Sensor Applications Research Articles

Microwave Remote Sensing with Hybrid Quantum Receiver.

Detecting a microwave signal that is emitted or reflected by distant targets is a powerful tool in fundamental science and industrial technology. Solid-state spins provide an opportunity to realize quantum-enhanced remote sensing under ambient conditions. However, the weak interaction between the free-space signal and atomic size sensor limits the sensitivity. This hinders the realization of practical quantum remote sensing. Here, we demonstrate active microwave remote sensing with a diamond-based hybrid quantum receiver by combining electromagnetic field localization at nanoscale with quantum spin manipulation. A method of differential spin refocusing (DSR) is developed to overcome the challenge of reducing the impact of inhomogeneities in spin-signal interaction, while the strength of interaction is enhanced by more than 3 orders with nanostructure. It improves the coherent interaction time of quantum receiver by 30-fold, substantially enhancing the sensitivity and stability. By detecting the reflected microwave with picotesla sensitivity, diamond remote sensing monitors the real-time status of a centimeter-sized target at 2 m distance. Our method is general to various solid-state spins. The results will expand the applications of solid-state spin quantum sensors in areas ranging from medical imaging to resource survey.

Investigating the impact of shear and bulk viscosity on the damping of confined acoustic modes in phononic crystal sensors

Phononic crystal (PnC) sensors are recognized for their capability to control acoustic wave propagation through periodic structures, presenting considerable potential across various applications. Despite advancements, the effects of fluid viscosity on PnC performance remain intricate and inadequately understood. This study theoretically investigates the influence of shear (dynamic) and bulk viscosity on acoustic wave damping in defective one-dimensional phononic crystal (1D PnC) sensors designed for detecting liquid analytes. Acetic acid with varying viscosities is considered to fill a cavity layer intermediated by a multilayer stack of lead and epoxy. The effects of dynamic and bulk viscosity on the resonance characteristics of the defective mode were analyzed. Numerical results reveal that increased dynamic viscosity leads to substantial broadening and decreased intensity of resonance peaks, accompanied by a shift to higher frequencies due to enhanced elastic wave attenuation and damping. At low dynamic viscosity (η = 0.2 ηd), numerous resonance peaks with varying intensities are observed. However, at higher viscosities (η = 2.0 ηd to η = 10.0 ηd), only one prominent peak appears in the spectrum. The intensity of this resonant peak starts at 98% for η = 2 ηd and decreases to 58.8% as the dynamic viscosity increases to η = 10 ηd. Additionally, the combined effect of dynamic and bulk viscosity introduces further damping, causing a strong shift of the resonance peak to higher frequencies, along with an increase in the full width at half maximum (FWHM) and a decrease in the quality factor (QF). These findings emphasize the necessity of incorporating both shear and bulk viscosity in the design of PnC sensors to enhance their sensitivity and accuracy in practical applications. This theoretical framework provides critical insights for optimizing sensor performance and bridging gaps between theoretical predictions and experimental observations, especially in 1D PnCs, offering potential solutions to challenges in real-world PnC sensor applications.

A wide linear range and highly sensitive electrochemical reduction of environmental hazard (p-Nitrotoluene) using carbon-based hybrid composite (Ti3C2TX@MnCo2O4)

The electrochemical sensor is receiving much attention because of the evolving on-time sensing technology. It is crucial to develop new catalysts for electrochemical sensor applications with favorable physicochemical, electrocatalytic properties and good conductivity to meet the demands of on-time monitoring applications. The excellence of this research work is the preparation of Ti3C2TX@MCO nanocomposite by ultra-sonication method for the sensing of p-Nitrotoluene (p-NT). The prepared electrode material exhibits excellent electrocatalytic properties towards the sensing of p-NT compared with other electrodes. The p-NT was quantified by Differential Pulse Voltammetry (DPV) and Amperometric (i-t) techniques. The good linear range was observed by DPV (3–1860 μM) and i-t method (0.18 – 4170 μM). The calculated limit of detection (LOD) from DPV and i-t methods are 93.5 and 35.1 nM, respectively. The sensitivity values calculated from DPV, and i-t methods are 1.68 µA/µM. cm2 and 1.71 µA/µM. cm2, respectively. The proposed sensor system exhibits better selectivity, reproducibility, repeatability and stability for sensing of p-NT. A real time p-NT detection study was conducted using environmental water samples.

3D printed hernia mesh implant: a conformability study

Aim: This study aims to explore the sensing capabilities of polyvinylidene fluoride-hydroxyapatite-chitosan (PVDF-HAP-CS) composite-based hernia mesh implants (of conformal/planar design), followed by in-vitro analysis for better understanding of the bio-stability in the patient’s body. Methods: For analyzing the sensing capabilities, a microstrip patch antenna (MPA)-based implantable sensor [with 17-4 precipitate hardened (PH) stainless steel (SS) (bio-compatible) and Cu alloy (non-biocompatible) materials as conducting plane/patch with PVDF-HAP-CS as dielectric material] has been considered separately in this study. Primarily, in this study, the 3D models of the hernia mesh implant have been designed in the high-frequency structure simulator (HFSS) software, and the sensing behaviour of the same has been recorded. Results: The HFSS results represent that for the 17-4PH SS-based sensor, resonant frequency (fr) decreases from 2.3953 to 2.3800 GHz, whereas the gain increases from 0.54 to 4.02 dB with a SAR value of 1.077 W/kg. The fr for Cu alloy increases up to 30° conformal angle and, after that, starts decreasing, whereas the gain reaches 3.24 dB with a SAR value of 1.238 W/kg. The in-vitro study highlights that both materials (17-4PH SS and Cu alloy) possess a low corrosion rate. Conclusions: The simulation-based comparison of the biosensors with conducting elements 17-4PH SS and Cu alloy for different conformal angles indicates that the 17-4PH SS shows promising results over Cu in terms of higher gain (up to 4.02 dB) and low SAR value (1.077 W/kg) with the fr lying in the industry scientific and medical (ISM) band and therefore may be used for implantable sensor applications and possesses the capability to be used as 3D-printed hernia mesh implant. The in-vitro results with the low corrosion rate ≈ of 5.1 × 10–8 mm/year, 17-4PH SS may be a suitable material for the fabrication of hernia mesh implant.

Optical and electric properties of tin oxide (SnO2) with reduced graphene oxide nanocomposite thin films

Due to their superior properties, two-dimensional (2D) nanomaterial materials have become increasingly popular for enhancing SnO2 thin films. In the paper, a thermionic vacuum arc (TVA) deposition system was used to produce a thin film of SnO2 with a reduced graphene oxide (rGO) nanocomposite. SnO2 thin films have become widely used in sensor applications, and these sensors have been shown to work at relatively high temperatures compared to room-temperature semiconductors. As a result, working temperatures affect the material properties. The surface properties of the deposited and post-annealed samples were investigated using field emission scanning electron microscopy integrated with energy dispersive x-ray spectroscopy and atomic force microscopy. The weight ratios of carbon and tin were calculated as 35 % and 65 %, respectively. The mean Z-height of the nanoparticles was determined to be 9 nm, and the distribution of the surface grains is nearly homogeneous. Following the post-annealing process, the thin film's band gap energy decreased from 3.78 eV to 3.25 eV. According to the photoluminescence spectra, emission peaks at 393 nm, 406 nm, and 443 nm were measured. The transmittance spectra of the various post-annealed samples at 150 °C were recorded, and they remained nearly the same. This consistency is a beneficial property of the thin film because SnO2:rGO nanocomposite thin films are designed to operate at relatively high temperatures. The present study investigates the advantages and properties of the post-annealed (repeating annealing) SnO2: rGO thin film.

Nonlinear piezoresistive effect of 4H–SiC for applications of high temperature pressure sensors

Nonlinear piezoresistive effect of 4H–SiC for applications of high temperature pressure sensors

Polaron formation via doping process in an organic semiconductor polymer based on thiophene-phenylene

In this research, we synthesized and analyzed the polymer 5-(5-(10-chlorodecyloxy)-2-methoxy-4-(5-methylthiophen-2-yl)phenyl)-5′-(2-(2-ethylhexyloxy)-5-methoxy-4-(5-methylthiophen-2-yl)phenyl)-2,2′-bithiophene (PTBT46). The polymer was dissolved in chloroform and subjected to gamma radiation doses ranging from 0 to 100 Gy (gray). We observed that PTBT46 can be doped with H+ions, as indicated by visible color changes, optical measurements, and a tenfold increase in conductivity. When analyzing PTBT46 in solution using THF (tetrahydrofuran) and chloroform, we found a notable solvent dependence. In chloroform, new absorption bands appeared at approximately 680 nm and 2630 nm after radiation doses of 25 to 100 Gy, which were not present in THF. These bands are attributed to polarons and bipolarons resulting from the doping process. Additionally, we observed a spectral “blue shift” with increasing H+concentration due to changes in molecular conjugation, without degradation of the polymer chain. This shift, confirmed by Fourier-transform infrared (FTIR) spectroscopy, is reversible and suggests potential applications in optoelectronic devices and advanced radiation sensors.

Harvesting the tuning mechanism of strategic polychrome and white light emission in NapH dye based on excited state intermolecular proton transfer

Organic white light emitting (WLE) materials have sparked a research boom due to their promising applications in display devices, artificial lighting, and molecular sensors. However, the complex luminescence mechanism of full-spectra emitting materials has limited the development of white light materials with high stability and reproducibility. In this study, building on the full-spectra luminescent naphthimide dye (NapH) introduced by Xu et al., (Chin. Chem. Lett. 35(2024), 108348), we report the solvent-sensitive excited state proton transfer (ESPT) properties and white light emission mechanism in NapH. Our theoretical research results show that the ESPT process of NapH molecule is hindered in the low-polar solvent tetrahydrofuran (THF), so only the blue fluorescence from the Enol* is observed in the experiment. In contrast, in polar solvents such as water (H2O) and methanol (MeOH), the formation of strong intermolecular hydrogen bonds successfully initiates the ESPT process, leading to the dual fluorescence observed in experiments, with blue emission from the Enol* and red emission from the Nap anion. In essence, different solvent environments can adjust several emission colors. Furthermore, we theoretically verify that the optimal white light emission can be achieved when the mixed solvent ratio of dimethyl sulfoxide (DMSO) and dioxane (DIOX) is 5:5, which aligns well with experimental results. More importantly, we elucidate the specific WLE mechanism from multiple perspectives, including potential energy curves and electron spectra. Our work not only displays the interaction models of NapH molecule in various solvents, but also reveals the underlying luminescence mechanism, thus providing a valuable theoretical reference for the development and advancement of new white light materials.

Effect of Trivalent Ho3+ Ion Doping on Structural, Magnetic, Optical, and Electrical Properties of BiFeO3 Nanoparticles

Holmium (Ho)‐doped bismuth ferrite (BiFeO3) nanoparticles are synthesized using the citrate‐gel autocombustion method to investigate their structural, dielectric, ferroelectric, and magnetic properties. X‐Ray diffraction analysis confirms the formation of a rhombohedral perovskite structure, with crystalline size decreasing from ≈14 to 7 nm as doping levels increase. Fourier‐transform infrared spectroscopy further validates the perovskite phase, while field emission scanning electron microscopy and energy‐dispersive X‐Ray spectroscopy confirm the nanocrystalline nature and composition of the samples. X‐Ray photoelectron spectroscopy verifies the successful incorporation of Ho3+ ions into the BiFeO3 matrix. The dielectric properties show high permittivity and low dielectric losses, while magnetic hysteresis loops reveal enhanced magnetic properties, including increased saturation magnetization, remanence, coercivity, squareness ratio, Bohr magneton, and magnetocrystalline anisotropy. These findings indicate that Ho‐doped BiFeO3 nanoparticles exhibit significantly improved electric and magnetic performance, positioning them as promising candidates for applications in magnetic storage devices and sensors.

A Flexible Multifunctional Sensor Based on an AgNW@ZnONR Composite Material.

A multifunctional sensor comprising flexible and transparent ultraviolet (UV) photodetectors (PDs) with strain gauges based on Ag nanowire (AgNW)@ZnO nanorods (ZnONRs) was fabricated using a cost-effective, simple, and efficient method. High-aspect ratio silver nanowires were synthesized using the polyol method. An AgNW@ZnONR composite was formed via the hydrothermal method to ensure the multifunctional capability of the flexible sensors. After refining the process parameters, the size of the ZnO nanorods was decreased to fabricate pliable multifunctional sensors using AgNW@ZnONRs. At a deposition of 0.207 g of AgNW@ZnONRs, the sensor achieves its maximum switching ratio and fastest response time under conditions of 2000 μW/cm2 UV optical power density. With a ton (rise time) of 2.7 s and a toff (fall time) of 2.3 s, the ratio of Ion to Ioff current is 1151. Additionally, the sensor's maximum optical current value correlates linearly with UV light's power density. The maximum response current increased from 222.5 pA to 588.1 pA, an increase of 164.3%, when the bending angle was increased from 15° to 90° for the sensor with a deposition of 0.276 g of AgNW@ZnONRs. There was no degradation in the response of the sensors after 10,000 bending cycles, as they have excellent stability and repeatability, which means they can meet the requirements of wearable sensor applications. Therefore, there is great potential for the practical application of multifunctional AgNW@ZnONRs in flexible sensors.

Graphene-Doped Piezoelectric Transducers by Kriging Optimal Model for Detecting Various Types of Laryngeal Movements.

This study fabricated piezoelectric fibers of polyvinylidene fluoride (PVDF) with graphene using near-field electrospinning (NFES) technology. A uniform experimental design table U*774 was applied, considering weight percentage (1-13 wt%), the distance between needle and disk collector (2.1-3.9 mm), and applied voltage (14.5-17.5 kV). We optimized the parameters using electrical property measurements and the Kriging response surface method. Adding 13 wt% graphene significantly improved electrical conductivity, increasing from 17.7 µS/cm for pure PVDF to 187.5 µS/cm. The fiber diameter decreased from 21.4 µm in PVDF/1% graphene to 9.1 µm in PVDF/13% graphene. Adding 5 wt% graphene increased the β-phase content by 6.9%, reaching 65.4% compared to pure PVDF fibers. Material characteristics were investigated using scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction analysis (XRD), contact angle measurements, and tensile testing. Optimal parameters included 3.47 wt% graphene, yielding 15.82 mV voltage at 5 Hz and 5 N force (2.04 times pure PVDF). Force testing showed a sensitivity (S) of 7.67 log(mV/N). Fibers were attached to electrodes for piezoelectric sensor applications. The results affirmed enhanced electrical conductivity, piezoelectric performance, and mechanical strength. The optimized piezoelectric sensor could be applied to measure physiological signals, such as attaching it to the throat under different conditions to measure the output voltage. The force-to-voltage conversion facilitated subsequent analysis.

Superior Electrochemical Sensor Application of Co3O4/C Heterostructure in Rapid Analysis of Anticancer Drug Palbociclib in Pharmaceutical Formulations and Biological Fluids.

In this work, we report a study examining how different salt concentrations affect the structure and electrochemical performance of two Co3O4/C materials designed for the fabrication of an easy, cheap, fast, safe, and useful electrochemical sensor for the detection of Palbociclib (PLB). Co3O4 nanoparticles were successfully created by encapsulating them in N-doped amorphous carbon matrices by using the molten salt-assisted approach. In this process, different amounts of potassium iodate and zeolitic imidazolate framework-12 (ZIF-12) were used, followed by pyrolysis at 800 °C. Optimum Co3O4 embedded porous carbon structures were obtained, and the composite with the highest electrochemical properties was modified to a glassy carbon electrode (GCE) surface for PLB detection. The linear response spanned from 1.0 to 5.0 μM, featuring a limit of detection (LOD) of 0.122 μM and a limit of quantification (LOQ) of 0.408 μM; the correlation coefficient was calculated as 0.995. The high sensitivity of the method in detecting PLB in pharmaceutical samples and human urine demonstrated its feasibility, with recovery percentages ranging from 99.3% to 101.3% and relative standard deviation (RSD) values of <3%. Therefore, this technique will make a significant contribution to monitoring and improving existing cancer treatment options.

A novel dual-detection electrochemiluminescence sensor for the selective detection of Hg2⁺ and Zn2⁺: Signal suppression and activation mechanisms

In this study, we developed a novel covalent organic framework (COF) material, termed RuCOFs, specifically designed and synthesized for electrochemiluminescence (ECL) sensor applications. RuCOFs are based on the classic ECL emitter Ru(dcbpy)32+, ingeniously integrating 4,4′,4''-(1,3,5-triazine-2,4,6-triyl) triphenylamine (TAPT) with [2,2′-bipyridine]-5,5′-diamine (BPYDA), forming a structure with a high specific surface area. This configuration not only significantly enhances the stability of the ECL signal but also provides ideal N,N′-bipyridine chelating sites for efficient metal ion recognition. Utilizing Ru(dcbpy)32+-functionalized COF (RuCOFs), a novel dual-function ECL sensor was developed, achieving high sensitivity and selectivity in detecting mercury (Hg2⁺) and zinc (Zn2⁺) ions. Experimental results indicate that Hg2⁺ significantly quenches the ECL signal, while Zn2⁺ markedly enhances it, with detection limits of 4.71 nM for Hg2⁺ and 6.57 nM for Zn2⁺ across a wide linear response range from 1 μM to 1 nM. This research not only demonstrates the significant advantages of COF-based ECL sensing platforms in tracking environmental metal ions but also opens new possibilities for environmental monitoring.

Superhydrophobic, Anti-Freezing and Multi-Cross-Linked Wearable Hydrogel Strain Sensor for Underwater Gesture Recognition.

Conductive hydrogel is considered to be one of the most potential sensing materials for wearable strain sensors. However, both the hydrophilicity of polymer chains and high water content severely inhibit the potential applications of hydrogel-based sensors in extreme conditions. In this study, a multicross-linked hydrogel was prepared by simultaneously introducing a double-network matrix, multiple conductive fillers, and free-moving ions, which can withstand an ultralow temperature below -80 °C. A superhydrophobic Ecoflex layer with a water contact angle of 159.1° was coated on the hydrogel using simple spraying and laser engraving methods. Additionally, the smart glove integrating five hydrogel strain sensors with a microprocessor was developed to recognize 12 types of diving gestures and synchronously transmit recognition results to smartphones. The superhydrophobic and antifreezing hydrogel strain sensor proposed in this study emerges promising potentials in wearable electronics, human-machine interfaces, and underwater applications.

Microwave biosensors utilizing metamaterial enhancement: Design and application

Microwave sensing technology has become increasingly widely applied in the biomedical field, playing a significant role in medical diagnosis, biological monitoring, and environmental warning. In recent years, the introduction of metamaterials has brought new possibilities and opportunities to microwave biosensors. This paper aims to explore the applications of microwave sensors in biosensing, with a particular emphasis on analyzing the crucial role of metamaterials in enhancing sensor performance and sensitivity. It provides a thorough examination of the fundamental principles, design strategies, fabrication techniques, and applications of microwave biosensors leveraging metamaterial enhancement. Moreover, it meticulously explores the latest applications spanning biomedical diagnostics, environmental monitoring, and food safety, shedding light on their transformative potential in healthcare, environmental sustainability, and food quality assurance. By delving into future research directions and confronting present challenges such as standardization and validation protocols, cost-effectiveness and scalability considerations and exploration of emerging applications, the paper provides a roadmap for advancing microwave biosensors with metamaterial enhancement, promising breakthroughs in multifaceted bioanalytical realms.

Electrodeposited ZnO Nanostructures on ITO Surfaces: Exploring Their Efficacy for Cholesterol Biosensing Applications

In this study, ZnO nanostructures were prepared by electrochemical anodization of electrodeposited Zn on ITO/glass substrates for cholesterol detection. The efficiency of the developed ZnO nanostructures in the detection of the Cholesterol oxidase (ChOx) enzyme was determined by the cyclic voltammetry method. The XRD and SEM results confirmed the synthesis of ZnO nanostructures prepared by the anodization method with various parameters. The effect of electrodeposition and anodization time on the morphology was observed. Cyclic voltammetry of ZnO/Zn/ITO/glass and Pt/ZnO/Zn/ITO/glass electrodes in electrolytes with various cholesterol concentrations was performed. The detection limit of the obtained Pt/ZnO/Zn/ITO/glass structured electrode was calculated as 0.965x10-3M. The resulting material with a layered structure may have potential applications in electrochemical sensors and biosensors in biomedical applications. In addition to biosensing performance, this study proposes a new approach for the development of ZnO-based biosensors that does not require expensive infrastructure and raw material costs, making it possible to develop high-sensitivity biosensor electrodes with lower detection limits with improvements to be made in future studies.

Flexible organic crystals with multi-stimuli-responsive CPL for broadband multicolor optical waveguides.

Flexible organic crystals, capable of transmitting light and responding to various external stimuli, are emerging as a new frontier in optoelectronic materials. They hold immense potential for applications in molecular machines, sensors, displays, and intelligent devices. Here, we report on flexible organic crystals based on single-component enantiomeric organic compounds, demonstrating multi-stimuli-responsive circularly polarized light (CPL). These crystals exhibit remarkable elasticity, responsiveness to light and acid vapors, and tunable circularly polarized optical signals. Upon exposure to acid vapors, the fluorescence of the crystals shifts from initial yellow emission to green emission, attributable to the protonation-induced inhibition of excited-state intramolecular proton transfer. Under UV irradiation, the fluorescence emission undergoes a red-shift, resulting from the molecular transformation from an enol configuration to a ketone configuration. Notably, both processes are reversible and can be restored under daylight. The integration of reversible fluorescence changes under light and acid vapors stimuli, CPL signals, and flexible optical waveguides within a single crystal paves the way for the application of organic crystals as all-organic chiral functional materials.

Recent Advances in Structure Design and Application of Metal Halide Perovskite-Based Gas Sensor.

Metal halide perovskites (MHPs) are emerging gas-sensing materials and have attracted considerable attention in gas sensors due to their unique bandgap structure and tunable optoelectronic properties. The past decade has witnessed significant developments in the gas-sensing field; however, their intrinsic structural instability and ambiguous gas-sensing mechanisms hamper their practical applications. Herein, we summarize the recent advances in MHP-based gas sensors. The physicochemical properties of MHPs are discussed at first. The structure design, including dimension design and engineering design, is overviewed as well as their fabrication methods, and we put forward our insights into the gas-sensing mechanism of MHPs. It is believed that enhanced understanding of gas-sensing mechanisms of MHPs are helpful for their application as gas-sensing materials, and structure design can enhance their stability, sensing sensitivity, and selectivity to target gases as gas sensors. Subsequently, the latest developments in MHP-based gas sensors are summarized according to their different application scenarios. Finally, we conclude with the current status and challenges in this field and propose future perspectives.

Continuous Microreactor‐Based Synthesis of SnO2 Nanoparticles for Sensor Applications

Tin oxide nanoparticles are well‐established materials with a wide range of applications, including optoelectronic devices and solid‐state gas sensors. Conventional synthesis methods of these systems are often based on batch processes. In this study, we compare batch and continuous synthesis methods for tin dioxide nanoparticles using precipitation and sol‐gel processes. For the continuous processes we applied the so called microjet reactor method. The nanoparticles were characterized by TEM, elemental analysis and XRD and exhibited particle sizes of 1.7‐3.0 nm and crystallite sizes of 1.7‐2.3 nm, consisting of tetragonal (P42/mnm) and orthorhombic (Pbcn) phases. We have evaluated different post‐synthesis purification methods to remove impurities such as chlorides and carbon‐hydrogen species. Each purification method exhibited unique advantages and side effects, providing insight into selecting the most appropriate method for specific applications. We also demonstrated the potential of these SnO2 nanoparticles as ethanol gas sensing materials and compared their performance with a commercial sensor.

Multifunctional Human-Computer Interaction System Based on Deep Learning-Assisted Strain Sensing Array.

Continuous and reliable monitoring of gait is crucial for health monitoring, such as postoperative recovery of bone joint surgery and early diagnosis of disease. However, existing gait analysis systems often suffer from large volumes and the requirement of special space for setting motion capture systems, limiting their application in daily life. Here, we develop an intelligent gait monitoring and analysis prediction system based on flexible piezoelectric sensors and deep learning neural networks with high sensitivity (241.29 mV/N), quick response (66 ms loading, 87 ms recovery), and excellent stability (R2 = 0.9946). The theoretical simulations and experiments confirm that the sensor provides exceptional signal feedback, which can easily acquire accurate gait data when fitted to shoe soles. By integrating high-quality gait data with a custom-built deep learning model, the system can detect and infer human motion states in real time (the recognition accuracy reaches 94.7%). To further validate the sensor's application in real life, we constructed a flexible wearable recognition system with human-computer interaction interface and a simple operation process for long-term and continuous tracking of athletes' gait, potentially aiding personalized health management, early detection of disease, and remote medical care.