Home Browse The effects of different positions on neurodevelopment in preterm...
ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
▬
✚
Study Protocol

The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol

[version 1; peer review: 1 approved]
Sharath Hullumani
https://orcid.org/0009-0000-2926-5609
1, Raghumahanti Raghuveer
https://orcid.org/0000-0001-7696-0786
2, Moh'd Irshad Qureshi2
Sharath Hullumani
https://orcid.org/0009-0000-2926-5609
1, Raghumahanti Raghuveer
https://orcid.org/0000-0001-7696-0786
2, Moh'd Irshad Qureshi2
PUBLISHED 23 Apr 2024
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

Introduction

Preterm birth poses significant challenges to infant health, with neurodevelopmental outcomes often affected. In the Neonatal Intensive Care Unit (NICU), positioning strategies are commonly employed with the aim of mitigating adverse effects and promoting neurodevelopment in preterm infants. However, the evidence regarding the impact of different positions on neurodevelopmental outcomes remains heterogeneous and inconclusive.

Objective

The aim of this systematic review is to evaluate the effects of different positioning strategies on neurodevelopmental outcomes in preterm infants admitted to Neonatal Intensive Care Units (NICUs).

Methods

A comprehensive search will be conducted in electronic databases including PubMed, MEDLINE, EMBASE, and Cochrane Library. To comply with the established guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the systematic review will be conducted to identify relevant studies published up to the date of the search. This systematic review protocol has been registered in PROSPERO to ensure thorough and transparent reporting of the search process, synthesis of findings, and analysis methods.

Discussion

In the context of preterm infants admitted to Neonatal Intensive Care Units (NICUs), the discussion surrounding the effects of different positions on neurodevelopmental outcomes is multifaceted and warrants careful consideration. Variations in study methodologies, including sample sizes, outcome measures, and follow-up durations, underscore the need for standardized approaches to facilitate comparison and synthesis of findings. The heterogeneity in reported outcomes, ranging from cognitive and motor development to sensory processing, highlights the complexity of neurodevelopmental assessment in this population and emphasizes the importance of comprehensive evaluation frameworks. Through rigorous synthesis and analysis of existing literature, our protocol aims to contribute meaningful insights that can drive future research agendas and enhance neurodevelopmental outcomes for this vulnerable population.

Systematic Review Registration number

CRD42023492163

Keywords

Infant Positioning, Positions, Preterm Infant, Neonatal intensive Care unit

Corresponding author: Sharath Hullumani
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2024 Hullumani S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Hullumani S, Raghuveer R and Qureshi MI. The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved]. F1000Research 2024, 13:314 (https://doi.org/10.12688/f1000research.148711.1) First published: 23 Apr 2024, 13:314 (https://doi.org/10.12688/f1000research.148711.1) Latest published: 23 Apr 2024, 13:314 (https://doi.org/10.12688/f1000research.148711.1)

Introduction

The care and management of preterm infants in Neonatal Intensive Care Units (NICUs) are pivotal for their overall health and developmental outcomes. Among the various factors influencing their development, the positioning of preterm infants has garnered significant attention. Positioning practices in NICUs vary widely, ranging from supine, prone, lateral, and tilted positions, each potentially impacting neurodevelopmental trajectories differently.1–5

Babies born before 37 weeks of gestation are categorized as preterm, disrupting their growth and development within the womb and exposing them to a different environment. Their immature organs aren’t ready for typical newborn care practices like swaddling and breastfeeding. Very preterm (under 28 weeks) and moderately preterm (28–32 weeks) babies often need complex interventions to survive, requiring caregivers with advanced skills. The global impact of prematurity, including its long-term effects, is significant, and more focus is needed on mitigating these negative consequences due to the limited progress in preventing preterm births. Further research is necessary to optimize the growth and development of premature infants, especially regarding neurodevelopmental outcomes.6,7

Although developmental care interventions have shown positive effects on preterm infants’ neurological outcomes and development, consistent implementation of best practices remains lacking. Among these interventions, developmental positioning stands out for its benefits on posture, musculoskeletal health, physiologic outcomes, and sleep patterns. However, there’s no standardized approach to developmental positioning; different methods, including commercial products and simple linen rolls, have been studied. Despite being recognized as crucial in NICUs, developmental positioning is not consistently adopted worldwide, and relying solely on positioning aids can create a false sense of security. Bridging the gap between evidence and practice in NICUs regarding developmental positioning is crucial, as its effectiveness is established, but methods to enhance proficiency in providing such care require further exploration.8–10

The neurodevelopmental journey of preterm infants is particularly sensitive during their NICU stay, given the critical period of brain development occurring outside the womb. The environment provided in the NICU, including the positioning of infants, plays a crucial role in shaping their neurological outcomes. Understanding the effects of different positions on neurodevelopment is paramount for optimizing care protocols and enhancing long-term outcomes for preterm infants.11

Despite numerous studies examining the influence of positioning on preterm infants’ neurodevelopment, the evidence remains fragmented and lacks comprehensive synthesis. Thus, a systematic review is warranted to consolidate existing literature, elucidate patterns, and provide insights into the optimal positioning strategies for promoting neurodevelopment in preterm infants within NICU settings.12–15

In this systematic review, we aim to analyze and synthesize the available evidence regarding the effects of different positions on neurodevelopmental outcomes in preterm infants admitted to NICUs. By systematically reviewing and critically appraising relevant studies, we seek to identify key factors influencing neurodevelopmental outcomes, explore potential mechanisms underlying the observed effects, and offer recommendations for evidence-based positioning practices in NICU settings.

Through this review, we aspire to contribute to the enhancement of NICU care protocols, facilitate informed decision-making among healthcare providers, and ultimately improve the neurodevelopmental outcomes of preterm infants during their critical early stages of life.

Review question(s)

“Does the available evidence support the influence of different positions on neurodevelopmental outcomes in preterm infants within Neonatal Intensive Care Units.

Inclusion criteria

Population

Preterm infants (gestational age <37 weeks) admitted to Neonatal Intensive Care Units, with inclusion criteria encompassing infants without major congenital anomalies or severe medical complications, and exclusion criteria comprising infants with congenital neurologic disorders or life-threatening conditions.

Intervention

The interventions involve examining various body positions (e.g., prone, supine, lateral) in preterm infants admitted to Neonatal Intensive Care Units, with inclusion criteria considering studies implementing position-based interventions and exclusion criteria excluding studies with combined interventions or those focusing solely on handling techniques without positional changes.16,17

Comparator

The interventions, involving various body positions in preterm infants admitted to Neonatal Intensive Care Units, will be compared against standard care or alternative positioning strategies, with inclusion criteria considering studies with a comparative design, and exclusion criteria involving studies lacking a control group or comparing interventions not related to positional changes.

Outcomes

The pre-specified main outcomes include neurodevelopmental assessments in preterm infants, defined by standardized tools measuring cognitive, motor, and sensory functions, with inclusion criteria incorporating studies reporting outcomes at follow-up periods during infancy and early childhood. The effect measures for the main outcomes, including cognitive, motor, and sensory functions in preterm infants, will primarily involve standardized mean differences (SMDs) or, if feasible, relative risks (RRs) with 95% confidence intervals, to quantify the impact of different positions on neurodevelopment in Neonatal Intensive Care Units.

Type of studies

Randomized Controlled trials, Systematic Review will be included. Non-randomized, cross-sectional studies, observational, descriptive studies, observational analytical research designs, such as case-control & and cohort studies, and qualitative study designs, such as qualitative case studies, narrative studies, etc., will be excluded. Since there are no resources available for translating research written in languages other than English, only published and unpublished English-language studies will be included. Targeted research that has been published between 2004-2024 will be included.

Methods

This protocol describes how a systematic review should be carried out in compliance with the PRISMA-P recommendations for systematic reviews that have been referred to. The F1000 journal methodology for the systematic review of effectiveness will be followed in all steps involved in carrying out this systematic review. This systematic review protocol has been registered in PROSPERO (CRD42023492163).

Search strategy

Selection Criteria: Studies that meet the inclusion requirements positioning techniques will be chosen. A thorough exploration of several electronic databases, such as PubMed/Medline, Scopus, and Cochrane Library, will be carried out to locate pertinent research articles published in peer-reviewed publications.

Study selection

The research findings will be managed using citation management software. After removing duplicates, two reviewers from each team will utilize Rayyan QCRI to screen and assess titles and abstracts in three domains based on inclusion and exclusion criteria.18,19 Using RRID, three independent reviewers will further scrutinize titles and abstracts against the review’s criteria. Once the initial screening is complete, all pertinent studies will undergo comprehensive evaluation by three independent reviewers to determine adherence to inclusion criteria. The final analysis will document reasons for exclusion of full-text papers that did not meet the inclusion criteria.

Assessment of methodological quality and risk of bias

Studies will be selected based on predefined inclusion/exclusion criteria, and data extraction will involve relevant details such as study design, participant characteristics, interventions, outcomes, and follow-up periods, using a standardized form, with extraction and recording conducted independently by two reviewers and discrepancies resolved through consensus.

In addition, a concurrent risk of bias assessment will be performed on the publications using the Standards for Reporting Implementation Studies (StaRI)20 checklist and, PEDRO Scale for rating the methodological quality of RCTs selected.21,22 It is also determined in advance to use the SWiM (Synthesis without Meta-analysis)20 guidelines to create a narrative overview of the chosen papers from the standpoint of implementation research.

Data extraction

Data items: Studies will be selected based on predefined criteria; data extraction will include study design, participant characteristics, interventions, and outcomes, performed using a standardized form; two independent reviewers will conduct the process, with discrepancies resolved through consensus and recorded systematically.

Extraction method: To methodically record pertinent data from each included study, a uniform data extraction form will be designed in Microsoft Excel sheet. The data will be extracted by two impartial reviewers, and any disagreements will be settled by discussion or, if required, consultation with a third reviewer.

Data synthesis

The effect measures for the main outcomes, including cognitive, motor, and sensory functions in preterm infants, will primarily involve standardized mean differences (SMDs) or, if feasible, relative risks (RRs) with 95% confidence intervals, to quantify the impact of different positions on neurodevelopment in Neonatal Intensive Care Units.

A detailed summary of the primary findings drawn from the included studies will be given, detailing the features of the subjects, the interventions, and the results. The narrative synthesis will entail a qualitative examination of the parallels and discrepancies among the study findings, with an emphasis on how well positing techniques impact the neurodevelopment in preterm infants.

Study status

Piloting of the study selection process is being undertaken.

Discussion

The findings of this systematic review provide insights into the complex interplay between positioning and neurodevelopment in preterm infants admitted to NICUs. While prone positioning may offer benefits for motor development, concerns regarding safety and adverse respiratory outcomes limit its widespread adoption. Conversely, supine positioning, while protective against SIDS, raises concerns regarding its potential impact on motor development. Lateral positioning and semi-reclined positioning represent alternative strategies that warrant further investigation to optimize neurodevelopmental outcomes in preterm infants.23,24

Clinical practice should prioritize individualized positioning strategies tailored to the specific needs of preterm infants, taking into account their gestational age, medical condition, and developmental stage. Multidisciplinary collaboration between neonatologists, physical therapists, and developmental specialists is essential to optimize positioning practices and minimize adverse outcomes. Future research should focus on longitudinal studies evaluating the long-term effects of different positioning strategies on neurodevelopmental outcomes, including motor, cognitive, and sensory function.

In conclusion, positioning plays a crucial role in the care of preterm infants admitted to NICUs, with potential implications for neurodevelopmental outcomes. Clinicians should weigh the benefits and risks of different positions and prioritize evidence-based practices to promote optimal neurodevelopment in this vulnerable population. Further research is needed to elucidate the optimal positioning strategies that balance the competing priorities of safety, respiratory support, and neurodevelopmental optimization in preterm infants.

Ethical considerations

Not applicable.

Data availability statement

No data are associated with this article.

Extended data

Figshare: PRISMA-P-checklist (A Systematic Review on the effects of Different Positions on Neurodevelopment in Preterm Infants admitted in Neonatal Intensive Care Units).pdf. https://doi.org/10.6084/m9.figshare.25283671.v1.

Figshare: Preliminary Data Search Strategy for A Systematic Review on the effects of Different Positions on Neurodevelopment in Preterm Infants admitted in Neonatal Intensive Care Units. https://figshare.com/s/a7b9cd9afe297050cf91.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

  • 1.  Flacking R, Lehtonen L, Thomson G, et al.: Closeness and separation in neonatal intensive care. Acta Paediatr. 2012 Oct; 101(10): 1032–1037. PubMed Abstract | Publisher Full Text | Free Full Text
  • 2.  Wang Y, Zhao T, Zhang Y, et al.: Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed. Med. 2021 Apr; 16(4): 282–291. PubMed Abstract | Publisher Full Text
  • 3.  Firmino C, Rodrigues M, Franco S, et al.: Nursing Interventions That Promote Sleep in Preterm Newborns in the Neonatal Intensive Care Units: An Integrative Review. Int. J. Environ. Res. Public Health. 2022 Sep 2; 19(17): 10953. PubMed Abstract | Publisher Full Text | Free Full Text
  • 4.  Cristóbal Cañadas D, Parrón Carreño T, Sánchez Borja C, et al.: Benefits of Kangaroo Mother Care on the Physiological Stress Parameters of Preterm Infants and Mothers in Neonatal Intensive Care. Int. J. Environ. Res. Public Health. 2022 Jun 11; 19(12): 7183. PubMed Abstract | Publisher Full Text | Free Full Text
  • 5.  Embleton ND, Jennifer Moltu S, Lapillonne A, et al.: Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J. Pediatr. Gastroenterol. Nutr. 2023 Feb 1; 76(2): 248–268. PubMed Abstract | Publisher Full Text
  • 6.  Bry A, Wigert H: Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study. BMC Psychol. 2019 Nov 29; 7(1): 76. PubMed Abstract | Publisher Full Text | Free Full Text
  • 7.  Eichenwald EC; COMMITTEE ON FETUS AND NEWBORN: Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants. Pediatrics. 2018 Jul; 142(1): e20181061. Epub 2018 Jun 18. PubMed Abstract | Publisher Full Text
  • 8.  Campbell-Yeo M, Johnston CC, Benoit B, et al.: Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial. Pain. 2019 Nov; 160(11): 2580–2588. PubMed Abstract | Publisher Full Text
  • 9.  Lapillonne A, Bronsky J, Campoy C, et al.: Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 2019 Aug; 69(2): 259–270. PubMed Abstract | Publisher Full Text
  • 10.  Angelhoff C, Blomqvist YT, Sahlén Helmer C, et al.: Effect of skin-to-skin contact on parents’ sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial. BMJ Open. 2018 Aug 1; 8(7): e021606. PubMed Abstract | Publisher Full Text | Free Full Text
  • 11.  Kurt FY, Kucukoglu S, Ozdemir AA, et al.: The effect of kangaroo care on maternal attachment in preterm infants. Niger. J. Clin. Pract. 2020 Jan; 23(1): 26–32. PubMed Abstract | Publisher Full Text
  • 12.  Aagaard H, Uhrenfeldt L, Spliid M, et al.: Parents’ experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit: a systematic review protocol. JBI Database System Rev. Implement. Rep. 2015 Oct; 13(10): 123–132. PubMed Abstract | Publisher Full Text
  • 13.  Pineda R, Guth R, Herring A, et al.: Enhancing sensory experiences for very preterm infants in the NICU: an integrative review. J. Perinatol. 2017 Apr; 37(4): 323–332. PubMed Abstract | Publisher Full Text | Free Full Text
  • 14.  Cristóbal Cañadas D, Bonillo Perales A, Galera Martínez R, et al.: Effects of Kangaroo Mother Care in the NICU on the Physiological Stress Parameters of Premature Infants: A Meta-Analysis of RCTs. Int. J. Environ. Res. Public Health. 2022 Jan 5; 19(1): 583. PubMed Abstract | Publisher Full Text | Free Full Text
  • 15.  Franck LS, O’Brien K: The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care. Birth Defects Res. 2019 Sep 1; 111(15): 1044–1059. PubMed Abstract | Publisher Full Text
  • 16.  de Bijl-Marcus K , Brouwer AJ, De Vries LS, et al.: Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study. Arch. Dis. Child. Fetal Neonatal Ed. 2020 Jul; 105(4): 419–424. PubMed Abstract | Publisher Full Text
  • 17.  Shukla VV, Bansal S, Nimbalkar A, et al.: Pain Control Interventions in Preterm Neonates: A Randomized Controlled Trial. Indian Pediatr. 2018 Apr 15; 55(4): 292–296. PubMed Abstract | Publisher Full Text
  • 18.  Moher D, Shamseer L, Clarke M, et al.: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst. Rev. 2015 Dec; 4(1): 1–9. PubMed Abstract | Publisher Full Text | Free Full Text
  • 19.  Ouzzani M, Hammady H, Fedorowicz Z, et al.: Rayyan—a web and mobile app for systematic reviews. Syst. Rev. 2016; 5: 210. PubMed Abstract | Publisher Full Text | Free Full Text
  • 20.  Pinnock H, Barwick M, Carpenter CR, et al.: Standards for Reporting Implementation Studies (StaRI) Statement. BMJ. 2017 Mar 6; 356: i6795. Publisher Full Text
  • 21.  Von Elm E, Altman DG, Egger M, et al.: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J. Clin. Epidemiol. 2008 Apr; 61(4): 344–349. Publisher Full Text
  • 22.  Chulz KF, Altman DG, Moher D: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010 Mar 23; 340: c332. PubMed Abstract | Publisher Full Text | Free Full Text
  • 23.  Campbell M, McKenzie JE, Sowden A, et al.: Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020 Jan 16; 368: l6890. Publisher Full Text
  • 24.  Hannan KE, Smith RA, Barfield WD, et al.: Association between Neonatal Intensive Care Unit Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants. J. Pediatr. 2020 Dec; 227: 114–120.e1. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 23 Apr 2024
Comment
Author details Author details
Competing interests
Grant information
Article Versions (1)
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
 - -
Citations
SEE MORE DETAILS
CITE
how to cite this article
Hullumani S, Raghuveer R and Qureshi MI. The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved]. F1000Research 2024, 13:314 (https://doi.org/10.12688/f1000research.148711.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 23 Apr 2024
Views
4
Cite
Reviewer Report 23 Aug 2025
Eugenio Baraldi, University of Padua, Padua, Italy 
Maria Elena Cavicchiolo, Department of Woman's and Child's Helath, University of Padua Department of Women's and Children's Health (Ringgold ID: 165488), Padua, Veneto, Italy 
Approved
VIEWS 4
https://doi.org/10.5256/f1000research.163058.r405122
This is a well written protocol, the introduction outlines the clinical problem: preterm infants face neurodevelopmental challenges, and positioning in the NICU may influence outcomes. The knowledge gap is well-defined: existing studies are heterogeneous and inconclusive and the objective is ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Baraldi E and Cavicchiolo ME. Reviewer Report For: The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved]. F1000Research 2024, 13:314 (https://doi.org/10.5256/f1000research.163058.r405122)
The direct URL for this report is:
https://f1000research.com/articles/13-314/v1#referee-response-405122
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Report a concern
  • Author Response 10 Sep 2025
    Dr. Sharath Hullumani V, Department of Paediatrics Physiotherapy, Datta Meghe Institute Higher Education and Research (DU), Sawangi Meghe, Wardha, 442004, India
    10 Sep 2025
    Author Response
    Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your ... Continue reading
    Report a concern
  • Respond or Comment
COMMENTS ON THIS REPORT
  • Author Response 10 Sep 2025
    Dr. Sharath Hullumani V, Department of Paediatrics Physiotherapy, Datta Meghe Institute Higher Education and Research (DU), Sawangi Meghe, Wardha, 442004, India
    10 Sep 2025
    Author Response
    Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your ... Continue reading
    Report a concern

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 23 Apr 2024
Comment

Open Peer Review

Reviewer Status

Alongside their report, reviewers assign a status to the article:

Approved
The paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved
Fundamental flaws in the paper seriously undermine the findings and conclusions

Reviewer Reports

Invited Reviewers
1
Version 1
23 Apr 24 		read
  1. Eugenio Baraldi, University of Padua, Padua, Italy
    Maria Elena Cavicchiolo, University of Padua Department of Women's and Children's Health (Ringgold ID: 165488), Padua, Italy

Comments on this article

All Comments(0)

Add a comment
Sign up for content alerts

Browse by related subjects

    keyboard_arrow_left Back to all reports
    Alongside their report, reviewers assign a status to the article:
    Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
    Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
    Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
    Sign In
    If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

    The email address should be the one you originally registered with F1000.
    Email address not valid, please try again

    You registered with F1000 via Google, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Google account password, please click here.

    You registered with F1000 via Facebook, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Facebook account password, please click here.

    Code not correct, please try again
    Email us for further assistance.
    Server error, please try again.