Beyond The Ring: Vegan Fighter, Bianca Silva

Capstones

Omowale Adewale, an amateur MMA fighter and boxer, spends his time outside the ring as director of Grassroots Artists MovEment (G.A.ME), an organization in the Bronx dedicated to provide resources to low-income residents like healthcare, access to healthy foods via means of gardening and youth incarceration prevention programs. He has been the director of G.A.ME since 2001 and routinely visits classrooms where he provides lectures on how to eat healthy foods-even incorporating vegan foods and implement after school physical programs like boxing where he occasionally serves as a trainer.

The Utility Of Semmes-Weinstein Monofilament Test In Detecting Carpal Tunnel Syndrome With Clinical Stage, Nerve Conduction Study, And Sonography Correlations, Lin-Yi Wang, Jyun-Ying Li, Yu-Chi Huang, Mei-Yun Liaw, Tsung-Hsun Yang, Yi-Jung Hsin, Willie Lee, Jui-Kun Chang, Ya-Ping Pong

Rehabilitation Practice and Science

Background and purpose: Nerve conduction study (NCS) and ultrasonography (US) are used to support the diagnosis of carpal tunnel syndrome (CTS). The ability of the Semmes-Weinstein monofilament test (SWMT), a sensibility threshold test, to detect CTS, and its relationship to clinical severity, NCS, and US, remain controversial. We conducted this study to address this controversy. Method: Thirty-three patients presenting with typical symptoms and signs of CTS and 20 normal subjects were enrolled. SWMT on the index finger, NCS, and US of the cross-sectional area of the median nerve at the pisiform level (PCSA) were performed. Receiver operating characteristic (ROC) curves …

Building A Clinical Decision Support System For Prescription Of Assistive Technology: An Example Of Wheelchair Prescription, Pei-Chin Chou, Wen-Chou Chi, Hsin-Shui Chen, Wen-Yih Hsieh, Wang-Che Li

Rehabilitation Practice and Science

Background and Purpose: The application of assistive technology has recently been paid attention to with the benefit of social welfare. However, less systematic and comprehensive consideration has been given to the prescription of assistive devices. Moreover, the efficacy of assistive devices has not been systematically examined yet due to the lack of integration of related information. Methods: This study firstly interviewed clinical assessors for assistive technology by field research. As users participated periodically, object-oriented systems development methodology and case diagram were used as a design tool to build a prototype system. Finally, web applications were built in Oracle database by …

Applying The Pzb Model In Evaluating The Service Quality Of Pediatric Rehabilitation, I-Hsiu Liou, Shu-Fen Sun, Chiao-Wen Hwang, Yin-Han Chen, Yu-Hsuan Lin, Min-Hui Li, Jue-Long Wang

Rehabilitation Practice and Science

背景：在兒童復健領域的文獻，鮮少有醫療品質之研究。除了接受復健醫療的兒童，家長參與復健因而會介入影響醫療服務提供者，家長的觀感與需求值得受到重視。目的：本研究以PZB服務品質缺口模式為基礎來分析病患對所接受醫療服務的期望與滿意度之落差，此落差即為醫療服務品質。方法：本研究工具為一結構式問卷，共25題，具有良好之信效度，改編自22題的SERVQUAL量表，內容包括五個構面，分別為（1）有形性（2）可靠性（3）反應性（4）確實性（5）關懷性。此研究共74位家長及10位治療師參與。治療師與家長的期望認知以單因子變異數分析進行，家長的期望分數與滿意度落差以配對-t檢定進行。結果：問卷回收率為100%。量表內容效度指標（contentvali dityindex）為0.93，量表的Cronbach's α係數為0.96，具高信度。本研究結果顯示治療師與家長在五個構面的整體期望與滿意度並無顯著組間差異，但組內整體期望與滿意度間均有顯著落差。家長特質分析顯示年齡與教育程度會影響期望與滿意度間之落差。家長重視的面向是治療室環境清潔、希望能在承諾時間內進行復健治療、治療師有足夠專業知識與經驗、可以了解兒童個別需求。本院目前迫切需改善的項目為充實治療室設備並維持環境清潔，在排定治療時間內根據病患需求提供個別化的復健課程，以提升本院兒童復健醫療品質。結論：此研究提供小兒復健醫療品質一個可以利用的評估方式。未來定期運用SERVQUAL可以作為醫療品質之監測。亦可在不同醫院以此工具評估比較醫院間醫療品質之差異。

Early Intervention For A Baby With Syndactyly: A Casereport, Chi-Min Yang, Shu-Yu Yang, Yu-Pei Tsai, Yu-Tin Tseng, Yu-Tin Tseng

Rehabilitation Practice and Science

Syndactyly is the most common congenital malformation of the limbs. Syndactyly refers to the clinical appearance of fingers or toes that have not undergone the normal process of separation and can be classified as simple, complex, complete or incomplete according to clinical severity and involvement. Clinically, syndactyly has primarily been treated with surgery. However, few studies have investigated relevant postsurgical rehabilitation interventions. This study reported a case involving an infant with severe syndactyly. After surgery, the infant received early rehabilitation intervention. We provided health education to caregivers to instruct them scar treatment on the hands, joint range of motion exercise, …

The Treatment Of A Large And Deeply Seated Left Cerebral Cavernous Malformation: A Casereport, Chui-Lee Wong, Jin-Shan Huang

Rehabilitation Practice and Science

Cerebral cavernous malformations (CCMs) are congenital vascular anomalies that are not visualized on angiography. However, computed tomography (CT) and magnetic resonance imaging (MRI) scans have highly increased the detection rate and the understanding of these lesions. CCMs have characteristic MRI findings, which facilitate differential diagnosis radiologically. CCMs are classified into 4 categories, according to their MRI and pathological characteristics. In addition, the nature history and the bleeding risk of each category of CCMs are different and critical in decision making regarding treatment. We report the case of a 73 years old female patient who presented with a history of mild …

Social Support Status In Informal Caregivers Of Stroke Patients, Yanyuh Lee, Yeehwa Wu, Ihsuan Chen, Kuchou Chang, Yuching Huang, Jenwen Hung

Rehabilitation Practice and Science

Objective: Informal caregivers play an important role in post-stroke care. In the present study, we aimed to investigate the social support status over an 18-month duration; the relationship between health status and social support level; and the predictors of low social support status in informal caregivers of stroke patients. Methods: We recruited eligible inpatients with first-ever ischemic stroke and their informal caregivers from a tertiary referral teaching hospital. The social support rating scale (SSRS) of the caregivers was determined at 3, 16, and 18 months after stroke onset. Beck depression inventory (BDI) as well as the physical and mental composite …

The Utility Of The Perceived Environmental Barriers In Community For The Community-Dwelling Elderly In Taiwan, Weichih Lien, Tashen Kuan, Jerhao Chang, Naiwen Guo

Rehabilitation Practice and Science

Background and Purpose: The purpose of this study was to find out the cut-off point of the Perceived Environmental Barriers in Community according to basic activity of daily living (BADL) and instrumental activity of daily living (IADL) independence in community-dwelling elderly in Taiwan. Methods: In this study, 200 community-dwelling elderly were sampled and administered with the Perceived Environmental Barriers in Community and Hierarchy of the Care Required (HCR). Receiver operating characteristic curves were used to find out the cut-off points of the Perceived Environmental Barriers in Community. Results: We found that the Physical/Structural domain and total score of the Perceived …

Comparison Of The Effects Of Prolotherapy And Traditional Physical Therapy In Low Back Pain Patients With Lumbosacral Transitional Vertebra, Weihan Chang, Shihwei Chou, Chienhung Chen, Chihkuan Wu, Katie P. Wu, Yinchou Lin

Rehabilitation Practice and Science

A lumbosacral transitional vertebra (LSTV) is a congenital musculoskeletal abnormality with a higher incidence in patients with low back pain as to the normal population. Such finding implicates that an altered mechanics caused by a transitional vertebra may contribute to pain generation. In cadavers with an LSTV, the iliolumbar ligament at the level immediately above the transitional vertebra was thinner and weaker than it was for cadavers without an LSTV. This ligament of LSTV is vulnerable to sprains in terms of structural and biomechanical alterations and may be the target of treatment. Twenty-two patients with chronic low back pain in …

Rehabilitation Effect Analysis Of Subacute Traumatic Brain Injury, Pao Huang, Jenhung Wang, Chihcheng Fan, Chungchao Liang, Shuman Lin, Clement Shihhsien Yang

Rehabilitation Practice and Science

Objective: Traumatic brain injury generally occurs when external force brings about damage to the tissues of the brain and is commonly accompanied by changes in the physical, cognitive, behavioral, and emotional domains of the affected person; such changes can result in social adaptation problems. Issues involving finance and/or family caregiver human resources also occur due to the fact that the survivor's disabilities linger. The primary goals of the present study are (1) to obtain an initial understanding of the rehabilitation services available to traumatic brain injury patients and (2) to analyze the effects of such rehabilitation on traumatic brain injury …

A Preliminary Evaluation On The Correlation Between Severity Of Hand Spasticity And Functional Recovery In Chronic Stroke Patients, Wan-Ling Hsu, Yi-Chieh Lien, Wei-Hsiu Chang, Chi-Tzu Feng, Kuei-Yu Chou, An-Fang Hsiao

Rehabilitation Practice and Science

Objective: This study is a secondary analysis of data from a previous project that attempts to analyze the correlation between severity of hand spasticity and functional recovery in chronic stroke patients. Methods: A total of 21 chronic stroke patients who received hand-stretching device or functional training were analyzed. The evaluation of outcomes included the Modified Ashworth Scale (MAS) for assessing hand spasticity; Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Functional Independence Measure (FIM), and Stoke Impact Scale (SIS) for evaluating functional recovery. Results: Correlation was found between MAS and FIM scores (p=.029), but due to bias on …

Assessment Of Visual Dysfunction In A Patient With Right Occipital Infarct, Li-Ting Tsai, Yu-Chin Su, William H.A. Beaudot, Yun-Hsiang Yang

Rehabilitation Practice and Science

Purpose: This study describes a patient with multiple visual impairments following right occipital infarction in the posterior cerebral artery (PCA) territory. The earliest stage of cortical processing of visual information occurs in the occipital lobe, so damage to this lobe causes not only visual field deficits but also other forms of visual problems. However, few cases of this sort have previously been reported in the literature. casereport: A 54-year-old female suffered from a progressive throbbing headache over the right occipital area for 2 weeks. Blurred vision and left hemianopia were found, and brain magnetic resonance imaging revealed cerebral infarction over …

Research News. Publications, 2015. Volume 2, University Of Mississippi. School Of Pharmacy, Soumyajit Majumdar

Publications (2015-)

Publications that appeared during the period July 1 through December 15, 2015

Hubungan Antibodi Anti Trombosit Terhadap Respon Transfusi Trombosit Pada Pasien Hemato-Onkologi Yang Mendapatkan Multitransfusi Trombosit Di Rs Dr. Cipto Mangunkusomo, Anna Mira Lubis, Aru W. Sudoyo, Shufrie Effendy, Tb Djumhana, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Pendahuluan: Multitransfusi donor random dan paparan terhadap konsentrat trombosit yang termasuk non-leukocyte depleted diketahui sebagai faktor risiko terjadinya alloimunisasi (HLA dan HPA) yang dapat menjadi salah satu penyebab kegagalan transfusi. Oleh karena itu, perlu dilakukan penelitian mengenai hubungan antibodi anti trombosit tersebut dengan kegagalan respon transfusi trombosit pada pasien hemato-onkologi sehingga dapat dilakukan metode seleksi donor dan crossmatching trombosit donor dan resipien.

Metode: Studi observasional dilakukan pada pasien hemato-onkologi dewasa yang mendapatkan multitransfusi trombosit di Rumah Sakit dr Cipto Mangunkusumo (RSCM) Jakarta. Pengamatan dilakukan pada respon transfusi dengan mengukur corrected count increment (CCI) 1 jam post transfusi dengan …

Faktor-Faktor Yang Berhubungan Dengan Kenaikan Cd4 Pada Pasien Hiv Yang Mendapat Highly Active Antiretroviral Therapy Dalam 6 Bulan Pertama, Indria Yogani, Teguh Harjono Karyadi, Anna Uyainah, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Pendahuluan: HIV adalah infeksi yang menyerang sistem kekebalan tubuh dengan CD4 sebagai sel targetnya. Ditemukannya Highly Active Antiretroviral Therapy (HAART) diharapkan mampu menurunkan angka morbiditas dan mortalitas HIV. Namun, kenaikan CD4 tidak sama untuk setiap pasien serta terdapat faktor lain yang berhubungan dengan kenaikan CD4 pada pasien HIV.

Metode: Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan di Unit Pelayanan Terpadu HIV Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta selama Mei- Juni 2014.. Data penelitian didapatkan dari rekam medis selama Januari 2004-Desember 2013. Analisis data menggunakan program SPSS dengan uji Mann Whitney, uji Chi Square atau Fisher …

Pengaruh Pemberian N-Acetylcysteine Oral Terhadap High Sensitivity C Reactive Protein (Hs-Crp) Pada Pasien Hemodialisis Kronis, Ratih Tri Kusuma Dewi, Parlindungan Siregar, Idrus Alwi, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Inflamasi dan stres oksidatif merupakan faktor risiko penyakit kardiovaskuler pada pasien penyakit ginjal kronis yang menjalani hemodialisis. Pasien hemodialisis kronis akan mengalami peningkatan kadar Hs-CRP. Hs-CRP merupakan marker inflamasi yang telah terbukti pada beberapa penelitian bermanfaat dalam memprediksi cardiovascular event. Pemberian N-Acetylcysteine (NAC) oral dapat digunakan sebagai strategi untuk menurunkan proses inflamasi yaitu disfungsi endotel dan stress oksidatif yang berperan pada atherosclerosis pada pasien hemodialsis. Pemberian NAC ini diharapkan dapat menurunkan angka morbiditas dan mortalitas karena penyakit kardiovaskuler.

Metode. Penelitian eksperimen dengan Randomized Double Blind Controlled Trial pada 65 pasien hemodialisis kronis yang memenuhi kriteria inklusi di …

How N.Y.’S Biggest For-Profit Nursing Home Group Flourishes Despite A Record Of Patient Harm, Jennifer Lehman

Capstones

How N.Y.'s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm

The state’s “character-and-competence” reviews are supposed to weed out operators with histories of violations and fines— but regulators don’t always act on the full story.

When Birth Control Hurts You: An Essure Investigation, Mia A. Garchitorena

Capstones

Thousands of women report having suffered from injuries and malfunctions related to Essure permanent birth control, including chronic pain, heavy bleeding, migration, or perforation. Many of these women also claim that Essure has caused nickel allergies, hair loss, bloating, rashes, unintended pregnancies, and death. What was promised to be an easy solution has become a life-altering problem.

As patient complaints have increased, experts have gone back and studied the science behind the approval of the Essure device. Their findings are startling: There were flaws with the studies that supported the Food and Drug Administration’s approval of the device, the experts …

She's Having A Baby And Cancer, Ashley Lewis

Capstones

In October 2011, Megan Harris, a 38-year-old high school teacher from Atlanta, Georgia, found out she was pregnant with a new addition to her happy family of three. But she didn’t know until three months later that she’d be planning a funeral rather than a nursery.

The Fight For Zadroga, Naeisha Rose

Capstones

The attack on the World Trade Center cost many first responders and volunteers, like Ken George, a retired highway crewmember who was part of the search and rescue, to lose their health. Ken had needs a respirator for his restricted airway disease, he is o n 33 medications and five years ago he had a heart attack. Bi- =weekly or monthly, he visits a doctor for his PTSD, his heart, his lungs and general healthcare. After seeing the devastating conditions that the responders like Ken worked in, Congresswoman C arolyn Maloney (D-12) worked tirelessly with many politicians, both Democrats and …

Special Muscles, Annamaria C. Scaccia

Capstones

Special Muscles is a documentary that explores living with Duchenne muscular dystrophy, a fatal degenerative disease that weakens the muscles at an aggressive rate. The film will give an uncensored look at how one family copes with inevitability of the disease and their journey chasing a promising experimental cure.

Special Muscles follows 7-year-old Pietro Scarso and his family as they face the challenges, complications and promise of treating Pietro’s progressive muscle disorder. The film travels from New York to Los Angeles to Philadelphia to document the Scarso family’s race against time as Pietro undergoes a 96-week clinical trial for Eteplirsen, …

Trombositopenia Refrakter, Andhika Rachman

Jurnal Penyakit Dalam Indonesia

Tranfusi trombosit berperan penting dalam manajemen kasus trombositopenia akibat kelainan hematologi dan onkologi. Namun, hampir sebagian besar pasien yang mendapatkan tranfusi trombosit berulang, sering mengalami kejadian tranfusi trombosit refrakter baik akibat faktor imunologi maupun non imunologi.

Faktor-Faktor Yang Berperan Terhadap Terjadinya Lipodistrofi Pada Pasien Hiv Yang Mendapatkan Terapi Antiretroviral Lini Pertama, Ratu Ratih Kusumayanti, Evy Yunihastuti, Dyah Purnamasari, F Witjaksono, Esthika Dewiasty

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Seiring dengan perkembangan antiretroviral, harapan hidup pasien HIV terus meningkat namun menjadi rentan terhadap efek samping pengobatan. Salah satu efek samping pengobatan adalah sindrom lipodistrofi, meliputi lipoatrofi, lipohipertrofi, atau gabungan keduanya. Faktor risiko yang dikaitkan dengan lipodistrofi pada HIV adalah usia, jenis kelamin, lama terapi antiretroviral, CD4 awal, Stadium HIV, dan pemakaian Stavudin. Belum ada publikasi di Indonesia yang meneliti kejadian lipodistrofi pada populasi pasien HIV yang mendapat terapi ARV lini pertama serta faktor-faktor yang memengaruhinya. Berdasarkan hal tersebut, penelitian ini dilakukan untuk mengetahui kejadian lipodistrofi pada pasien HIV dalam terapi ARV lini pertama berbasis Stavudin dan Zidovudin …

Pendekatan Diagnosis Dan Tatalaksana Endokarditis Infektif Dengan Komplikasi Emboli Septik Pulmoner Pada Pasien Hemodialisis Kronik, Jeremia Immanuel Siregar, Imelda Maria Loho, Idrus Alwi

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Endokarditis infektif (EI) pada pasien hemodialisis (HD) merupakan salah satu contoh EI yang terkait dengan perawatan kesehatan dan menjadi penyebab kematian kedua pada pasien HD setelah penyakit kardiovaskuler. Penggunaan kateter intravaskuler sebagai akses HD meningkatkan risiko kejadian bakteremia sebesar sepuluh kali lipat serta infeksi “metastatik” seperti EI dan emboli septik pulmoner sebesar 10-40%. Ilustrasi Kasus. Seorang laki-laki berusia 35 tahun datang dengan keluhan dyspnea d’effort, orthopnea, dan post-nocturnal dyspnea, disertai batuk dengan bercak darah dan demam tinggi sejak lima hari sebelum masuk rumah sakit. Pasien menjalani HD kronik selama 15 bulan dengan menggunakan catheter double-lumen (CDL). Dari pemeriksaan fisik …

Pendekatan Diagnosis Dan Tatalaksana Infark Ventrikel Kanan, R Fidiaji Hs, Sally Aman Nasution

Jurnal Penyakit Dalam Indonesia

Fungsi optimal jantung merupakan hasil interaksi dari berbagai bagian jantung, baik ventrikel kiri maupun ventrikel kanan. Namun, perkembangan diagnosis dan tatalaksana kegawatan jantung umumnya berpusat pada disfungsi ventrikel kiri. Perkembangan keilmuan saat ini memperlihatkan bahwa disfungsi ventrikel kanan juga mengakibatkan gangguan hemodinamik yang signifikan dan membutuhkan tatalaksana yang berbeda dengan tatalaksana disfungsi ventrikel kiri. Infark ventrikel kanan umumnya bukan merupakan suatu kasus tunggal, namun seringkali menyertai infark ventrikel kiri. Identifikasi infark ventrikel kanan pada kondisi tersebut, dapat mempengaruhi tatalaksana yang dilakukan pada suatu sindrom koroner akut.

Association Between Depression And Aggression In Rural Women, Laetitia Meyrueix, Gabriel Durham, Jasmine Miller, K. Bryant Smalley Phd, Psyd, Jacob C. Warren Phd

Journal of Health Disparities Research and Practice

Rural women represent approximately 20% of women living in the United States, yet research on the specific mental health needs of rural women is limited. Given the well-recognized gender-linked disparity in depression, its correlated symptoms in women still need much investigation. While emerging notions of depression in men embrace potential symptoms related to irritability and aggression, less research has focused on the potential role of aggression in depressed women. This connection may be particularly relevant for rural women who face unique mental health stressors in comparison to their urban counterparts. The purpose of this study was to examine if aggression …

Attitudes Toward Breast Cancer Genetic Testing In Five Special Population Groups, Amelie G. Ramirez, Patricia Chalela, Kipling J. Gallion, Edgar Muñoz, Alan E. Holden, Linda Burhansstipanov, Selina A. Smith, Evaon Wong-Kim, Stephen W. Wyatt, Lucina Suarez

Journal of Health Disparities Research and Practice

Purpose: This study examined interest in and attitudes toward genetic testing in 5 different population groups.

Methods: The survey included African American, Asian American, Latina, Native American, and Appalachian women with varying familial histories of breast cancer. A total of 49 women were interviewed in person. Descriptive and nonparametric statistical techniques were used to assess ethnic group differences.

Results: Overall, interest in testing was high. All groups endorsed more benefits than risks. There were group differences regarding endorsement of specific benefits and risks: testing to “follow doctor recommendations” (p=0.017), “concern for effects on family” (p=0.044), “distrust of modern medicine” (p=0.036), …

Hawai‘I’S Caring Communities Initiative: Mobilizing Rural And Ethnic Minority Communities For Youth Suicide Prevention, Jane J. Chung-Do, Deborah A. Goebert, Kris Bifulco, Tasha Tydingco, Antonia Alvarez, Davis Rehuher, Jeanelle Sugimoto-Matsuda, Bridget Arume, Pohai Wilcox

Journal of Health Disparities Research and Practice

Youth suicide is a serious, yet preventable, public health concern for ethnic minorities and rural communities. This paper describes the youth leadership model utilized by Hawai‘i’s Caring Communities Initiative (HCCI) and provides reflections on the important factors for success in implementing a youth and community advocacy project for youth suicide prevention. HCCI partnered with six youth and community organizations who serve ethnic minority and rural communities across the State of Hawai‘i to train youth leaders and community members in suicide prevention, in order to develop community awareness activities that are grounded in each community’s strengths and needs. The work of …

Epidemiology Of Hiv Among American Indians And Alaska Natives – United States, 2008-2011, Frances J. Walker, Jane M. Kelly, Mona Doshani, Neeraja Saduvala, Joseph Prejean

Journal of Health Disparities Research and Practice

American Indians/Alaska Natives (AI/AN) diagnosed with HIV infection have poorer survivorship and a higher percentage of Stage 3 (AIDS] diagnoses within one year of HIV diagnosis, compared to most race/ethnicity groups. National HIV surveillance data for 2008-2011 were used to determine diagnosis rates of HIV infection, persons living with HIV, and persons with a late diagnosis (Stage 3 within three months of HIV diagnosis) by selected characteristics for AI/AN and a combined other race/ethnicity group. The highest percentages of 862 AI/AN diagnosed with HIV infection were among males (75.7%), AI/AN aged 25-34 years (32.9%), persons living in large metropolitan areas …

Racial Disparities In The Association Between Stress And Preterm Birth, Saba W. Masho, Sarah Kye Price, Patricia Anne Kinser, Nancy Jallo

Journal of Health Disparities Research and Practice

Background: High levels of maternal stress have been linked to preterm births. However, findings from previous studies are inconsistent due to the varied use of stress measures. This study examined the effect of maternal stress on preterm birth, using both psychosocial and physiological measures.

Methods: This study was conducted among 231 pregnant women enrolled during their first prenatal care visit. Presence of stress was assessed at enrollment using the Perceived Stress Scale (PSS) and Stressful Life Events Inventory (SLEI). Samples of maternal salivary cortisol were obtained during the first trimester and birth outcomes were ascertained at delivery. Multiple …