General Behavior Research Articles

Definition, Fabrication, and Compression Testing of Sandwich Structures with Novel TPMS-Based Cores.

Triply periodic minimal surfaces (TPMSs) constitute a type of metamaterial, deriving their unique characteristics from their microstructure topology. They exhibit wide parameterization possibilities, but their behavior is hard to predict. This study focuses on using an implicit modeling method that can effectively generate novel thin-walled metamaterials, proposing eight shell-based TPMS topologies and one stochastic structure, along with the gyroid acting as a reference. After insights into the printability and design parameters of the proposed samples are presented, a cell homogeneity analysis is conducted, indicating the level of anisotropy of each cellular structure. For each of the designed metamaterials, multiple samples were printed using a stereolithography (SLA) method, using a constant 0.3 relative density and 50 µm resolution. To provide an understanding of their behavior, compression tests of sandwich-type specimens were performed and specific deformation modes were identified. Furthermore, the study estimates the general mechanical behavior of the novel TPMS cores at different relative densities using an open cell mathematical model. Alterations of the uniform topologies are then suggested and the way these modifications affect the compressive response are presented. Thus, this paper demonstrates that an implicit modeling method could easily generate novel thin-walled TPMSs and stochastic structures, which led to identifying an artificially designed structure with superior properties to already mature topologies, such as the gyroid.

Experimental and numerical investigation on composite beam–column joint connection behavior using different types of connection schemes

Abstract Over the past few decades, composite joints have been regarded as one of the most promising approaches. After reviewing the research articles dealing with composite beam-column joints, it can be withdrawn that few researchers studied and developed different types of composite beam-column joints. The objectives of this paper to study the effect and behavior of different connection types on the composite beam – column joint under repeated loading as well as to investigate new forms of slab connection with column flange in composite connection joints, aiming to enhance the behaviors of the joints and make the slab endure a part of the load in a more efficient way. Five specimens with various connection types were tested to failure; the composite model number two (CM2) was considered the control specimen. Regarding the ultimate moment, the result found that CM5 has moment 50.47% more than control specimen, the lowest rotation value was in CM5. The general behaviours of the FEM were in good accordance with the experiment results. According to the parametric a higher yield strength is more rigid stiffer, the effect of web thickness on the load is too small and increase in load resistance with an increase in beam flange thickness.

Flexural behaviour of BFRP grid/bar reinforced UHPC beams and slabs

This study investigates the integration of Basalt Fiber Reinforced Polymer (BFRP) and Ultra-High Performance Concrete (UHPC), which exhibit significant potential for a durable and sustainable solution in marine and offshore infrastructure. An experimental program of BFRP grid/bar-reinforced UHPC beams and slabs subjected to four-point bending is presented. A total of nine beams and ten slabs were prepared and tested to investigate the effect of BFRP reinforcement ratio (0 %–3.33 %), type of reinforcement (grid and bar), and steel fiber content of UHPC (0 %, 1 %, 2 % and 3 %). The results revealed that the inclusion of BFRP reinforcement, even at a small reinforcement ratio, is feasible to enhance structural ductility due to the large rupture strain and superior strength characteristics of BFRP material. Moreover, the steel fibers played a crucial role in preventing shear failures of UHPC and creep failures of BFRP reinforcement. Within a range of 0–2 %, the steel fiber content not only benefited the load-resistance and deformation capacity but also effectively improved the cracking load. However, high fiber content (3 %) had a minimal contribution to load-bearing capacity and negatively affected ductility. A theoretical model based on the deflection method was employed to forecast the general behaviour of the flexural members. Comparisons between experimental results and numerical predictions confirm its accuracy.

Fertility and teratogenic study of the aqueous extract of Hibiscus sabdariffa L. in female Sprague Dawley rats

Hibiscus sabdariffa (roselle) has long been gaining attention in phytotherapy research due to its medicinal properties. Despite its benefits, there is very scarce information available on the reproductive toxicity of this plant. The aqueous extract of H. sabdariffa (AEHS) was tested in the present study to investigate its potential effects on fertility and teratogenicity in 40 female Sprague Dawley rats. AESH treatment was administered orally by gavage at four different dosages: 250, 500 and 1000 mg/kg/day or distilled water (control). Treatment began from pre-mating and continued through mating up to the 19th day of pregnancy periods. Throughout this study, the reproductive parameters were evaluated until the day of sacrifice (day 20th of pregnancy). Results obtained revealed no significant differences in general physical health, behaviours and maternal body weights throughout the treatment period. Furthermore, the mean length of the oestrous cycle was not statistically affected, even though a few rats displayed irregular cycles. In addition, there was no statistical significance in the mating and pregnancy indices, number of corpora lutea and implantation sites, percentages of pre-implantation loss and postimplantation death and reproductive organ weights. Foetal parameters such as the number of live foetuses, sex ratio and body weight were also not statistically affected by AESH. Ultimately, there were no signs of teratogenicity observed since none of the foetuses exhibited congenital malformations. In conclusion, these findings imply that the oral administration of AEHS up to 1000 mg/kg/day did not pose any significant toxicity on the fertility and teratogenicity but slightly affected the oestrous cycle in rats.

Detectability of residual stress anomalies in railway wheels with different geometries subjected to thermal overload based on back gauge change

Temperature increases of railway wheels due to frictional braking on the running surface (wheel tread) can lead to maintenance challenges such as tread wear and thermal cracking. While heating within the anticipated design range should not adversely affect the structural safety of the wheels, excessive temperature rises resulting from brake system failures can induce tensile residual stresses in the rim, potentially leading to wheel fracture. Detecting wheels with abnormal residual stresses is therefore crucial for railway safety, and monitoring residual displacements in the rim due to changes in circumferential residual stresses is an implementable approach. However, the shape of the wheel web varies, and the displacement response to thermal input differs depending on the wheel geometries. This study aims to explore general deformation behaviours related to wheel shape and elucidate the relationship between shape and heat resistance. The elastic-plastic finite element analysis employing simplified intense thermal input revealed that residual deformation after excessive thermal loading consistently results in back gauge expansion, although the deformation and stress responses differ based on the web geometry. Differences in heat resistance are indicated by the variation in the temperature at which compressive yielding due to thermal stress occurs, depending on the web shape. The residual stress detectability of each wheel is determined based on the principle that greater residual displacement at lower stress indicates higher anomaly detectability.

Punching shear behavior for flat slabs with CFRP and openings

This study is devoted to investigate the flexural behavior of geopolymer flat slab that have transverse web openings with CFRP. The shear reinforcement is considered one of the important solutions to increase the resistance of the slabs to the failure of the punching shear and it is also possible through the use of these collars to provide service openings next to the columns. Three molds made of wood were prepared to examine 15 samples of geopolymer concrete under concentrated conditions, Dimensions of section are of total (70*70*7 cm) and Dimensions of column (15*15*15 cm). Three groups of models comprise the models for this research: the first group looks at the impact of the column's location; the second group looks at the impact of an opening next to the column or not; and the third group looks at the impact of CFRP. The findings demonstrated that the presence of transverse web openings affects the general flexural behavior of flat slab geopolymer reinforced concrete as a result of the reduction of concrete within the geopolymer concrete section. CFRP specimens demonstrated superior due to the inherent mechanical properties of the material. Among the various repairing procedures used, the full wrapping technique yielded the best results after the repairs.

Experimental and numerical investigation of low‐velocity impact behavior and failure mode of shear deficient RC beam strengthened with CFRP strips

AbstractIt is well‐known that shear failure is a collapse mechanism that is the riskiest, fastest, and catastrophic and occurs with no visible signs of damage or prior warning for RC beams. Therefore, to prevent brittle shear failure, the RC beams should include sufficient shear reinforcement, such as stirrups, and be designed to have sufficient shear capacity. However, the RC beams' shear capacity becomes inadequate for various reasons. One of these reasons may be the acting of the impulsive impact load, which is uncommon and disregarded in the design phase on the RC beams. An experimental program was conducted to examine the impact behavior and failure mode of shear‐deficient RC beams in the scope of the present study. Besides, it aims to investigate the effectiveness of the strengthening method using CFRP strips in improving the general behavior, failure mode, and performance of shear‐deficient RC beams exposed to impact load. The time histories of the accelerations, displacements, impact loads, and strains in the CFRP strips were measured. They were interpreted how they are affected by experimental variables examined in the experimental study. Furthermore, the finite element model of the specimens was generated in the LS‐DYNA software, and the experimental and numerical results were compared by performing finite element analysis in terms of failure modes and general behavior.

Induced gravitational waves: the effect of first order tensor perturbations

Scalar induced gravitational waves contribute to the cosmological gravitational wave background. They can be related to the primordial density power spectrum produced towards the end of inflation and therefore are a convenient new tool to constrain models of inflation. These waves are sourced by terms quadratic in perturbations and hence appear at second order in cosmological perturbation theory. While the focus of research so far was on purely scalar source terms we also study the effect of including first order tensor perturbations as an additional source. This gives rise to two additional source terms: a term quadratic in the tensor perturbations and a cross term involving mixed scalar and tensor perturbations. We present full analytical expressions for the spectral density of these new source terms and discuss their general behaviour. To illustrate the generation mechanism we study two toy models containing a peak on small scales. For these models we show that the scalar-tensor contribution becomes non-negligible compared to the scalar-scalar contribution on smaller scales. We also consider implications for future gravitational wave surveys.

Aspects of Everpresent Λ. Part II. Cosmological tests of current models

This paper investigates Everpresent Λ, a stochastic dark energy model motivated by causal set theory and unimodular gravity, and confronts it with two key observational data sets, Supernova Ia (SN Ia) and Cosmic Microwave Background (CMB) data. A key feature of this model is that Λ fluctuates over time and on average the magnitude of its fluctuations is of the order of the dominant energy density (be it radiation or matter) for the given epoch. In particular, we focus on a phenomenological implementation of Everpresent Λ known as Model 1. The random fluctuations in Everpresent Λ realizations are generated using seed numbers, and we find that for a small fraction of seeds Model 1 is capable of producing realizations that fit SN Ia data better than ΛCDM. We further investigate what features distinguish these realizations from the more general behaviour, and find that the “good” realizations have relatively small fluctuations at low redshifts (z < 1.5), which do not closely track the matter density. We find that Model 1 struggles to improve on ΛCDM at describing the CMB data. However, by suppressing the values of Λ near the last scattering surface, as suggested in [1], we find a large improvement in the best fit of the model, though still with a χ 2 value much larger than that of ΛCDM. We also study the allowed variation of the dark energy density by the CMB constraints in a more model-independent manner, and find that some variation (especially prior to recombination) is possible and in fact can lead to improvement over ΛCDM and reduce the Hubble tension, in line with some early dark energy proposals. However, for the kinds of variations considered, the favoured fluctuations are smaller in magnitude than is typical in current Everpresent Λ models.

Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study

IntroductionThe majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This...

Phytochemical Factor Analysis of Some Extra Virgin Olive Oils (Olivae oleum) and the Effects of Storage Under Different Conditions—Simulating General Consumer Behavior

Phytochemical Factor Analysis of Some Extra Virgin Olive Oils (Olivae oleum) and the Effects of Storage Under Different Conditions—Simulating General Consumer Behavior

Unveil the toxicity induced on early life stages of zebrafish (Danio rerio) exposed to 3,4-methylenedioxymethamphetamine (MDMA) and its enantiomers

The increased detection of the recreational drug 3,4-methylenedioxymethamphetamine (MDMA) in aquatic ecosystems, has raised concern worldwide about its possible negative impacts on wildlife. MDMA is produced as racemate but its enantioselective effects on non-target organisms are poorly understood. Therefore, this study aimed to provide a comprehensive study of the toxicity of MDMA and its enantiomers in the early life stages of zebrafish (Danio rerio). Zebrafish embryos (≈3 h post fertilization) were exposed to different concentrations (0.02, 0.2, 2, 20, and 200 μg/L) of (R,S)-MDMA and both pure enantiomers.Both enantiomers induced effects on embryonic development, DNA integrity, and behaviour and enantioselective effects were noted. (S)-MDMA exhibits higher toxic effects on embryonic development level with increased mortality and severity of teratogenic effects, and behavioural abnormalities in acoustic startle-habituation response. (R)-MDMA affected general activity and avoidance behaviour, showing greater inhibitory effects on behavioural activity. Additionally, (R,S)-MDMA induced higher genotoxic effects than the two isolated enantiomers. These results are of concern at populational levels since effects on mortality, development, and behaviour were observed even at environmentally relevant concentrations, which can cause a reduction of larval viability and in the number of individuals in each generation, and an increase in the risk of predation of the organisms. Yet, the bioaccumulation studies showed that MDMA is not accumulated in zebrafish.Therefore, this work demonstrated for the first time the occurrence of MDMA enantiotoxicity in the early life stages of zebrafish, which should be considered in further environmental risk assessments involving fish species or other non-target aquatic organisms.

Analysis of waves dynamics in a rotating detonation combustor fueled by kerosene

The wave dynamics play a crucial role in the operation characteristics of the rotating detonation engine. We conducted numerical simulations of a rotating detonation combustor (RDC) using multicomponent reactive Navier–Stokes equations coupled with a discrete phases model. The RDC in this research employs a configuration with multiple coaxial injectors supplying oxygen-enriched air and kerosene spray at room temperature. To accurately identify and analyze waves within the RDC, we proposed a three-dimensional transient detonation wave detection method based on the combined parameters of normal Mach number and heat release rate in the flow field. Two typical wave modes, referred to as single-wave mode and counter-waves mode, are identified and then selected to conduct a detailed wave dynamics analysis. The general wave behavior is discussed, and velocity deficit is compared for these two wave modes. For the single-wave mode, intermittent micro-explosions are observed generating retonation waves periodically in the unburnt pockets behind the rotating detonation shock front. For the counter-waves mode, we analyzed the collision process of the two waves and the coupling/decoupling of the shock front with the detonative heat release zone, revealing the reason for significant velocity deficits in this wave mode. This research demonstrates that micro-explosions intermittently occur in the multiphase RDC in both single-wave and counter-waves modes and generate micro explosion shock waves periodically, which influence the complicated wave dynamics behavior.

Disease disclosure in the workplace in people living with rheumatic diseases: an exploratory study.

Rheumatic musculoskeletal diseases (RMDs) are the causes of frequent absence from work and loss of productivity. As (in)visible diseases, it is up to the individuals to decide if disclosing their diagnosis, with important repercussions also within the workplace. Still little is known about disease disclosure in the workplace (DD-W) in patients with RMDs. This study aimed to investigate socio-demographic, clinical, and psychological predictors of DD-W among working patients with RMDs. A cross-sectional Italian national study captured DD-W in people with RMDs. An online survey was developed using ad-hoc questions and scientific questionnaires to explore demographics and work-related, clinical, and psychological factors. Stepwise logistic regressions were run to identify significant predictors of DD-W. A total of 250 working rheumatic patients completed the survey; 81.2% of the participants enacted DD-W. DD-W behaviors were predicted by perceived visibility of the RMD (p=0.008), work type (p=0.022), general DD behaviors (p<0.001), and perceived family support (p=0.023). Among RMD patients, psoriatic arthritis participants had higher probabilities of DD-W (p=0.02), whereas lower probabilities were detected in fibromyalgia patients (p=0.003). Lower disease duration corresponded in the sample to higher probabilities of DD-W (p=0.036). The majority of RMD patients in this study enacted DD-W. DD-W was associated with medical, occupational, and psychological factors, supporting the multidimensionality of the process. Further research on the subject might help foster better DD-W decision-making processes for RMD patients while promoting intervention strategies in education, policy, and culture.

Exploring Podcast And Videocast Consumption: A Construct Development And Validation Study Using TPB

Digital content consumption, particularly through podcasts and videocasts, is rapidly reshaping media engagement patterns globally. While existing research has explored general online behavior, there remains a gap in understanding the psychological drivers specific to digital audio and video content consumption, especially in emerging markets. This study aims developed and validated a Digital Content Consumption (DCC) scale within the Brazilian context, integrating it with the Theory of Planned Behavior (TPB) to enhance our understanding of consumption behavior. A cross-sectional survey was conducted among Brazilian consumers during thew month May of 2023. Participants were recruited through a convenience sample of adult internet users who had consumed podcasts or videocasts within the past month. The primary exposure was the consumption of digital audio and video content. The study employed Exploratory Factor Analysis, Confirmatory Factor Analysis, and Structural Equation Modeling (SEM) to analyze the data and validate the DCC scale. The final sample comprised 223 participants, with a mean age of 32 years and an even gender distribution. The SEM analysis demonstrated a strong model fit for the DCB scale within the TPB framework. Attitudes emerged as a significant predictor of both intention and behavior in digital content consumption. Utilitarianism was found to mediate the relationship between attitudes and consumption. The DCCB scale showed high internal consistency and construct validity across different demographic subgroups. The development and validation of the DCC scale provide a robust tool for measuring digital content consumption behavior. This study extends the application of the Theory of Planned Behavior to the specific domain of podcast and videocast consumption, offering valuable insights for content creators and marketers. Future research should explore the scale's applicability in diverse cultural contexts and its potential for predicting long-term engagement patterns with longitudinal studies

Synthesis, general physicochemical behaviour and magnetic studies of the macrocyclic bis-pyridine derivatives [TTDPzM(py)2]·2H2O (M = MnII, CoII, NiII)

In our extensive work on phthalocyanine-like macrocycles carrying peripherally attached strongly electron-withdrawing 1,2,5-thia/selenodiazol rings we recently reported on the FeII species of formula [TTDPzFe(py)2].2H2O (TTDPz = tetrakis(thiadiazole)porphyrazinato dianion). The present work deals with the synthesis and extended physicochemical studies of the series of related macrocycles [TTDPzM(py)2].2H2O (M = MnII, CoII, NiII). The diffractograms of three solid samples of the NiII complex [TTDPzNi(py)2]·2H2O, obtained from different synthetic procedures, indicate that the species is reproducibly obtained. All three samples are isomorphous with each other as shown by their X-ray powder diffractograms. Based on the comparison of the IR spectra of [TTDPzNi(py)2].2H2O and the related desolvated [TTDPzNi], the IR absorption peaks belonging to the pyridine molecules could be identified. The systematic presence of the two water molecules in all three species suggests that forms of contact do exist in the form of hydrogen bonds between them and the S and N atoms present peripherally in the thiadiazole groups of the macrocyclic units. As regard to the elimination of water, the thermograms (in inert atmosphere in the range 25–600 °C) indicate in all cases that loss of water occurs below 100 °C but loss of pyridine occurs over a broad range 100–300 °C for the MnII and CoII species whereas for the NiII complex it takes place in the narrow range 200–220 °C. In relation to the parallel series of metallophthalocyanines, i.e. [PcM] (M = MnII, FeII, CoII), it is noted that the NiII analog has not been reported in the literature and in a direct experiment it has been proved that [PcNi] heated in pyridine is obtained unchanged, the different behavior for the NiII TTDPz derivative due to the electron withdrawing effect of the external thiadiazole substituents, which makes favorable axial pyridine coordination in the complex. Completely insoluble in water, the triad of TTDPz derivatives are extremely low-soluble in non-donor or low donor solvents. This precluded any attempt to isolate single crystals for single-crystal X-ray work. Their UV–visible spectra show essential similarities in whatever organic solvent is used with clearly positioned Soret (300–400 nm) and Q-band absorptions (630–650 nm). Variable temperature magnetic susceptibility and magnetization studies reveal that the [TTDPzM(py)2].2H2O complexes all show paramagnetism with ground state spins of 3/2 (MnII), ½ (CoII) and 1 (NiII), supported by fitting the data to spin Hamiltonian formalism, vide infra. Comparisons are made with the magnetism of [PcM] analogues with key differences noted for M = NiII.

Constitutive modelling and wave propagation through a class of anisotropic elastic metamaterials with local rotation

Elastic metamaterials are typically periodic materials possessing unit cells endowed with engineered architecture much smaller than the typical phenomenological length scale. The development of continuum models capable of accurately representing the effects of this aforementioned architecture is extremely challenging, and hence a sparsely developed area. This paper develops a novel 2-D continuum model capable of capturing the dynamic behaviour of a class of anisotropic elastic metamaterials with local rotational elements in the long wavelength limit. A constitutive relation incorporating these local rotational effects is proposed, and ratified using a representative discrete model using linear Hookean springs and identical rigid disks. The new continuum model is used to generate a dispersion relation for harmonic plane waves propagating in an arbitrary direction, which is subsequently compared to the dispersion behaviour of the original discrete model. The general behaviour of this continuum when subjected to 2-D planar harmonic wave propagation in the anisotropic medium is then analyzed, with specific attention given to the effect of material anisotropy and wave propagation direction. This work is the first of its kind to create a new continuum model of a class of anisotropic elastic metamaterials with local rotational effects.

Predicting undergraduate OSCE performance using traditional and construct-driven situational judgment tests at admission.

Situational Judgement Tests (SJTs) are popular to screen for social skills during undergraduate medical admission as they have been shown to predict relevant study outcomes. Two different types of SJTs can be distinguished: Traditional SJTs, which measure general effective behavior, and construct-driven SJTs which are designed to measure specific constructs. To date, there has been no comparison of the predictive validity of these two types of SJTs in medical admission. With the present research, we examine whether the HAM-SJT, a traditional SJT, and the CD-SJT, a construct-driven SJT with an agentic and a communal scale, administered during undergraduate medical admission can predict OSCE (i.e., objective structured clinical examination) performance in a low-stakes (nLS = 159) and a high-stakes (nHS = 160) sample of medical students. Results showed a moderate positive relation between the communal scale of the CD-SJT and performance in OSCE stations with trained patients in the high-stakes sample (r =.20, p =.009). This SJT had also an incremental value in predicting the OSCE performance above and beyond GPA (i.e., grade point average), a science test (i.e., HAM-Nat), and gender (ß = 0.18, 95% CI [0.03; 0.33], p =.020). That is, individuals who chose more communal behavioral responses in the SJT were rated more favorably in interactions with trained patients in the OSCE. A comparable correlation coefficient was observed for the HAM-SJT when controlling for range restriction due to admission (rraw = 0.14 vs. rcontrolled = 0.20). Our research provides a first indication for the predictive validity of construct-driven SJTs in high-stakes undergraduate medical admission.

CROSS-CULTURAL DYNAMICS IN INDIA: A STUDY OF PUNJAB AND RAJASTHAN

The cross-cultural distinctions between the two unique areas of Punjab and Rajasthan are examined in this study, with an emphasis on the ways in which these differences affect consumer decision-making processes and more general socioeconomic behaviours. Punjab's rural, community-focused culture stands in stark contrast to Rajasthan's opulent, royal customs. The goal of the study is to pinpoint the cultural cues that influence consumer behaviour. The study looks into how cultural values influence consumer behaviours, purchasing behaviour, and preferences. The comparative research sheds light on the many frameworks for decision-making that are in use in these culturally different areas. With the goal of helping entrepreneurs, marketers, and politicians better interact with regional markets, this study advances our understanding of India's cultural variety. This research reveals the intricacies of cross-cultural relations in Northern India, providing essential perspectives on the evolving interaction between tradition and modernity in consumer behaviour.

Knowledge of pregnancy care behaviors, complications, and urgent maternal warning signs up to one year postpartum among Georgia residents

ObjectivesMaternal mortality in the U.S. continues to increase, and the State of Georgia has one of the highest maternal mortality rates among the 50 states at 33.9 deaths per 100,000 live births, disproportionately affecting Black and rural populations. This study sought to ascertain knowledge of adults living in Georgia about proper pregnancy care behaviors and their ability to identify warning signs and symptoms (WSS) of life-threatening complications during pregnancy and up to 1-year postpartum.MethodsIn 2022, using a cross-sectional study design, a questionnaire including items from validated instruments was distributed to adults residing in Georgia through social media and email. Questions were grouped into categories: total pregnancy knowledge, general pregnancy care behaviors, and pregnancy and postpartum WSS. Based on correct answer choices, scores were created for each of the four categories and compared by gender, age, education, race, and ethnicity using multiple linear regressions.ResultsParticipants (n = 588) ranged from 18 to 76 years old and were primarily female (80%). The vast majority (83.3%) failed to identify important pregnancy care behaviors. More than half of all participants were unable to recognize pregnancy and postpartum WSS of complications, 52% and 56% respectively. Male, Black, and Hispanic self-identified adults exhibited lower recognition of pregnancy care behaviors and WSS of pregnancy and postpartum complications, relative to other genders, races, and ethnic groups, respectively (p < 0.001).ConclusionsThis research identified important gaps in maternal health knowledge among adults living in the State of Georgia, highlighting specific opportunities for intervention and offering evidence-based information that can help improve health literacy for better maternal outcomes.