Psychometric Properties of the Malay Version of the Coach-Athlete Relationship Questionnaire for Coaches and Athletes.

Background: In the world of sports, motivation is an essential concept that can affect the sporting performance of athletes and help them accomplish their goals. The coach is regarded as an important individual with the ability to significantly influence the athlete's motivation. To assess the impact of the coach-athlete relationship on motivation, the objective of this study was to evaluate the psychometric properties of the Malay version of the Coach-Athlete Relationship Questionnaire (CART-Q) for coaches and athletes. Methods: A cross-sectional survey was conducted among the coaches and athletes in Malaysia. Data were collected using a convenience sampling approach over a 6-month period. The study was carried out in two phases using two independent samples of coaches and athletes to assess the construct validity and internal consistency of the Malay version of the CART-Q. The CART-Q consisted of 11 items measuring three constructs: i) closeness (four items), ii) commitment (three items) and iii) complementarity (four items). In phase 1, the subjects consisted of 211 coaches (21 years old-65 years old) from both sexes and from individual and team sports, ranging from levels 1 to 5. In phase 2, the subjects consisted of 362 athletes (12 years old-39 years old), also from both sexes and from individual and team sports. The statistical analyses performed included confirmatory factor analysis (CFA) to validate the translated version scale, composite reliability (CR), average variance extracted (AVE) and internal consistency (Cronbach's alpha). Results: In phase 1, the sample of coaches, with 190 males (90.0%) and 21 females (10.0%), had a mean age of 38.6 (SD = 8.74) years old. The major sport type was archery (19.0%). The CFA revealed adequate fit indices with all 11 items retained (root mean square error of approximation [RMSEA] = 0.059, comparative fit index [CFI] = 0.964, Tucker and Lewis Index [TLI] = 0.950, standardised root mean square residual [SRMR] = 0.037). The CR values were closeness = 0.874, commitment = 0.566 and complementarity = 0.757. The AVE values were closeness = 0.357, commitment = 0.194 and complementarity = 0.275. The Cronbach's alpha values were closeness = 0.867, commitment = 0.553 and complementarity = 0.794. In phase 2, the sample of athletes, with 175 males (48.1%) and 189 females (51.9%), had a mean age of 20.2 (SD = 3.35) years old. The major sport type was archery (11.5%). The CFA revealed satisfactory fit indices with all 11 items retained (RMSEA = 0.092, CFI = 0.948, TLI = 0.924, SRMR =.038). The CR values were closeness = 0.893, commitment = 0.786 and complementarity = 0.949. The AVE values were closeness = 0.401, commitment = 0.253 and complementarity = 0.418. The Cronbach's alpha values were closeness = 0.900, commitment = 0.772 and complementarity = 0.900. Conclusion: Overall, the study findings supported the conclusion that the Malay version of the CART-Q has adequate psychometric properties to assess the perceptions of coaches and athletes regarding their relationship.

Revolutionizing indoor air quality monitoring through IoT innovations: a comprehensive systematic review and bibliometric analysis.

Indoor air quality (IAQ) in the built environment is significantly influenced by particulate matter, volatile organic compounds, and air temperature. Recently, the Internet of Things (IoT) has been integrated to improve IAQ and safeguard human health, comfort, and productivity. This review seeks to highlight the potential of IoT integration for monitoring IAQ. Additionally, the paper details progress by researchers in developing IoT/mobile applications for IAQ monitoring, and their transformative impact in smart building, healthcare, predictive maintenance, and real-time data analysis systems. It also outlines the persistent challenges (e.g., data privacy, security, and user acceptability), hampering effective IoT implementation for IAQ monitoring. Lastly, the global developments and research landscape on IoT for IAQ monitoring were examined through bibliometric analysis (BA) of 106 publications indexed in Web of Science from 2015 to 2022. BA revealed the most significant contributing countries are India and Portugal, while the top productive institutions and researchers are Instituto Politecnico da Guarda (10.37% of TP) and Marques Goncalo (15.09% of TP), respectively. Keyword analysis revealed four major research themes: IoT, pollution, monitoring, and health. Overall, this paper provides significant insights for identifying prospective collaborators, benchmark publications, strategic funding, and institutions for future IoT-IAQ researchers.

Purification, identification and molecular docking studies of antioxidant and anti-inflammatory peptides from Edible Bird's Nest.

This study investigated antioxidant and anti-inflammatory peptides from Edible Bird's Nest (EBN). The prepared EBN peptides were sequentially separated, purified, and successively identified by ultrafiltration, gel filtration and mass spectrometry techniques. Four potential antioxidant and anti-inflammatory peptides were identified as Peptide 1 (LFWSPSVYLK), Peptide 2 (GWPHLEDNYLDW), Peptide 3 (NPPADLHK) and Peptide 4 (GDLAYLDQGHR). Molecular docking analysis revealed that Peptide 1 and Peptide 2 can competitively interrupt the formation of Keap1-Nrf2 due to the presence of hydrophobic and antioxidant amino acids in their peptide sequences. Peptide 3 and Peptide 4 have a strong effect on interacting with the binding site of IKK-ß due to the interaction of anti-inflammatory amino acids and C-terminal arginine/lysine. The four peptides were synthesised and validated for their antioxidant and anti-inflammatory activities. The results suggest that the four peptides may serve as promising bioactive peptides for preventing oxidative stress and inflammation-related diseases.

Transforming pollution into solutions: A bibliometric analysis and sustainable strategies for reducing indoor microplastics while converting to value-added products.

Microplastics (MPs), as emerging indoor contaminants, have garnered attention due to their ubiquity and unresolved implications for human health. These tiny particles have permeated indoor air and water, leading to inevitable human exposure. Preliminary evidence suggests MP exposure could be linked to respiratory, gastrointestinal, and potentially other health issues, yet the full scope of their effects remains unclear. To map the overall landscape of this research field, a bibliometric analysis based on research articles retrieved from the Web of Science database was conducted. The study synthesizes the current state of knowledge and spotlights the innovative mitigation strategies proposed to curb indoor MP pollution. These strategies involve minimizing the MP emission from source, advancements in filtration technology, aimed at reducing the MP exposure. Furthermore, this research sheds light on cutting-edge methods for converting MP waste into value-added products. These innovative approaches not only promise to alleviate environmental burdens but also contribute to a more sustainable and circular economy by transforming waste into resources such as biofuels, construction materials, and batteries. Despite these strides, this study acknowledges the ongoing challenges, including the need for more efficient removal technologies and a deeper understanding of MPs' health impacts. Looking forward, the study underscores the necessity for further research to fill these knowledge gaps, particularly in the areas of long-term health outcomes and the development of standardized, reliable methodologies for MP detection and quantification in indoor settings. This comprehensive approach paves the way for future exploration and the development of robust solutions to the complex issue of microplastic pollution.

Demoralization syndrome in burn patients: A cross-sectional study.

AIMS: To investigate the status of demoralization syndrome and the factors affecting demoralization in burn patients. METHODS: This study employed a cross-sectional research design and utilized a face-to-face questionnaire to gather data from adult burn patients with burn depths classified as second-degree or higher. The Demoralization Scale Mandarin Version, the Perceived Social Support Scale, the Herth Hope Index, and the Medical Coping Method Questionnaire were used to assess the level of demoralization, perceived social support, sense of hope, and coping strategies, respectively. General information, including socio-demographic data and disease characteristics, were collected. The patients' level of demoralization was categorized as the mean ± 1 standard deviation of the DS-MV scores. The data was analyzed using IBM SPSS 26.0 software to explore the relationship between the variables. RESULTS: This study included 381 burn patients with a mean DS-MV score of 34.62 ± 18.319. Of these, 66 (17.3%) had mild demoralization, 241 (63.3%) had moderate demoralization, and 74 (19.4%) had severe demoralization. Cause of burn, total burn area, average monthly income of the individual, occupation, sense of hope, perceived social support, and medical coping strategies were the important factors associated with the severity of demoralization in burn patients. CONCLUSIONS: Patients with burn injuries exhibit a notable prevalence and severity of demoralization indicating focused attention. By considering associated risk factors, healthcare professionals can devise and execute tailored intervention strategies aimed at mitigating the occurrence and intensity of demoralization in burn patients.

Turning plastics/microplastics into valuable resources? Current and potential research for future applications.

Plastics are a wide range of synthetic or semi-synthetic materials, mainly consisting of polymers. The use of plastics has increased to over 300 million metric tonnes in recent years, and by 2050, it is expected to grow to 800 million. Presently, a mere 10% of plastic waste is recycled, with approximately 75% ended up in landfills. Inappropriate disposal of plastic waste into the environment poses a threat to human lives and marine species. Therefore, this review article highlights potential routes for converting plastic/microplastic waste into valuable resources to promote a greener and more sustainable environment. The literature review revealed that plastics/microplastics (P/MP) could be recycled or upcycled into various products or materials via several innovative processes. For example, P/MP are recycled and utilized as anodes in lithium-ion (Li-ion) and sodium-ion (Na-ion) batteries. The anode in Na-ion batteries comprising PP carbon powder exhibits a high reversible capacity of ∼340 mAh/g at 0.01 A/g current state. In contrast, integrating Fe3O4 and PE into a Li-ion battery yielded an excellent capacity of 1123 mAh/g at 0.5 A/g current state. Additionally, recycled Nylon displayed high physical and mechanical properties necessary for excellent application as 3D printing material. Induction heating is considered a revolutionary pyrolysis technique with improved yield, efficiency, and lower energy utilization. Overall, P/MPs are highlighted as abundant resources for the sustainable production of valuable products and materials such as batteries, nanomaterials, graphene, and membranes for future applications.

Airborne microplastic/nanoplastic research: a comprehensive Web of Science (WoS) data-driven bibliometric analysis.

This paper presents the landscape of research on airborne microplastics and nanoplastics (MPs/NPs) according to the bibliometric analysis of 147 documents issued between 2015 and 2021, extracted from the Web of Science database. The publications on airborne MPs/NPs have increased rapidly from 2015 onwards, which is largely due to the existence of funding support. Science of the Total Environment is one of the prominent journals in publishing related papers. China, England, the USA, and European Countries have produced a significant output of airborne MP/NP research works, which is associated with the availability of funding agencies regionally or nationally. The research hotspot on the topic ranges from the transport of airborne MPs/NPs to their deposition in the terrestrial or aquatic environments, along with the contamination of samples by indoor MPs/NPs. Most of the publications are either research or review papers related to MPs/NPs. It is crucial to share the understanding of global plastic pollution and its unfavorable effects on humankind by promoting awareness of the existence and impact of MPs/NPs. Funding agencies are vital in boosting the research development of airborne MPs/NPs. Some countries that are lacking funding support were able to publish research findings related to the field of interest, however, with lesser research output. Without sufficient fundings, some impactful publications may not be able to carry a substantial impact in sharing the findings and discoveries with the mass public.

Critical review on airborne microplastics: An indoor air contaminant of emerging concern.

Airborne Microplastics (MPs), an emerging environmental issue, have gained recent attention due to their newfound presence in indoor environments. Utilizing the Web of Science database for literature collection, the paper presents a comprehensive review of airborne MPs including emission sources, assessment methods, exposure risks, and mitigation strategies. This review delves into the diverse sources and mechanisms influencing indoor airborne MP pollution, underscoring the complex interplay between human activities, ventilation systems, and the characteristics of indoor environments. Major sources include the abrasion of synthetic textiles and the deterioration of flooring materials, with factors like carpeting, airflow, and ventilation significantly impacting MP levels. Human activities, such as increased movement in indoor spaces and the intensive use of plastic-based personal protective equipment (PPE) post-pandemic, notably elevate indoor MP concentrations. The potential health impacts of airborne MPs are increasingly concerning, with evidence suggesting their role in respiratory, immune, and nervous system diseases. Despite this, there is a scarcity of information on MPs in diverse indoor environments and the inhalation risks associated with the frequent use of PPE. This review also stresses the importance of developing effective strategies to reduce MP emissions, such as employing HEPA-filtered vacuums, minimizing the use of synthetic textiles, and enhancing indoor ventilation. Several future research directions were proposed, including detailed temporal analyses of indoor MP levels, interactions of MP with other atmospheric pollutants, the transport dynamics of inhalable MPs (≤10 µm), and comprehensive human exposure risk assessments.

Perspectives on human movement considerations in indoor airflow assessment: a comprehensive data-driven systematic review.

Understanding particle dispersion characteristics in indoor environments is crucial for revising infection prevention guidelines through optimized engineering control. The secondary wake flow induced by human movements can disrupt the local airflow field, which enhances particle dispersion within indoor spaces. Over the years, researchers have explored the impact of human movement on indoor air quality (IAQ) and identified noteworthy findings. However, there is a lack of a comprehensive review that systematically synthesizes and summarizes the research in this field. This paper aims to fill that gap by providing an overview of the topic and shedding light on emerging areas. Through a systematic review of relevant articles from the Web of Science database, the study findings reveal an emerging trend and current research gaps on the topic titled Impact of Human Movement in Indoor Airflow (HMIA). As an overview, this paper explores the effect of human movement on human microenvironments and particle resuspension in indoor environments. It delves into the currently available methods for assessing the HMIA and proposes the integration of IoT sensors for potential indoor airflow monitoring. The present study also emphasizes incorporating human movement into ventilation studies to achieve more realistic predictions and yield more practical measures. This review advances knowledge and holds significant implications for scientific and public communities. It identifies future research directions and facilitates the development of effective ventilation strategies to enhance indoor environments and safeguard public health.

Factors influence the dignity of burns patients: A cross-sectional study.

BACKGROUND: There is a high incidence of burns in China and the sequelae of post-burn scar growth, disfigurement, and other body image disorders can cause serious psychological distress to burns patients, and negatively affecting the patient's dignity. However, there is limited knowledge relating to the dignity of burns patients. AIM: To investigate the factors that affect dignity in burns patients. DESIGN: Cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT: We recruited 323 burn patients from the burn unit of a tertiary care hospital. The Patient Dignity Scale, Burn Specific Health Scale-Brief, Hospital Anxiety and Depression Scale were used to assess burn patients' dignity, quality of life, anxiety, and depression, respectively. 18 sociodemographic variables were included in the questionnaire. ETHICAL CONSIDERATIONS: Before the data were collected, the study protocol was reviewed and approved by the Ethics Committee of the Guangzhou Red Cross Hospital of Jinan University (Reference: 2022-149-02) and all patients provided and signed informed consent forms. FINDINGS: This study included 323 burns patients; of these, 26 (8%) had a mild loss of dignity, 94 (29.1%) had a moderate loss of dignity, 125 (38.7%) had a severe loss of dignity, and 78 (24.1%) had a very severe loss of dignity. The main factors that influence the loss of dignity in burns patients, including the department in which the patient was treated after their burns, gender, the clinical stage of the burn, quality-of-life, depression, resident medical insurance, the cause of the burn, and the burn site. CONCLUSIONS: In most cases, the loss of dignity after burn injury is serious. Clinical health care professionals can provide personalized whole-life dignity care for patients by considering the factors that affect the dignity of burns patients, developing targeted dignity management programs, and implementing individualized interventions to maintain dignity, thus helping burns injury patients return to social life and work.

Current and potential approaches on assessing airflow and particle dispersion in healthcare facilities: a systematic review.

An indoor environment in a hospital building requires a high indoor air quality (IAQ) to overcome patients' risks of getting wound infections without interrupting the recovery process. However, several problems arose in obtaining a satisfactory IAQ, such as poor ventilation design strategies, insufficient air exchange, improper medical equipment placement and high door opening frequency. This paper presents an overview of various methods used for assessing the IAQ in hospital facilities, especially in an operating room, isolation room, anteroom, postoperative room, inpatient room and dentistry room. This review shows that both experimental and numerical methods demonstrated their advantages in the IAQ assessment. It was revealed that both airflow and particle tracking models could result in different particle dispersion predictions. The model selection should depend on the compatibility of the simulated result with the experimental measurement data. The primary and secondary forces affecting the characteristics of particle dispersion were also discussed in detail. The main contributing forces to the trajectory characteristics of a particle could be attributed to the gravitational force and drag force regardless of particle size. Meanwhile, the additional forces could be considered when there involves temperature gradient, intense light source, submicron particle, etc. The particle size concerned in a healthcare facility should be less than 20 µm as this particle size range showed a closer relationship with the virus load and a higher tendency to remain airborne. Also, further research opportunities that reflect a more realistic approach and improvement in the current assessment approach were proposed.

Effects of medical staff's turning movement on dispersion of airborne particles under large air supply diffuser during operative surgeries.

The present study examines the effect of medical staff's turning movements on particle concentration in the surgical zone and settlement on the patient under single large diffuser (SLD) ventilation. A computational domain representing the operating room (OR) was constructed using computer-aided design (CAD) software. The airflow and particle models were validated against the published data before conducting the case studies. The airflow in the OR was simulated using an RNG k-ε turbulence model, while the dispersion of the particles was simulated using a discrete phase model based on the Lagrangian approach. A user-defined function (UDF) code was written and compiled in the simulation software to describe the medical staff member's turning movements. In this study, three cases were examined: baseline, SLD 1, and SLD 2, with the air supply areas of 4.3 m2, 5.7 m2, and 15.9 m2, respectively. Results show that SLD ventilations in an OR can reduce the number of dispersed particles in the surgical zone. The particles that settled on the patient were reduced by 41% and 39% when using the SLD 1 and SLD 2 ventilations, respectively. The use of the larger air supply area of SLD 2 ventilation in the present study does not significantly reduce the particles that settle on a patient. Likewise, the use of SLD 2 ventilation may increase operating and maintenance costs.

Systematic study on the relationship between particulate matter and microbial counts in hospital operating rooms.

In this study, a systematic procedure for establishing the relationship between particulate matter (PM) and microbial counts in four operating rooms (ORs) was developed. The ORs are located in a private hospital on the western coast of Peninsular Malaysia. The objective of developing the systematic procedure is to ensure that the correlation between the PMs and microbial counts are valid. Each of the procedures is conducted based on the ISO, IEST, and NEBB standards. The procedures involved verifying the operating parameters are air change rate, room differential pressure, relative humidity, and air temperature. Upon verifying that the OR parameters are in the recommended operating range, the measurements of the PMs and sampling of the microbes were conducted. The TSI 9510-02 particle counter was used to measure three different sizes of PMs: PM 0.5, PM 5, and PM 10. The MAS-100ECO air sampler was used to quantify the microbial counts. The present study confirms that PM 0.5 does not have an apparent positive correlation with the microbial count. However, the evident correlation of 7% and 15% were identified for both PM 5 and PM 10, respectively. Therefore, it is suggested that frequent monitoring of both PM 5 and PM 10 should be practised in an OR before each surgical procedure. This correlation approach could provide an instantaneous estimation of the microbial counts present in the OR.

The Symptoms and Factors Associated With Posttraumatic Stress Disorder for Burns Nurses: A Cross-Sectional Study From Guangdong Province in China.

The symptoms of posttraumatic stress disorder (PTSD) among medical staff have become a significant issue. Environments related to burns are highly stressful for nurses and can lead to PTSD, thus affecting their mental health. It is vital to consider that the quality of burns care, and the outcomes of such treatments, may be threatened if nurses experience PTSD. We evaluated PTSD symptoms in burns nurses and explored the correlations between demographic characteristics, work-related characteristics, professional identity, turnover intention, and PTSD symptoms. This was a cross-sectional study involving 273 nurses working in the burns unit from Guangdong, China, between July and August 2019. Nurses were recruited from 30 hospitals and completed three validated psychological questionnaires: Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), Professional Identity Scale (PIS) for nurses, and Turnover Intention Questionnaire (TIQ). We also collated information relating to sociodemographic and work-related characteristics. The cutoff point for the PCL-C was defined as 38 points; 17.22% (n = 47) of participants scored higher than or equal to 38. The PCL-C score was negatively correlated with professional identity level (P < .01) and positively correlated with turnover intention (P < .01). The workplace, mean monthly income, experience of workplace violence, and professional identity level were important factors and all associated with the severity of PTSD. PTSD symptoms were common in burns nurses. Attention should be paid to the mental well-being of these staff. Screening processes need to be initiated to identify individuals suffering from PTSD and take appropriate early interventional action.

Spatiotemporal analysis of pertussis in Hunan Province, China, 2009-2019.

OBJECTIVES: This study aims to explore the spatial and spatiotemporal distribution of pertussis in Hunan Province, and provide a scientific basis for targeting preventive measures in areas with a high incidence of pertussis. DESIGN: In this retrospective spatial and spatiotemporal (ecological) study, the surveillance and population data of Hunan Province from 2009 to 2019 were analysed. The ArcGIS V.10.3 software was used for spatial autocorrelation analysis and visual display, and SaTScan V.9.6 software was used for statistical analysis of spatiotemporal scan data. SETTINGS: Confirmed and suspected pertussis cases with current addresses in Hunan Province and onset dates between 1 January 2009 and 31 December 2019 were included in the study. PARTICIPANTS: The study used aggregated data, including 6796 confirmed and suspected pertussis cases. RESULTS: The seasonal peak occurred between March and September, and scattered children were at high risk. The global Moran's I was between 0.107 and 0.341 (p<0.05), which indicated that the incidence of pertussis in Hunan had a positive spatial autocorrelation. The results of local indicators of spatial autocorrelation analysis showed that the hot spots were mainly distributed in the northeast region of Hunan Province. Moreover, both purely space and spatiotemporal scans showed that the central and northeastern parts were the most likely cluster areas with an epidemic period between March and October in 2018 and 2019. CONCLUSION: The distribution of the pertussis epidemic in Hunan Province from 2009 to 2019 shows spatiotemporal clustering. The clustering areas of the pertussis epidemic were concentrated in the central and northeastern parts of Hunan Province between March and October 2018 and 2019. In areas with low pertussis incidence, the strengthening of the monitoring system may reduce under-reporting. In areas with high pertussis incidence where we could study whether the genes of endemic pertussis strains are mutated and differ from vaccine strains.

The occurrence of post-traumatic stress disorder (PTSD), job burnout and its influencing factors among ICU nurses.

OBJECTIVE: This study was designed to explore the occurrence of post-traumatic stress disorder (PTSD) symptoms, job burnout and its influencing factors among nurses in intensive care units (ICU). METHODS: A total of 150 ICU nurses were selected for questionnaire survey by systematic sampling and 143 questionnaires were returned. The questionnaires included a PTSD Checklist-Civilian Version (PCL-C), Maslach Burnout Inventory (MBI), Connor-Davidson Resilience Scale (CD-RISC) and the Social Support Rating Scale (SSRS). ICU nurses were divided into positive and negative groups according to PCL-C scores, the differences between the groups were compared, and the influencing factors for the occurrence of PTSD were analyzed. RESULTS: ICU nurses had PCL-C scores ranging from 11 to 55 and were divided into the positive group (PCL-C ≥ 38, N=32) and the negative group (PCL-C < 38, N=111) according to the presence of PTSD, with a positive rate of 22.38%. The total MBI scores and scores in emotional exhaustion, depersonalization, and personal accomplishment in the positive group were significantly higher than those in the negative group, (P < 0.05). Health status, years of experience, age, CD-RISC scores, and SSRS scores showed significant difference between the two groups (P < 0.05). Multivariate logistic regression showed that MBI score was an independent risk factor for the development of PTSD symptoms among ICU nurses (OR > 1, P < 0.05), while CD-RISC score was a protective factor (OR < 1, P < 0.05). CONCLUSION: The incidence rate of PTSD among ICU nurses was 22.38%, and MBI score and CD-RISC score were independent influencing factors for the occurrence of PTSD symptoms.

A comparison of two different fluid resuscitation management protocols for pediatric burn patients: A retrospective study.

OBJECTIVE: Pediatric burn patients are more susceptible to burn shock than adults, and an effective fluid management protocol is critical to successful resuscitation. Our research aim was to investigate the safety and efficacy of two protocols for pediatric burn patients for use within the first 24h. METHODS: A total of 113 pediatric burn patients were enrolled from January 2007 to October 2012. Of those patients, 57 received fluid titration regimens of alternating crystalloids and colloids once within 2h in the first 24h after burn (Group A), whereas the remaining patients received regimens of alternating crystalloids and colloids once within 1h in the first 24h after burn (Group B). The safety, fluid volume infused and urine output were recorded and compared. RESULTS: All the patients survived in the first 24h after burn. There were no significant differences between Group A and Group B in lactic acid (LA) level and base excess (BE). The water infused in Group A were greater than that of Group B in the first 24h (P=0.024). No significant differences were found in total volume intake and hourly urine output between the 2 groups in the first 24h. CONCLUSION: The implementation of fluid resuscitation using either protocol A or protocol B is safe and effective for pediatric burn patients in the first 24h. The total fluid infused were similar between two protocols. But using protocol A may be more convenient and labor-saving for nurses.