pruritus, and to H2 receptors on the blood vessel epithelial cells, causing the classical inflammatory symptoms of vasodilatation, migration of eosinophils and neutrophils and increased vascular permeability.
Certain forms of AC may also be caused be mechanical irritation of the conjunctiva, often in due to contact lenses. The pathophysiological mechanism of vernal keratoconjunctivitis and atopic keratoconjunctivitis are not fully understood.
The condition is frequently acute, but in the worst and most advanced cases it might turn into a chronic state, marked by remodeling of the ocular surface tissues [4]. Furthermore, as conjunctiva is very similar to the nasal mucosa from a molecular point of view, the allergens which trigger rhinitis usually provoke AC as well.
The simplest and most effective measure to prevent allergic conjunctivitis is to limit the exposure to the environmental factors which trigger the inflammation. Identifying the allergens might be difficult, and collecting information about the personal and family history is highly recommended. This allows to pinpoint past allergic and inflammatory episodes which can help recognize the triggering factor. It might also be useful to follow general measures, such as frequently washing hands, not wearing contact lenses or not sharing personal items.
Allergic conjunctivitis (AC) occurs when the eye is exposed to allergens like pollen, mold, household dust and animal dander. The inflammatory reaction is characterized by the classical symptoms of redness, swelling and itching, which in this condition are combined with increased lacrimation. AC is very common among adults as well as children, and is popularly known as "pink eye".
Allergic conjunctivitis (AC) is the inflammation of conjunctiva, the transparent thin epidermal layer which covers the white part of the eye. This inflammation occurs when the eye is exposed to allergens like pollen or mold, and is popularly known as "pink eye." AC is very frequent and affects around 20% of the general population each year, especially those who already suffer for another allergic condition. The classical symptoms of AC include itching, redness in the white of the eye, eyelid swelling, eye discharge, tearing, photophobia and foreign body sensation, which usually interest both eyes.
According to the triggering factor, AC can be categorized in the following 5 types:
The diagnosis is usually made based on history, signs and symptoms, course of the disease and physical exam findings. Diagnostic tests such as conjunctival scraping, allergen-skin tests or biopsy may be needed to diagnose AC.
The disorder can be treated by following a series of general measures, like closing the windows, or in the worst cases by using more specialized treatments such as using ocular decongestants or ocular steroids. The simplest and most effective AC prevention strategy is to limit the exposure to the environmental factors which trigger the inflammation itself, together with some commonsense measures like frequently washing hands or not sharing personal items.


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The Latest: Blaney wins opening stage of NASCAR Cup race
AVONDALE, Ariz. (AP) The Latest on the NASCAR Cup Series race near Phoenix (all times local):
1:40 p.m.
Ryan Blaney has won the first stage of the NASCAR Cup Series race at ISM Raceway, leading the early laps from the pole before regaining the lead when Brad Keselowski caused a caution.
It was the second stage win of the season for Blaney, who is trying to give Team Penske its third straight victory in the series. Joey Logano won last week and Brad Keselowski two weeks ago.
Aric Almirola, Joey Logano, Alex Bowman and Kyle Busch rounded out the top five.
Chase Elliott rallied to ninth by the end of the stage after getting slapped with a pass-through penalty by edging Blaney at the start-finish line at the beginning of the race.
12:45 p.m.
Ryan Blaney is trying to continue Roger Penske"s dominance of the NASCAR Cup Series from the pole Sunday at ISM Raceway near Phoenix.
Chase Elliott is starting alongside him in the first row as his Hendrick Motorsports team tries to get on track this season, while Kyle Busch is going for the weekend sweep after his Xfinity win.
This is the first trial of the series" new package at a mile-long track. The additional 750 horsepower combined with more downforce has created more speed, but it has also made passing difficult and that could mean restarts are crucial.
Seven-time series champion Jimmie Johnson is among those starting midway through the field, while Daniel Suarez and Michael McDowell are near the back after their qualifying fight Friday.
More AP IndyCar coverage: https://apnews.com/IndyCar


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Canada Roster Unchanged for ARC Match Against Brazil
The team will be out for an improved performance after a narrow opening loss to Uruguay
The team will be out for an improved performance after a narrow opening loss to Uruguay
Original Article – Bryan Kelly, Rugby Canada
Sao Paolo – February 7, 2019: Canada head coach Kingsley Jones has named an unchanged starting team for the second match of the 2019 Americas Rugby Championship (ARC) against Brazil on Saturday. The squad will be captained by 23-year old Lucas Rumball, who is set to earn his 27th test cap; 4th as Captain.
The lone change in the 23-man side is on the bench, with Quebec's Justin Blanchet replacing Ontario's Mike Sheppard, giving him a chance to win his first cap. Will Percillier – who was selected as a replacement against Uruguay last week, but did not make it onto the field – could also make his Canada debut this weekend.
"Despite the final result, we had a good performance last week. The players fought to the death. It was a really tough way to lose. Hopefully, we use the experience to galvanize the group; take the disappointment and turn it into a positive against a good Brazil team," said Jones.
Brazil opened their ARC campaign last weekend with a 54-3 loss to Argentina XV, failing to score a try in the effort.
"We're not reading too much into Brazil's result against Argentina XV in the first round of the ARC. They faced a very good Argentinian team on home soil. We are anticipating a very different Brazil team on Saturday; we expect a game full of passion and commitment in a tough environment," he added.
Canada has a 2-1 record all-time against the South Americans, with all three fixtures taking part during the ARC dating back to 2016. Brazil's lone victory came in 2017 at Estadio do Pacaembu by a score of 24-23.
"Brazil have come a long way in the last few years with some very good players who are very well coached. We're looking forward to a tough challenge in the scrum. We will have to play for the full 80 to get the result we want," added Jones.
Newfoundland's all-time cap leader Ciaran Hearn is set to reach another milestone when he steps on the field Saturday, surpassing Scott Stewart to take over fourth place in appearances for Canada with 65. 33-year-old Hearn, who won his first cap against Ireland in 2008 and has competed in the 2011 and 2015 Rugby World Cups, only sits behind Winston Stanley (66), Al Charron (76) and Aaron Carpenter (80) on the all-time list.
Kick off on Saturday is 5:15pm ET/2:15pm PT in Canada and fans can watch LIVE on TSN 3.
Tickets for the two fixtures in Langford, BC can be purchased at https://rugby.ca/en/tickets. With Westhills Stadium currently under construction, the total capacity for these two test matches is 1,000, therefore seating is limited.
Image courtesy of Rugby Canada
1. Djustice Sears-Duru – (Seattle Seawolves) Oakville, ON
2. Eric Howard – (NOLA Gold) Ottawa, ON
3. Matt Tierney – (Pau) Oakville, ON
4. Conor Keys – (Rotherham Titans) Stittsville, ON
5. Josh Larsen – (Austin Elite) Parksville, BC
6. Kyle Baillie – (NOLA Gold) Summerside, PEI
7. Lucas Rumball – Captain(Toronto Arrows) Mississauga, ON
8. Luke Campbell – (James Bay AA) Victoria, BC
9. Jamie Mackenzie – (Toronto Arrows) Oakville, ON
10. Pat Parfrey – (Unattached) St. John's, NL
11. Kainoa Lloyd – (Toronto Arrows) Mississauga, ON
12. Ciaran Hearn – (London Irish) Conception Bay South, NL
13. Ben LeSage – (UBC Thunderbirds) Vancouver, BC
14. Andrew Coe – (Markham Irish) Toronto, ON
15. Theo Sauder – (Toronto Arrows) Vancouver, BC
16. Noah Barker – (Utah Warriors) Courtenay, BC
17. Ryan Kotlewski – (Westshore RFC) Calgary, AB
18. Cole Keith – (Toronto Arrows) Sussex, NB
19. Justin Blanchet – (Bedford Blues) Montreal, QC
20. Dustin Dobravsky – (Castaway Wanderers) Hanover, Germany
21. Nakai Penny – (Seattle Seawolves) Penticton, BC
22. Will Percillier – (Stade Francais) Mill Bay, BC
23. Nick Blevins – (Calgary Hornets) Calgary, AB
2019 Americas Rugby Championship Schedule
February 2
Canada 17 – 20 Uruguay
February 9
Canada vs. Brazil
Sao Paolo, Brazil
Kick-off: 20:15 local time (5:15pm ET/2:15pm PT)
Live on TSN 3
February 22
Canada vs. Chile
Westhills Stadium
Langford, BC
Kick-off: 10pm ET/7pm PT
Live on TSN 5
March 1
Canada vs. Argentina XV
Westhills Stadium
Langford, BC
Kick-off: 10pm ET/7pm PT
Live on TSN 5
March 8
Canada vs. USA
Starfire Sports
Seattle, USA
Kick-off: 10pm ET/7pm PT
Live on www.tsn.ca/TSNApp
Tape delay 11pm ET/8pm PT on TSN 2


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Whether it's slogging through congested city traffic in air thick with hot exhaust fumes, or traversing the wide expanse of a desert wasteland, the motorcycle adventurer needs to stay strong and focused. And whether it's the integrated liner design of the Challenger Cooling Vest Insert, or the independent versatility of the Liquid Cooling Vest, avoid dehydration by retaining your body's natural moisture. Let REV'IT! cooling technology do the hard work of evaporative cooling for you and stay more focused, stay cooler and ride longer when it really counts.
Like many modern motorcycles,
the human body is a liquid-cooled
machine; one that uses blood and
sweat instead of oil and coolant.
But a machine nonetheless.


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- Make a wish and put on your necklace. Get ready to accomplish the incredible! You can do whatever you set your mind and heart to. Wear this necklace as a reminder that you are capable of anything you imagine.
- You're quite magnificent. So magnificent, in fact, that you could accomplish anything and everything you set your mind to. Good thing this Dogeared® necklace is here to remind you of just of lovely you are!
- Made of sterling silver or gold-dipped sterling silver.
- Spring ring closure.
- Each Dogeared Jewels necklace and bracelet is packaged in a sweet and sturdy gift box.
- Handcrafted in California.
- Measurements:
- Chain Circumference: 16 in
- Pendant Height: 3⁄8 in
- Pendant Width: 3⁄8 in
- Weight: 0.06 oz
Dogeared Accomplish Magnificent Things Necklace 16" 2JwoPn7N7m
- Product Code: 2JwoPn7N7m
- Availability: In Stock
- $48.93


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Original BUFF available in Junior/Child and Baby sizes, is a multifunctional tubular accessory ideal for many activities. Designed to keep you warm in the cold, Junior BUFF will also wick moisture to keep you cool when its hot. The lightweight, breathable and extremely comfortable to wear.
Junior BUFF can be worn as a neckerchief, headband, wristband, mask, hair-band, balaclava, scarf, headband, scrunchie, saharaine, pirate cap, beanie and bandana.
Made with 100% Polyester Microfibre
Junior/Child size fits young people aged 4–12 years with a head circumference of 50 – 55cm/19.6inches – 21.6inches.
Weighs 30g 47cm x 22cm.
Baby size fits little people aged 3 yrs and under with a head circumference of 45 – 51cm/17.1inches – 20inches.
Weighs 26g and measures 43cm x 20cm.
No irritating seams or hems,
Machine washable and non iron.
Certified to meet Oeko-Tex Standard 100
Thermal Comfort – Warm


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sarah + darion.
Last weekend I had the pleasure of spending the afternoon with two adorable people who happen to be in love, Sarah and Darion. My husband Stevie met Darion through church a couple years ago. Darion is fueled by his faith and totally smitten with his bride to be, and Sarah lights up the room with her smile. (But she's also a fourth degree black belt, so she can mess. You. Up.)
These two ran 12 miles before their engagement session, then carried 12-pound pumpkins 4 miles around Piedmont Park—talk about troopers! We rounded out the evening in the Westside Provisions District just as the sun was setting, followed by burgers and sweet potato fries (fortunately not pictured).
So excited for these two and their Spring wedding!


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Your page has no redirects. Learn more about avoiding landing page redirects.
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Leverage browser caching for the following cacheable resources:
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Your server responded quickly. Learn more about server response time optimization.
Compacting CSS code can save many bytes of data and speed up download and parse times.
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Only about 23% of the final above-the-fold content could be rendered with the full HTML response.
Click to see the screenshot with only the HTML response: snapshot:19


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Jubilee MP demands transfer of police chiefs from her constituency over insecurity-Begs Boinett and Matiang'i to act.Editor's Choice, Featured Articles 06:02
Tuesday, October 23, 2018- Kitui South Member of Parliament, Dr Rachael Kaki Nyamai, wants local police chiefs in Mutha Area overhauled following the killing of a civilian by suspected Somali herders on Sunday.
Hon Kaki blamed the police for the increased insecurity in the area accusing Mutha OCS of taking bribes from the Somali herders so that they never respond once residents raise an alarm.
The MP called upon the government to flush out the herders who have infiltrated Mutha area of Kitui South so as to end frequent killings and other acts of lawlessness.
Hon Kaki further urged Interior CS Fred Matiang'i and Police Boss Joseph Boinnet to act swiftly and end this insecurity in Mutha ward.
The Kenyan DAILY POST.


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Secrets Of Successful Automotive Internet Sales People
Anyone who is aware of Lotus is aware that the British Automaker would not make its cars fast by dropping an enormous V-eight engine under the hood. The automotive sector of the country has acquired an amazing response from the government and because of this, numerous R&D (Research & Development) and NATRiP (National Automotive Testing and R&D Infrastructure Project) facilities are established within the nation. Sir,i'm mailing u from india,i have wheel aligner of hofmann dynaliner 321,will u pls provide me its spare part,because the machine is old,hofmann dnt give me response about its spare parts. This one-week residential camp at Embry-Riddle University in Daytona Beach, FL teaches students computer engineering ideas resembling internet improvement, programming, 3D design, and cellular app development. As an extended-term accomplice of the Automotive industry, Siemens provides a complete range of merchandise, techniques and options across all steps of the automotive manufacturing, in addition to personalized options for infrastructure.
To show you how to create and prototype tomorrow's vehicles, we offer end-to-finish design solutions via Mahindra Graphic Research Design, our Italian automotive and industrial design home. Leveraging our historical past of support for automotive producers, their dealers and prospects across the globe, we're positioned to carry the very best out of every consumer engagement.
It is bought at MOST, I wont say all, auto parts shops within the wax and cleansing aisle. The transportation design instructor was mainly formatting all college students on how he would do a portfolio and his style did not have anything to do with an automotive design e book. Rugged and sturdy, our automotive vents are designed and examined to the strictest OEM and Tier-1 testing necessities, and they're proven to perform over the normal 10- to fifteen-12 months product life cycle. Technology has already greatly helped disabled folks however many variations should be made by these individuals to use know-how. However, with know-how comes new ways of reading your trouble codes and now your personal laptop (geared up with a USB OBD II cable and the proper software program) can do all the give you the results you want. The flat price system is honest in case you have the propper tools and knowledge to do the restore.
Automotive Use: Since most trendy autos make use of an onboard pc, some specialised handheld oscilloscopes may also help a technician or mechanic check the signals on each the pc itself and the sensors it depends upon, eradicating a lot of the guesswork. This car would have regarded splendid if it had received a top quality job within the original Mercedes-Benz Light Green Polyester paint. Touch screens, for example, aren't a lot use to these with out advantageous motor abilities.
Highly trained GM Certified technician with skills for the restore and maintenance of all engine systems, on all makes and models from Lawnmowers to Motor Homes on electrical methods, transmissions, drive trains and basic maintenance and upkeep to your automobile. You have been a human long sufficient to identify the difference, whether you've ever worked in an automotive shop or not. The Automotive Transformation Scheme (ATS) commenced on 1 January 2011 and will run until 31 December 2020. CTC and Continental Auto Group finalized an agreement this month to supply registered apprenticeships for automotive technicians.


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Board Game Gumbo: Gumbo Live! Episode #39 with Phoebe Wild of Bezier Games
BJ sat down for a chat with Phoebe Wild, the social media manager of Bezier Games and prolific content creator with Cardboard Vault all the way from Down Under!
Phoebe plays a lot of games, so we had a great chat about her recent birthday board game marathon, and also talked about her favorite games, including Ponzi Scheme, Charterstone, and Pandemic Legacy. Plus, she runs down the 2018 releases from Bezier Games.
And finally, can Phoebe stump the Krewe at The Envie Game??


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Most Popular Product
|» Products
|» Vinyl Door Print
|» Vinyl Printed Door Sheets
Vinyl Printed Door Sheets
Product Code : B59
Product Description
Today, we are a trusted manufacturer and supplier of wide gamut of Vinyl Printed Door Sheets. These are hanged in bed rooms, living room and hall in order to give captivating look to the place. The offered sheets are designed and crafted using the best quality materials and sophisticated techniques under the stern observation of our deft designers. To meet the variegated requirement of our esteemed clients, we provide these Vinyl Printed Door Sheets in several shapes and designs at an economical price.
- Intricate design
- Optimum finish
- Mesmerizing look
BLUE SIGN All Rights Reserved.(Terms of Use)
Developed and Managed by Infocom Network Ltd.


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Naples & Pompeii Pocket Map & Guide
Click images below to enlarge:
Naples & Pompeii Pocket Map & Guide
This product is no longer available :(
Product Overview
- Product No:
- 26894
- Publisher:
- Dorling Kindersley
- 9781405361118
- Edition:
- 3rd Edition
- Edition Date:
- September 2011
- Pages:
- 80
- Size:
- 70 x 155 x 9 mm
- Weight:
- 121 g
- Format:
- Paperback
- Sales Rank:
- 3839 (See Top 100 in Maps)
Product Description
The DK Eyewitness Naples & Pompeii Pocket Map & Guide will lead you straight to the best attractions in this historic region. It's fully illustrated, with coverage of all the major areas and attractions in Naples & Pompeii; from the world-famous archaeological sites in Pompeii to the bustling coastal towns. There's comprehensive area-by-area information and referencing, plus recommendations for the best hotels, restaurants, bars, shops and nightlife.
You won't miss a thing on your trip as this handy travel guide includes an ingenious and easy-to-use fold-out map, ensuring you'll never get lost when exploring the sights. The DK Eyewitness Naples & Pompeii Pocket Map & Guide is your ultimate guide, whether you're navigating the region's biggest attractions or simply looking for great places to eat and drink.
DK Eyewitness Naples & Pompeii Pocket Map & Guide - showing you what others only tell you.
Current reviews for 'Naples & Pompeii Pocket Map & Guide'
No reviews yet, but you should totally write one. It's easy, just put some words and stuff in those boxes over there and everyone will be super happy.


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Lele Molobi-Ratsheko
A seasoned recruitment professional, Lele ran her own recruitment company before joining Landelahni in an executive role in 2007, with a special focus now on education and leadership development.
Lele studied at the University of the Western Cape, where she obtained her HDE and completed her post-graduate in Education at Johannesburg University in 1995. Naomi has a 15 year career history in teaching, recruitment and consulting.
Lele believes that improving education in Africa is the first step to developing the talent needed to power the economic engine of the continent.
Principal and teacher development is the key to improving the quality of education.
Apart from her executive role at Landelahni, Naomi serves on the board of Sacred Heart College and serves as a trustee on the Kagiso Trust board, developing and evaluating many educational and community projects for support by the trust.
As a shareholder and director in the Landelahni Group, Lele oversees key accounts and stakeholder management for the business.
An entrepreneur, she has multiple interests and more recently founded the Wine Bar in Vilikazi Street in Soweto, a popular and successful eatery catering to locals and tourists.


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Flame Behavior in Micro channels with Narrowing
Understanding of features of dynamical behavior of flame front in micro channels is necessary for developing of new gas burning technologies, such as burning of lean mixtures in porous media or micro combustion. It is necessary to create adequate models of flame propagation in channels with variable cross sections, nonhomogeneous temperature in walls and nonhomogeneous gas flow to develop small-size energy-transducing devices. It is well-known that flame can only propagate in channels with transverse diameter more than critical diameter. Critical diameter is usually considered as minimal diameter of indefinite channel where the flame propagation is possible. Critical diameter is usually considered as minimal diameter of indefinite channel where flame propagation is possible. Not only transverse size of a channel influences on flame propagation in micro devices, but its geometry and flow speed as well. The problem about flame propagation in the flow of inflammable mixture is solved in the present study. It is assumed that flame can freely propagate far from narrowing zone because diameter of the channel is more that critical diameter there. Diameter of narrowing zone is less than critical diameter. Data about gas flow velocity, length and diameter of narrowing, which influence on flame propagation limit, are gotten. It is shown that flame can pass through the narrowing even if transverse size is less than critical one, because time of heat exchange between chemical reaction zone and channel walls is limited and depends on the gas flow velocity. Critical diameter of narrowing depending on flow velocity and longitudinal size was constructed. Calculations are made in the frame of two-dimensional model with one-step chemical kinetics, which take into account structure of viscous flow and heat exchange between gas and channel walls.


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Fantasie Rebecca Uw Spacer Moulded Bra Cranberry
Contour/t-shirt, spacer foam underwire cups offer great support, are light and breathe.
Seamless, semi-firm contour cups enable modesty without adding bulk.
Center panel - narrow, tall triangle has bow at top.
Geometric Swiss embroidery at center panel and sides adds lustrous beauty.
Elastic along top and bottom of sides and back for custom fit and comfort.
Diamond-patterned, embroidered applique at inside strap edges presents a beautiful neckline.
Wide elastic straps adjust in the back with coated metal hardware.
Straps are kicked in (placed closer) in back to help prevent slipping.
Back coated metal hook-and-eye closure
Sorry, currently out of stock