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Full-Text Articles in Medicine and Health Sciences

Mental Health Problems Among Elementary School Students Mandated To E-Learning: A Covid-19 Rapid Review Caveat, Renée M. D'Amore, Angelina N. Halpern, Lauren R. Reed, Kevin M. Gorey Jul 2023

Mental Health Problems Among Elementary School Students Mandated To E-Learning: A Covid-19 Rapid Review Caveat, Renée M. D'Amore, Angelina N. Halpern, Lauren R. Reed, Kevin M. Gorey

International Journal of School Social Work

Extended lockdowns during the COVID-19 pandemic mandated millions of students worldwide to e-learning and by default made many of their parents proxy homeschool teachers. Preliminary anecdotal, journalistic and qualitative evidence suggested that elementary school children and their parents were probably most vulnerable to this stressor and most likely to experience mental health problems because of it. We responded with a rapid review of 15 online surveys to estimate the magnitude of such risks and their predictors between 2020 and 2021. The pooled relative risk of mental health problems among school children and their parents was substantial (RR = 1.97). Moreover, …


Mental Health Of University Nursing Students: A Literature Review, Mackenzie Carpenter Apr 2023

Mental Health Of University Nursing Students: A Literature Review, Mackenzie Carpenter

Honors Projects

This paper explores the ongoing issue of mental health, specifically in nursing students. In addition to maintaining good academic status through exams, assignments, and papers, nursing students must also endure the stressful environment of a clinical setting. Through summarizing research and drawing overall conclusions, this paper examines the contributing and alleviating factors to poor mental health in this population. Data was obtained from studies published from 2017 to 2023 in the CINAHL database, and 11 studies were retrieved from a data collection process to be included in this review. Multiple studies show a low deviation in mental health levels, healthy …


College Students' Relationship With Attention Deficit Hyperactivity Disorder And Learning Accommodations At The University Of Nebraska-Lincoln, Brianna Danehey, Kim Hansen Dr., Chelsea Witt Dr. Mar 2023

College Students' Relationship With Attention Deficit Hyperactivity Disorder And Learning Accommodations At The University Of Nebraska-Lincoln, Brianna Danehey, Kim Hansen Dr., Chelsea Witt Dr.

Honors Theses

Attention deficit hyperactivity disorder (ADHD) can provide many challenges for college students due to difficulties focusing, multi-tasking, and staying organized. Colleges are required to offer academic accommodations to students with disabilities in an attempt to provide students with an equitable learning environment. However, accommodations may be ineffective if they are highly unattainable, unused by the student once granted, or hindered by university faculty.

The objective of this study was to identify barriers to receiving effective and beneficial academic accommodations for individuals with ADHD at the University level and to provide insight into college students' knowledge and relationships relating to the …


Educating Nurses On Mental Fatigue, Tawanna Ann Canty Jan 2023

Educating Nurses On Mental Fatigue, Tawanna Ann Canty

Walden Dissertations and Doctoral Studies

Education correlates with nurse performance and avoiding mental fatigue. This project attempted to answer the question, “Educating nurses on mental fatigue will increase knowledge” focusing on educating rehabilitative nurses regarding mental fatigue. The project was guided by the Analysis, Design, Develop, Implement, and Evaluate model. Twenty rehabilitative nurses were administered a pretest consisting of 10 multiple-choice test questions. They received education on mental fatigue through PowerPoint presentations and handouts. After completing the education, participants were administered a posttest with the same 10 questions. An evaluation tool consisting of six questions was completed measuring an increase in knowledge after the posttest. …


Educating Nurses On Mental Fatigue, Tawanna Ann Canty Jan 2023

Educating Nurses On Mental Fatigue, Tawanna Ann Canty

Walden Dissertations and Doctoral Studies

Education correlates with nurse performance and avoiding mental fatigue. This project attempted to answer the question, “Educating nurses on mental fatigue will increase knowledge” focusing on educating rehabilitative nurses regarding mental fatigue. The project was guided by the Analysis, Design, Develop, Implement, and Evaluate model. Twenty rehabilitative nurses were administered a pretest consisting of 10 multiple-choice test questions. They received education on mental fatigue through PowerPoint presentations and handouts. After completing the education, participants were administered a posttest with the same 10 questions. An evaluation tool consisting of six questions was completed measuring an increase in knowledge after the posttest. …


Faculty And Staff Perceptions Of Mental Health Services In The Elementary Schools Of A Rural District, Vera Collins Richardson Jan 2023

Faculty And Staff Perceptions Of Mental Health Services In The Elementary Schools Of A Rural District, Vera Collins Richardson

Doctor of Education Dissertations

This case study focused on the perceptions of faculty and staff of mental health services at the elementary level in a rural district. Mental health services provided in elementary school settings can ultimately change the outcome of individuals’ lives. Many districts in North Carolina lack the funds to hire mental health counselors, and must rely on elementary school counselors to take the lead in providing students with the mental health care they need. This qualitative case study focused on the perceptions of faculty and staff and was the primary focus of this research. An analysis of feedback from three elementary …


Faculty And Student Online Experiences Amidst The Covid-19 Pandemic: A Descriptive Study (Part 2), Shelley Cobbett, Patricia A. Hansen-Ketchum, Nadine Ezzeddine, Debbie Brennick, Willena I. Nemeth Oct 2022

Faculty And Student Online Experiences Amidst The Covid-19 Pandemic: A Descriptive Study (Part 2), Shelley Cobbett, Patricia A. Hansen-Ketchum, Nadine Ezzeddine, Debbie Brennick, Willena I. Nemeth

Quality Advancement in Nursing Education - Avancées en formation infirmière

Background: Prior to the declaration of the global pandemic in March 2020, little research was available related to online teaching and learning within a professional practice discipline. Post secondary institutions pivoted from “learning as usual” to teaching almost completely in the online environment during a very short time frame. A plethora of related publications have since contributed to knowledge development across many educational programs.

Method: This multi-site research study was conducted to gather and examine the perspectives of nursing faculty and students’ lived experiences while teaching and learning online at the beginning of the global pandemic. Design: Descriptive survey study. …


The Child Care Crisis: Through The Social Ecological Lens, Jocelyne Saldana Aug 2022

The Child Care Crisis: Through The Social Ecological Lens, Jocelyne Saldana

Master's Projects and Capstones

Abstract

Objective - Working mothers face mental strain when returning to work due to the challenges of the current child care system. It is unclear how the instability of the child care sector impacts the mental health of working mothers.

Methods - The systematic review of literature was conducted to identify existing evidence to determine the influence access to quality, dependable, and affordable child care has on maternal mental health outcomes in working mothers. Multiple databases were used including PubMed and Scopus.

Results - Subsidized programs help reduce the cost of child care, however, income eligibility criteria makes it difficult …


The Passive Approach: How Academically Motivated Students Approach Their Mental Health., Megan E. Mccoy Jun 2022

The Passive Approach: How Academically Motivated Students Approach Their Mental Health., Megan E. Mccoy

Anthós

The research utilizes qualitative interviews and focus groups to understand how academically motivated students approach their mental health. Mental health is defined as “emotional, psychological, and social well-being,” by the Center for Disease Control and Prevention and is becoming a more significant concern in collegiate student populations. At Portland State University, the effects of mental health concerns on students are nearly double that of students around the U.S (Community Commons, n.d.). Academically motivated students are a group who seemingly strive for success and likely experience high levels of stress daily. The study found that students often take a passive approach …


The Effects Of The Transition From Pre-Nursing To Nursing On Mental Health, Andrew J. Davis, Paige R. Mullins, Kimberly A. Sell May 2022

The Effects Of The Transition From Pre-Nursing To Nursing On Mental Health, Andrew J. Davis, Paige R. Mullins, Kimberly A. Sell

Undergraduate Honors Theses

Mental health is an ever-growing crisis among adolescents and young adults, with suicide as second leading cause of death and the number of those negatively affected continually on the rise. Transitions are one of the major stressors prevalent among these age groups, placing individuals at risk for mental health deficits. This quantitative voluntary response comparative study assesses the transitional mental health of pre-nursing students and students in the nursing program at East Tennessee State University. Emailed to all with a declared major of pre-nursing or nursing, this study measured mental health using evidenced based assessment tools. The PHQ-9 for depression …


An Examination Of The Underutilization Of Mental Health Resources In Collegiate Student-Athletes, Kathleen Olivia Glover Apr 2022

An Examination Of The Underutilization Of Mental Health Resources In Collegiate Student-Athletes, Kathleen Olivia Glover

Masters Theses

Previous and developing literature indicates that collegiate student-athletes, while more susceptible to psychological problems, are underutilizing mental health resources. This project examines the aforementioned problem through the use of extensive student-athlete mental health literature to identify themes that are affecting student-athlete’s likeliness of seeking psychological services. Throughout the themes, the need for additional support from student-athlete stakeholders is presented. A workshop series to guide increased mental health literacy in student-athlete stakeholders to create opportunities to recognize signs of mental illness and form cultures that encourage the utilization of psychological services is constructed. It is anticipated that by including stakeholders in …


The Influence Of Losing A Parent In The Development Of Anxiety, Depression, And Academic Motivation In Latino College Students, Sandra Luz Galvan Jan 2022

The Influence Of Losing A Parent In The Development Of Anxiety, Depression, And Academic Motivation In Latino College Students, Sandra Luz Galvan

Graduate Research Theses & Dissertations

The current study focuses on understanding how the potential consequences of losing a parent before the age of eighteen influence depression, anxiety, and academic motivation in Latino college students. The study also explored how social support could interfere with these consequences. Five participants were recruited from various universities, and they were interviewed virtually, guided by a phenomenology design. The data was analyzed using a narrative approach. The results show that social support is fundamental to mitigating the consequences of losing a parent at a young age. It is recommended that future research consider the difference between losing a mother and …


Bridging Mental Healthcare, Kristin L. White Dec 2021

Bridging Mental Healthcare, Kristin L. White

MSN Capstone Projects

Nurses have an important role in the care given to mental health patients presenting to the emergency department (ED). Without expectations or encouragement toward growth or continued education, the quality of care and the therapeutic ability for care are crippled, as evidenced by nurses' knowledge/competency deficits and negative attitudes. Through ongoing/continued education, the cultivation of a therapeutic culture toward patients that present to the ED for mental health complaints could result. Additionally, these improvements in care, in turn, could promote not only the closure of gaps that exist for quality mental healthcare but may also lead to an increase in …


Predictors Of Goal Attainment Among High School Students In Accelerated Academic Curricula Receiving School-Based Motivational Interviewing Intervention, Camille E. Hanks Jul 2021

Predictors Of Goal Attainment Among High School Students In Accelerated Academic Curricula Receiving School-Based Motivational Interviewing Intervention, Camille E. Hanks

USF Tampa Graduate Theses and Dissertations

Students enrolled in Advanced Placement (AP) courses and International Baccalaureate (IB) programs represent a unique group of adolescents given the high demands of their rigorous coursework and the elevated stress they experience compared to peers in the general education (Suldo & Shaunessy-Dedrick, 2013). These students are often missed in traditional screening procedures that tend to identify students struggling academically or exhibiting disruptive behaviors. Fortunately, Shaunessy-Dedrick and colleagues (2021) developed a comprehensive school-based intervention program, including universal (Tier 1) and selective (Tier 2) components, which aims to support the well-being of AP/IB students. The Tier 2 component of this program (i.e., …


Mental Health In U.S. Schools: Problems, Interventions, And Future Directions, Emma Rumpf-Snavely Dec 2020

Mental Health In U.S. Schools: Problems, Interventions, And Future Directions, Emma Rumpf-Snavely

Journal of Critical Issues in Educational Practice

The psychological well-being of American children has been a concern due to the rise in mental health issues. Efforts have been made to tackle some of the issues that are most prevalent among youth such as stress, depression, bullying, substance abuse, suicide and self-harm. Attempted solutions include legislation at the state level, school-wide regulations, and individualized supports. Despite these efforts, there are still discrepancies with implementation and regulation of policies and programs. These inconsistencies have resulted in the continual decline in the mental health of American youth. The United States can gain a more focused direction for their mental health …


Mental Health Of Students: A Teacher Resource, Kathryn Seguin Dec 2020

Mental Health Of Students: A Teacher Resource, Kathryn Seguin

Honors Projects

Mental Health of Students: A Teacher Resource is a professional website regarding the four main types of mental health disorders, which are anxiety, depression, attention deficit hyperactivity disorder, and substance use. The website also includes both a detailed list of legal responsibilities of teachers and a list of school personnel to be involved in improving the mental health of students. The objective is for the website to be used for the educational basis of teachers regarding mental health issues in their students and is a compilation of research information collected from several sites.


Who Will Care For The Early Care And Education Workforce? Covid-19 And The Need To Support Early Childhood Educators’ Emotional Well-Being, Mark Nagasawa, Kate Tarrant Jul 2020

Who Will Care For The Early Care And Education Workforce? Covid-19 And The Need To Support Early Childhood Educators’ Emotional Well-Being, Mark Nagasawa, Kate Tarrant

Straus Center for Young Children & Families

This brief report describes issues and opportunities related to early childhood educators' emotional well-being that emerged from a survey exploring how the COVID-19 was affecting early educators across New York City and New York State (n=3355). Among our key findings were: (1) that mental health support was the most frequently identified need (n=910); (2) professional mental health was the least reported approach to coping (n=216); and (3) how those teaching and caring remotely were approximately one-and-a- half times more likely to rate their emotional well-being as lower than those whose sites were closed (CI 95% 1.157, 1.896). We argue, given …


Abriendo Futuros: A Program For Rural Indigenous Girls In Yucatan, Mexico, Fabiola Romero, Ludivine Cicolella, Silvana Larrea, A. Fallone, Isabel Vieitez Martínez Mar 2020

Abriendo Futuros: A Program For Rural Indigenous Girls In Yucatan, Mexico, Fabiola Romero, Ludivine Cicolella, Silvana Larrea, A. Fallone, Isabel Vieitez Martínez

Poverty, Gender, and Youth

The Abriendo Futuros (AF) program builds on the Council’s global experience of designing and implementing successful girl-centered programs in Africa, Asia, the Middle East, and Latin America and the Caribbean. AF aims to improve the living conditions of Mayan girls (10–18 years) and contribute to the achievement of gender equity in the Yucatan. The program’s community-focused strategy seeks to empower girls through interpersonal communication and participatory workshops. Girls in selected communities are divided into age groups (10–14 and 15–18) that meet weekly with a mentor in safe spaces. The program’s mentors are young women aged 20–30 from the communities, who …


Association Between Mental Health And Healing Among Elderly Physical Therapy Patients, Marlee C. Daniel, Kristen Mcalexander Feb 2020

Association Between Mental Health And Healing Among Elderly Physical Therapy Patients, Marlee C. Daniel, Kristen Mcalexander

International Journal of Exercise Science: Conference Proceedings

Despite their documented successes, mental health interventions are rarely a focus during physical therapy treatments, particularly among the geriatric population. PURPOSE: To measure mental health status and perceived healing among physical therapy patients aged 60 years or older. METHODS: Ten participants (5 males, 5 females) were recruited at a local physical therapy clinic. Three participants (N males=1, M age=67 years, N females=2, M age=80.5 years), were able to complete a modified version of the Generalized Anxiety Disorder 7-item Scale (GAD-7) that included a self-reported healing scale. RESULTS: Female participants reported feeling nervous, worried, and fearful less …


Population Council Annual Evaluation Report: Opening Futures (Abriendo Futuros) For Indigenous Girls In Yucatan, Mexico, Silvana Larrea Jan 2020

Population Council Annual Evaluation Report: Opening Futures (Abriendo Futuros) For Indigenous Girls In Yucatan, Mexico, Silvana Larrea

Poverty, Gender, and Youth

This Population Council Annual Evaluation Report includes evaluation activities from December 1, 2015 to December 1, 2019, and future evaluation plans (2019–21), as part of the Opening Futures (Abriendo Futuros) project for indigenous girls in Yucatan, Mexico. The first section describes the finalized analysis of the impact evaluation of the pilot phase; the second section reports the progress of evaluation activities; and the third section includes an evaluation of future plans for the period December 1, 2019 to November 30, 2021.


Examining The Efficacy Of A School-Based Mental Health Program In Iowa, Karen A. Rodriguez Jan 2020

Examining The Efficacy Of A School-Based Mental Health Program In Iowa, Karen A. Rodriguez

Walden Dissertations and Doctoral Studies

Evidence shows that treating mental health issues positively impacts academic and other life outcomes for students. However, there remains a gap in knowledge specific to academic outcomes and to rural school districts. It is important for mental health providers, educators, and third-party payers to gain an understanding of how treating mental health in the school setting affects student performance. The purpose of this quantitative study, which had contribution analysis as its theoretical framework, was to examine the academic and behavioral outcomes of participating in a school-based mental health (SBMH) program in rural school districts in Iowa. The specific focus was …


Exploring The Association Between Nutrition And Mental Health In Adolescence: A Systematic Literature Review, Asia Walker, Andrea Mcdonald, Angela Branch-Vital Jan 2020

Exploring The Association Between Nutrition And Mental Health In Adolescence: A Systematic Literature Review, Asia Walker, Andrea Mcdonald, Angela Branch-Vital

Pursue: Undergraduate Research Journal

Introduction: Throughout life, proper nutrition is important to the brain as it affects cognition and intellectual development. Studies have shown that a lack of certain nutrients can affect the body’s ability to perform mentally and physically. Annually, 14% of children in the United States receive mental health illness diagnoses. However, the link between nutrition and mental health is not clear. The purpose of this systematic literature review on mental health and nutrition in adolescence is to identify any gaps that require future research efforts. Methods: The Elton Bryson Stephens Company ( EBSCO), ProQuest, and Journal Storage (JSTOR) databases were used …


Animal Assisted Therapy And Support Animals, What Mental Health Professionals Know And Understand, Alexandro H. Velez Aug 2019

Animal Assisted Therapy And Support Animals, What Mental Health Professionals Know And Understand, Alexandro H. Velez

UNLV Theses, Dissertations, Professional Papers, and Capstones

Animal-assisted therapy can greatly benefit mental health professionals with clients in and out of the school settings in many ways. It is believed mental health professionals are successfully implementing Animal Assisted Therapy, even though some are not. Mental health professionals who are not using Animal Assisted Therapy are not doing so as the result of various variables, such as lack of information, knowledge, training, certification and policies, which prevents them from using Animals Assisted Therapy with clients and the community. It is also believed some mental health professionals are using animals as part of therapeutic interventions without proper training. The …


Refugee Women's Needs: The Athens Case, Melissa J. Diamond Jul 2019

Refugee Women's Needs: The Athens Case, Melissa J. Diamond

Journal of Refugee & Global Health

Medicins sans Frontiers estimates that twenty-five per cent of new asylum-seeking arrivals in Athens in 2016 were women [1]. Despite the sizable number of women asylum seekers arriving in Athens, women’s voices are often excluded from research on refugee needs. This research sought to understand the needs of women asylum seekers in Athens through the collection of qualitative data on their needs and experiences upon arriving in Athens. Twelve women from Syria, Afghanistan and other countries (background withheld for confidentiality) participated. The sampled women demonstrated an acute understanding of their own needs and the needs of their communities. While many …


Protocol For A Study Investigating The Influence Of Graded Levels Of Human Support On Adherence And Outcomes Of An Online, Multimodal Lifestyle Intervention To Improve Mental Health, Mel Renfrew, Darren Morton, Lillian Kent, Peter Beamish, Jason Hinze, Geraldine Przybylko, Bevan Craig Jul 2019

Protocol For A Study Investigating The Influence Of Graded Levels Of Human Support On Adherence And Outcomes Of An Online, Multimodal Lifestyle Intervention To Improve Mental Health, Mel Renfrew, Darren Morton, Lillian Kent, Peter Beamish, Jason Hinze, Geraldine Przybylko, Bevan Craig

Peter Beamish

Introduction: Mental health is in global jeopardy and devising effective preventative and curative solutions are vital. Lifestyle interventions have been shown to be efficacious for improving mental health; however, in a progressively digital culture, face-to-face (F2F) interventions are being replaced by online and mobile options.1 While online delivery can overcome ‘hurdles’ of inaccessibility and may also be more ‘scalable’, it poses unique challenges, as decreasing levels of human support can affect adherence to lifestyle interventions and associated outcomes.2,3,4 Research is needed to better understand the importance of human support in online interventions and the type and dosage of …


Protocol For A Study Investigating The Influence Of Graded Levels Of Human Support On Adherence And Outcomes Of An Online, Multimodal Lifestyle Intervention To Improve Mental Health, Mel Renfrew, Darren Morton, Lillian Kent, Peter Beamish, Jason Hinze, Geraldine Przybylko, Bevan Craig Jul 2019

Protocol For A Study Investigating The Influence Of Graded Levels Of Human Support On Adherence And Outcomes Of An Online, Multimodal Lifestyle Intervention To Improve Mental Health, Mel Renfrew, Darren Morton, Lillian Kent, Peter Beamish, Jason Hinze, Geraldine Przybylko, Bevan Craig

Lillian Kent

Introduction: Mental health is in global jeopardy and devising effective preventative and curative solutions are vital. Lifestyle interventions have been shown to be efficacious for improving mental health; however, in a progressively digital culture, face-to-face (F2F) interventions are being replaced by online and mobile options.1 While online delivery can overcome ‘hurdles’ of inaccessibility and may also be more ‘scalable’, it poses unique challenges, as decreasing levels of human support can affect adherence to lifestyle interventions and associated outcomes.2,3,4 Research is needed to better understand the importance of human support in online interventions and the type and dosage of …


Protocol For A Study Investigating The Influence Of Graded Levels Of Human Support On Adherence And Outcomes Of An Online, Multimodal Lifestyle Intervention To Improve Mental Health, Mel Renfrew, Darren Morton, Lillian Kent, Peter Beamish, Jason Hinze, Geraldine Przybylko, Bevan Craig Jul 2019

Protocol For A Study Investigating The Influence Of Graded Levels Of Human Support On Adherence And Outcomes Of An Online, Multimodal Lifestyle Intervention To Improve Mental Health, Mel Renfrew, Darren Morton, Lillian Kent, Peter Beamish, Jason Hinze, Geraldine Przybylko, Bevan Craig

Darren Morton

Introduction: Mental health is in global jeopardy and devising effective preventative and curative solutions are vital. Lifestyle interventions have been shown to be efficacious for improving mental health; however, in a progressively digital culture, face-to-face (F2F) interventions are being replaced by online and mobile options.1 While online delivery can overcome ‘hurdles’ of inaccessibility and may also be more ‘scalable’, it poses unique challenges, as decreasing levels of human support can affect adherence to lifestyle interventions and associated outcomes.2,3,4 Research is needed to better understand the importance of human support in online interventions and the type and dosage of …


Correctional Officers’ Perceptions And Attitudes Toward Mental Health Within The Prison System, Alexandra Rose Serafini Jun 2018

Correctional Officers’ Perceptions And Attitudes Toward Mental Health Within The Prison System, Alexandra Rose Serafini

Electronic Theses, Projects, and Dissertations

This research explored correction officers’ perceptions and attitudes in relation to inmates with mental health issues. In a qualitative fashion, semi-structured interviews were conducted with five correction officers in Southern California (N = 5) during the Winter 2018 Quarter. Using thematic analysis, this study identified six major themes from the interview data: mental health has remained a prominent issue within the prison population; correction officers were fairly knowledgeable about mental health; correction officers perceived themselves as having to play a limited role in the rehabilitation of inmates with mental health problems; constant prompts in daily activities and medication management were …


The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer Apr 2018

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …


Support And Care For The Mental Health Of Collegiate Athletes, Brynn C. Griffith Oct 2017

Support And Care For The Mental Health Of Collegiate Athletes, Brynn C. Griffith

Student Publications

While college is often one of the best times of a person’s life, it is also often one of the most challenging. College students are under immense pressure to succeed in all of their activities while still doing well in their classes and graduating within four years. This especially holds true for collegiate athletes. Student-athletes are under constant pressure to succeed in both the classroom as well as the athletic field. Balancing these challenges can be overwhelming for athletes to handle. Stress from academics and the new social structure is tough but when athletics are added, sometimes it gets to …