A client is a member of an HMO and has chronic shoulder pain from an old injury. The client has decided to pursue shoulder surgery and the HMO has required a utilization review. What will this review focus on

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Answer 1

A client is a member of an HMO and has chronic shoulder pain from an old injury. The client has decided to pursue shoulder surgery and the HMO has required a utilization review. His review will focus on The costs and benefits of the proposed surgery.

Health maintenance organization is referred to as HMO. Doctors, hospitals, and other healthcare professionals that have agreed to accept payment at a specific level for any services they perform are part of an HMO's network.Insurance companies use the utilization review process to determine the need for medical care and to guarantee that payment will be made for the care. Precertification or preauthorization for elective treatments, concurrent evaluation, and, if necessary, retrospective review for emergency cases are all common components of utilization review. Profits are usually a pertinent factor, but many other factors would be taken into account. A utilization review does not primarily focus on the client's baseline functioning or the circumstances of the first injury.

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Related Questions

How many calories would she be recommended to each from each major macronutrient group based on AMDR

Answers

45-65% your daily carbs and fat

B vitamins, which are water-soluble, should be consumed daily, but A vitamins, which are fat-soluble, can be consumed more sporadically. Why is this true

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Vitamin A can be stored in the body fat, but B vitamins are not stored by the body that is why B vitamins, which are water-soluble, should be consumed daily, but A vitamins, which are fat-soluble, can be consumed more sporadically.

How are Vitamin A and Vitamin B consumed?B-complex vitamins are water-soluble nutrients that must be ingested daily because they cannot be stored by the body. When storing and preparing food, these vitamins are easily degraded or removed.The vitamin B complex is essential for regular bodily growth and development, good skin, normal neuron and heart function, and red blood cell production in addition to acting as cofactors in biochemical reactions.When foods containing fat-soluble vitamins, like Vitamin A, are cooked, they do not lose their potency. These vitamins are not constantly required by the body, so when not in use, the body stores them in the liver and adipose tissue.

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Sensory nerves are affected in amyotrophic lateral sclerosis. True or false

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Dorsal roots and sensory nerves from ALS patients have shown loss of myelinated fibers and axonal degradation.

Becky's 2 year old son cannot walk because he was born with Spina Bifida. What should she do to help reduce the chance that her next baby will have this disorder

Answers

Becky should consume enough Folic acid and Zinc supplements  to help reduce the chance that her next baby will have Spina Bifida.

Spina bifida is a disorder of the spine that is typically visible from birth. Such a defect affects the neural tube (NTD).If the neural tube does not fully shut, spina bifida may develop anywhere along the spine. The backbone that protects the spinal cord does not properly form and close when the neural tube does not completely seal. The spinal cord and nerves are frequently harmed as a result of this. It is essential to have adequate folic acid in your body by the first few weeks of pregnancy to stop spina bifida. Due to the fact that many women don't find out they're pregnant until this point, physicians advise all women of reproductive age to take a 400 microgram (mcg) folic acid supplement everyday.

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which vascular device is double-lumened for adminstration of chemotherapy antibiotic thearpy and iv fluids

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Answer:
pick line or central line.

Explanation:
Vascular - in the vein
Double lumened - two connectors
Both the pick line and a central line are utilized for chemotherapy antibiotic therapy and IV fluids.

What could improve the peer review process?

Answers

Answer:

One possible solution would be to make reviewers' comments available to all reviewers. In this way, reviewers would be able to discuss the heterogeneities in their evaluations, helping to clarify whether an update of the manuscript by the authors is, in fact, a reasonable task

Explanation:

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you can never ever in your life of purity cure friend pressure

Although it may vary from a short narrative description of a minor procedure to a more formal report dictated by surgeons, all operative reports contain

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Answer:

procedure performed

Explanation:

Operative reports, which may be descriptive summaries or formal reports, sometimes include important information relating to surgical procedures.

These include information about the patient, preoperative diagnosis, surgical technique, findings, reasons for surgery, anesthesia details, specimens taken, drains or catheters used, estimated blood loss, postoperative diagnosis, complications. Post-operative conditions, procedures performed by other specialists, and surgical dictation.

Patient care, treatment continuation and legal paperwork all depend on these reports. They help with postoperative care and promote good communication between medical teams while providing important insights for health care practitioners. Depending on the complexity of the method and institutional constraints, the level of information may change.

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A 7-year-old patient goes into sudden cardiac arrest. You initiate cpr and correctly perform chest compressions at which rate?.

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Rate of a 100 per minute

A client has recently been prescribed carbamazepine (Tegretol), an anticonvulsant, for the management of a seizure disorder. What foods should the health care professional advise the client to avoid

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The health care professional advises the client to avoid grapefruit.

Do not take Tegretol prolonged-launch capsules which are broken or have chips or cracks. Grapefruit and grapefruit juice can also boom the outcomes of this medicine by increasing the amount inside the frame. You must no longer devour grapefruit or drink grapefruit juice even as you're taking this remedy.

Nausea, vomiting, dizziness, drowsiness, constipation, dry mouth, or unsteadiness may also occur. If any of those outcomes close or worsen, tell your medical doctor or pharmacist directly.

Drinking alcohol with this medicinal drug can motive side results, and also can increase your threat of seizures. Grapefruit may additionally interact with carbamazepine and cause undesirable aspect outcomes. Keep away from the use of grapefruit merchandise.

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which type of immunity would a 4-year-old child develop during the course of an infection with varicella

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According to the research, the correct option is Active Immunity. It would be the type of immunity that a 4-year-old child develops during the course of an infection with varicella.

What is Active Immunity?

It is a nonspecific immunity developed from birth that provides defense (immunity) against invading pathogens ranging from viruses to parasites.

It has a major role in the induction of the acquired immune response where innate immune recognition is genetically governed and the specificity of each R is genetically predetermined, being able to recognize a few hundred Ag (pathogen-associated molecular patterns: LPS, peptidoglycan, DNA etc

Therefore, we can conclude that According to the research, the correct option is Active Immunity. It would be the type of immunity that a 4-year-old child develops during the course of an infection with varicella.

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If a person consumes an extra 500 calories per day, how long would it take before he or she gained one pound of fat?
A. 7 days
B. 10 days
C. 5 days
D. 14 days

Answers

Answer:

A. 7 Days

Explanation:

The hyperalgesia that is common in phantom limb pain could potentially be blocked if a new drug was developed that could prevent (without triggering any side-effects) the ______.

Answers

The hyperalgesia that is common in phantom limb pain could potentially be blocked if a new drug was developed that could prevent (without triggering any side effects) option(b) i.e, the diffusion of calcium ions through NMDA receptors.

What is hyperalgesia?

Heightened pain perception and a strong emotional reaction to it. When the nerves or the chemical makeup of the nerve pathways involved in pain perception are damaged, hyperalgesia may result.

An illustration would be if someone had elbow surgery and the discomfort gradually got worse rather than better.

Your body's particular nerve receptors are becoming more sensitive, which is the reason for this. As a result of a surgery or procedure, tissue or nerve injury may result in hyperalgesia. Additionally, it can happen to persons who are using opioids.

Drugs known as NMDA receptor antagonists block your pain receptors, inhibit your pain response, and lessen your pain. NMDA receptor antagonists like ketamine and methadone are frequently used for treating hyperalgesia include ketamine and methadone.

When the brain's glutamate concentration rises, too much calcium is released, which can harm the nerve cells. NMDA antagonists bind to NMDA receptors and stop glutamate from binding, which stops calcium from entering the nerve cells.

The complete question is:

The hyperalgesia that is common in phantom limb pain could potentially be blocked if a new drug was developed that could prevent (without triggering any side-effects) the ______.

a) binding of enkephalins to NMDA receptors

b) diffusion of calcium ions through NMDA receptors

c) release of enkephalins diffusion of enkephalins

d) across synaptic clefts

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How does social justice and health inequities influence population health care provision

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Social justice is the idea that everyone should have the same rights and chances, including the right to better health. Still, there are now health differences that are avoidable, unnecessary, and unfair. These differences are caused by laws and practices that give money, power, and resources to different communities in different ways based on class, race, gender, location, and other factors.

Health disparities are to blame for more than 30% of the direct medical costs that black, Hispanic, and Asian-Americans have to pay in the United States. Due to unequal access to health care and other services that help people stay healthy, these people are often sicker and have to pay more for their care when they do find it. Over the course of four years, this percentage adds up to more than $230 billion. Also, research has shown that clinicians tend to think less of people of color and that their unconscious racial bias makes it harder for them to communicate and lowers the quality of care they give.

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Each producer who initiates the application must submit the following to the insurance company with or as part of each applicaton

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Each producer who initiates the application must submit the following to the insurance company with or as part of the application, a statement required to be signed by both applicant and the producer confirming whether the applicant has the existing policies or contracts.

If the statement submitted by the applicant says no, that is, the applicant does not have existing policies or contracts, then the producer's task with respect to the replacement is done and he has nothing to do further.

However, if the statement says yes regarding the existing policies or contracts, then the producer is required to read and present to the applicant, a notice regarding the replacements in the manner described in Appendix A. The notice is compulsorily required to be signed by both applicant and the producer.

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Having type 2 diabetes, smoking, physical inactivity, a low HDL cholesterol level, and an elevated LDL cholesterol level represent risk factors for

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Having type 2 diabetes, smoking, physical inactivity, a low HDL cholesterol level, and an elevated LDL cholesterol level represent risk factors for heart disease.

What is heart disease?

Coronary artery disease is mistakenly and narrowly referred to as "heart disease".

Cardiovascular disease, which refers to any condition of the heart or blood arteries, is not the same as heart disease.

The four types of heart disease.

Coronary artery diseaseArrhythmiaHeart valve diseaseHeart failure

The most typical cause of coronary artery disease is atherosclerosis, which is a buildup of fatty plaques in your arteries.

Coronary artery disease (CAD), heart arrhythmias, heart failure, heart valve disease, pericardial disease, cardiomyopathy (Heart Muscle Disease), congenital heart disease are the symptoms of heart disease.

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ten minutes after the initiation of a blood transfusion, a client reports chills and flank pain. which nursing action

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Ten minutes after the initiation of a blood transfusion, a client reports chills and flank pain. The immediate nursing action should be 1 stopping the transfusion.

Fever and chills during transfusion are believed to be brought about by recipient antibodies responding with white cell antigens or white cell parts in the blood product or because of cytokines that gather in the blood products during storage.

This is an indication of an intense hemolytic transfusion response, showing that the beneficiary's blood is contrary to the transfused blood. The pain is brought about by hemolysis, agglutination, and capillary blocking connecting the kidneys. After inducing and acknowledging such indispensable signs the infusion of blood should immediately be stopped and afterward normal saline ought to be mixed to keep the line patent and keep up with blood volume.

Your question is incomplete, but most probably your full question was…

Ten minutes after the initiation of a blood transfusion, a client reports chills and flank pain. What is the next nursing action?

Stop the transfusion.Obtain the vital signs.Assess the pain further.Increase the flow of normal saline.

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PREOPERATIVE DIAGNOSIS
Hypertensive stage 5 chronic kidney disease and need of dialysis access.

POSTOPERATIVE DIAGNOSIS
Same.

PRIMARY PROCEDURE
PLACEMENT OF ARTERIOVENOUS FISTULA, CIMINO-TYPE PROCEDURE.

PROCEDURE
After informed consent, the patient was brought to the operating room and placed supine on the table. After induction of anesthesia, the patient was prepped and draped appropriately. The cephalic vein and radial artery were identified and marked. An area was marked between these 2, and the area was infiltrated with Marcain and epinephrine prior to making the incision. The cephalic vein was dissected out first followed by the radial artery. The distal end of the vein was clamped and transected. The radial artery and both ends were occluded. Bleeding was controlled appropriately with clamps. An end-to-end anastomosis was performed with GoreTex sutures. Prior to completing the anastomosis, the fistula was flushed with heparinized saline. The procedure was completed with the final sutures. Evaluation of the flow in the vessel resulted in good thrill and bruit present throughout the entire area. The subcutaneous tissue and skin were closed appropriately, and sterile dressings were applied. The fistula will be evaluated in the next 24 hours for dialysis use.
ICD-10-CM:
ICD-10-CM:

Answers

The codes assigned to this patient are:

ICD 10 - N18, Chronic renal failure.

ICD 10 I77.0 Acquired arteriovenous fistula

What does the ICD mean?

The International Classification of Diseases and Related Health Problems, better known as the ICD, is one of the main epidemiological tools in everyday medical practice. The main function of the ICD is to monitor the incidence and prevalence of diseases, through universal standardization.

With this information, we can conclude that ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems.

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After single dose of antibiotics, how many days should a person with a bacterial infection abstain from sexual intercourse

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It is advised to refrain from having sexual intercourse for 7 days at least. But this can vary based on the disease.

Sexually Transmitted Infections

Sexually transmitted infections are infections that are passed from one person to another sexually.  Some of the most common STIs are Bacterial vaginosis, Chlamydia, Syphilis, Gonorrhea, Hepatitis-B, Herpes, HPV, Pelvic Inflammatory Diseases, Crabs, etc.

STIs are commonly seen and can be transmitted by various non-penetrative sexual contact. Many STIs are caused by bacteria which can be cured by antibiotic treatment The treatment can be a single dose or a full course that lasts 7 days. If there is any limitation do express that to the doctor. Similarly, inform the previous partners to get them checked up.

Note: - I believe your question lacks a key component and the question should have been “after a single dose of antibiotics, how many days should a person with a bacterial infection that can be sexually transmitted (STI) abstain from sexual intercourse.”

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which potential life threatening condition would be considered during the primary survey for a client admitted

Answers

An internal catastrophe that could endanger the patients is a fire in a hospital.

What is a Life-threatening condition?

A condition for which a successful cure may be possible but not guaranteed. A condition that poses a risk of death usually develops quickly, with an abrupt or acute onset, and it may or may not be related to another condition that poses a risk of death.

A few examples of medical emergencies are

Difficulty breathing, such as asthma or an allergic reaction. Major harm (e.g. open chest wound with trouble breathing, spinal or neck injury with loss of sensation or motion, an obvious fracture or dislocation, especially with visible bone). Severe allergic reaction with swelling in the throat. Extreme asthma. Unconsciousness or inactivity. An episode of acute asthma (which is not responding to usual medication).Amputation or laceration of a limb (e.g. finger).Reaction to a bee sting (with hives or swelling of your whole arm or leg).

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Which type of food components increase risk for obesity, type 2 diabetes, hypertension, cardiovascular disease and cancer

Answers

Answer:

The risk for obesity, type 2 diabetes , hypertension, cardiovascular disease and cancer is increased by the consumption of a diet high in saturated fats.

Explanation:

Saturated fats are found in foods like butter, ghee, cakes, ghee, cheese and fatty cuts of meat.

Saturated fats are considered to be unhealthy fats. Saturated fats are generally solid at room temperature. Consumption of saturated fats can lead to many cardiovascular diseases and other health problems.

Excess intake of saturated fats can increase the LDL cholesterol in the body and cause buildup of cholesterol in the arteries which increases the risk for cardiovascular diseases.

Saturated fats can  increase the calories  in one’s diet which can lead to obesity and other health problems.

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The risk for obesity, type 2 diabetes, hypertension, cardiovascular disease, and cancer is increased by the consumption of a diet high in saturated fats.

Effects of saturated fats on human body:

Saturated fats are found in foods like butter, ghee, cakes, ghee, cheese, and fatty cuts of meat. Saturated fats are considered to be unhealthy fats. Saturated fats are generally solid at room temperature. Consumption of saturated fats can lead to many cardiovascular diseases and other health problems. Excess intake of saturated fats can increase the LDL cholesterol in the body and cause the build-up of cholesterol in the arteries which increases the risk for cardiovascular diseases. Saturated fats can increase the calories in one’s diet which can lead to obesity and other health problems.

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While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a weak cough, faint inspiratory stridor, and cyanosis around the lips. You should:

Answers

In this given situation, we should stand behind him and administer abdominal thrusts.

Which part of the body should abdominal thrusts be administered?

Place the fist's thumb side against the person's stomach, just above the belly button and below the ribs. The muscle of the diaphragm can be felt. With the other hand over the fist, make a quick, powerful upward thrust into this muscle. Keep performing abdominal thrusts until the thing exits.

In order to remove things from the throat, the Heimlich maneuver employs abdominal thrusts. The diaphragm is a muscle that lies beneath the lungs. To assist the lungs in exhaling air, this muscle contracts. The Heimlich maneuver works by creating an artificial cough.

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seminoma of the testicle generally appears on ultrasound as a(n) _____________ mass. * 5 points Hypoechoic Hyperechoic Anechoic Complex

Answers

Seminoma of the testicle generally appears on ultrasound as a Hypoechoic mass.

What is Seminoma of the testicle?Testicular seminomas are a type of germ cell tumor and the most common testicular tumors.A painless testicular mass but there may be some degree of testicular discomfort.In ultrasound, seminomas usually appear as a homogeneous intratesticular mass of low echogenicity.Solid, homogenous, hypoechoic and usually oval in shape relative to the normal testicular parenchyma.

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A client presents with a positive home pregnancy test. The client has a 7-month-old baby and a 2-year-old child with her. What is a priority assessment to be completed during this visit

Answers

A priority assessment to be completed during this visit is whether there are good human and financial conditions for the new pregnant women, whether it is necessary for the government to intervene with measures to protect the baby and children.

When should you seek the Municipal Guardianship Council?

The agency must be called upon in any situation that constitutes a threat or violation of the rights of children and adolescents due to lack, omission or abuse of parents, guardians, society or the State or due to the minor's own conduct.

With this information, we can conclude that the Municipal Guardianship Council should promote, by simple administrative decision, the removal of the child or adolescent from family life as a "antecedent" measure to institutional reception.

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Excessive intake of iron can lead to a condition called hemochromatosis, which leads to damage of the ________.

Answers

Answer:

Hemochromatosis can lead to damage of the liver, heart and pancreas.

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Prostate cancer is the most common occurring cancer in men. Early detection increases the chance of cure. What yearly screenings are recommended for early detection of prostate cancer

Answers

A man require PSA testing between the ages of 40 and 54, even if the usual recommendations suggest beginning at age 55. The person should get tested once in two years for early detection of prostate cancer.

By checking a man's blood for prostate-specific antigen (PSA) levels, prostate cancer is frequently detected early. The digital rectal exam is an additional method of detecting prostate cancer (DRE). The doctor feels the prostate gland with a finger inserted into the rectum while wearing gloves and lubricant.Prostate cancer may be early-staged detected using a DRE or a PSA test. However, it is unclear whether therapy and early detection reduce the risk of dying from prostate cancer. One should discuss the advantages and disadvantages of prostate cancer screening with your doctor.

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Certified Exercise Physiologists gear workouts to address client concerns. Education is an important component in order to:

Answers

Education is an important component in order to make the sessions interesting and meaningful for clients.

Most clients have a specific concern and the verbal communication along with the demonstration helps meet the client goals on time. The need and the posture along with the target muscle should be explained. The clarification about the exercises encourages and motivates the person to exercise regularly. The client must be educated on how the muscle should feel while performing a new strength exercise.

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In the context of assessment of a thigh injury, _____ is a bony landmark of the thigh that should be palpated.

Answers

In the context of assessment of a thigh injury, greater trochanter is a bony landmark of the thigh that should be palpated.

The greater trochanter belongs to the skeletal system and is part of the femur which is large, irregular and quadrilateral eminence.

The thigh injury can be assessed by the palpation of the greater trochanter.

Thigh injuries generally happen due to various strains, like Hip flexor strains, quadriceps strain, Groin strains etc. Thigh injuries can also be caused due to contusion.

The palpation of the greater trochanter, gives a positive predictive value of 83%. The findings are seen on magnetic resonance imaging.

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__________ is an acute inflammation of the first two meninges that cover the brain and spinal cord.

Answers

Answer:

meningitis

Explanation:

Inflammation of the meninges, the membranes that surround the brain and spinal cord, is called meningitis; inflammation of the brain itself is called encephalitis.

To best protect the health of adolescents, it is especially important to: Group of answer choices Stop the spread of parasitic infections Stop the spread of malaria Stop the spread of measles Preserve the gains made in the past few decades in child health

Answers

To best protect the health of adolescents, it is especially important to Preserve the gains made in the past few decades in child health.

Early in life, children experience rapid growth and development, which is highly influenced by the elements indicated above. sufficient supplemental feedings, exclusive breastfeeding,  For best results, stimulation, a secure environment, and care must be provided.To promote healthy physical, mental, social, and cognitive growth and to  deleterious effects on both long-term health and short-term survival as well as growth. The basis for lifelong learning, behavior, and health is laid throughout early childhood development. Early childhood experiences influence a child's brain and their ability to learn, get along with others, and cope with daily stressors and challenges.

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To decrease the risk of ________, women who are capable of becoming pregnant are urged to consume at least 400 micrograms daily of________.

Answers

To decrease the risk of neural tube defects, women who are capable of becoming pregnant are urged to consume at least 400 micrograms daily of folic acid.

To avoid neural tube abnormalities, the US Public Health Service advises pregnant women to take 400 micrograms (mcg) of folic acid daily. Folic acid can reduce some birth defects of the brain and spinal cord by more than 70 percent. These birth defects are called neural tube defects (NTDs). Such defects occur when the spinal cord fails to close properly. The most common neural tube defect is spina bifida.

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