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Articles 1 - 27 of 27

Full-Text Articles in Alternative and Complementary Medicine

Assessing Correlation Between Manual Dexterity, Specialty Choice And Desire To Practice Omt In Newly Admitted Osteopathic Medical Students, Valerie Rome, Nils Brolis May 2023

Assessing Correlation Between Manual Dexterity, Specialty Choice And Desire To Practice Omt In Newly Admitted Osteopathic Medical Students, Valerie Rome, Nils Brolis

Rowan-Virtua Research Day

Is there any relationship between manual dexterity, specialty choice, and the use of osteopathic manipulative treatment (OMT) in newly-admitted osteopathic medical students? Hand dexterity has previously been associated with surgical skill development in medical residents. There is currently a gap in the scientific literature in regards to the use of one’s hands and the career choice they ultimately pursue, in addition to interest in performing OMT in their respective fields. To help elucidate the answer this question, this SMRF project aimed to evaluate the relationship between manual dexterity, specialty choice, and use of osteopathic manipulative treatment (OMT) in newly admitted …


Case Report And Review: Hawthorne Root Toxicity, James Espinosa, Darren Finn, Alan Lucerna May 2023

Case Report And Review: Hawthorne Root Toxicity, James Espinosa, Darren Finn, Alan Lucerna

Rowan-Virtua Research Day

Here we present the case of a patient who purchased a hawthorn root product, Raiz de Tejocote, for weight loss purposes. The side effect profile seen, including a positive digoxin level, are consistent with hawthorn root. This case reinforces the importance of asking a patient about all medications, including over the internet medications.


Impact Of Osteopathic Manipulative Therapy (Omt) On Morbidity In Pregnant Persons Aged 18-39, Jessica-Sophie Chang Horoschak May 2023

Impact Of Osteopathic Manipulative Therapy (Omt) On Morbidity In Pregnant Persons Aged 18-39, Jessica-Sophie Chang Horoschak

Rowan-Virtua Research Day

Background: Rates of maternal morbidity and mortality in the United States continue to rise.1 Pregnant persons are more vulnerable to stress and morbidities associated with the physiological changes of pregnancy. Low back pain and posterior pelvic pain are of high incidence experienced in pregnant persons.2 Prevention strategies are necessary to improve maternal health outcomes in the United States. Some studies have shown that Osteopathic Manipulative Therapy (OMT) can be an effective treatment modality for pregnant patients experiencing somatic pain. These studies, however, are limited and of small sample size.

Purpose: To examine the current literature on the impact of OMT …


Whole Body Cryotherapy As A Novel Treatment For Long Covid Syndrome Associated Brain Fog, James Mack, Brandon Goodwin, Paras Patel, Kyra Herman, Daniel Casal, Emily Levenson May 2023

Whole Body Cryotherapy As A Novel Treatment For Long Covid Syndrome Associated Brain Fog, James Mack, Brandon Goodwin, Paras Patel, Kyra Herman, Daniel Casal, Emily Levenson

Rowan-Virtua Research Day

SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19), was first discovered in December 2019 in Wuhan, China when adults began presenting with severe pneumonia of an unknown cause. SARS-CoV-2 can cause a wide range of clinical manifestations. SARS-CoV-2 can penetrate the olfactory mucosa and may enter the brain through the cribriform plate along the olfactory tract, through vagal or trigeminal pathways, or pass through the blood-brain barrier. Once inside the brain, levels of inflammatory cytokines are increased and can lead to altered learning, memory, neuroplasticity, hallucinations, nightmares, cognitive and attention deficits, new-onset anxiety and depression, and psychosis. A theoretical treatment for …


Barriers To Doula Use In New Jersey After 2021 Medicaid Coverage Expansion, June Solow, Aashna Reddy, Natali Sharma, Jonathan Lewis May 2023

Barriers To Doula Use In New Jersey After 2021 Medicaid Coverage Expansion, June Solow, Aashna Reddy, Natali Sharma, Jonathan Lewis

Rowan-Virtua Research Day

Background: Doulas are trained non-clinical professionals that provide continuous support to a pregnant mother from the prenatal to postpartum period. Presence of a doula has been shown to benefit both mother and newborn health.

Purpose: To determine what prevents doula utilization in New Jersey.

Methods: A review of the current literature about doulas, mothers, clinicians, and legislation in other states was conducted. This included qualitative and quantitative data gathered in the United States.

Results: The most significant barrier from both the mother’s and doula’s perspectives is cost. Besides cost, diversity and number of doulas is low. A major barrier to …


The Use Of Osteopathic Manipulative Medicine To Treat Common Pediatric Conditions: A Literature Review, Sonya Priven, Emily Meale, Danielle Cooley May 2023

The Use Of Osteopathic Manipulative Medicine To Treat Common Pediatric Conditions: A Literature Review, Sonya Priven, Emily Meale, Danielle Cooley

Rowan-Virtua Research Day

Context: Doctors of Osteopathic Medicine (DOs) are physicians who are trained in the practice of osteopathic manipulative treatment (OMT). OMT is a form of manual manipulation that can be applied to the patient’s body to aid the body in its own healing properties. The overprescribing and overuse of medication is currently a problem, as it can result in adverse consequences such as antibiotic resistance. Exploring OMT as either an alternative or as a complementary therapy in the pediatric population is beneficial in potentially curbing antibiotic use and improving symptoms and disease-related processes.

Objective: To explore OMT as a therapy for …


The Efficacy Of Osteopathic Manipulative Treatment In Reducing Pain Medication Usage In Chronic Pain Patients: A Brief Literature Review, Catherine Alapatt, Kinjal Shah May 2023

The Efficacy Of Osteopathic Manipulative Treatment In Reducing Pain Medication Usage In Chronic Pain Patients: A Brief Literature Review, Catherine Alapatt, Kinjal Shah

Rowan-Virtua Research Day

Chronic pain is one of the most common complaints for adult patients. Chronic pain almost always includes a pharmacological approach which can involve opioids and non opioids. Non-pharmacological approaches are less commonly used by patients with chronic pain, despite the significant misuse of opioids in the treatment of chronic pain. There is a need for nonpharmacological therapies in the treatment of chronic pain patients to lessen the misuse of opioids. One underused form of nonpharmacological therapy for chronic pain is OMT. There have been several studies demonstrating OMT to be effective in treating chronic pain conditions. In addition, there is …


The Virtues Of Osteopathic Manipulative Treatments In Patients With Opioid Use Disorder, Rachel Shmuts, Heather Soled, Kyle Street, David Abend May 2023

The Virtues Of Osteopathic Manipulative Treatments In Patients With Opioid Use Disorder, Rachel Shmuts, Heather Soled, Kyle Street, David Abend

Rowan-Virtua Research Day

As America continues to face the opioid epidemic, numerous people have made great strides in receiving formal treatment for their opioid use disorder (OUD). This research seeks to examine the effects providing OMT along with traditional OUD pharmacological methods in providing results for patients. By utilizing prior research on OMT techniques, we were able to uncover how effective OMT can be in reducing the time and discomfort associated with seeking opioid recovery. OMT in combination with traditional pharmacology was associated with reduction of somatic pain, higher success with MAT, as well as lowered costs. This research also highlights the importance …


Differences Between Complementary And Alternative Medicine Use Among Chinese Immigrants, Emily Wang, Heet Patel, Jiexi Hu May 2023

Differences Between Complementary And Alternative Medicine Use Among Chinese Immigrants, Emily Wang, Heet Patel, Jiexi Hu

Rowan-Virtua Research Day

Among Asian-American patients, complementary and alternative medicine is utilized at an exceedingly high rate alongside conventional medicine, due to it being more readily accessible and affordable. It is also a form of medicine that Asian people are more attuned to due to having been used for generations in their culture.1 Surveys conducted by Mackenzie et al., demonstrate that complementary and alternative medicine (CAM) is reportedly used at a higher rate in females of Asian descent and amongst uninsured patients as well as with patients of a lower educational status. 2 In addition, multiple studies have also demonstrated that patients suffering …


Release The Kratom: Post-Acute Withdrawal Syndrome In A 70 Year Old Male, Nardin El-Shammaa, Kyle Street, Narshima Pinninti May 2023

Release The Kratom: Post-Acute Withdrawal Syndrome In A 70 Year Old Male, Nardin El-Shammaa, Kyle Street, Narshima Pinninti

Rowan-Virtua Research Day

Centuries in Eastern medicine.. Kratom has been commonly used for chronic pain and opiate withdrawal symptoms with first reported cases in the United States in the early 2000s. It is a plant that consists of psychoactive alkaloids that target opioid receptors with different affinity. Effects from Kratom are dose-dependent, at lower doses, it acts as a stimulant, while at higher doses produces analgesia and euphoria. Although Kratom is legal and easily accessible over the counter, there have been increasing reports of potential for addiction and toxicity. Cessation of Kratom can result in withdrawal symptoms similar to opiate withdrawal. Here we …


The Blurred Lines Between Medicine And Wellness: A Historical Approach Comparing Osteopathic Physicians, Chiropractors, And Physical Therapists, Heather Soled, Dylan Trawinski, Sonya Priven, Sheam Jahan May 2023

The Blurred Lines Between Medicine And Wellness: A Historical Approach Comparing Osteopathic Physicians, Chiropractors, And Physical Therapists, Heather Soled, Dylan Trawinski, Sonya Priven, Sheam Jahan

Rowan-Virtua Research Day

In modern society, there stands a large number of medical titles with nuances that complicate the layperson’s ability to differentiate standard of care and capabilities. As the world evolves, new job opportunities in the medical and related fields are being constructed to provide positions with various levels of certifications that qualify many caregivers to provide similar and often coexisting levels of care. Some disciplines may agree or disagree on principle; this is just one point of confusion for the mass. Furthermore, disciplines that disagree on principle may still apply analogous treatment models. Such confusion has yielded several challenges for less …


An Herbal Liver Effect: Ashwagandha-Induced Hepatotoxicity, Mohammad Rattu, Eric Maddock, James Espinosa, Alan Lucerna, Neeharika Bhatnagar May 2022

An Herbal Liver Effect: Ashwagandha-Induced Hepatotoxicity, Mohammad Rattu, Eric Maddock, James Espinosa, Alan Lucerna, Neeharika Bhatnagar

Rowan-Virtua Research Day

Ashwagandha is a popular Ayurvedic herb that is derived from the extracts of the roots of Withania somnifera, an evergreen shrub endemic to India and Southeast Asia. It is generally utilized as a tonic to increase one’s energy and reduce stress levels. Often referred to as “Indian ginseng”, it provides neuroprotective and anti-inflammatory properties that address stress, pain, and fatigue. Additionally, it may assist in dealing with rashes, diabetes, and arthritis. It has also been shown to counteract the effects of aging. Though these properties have not been shown in prospective studies, it has become a popular product among western …


Case Report: Epigastric Abdominal Pain From Beverage Ingestion Of Freshly Squeezed Juice Of The Hardy Orange Flying Dragon Plant (Poncirus Trifoliata), James Espinosa, Alan Lucerna, David Ho May 2022

Case Report: Epigastric Abdominal Pain From Beverage Ingestion Of Freshly Squeezed Juice Of The Hardy Orange Flying Dragon Plant (Poncirus Trifoliata), James Espinosa, Alan Lucerna, David Ho

Rowan-Virtua Research Day

We report the case of a 25 year old male who presented to the ED with epigastric abdominal pain after ingesting a freshly squeezed beverage form of Flying Dragon Hardy Orange plant (Poncirus trifoliata). Poison control was contacted and recommended symptomatic treatment only. The patient’s pain resolved while in the emergency department. Seed and rind preparations have been used as an herbal remedy in East Asia. Freshly squeezed Poncirus trifoliata can cause significant abdominal pain.


Effect Of Osteopathic Manipulative Treatment In Patients With Postural Orthostatic Tachycardia Syndrome (Pots): A Literature Review, Sidharth Sahni, Harrison Jordan, Binoy Desai, Danielle Cooley, Alexander King May 2022

Effect Of Osteopathic Manipulative Treatment In Patients With Postural Orthostatic Tachycardia Syndrome (Pots): A Literature Review, Sidharth Sahni, Harrison Jordan, Binoy Desai, Danielle Cooley, Alexander King

Rowan-Virtua Research Day

Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by autonomic dysregulation resulting in diminished blood flow and excessive tachycardia.

POTS has been scarcely studied in the clinical setting. A review of literature generated only four articles, only one of which met the established criteria.

A follow up study to evaluate the effect of OMT on the quality of life for patients with POTS is planned. The hypothesis is that osteopathic manipulation plays a role in the management of POTS, as patients should experience improvement in their symptoms and their overall quality of life.


Comparing The Relapse Rate Between Medication Assisted-Only Treatment And Medication-Assisted Treatment With An Osteopathic Manipulative Treatment Regimen In Patients With Musculoskeletal Pain, Karen Huang, Danielle Cooley May 2022

Comparing The Relapse Rate Between Medication Assisted-Only Treatment And Medication-Assisted Treatment With An Osteopathic Manipulative Treatment Regimen In Patients With Musculoskeletal Pain, Karen Huang, Danielle Cooley

Rowan-Virtua Research Day

Since the opioid crisis first began in 1991, opioid-related overdoses in the United States have continued to increase dramatically, killing nearly 47,000 people in 2018, and making it one of the most pressing issues in healthcare. The most reported reason for misuse of pain relievers was to relieve physical pain. The increase in opioid abuse has also led to an increase in patients seeking medication-assisted treatment (MAT).

Osteopathic manipulative treatment (OMT) has been shown to have efficacy in relieving both chronic and acute pain. No current studies have investigated the use of OMT as an adjunct treatment to MAT for …


Improvement Of Memory Loss Through Dietary Intervention In The Assisted Living And Rehabilitative Settings, Alexander Swartz, Martin Forsberg May 2022

Improvement Of Memory Loss Through Dietary Intervention In The Assisted Living And Rehabilitative Settings, Alexander Swartz, Martin Forsberg

Rowan-Virtua Research Day

• The ketogenic diet is a popular, controversial diet that fuels the brain through beta-oxidation of fatty acids and production of ketone bodies, the most populous of which is betahydroxybutyrate (BHB).

  • The ketogenic diet consists of 70-80% fats, 20-25% protein, and 5-10% carbohydrates.

• Medically, the ketogenic diet is utilized in patients with epilepsy and recommended by some physicians to improve general health through weight loss and insulin sensitivity.

• Key factors of neurodegeneration include glucose hypometabolism, oxidative damage, and neuroinflammation.

  • Studies have shown that with ingestion of exogenous ketones alone, or endogenous ketonemia through a ketogenic diet, there is: …


Omm As A Complementary Therapy For Chronic Shoulder Overuse Injury In A Division Iii Softball Pitcher, Drew Saltzman, Ruchir Nanavati, Taylor Parsons, Seungkyu Park, David Abend Do May 2022

Omm As A Complementary Therapy For Chronic Shoulder Overuse Injury In A Division Iii Softball Pitcher, Drew Saltzman, Ruchir Nanavati, Taylor Parsons, Seungkyu Park, David Abend Do

Rowan-Virtua Research Day

At the height of the season, baseball and softball pitchers are playing 4-5 games a week and practicing on days without games. As a result, they put tremendous additive stress on their throwing shoulder and elbow joint.

This case utilized a novel, non-invasive osteopathic approach to improving shoulder mobility in a Division III athlete. If used on a regular basis, the shoulder mobility technique shows utility for athletes suffering from overuse injury. Our patient showed mild qualitative improvement, however they continue to use OMM as complementary treatment and describe a moderate qualitative improvement.


Use Of Pocus And Omt For Anterior Shoulder Reduction, David Ho, James Espinosa, Alan Lucerna, Neeharika Bhatnagar May 2022

Use Of Pocus And Omt For Anterior Shoulder Reduction, David Ho, James Espinosa, Alan Lucerna, Neeharika Bhatnagar

Rowan-Virtua Research Day

Shoulder dislocations are very a common presentation in the emergency department. This represents about 50% of all joint dislocations presenting to the ER. Over 95% of the dislocations are anterior. Approximately 70% of shoulder dislocations occur in men and in both genders, the prevalence of shoulder dislocations occurs in a bimodal distribution in age in those younger than 20 and over 60 years old. Shoulder dislocation can occur anteriorly, posteriorly, and inferiorly. In an anterior dislocation, excessive force from external rotation and abduction causes a tear in the anterior ligamentous capsule3, causing the humeral head to dislocate from the glenoid …


Physical Activity As A Means Of Improving Quality Of Life In Individuals With Chronic Pain, Tracy Tauro May 2022

Physical Activity As A Means Of Improving Quality Of Life In Individuals With Chronic Pain, Tracy Tauro

Rowan-Virtua Research Day

Pharmacologic management of chronic pain has variable results, sometimes resorting to ineffective and dangerous opioids that can potentiate substance abuse in a vulnerable population.

Exercise is unique in its ability to positively impact both the molecular and psychological aspects of chronic pain. Its role in decreasing inflammation as well as improving mental health make it an excellent option for improving quality of life.

Physicians should work with their patients to develop a patient-centered exercise plan to manage chronic pain.


Acceptability And Effectiveness Of A Novel Cycling Training On The Parkinsonian Motor And Psychiatric Symptoms In Individuals With Schizophrenia: A Pilot Study., Mehmet Uygur, Thomas J. Dinzeo Sep 2021

Acceptability And Effectiveness Of A Novel Cycling Training On The Parkinsonian Motor And Psychiatric Symptoms In Individuals With Schizophrenia: A Pilot Study., Mehmet Uygur, Thomas J. Dinzeo

Faculty Scholarship for the College of Science & Mathematics

BACKGROUND: Recent evidence suggests that high-speed, low-resistance stationary cycling training (termed as speedwork) alleviates motor symptoms in people with Parkinson's disease. Similar motor symptoms commonly exist in people with schizophrenia (Sz); however, they were neglected in the previous literature.

OBJECTIVES: Our objective was to evaluate if speedwork could also be used as a strategy to improve parkinsonian motor symptoms in Sz. We aimed 1) to evaluate the adherence and acceptability of speedwork in Sz, 2) to assess test-retest reliability of the motor assessments that are novel to Sz research, 3) to evaluate the effectiveness of speedwork in improving parkinsonian motor, …


Further Understanding The Efficacy Of Music-Based Cognitive Remediation Therapy For Patients With Traumatic Brain Injury, Sruthi Nanduri May 2021

Further Understanding The Efficacy Of Music-Based Cognitive Remediation Therapy For Patients With Traumatic Brain Injury, Sruthi Nanduri

Rowan-Virtua Research Day

Objective

To further assess the efficacy of music-based interventions in patients with traumatic brain injury and its therapeutic application to cognitive, motor and sensory deficits due to neurological sequalae

Introduction

- Traumatic brain injury is a direct result of an external force disabling neurological and neurophysiological functioning

- Sensory, motor, emotional, language and cognitive functioning impaired

- Treatment is usually cognitive remediation therapy (CR)

- In correspondence, music enhances cognitive performance via neural plasticity

- Current literature shows preliminary evidence of the positive results of music in parallel with CR


Acupuncture And Its Effects On Chronic Pain, Pavan Patel, Michael Sabia, Jashen Patheja, Rohan Kapoor, Tiffany Mathias, Tameem Murtaza Dec 2020

Acupuncture And Its Effects On Chronic Pain, Pavan Patel, Michael Sabia, Jashen Patheja, Rohan Kapoor, Tiffany Mathias, Tameem Murtaza

Cooper Rowan Medical Journal

Abstract

Acupuncture is an complementary form of medicine that has relatively recently become a component of traditional Chinese medicine (TCM). It involves the application of thin needles at specific points throughout the body, although initially, general areas instead of points were used. There are estimated to be about 395 different points that can be utilized, and the technique behind using these points can vary widely between practitioners. In addition to acupuncture points, TCM is said to use meridians or pathways along with qi, or energy flows. In terms of acupunctures’ utility, it has been known to treat a variety of …


Minding The Mindfulness Research In Healthcare: More Data On Diversity Are Urgently Needed, Basant Pradhan Md Feb 2020

Minding The Mindfulness Research In Healthcare: More Data On Diversity Are Urgently Needed, Basant Pradhan Md

Cooper Rowan Medical Journal

Amongst the myriads of applications of meditative practice, mindfulness meditation can be arguably the simple yet most evidence-based type of meditative method. This simple and age-old technique emphasizes upon cultivating in the practitioner a nonjudgmental awareness on a moment-to-moment basis. Mindfulness meditation was introduced to the American audience in the early 1990’s by Jon Kabat-Zinn, and beginning the early 2000s has seen an exponential growth trajectory that continues to this day. However, its rising popularity has given rise to considerable misinformation and misunderstanding as well.


Stimulating Interest In Medicine Assisted Manipulation (Mam)/Manipulation Under Anesthesia (Mua) As A Complementary Treatment Modality For Chronic Pain And Opioid Use, David Abend Do, Alexis Dunn, Guy K. Guibilato, J. Scott Lazaro, Bharani Pusukur, Teymur Aliyev, Anthony Ascione, Michael Mcaree May 2019

Stimulating Interest In Medicine Assisted Manipulation (Mam)/Manipulation Under Anesthesia (Mua) As A Complementary Treatment Modality For Chronic Pain And Opioid Use, David Abend Do, Alexis Dunn, Guy K. Guibilato, J. Scott Lazaro, Bharani Pusukur, Teymur Aliyev, Anthony Ascione, Michael Mcaree

Rowan-Virtua Research Day

The objective of this clinical review is to stimulate interest in medicine assisted manipulation (MAM), also known as manipulation under anesthesia (MUA). By providing evidence from published studies regarding the use of MUA, as well as identifying its benefits and limitations, our group hopes to increase awareness of this technique and contribute to its implementation to assist in overall pain reduction and reduce opioid medication dosing. A retrospective literature review was undertaken to investigate the extent of published information on the topic in order to compile evidence based data and provide the reader with a summary of both the benefits …


Mental Health Symptom Severity In Cannabis-Using And Non-Using Veterans With Probable Ptsd, Matthew J. Johnson, John D. Pierce, Shahrzad Mavandadi, Johanna Klaus, Diana Defelice, Erin Ingram, David W. Oslin May 2019

Mental Health Symptom Severity In Cannabis-Using And Non-Using Veterans With Probable Ptsd, Matthew J. Johnson, John D. Pierce, Shahrzad Mavandadi, Johanna Klaus, Diana Defelice, Erin Ingram, David W. Oslin

Rowan-Virtua Research Day

BACKGROUND:

Posttraumatic Stress Disorder (PTSD) is a disabling illness suffered by many veterans returning from war. Some veterans believe that cannabis may be therapeutic for PTSD. The purpose of this study was to better understand the association between cannabis use and PTSD symptoms.

METHODS:

The study was a matched case-control cross-sectional evaluation of the psychiatric and sociocultural associations of cannabis use in veterans with probable PTSD. Patient self-report measures were examined comparing cannabis users (cases) to non-users (controls) who were case-matched on age and gender.

RESULTS:

Results indicated that there were no significant differences between cases and controls in mean …


The Effect Of Omm On Opioid Users With Chronic Low Back Pain, Danielle Cooley D.O., James Bailey D.O., Deanna Janora M.D., Catherine Fusco D.O., Kishan Patel May 2019

The Effect Of Omm On Opioid Users With Chronic Low Back Pain, Danielle Cooley D.O., James Bailey D.O., Deanna Janora M.D., Catherine Fusco D.O., Kishan Patel

Rowan-Virtua Research Day

In the United States, approximately 100 million adults are affected by chronic pain, which reduces their quality of life and productivity, while accounting for billions in health care costs and lost revenue. (1) Opioids are considered the gold standard in the pharmacological treatment for chronic pain conditions, and prescriptions for opiates/opioids increased by 400% from 1999 to 2010. (1,2) Although opioid treatment is warranted during postsurgical and active cancer pain, physicians still commonly overprescribe opioids, which has led to addiction, high deaths rates by overdose, and the spread of communicable diseases. (1)

Since chronic pain is sustained by noxious sensory …


Effects Of Vitamin D Supplementation, Keith R. Anacker Oms-Ii, Adarsh K. Gupta Do May 2018

Effects Of Vitamin D Supplementation, Keith R. Anacker Oms-Ii, Adarsh K. Gupta Do

Rowan-Virtua Research Day

Vitamin D (1,25-dihydroxycholecalciferol) is known to be a fat soluble vitamin. We hypothesized that losing weight would thus cause an increase in serum vitamin D levels. To investigate this, a retrospective chart review was performed in which data including sex, age, race, serum Vitamin D levels, body weight and more, of 200 Rowan SOM Family Medicine patients for up to 6 doctor’s office visits each were collected. These data were then analyzed using Microsoft Excel and IBM SPSS. We found while there was a significant positive correlation between weight loss and serum Vitamin D levels, there was not a significant …