Chula Vista, California
Chula Vista is the second largest city in the San Diego metropolitan area, the seventh largest city in Southern California, the fourteenth largest city in the state of California, the 74th-largest city in the United States. The population was 243,916 as of the 2010 census. Located just 7.5 miles from downtown San Diego and 7.5 miles from the Mexican border in the South Bay region of the metropolitan area, the city is at the center of one of the richest economic and culturally diverse zones in the United States. Chula Vista is so named because of its scenic location between the San Diego Bay and coastal mountain foothills. Founded in the early 19th century, fast population growth has been observed in the city. Located in the city is one of America's few year-round United States Olympic Training centers and popular tourist destinations include Aquatica San Diego, Mattress Firm Amphitheatre, the Chula Vista marina, the Living Coast Discovery Center. Fossils of aquatic life, in the form of a belemnitida from the Jurassic have been found within the modern borders of Chula Vista.
It is not. It isn't until 10,000 years ago, that human activity has been found within the modern borders of Chula Vista in Otay Valley of the San Dieguito people; the oldest site of human settlement within the modern boundaries of Chula Vista, was named Otai by the Spanish in 1769, had been occupied as far back as 7,980 years ago. Another place where humans first settled within the modern boundaries of Chula Vista was at the Rolling Hills Site, which dates back to 7,000 years ago. In the year 3000 BCE, people speaking the Yuman language began movement into the region from the Lower Colorado River Valley and southwestern Arizona portions of the Sonoran desert; the Kumeyaay tribe came to populate the land, on which the city sits today, who lived in the area for hundreds of years. In the year 1542 CE, a fleet of three Spanish Empire ships commanded by Juan Rodríguez Cabrillo, sailed into San Diego Harbor. Early explorations by Spanish conquistadors, such as these, led to Spanish claims of the land.
The historic land on which Chula Vista sits became part of the 1795 land grant known as Rancho del Rey or The King's Ranch. The land was renamed Rancho de la Nación. After Mexico became independent from Spain, what is now Chula Vista became part of Alta California. Beginning in 1829, the land, now Chula Vista was divided among Rancho Janal, Rancho Otay, Rancho de la Nación and Rancho La Punta. During the Mexican–American War, California was claimed by the United States, regardless of the California independence movement that had swept the state. Though California was now under the jurisdiction of the United States, land grants were allowed to continue in the form of private property. In 1873, the United States Army built a telegraph line between San Diego and Fort Yuma which ran through Telegraph Canyon in Chula Vista. In the 1870s and 1880s mining was done on Rancho Janal; the San Diego Land and Town Company developed lands of the Rancho de la Nación for new settlement. The town began as a five thousand acre development, with the first house being erected in 1887.
Around this time, the lemon was introduced to the city, by a retired professor from the University of Wisconsin. Chula Vista can be translated from Spanish as "beautiful view"; the 1888 completion of the dam allowed for irrigation of Chula Vista farming lands. Chula Vista became the largest lemon-growing center in the world for a period of time; as of February 2019, the oldest surviving buildings in Chula Vista originate from around this time, including the Barber house, the Cordrey house. Additionally, the Coronado Belt Line Railroad was built through Chula Vista, connecting Hotel Del Coronado with the National City, where Southern California Railroad terminated. Another railroad built through Chula Vista, was the National City and Otay Railroad, routed down Third Avenue. During the depression at the end of the century, industrial employment in Chula Vista was limited to the La Punta Salt Works and packing houses; the citizens of Chula Vista voted to incorporate on October 17, 1911. The State approved in November.
One of its first city council members was a former Clevelandite Greg Rogers, a leader of the Chula Vista Yacht Club. The yacht club would the first on the West Coast to build race specific boats, which resulted in a uniquely designed sloop. In 1915, a Carnegie Library was built on F Street. In the 1910s, Chinese and Mexican farm laborers worked the fields within the city, with most commuting in from Downtown San Diego and Logan Heights. In January 1916, Chula Vista was impacted by the Hatfield Flood, named after Charles Hatfield, when the Lower Otay Dam collapsed flooding the valley surrounding the Otay River. In 1916, the Hercules Powder Company opened a 30-acre bayfront site, now known as Gunpowder point, which produced substances used to make cordite, a gun propellant used extensively by the British Armed Forces during World War I. In 1920, the San Diego Country Club opened in Chula Vista, with its clubhouse designed by Richard Requa who had worked on the California Pacific International Exposition.
In 1925, aviation began in Chula Vista, with the
LAC+USC Medical Center
Los Angeles County+USC Medical Center known as County/USC, or by the abbreviation LAC+USC, is a 600-bed public teaching hospital located at 2051 Marengo Street in the Boyle Heights neighborhood of Los Angeles, California. LAC+USC Medical Center is operated by the County of Los Angeles; the LAC+USC doctors are faculty of the Keck School of Medicine of USC. Los Angeles County+USC Medical Center is one of the largest public hospitals and medical training centers in the United States, the largest single provider of healthcare in Los Angeles County, it provides healthcare services for the region's medically underserved, is a Level I trauma center and treats over 28 percent of the region's trauma victims. It provides care for half of all sickle-cell anemia patients and those people living with AIDS in Southern California; the LAC+USC Medical Center provides a full spectrum of emergency and outpatient services to only Medi-Cal recipients. These include medical, emergency/trauma, obstetrical and pediatric services as well as psychiatric services for adults and children.
LAC+USC is one of the busiest public hospitals in the Western United States, with nearly 39,000 inpatients discharged, one million ambulatory care patient visits each year. The Emergency Department is one of the world's busiest, with more than 150,000 visits per year. LAC+USC operates one of only three burn centers in Los Angeles County and one of the few Level III Neonatal Intensive Care Units in Southern California. LAC+USC is the home of the Los Angeles County College of Nursing and Allied Health, which has prepared registered nurses for professional practice since its founding in 1895. LAC+USC serves as the host facility for the U. S. Navy's Trauma Training Center, allowing uniformed medical professionals valuable exposure to trauma cases that prepare them to treat battlefield injury on the front lines with the United States Marine Corps, at sea with the Navy, or ashore at Fleet Hospitals and Shock Trauma Platoons. In 2013, American Cancer Society awarded LAC+USC with the Harold P. Freeman Award in recognition of the hospital's achievements to reduce cancer disparities among medically underserved populations.
The original hospital, located at 1200 State Street, opened in 1923. Its art-deco construction had 800 patient beds; the 1994 Northridge earthquake on January 17, 1994 renewed concerns about building safety codes, those for hospitals. The California Hospital Seismic Safety Law was signed into law on September 21, 1994; the new law took the 1200 State Street building out of compliance of earthquake and fire safety codes. To address the problem, a new modern facility was proposed and constructed nearby, at 2051 Marengo Street. Designed by a joint venture of HOK and LBL Associated Architects, the new $1 billion hospital consists of three linked buildings: a clinic tower, a diagnostic and treatment tower, an inpatient tower, in total supporting 600 patient beds; the new facility has a larger number of intensive care beds to handle patients in the aftermath of disasters. The new facility was ready by 2008, on November 8 of that year, the new hospital was opened. Transfer of all inpatients from Women's and Children's Hospital and the 1200 State Street building made the retirement of the original hospital complex official.
The old building at 1200 State Street still stands. The Wellness Center, on the first floor of the old building, was opened in 2014, it is open to the public and includes offices for nonprofit organizations, community outreach and classes for wellness activities, a dance studio, a small YMCA on State Street, extensive new landscaping. While this building no longer meets the California Hospital Seismic Safety Law, it does meet current seismic standards for non-hospital use; as of 2008, the original pediatrics & obstetrics ward is abandoned, sits covered in graffiti, visible from US-101. The Los Angeles County Hospital and the University of Southern California Medical School were first affiliated in 1885, five years after USC was founded, it was established as a 100-bed hospital with 47 patients. The present-day LAC+USC complex is adjacent to the University of Southern California Health Sciences Campus, which includes the USC Keck School of Medicine, USC School of Pharmacy, Keck Hospital of USC, the USC Norris Comprehensive Cancer Center and Hospital.
In 2004, the hospital appointed its first female Chief of Staff, Cynthia Stotts, D. O. in the 158-year history of the hospital. She was the first osteopathic physician to serve in that position; the station of the same name on the El Monte Busway for the Metro Silver Line and Foothill Transit Silver Streak is located within walking distance from the hospital. Additionally, Metro lines 70, 71, 106, 251, 751, 605 serve the hospital. Marilyn Monroe was born in the charity ward on June 1, 1926; the hospital has a jail ward. In 1954, Stan Getz was processed in the jail ward as his wife gave birth to their third child one floor below, he had been arrested for attempting to rob a pharmacy to get a morphine fix. The 1962 film The Interns starring Cliff Robertson was filmed around the hospital; the hospital was featured in the 1953 version of The War Of The Worlds directed by Byron Haskins in scenes depicting the evacuation of Los Angeles from the oncoming Martians. The distinct Art Deco-style main building served as the exterior of the hospital in the 1998 movie City of Angels.
In Terminator: The Sarah Connor Chronicles, the episode entitled "The Good Wound", exterior shots of the older LAC+US
Stanford University Medical Center
Stanford University Medical Center is a medical complex which includes Stanford Health Care and Stanford Children's Health. It is ranked as one of the best hospitals in the United States and serves as a teaching hospital for the Stanford University School of Medicine. Stanford Health Care is located at 300 Pasteur Drive, California, it is ranked as one of the best hospitals in the United States by US News and World Report and serves as the primary teaching hospital for the Stanford University School of Medicine. The facility, located at the north end of the university campus, includes the main hospital building, Stanford Comprehensive Cancer Center, Blake Wilbur Building, Boswell Building, Hoover Pavilion, an outpatient psychiatry facility; the roof of the main building contains a landing facility and Life Flight helicopter. Stanford Health Care provides both general acute care services and tertiary medical care for patients locally and internationally. Organ transplantation, cancer diagnosis and treatment, cardiovascular medicine and surgery, neurosciences are clinical specialties of worldwide renown.
Among its many achievements, the first combined heart-lung transplant in the world was completed at Stanford University Medical Center in 1981. The hospital plays a key role in the training of other medical professionals, it provides a clinical environment for the medical school’s researchers as they study ways to translate new knowledge into effective patient care. Full-time Stanford faculty and community physicians make up the hospital medical staff. Stanford Hospital is home to a Level I trauma center, it became a trauma center in 1986 and first received American College of Surgeons certification as a Level I trauma center in 1998. The hospital's history began with the foundation of the Stanford Home for Convalescent Children in 1911; when the Stanford Medical School moved south from San Francisco in 1959, the Stanford Hospital was established and was co-owned with the city of Palo Alto. It was renamed; the Beckman Center for Molecular and Genetic Medicine opened in 1989. In 1999, Stanford University approved a $185 million, five-year plan to improve the 40-year-old School of Medicine facility.
The Center for Clinical Sciences Research opened in 2000. The Clark Center for interdisciplinary research and bioengineering opened in 2004. In 2009, the Stanford outpatient clinics, which were running out of expansion room, were relocated to the Stanford Medicine Outpatient Center, a large new site in Redwood City, California occupied by the corporate headquarters of Excite@Home; the buildings were extensively remodeled for medical use to provide facilities the clinics' old homes lacked. For example, the Sleep Disorders Clinic's new sleep lab has thorough soundproofing and can accommodate a few morbidly obese patients; the inpatient facilities remain on the Stanford campus. The Stanford Life Flight program began May 1, 1984. Stanford Life Flight flies in an EC 145 helicopter that can fly under both visual and instrument flight rules, allowing for response to calls in nearly any weather; the aircraft will accommodate two patients with two Flight Nurses, or one patient with up to four caregivers, plus the Pilot.
The hospital's medical staff numbers 1,910 with an additional 850 interns and residents, as well as nearly 1,500 registered nurses and 610 licensed beds. Stanford Clinics, the group practice of most faculty physicians of Stanford University School of Medicine, includes 493 full-time faculty physicians, their areas of expertise range from primary care to the most advanced medical and surgical specialties. Stanford Clinics offer subspecialty service areas. Under the supervision of faculty physicians, Stanford medical students and residents participate in patient care in most specialties; the clinics participate in preferred provider health care programs as well as MediCal. Stanford University Medical Center is world-renowned for its work in cardiovascular medicine and surgery, organ transplantation, neurology and cancer diagnosis and treatment, it hosts 20,000 inpatients yearly. In 2017, Stanford Hospital was ranked by U. S. News & World Report as the 9th-best hospital out of 5,462 medical centers in the United States, third in the West Coast after the UCSF Medical Center and the UCLA Medical Center As of 2018, Stanford received high rankings in the following specialties: The Lucile Packard Children's Hospital was founded in 1991.
It is located at 725 Welch Road, Palo Alto, adjacent to the Stanford campus. In 2007 it was ranked as the #10 best children's hospital in the United States by U. S. News & World Report; this hospital in the CA Healthcare Atlas A project by OSHPD
San Diego is a city in the U. S. state of California. It is in San Diego County, on the coast of the Pacific Ocean in Southern California 120 miles south of Los Angeles and adjacent to the border with Mexico. With an estimated population of 1,419,516 as of July 1, 2017, San Diego is the eighth-largest city in the United States and second-largest in California, it is part of the San Diego–Tijuana conurbation, the second-largest transborder agglomeration between the U. S. and a bordering country after Detroit–Windsor, with a population of 4,922,723 people. The city is known for its mild year-round climate, natural deep-water harbor, extensive beaches, long association with the United States Navy, recent emergence as a healthcare and biotechnology development center. San Diego has been called "the birthplace of California". Home to the Kumeyaay people, it was the first site visited by Europeans on what is now the West Coast of the United States. Upon landing in San Diego Bay in 1542, Juan Rodríguez Cabrillo claimed the area for Spain, forming the basis for the settlement of Alta California 200 years later.
The Presidio and Mission San Diego de Alcalá, founded in 1769, formed the first European settlement in what is now California. In 1821, San Diego became part of the newly independent Mexico, which reformed as the First Mexican Republic two years later. California became part of the United States in 1848 following the Mexican–American War and was admitted to the union as a state in 1850; the city is the seat of San Diego County and is the economic center of the region as well as the San Diego–Tijuana metropolitan area. San Diego's main economic engines are military and defense-related activities, international trade, manufacturing; the presence of the University of California, San Diego, with the affiliated UCSD Medical Center, has helped make the area a center of research in biotechnology. The original inhabitants of the region are now known as the San La Jolla people; the area of San Diego has been inhabited by the Kumeyaay people. The first European to visit the region was explorer Juan Rodríguez Cabrillo, sailing under the flag of Castile but born in Portugal.
Sailing his flagship San Salvador from Navidad, New Spain, Cabrillo claimed the bay for the Spanish Empire in 1542, named the site "San Miguel". In November 1602, Sebastián Vizcaíno was sent to map the California coast. Arriving on his flagship San Diego, Vizcaíno surveyed the harbor and what are now Mission Bay and Point Loma and named the area for the Catholic Saint Didacus, a Spaniard more known as San Diego de Alcalá. On November 12, 1602, the first Christian religious service of record in Alta California was conducted by Friar Antonio de la Ascensión, a member of Vizcaíno's expedition, to celebrate the feast day of San Diego. Permanent colonization of California and of San Diego began in 1769 with the arrival of four contingents of Spaniards from New Spain and the Baja California peninsula. Two seaborne parties reached San Diego Bay: the San Carlos, under Vicente Vila and including as notable members the engineer and cartographer Miguel Costansó and the soldier and future governor Pedro Fages, the San Antonio, under Juan Pérez.
An initial overland expedition to San Diego from the south was led by the soldier Fernando Rivera and included the Franciscan missionary and chronicler Juan Crespí, followed by a second party led by the designated governor Gaspar de Portolà and including the mission president Junípero Serra. In May 1769, Portolà established the Fort Presidio of San Diego on a hill near the San Diego River, it was the first settlement by Europeans in. In July of the same year, Mission San Diego de Alcalá was founded by Franciscan friars under Serra. By 1797, the mission boasted the largest native population in Alta California, with over 1,400 neophytes living in and around the mission proper. Mission San Diego was the southern anchor in Alta California of the historic mission trail El Camino Real. Both the Presidio and the Mission are National Historic Landmarks. In 1821, Mexico won its independence from Spain, San Diego became part of the Mexican territory of Alta California. In 1822, Mexico began its attempt to extend its authority over the coastal territory of Alta California.
The fort on Presidio Hill was abandoned, while the town of San Diego grew up on the level land below Presidio Hill. The Mission was secularized by the Mexican government in 1834, most of the Mission lands were granted to former soldiers; the 432 residents of the town petitioned the governor to form a pueblo, Juan María Osuna was elected the first alcalde, defeating Pío Pico in the vote. However, San Diego had been losing population throughout the 1830s and in 1838 the town lost its pueblo status because its size dropped to an estimated 100 to 150 residents. Beyond town Mexican land grants expanded the number of California ranchos that modestly added to the local economy. Americans gained increased awareness of California, its commercial possibilities, from the writings of two countrymen involved in the officially forbidden, to foreigners, but economically significant hide and tallow trade, where San Diego was a major port and the only one with an adequate harbor: William Shaler's "Journal of a Voyage Between China and the North-Western Coast of America, Made in 1804" and Richard Henry Dana's more substantial and convincing account, of his 1834–36 voyage, the classic Two Years Before the Mast.
In 1846, the United States went to war against Mexico and sent a naval and land expedition to conquer Alta California. At firs
Los Robles Hospital & Medical Center
Los Robles Hospital & Medical Center is the largest hospital in eastern Ventura County. It is a hospital and medical center complex in the city of California, it is a 321-bed acute care hospital with a level II trauma center. The facility is owned by HCA−Hospital Corporation of America, operated by their HCA Far West Division. Los Robles means "The Oaks" in Spanish, the name refers to the thousands of oak trees in surrounding Thousand Oaks, it had 1,720 employees in 2016. The hospital and medical center complex was built by the Linde family, opened on November 12, 1968 as a 220-bed general acute-care facility; the first open-heart surgery in Ventura County was performed here on June 24, 1970. The hospital is known statewide for its Hyperbaric Medicine Unit, launched in June 1974, it was one of six such units in Southern California in the late 1980s. It is known for being the most specialized heart center in Ventura County, the first heart catheterization in the region was performed here in December 1969.
Los Robles opened a Pacemaker Clinic in 1972, three years prior to the nation's first pacemakers being implanted. Besides 24-hour emergency services, the hospital is home of Los Robles SurgiCenter and Breast Center, Conejo Medical Magnetic Resonance Systems, North Oaks Radiation, the Conejo Renal Center, they had a total staff of over 400 physicians as of 2002. Among its medical services are critical- and intensive care units, a comprehensive cancer center, surgical- and medical care units, operating rooms, home services, a senior center, rehabilitation center, a pain management facility. Los Robles Hospital, completed in November 1968 had a 223 bed facility which included modern maternity and pediatric sections, extensive specialized medical departments, a trained staff of over 400 employees; the four-story structure was the largest hospital in Southeast Ventura County as of 1973, it overlooks the western reaches of Thousand Oaks. Ventura County's first triplets were born at Los Robles in June 1976.
The site of the hospital was home to a Chumash summer camp in pre-colonial times. The hospital is accredited by the Joint Commission of Accreditation of Health Care Organizations, is nationally renowned for its cardiac care, it has earned multiple top honors for its specialized care. It has been rated one of the best hospitals in America for cardiac care by Center for Medicare and Medicaid Services, it is rated in the top 5% of U. S. hospitals for clinical excellence by National Research Corporation. It is the only California hospital to be certified by both Ventura- and Los Angeles County as a STEMI-designated site for rapid heart attack response, it has been a #1 Consumer Choice Award Winner by the National Research Corporation. Furthermore, Los Robles was the first Ventura County hospital to receive a full accreditation designation by National Accreditation Program for Breast Centers, it was the first hospital in Ventura County to be awarded the comprehensive stroke certification from DNV GL in 2016.
The accreditation is one of 14 in California, reflects the highest level of competence for treating acute stroke. Tom Laughlin, actor Joseph Stefano, screenwriter for the film Psycho Sandra Dee, actress Eric Turner, NFL-player Jerry Heller, music manager Robert Urich, actor Robert E. Conot and author Ed Savko, owner of The Rock Store Stanley Holden, ballet dancer Official Los Robles Hospital & Medical Center website This hospital in the CA Healthcare Atlas — a project by OSHPD
Harbor–UCLA Medical Center
Harbor–UCLA Medical Center is a 570-bed public teaching hospital located at 1000 West Carson Street in Torrance, California within Los Angeles County, United States. Harbor–UCLA Medical Center is funded by the County of Los Angeles, serves as the Level I Trauma Center for the South Bay area. A medical facility was opened on the site in 1943 as the U. S. Army's Port of Embarkation Hospital, a receiving point for the wounded returned from the Pacific theater during World War II. Situated on a tract of 80 acres, it had an administration building and a large number of barracks wards arranged under the cottage system. In February 1946, the county purchased the facility from the Federal Government in order to decentralize the activities of the Los Angeles County General Hospital, one of the largest institutions of its kind in the world, founded a branch hospital to serve the Harbor and Long Beach; the Los Angeles County Harbor General Hospital began its affiliation with UCLA School of Medicine in 1951.
Construction of the present eight-story hospital building was completed in 1962 on the easterly portion of the grounds, at Carson Street and Vermont Avenue, replacing a number of the wooden barracks and cottages comprising Harbor General. Affiliation with the UCLA School of Dentistry was established in 1972. In 1978, the name of the hospital was changed to Los Angeles County Harbor–UCLA Medical Center in order to draw attention to its working relationship with the UCLA School of Medicine; the main building was portrayed as Rampart General Hospital in the popular TV series Emergency!. Harbor–UCLA Medical Center is home of the Los Angeles Biomedical Research Institute, one of the largest independent, not-for-profit biomedical research institutes in the United States. Known as Harbor-UCLA Research and Education Institute, the LA BioMed has been conducting biomedical research, training young scientists and providing community services, including childhood immunization, nutrition assistance and anti-gang violence programs over the past 50 years.
Pioneering research in many fields such as reproductive endocrinology, infectious diseases and respiratory medicine has brought worldwide attention to the Harbor-UCLA campus. Among the major milestones are: In 1984, Harbor-UCLA was the first institution in the world to achieve successful pregnancies using the technique of ovum transfer; the research team was directed by Dr. John Buster that performed history's first embryo transfer from one woman to another resulting in a live birth and led to the announcement on February 3, 1984. In the procedure, an embryo, just beginning to develop was transferred from one woman in whom it had been conceived by artificial insemination to another woman who gave birth to the infant 38 weeks later; the sperm used in the artificial insemination came from the husband of the woman. This scientific breakthrough established standards and became an agent of change for women suffering from the afflictions of infertility and for women who did not want to pass on genetic disorders to their children.
Donor embryo transfer has given women a mechanism to become pregnant and give birth to a child that will contain their husband's genetic makeup. Although donor embryo transfer as practiced today has evolved from the original non-surgical method, it now accounts for 5% of in vitro fertilization recorded births; this work established the technical foundation and legal-ethical framework surrounding the clinical use of human oocyte and embryo donation, a mainstream clinical practice, which has evolved over the past 25 years. Building upon Dr. Buster's groundbreaking research and since the initial birth announcement in 1984, well over 47,000 live births resulting from donor embryo transfer have been and continue to be recorded by the Centers for Disease Control in the United States to infertile women, who otherwise would not have had children by any other existing method; the discovery by A. F. Parlow, PhD of the molecular structure of the human follicle stimulating hormone and luteinizing hormone.
The Parlow Pituitary Hormone and Antisera Laboratory produces purified pituitary components which are used in research and therapy around the world. One of the hormones produced, human growth hormone, is used to prevent severe growth retardation in thousands of children around the world. Dr. Delbert Fisher was the first to comprehensively characterize the ontogenesis of fetal thyroid development, he went on to conceptualize and develop a simple effective newborn screening test for congenital hypothyroidism, including developing the micro assay methods that made it possible to screen on a national scale. Internationally renowned genetics research to help treat and prevent short stature, led by Dr. David Rimoin, he was responsible for early work on disorders of growth hormone metabolism, for expanding the knowledge of dwarfism and developing the $2.2 million Skeletal Dysplasia Center at Harbor-UCLA. Dr. J. Michael Criley's cardiac research into improved cardiac resuscitation techniques and better training of emergency paramedics, leading to the country's first hospital-based paramedic training program.
A major discovery in defining the basic biochemical defect in a skin disease, known as x-linked ichthyosis. Dr. Larry Shapiro's discovery that this was a hereditary disease was a significant breakthrough and led to improved treatment strategies. Dr. Michael Kaback's advances in developing and improving screening for Tay–Sachs disease, an inherited, fatal disorder. Harbor-UCLA has become the headquarters for the California and international screening programs for the disease. Definitive studies of lung surfactant have resulted in saving the lives of thousands of premature