Ansiedade social e assertividade na adolescência

O presente trabalho pretende caracterizar a associação entre ansiedade social e assertividade na adolescência, bem como desenvolver um modelo compreensivo e de intervenção teórica e empiricamente fundamentado acerca desta problemática. A ansiedade social é definida por medo intenso em situações sociais, associado a crenças negativas predisponentes e comportamentos de segurança ou evitamento subsequentes de situações sociais. A assertividade consiste numa resposta comportamental de auto-expressão empática, fundamentada em crenças positivas e activação emocional reduzida. Assim, estes dois conceitos parecem estar em dissonância, uma vez que, por definição, a ansiedade social surge associada a défice de comportamentos sociais adequados e a assertividade a diminuída activação ansiosa em eventos sociais. Por outro lado, ansiedade social e défice assertivo poderão fundamentar-se em mecanismos psicológicos semelhantes. Para verificar estas duas premissas, o presente trabalho utilizou uma amostra de 679 adolescentes do ensino secundário público de ambos os sexos. Para avaliar a ansiedade social nas três dimensões do funcionamento psicológico foram utilizadas a Escala de Crenças e Pensamentos Sociais e a Escala de Ansiedade e Evitamento de Situações Sociais para Adolescentes. No caso da assertividade, foram utilizados o Questionário de Esquema Interpessoal Assertivo e Escala de Comportamento Interpessoal. A análise de dados permite verificar a existência de uma associação recíproca negativa entre ansiedade social e assertividade, em todos os níveis considerados. Igualmente, os resultados obtidos indicam que esta associação poderá ser fundamentada na existência de baixas crenças sociais positivas que activam pensamentos sociais negativos e subsequentemente ansiedade e desconforto em situações sociais e reduzida frequência de comportamento assertivo. Esta conclusão fundamentou uma intervenção integrada para a promoção da gestão de ansiedade social e da prática de competências assertivas. Esta intervenção foi construída, implementada e avaliada em dois ensaios clínicos junto a 6 adolescentes. Os resultados de significância clínica indicam que o programa tem eficácia terapêutica, ainda que este estudo preliminar não exclua a necessidade de uma avaliação mais aprofundada do benefício associado a esta intervenção. Estes trabalhos assumem, assim, implicações educativas e terapêuticas, ao permitir explicitar e clarificar a associação entre ansiedade social e assertividade, e ao contribuir para o desenvolvimento e avaliação de formas de intervenção adequadas junto ao adolescente social tímido ou inibido. A compreensão e intervenção preventiva para a promoção do ajustamento psicossocial do adolescente emergem como uma realidade possível, pertinente e acessível a todos os agentes educativos.

Competências na utilização das ferramentas/serviços Web 2.0

A evolução da sociedade e da tecnologia sustenta a globalização da sociedade atual e exige aos cidadãos novas literacias. A educação na sociedade do conhecimento é indissociável das Tecnologias de Informação e Comunicação (TIC), tanto como elemento mediador como potenciador das aprendizagens. A Web 2.0, entendida como Web social, potencia o acesso à informação, faculta aos docentes a oportunidade de desenvolver os seus conhecimentos e competências, e oferece oportunidades de construção de situações inovadoras de educação no seu percurso profissional, promovendo condições de aprendizagem ao longo da vida. O presente estudo, formalmente integrado no Programa Doutoral em Multimédia em Educação da Universidade de Aveiro, valoriza o levantamento da perceção da necessidade de envolvimento dos docentes em processos informais de aprendizagem ao longo da vida, na promoção do seu desenvolvimento profissional, salientando o papel das redes sociais neste contexto. Adotou-se como metodologia de investigação o survey, com o objetivo de realizar o levantamento das competências de utilização da Web 2.0 pelos professores do ensino básico e secundário, das escolas do ensino público do concelho de Aveiro, no contexto da aprendizagem informal. Através do survey procurou-se caracterizar o contexto profissional em que estes professores estão inseridos, considerando essencialmente duas dimensões: i) equipamentos e recursos e ii) atitude geral da escola face à integração das TIC nas rotinas profissionais. Centrou-se na obtenção de dados que permitissem a descrição de: i) competências TIC dos professores e a identificação dos seus percursos formativos e necessidades de formação; ii) hábitos e finalidades de utilização das tecnologias digitais em contexto profissional e de desenvolvimento profissional; e, ainda, iii) utilização de redes sociais/comunidades educativas, vantagens e condicionantes identificadas e importância para o desenvolvimento profissional; e, finalmente, iv) levantamento da opinião dos professores acerca das suas perceções de impactes associados à integração da utilização das redes nas suas práticas profissionais, nomeadamente nas práticas educativas. Os dados obtidos foram analisados, numa perspetiva qualitativa e exploratória, em função das frequências relativas de resposta e comparando os diferentes grupos de docentes identificados – professores de escolas básicas e professores de escolas secundárias; professores membros e não membros de redes. Os resultados apontam para uma melhoria das competências dos professores na utilização das TIC, sobretudo ao nível das competências básicas, face a outros estudos anteriores realizados em Portugal, como por exemplo Paiva (2002), Barbosa (2009) e Brito (2010). Uma grande parte dos docentes utiliza redes sociais/comunidades educativas, tendo-se identificado prioritariamente uma utilização de cariz genérico e tendencialmente pouco frequente, em detrimento de uma utilização de redes de cariz mais profissional. Os professores, no geral, e os utilizadores de redes, em particular, reconhecem o potencial educativo destas ferramentas/serviços Web 2.0. As conclusões apontam para a necessidade das escolas assumirem o incentivo e a adoção de estratégias que possam impulsionar o desenvolvimento de competências de utilização das TIC/ferramentas e serviços Web 2.0 que garantam equidade no acesso a redes sociais/comunidades educativas pelos professores. Esta recomendação pretende constituir uma via para as escolas promoverem a criação de redes sociais/comunidades educativas e fomentarem, pela sua utilização, o desenvolvimento de hábitos de trabalho colaborativo e de partilha entre os seus professores, contribuindo desta forma para potenciar as competências dos professores no acompanhamento da evolução tecnológica e no acesso a outras oportunidades de desenvolvimento profissional ao longo da vida. Isto é, “equipar” os professores para melhor poderem enfrentar os desafios do Século XXI para a educação, na preparação dos jovens para a sociedade global do conhecimento.

Anodes for protonic ceramic fuel cells (PCFCs)

One of the more promising possibilities for future “green” electrical energy generation is the protonic ceramic fuel cell (PCFC). PCFCs offer a low-pollution technology to generate electricity electrochemically with high efficiency. Reducing the operating temperature of solid oxide fuel cells (SOFCs) to the 500-700°C range is desirable to reduce fabrication costs and improve overall longevity. This aim can be achieved by using protonic ceramic fuel cells (PCFCs) due to their higher electrolyte conductivity at these temperatures than traditional ceramic oxide-ion conducting membranes. This thesis deals with the state of the art Ni-BaZr0.85Y0.15O3-δ cermet anodes for PCFCs. The study of PCFCs is in its initial stage and currently only a few methods have been developed to prepare suitable anodes via solid state mechanical mixing of the relevant oxides or by combustion routes using nitrate precursors. This thesis aims to highlight the disadvantages of these traditional methods of anode preparation and to, instead, offer a novel, efficient and low cost nitrate free combustion route to prepare Ni-BaZr0.85Y0.15O3-δ cermet anodes for PCFCs. A wide range of techniques mainly X-ray diffraction (XRD), scanning electron microscopy (SEM), environmental scanning electron microscopy, (ESEM) and electrochemical impedance spectroscopy (EIS) were employed in the cermet anode study. The work also offers a fundamental examination of the effect of porosity, redox cycling behaviour, involvement of proton conducting oxide phase in PCFC cermet anodes and finally progresses to study the electrochemical performance of a state of the art anode supported PCFC. The polarisation behaviour of anodes has been assessed as a function of temperature (T), water vapour (pH2O), hydrogen partial pressures (pH2) and phase purity for electrodes of comparable microstructure. The impedance spectra generally show two arcs at high frequency R2 and low frequency R3 at 600 °C, which correspond to the electrode polarisation resistance. Work shows that the R2 and R3 terms correspond to proton transport and dissociative H2 adsorption on electrode surface, respectively. The polarization resistance of the cermet anode (Rp) was shown to be significantly affected by porosity, with the PCFC cermet anode with the lowest porosity exhibiting the lowest Rp under standard operating conditions. This result highlights that porogens are not required for peak performance in PCFC anodes, a result contrary to that of their oxide-ion conducting anode counterparts. In-situ redox cycling studies demonstrate that polarisation behaviour was drastically impaired by redox cycling. In-situ measurements using an environmental scanning electron microscopy (ESEM) reveal that degradation proceeds due to volume expansion of the Ni-phase during the re-oxidation stage of redox cycling.The anode supported thin BCZY44 based protonic ceramic fuel cell, formed using a peak performing Ni-BaZr0.85Y0.15O3-δ cermet anode with no porogen, shows promising results in fuel cell testing conditions at intermediate temperatures with good durability and an overall performance that exceeds current literature data.

A Spiking Neural Network Model of the Medial Superior Olive using Spike Timing Dependent Plasticity for Sound Localisation

Sound localization can be defined as the ability to identify the position of an input sound source and is considered a powerful aspect of mammalian perception. For low frequency sounds, i.e., in the range 270 Hz-1.5 KHz, the mammalian auditory pathway achieves this by extracting the Interaural Time Difference between sound signals being received by the left and right ear. This processing is performed in a region of the brain known as the Medial Superior Olive (MSO). This paper presents a Spiking Neural Network (SNN) based model of the MSO. The network model is trained using the Spike Timing Dependent Plasticity learning rule using experimentally observed Head Related Transfer Function data in an adult domestic cat. The results presented demonstrate how the proposed SNN model is able to perform sound localization with an accuracy of 91.82% when an error tolerance of +/-10 degrees is used. For angular resolutions down to 2.5 degrees , it will be demonstrated how software based simulations of the model incur significant computation times. The paper thus also addresses preliminary implementation on a Field Programmable Gate Array based hardware platform to accelerate system performance.

Source localization with vector sensor array during the makai experiment

Vector sensors measure both the acoustic pressure and the three components of particle velocity. Because of this, a vector sensor array (VSA) has the advantage of being able to provide substantially higher directivity with a much smaller aperture than an array of traditional scalar (pressure only) hydrophones. Although several, most of them theoretic, works were published from early nineties, only in the last years due to improvements and availability of vector sensor technology, the interest on field experiments with VSA increased in the scientific community. During the Makai Experiment, that took place off the coast of Kauai I., Hawaii, in September 2005, real data were collected with a 4 element vertical VSA. These data will be discussed in the present paper. The acoustic signals were emitted from a near source (low frequency ship noise) and two high frequency controlled acoustic sources located within a range of 2km from the VSA. The advantages of the VSA over traditional scalar hydrophone arrays in source localization will be addressed using conventional beamforming.

Interpretation of pictograms by 3rd grade pupils: the teacher’s role

In this paper we analyze how a primary school teacher (João) leads the discussion of a task in a grade 3 class aimed at reading and interpreting pictograms. The paper is part of a larger study that follows an interpretative and qualitative research methodology with a case study design. The results indicate that, in his teaching practice, the teacher strives to ask questions so that his pupils are not limited to the identification of categories of high and low frequency characteristic, that is, "reading the data", but also raises questions related to "reading between the data" and "beyond the data."

Ocean Boundary Layer Dynamics and Air-Sea Interaction

Thesis (Ph.D.)--University of Washington, 2005-12

Modeling of the lung impedance using a fractional order ladder network with constant phase elements

The self similar branching arrangement of the airways makes the respiratory system an ideal candidate for the application of fractional calculus theory. The fractal geometry is typically characterized by a recurrent structure. This study investigates the identification of a model for the respiratory tree by means of its electrical equivalent based on intrinsic morphology. Measurements were obtained from seven volunteers, in terms of their respiratory impedance by means of its complex representation for frequencies below 5 Hz. A parametric modeling is then applied to the complex valued data points. Since at low-frequency range the inertance is negligible, each airway branch is modeled by using gamma cell resistance and capacitance, the latter having a fractional-order constant phase element (CPE), which is identified from measurements. In addition, the complex impedance is also approximated by means of a model consisting of a lumped series resistance and a lumped fractional-order capacitance. The results reveal that both models characterize the data well, whereas the averaged CPE values are supraunitary and subunitary for the ladder network and the lumped model, respectively.

Coluna de som utilizando array de transdutores de ultrasons

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia de Electrónica e Telecomunicações

Doenças raras na Ilha de S. Miguel : caracterização epidemiológica

RESUMO:O conceito de doenças raras como entidade própria começou a ser divulgado na comunidade médica no início deste século. A perspectiva de congregar múltiplas patologias, com características diferentes, valorizando a baixa frequência com que ocorrem na população interessou a comunidade científica, famílias, indústria e serviços de saúde. Esperava-se encontrar estratégias para melhorar a qualidade dos cuidados de saúde prestados a estes doentes. Uma vez que a informação científica sobre doenças raras está dispersa por diversas fontes o primeiro grande desafio foi sistematizar de forma a obter o “estado da arte”. A investigação que decorreu entre 2001 e 2010 teve como objectivo principal a caracterização dos doentes e das doenças raras numa população com características restritas mas não fechada como é o caso da ilha de S. Miguel nos Açores. Foram identificados 467 doentes a partir de várias fontes e monitorizado o nascimento de recém-nascidos com doença rara durante 10 anos. A prevalência das doenças raras encontrada na ilha de S. Miguel foi de 0,34% e a inerente à definição de doença rara foi de 6 % a 8 % da população na União Europeia. A diferença encontrada poderá decorrer de se ter sobrestimado o verdadeiro valor da prevalência das doenças raras na União Europeia. A incidência de doenças raras determinada na amostra foi de 0,1% e a taxa de mortalidade por causa específica foi de 0,14‰. O diagnóstico foi confirmado por técnicas laboratoriais de citogenética ou genética molecular em 43% dos doentes da amostra. Não foi identificado nenhum agregado populacional com doença rara para além do já conhecido para a DMJ. A criação de uma metodologia de estudo implicou a construção de um registo de doentes. Para tal foi utilizado o conhecimento adquirido anteriormente sobre uma doença rara que serviu de paradigma: a doença de Machado-Joseph. Na sequência dos resultados obtidos foi considerado útil a introdução de variáveis como a figura do cuidador, o cônjuge, o número de filhos do casal, a data da primeira consulta de Genética, o tempo decorrido entre o início dos sintomas e o acesso à consulta de Genética e entre esta actividade e dispor do diagnóstico para melhor compreender o contexto de vida destes doentes na perspectiva de poderem vir a ser incorporadas como indicadores. ----------- ABSTRACT: The concept of rare diseases as a condition began to be disclosed in the medical community at the beginning of this century.The prospect of bringing together multiple pathologies, with different features, enhancing the low frequency with which they occur in the population interested the scientific community, families, industry and health care services. The aim was to find strategies to improve the quality of care provided to these patients. Given that the scientific information on rare diseases is spread out across several sources the first major challenge was to systematize in order to get the "state of the art". The research took place between 2001 and 2010 and had as its main objective the characterization of patients and rare diseases in a population with specific features, but not confined, like in the case of the São Miguel Island in Azores. During 10 years were identified 467 patients from multiple sources and were observed the newborns with rare diseases. Prevalence of rare diseases found in the São Miguel Island was 0,34% compared to the 6% to 8% by definition of rare disease in the population in European Union. This discrepancy may be explained by a likely frequency of overrated rare diseases in European Union. The incidence of rare diseases in the sample was 0,1% and the specific mortality rate was 0,14 ‰. This diagnosis was confirmed by cytogenetic or molecular genetics analysis in 43% of patients in the sample. No population cluster was identified with rare disease besides the already known for Machado-Joseph Disease. The methodology for the study involved the construction of a database of patients. For such purpose it was used previously acquired knowledge on a rare disease paradigm: the Machado-Joseph disease. It was useful to introduce the following variables to properly establish the results: caregiver, spouse, number of children, date of first Genetics appointment, elapsed time between onset of symptoms and access to first appointment as well as this and the final diagnosis to better understand the context of life of these patients in order to incorporate them as rates.

Ecology and neurophysiology of sleep in two wild sloth species

Study Objectives: Interspecific variation in sleep measured in captivity correlates with various physiological and environmental factors, including estimates of predation risk in the wild. However, it remains unclear whether prior comparative studies have been confounded by the captive recording environment. Herein we examine the impact of predation pressure on sleep in sloths living in the wild. Design: Comparison of two closely related sloth species, one exposed to predation and one free from predation. Setting: Panamanian mainland rainforest (predators present) and island mangrove (predators absent). Participants: Mainland (Bradypus variegatus, 5 males and 4 females) and island (Bradypus pygmaeus, 6 males) sloths. Interventions: None. Measurements and Results: EEG and EMG activity were recorded using a miniature data logger. Although both species spent between 9 and 10 hours per day sleeping, the mainland sloths showed a preference for sleeping at night, whereas island sloths showed no preference for sleeping during the day or night. EEG activity during NREM sleep showed lower low-frequency power, and increased spindle and higher frequency power in island sloths when compared to mainland sloths. Conclusions: In sloths sleeping in the wild, predation pressure influenced the timing of sleep, but not the amount of time spent asleep. The preference for sleeping at night in mainland sloths may be a strategy to avoid detection by nocturnal cats. The pronounced differences in the NREM sleep EEG spectrum remain unexplained, but might be related to genetic or environmental factors.

T-type Ca2+ channels, SK2 channels and SERCAs gate sleep-related oscillations in thalamic dendrites.

T-type Ca2+ channels (T channels) underlie rhythmic burst discharges during neuronal oscillations that are typical during sleep. However, the Ca2+-dependent effectors that are selectively regulated by T currents remain unknown. We found that, in dendrites of nucleus reticularis thalami (nRt), intracellular Ca2+ concentration increases were dominated by Ca2+ influx through T channels and shaped rhythmic bursting via competition between Ca2+-dependent small-conductance (SK)-type K+ channels and Ca2+ uptake pumps. Oscillatory bursting was initiated via selective activation of dendritically located SK2 channels, whereas Ca2+ sequestration by sarco/endoplasmic reticulum Ca2+-ATPases (SERCAs) and cumulative T channel inactivation dampened oscillations. Sk2-/- (also known as Kcnn2) mice lacked cellular oscillations, showed a greater than threefold reduction in low-frequency rhythms in the electroencephalogram of non-rapid-eye-movement sleep and had disrupted sleep. Thus, the interplay of T channels, SK2 channels and SERCAs in nRt dendrites comprises a specialized Ca2+ signaling triad to regulate oscillatory dynamics related to sleep.

Relación entre anchoveta y ambiente a diferentes escalas temporales

Relación entre anchoveta y ambiente a diferentes escalas temporales. Bol Inst Mar Perú 25(1-2):13-21.- Se estudió la relación del ambiente y la anchoveta peruana (Engraulis ringens) en el Ecosistema de Afloramiento Peruano (EAP). Se hipotetiza que en la zona de afloramiento comprendida entre 5°S - 13°S se presenta una relación negativa entre la temperatura, concentración de oxígeno y desembarques de anchoveta en escalas de tiempo decadales. En series de tiempo mensuales observadas entre 1950 – 2008, se analizó la temperatura superficial, subsuperficial, oxígeno, clorofila-a y desembarques de anchoveta y sardina, aplicando métodos estadísticos y espectrales para obtener modos temporales decadales y caracterizar la modulación a baja frecuencia de sus ciclos estacionales. También se usaron datos de reanálisis para caracterizar los cambios estacionales a partir de los forzamientos (remoto y local) ambientales del EAP. Se encontró una fuerte asociación a escala decadal entre las series ambientales costeras y los desembarques de anchoveta y se sugiere que la covariabilidad ambiental en escalas temporales interanuales, intraestacionales, decadales, seculares frente al EAP se incrementará durante la próxima década.

Far infrared reflectance and optical properties of organic superconductor (TMTSF)2ClO4 /

Polarized reflectance measurements of the quasi I-D charge-transfer salt (TMTSFh CI04 were carried out using a Martin-Puplett-type polarizing interferometer and a 3He refrigerator cryostat, at several temperatures between 0.45 K and 26 K, in the far infrared, in the 10 to 70 cm- 1 frequency range. Bis-tetramethyl-tetraselena-fulvalene perchlorate crystals, grown electrochemically and supplied by K. Behnia, of dimensions 2 to 4 by 0.4 by 0.2 mm, were assembled on a flat surface to form a mosaic of 1.5 by 3 mm. The needle shaped crystals were positioned parallel to each other along their long axis, which is the stacking direction of the planar TMTSF cations, exposing the ab plane face (parallel to which the sheets of CI04 anions are positioned). Reflectance measurements were performed with radiation polarized along the stacking direction in the sample. Measurements were carried out following either a fast (15-20 K per minute) or slow (0.1 K per minute) cooling of the sample. Slow cooling permits the anions to order near 24 K, and the sample is expected to be superconducting below 1.2 K, while fast cooling yields an insulating state at low temperatures. Upon the slow cooling the reflectance shows dependence with temperature and exhibits the 28 cm- 1 feature reported previously [1]. Thermoreflectance for both the 'slow' and 'fast' cooling of the sample calculated relative to the 26 K reflectance data indicates that the reflectance is temperature dependent, for the slow cooling case only. A low frequency edge in the absolute reflectance is assigned an electronic origin given its strong temperature dependence in the relaxed state. We attribute the peak in the absolute reflectance near 30 cm-1 to a phonon coupled to the electronic background. Both the low frequency edge and the 30 cm-1 feature are noted te shift towards higher frequcncy, upon cntering the superconducting state, by an amount of the order of the expected superconducting energy gap. Kramers-Kronig analysis was carried out to determine the optical conductivity for the slowly cooled sample from the measured reflectance. In order to do so the low frequency data was extrapolated to zero frequency using a Hagen-Ru bens behaviour, and the high frequency data was extended with the data of Cao et al. [2], and Kikuchi et al. [3]. The real part of the optical conductivity exhibits an asymmetric peak at 35 cm-1, and its background at lower frequencies seems to be losing spectral weight with lowering of the temperature, leading us to presume that a narrow peak is forming at even lower frequencies.

The cardiovascular hemodynamic responses to various levels of orthostatic stress in children

The ability of the cardiovascular system to quickly and efficiently adapt to an orthostatic stress is vital for the human body to function on earth. The way in which the various aspects of the cardiovascular system work together to counteract an orthostatic stress has been previously quantified in the adult population. However, there are still many unknowns surrounding the topic of how the cardiovascular system functions to cope with this same stress in children. The purpose of this study was to describe the cardiovascular hemodynamic adaptations to various levels of orthostatic stress induced using a lower body negative pressure (LBNP) chamber in pre-pubertal boys. A secondary purpose was to determine indices of baroreceptor sensitivity (BRS) at both rest and during low levels of LBNP in this same pediatric sample. Finally, this study aimed to compare the relative responses to LBNP between the children and adults. To complete the study 20 healthy pre-pubertal boys and adult males (9.3 ± 1.1 and 23 ± 1.8 years of age respectively) were recruited and randomly exposed to three levels of LBNP (15, 20 and 25 mmHg). At rest and during the application of the LBNP heart rate (HR), manual and bcat-by-beat systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) were monitored continuously. Aortic diameter was measured at rest and peak aortic blood velocity (PV) was recorded continuously for at least I minute during each baseline and LBNP condition. From the raw data HR, stroke volume (SV), cardiac output (Q), total peripheral resistance (TPR), low frequency baroreceptor sensitivity (LF BRS), high frequency baroreceptor sensitivity (HF BRS) and LFIIIF ratio were calculated. At rest, llR wa'i higher and SBP, SV, Q and LF/HF ratio were lower in the children compared to the adult males (pgJ.05). In response to the increasing LEN!> IIR and TPR increased, and LF BRS. SV and Q decreased in the adult group (pSf).05). while the same levels of LBNP caused an increase in TPR and a decrease in SBP, SV and Q in the children (pSf).05). Although not significant, the LF/HF ratio in the adult group showed an increasing trend in response to increased negative pressure (p=O.088). As for resting BRS, there were no significant differences in LF or HF BRS between the children and the adults despite a tendency for both measures to be 18% lower in the children. Also the LF/HF ratio was almost significantly greater in the adults compared to the children (p=O.057). In addition, a comparison between the relative adult and child responses to LBNP yielded no significant group by level interactions. This result should be taken with caution though, as the low sample size and high measurement variability generated very low statistical power for this analysis. In conclusion, the results of this study suggest that the hemodynamic adaptations to an orthostatic stress were less pronounced in the prepubertal males, most likely due to an underdeveloped autonomic system. These results need to be strengthened by further research before any implications can be derived for health care purposes.