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Articles 6031 - 6060 of 328508
Full-Text Articles in Entire DC Network
Quantifying Qtc Prolongation Risk At Scale: Cardiac Safety Implications Of Moxifloxacin-Based Tb Regimens, Wesley Augustus Kim, Nikhila Arcakam, Brandon Velazquez
Quantifying Qtc Prolongation Risk At Scale: Cardiac Safety Implications Of Moxifloxacin-Based Tb Regimens, Wesley Augustus Kim, Nikhila Arcakam, Brandon Velazquez
Rowan-Virtua Research Day
Tuberculosis treatment is undergoing its most significant transformation in decades. In recent years, updated ATS/CDC/ERS/IDSA guidelines introduced a new 4-month drug-susceptible TB regimen that incorporates moxifloxacin as a core component. These landmark guideline shifts mean that moxifloxacin exposure among TB patients globally is set to expand dramatically. This drug replaces the ethambutol component of standard TB regiment commonly associated with optic neuritis as a side effect. Yet there is a critical blind spot: while individual studies have documented moxifloxacin’s QT interval-prolonging effects, no research has modeled what happens when this drug is rolled out to millions of patients who simultaneously …
Effective Peer Feedback With The Situation-Behavior-Impact (Sbi) Model, Steven Garwood, Dawn Shell, Emily Hoffman
Effective Peer Feedback With The Situation-Behavior-Impact (Sbi) Model, Steven Garwood, Dawn Shell, Emily Hoffman
Rowan-Virtua Research Day
Providing effective peer feedback is an essential professional skill in medical education, yet students often receive limited formal training in how to deliver feedback constructively. This study describes the design, implementation, and outcomes of a one‑hour synchronous workshop introducing first‑year medical students to the Situation–Behavior–Impact (SBI) feedback model. The interactive session combined didactic instruction, large‑group discussion of effective feedback characteristics, and small‑group practice creating structured SBI feedback statements. Effectiveness was evaluated using pre‑ and post‑workshop confidence surveys and a rubric‑based analysis of 75 group‑generated feedback statements. Following the workshop, 98% of students agreed or strongly agreed they could apply the …
Ketamine With Opioids Vs. Ketamine With Non-Opioid Analgesics For Vaso-Occlusive Crisis In Sickle Cell Disease: A Prisma-Style Scoping Review, Akhil Tumpudi
Rowan-Virtua Research Day
Vaso-occlusive crises (VOCs) are the hallmark of Sickle Cell Disease (SCD) and a leading cause of hospitalization. Pain management relies heavily on opioids, but repeated exposure carries risks including tolerance, hyperalgesia, and adverse effects. Ketamine, an NMDA receptor antagonist, has emerged as an adjunctive agent with potential opioid-sparing effects (1–3,7). Systematic reviews suggest ketamine may reduce pain scores and possibly opioid requirements, though pooled results remain inconsistent (5,6,8). While ketamine + opioid regimens have been studied, the feasibility, efficacy, and safety of ketamine combined with non-opioid analgesics for VOC remain largely unknown. Understanding the comparative effectiveness of these approaches is …
Anticholinergic Toxicity Presenting As Acute Stroke Mimic: A Case Report, Dean Austin Esma, Kelsey Murray, James Espinosa, Alan Lucerna
Anticholinergic Toxicity Presenting As Acute Stroke Mimic: A Case Report, Dean Austin Esma, Kelsey Murray, James Espinosa, Alan Lucerna
Rowan-Virtua Research Day
Anticholinergic toxicity classically presents with a constellation of peripheral and central symptoms including tachycardia, mydriasis, dry skin, urinary retention, and altered mental status. However, central anticholinergic effects can predominate, presenting as isolated delirium without peripheral manifestations. This report presents a case of a 57-year-old woman who developed acute altered mental status and aphasia following cumulative anticholinergic exposure from over-the-counter cold medications, initially triggering a stroke alert
Facial Skin Discoloration After Topical Silver Sulfadiazine: A Case Report, Hannah Culleny, Philip Carhart, James Espinosa, Neel Parikh, Alan Lucerna, Henry Schuitema
Facial Skin Discoloration After Topical Silver Sulfadiazine: A Case Report, Hannah Culleny, Philip Carhart, James Espinosa, Neel Parikh, Alan Lucerna, Henry Schuitema
Rowan-Virtua Research Day
Silver sulfadiazine (Silvadene) is a topical antimicrobial commonly used in burn management. Although generally well tolerated, excessive or prolonged application may result in cutaneous pigmentation changes due to silver deposition.
Here we present the case of a a 45-year-old woman who presented with diffuse gray-blue facial discoloration five days after sustaining a minor thermal injury. She had been prescribed topical silver sulfadiazine but applied the medication to her entire face and continued use after wound resolution. Physical examination demonstrated asymptomatic hyperpigmented gray-blue macules confined to areas of application. There were no signs of inflammation or systemic involvement. Discontinuation of the …
A Systems Perspective On Workstation Ergonomic Principles And Their Application In Emergency Care Environments, James Espinosa, Alan Lucerna
A Systems Perspective On Workstation Ergonomic Principles And Their Application In Emergency Care Environments, James Espinosa, Alan Lucerna
Rowan-Virtua Research Day
Background: Workstation ergonomic principles are commonly included in mandatory healthcare training programs. These recommendations—monitor height relative to eye level, neutral arm positioning, and adjustable seating—derive largely from occupational ergonomics literature designed to reduce musculoskeletal strain and improve comfort during computer work. Emergency Departments (EDs), however, represent dynamic environments with shared workstations and workflow interruptions that may influence the implementation of these recommendations.
Objective: To summarize the evidence supporting commonly taught workstation ergonomic principles and frame them within a systems perspective of ED work environments.
Methods: Narrative review of occupational ergonomics guidelines, ergonomic intervention studies, and human factors literature relevant to …
The Ed Is Inherently Interleaved: The Learning Theory Case For Hybrid Resident Conference Curriculum Design In Emergency Medicine: Block For Onboarding And For Specialized Topics With Predominant Interleaving For Intermediate And Advanced Residents, James Espinosa, Alan Lucerna
The Ed Is Inherently Interleaved: The Learning Theory Case For Hybrid Resident Conference Curriculum Design In Emergency Medicine: Block For Onboarding And For Specialized Topics With Predominant Interleaving For Intermediate And Advanced Residents, James Espinosa, Alan Lucerna
Rowan-Virtua Research Day
Background
Emergency medicine (EM) training occurs within a clinical environment characterized by rapid context switching, diagnostic uncertainty, and frequent transitions between unrelated clinical problems. Didactic curricula that rely only on block-based topic organization may not fully reflect the cognitive demands of real emergency department practice.
Objective
To propose a developmentally adaptive hybrid model of EM curricular design that integrates early block learning during the onboarding phase of new residents, progressing to a general approach of interleaved learning. Specialized topics, can be introduced using block learning at any time during the residency years.
Methods / Conceptual Approach
This conceptual educational model …
Might Ite And Board Preparation Be Both Informative And Neurobiologically Formative? A Plausibility Argument Linking Study Processes To Hippocampal–Cortical Memory Consolidation, Pattern Recognition Networks, And Cognitive Efficiency, James Espinosa, Alan Lucerna
Might Ite And Board Preparation Be Both Informative And Neurobiologically Formative? A Plausibility Argument Linking Study Processes To Hippocampal–Cortical Memory Consolidation, Pattern Recognition Networks, And Cognitive Efficiency, James Espinosa, Alan Lucerna
Rowan-Virtua Research Day
Background: The in-service training exam ( ITE ) and board preparation are traditionally framed as processes of information acquisition and evaluation. Educational discussions typically focus on knowledge transfer, study strategies, and examination performance. However, modern neuroscience suggests that sustained, emotionally salient, and repetitive cognitive challenge in adulthood can produce durable neuroplastic adaptations. Might such residency training be not only informative but also formative?
Objective: To propose a conceptual framework in which board preparation may be both informative and neurobiologically formative, functioning as a training environment that promotes integration of neural systems involved in memory retrieval, pattern recognition, and decision-making under …
The Use Of Prazosin In Individuals With Post-Traumatic Stress Disorder: A Scoping Review Protocol, Priyal Pritesh Shah, Marisa Riebesell, Afshan Khan, Amanda M. Carey, Emily Balog, Martin Forsberg
The Use Of Prazosin In Individuals With Post-Traumatic Stress Disorder: A Scoping Review Protocol, Priyal Pritesh Shah, Marisa Riebesell, Afshan Khan, Amanda M. Carey, Emily Balog, Martin Forsberg
Rowan-Virtua Research Day
Background: Post-Traumatic Stress Disorder (PTSD) is a prevalent and debilitating condition, and is most often associated with sleep disturbances such as nightmares, flashbacks, and heightened arousal. Prazosin, an alpha-1 adrenergic antagonist, has been widely used for PTSD symptoms, however findings across studies are variable and limited, and the scope of existing evidence is not well established.
Objective: This scoping review aims to systematically map the literature on the use of prazosin in individuals with PTSD across diverse populations, settings, and study designs.
Methods: The scoping review will be conducted in accordance with JBI methodology and reported following PRISMA-ScR guidelines. A …
Neuro Visual Training For Post Tbi Rehabilitation: A Three-Patient Case Series, Isha Shashi, Joseph Clark, Aidan Butler, Kevin Kohmescher
Neuro Visual Training For Post Tbi Rehabilitation: A Three-Patient Case Series, Isha Shashi, Joseph Clark, Aidan Butler, Kevin Kohmescher
Rowan-Virtua Research Day
Abstract.
Introduction:
Post-concussion syndrome (PCS) often presents with persistent symptoms following mild traumatic brain injury (mTBI), leading to significant delays in recovery. This case study explores the efficacy of a novel rehabilitation approach, of intensive NeuroVisual Training (NVT), in treating PCS for three patients presenting with chronic symptoms. We initiated an intense training program for 1 week, 8 hours per day, and call this a bootcamp.
Methods:
This is a three-patient case series. All patients were evaluated using traditional NeuroVisual assessments and cognitive assessments. All patients were greater than 6 months post-injury. All underwent a full 5-day bootcamp specifically tailored …
Sleep Architecture And Delirium In Patients With Intracerebral Hemorrhage: A Preliminary Observational Study, Lily Roessler, Kevin Eaise, Jamie Feinour Msn, Crnp, Jennifer Jond Ms, Pa-C, Vanessa Salasky Md, Mikel Shea Ehntholt Md, Bethany C. Young
Sleep Architecture And Delirium In Patients With Intracerebral Hemorrhage: A Preliminary Observational Study, Lily Roessler, Kevin Eaise, Jamie Feinour Msn, Crnp, Jennifer Jond Ms, Pa-C, Vanessa Salasky Md, Mikel Shea Ehntholt Md, Bethany C. Young
Rowan-Virtua Research Day
Background: Delirium is common among ICU stroke patients and could possibly be associated with disrupted sleep. However, the relationship between specific sleep characteristics and delirium remains unclear.
Objective: To evaluate the association between sleep architecture and delirium in intracerebral hemorrhage (ICH) patients in the ICU.
Methods: We performed a primary analysis of 14 ICU ICH patients who underwent polysomnography. Sleep variables included total sleep time, sleep efficiency, sleep stages (N1, N2, N3, REM), arousal index, and sleep latency. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Patients were categorized by presence or absence of delirium. Continuous …
Vitamin K And The Vaccine Cascade: Pediatric Patterns In Southern Nj, Kianna Bruzzo, Clare Stephens, Nicole Streeks-Wooden
Vitamin K And The Vaccine Cascade: Pediatric Patterns In Southern Nj, Kianna Bruzzo, Clare Stephens, Nicole Streeks-Wooden
Rowan-Virtua Research Day
Background:
Intramuscular (IM) vitamin K is recommended at birth to prevent vitamin K deficiency bleeding (VKDB), a potentially life-threatening condition that can result in intracranial hemorrhage or death. Prior research suggests a relationship between refusal of vitamin K prophylaxis at birth and subsequent vaccination patterns, with refusal potentially extending to other neonatal preventive services. In New Jersey, vaccination trends from 2017–2025 demonstrate a decline in the proportion of pre-kindergarten children meeting school vaccination requirements. This study aims to explore whether vitamin K administration at birth is associated with subsequent vaccination patterns in South Jersey.
Methods:
A retrospective cohort study was …
Improving Hypertension Control Among Middle-Aged, Black, Female Patients Through Staff Education On Evidence-Based Joint National Committee Guidelines, Afolake Oyinlola
Improving Hypertension Control Among Middle-Aged, Black, Female Patients Through Staff Education On Evidence-Based Joint National Committee Guidelines, Afolake Oyinlola
Walden Dissertations and Doctoral Studies
No abstract provided.
Staff Education To Use Best Practices For Implementing And Utilizing The Digital Depression Screening Tool In An Outpatient Psychiatric Clinic, Robert James
Walden Dissertations and Doctoral Studies
No abstract provided.
Maternal And Mental Health Action Plan To Improve Perinatal Outcomes Across The Continuum Of Care In A Community-Based Hospital, Hannah Simmons
Maternal And Mental Health Action Plan To Improve Perinatal Outcomes Across The Continuum Of Care In A Community-Based Hospital, Hannah Simmons
Walden Dissertations and Doctoral Studies
No abstract provided.
Implementation Of The Prapare Social Determinants Of Health Screening Tool, Munachiso Iheonunekwu
Implementation Of The Prapare Social Determinants Of Health Screening Tool, Munachiso Iheonunekwu
Walden Dissertations and Doctoral Studies
No abstract provided.
Underdiagnosis Of Bipolar Disorder And Under Utilization Of The Mood Disorder Questionnaire, Sandeep Grewal
Underdiagnosis Of Bipolar Disorder And Under Utilization Of The Mood Disorder Questionnaire, Sandeep Grewal
Walden Dissertations and Doctoral Studies
No abstract provided.
Staff Education On Post Discharge Follow Up Care To Improve Staff Knowledge, Collins Scott
Staff Education On Post Discharge Follow Up Care To Improve Staff Knowledge, Collins Scott
Walden Dissertations and Doctoral Studies
No abstract provided.
Trauma-Informed De-Escalation Staff Education For Outpatient Psychiatric Nursing, Alice Sesay
Trauma-Informed De-Escalation Staff Education For Outpatient Psychiatric Nursing, Alice Sesay
Walden Dissertations and Doctoral Studies
No abstract provided.
Staff Education On Crisis Management Protocol For Aggressive Behaviors In Patients With Developmental Disabilities, Kenneth Mbuen
Staff Education On Crisis Management Protocol For Aggressive Behaviors In Patients With Developmental Disabilities, Kenneth Mbuen
Walden Dissertations and Doctoral Studies
No abstract provided.
Invisible Shipwrecks And Neurological Endangerment: The Trade-Off In Seeking Asylum - Reframing The Neurobiological Cost Of Forced Migration, Eisha Giran
CISLA Senior Integrative Projects
Forced migration along the Spain–Morocco route represents one of the most visible humanitarian crises of the twenty-first century, yet its neurological dimensions remain insufficiently examined. This paper investigates how prolonged displacement and trauma reshape neural systems involved in stress regulation, memory, and emotional processing. It introduces the concept of neurological endangerment, defined as a condition of prolonged and inescapable threat exposure during forced migration in which stress-response systems remain chronically activated, opportunities for recovery are structurally constrained, and cumulative neurobiological risk persists beyond the period of immediate danger.
To address the gap between biological measurement and lived experience, this paper …
Point-Of-Care Intestinal Ultrasound Is Associated With Reduced Colonoscopy Utilization And Improved Clinical Decision-Making In Ibd, Lakumi Dias, Ashlyn Mcclelland, Amy Glasofer, Charalampos Papachristou, Yecheskel Schneider, Sanket Patel
Point-Of-Care Intestinal Ultrasound Is Associated With Reduced Colonoscopy Utilization And Improved Clinical Decision-Making In Ibd, Lakumi Dias, Ashlyn Mcclelland, Amy Glasofer, Charalampos Papachristou, Yecheskel Schneider, Sanket Patel
Rowan-Virtua Research Day
Background:
Point-of-care intestinal ultrasound (IUS) enables real-time assessment of bowel inflammation, and it is underutilized in the United States. IUS provides visualization of bowel wall thickness, vascularity, and complications without radiation or bowel preparation. Prior studies demonstrate that IUS changes management and reduces reliance on invasive testing. This study hypothesizes that IUS will impact downstream clinical decision-making in a U.S. outpatient IBD cohort by decreasing invasive procedures and supporting appropriate treatment decisions.
Methods:
A retrospective cohort study was performed. Logistic regression and chi-square tests assessed associations between IUS use, colonoscopy referral, hospital utilization, and treatment modification. A derived “surveillance-due” variable …
Assessing Medical Trainees Knowledge Of Secondary Traumatic Stress Before And After Clinical Experiences At The Cares Institute: A Literature Review, Anastasiya Matveyenko, Sarah Kleinle, Paul Furtaw, Rachel Silliman Cohen
Assessing Medical Trainees Knowledge Of Secondary Traumatic Stress Before And After Clinical Experiences At The Cares Institute: A Literature Review, Anastasiya Matveyenko, Sarah Kleinle, Paul Furtaw, Rachel Silliman Cohen
Rowan-Virtua Research Day
Secondary Traumatic Stress (STS) has been positively correlated with burnout in healthcare professionals through numerous studies. It is defined as the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by another individual. Medical students experience high level of STS due to exposure to trauma during multiple clinical rotations. Child Abuse Research Education and Service (CARES) Institute treats children who have experiences of abuse, neglect, and other forms of trauma. As part of the current curriculum, Rowan SOM students rotate at the CARES Institute for at least a day for up to a month and might …
+Cd49a+Cd103+ Cytotoxic Tissue-Resident Natural Killer Cells Infiltrate And Control Solid Epithelial Tumor Growth In Mice, Nina B Horowitz, Jennifer A Foltz, Et Al.
+Cd49a+Cd103+ Cytotoxic Tissue-Resident Natural Killer Cells Infiltrate And Control Solid Epithelial Tumor Growth In Mice, Nina B Horowitz, Jennifer A Foltz, Et Al.
2020-Current year OA Pubs
Human tissue-resident natural killer (NK) cells (trNK cells), broadly defined by markers of tissue residency, such as CD49a [
Improving Blood Pressure Through A Multimodal Intervention, Kalynn Solomey
Improving Blood Pressure Through A Multimodal Intervention, Kalynn Solomey
Evidence-Based Practice Project Reports
Hypertension is a major modifiable risk factor for cardiovascular disease and remains a significant public health concern in the United States (Centers for Disease Control and Prevention [CDC], 2023a). Despite the availability of effective pharmacological therapies, many patients struggle to achieve adequate blood pressure control, highlighting the need for accessible, evidence-based lifestyle interventions. An extensive literature search of five databases provided 11 articles for utilization. The purpose of this project was to evaluate the effectiveness of a multimodal intervention that included hypertension education, individualized lifestyle counseling, self-measured blood pressure training, and a progressive walking program in reducing systolic blood pressure …
Characterizing Core Outcomes Of Responsible Stewardship For Human Genomic Data In The Cloud, Vasiliki Rahimzadeh, Bronwyn Walsh, Heidi L Rehm, Mildred Cho, Amy L Mcguire
Characterizing Core Outcomes Of Responsible Stewardship For Human Genomic Data In The Cloud, Vasiliki Rahimzadeh, Bronwyn Walsh, Heidi L Rehm, Mildred Cho, Amy L Mcguire
Center for Medical Ethics and Health Policy Staff Publications
We present findings from a scoping review of the genomic data sharing literature used to inform a core outcomes set for responsible data stewardship in the cloud. Genomic and related health data stemming from government funded research have undergone mass migration to the cloud where they can be more securely stored, accessed, and analyzed within shared computing environments. While this migration reflects a shift in privacy and security infrastructure for cloud-based repositories as oversight becomes more globalized, it also necessitates new data stewardship responsibilities to align authorized data access with ethical data use. Responsible data stewardship refers to the ethical …
Missense Mutations In The Snca Gene: Molecular Mechanisms And Clinical Implications, Pranaya Gade, Nishant Patel, Jamir Pitton Rissardo, Jorge Patino, Ana Fornari-Caprara, Ian Walker
Missense Mutations In The Snca Gene: Molecular Mechanisms And Clinical Implications, Pranaya Gade, Nishant Patel, Jamir Pitton Rissardo, Jorge Patino, Ana Fornari-Caprara, Ian Walker
Rowan-Virtua Research Day
The SNCA gene on chromosome 4 encodes the alpha-synuclein (αSyn) protein, which plays a central role in the pathogenesis of synucleinopathies, including Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). While αSyn has established roles in synaptic vesicle dynamics and neuronal signaling, alterations in SNCA regulation and sequence contribute to protein misfolding, aggregation, and loss of function. Alterations in secondary and tertiary structure, as well as protein aggregation, affect biochemical interactions, ultimately leading to pathogenesis. This review outlines the molecular architecture of the SNCA gene, including regulatory regions, alternative splicing, and untranslated regions that influence …
Prevalence And Clinical Correlates Of Restless Legs Syndrome In Neuromyelitis Optica Spectrum Disorder: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md
Prevalence And Clinical Correlates Of Restless Legs Syndrome In Neuromyelitis Optica Spectrum Disorder: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md
Rowan-Virtua Research Day
Background: Restless legs syndrome (RLS) is increasingly recognized in neuromyelitis optica spectrum disorder (NMOSD), yet published prevalence estimates remain highly variable, largely because of small sample sizes and methodological heterogeneity. We sought to estimate the pooled prevalence of RLS in NMOSD using published observational studies. Methods: A systematic literature search of PubMed was performed using the terms “restless legs syndrome” AND “neuromyelitis optica spectrum disorder”, identifying all original studies reporting RLS prevalence in NMOSD. Seven studies (2016–2026) met inclusion criteria. Study‑level data on RLS events and NMOSD sample size were extracted. A proportion‑weighted fixed‑effect meta‑analysis was performed. Pooled prevalence estimates …
Informed Consent For Porcine Islet Xenotransplantation To Treat Type 1 Diabetes: A Scoping Review, Jennifer Kovalcik, Sheetal Mohanty, Mairead Clare Higgins, Daniel J. Hurst
Informed Consent For Porcine Islet Xenotransplantation To Treat Type 1 Diabetes: A Scoping Review, Jennifer Kovalcik, Sheetal Mohanty, Mairead Clare Higgins, Daniel J. Hurst
Rowan-Virtua Research Day
Purpose: The objective of this review is to systematically map and synthesize the existing literature regarding informed consent for porcine islet xenotransplantation for the treatment of Type 1 Diabetes.
Methods: The search was conducted in May 2025 through the following databases: PubMed, SCOPUS, EMBASE, and CINAHL. Broad search strings were used to combine the text words “islet” AND “xenotransplantation” AND “consent” or similar permutations and combinations. Peer-reviewed articles were included if they were published between January 1990 and May 2025 and written in English. The final search results were manually exported to a reference manager system (Zotero), and the PRISMA-ScR …
Impact Of Early Term Induction Of Labor On Cesarean Delivery And Impact Of Early Term Induction Of Labor On Cesarean Delivery And Maternal-Fetal Outcomes In Patients With Obesity: A Maternal-Fetal Outcomes In Patients With Obesity, Priya Patel, Nathanael Hoskins
Impact Of Early Term Induction Of Labor On Cesarean Delivery And Impact Of Early Term Induction Of Labor On Cesarean Delivery And Maternal-Fetal Outcomes In Patients With Obesity: A Maternal-Fetal Outcomes In Patients With Obesity, Priya Patel, Nathanael Hoskins
Rowan-Virtua Research Day
Introduction: Obesity (body mass index [BMI] ≥30 kg/m²) in pregnancy is associated with increased risks, including gestational diabetes, hypertensive disorders, and higher cesarean delivery (CD) rates. Evidence supporting early-term (37 0/7–38 6/7 weeks) induction of labor (IOL) to improve outcomes remains limited. This study evaluated whether IOL in patients with obesity is associated with decreased CD rates.
Methods: This retrospective cohort study included pregnancies undergoing IOL between 37 0/7 and 41 6/7 weeks from 2018–2023 at a single institution. Exclusion criteria included spontaneous labor, prior CD, multiple gestations, fetal anomalies, non-vertex presentation, and pre-labor rupture of membranes. Primary exposures were …