About me

I am a Consultant Urogynaecologist working at Sheffield Teaching Hospitals (STH), one of UK’s busiest and most successful NHS foundation trusts and joined the trust in 2009 after completing my subspecialty training in Urogynaecology. I am the lead for the Perineal trauma services, Paediatric Gynaecology services and Laparoscopic Urogynaecology services at STH. I am actively involved in research, teaching and training and hold several Grants. I have over 60 publications in several areas of Urogynaecology and have widely published on Sexual Function in women with pelvic floor disorders.

My Qualifications

  • MD 2018
  • FRCOG 2013
  • Subspecialty training in Urogynaecology 2008
  • CCT (Obstetrics and Gynaecology) 2008
  • BSCCP 2006
  • Urodynamics SSM 2006
  • Gynaecology Scanning SSM 2006
  • Postgraduate Certificate in Medical Education 2004
  • MRCOG 2000
  • MBBS 1995
  • MD 1999

Prizes

  • Tim Chard Award- Supervised Medical student award for Case history to RCOG. 2017
  • KV Bailey award- Supervised Registrar project on Women’s Attitudes attending PTC. 2016
  • Calcutta Eden Award RCOG – Supervised BMedSci student. 2015
  • First Prize - Harold Malkin Award. RCOG. 2007
  • First Prize - Annual Research meeting of the BSUG. RCOG 2007
  • First Prize - North Trent Regional SpR Presentation. RHH, Sheffield. 2007
  • Gold Medal - BMOGS Spring Meeting, Kettering General Hospital, 2006
  • Gold Medal - BMOGS Autumn Meeting, Birmingham Women Hospital, 2005
  • Gold Medal - BMOGS Spring Meeting, Chepstow, Monmouthshire, 2002
  • First Prize - North Trent SHO Presentation for Obstetrics and Gynaecology Doncaster Royal Infirmary, Doncaster. 2001
  • First Prize - Annual Function of the Surgical Society, PMCH, Bihar, India 1994
  • First Prize - Symposium on Cardiac Failure, PMCH, Bihar, India 1994
  • First Prize - Inter-College English Debate, PMCH, Bihar, India 1992

Academic Distinctions

  • Gold Medal in General Surgery 1995
  • Gold Medal in Ophthalmology 1995
  • Distinctions in Otorhinolaryngology 1995
  • Distinctions in Forensic Medicine and Toxicology 1993
  • Distinctions in Anatomy 1991
  • Distinctions in Physiology 1991
  • Distinctions in Biochemistry 1991

Awards and Grants

  • Insigneo Grant: Elastometer Study for assessment of the Pelvic Floor. 2014
  • Ernest Finch Training fellowship for Consultants. 2013
  • STH Small Grants Scheme (£3000) : Systematic review of the impact of Prolapse surgery on sexual function. 2012
  • Research for patient benefit NiHR Grant (£250,000): Impact of phsyiotherapy on sexual function and a comparison of standard versus electrical stimulation) IPSU study. 2011.
  • STH Small Grants Scheme (£3,200): Systematic review of the impact of stress incontinence surgery on sexual function. 2009
  • UKCS Small Grants Scheme (£2,500): Impact of the Virtual Perineal Trauma clinic on quality and cost of patient care in urogynaecology:a cohort study. 2009
  • Pfizer UK Overactive Bladder/ Detrusor Overactivity Competitive Grants Programme (£10,000): Impact of treatment of OAB on Sexual Function. 2009
  • Medical research Grant - Sheffield Teaching hospitals Charitable Trust (£50,000): Assessing the impact of ePAQ on quality and cost of patient care in Urogynaecology an RCT (co-applicant). 2007
  • Best Candidate Award MOET, Heart of England Foundation Trust.2006
  • Bursary by the West Midlands Deanery of £ 1000 (Postgraduate Certificate in Medical Education at Wolverhampton University.2004

Publications

I am actively involved in Research and Innovation and have presented my work Nationally and Internationally. My publications include -
Peer reviewed articles
  • Campbell P, Jha S, Cutner A. Vaginal mesh in prolapse surgery. TOG Obsterician and Gynaecologist. Volume 20, Issue 1 January 2018 Pages 49–56
  • Vickers H, Gray T, Jha S. Amenorrhoea. InnovAiT Vol 11, Issue 2, pp. 80 - 88. First Published January 24, 2018 https://doi.org/10.1177/1755738017737101
  • Long E, Jha S.Factors that influence patient preference for mode of delivery following an Obstetric Anal Sphincter Injury. Eur J Obstet Gynecol Reprod Biol. 2018 Feb;221:28-33. doi: 10.1016/j.ejogrb.2017.12.002. Epub 2017 Dec 8.
  • Sadler S, Holmes M, Ren S, Holden S, Jha S, Thokala P. Cost-effectiveness of antibiotic treatment of uncomplicated urinary tract infection in women: a comparison of four antibiotics. BJGP Open 19 September 2017; BJGP-2017-0143. DOI: https://doi.org/10.3399/bjgpopen17X101097
  • Gray T, Li W, Campbell P, Jha S, Radley S.Evaluation of coital incontinence by electronic questionnaire: prevalence, associations and outcomes in women attending a urogynaecology clinic. Int Urogynecol J. 2017 Jun 15. doi: 10.1007/s00192-017-3380-x
  • Jha S, Cutner A, Moran P. The UK National Prolapse Survey: 10 years on. Int Urogynecol J. 2017 Sep 15
  • Jha S. Birds of a feather? Jun 2017. BJOG. An International Journal of Obstetrics & Gynaecology
  • Jha S, Walters SJ, Bortolami O, Dixon S, Alshreef A.Impact of Pelvic Floor Muscle Training on Sexual function of women with Urinary Incontinence and a comparison of electrical stimulation versus standard treatment (IPSU Trial): a randomised controlled trial. Jun 2017. Physiotherapy
  • Jha S, Parker V.Risk Factors for Recurrent Obstetric Anal Sphincter Injury (rOASI): A Systematic Review and Meta-analysis. Obstetrical and Gynecological Survey.Sep 2016
  • Jha S. Wrongful Birth Following Failed Sterilisation. BJOG 2016 September; 123 (10): 1683
  • Campbell P, Cloney L, Jha S. Abdominal Versus Laparoscopic Sacrocolpopexy: A Systematic Review and Meta-analysis. Obstet Gynecol Surv 2016 August;71(7):435-42.
  • May L, Jha S, Abdi S. Management of massive retropubic haematoma post-TVT. Int Urogynecol J 2016 August;27(8):1279-80
  • Jha S, Gopinath D.Prolapse or incontinence: what affects sexual function the most? Int Urogynecol J 2016 April;27(4):607-11.
  • Jha S, Parker V. Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis.Int Urogynecol J. 2016 Jun;27(6):849-57. doi: 10.1007/s00192-015-2893-4. Epub 2015 Dec 16.
  • Jha S. Impact of treatment of overactive bladder with anticholinergics on sexual function. Arch Gynecol Obstet 2015 Jul 30 [Epub ahead of print]
  • Jha S. The minefield of informed consent. BJOG 2015 Aug;122(9):1243
  • Jha S, Sultan AH. Obstetric anal sphincter injury: the changing landscape. BJOG 2015 Jun;122(7):931
  • Mistry H, Jha S. Pregnancy with a pinhole introitus: A report of two cases and a review of the literature. Eur J Contracept Reprod Health Care 2015 Dec;20(6):490-4
  • Cloney L, Jha S. A paraurethal cyst with calculi. Int Urogynecol J 2015 Aug;26(8):1247-8
  • Gopinath D, Jha S. Multidisciplinary team meetings in urogynaecology. Int Urogynecol J 2015 Aug;26(8):1221-7
  • Jha S. Ureteric injury: always a guilty verdict? BJOG 2015 Mar;122(4):499
  • Kapaya H, Hashim S, Jha S. OASI: a preventable injury? Eur J Obstet Gynecol Reprod Biol 2015 Feb;185:9-12
  • Jha S, Gray T. A systematic review and meta-analysis of the impact of native tissue repair for pelvic organ prolapse on sexual function. Int Urogynecol J 2015 Mar;26(3):321-7
  • Jha S. The rise and fall of the vaginal mesh. BJOG 2014 Oct;121(11):1438
  • Jha S, Toozs-Hobson P . Impact of ethnicity on urodynamics outcomes. J of Obs and Gynae 2014 Feb;34(2):198-9
  • Jha S, Bika N. Uterine Rupture following termination of pregnancy in a scarred uterus: Case series and literature review. Journal of Obstetrics and Gynaecology Jan. 2014
  • Rogers et al. A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogyne J. 2013, 24 (7), 1091-1103
  • Rockwood TH, Constantine ML, Adegoke O, et al. The PISQ-IR: considerations in scale scoring and development. Int Urogynecol J 2013 Jul;24(7):1105-22
  • Dua A, Jha S, Farkas A, Radley S. The effect of prolapse repair on sexual function in women. J Sex Med 2012 May;9(5):1459-65
  • Duru C, Jha S, Lashen H. Urodynamic outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. Obstet Gynecol Surv 2012 Jan;67(1):45-54
  • Jha S, Strelley K, Radley S. Incontinence during intercourse: myths unravelled. Int Urogynecol J 2012 May;23(5):633-7
  • Dua A, Radley S, Brown S, Jha S, Jones G. The effect of posterior colporrhaphy on anorectal function. Int Urogynecol J 2012 Jun;23(6):749-53.
  • Jha S, Ammenbal M, Metwally M. Impact of incontinence surgery on sexual function: a systematic review and meta-analysis. J Sex Med 2012 Jan;9(1):34-43
  • Jha S, Moran P. The UK national prolapse survey: 5 years on. Int Urogynecol J 2011 May;22(5):517-28. Jha S, Thakar R. Female sexual dysfunction. Eur J Obstet Gynecol Reprod Biol 2010 Dec;153(2):117-23
  • Dua A, Radley S , Jha S , Farkas A . The relationship between age and Impact of pelvic floor symptoms. Neurourology and Urodynamics; August 2010; 29(6): 805-12
  • Raffi F, Jha S, Radley S. Complete bladder prolapse: a case report and literature review. Int Urogynecol J 2010 Dec;21(12):1573-5
  • Jha S, Jones G, Radley S, Farkas A. Factors influencing outcome following the tension-free vaginal tape (TVT). Eur J Obstet Gynecol Reprod Biol 2009 May;144(1):85-7
  • Jha S, Freeman R, Toozs-Hobson P, Richmond D. Urogynaecology training in the UK: past, present and future. Int Urogynecol J Pelvic Floor Dysfunct 2009 Apr;20(4):377-80
  • Jha S, Radley S, Farkas A, Jones G. The impact of TVT on sexual function. Int Urogynecol J Pelvic Floor Dysfunct 2009 Feb;20(2):165-9
  • Jha S, Radley S, Shorthouse A. Infected midurethral tape presenting as an ischiorectal abscess. Int Urogynecol J Pelvic Floor Dysfunct 2008 Jun;19(6):877-9
  • Jha S, Parsons M. Treatment of overactive bladder in the aging population: focus on darifenacin. Clin Interv Aging 2006;1(4):309-16
  • Jones GL, Radley SC, Lumb J, Jha S. Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19(10):1337-1347
  • Jha S, Toozs-Hobson P, Parsons M. Does Preoperative urodynamics alter the management of prolapse surgery? Journal of Obstetrics and Gynaecology.2008.Volume 28, Number 3
  • Jha S, Moran PA. National survey on the management of prolapse in the UK. Neurourol Urodyn 2007;26(3):325-31
  • Jha S, Moran P, Greenham H, Ford C. Sexual function following surgery for urodynamic stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2007 Aug;18(8):845-50
  • Jha S, Moran P, Blackwell A, Greenham H. Integrated care pathways: the way forward for continence services? Eur J Obstet Gynecol Reprod Biol 2007 Sep;134(1):120-5
  • Jha S, Arunkalaivanan AS, Situnayake RD. Prevalence of incontinence in women with benign joint hypermobility syndrome. Int Urogynecol J Pelvic Floor Dysfunct 2007 Jan;18(1):61-4
  • Jha S, Chan KK, Poole CJ, Rollason TP. Pregnancy following recurrent angiosarcoma of the ovary--a case report and review of literature. Gynecol Oncol 2005 Jun;97(3):935-7
  • Jha P, Jha S, Millane TA. Peripartum cardiomyopathy complicated by pulmonary embolism and pulmonary hypertension. Eur J Obstet Gynecol Reprod Biol 2005 Nov 1;123(1):121-3
  • Jha S, Arunkalaivanan AS, Davis J. Surgical management of stress urinary incontinence: a questionnaire based survey. Eur Urol 2005 May;47(5):648-52
  • Jha S, Gee H, Coomarasamy A. Women's attitudes to HIV screening in pregnancy in an area of low prevalence. BJOG 2003 Feb;110(2):145-8
  • Jha S, Sabharwal S. Outcome of colposcopy in women with postcoital bleeding and negative or no cytology - results of a one year audit. Journal of Obstetrics and Gynaecology 2002; 22(3): 299-301
  • Jha S, Roberts LJ Acrania. Journal of Obstetrics and Gynaecology 2003; 23(1): 78
  • Jha S, Haldar M.K, Roberts L.J. Primary ovarian pregnancy with an IUCD in-situ. Journal of Obstetrics and Gynaecology 2002; 22 (1): 104-105
Review
  • Botulinum Toxin in Gynaecology . Current Women's Health Reviews, 2016. 12(2): 105-114
  • A Review of Pelvic Organ Prolapse during Pregnancy. Current Womens Health Reviews. Vol. 10, No.1, 2014
  • Litigation in gynaecology. Swati Jha and Sarah Rowland. TOG 2014; 16 (1): 51-57
  • Urological complications following gynaecological surgery. Gopinath D, Jha S Obstetrics Gynaecology & Reproductive Medicine 01/2013; 23(11):337–342
  • Vaginal Vault Evisceration. Gandhi P, Jha S. The Obstetrician & Gynaecologist Volume 13, Issue 4, pages 231–237, October 2011
  • Female sexual DysfunctionJha S .Thakar R. Eur.J.Obstet.Gynecol.Reprod.Biol. 2010;153:117-23
  • Urogynaecology training in the UK: past present and future. Jha S, Freeman R, Toozs Hobson P, Richmond D. Int.Urogynecol.J.Pelvic.Floor.Dysfunct. 2009. 20; 4: 377- 380.
  • Management of Stress Urinary Incontinence. Jha S, Radley S. Trends in urology, Gynaecology and Sexual health. 2009. 4; 23- 28.
  • Urinary Incontinence: assessment and investigation. Jha S, Farkas A. Obstetrics and Gynaecology Today. 2007;12(11): 509-513
  • Painful Bladder and Interstitial Cystitis. Jha S, Parsons M, Toozs-Hobson P. TOG. 2007; 9: 34-41
  • Treatment of Overactive bladder in the aging population: focus on darifenacin. Jha S, Parsons M.Clinical Interventions in Aging.2006:1(4):309- 316
  • Ureteric injury in obstetrical and gynaecological surgery. Jha S, Coomarasamy A, Chan K K. TOG. 2004; 6 (4). 203-208
Book Chapters
  • Vaginal Vault Evisceration (Gynecologic and Obstetric Surgery - Challenges and Management Options)
  • Sling procedures: Sexual dysfunction (Gynecologic and Obstetric Surgery - Challenges and Management Options)
  • Antepartum haemorrhage. Antenatal Disorders for the MRCOG. 2014
  • Vaginal Vault evisceration. Gynecologic and Obstetric Surgery. 2013
  • TVT and sexual problems. Gynecologic and Obstetric Surgery.2013
  • Problems associated with sexual activity . Jha S. Volume I Section VI Associated Disorders For Cardozo and Staskin. Textbook of Female Urology. 3rd Edition. Informa Healthcare. Volume 1, Section 6. 567- 575. 2010
  • Urinary tract injuries. S Jha. Oxford Desk Reference - Obstetrics and Gynaecology. S. Arulkumaran and A Monga. 2010
  • Uterovaginal prolapse. Oxford Desk Reference - Obstetrics and Gynaecology. S. Arulkumaran and A Monga. 2010
  • Pre-Test Assessment Using Questionnaires. Radley S; Jha S. Urodynamics Illustrated By P Toozs Hobson and R Thakar. RCOG. 2010
  • Chronic pelvic pain. Obstetrics and Gynaecology in Primary Care. Jha S. RCGP Publication. ISBN: 0 85084 285 9. 2003
Case Reports
  • Uterine Rupture following termination of pregnancy in a scarred uterus: Case series and literature review. Jha S et al. Journal of Obstetrics and Gynaecology 2013
  • Complete bladder prolapse: a case report and literature review. Raffi F, Jha S, Radley S. Complete bladder prolapse: a case report and literature review. Int.Urogynecol.J.Pelvic.Floor.Dysfunct. 2010;21:1573-5
  • Ischiorectal Abscess following Retropubic IVS Tape.Jha S, Radley S, Shorthouse A. Accepted for publication in the International Urogynaecology Journal. (Video presentation at IUGA Cancun. 2007)
  • Peripartum cardiomyopathy complicated by pulmonary embolism and pulmonary hypertension. Jha P, Jha S, Millane P A. Eur J Obstet Gynecol Reprod Biol. 2005 Nov 1; 123(1):121-3
  • Pregnancy following recurrent angiosarcoma of the ovary-a case report and review of literature. Jha S, Chan K K, Poole C, Rollason T. Gynaecologic Oncology.2005; 97 (3): 935-937
  • Acrania. Jha S, Roberts LJ. Journal of Obstetrics and Gynaecology 2003; 23(1): 78
  • Primary ovarian pregnancy with an IUCD in-situ. Jha S, Haldar M.K, Roberts L.J. Journal of Obstetrics and Gynaecology 2002; 22 (1): 104-105
Abstracts
  • Injection of Zuidex using implacer for stress urinary incontinence. Arunkalaivanan A, Jha S. (Video) ICS, Paris. 2004
Posters
  • Society for Reproductive Investigation’s 64th Annual Scientific Meeting. Poster presentation "High Pelvic Floor Muscle Stiffness Measured by Vaginal Elastometry Is a Risk Factor for Delayed Second Stage of Labour, Instrumental Vaginal Delivery and Pelvic Floor Damage
  • The effects of Posterior Colporrhaphy on Anorectal Function: A Dua., S. Radley, G Jones, S Jha, S Brown. IUGA 2011/ UKCS 2011
  • The effects of Prolapse repair on Sexual Function. A Dua, S Jha, S Radley, G Jones, A Farkas. IUGA 2011/ UKCS 2011
  • The UK National Prolapse Survey: 5 years on. Jha S, Moran P.IUGA/ICS 2010
  • Outcome of TVT in Mixed Incontinence and its impact on OAB. IUGA.2009. Como. Italy (Poster Presentation)
  • Do age and symptom severity influence TVT outcome? IUGA, Mexico. 2007; UKCS, Birmingham. 2007
  • Patient experience of e-PAQ in clinical practice. IUGA, Mexico. 2007; UKCS, Birmingham. 2007
  • National Survey on the management of anterior and posterior vaginal wall prolapse. ICS, Norwich, UK. 2006
  • National Survey on the management of Apical Vaginal Prolapse. ICS, Norwich, UK. 2006
Letters
  • Letter from India. Jha S. BMA News. 17th October.2009, 19th June. 2009, 9th August 2003
  • What should we tell women preoperatively? Jha S, Toozs-Hobson P. The Obstetrician and Gynaecologist (Lond) 2007; 9: 65
Others
  • The Virtual Urogynaecology Clinic. Radley S, Jha S. Continence UK. 2010
  • Letter from India. Jha S. BMA News. 17th October.2009, 19th June. 2009, 9th August 2003
  • The benefits of an Internet pelvic floor questionnaire. Radley S; Jha S. Continence UK March 2007, Vol 1: Issue 1
  • e-PAQ: bringing quality of life to routine practice. Radley S, Jha S . New Wave.
  • The official Newsletter of the Association of GI physiologists. February 2007, Volume 9 : Issue 1
  • Urinary incontinence: a secondary care perspective. Toozs-Hobson P; Jha S; Birmingham Womens Hospital.
  • Incontinence management handbook and guide to commissioning continence services. Guidelines and Guidelines in Practice. Connect Medical.

Research Interests

Incontinence and prolapse have always been the main focus of my research and publications. Since taking up post as a Consultant, in spite of full time clinical commitments I have continued to be research active and published book chapters, peer reviewed papers and presented at National and International meetings. I have been particularly interested in Sexual function in women with urinary incontinence and have published widely on this subject. I have recently completed recruitment to a multi-centre International trial aimed at developing a validated questionnaire for assessment of sexual function in women with pelvic floor dysfunction co-ordinated by Minnesota University in the US. I am conducting a trial looking at sexual function in women on anticholinergics for overactive bladder.

I am currently evaluating the multidisciplinary team working in Urogynaecology and how it affects clinical practice in complex and primary Urogynaecology problems.

MD Research (Sheffield University)

My chief research interest is in the field of Sexual Function in women with pelvic floor dysfunction. In a study I did 2 years ago, women undergoing a primary continence procedure for urodynamic stress incontinence were assessed preoperatively and six months post operatively using the Pelvic organ prolapse and urinary incontinence sexual function questionnaire (PISQ). This research project has been awarded the Harold Malkin prize for 2007 and led to several presentations and publications. I subsequently conducted another study also assessing sexual function before and after primary continence surgery using ePAQ as the assessment tool and result was very similar. This is also the subject of my MD thesis.

Reviewer

I am a reviewer for the following scintific journals -
  • Journal of Urology
  • British Journal of Obstetrics and Gynaecology
  • International Urogynaecology Journal including Pelvic floor dysfunction
  • European Journal of Obstetrics & Gynecology and Reproductive Biology

Presentations

National & International (excluding local / regional in the past 7 years)
  • ISPOR 19th Annual European Congress Vienna and SMDM conference in Canada Title: ANTIBIOTIC TREATMENT OF UNCOMPLICATED URINARY TRACT INFECTION IN WOMEN: A COMPARATIVE COST-EFFECTIVENESS STUDY
  • SR and meta-analysis of abdominal versus laparoscopic scp: UKCS Belfast. 14.04.16
  • Urogynaecology and Vaginal surgery ATSM National Trainee Survey . Annual Scientific Update in Urogynaecology. 11th November 2016
  • Prevalence of Coital Incontinence in women attending a urogynaecology clinic and its association with SUI and OAB; Annual Scientific Update in Urogynaecology. 11th November 2016
  • IPSU study: a randomized control trial. Annual Scientific Update in Urogynaecology. 11th November 2016
  • The Urogynaecology MDT. Gopinath D. Jha S. UKCS. 2014
  • What affects Sexual function more Incontinence or prolapse. Gopinath D. Jha S. IUGA 2013
  • Incontinence during intercourse: Myths unravelled. Jha S. Strelly K, Radley S. IUGA June 2011
  • Impact of OASI : are 4th degree tears really worse than 3rd degree tears. Jha S, P Amarad, Tracey L, Hunt L. IUGA June 2011
  • Impact of Incontinence surgery on Sexual Function: a Systematic Review and meta-analysis . Jha S, Ammembal M K, Metwally M. IUGA/ICS 25-27 Aug 2010
  • The relationship between age & the impact of pelvic floor symptoms: 'The 4,000 women study' Dua A, Radley S, Jones G , Jha S, Farkas A, Brown S. IUGA/ICS 25-27 Aug 2010
  • Evaluation of risk factors for Obstetric Anal Sphincter Injury (OASI): Is Risk Scoring System feasible? Kamath Ammembal M , Jha S, Keriakos R ; UKCS April 2010; IUGA/ICS 25-27 Aug 2010
  • Impact of Ethnicity on Urodynamic outcomes. UKCS 2009. Swansea.
  • Relationship between OAB and the Outcome with TVT. UKCS 2009. Swansea
  • Sexual Function following a TVT. Taiwan, IUGA. 2008. UKCS, Basingstoke. 2008. Annual Research Meeting BSUG, RCOG. 2007
  • Training in Urogynaecology in the UK. EUGA. Budapest.2008
  • Impact of Parkinson Disease on the Pelvic Floor. Taiwan, IUGA. 2008.UKCS. Basingstoke. 2008
  • The bladder is a complex witness. UKCS, Basingstoke. 2008.(Poster at Taiwan, IUGA. 2008)