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Dive into the research topics where Kelly Timbers is active.

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Featured researches published by Kelly Timbers.


Contraception | 2002

Magnetic resonance imaging to determine the distribution of a vaginal gel: before, during, and after both simulated and real intercourse

E. Scott Pretorius; Kelly Timbers; Daniel Malamud; Kurt T. Barnhart

Abstract To provide effective contraception and protection against sexually transmitted disease, vaginal gels should maximally cover the cervical os and the vaginal epithelium before, during and after intercourse. To non-invasively monitor the intravaginal distribution of an applied intravaginal gel, we performed high-resolution magnetic resonance imaging (MRI) of the female pelvis before, during and after both real and simulated sexual intercourse. We sought to determine whether simulated intercourse with a plastic phallus could be used as a surrogate for real intercourse for such experiments. Dilute gadolinium chelate solution was mixed with Gynol-II gel and introduced intravaginally to volunteer female human subjects using a conventional applicator. MRI was performed at 1.5 Tesla with a surface coil. Imaging of the female pelvis was performed: (1) immediately after insertion of the gel; (2) during real intercourse with a male partner (2 subjects) or simulated intercourse with a plastic phallus (4 subjects); and (3) after completion of real or simulated intercourse. Subjects were studied after application of both 3 mL and 5 mL of vaginal gel. Measurements of gel thickness covering the vaginal mucosa were made digitally using electronic calipers. The bolus of gel is initially located in the upper vaginal canal, superior to the urogenital diaphragm. Both real and simulated intercourse dramatically increases the spread of gel to the lower vagina. The cervix appears to be adequately covered with gel both before and after intercourse. Increasing the volume of the gel increases initial vaginal mucosal coverage but also increases leakage from the introitus. No statistically significant differences in vaginal mucosal coverage were found between patients having undergone real vs. simulated intercourse, or on post-intercourse scans of 3 mL versus 5 mL. MRI is a sensitive, reproducible means of tracking the spread of intravaginal medications.


Journal of Womens Health | 2009

Prediction of outcome in women with symptomatic first-trimester pregnancy: focus on intrauterine rather than ectopic gestation.

Bruno C. Casanova; Mary D. Sammel; Jesse Chittams; Kelly Timbers; Jennifer L. Kulp; Kurt T. Barnhart

OBJECTIVE Symptoms of vaginal bleeding and abdominal pain are common in cases of ectopic pregnancy (EP), spontaneous abortions (SAB), and complications of an intrauterine pregnancy (IUP). It is important to determine if efforts should focus on differentiating EP from an IUP (IUP + SAB) or a viable IUP from a nonviable gestation (EP + SAB) in women at risk for EP. METHODS This is a retrospective cohort study of women who presented with bleeding or pain or both during the first trimester of pregnancy. The cohort was divided into subjects diagnosed with IUP vs. (EP + SAB). The same cohort was then divided into subjects diagnosed with EP vs. (IUP + SAB). Logistic regression models based on risk factors for both outcomes (EP vs. [IUP + SAB] and IUP vs. [EP + SAB]) were obtained. ROC curves as well as Hosmer-Lemeshow goodness of fit and Akaikes information criterion (AIC) were used. RESULTS Overall, 18.1% (n = 367) of the women were diagnosed with EP, 58.8% (n = 1192) were diagnosed with an SAB, and 23.1% (n = 467) had an ongoing IUP. The area under the ROC curve for the model IUP vs. (EP + SAB) was statistically greater than the model EP vs. (IUP + SAB), p < 0.001. AIC and Hosmer-Lemeshow goodness of fit confirmed the better accuracy of the model comparing IUP vs. (EP + SAB). CONCLUSIONS Information collected at initial presentation from women at risk for EP to be used for building prediction rules should focus on differentiating a viable from a nonviable pregnancy rather than attempting to distinguish an extrauterine from an intrauterine pregnancy. However, this distinction should not affect current clinical care.


Contraception | 2002

Use of MRI to determine the in vivo position of a silicone vaginal barrier contraceptive device.

E. Scott Pretorius; Kurt T. Barnhart; Kelly Timbers; Christine K. Mauck

This study was performed to determine the location of a silicone rubber vaginal barrier contraceptive device, the Leas Shield, in vivo. Two women, one parous and one nulligravid, were enrolled in the study. Surface coil, multiplanar Magnetic Resonance Imaging (MRI) was performed immediately following insertion of the contraceptive device, and was repeated following 35-40 min of normal ambulation by the participant.The contraceptive device was markedly hypointense to pelvic structures on both T1 and T2 weighted images. Its position within the vagina and relationship to the cervix were readily identifiable on MR images. The device was located in the upper vagina and completely covered the cervix in both patients. The valve appeared closed, and there was no apparent pressure on the urethra. The position was not altered by ambulation. In conclusion, MRI was a reproducible and rapid means for noninvasively determining the intravaginal location and orientation of a barrier contraceptive device. After insertion, the Leas Shield occupies the upper vagina and completely covers the cervix.


Fertility and Sterility | 2002

Magnetic resonance imaging to determine the distribution of a vaginal gel: before, during and after both simulated and real intercourse

E. Scott Pretorius; Kurt T. Barnhart; Kelly Timbers; Daniel Malamud

To provide effective contraception and protection against sexually transmitted disease, vaginal gels should maximally cover the cervical os and the vaginal epithelium before, during and after intercourse. To non-invasively monitor the intravaginal distribution of an applied intravaginal gel, we performed high-resolution magnetic resonance imaging (MRI) of the female pelvis before, during and after both real and simulated sexual intercourse. We sought to determine whether simulated intercourse with a plastic phallus could be used as a surrogate for real intercourse for such experiments. Dilute gadolinium chelate solution was mixed with Gynol-II gel and introduced intravaginally to volunteer female human subjects using a conventional applicator. MRI was performed at 1.5 Tesla with a surface coil. Imaging of the female pelvis was performed: (1) immediately after insertion of the gel; (2) during real intercourse with a male partner (2 subjects) or simulated intercourse with a plastic phallus (4 subjects); and (3) after completion of real or simulated intercourse. Subjects were studied after application of both 3 mL and 5 mL of vaginal gel. Measurements of gel thickness covering the vaginal mucosa were made digitally using electronic calipers. The bolus of gel is initially located in the upper vaginal canal, superior to the urogenital diaphragm. Both real and simulated intercourse dramatically increases the spread of gel to the lower vagina. The cervix appears to be adequately covered with gel both before and after intercourse. Increasing the volume of the gel increases initial vaginal mucosal coverage but also increases leakage from the introitus. No statistically significant differences in vaginal mucosal coverage were found between patients having undergone real vs. simulated intercourse, or on post-intercourse scans of 3 mL versus 5 mL. MRI is a sensitive, reproducible means of tracking the spread of intravaginal medications.


Contraception | 2004

In vivo distribution of a vaginal gel: MRI evaluation of the effects of gel volume, time and simulated intercourse

Kurt T. Barnhart; E. Scott Pretorius; Kelly Timbers; David Shera; Mayadah Shabbout; Daniel Malamud


Contraception | 2005

Vaginal distribution of two volumes of the novel microbicide gel cellulose sulfate (2.5 and 3.5 mL)

Kurt T. Barnhart; E. Scott Pretorius; Alka Shaunik; Kelly Timbers; Marlina D. Nasution; Christine K. Mauck


Contraception | 2005

Distribution of a 3.5-mL (1.0%) C31G vaginal gel using magnetic resonance imaging

Kurt T. Barnhart; E. Scott Pretorius; Kelly Timbers; David Shera; Mayadah Shabbout; Daniel Malamud


Contraception | 2005

In vivo assessment of Nuvaring® placement

Kurt T. Barnhart; Kelly Timbers; E. Scott Pretorius; Kathleen Lin; Alka Shaunik


Fertility and Sterility | 2004

Hormone pattern after misoprostol administration for a nonviable first- trimester gestation

Kurt T. Barnhart; Thomas J. Bader; Xiangke Huang; Margaret M Frederick; Kelly Timbers; Jun Jim Zhang


Fertility and Sterility | 2007

Prediction of outcome for women with symptomatic first trimester pregnancy: The focus should be on intrauterine rather than ectopic gestation

B.F. Casanova; Mary D. Sammel; Jesse Chittams; Kelly Timbers; Kurt T. Barnhart

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Kurt T. Barnhart

University of Pennsylvania

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David Shera

Children's Hospital of Philadelphia

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Mayadah Shabbout

Children's Hospital of Philadelphia

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Alka Shaunik

University of Pennsylvania

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Christine K. Mauck

Eastern Virginia Medical School

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Jesse Chittams

University of Pennsylvania

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Kathleen Lin

University of Pennsylvania

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Mary D. Sammel

University of Pennsylvania

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