Maternal Health Outcome and Economic Growth in Sub-Saharan Africa: A Dynamic Panel Analysis

Maternal health outcome is one of the major population development challenges in Sub-Saharan Africa. The region has the highest maternal mortality ratio, despite the progressive economic growth in the region during the global economic crisis. It has been hypothesized that increase in economic growth will reduce the level of maternal mortality. The purpose of this study is to investigate the existence of the negative relationship between health outcome proxy by maternal mortality ratio and economic growth in Sub-Saharan Africa. The study used the Pooled Mean Group estimator of ARDL Autoregressive Distributed Lag (ARDL) and the Kao test for cointegration to examine the short-run and long-run relationship between maternal mortality and economic growth. The results of the cointegration test showed the existence of a long-run relationship between the variables considered for the study. The long-run result of the Pooled Mean group estimates confirmed the hypothesis of an inverse relationship between maternal health outcome proxy by maternal mortality ratio and economic growth proxy by Gross Domestic Product (GDP) per capita. Thus increasing economic growth by investing in the health care systems to reduce pregnancy and childbirth complications will help reduce maternal mortality in the sub-region.

Stochastic Optimization of a Vendor-Managed Inventory Problem in a Two-Echelon Supply Chain

The purpose of this paper is to develop a multi-product economic production quantity model under vendor management inventory policy and restrictions including limited warehouse space, budget, and number of orders, average shortage time and maximum permissible shortage. Since the “costs” cannot be predicted with certainty, it is assumed that data behave under uncertain environment. The problem is first formulated into the framework of a bi-objective of multi-product economic production quantity model. Then, the problem is solved with three multi-objective decision-making (MODM) methods. Then following this, three methods had been compared on information on the optimal value of the two objective functions and the central processing unit (CPU) time with the statistical analysis method and the multi-attribute decision-making (MADM). The results are compared with statistical analysis method and the MADM. The results of the study demonstrate that augmented-constraint in terms of optimal value of the two objective functions and the CPU time perform better than global criteria, and goal programming. Sensitivity analysis is done to illustrate the effect of parameter variations on the optimal solution. The contribution of this research is the use of random costs data in developing a multi-product economic production quantity model under vendor management inventory policy with several constraints.

Multidisciplinary Approach to Diagnosis of Primary Progressive Aphasia in a Younger Middle Aged Patient

Primary progressive aphasia (PPA) is a neurodegenerative disease similar to frontotemporal and semantic dementia, while having a different clinical image and anatomic pathology topography. Nonetheless, they are often included under an umbrella term: frontotemporal lobar degeneration (FTLD). In the study, examples of diagnosing PPA are presented through the multidisciplinary lens of specialists from different fields (neurologists, psychiatrists, clinical speech therapists, clinical neuropsychologists and others) using a variety of diagnostic tools such as MR, PET/CT, genetic screening and neuropsychological and logopedic methods. Thanks to that, specialists can get a better and clearer understanding of PPA diagnosis. The study summarizes the concrete procedures and results of different specialists while diagnosing PPA in a patient of younger middle age and illustrates the importance of multidisciplinary approach to differential diagnosis of PPA.

Validity of Universe Structure Conception as Nested Vortexes

This paper introduces the Nested Vortexes conception of the universe structure and interprets all the physical phenomena according this conception. The paper first reviews recent physics theories, either in microscopic scale or macroscopic scale, to collect evidence that the space is not empty. But, these theories describe the property of the space medium without determining its structure. Determining the structure of space medium is essential to understand the mechanism that leads to its properties. Without determining the space medium structure, many phenomena; such as electric and magnetic fields, gravity, or wave-particle duality remain uninterpreted. Thus, this paper introduces a conception about the structure of the universe. It assumes that the universe is a medium of ultra-tiny homogeneous particles which are still undiscovered. Like any medium with certain movements, possibly because of a great asymmetric explosion, vortexes have occurred. A vortex condenses the ultra-tiny particles in its center forming a bigger particle, the bigger particles, in turn, could be trapped in a bigger vortex and condense in its center forming a much bigger particle and so on. This conception describes galaxies, stars, protons as particles at different levels. Existing of the particle’s vortexes make the consistency of the speed of light postulate is not true. This conception shows that the vortex motion dynamic agrees with the motion of all the universe particles at any level. An experiment has been carried out to detect the orbiting effect of aggregated vortexes of aligned atoms of a permanent magnet. Based on the described particle’s structure, the gravity force of a particle and attraction between particles as well as charge, electric and magnetic fields and quantum mechanics characteristics are interpreted. All augmented physics phenomena are solved.

The Price of Knowledge in the Times of Commodification of Higher Education: A Case Study on the Changing Face of Education

Current developments in the Western economies have turned some universities into corporate institutions driven by practices of production and commodity. Academia is increasingly becoming integrated into national economies as a result of students paying fees and is consequently using business practices in student retention and engagement. With these changes, pedagogy status as a priority within the institution has been changing in light of these new demands. New strategies have blurred the boundaries that separate a student from a client. This led to a change of the dynamic, disrupting the traditional idea of the knowledge market, and emphasizing the corporate aspect of universities. In some cases, where students are seen primarily as a customer, the purpose of academia is no longer to educate but sell a commodity and retain fee-paying students. This paper considers opposing viewpoints on the commodification of higher education, reflecting on the reality of maintaining a pedagogic grounding in an increasingly commercialized sector. By analysing a case study of the Student Success Festival, an event that involved academic and marketing teams, the differences are considered between the respective visions of the pedagogic arm of the university and the corporate. This study argues that the initial concept of the event, based on the principles of gamification, independent learning, and cognitive criticality, was more clearly linked to a grounded pedagogic approach. However, when liaising with the marketing team in a crucial step in the creative process, it became apparent that these principles were not considered a priority in terms of their remit. While the study acknowledges in the power of pedagogy, the findings show that a pact of concord is necessary between different stakeholders in order for students to benefit fully from their learning experience. Nevertheless, while issues of power prevail and whenever power is unevenly distributed, reaching a consensus becomes increasingly challenging and further research should closely monitor the developments in pedagogy in the UK higher education.

NANCY: Combining Adversarial Networks with Cycle-Consistency for Robust Multi-Modal Image Registration

Multimodal image registration is a profoundly complex task which is why deep learning has been used widely to address it in recent years. However, two main challenges remain: Firstly, the lack of ground truth data calls for an unsupervised learning approach, which leads to the second challenge of defining a feasible loss function that can compare two images of different modalities to judge their level of alignment. To avoid this issue altogether we implement a generative adversarial network consisting of two registration networks GAB, GBA and two discrimination networks DA, DB connected by spatial transformation layers. GAB learns to generate a deformation field which registers an image of the modality B to an image of the modality A. To do that, it uses the feedback of the discriminator DB which is learning to judge the quality of alignment of the registered image B. GBA and DA learn a mapping from modality A to modality B. Additionally, a cycle-consistency loss is implemented. For this, both registration networks are employed twice, therefore resulting in images ˆA, ˆB which were registered to ˜B, ˜A which were registered to the initial image pair A, B. Thus the resulting and initial images of the same modality can be easily compared. A dataset of liver CT and MRI was used to evaluate the quality of our approach and to compare it against learning and non-learning based registration algorithms. Our approach leads to dice scores of up to 0.80 ± 0.01 and is therefore comparable to and slightly more successful than algorithms like SimpleElastix and VoxelMorph.

Polarization Insensitive Absorber with Increased Bandwidth Using Multilayer Metamaterial

A wide band polarization insensitive metamaterial absorber with bandwidth enhancement in X and C band is proposed. The structure proposed here consists of a periodic unit cell of resonator arrangements in double layer. The proposed structure shows near unity absorption at frequencies of 6.21 GHz and 10.372 GHz spreading over a bandwidth of 1 GHz and 6.21 GHz respectively in X and C bands. The proposed metamaterial absorber is designed so as to increase the bandwidth. The proposed structure is also independent for TE and TM polarization. Because of its simple implementation, near unity absorption and wide bandwidth this dual band polarization insensitive metamaterial absorber can be used for EMI/EMC applications.

Effects of Milling Process Parameters on Cutting Forces and Surface Roughness When Finishing Ti6al4v Produced by Electron Beam Melting

Electron Beam Melting (EBM) is a metal powder bed-based Additive Manufacturing (AM) technology, which uses computer-controlled electron beams to create fully dense three-dimensional near-net-shaped parts from metal powder. It gives the ability to produce any complex parts directly from a computer-aided design (CAD) model without tools and dies, and with a variety of materials. However, the quality of the surface finish in EBM process has limitations to meeting the performance requirements of additively manufactured components. The aim of this study is to investigate the cutting forces induced during milling Ti6Al4V produced by EBM as well as the surface quality of the milled surfaces. The effects of cutting speed and radial depth of cut on the cutting forces, surface roughness, and surface morphology were investigated. The results indicated that the cutting speed was found to be proportional to the resultant cutting force at any cutting conditions while the surface roughness improved significantly with the increase in cutting speed and radial depth of cut.

Obesity and Bone Mineral Density in Patients with Large Joint Osteoarthritis

Along with the global aging of population, the number of people with somatic diseases is increasing, including such interrelated pathologies as obesity, osteoarthritis (OA) and osteoporosis (OP). The objective of the study is to examine the connection between body mass index (BMI), OA and bone mineral density (BMD) of lumbar spine, femoral neck and trabecular bone score (TBS) in postmenopausal women with OA. We have observed 359 postmenopausal women (50-89 years old) and divided them into four groups by age: 50-59 yrs, 60-69 yrs, 70-79 yrs and over 80 years old. In addition, according to the American College of Rheumatology (ACR) Clinical classification criteria for knee and hip OA, we divided them into 2 groups: group I – 117 females with symptomatic OA (including 89 patients with knee OA, 28 patients with hip OA) and group II –242 women with a normal functional activity of large joints. Analysis of data was performed taking into account their BMI, classified by World Health Organization (WHO). Diagnosis of obesity was established when BMI was above 30 kg/m2. In woman with obesity, a symptomatic OA was detected in 44 postmenopausal women (41.1%), a normal functional activity of large joints - in 63 women (58.9%). However, in women with normal BMI – 73 women, who account for 29.0% of cases, a symptomatic OA was detected. According to a chi-squared (χ2) test, a significantly higher level of BMI was detected in postmenopausal women with OA (χ2 = 5.05, p = 0.02). Women with a symptomatic OA had a significantly higher BMD of lumbar spine compared with women who had a normal functional activity of large joints. No significant differences of BMD of femoral necks or TBS were detected in either the group with OA or with a normal functional activity of large joints.

Behavioral Response of Bee Farmers to Climate Change in South East, Nigeria

The enigma climate change is no longer an illusion but a reality. In the recent years, the Nigeria climate has changed and the changes are shown by the changing patterns of rainfall, the sunshine, increasing level carbon and nitrous emission as well as deforestation. This study analyzed the behavioural response of bee keepers to variations in the climate and the adaptation techniques developed in response to the climate variation. Beekeeping is a viable economic activity for the alleviation of poverty as the products include honey, wax, pollen, propolis, royal jelly, venom, queens, bees and their larvae and are all marketable. The study adopted the multistage sampling technique to select 120 beekeepers from the five states of Southeast Nigeria. Well-structured questionnaires and focus group discussions were adopted to collect the required data. Statistical tools like the Principal component analysis, data envelopment models, graphs, and charts were used for the data analysis. Changing patterns of rainfall and sunshine with the increasing rate of deforestation had a negative effect on the habitat of the bees. The bee keepers have adopted the Kenya Top bar and Langstroth hives and they establish the bee hives on fallow farmland close to the cultivated communal farms with more flowering crops.

Comparative Parametric Analysis on the Dynamic Response of Fibre Composite Beams with Debonding

Fiber Reinforced Polymer (FRP) composites enjoy an array of applications ranging from aerospace, marine and military to automobile, recreational and civil industry due to their outstanding properties. A structural glass fiber reinforced polymer (GFRP) composite sandwich panel made from E-glass fiber skin and a modified phenolic core has been manufactured in Australia for civil engineering applications. One of the major mechanisms of damage in FRP composites is skin-core debonding. The presence of debonding is of great concern not only because it severely affects the strength but also it modifies the dynamic characteristics of the structure, including natural frequency and vibration modes. This paper deals with the investigation of the dynamic characteristics of a GFRP beam with single and multiple debonding by finite element based numerical simulations and analyses using the STRAND7 finite element (FE) software package. Three-dimensional computer models have been developed and numerical simulations were done to assess the dynamic behavior. The FE model developed has been validated with published experimental, analytical and numerical results for fully bonded as well as debonded beams. A comparative analysis is carried out based on a comprehensive parametric investigation. It is observed that the reduction in natural frequency is more affected by single debonding than the equally sized multiple debonding regions located symmetrically to the single debonding position. Thus it is revealed that a large single debonding area leads to more damage in terms of natural frequency reduction than isolated small debonding zones of equivalent area, appearing in the GFRP beam. Furthermore, the extents of natural frequency shifts seem mode-dependent and do not seem to have a monotonous trend of increasing with the mode numbers.

The Significance of Cultural Risks for Western Consultants Executing Gulf Cooperation Council Megaprojects

Differences in commercial, professional and personal cultural traditions between western consultants and project sponsors in the Gulf Cooperation Council (GCC) region are potentially significant in the workplace, and this can impact on project outcomes. These cultural differences can, for example, result in conflict amongst senior managers, which can negatively impact the megaproject. New entrants to the GCC often experience ‘culture shock’ as they attempt to integrate into their unfamiliar environments. Megaprojects are unique ventures with individual project characteristics, which need to be considered when managing their associated risks. Megaproject research to date has mostly ignored the significance of the absence of cultural congruence in the GCC, which is surprising considering that there are large volumes of megaprojects in various stages of construction in the GCC. An initial step to dealing with cultural issues is to acknowledge culture as a significant risk factor (SRF). This paper seeks to understand the criticality for western consultants to address these risks. It considers the cultural barriers that exist between GCC sponsors and western consultants and examines the cultural distance between the key actors. Initial findings suggest the presence to a certain extent of ethnocentricity. Other cultural clashes arise out of a lack of appreciation of the customs, practices and traditions of ‘the Other’, such as the need for avoiding public humiliation and the hierarchal significance rankings. The concept and significance of cultural shock as part of the integration process for new arrivals are considered. Culture shock describes the state of anxiety and frustration resulting from the immersion in a culture distinctly different from one's own. There are potentially substantial project risks associated with underestimating the process of cultural integration. This paper examines two distinct but intertwined issues: the societal and professional culture differences associated with expatriate assignments. A case study examines the cultural congruences between GCC sponsors and American, British and German consultants, over a ten-year cycle. This provides indicators as to which nationalities encountered the most profound cultural issues and the nature of these. GCC megaprojects are typically intensive fast track demanding ventures, where consultant turnover is high. The study finds that building trust-filled relationships is key to successful project team integration and therefore, to successful megaproject execution. Findings indicate that both professional and social inclusion processes have steep learning curves. Traditional risk management practice is to approach any uncertainty in a structured way to mitigate the potential impact on project outcomes. This research highlights cultural risk as a significant factor in the management of GCC megaprojects. These risks arising from high staff turnover typically include loss of project knowledge, delays to the project, cost and disruption in replacing staff. This paper calls for cultural risk to be recognised as an SRF, as the first step to developing risk management strategies, and to reduce staff turnover for western consultants in GCC megaprojects.

Study on the Electrochemical Performance of Graphene Effect on Cadmium Oxide in Lithium Battery

Graphene and CdO with different stoichiometric ratios of Cd(CH₃COO)₂ and graphene samples were prepared by hydrothermal reaction. The crystalline phases of pure CdO and 3CdO:1graphene were identified by X-ray diffraction (XRD). The particle morphology was studied with SEM. Furthermore, impedance measurements were applied. Galvanostatic measurements for the cells were carried out using potential limits between 0.01 and 3 V vs. Li/Li⁺. The current cycling intensity was 10⁻⁴ A. The specific discharge capacity of 3CdO-1G cell was about 450 Ah.Kg⁻¹ up to more than 100 cycles.

Adomian’s Decomposition Method to Functionally Graded Thermoelastic Materials with Power Law

This paper presents an iteration method for the numerical solutions of a one-dimensional problem of generalized thermoelasticity with one relaxation time under given initial and boundary conditions. The thermoelastic material with variable properties as a power functional graded has been considered. Adomian’s decomposition techniques have been applied to the governing equations. The numerical results have been calculated by using the iterations method with a certain algorithm. The numerical results have been represented in figures, and the figures affirm that Adomian’s decomposition method is a successful method for modeling thermoelastic problems. Moreover, the empirical parameter of the functional graded, and the lattice design parameter have significant effects on the temperature increment, the strain, the stress, the displacement.

Comparison between Conventional Bacterial and Algal-Bacterial Aerobic Granular Sludge Systems in the Treatment of Saline Wastewater

The increasing generation of saline wastewater through various industrial activities is becoming a global concern for activated sludge (AS) based biological treatment which is widely applied in wastewater treatment plants (WWTPs). As for the AS process, an increase in wastewater salinity has negative impact on its overall performance. The advent of conventional aerobic granular sludge (AGS) or bacterial AGS biotechnology has gained much attention because of its superior performance. The development of algal-bacterial AGS could enhance better nutrients removal, potentially reduce aeration cost through symbiotic algae-bacterial activity, and thus, can also reduce overall treatment cost. Nonetheless, the potential of salt stress to decrease biomass growth, microbial activity and nutrient removal exist. Up to the present, little information is available on saline wastewater treatment by algal-bacterial AGS. To the authors’ best knowledge, a comparison of the two AGS systems has not been done to evaluate nutrients removal capacity in the context of salinity increase. This study sought to figure out the impact of salinity on the algal-bacterial AGS system in comparison to bacterial AGS one, contributing to the application of AGS technology in the real world of saline wastewater treatment. In this study, the salt concentrations tested were 0 g/L, 1 g/L, 5 g/L, 10 g/L and 15 g/L of NaCl with 24-hr artificial illuminance of approximately 97.2 µmol m¯²s¯¹, and mature bacterial and algal-bacterial AGS were used for the operation of two identical sequencing batch reactors (SBRs) with a working volume of 0.9 L each, respectively. The results showed that salinity increase caused no apparent change in the color of bacterial AGS; while for algal-bacterial AGS, its color was progressively changed from green to dark green. A consequent increase in granule diameter and fluffiness was observed in the bacterial AGS reactor with the increase of salinity in comparison to a decrease in algal-bacterial AGS diameter. However, nitrite accumulation peaked from 1.0 mg/L and 0.4 mg/L at 1 g/L NaCl in the bacterial and algal-bacterial AGS systems, respectively to 9.8 mg/L in both systems when NaCl concentration varied from 5 g/L to 15 g/L. Almost no ammonia nitrogen was detected in the effluent except at 10 g/L NaCl concentration, where it averaged 4.2 mg/L and 2.4 mg/L, respectively, in the bacterial and algal-bacterial AGS systems. Nutrients removal in the algal-bacterial system was relatively higher than the bacterial AGS in terms of nitrogen and phosphorus removals. Nonetheless, the nutrient removal rate was almost 50% or lower. Results show that algal-bacterial AGS is more adaptable to salinity increase and could be more suitable for saline wastewater treatment. Optimization of operation conditions for algal-bacterial AGS system would be important to ensure its stably high efficiency in practice.

Implementing Education 4.0 Trends in Language Learning

The fourth industrial revolution is changing the role of education substantially and, therefore, the role of instructors and learners at all levels. Education 4.0 is an imminent response to the needs of a globalized world where humans and technology are being aligned to enable endless possibilities, among them the need for students, as digital natives, to communicate effectively in at least one language besides their mother tongue, and also the requirement of developing theirs. This is an exploratory study in which a control group (N = 21), all of the students of Spanish as a foreign language at the university level, after taking a Spanish class, responded to an online questionnaire about the engagement, atmosphere, and environment in which their course was delivered. These aspects considered in the survey were relative to the instructor’s teaching style, including: (a) active, hands-on learning; (b) flexibility for in-class activities, easily switching between small group work, individual work, and whole-class discussion; and (c) integrating technology into the classroom. Strongly believing in these principles, the instructor deliberately taught the course in a SCALE-UP room, as it could facilitate such a positive and encouraging learning environment. These aspects are trends related to Education 4.0 and have become integral to the instructor’s pedagogical stance that calls for a constructive-affective role, instead of a transmissive one. As expected, with a learning environment that (a) fosters student engagement and (b) improves student outcomes, the subjects were highly engaged, which was partially due to the learning environment. An overwhelming majority (all but one) of students agreed or strongly agreed that the atmosphere and the environment were ideal. Outcomes of this study are relevant and indicate that it is about time for teachers to build up a meaningful correlation between humans and technology. We should see the trends of Education 4.0 not as a threat but as practices that should be in the hands of critical and creative instructors whose pedagogical stance responds to the needs of the learners in the 21st century.

Shifting Paradigms of Culture: Rise of Secular Sensibility in Indian Literature

Burgeoning demand of ‘Secularism’ has shaken the pillars of cultural studies in the contemporary literature. The perplexity of the culturally estranged term ‘secular’ gives rise to temporal ideologies across the world. Hence, it is high time to scan this concept in the context of Indian lifestyle which is a blend of assimilated cultures woven in multiple religious fabrics. The infliction of such secular taste is depicted in literary productions like ‘Satanic Verses’ and ‘An Area of Darkness’. The paper conceptually makes a cross-cultural analysis of anti-religious Indian literary texts, assessing its revitalization in current times. Further, this paper studies the increasing popularity of secular sensibility in the contemporary times. The mushrooming elements of secularism such as abstraction, spirituality, liberation, individualism give rise to a seemingly newer idea i.e. ‘Plurality’ making the literature highly hybrid. This approach has been used to study Indian modernity reflected in its literature. Seminal works of stalwarts are used to understand the consequence of this cultural synthesis. Conclusively, this theoretical research inspects the efficiency of secular culture, intertwined with internal coherence and throws light on the plurality of texts in Indian literature.

Authentication of Physical Objects with Dot-Based 2D Code

Counterfeit goods and documents are a global problem, which needs more and more sophisticated methods of resolving it. Existing techniques using watermarking or embedding symbols on objects are not suitable for all use cases. To address those special needs, we created complete system allowing authentication of paper documents and physical objects with flat surface. Objects are marked using orientation independent and resistant to camera noise 2D graphic codes, named DotAuth. Based on the identifier stored in 2D code, the system is able to perform basic authentication and allows to conduct more sophisticated analysis methods, e.g., relying on augmented reality and physical properties of the object. In this paper, we present the complete architecture, algorithms and applications of the proposed system. Results of the features comparison of the proposed solution and other products are presented as well, pointing to the existence of many advantages that increase usability and efficiency in the means of protecting physical objects.

Intensity Analysis to Link Changes in Land-Use Pattern in the Abuakwa North and South Municipalities, Ghana, from 1986 to 2017

The continuous increase in population implies increase in food demand. There is, therefore, the need to increase agricultural production and other forest products to ensure food security and economic development. This paper employs the three-level intensity analysis to assess the total change of land-use in two-time intervals (1986-2002 and 2002-2017), the net change and swap as well as gross gains and losses in the two intervals. The results revealed that the overall change in the 31-year period was greater in the second period (2002-2017). Agriculture and forest categories lost in the first period while the other land class gained. However, in the second period agriculture and built-up increased greatly while forest, water bodies and thick bushes/shrubland experienced loss. An assessment revealed a reduction of forest in both periods but was greater in the second period and expansion of agricultural land was recorded as population increases. The pixels gaining built-up targeted agricultural land in both intervals, it also targeted thick bushes/shrubland and waterbody in the second period only. Built-up avoided forest in both intervals as well as waterbody and thick bushes/shrubland. To help in developing the best land-use strategies/policies, a further validation of the social factors is necessary.

Leveraging Li-Fi to Enhance Security and Performance of Medical Devices

The network connectivity of medical devices is increasing at a rapid rate. Many medical devices, such as vital sign monitors, share information via wireless or wired connections. However, these connectivity options suffer from a variety of well-known limitations. Wireless connectivity, especially in the unlicensed radio frequency bands, can be disrupted. Such disruption could be due to benign reasons, such as a crowded spectrum, or to malicious intent. While wired connections are less susceptible to interference, they inhibit the mobility of the medical devices, which could be critical in a variety of scenarios. This work explores the application of Light Fidelity (Li-Fi) communication to enhance the security, performance, and mobility of medical devices in connected healthcare scenarios. A simple bridge for connected devices serves as an avenue to connect traditional medical devices to the Li-Fi network. This bridge was utilized to conduct bandwidth tests on a small Li-Fi network installed into a Mock-ICU setting with a backend enterprise network similar to that of a hospital. Mobile and stationary tests were conducted to replicate various different situations that might occur within a hospital setting. Results show that in room Li-Fi connectivity provides reasonable bandwidth and latency within a hospital like setting.