Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our ho...Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our hospital from May 2022 to May 2023 were selected for the study.They were divided into Group A(45,conventional teaching method)and Group B(45 cases,PBL independent learning model)by randomized numerical table method to compare the effects of the two groups.Results:The teaching effect indicators and student satisfaction scores in Group B were higher than those in Group A(P<0.05).Conclusion:The use of the PBL independent learning model in the teaching of CIS first aid can significantly improve the teaching effect and student satisfaction.展开更多
A delayed HIV/AIDS epidemic model with treatment and vertical transmission is investigated. The model allows some infected individuals to move from the symptomatic phase to the asymptomatic phase;next generation of in...A delayed HIV/AIDS epidemic model with treatment and vertical transmission is investigated. The model allows some infected individuals to move from the symptomatic phase to the asymptomatic phase;next generation of infected individuals may be infected and it will take them some time to get maturity and infect others. Mathematical analysis shows that the global dynamics of the spread of the HIV/AIDS are completely determined by the basic reproduction number R0 for our model. If R0 R0 > 1.展开更多
Objective This study was to investigate the HIV current situation in Liangshan prefecture, in order to predict prevalence and transmission trends. Methods Region-specific population, behavior, serosurveillence, and po...Objective This study was to investigate the HIV current situation in Liangshan prefecture, in order to predict prevalence and transmission trends. Methods Region-specific population, behavior, serosurveillence, and policy/program data (from 1995 to 2020) were gathered from various local and national organizations and applied to the Asian Epidemic Model (AEM) and used to derive estimates of future HIV prevalence, epidemic trends, and outcomes of intervention strategies. Results The AEM projections for 2020 included increased number of people living with HIV (PLHIV; to 136 617), increased HIV prevalence (2.51%), and 8037 deaths from acquired immunodeficiency syndrome (AIDS) in this region. However, the overall HIV incidence rate (per 10 000) was projected to decline from 27 in 2015 to 22 in 2020, largely due to a predicted decrease in HIV infection rate (per 10 000) from 658 in 2013 to 621 in 2020 among intravenous drug users. In contrast, the cases of HIV infection per i0 000 was projected to increase from 420 in 2010 to 503 in 2020 among men who have sex with men, and from 8 in 2010 to 15 in 2020 among the general population. The predominant risk factor for HIV transmission over the next decade in Liangshan was casual sex. Community-based outreach strategies to reduce injected drug use and casual sex, and to promote condom use, were predicted as effective interventions to decrease HIV transmission. Conclusion Implementation of a comprehensive public health program, with targeting to the region-specific at-risk populations, will help to mitigate HIV/AIDS spread in Liangshan.展开更多
This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative qu...This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were inter-viewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Coun-seling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some ex-isting problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the commu-nity-based VCT/PITC through 4 paths. Then we establish the community HIV health care center con-stituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.展开更多
目的调查HIV/AIDS患者出现肝损伤发生情况,建立其预测模型并进行验证。方法选择2021年1~12月四川绵阳四○四医院接诊的290例新确诊HIV/AIDS患者,以7∶3分为模型组203例与验证组87例。收集可能影响HIV/AIDS患者肝损伤的因素,根据有无出...目的调查HIV/AIDS患者出现肝损伤发生情况,建立其预测模型并进行验证。方法选择2021年1~12月四川绵阳四○四医院接诊的290例新确诊HIV/AIDS患者,以7∶3分为模型组203例与验证组87例。收集可能影响HIV/AIDS患者肝损伤的因素,根据有无出现肝损伤将患者分为2组,比较2组患者性别、年龄、BMI等各因素,采用LASSO回归筛选变量后行多因素Logistic回归筛选出独立性影响因素,根据Logistic回归结果构建列线图模型。结果肝损伤组与无肝损伤组患者饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、使用其他类型抗反转录病毒药物、磺胺类药物使用情况、糖尿病、心血管病、营养状况差异均具有统计学意义(P<0.05)。LASSO回归模型筛选出7个潜在影响因素:饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况。多因素Logistic回归分析显示:饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素(P<0.05)。基于上述影响因素构建HIV/AIDS患者肝损伤风险预测的列线图模型,模型组列线图模型预测HIV/AIDS患者肝损伤的受试者操作曲线下面积(area under the subject curve,AUC)为0.969(95%CI:0.904,0.988);验证组AUC为0.971(95%CI:0.905,0.992)。Bootstrap法重复抽样1000次,并以验证组进行验证,校准曲线结果显示:模型组与验证组预测曲线与标准曲线基本拟合;H-L拟合优度检验结果显示,该列线图模型预测HIV/AIDS患者肝损伤的概率与实际概率比较,差异无统计学意义(χ^(2)=2.088,P=0.148)。模型组决策曲线分析结果显示:当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.15~0.95时,患者的净受益率>0;验证组决策曲线分析结果显示:当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.10~0.95时,患者的净受益率>0。结论饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素,基于上述因素构建的列线图模型用于HIV/AIDS肝损伤风险预测具有较高的准确度。展开更多
Recently,computer aided diagnosis(CAD)model becomes an effective tool for decision making in healthcare sector.The advances in computer vision and artificial intelligence(AI)techniques have resulted in the effective d...Recently,computer aided diagnosis(CAD)model becomes an effective tool for decision making in healthcare sector.The advances in computer vision and artificial intelligence(AI)techniques have resulted in the effective design of CAD models,which enables to detection of the existence of diseases using various imaging modalities.Oral cancer(OC)has commonly occurred in head and neck globally.Earlier identification of OC enables to improve survival rate and reduce mortality rate.Therefore,the design of CAD model for OC detection and classification becomes essential.Therefore,this study introduces a novel Computer Aided Diagnosis for OC using Sailfish Optimization with Fusion based Classification(CADOC-SFOFC)model.The proposed CADOC-SFOFC model determines the existence of OC on the medical images.To accomplish this,a fusion based feature extraction process is carried out by the use of VGGNet-16 and Residual Network(ResNet)model.Besides,feature vectors are fused and passed into the extreme learning machine(ELM)model for classification process.Moreover,SFO algorithm is utilized for effective parameter selection of the ELM model,consequently resulting in enhanced performance.The experimental analysis of the CADOC-SFOFC model was tested on Kaggle dataset and the results reported the betterment of the CADOC-SFOFC model over the compared methods with maximum accuracy of 98.11%.Therefore,the CADOC-SFOFC model has maximum potential as an inexpensive and non-invasive tool which supports screening process and enhances the detection efficiency.展开更多
In this paper,a stochastic multi-group AIDS model with saturated incidence rate is studied.We prove that the system is persistent in the mean under some parametric restrictions.We also obtain the sufficient condition ...In this paper,a stochastic multi-group AIDS model with saturated incidence rate is studied.We prove that the system is persistent in the mean under some parametric restrictions.We also obtain the sufficient condition for the existence of the ergodic stationary distribution of the system by constructing a suitable Lyapunov function.Our results indicate that the existence of ergodic stationary distribution does not rely on the interior equilibrium of the corresponding deterministic system,which greatly improves upon previous results.展开更多
Background: Botswana is regarded as a leader of progressive HIV/AIDS policy, as the first country in sub-Saharan Africa to establish a free, national antiretroviral therapy program. In light of such programmatic succe...Background: Botswana is regarded as a leader of progressive HIV/AIDS policy, as the first country in sub-Saharan Africa to establish a free, national antiretroviral therapy program. In light of such programmatic successes, it is important to evaluate the potentially changing relationship of HIV/AIDS to the wellbeing of individuals, households, and institutions in the country. Methods: We evaluate the effects of HIV-related illness on absenteeism and earnings several years after the start of the national treatment program among a random sample of adults in Botswana using survey data from 3999 individuals aged 15 to 49, using quasi-experimental methods. We compare absenteeism between individuals with and without HIV-related illness, using a propensity score matching approach. We then estimate the effect of HIV-related illness on earnings using a Heckman selection model to account for selection into the workforce. We stratify our analyses by sex. Results: Men and women with HIV-related illness were absent by about 5.2 and 3.3 additional days, respectively, in the month prior to the survey compared to matched controls, and earned approximately 38% and 43% less, respectively, in the month prior to the survey compared to those without HIV-related illness. Conclusions: HIV-related illness appears to increase absenteeism in this sample and dramatically reduce earnings. The findings suggest a need for policies that confer greater financial security to individuals with HIV/AIDS in Botswana.展开更多
This study investigates the impact of various factors on the lifespan and diagnostic time of HIV/AIDS patients using advanced statistical techniques. The Power Chris-Jerry (PCJ) distribution is applied to model CD4 co...This study investigates the impact of various factors on the lifespan and diagnostic time of HIV/AIDS patients using advanced statistical techniques. The Power Chris-Jerry (PCJ) distribution is applied to model CD4 counts of patients, and the goodness-of-fit test confirms a strong fit with a p-value of 0.6196. The PCJ distribution is found to be the best fit based on information criteria (AIC and BIC) with the smallest negative log-likelihood, AIC, and BIC values. The study uses datasets from St. Luke hospital Uyo, Nigeria, containing HIV/AIDS diagnosis date, age, CD4 count, gender, and opportunistic infection dates. Multiple linear regression is employed to analyze the relationship between these variables and HIV/AIDS diagnostic time. The results indicate that age, CD4 count, and opportunistic infection significantly impact the diagnostic time, while gender shows a nonsignificant relationship. The F-test confirms the model's overall significance, indicating the factors are good predictors of HIV/AIDS diagnostic time. The R-squared value of approximately 72% suggests that administering antiretroviral therapy (ART) can improve diagnostic time by suppressing the virus and protecting the immune system. Cox proportional hazard modeling is used to examine the effects of predictor variables on patient survival time. Age and CD4 count are not significant factors in the hazard of HIV/AIDS diagnostic time, while opportunistic infection is a significant predictor with a decreasing effect on the hazard rate. Gender shows a strong but nonsignificant relationship with decreased risk of death. To address the violation of the assumption of proportional hazard, the study employs an assumption-free alternative, Aalen’s model. In the Aalen model, all predictor variables except age and gender are statistically significant in relation to HIV/AIDS diagnostic time. The findings provide valuable insights into the factors influencing diagnostic time and survival of HIV/AIDS patients, which can inform interventions aimed at reducing transmission and improving early diagnosis and treatment. The Power Chris-Jerry distribution proves to be a suitable fit for modeling CD4 counts, while multiple linear regression and survival analysis techniques provide insights into the relationships between predictor variables and diagnostic time. These results contribute to the understanding of HIV/AIDS patient outcomes and can guide public health interventions to enhance early detection, treatment, and care.展开更多
文摘Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our hospital from May 2022 to May 2023 were selected for the study.They were divided into Group A(45,conventional teaching method)and Group B(45 cases,PBL independent learning model)by randomized numerical table method to compare the effects of the two groups.Results:The teaching effect indicators and student satisfaction scores in Group B were higher than those in Group A(P<0.05).Conclusion:The use of the PBL independent learning model in the teaching of CIS first aid can significantly improve the teaching effect and student satisfaction.
文摘A delayed HIV/AIDS epidemic model with treatment and vertical transmission is investigated. The model allows some infected individuals to move from the symptomatic phase to the asymptomatic phase;next generation of infected individuals may be infected and it will take them some time to get maturity and infect others. Mathematical analysis shows that the global dynamics of the spread of the HIV/AIDS are completely determined by the basic reproduction number R0 for our model. If R0 R0 > 1.
基金funded by China-MSD HIV/AIDS Partnership Project(2012-83)Comprehensive Assessment for HIV/AIDS Control and Prevention in Sichuan Province Project(2006-2010)
文摘Objective This study was to investigate the HIV current situation in Liangshan prefecture, in order to predict prevalence and transmission trends. Methods Region-specific population, behavior, serosurveillence, and policy/program data (from 1995 to 2020) were gathered from various local and national organizations and applied to the Asian Epidemic Model (AEM) and used to derive estimates of future HIV prevalence, epidemic trends, and outcomes of intervention strategies. Results The AEM projections for 2020 included increased number of people living with HIV (PLHIV; to 136 617), increased HIV prevalence (2.51%), and 8037 deaths from acquired immunodeficiency syndrome (AIDS) in this region. However, the overall HIV incidence rate (per 10 000) was projected to decline from 27 in 2015 to 22 in 2020, largely due to a predicted decrease in HIV infection rate (per 10 000) from 658 in 2013 to 621 in 2020 among intravenous drug users. In contrast, the cases of HIV infection per i0 000 was projected to increase from 420 in 2010 to 503 in 2020 among men who have sex with men, and from 8 in 2010 to 15 in 2020 among the general population. The predominant risk factor for HIV transmission over the next decade in Liangshan was casual sex. Community-based outreach strategies to reduce injected drug use and casual sex, and to promote condom use, were predicted as effective interventions to decrease HIV transmission. Conclusion Implementation of a comprehensive public health program, with targeting to the region-specific at-risk populations, will help to mitigate HIV/AIDS spread in Liangshan.
基金supported by a grant from the Global Fund(No. 2008-NGS-26)
文摘This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were inter-viewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Coun-seling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some ex-isting problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the commu-nity-based VCT/PITC through 4 paths. Then we establish the community HIV health care center con-stituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.
文摘目的调查HIV/AIDS患者出现肝损伤发生情况,建立其预测模型并进行验证。方法选择2021年1~12月四川绵阳四○四医院接诊的290例新确诊HIV/AIDS患者,以7∶3分为模型组203例与验证组87例。收集可能影响HIV/AIDS患者肝损伤的因素,根据有无出现肝损伤将患者分为2组,比较2组患者性别、年龄、BMI等各因素,采用LASSO回归筛选变量后行多因素Logistic回归筛选出独立性影响因素,根据Logistic回归结果构建列线图模型。结果肝损伤组与无肝损伤组患者饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、使用其他类型抗反转录病毒药物、磺胺类药物使用情况、糖尿病、心血管病、营养状况差异均具有统计学意义(P<0.05)。LASSO回归模型筛选出7个潜在影响因素:饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况。多因素Logistic回归分析显示:饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素(P<0.05)。基于上述影响因素构建HIV/AIDS患者肝损伤风险预测的列线图模型,模型组列线图模型预测HIV/AIDS患者肝损伤的受试者操作曲线下面积(area under the subject curve,AUC)为0.969(95%CI:0.904,0.988);验证组AUC为0.971(95%CI:0.905,0.992)。Bootstrap法重复抽样1000次,并以验证组进行验证,校准曲线结果显示:模型组与验证组预测曲线与标准曲线基本拟合;H-L拟合优度检验结果显示,该列线图模型预测HIV/AIDS患者肝损伤的概率与实际概率比较,差异无统计学意义(χ^(2)=2.088,P=0.148)。模型组决策曲线分析结果显示:当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.15~0.95时,患者的净受益率>0;验证组决策曲线分析结果显示:当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.10~0.95时,患者的净受益率>0。结论饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素,基于上述因素构建的列线图模型用于HIV/AIDS肝损伤风险预测具有较高的准确度。
基金The authors extend their appreciation to the Deanship of Scientific Research at King Khalid University for funding this work under grant number(RGP 2/142/43)Princess Nourah bint Abdulrahman University Researchers Supporting Project number(PNURSP2022R151)+1 种基金Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.The authors would like to thank the Deanship of Scientific Research at Umm Al-Qura University for supporting this work by Grant Code:22UQU4310373DSR13This research project was supported by a grant from the Research Center of the Female Scientific and Medical Colleges,Deanship of Scientific Research,King Saud University.
文摘Recently,computer aided diagnosis(CAD)model becomes an effective tool for decision making in healthcare sector.The advances in computer vision and artificial intelligence(AI)techniques have resulted in the effective design of CAD models,which enables to detection of the existence of diseases using various imaging modalities.Oral cancer(OC)has commonly occurred in head and neck globally.Earlier identification of OC enables to improve survival rate and reduce mortality rate.Therefore,the design of CAD model for OC detection and classification becomes essential.Therefore,this study introduces a novel Computer Aided Diagnosis for OC using Sailfish Optimization with Fusion based Classification(CADOC-SFOFC)model.The proposed CADOC-SFOFC model determines the existence of OC on the medical images.To accomplish this,a fusion based feature extraction process is carried out by the use of VGGNet-16 and Residual Network(ResNet)model.Besides,feature vectors are fused and passed into the extreme learning machine(ELM)model for classification process.Moreover,SFO algorithm is utilized for effective parameter selection of the ELM model,consequently resulting in enhanced performance.The experimental analysis of the CADOC-SFOFC model was tested on Kaggle dataset and the results reported the betterment of the CADOC-SFOFC model over the compared methods with maximum accuracy of 98.11%.Therefore,the CADOC-SFOFC model has maximum potential as an inexpensive and non-invasive tool which supports screening process and enhances the detection efficiency.
基金The work was supported by NSF of China(11801041,11871473)Foudation of Jilin Province Science and Technology Development(20190201130JC)+1 种基金Scientific Rsearch Foundation of Jilin Provincial Education Department(JJKH20181172KJ,JJKH20190503KJ)Natural Science Foundation of Changchun Normal University.
文摘In this paper,a stochastic multi-group AIDS model with saturated incidence rate is studied.We prove that the system is persistent in the mean under some parametric restrictions.We also obtain the sufficient condition for the existence of the ergodic stationary distribution of the system by constructing a suitable Lyapunov function.Our results indicate that the existence of ergodic stationary distribution does not rely on the interior equilibrium of the corresponding deterministic system,which greatly improves upon previous results.
文摘Background: Botswana is regarded as a leader of progressive HIV/AIDS policy, as the first country in sub-Saharan Africa to establish a free, national antiretroviral therapy program. In light of such programmatic successes, it is important to evaluate the potentially changing relationship of HIV/AIDS to the wellbeing of individuals, households, and institutions in the country. Methods: We evaluate the effects of HIV-related illness on absenteeism and earnings several years after the start of the national treatment program among a random sample of adults in Botswana using survey data from 3999 individuals aged 15 to 49, using quasi-experimental methods. We compare absenteeism between individuals with and without HIV-related illness, using a propensity score matching approach. We then estimate the effect of HIV-related illness on earnings using a Heckman selection model to account for selection into the workforce. We stratify our analyses by sex. Results: Men and women with HIV-related illness were absent by about 5.2 and 3.3 additional days, respectively, in the month prior to the survey compared to matched controls, and earned approximately 38% and 43% less, respectively, in the month prior to the survey compared to those without HIV-related illness. Conclusions: HIV-related illness appears to increase absenteeism in this sample and dramatically reduce earnings. The findings suggest a need for policies that confer greater financial security to individuals with HIV/AIDS in Botswana.
文摘This study investigates the impact of various factors on the lifespan and diagnostic time of HIV/AIDS patients using advanced statistical techniques. The Power Chris-Jerry (PCJ) distribution is applied to model CD4 counts of patients, and the goodness-of-fit test confirms a strong fit with a p-value of 0.6196. The PCJ distribution is found to be the best fit based on information criteria (AIC and BIC) with the smallest negative log-likelihood, AIC, and BIC values. The study uses datasets from St. Luke hospital Uyo, Nigeria, containing HIV/AIDS diagnosis date, age, CD4 count, gender, and opportunistic infection dates. Multiple linear regression is employed to analyze the relationship between these variables and HIV/AIDS diagnostic time. The results indicate that age, CD4 count, and opportunistic infection significantly impact the diagnostic time, while gender shows a nonsignificant relationship. The F-test confirms the model's overall significance, indicating the factors are good predictors of HIV/AIDS diagnostic time. The R-squared value of approximately 72% suggests that administering antiretroviral therapy (ART) can improve diagnostic time by suppressing the virus and protecting the immune system. Cox proportional hazard modeling is used to examine the effects of predictor variables on patient survival time. Age and CD4 count are not significant factors in the hazard of HIV/AIDS diagnostic time, while opportunistic infection is a significant predictor with a decreasing effect on the hazard rate. Gender shows a strong but nonsignificant relationship with decreased risk of death. To address the violation of the assumption of proportional hazard, the study employs an assumption-free alternative, Aalen’s model. In the Aalen model, all predictor variables except age and gender are statistically significant in relation to HIV/AIDS diagnostic time. The findings provide valuable insights into the factors influencing diagnostic time and survival of HIV/AIDS patients, which can inform interventions aimed at reducing transmission and improving early diagnosis and treatment. The Power Chris-Jerry distribution proves to be a suitable fit for modeling CD4 counts, while multiple linear regression and survival analysis techniques provide insights into the relationships between predictor variables and diagnostic time. These results contribute to the understanding of HIV/AIDS patient outcomes and can guide public health interventions to enhance early detection, treatment, and care.