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Psychiatric and Mental Health Commons™
Open Access. Powered by Scholars. Published by Universities.®
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- Walden University (6)
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Articles 1 - 30 of 44
Full-Text Articles in Psychiatric and Mental Health
Employing Telepsychiatry Services To Assess The Prevalence And Identify Mental Health Disorders Using The Phq-9 And Gad-7 In Resource-Constrained Regions Of Dadar Mansehra, Pakistan: An Observational Cross-Sectional Study, Iffat Zafar Aga, Sara Saeed Khurram, Mahek Karim, Muhammad Muzzamil, Shahkamal Hashmi, Kashif Shafique
Employing Telepsychiatry Services To Assess The Prevalence And Identify Mental Health Disorders Using The Phq-9 And Gad-7 In Resource-Constrained Regions Of Dadar Mansehra, Pakistan: An Observational Cross-Sectional Study, Iffat Zafar Aga, Sara Saeed Khurram, Mahek Karim, Muhammad Muzzamil, Shahkamal Hashmi, Kashif Shafique
Medical College Documents
Objective: This study aims to measure the prevalence of mental health disorders in low-resource settings through telepsychiatry and evaluate data from Pakistan's Sehat Kahani nurse-assisted online clinics serving low-income communities. This will help to understand the magnitude and nature of the demand for contextual therapies to promote mental health. The paper will discuss the challenges faced in these settings, such as limited access to mental health facilities, stigma and opportunities telemedicine brings.
Design: An observational cross-sectional study of telepsychiatry consultations using Patient Health Questionnaire-9 and Generalised Anxiety Disorder-7 to screen for depression and anxiety was conducted between October and December …
A Helping Hand Out Of The River: Refugee Perspectives For Provider Engagement, Brian L. Isakson, Elizabeth R. Stein, Alexandra Olson, Destiny Waggoner, Jill Holtz, Sara Ali, Suha Amer, Martin Ndayisenga
A Helping Hand Out Of The River: Refugee Perspectives For Provider Engagement, Brian L. Isakson, Elizabeth R. Stein, Alexandra Olson, Destiny Waggoner, Jill Holtz, Sara Ali, Suha Amer, Martin Ndayisenga
Journal of Patient-Centered Research and Reviews
Purpose: A growing number of refugee groups are seeking care within the U.S. health care system for medical, psychological, and social needs. Research is limited in understanding refugee-specific conceptualizations of helping relationships and provider characteristics that improve interactions in health systems. This study aimed to identify provider characteristics that facilitate engagement and helpfulness in a refugee-specific population from refugee participant voices to inform future practices of health care clinics.
Methods: Semi-structured interviews with refugee participants were conducted to assess 1) experiences moving on from difficult experiences, 2) engagement with the health system, and 3) provider characteristics that facilitated engagement and …
Psychological Violence And Manipulative Behavior In Couple: A Focus On Personality Traits, Carmela Mento, Clara Lombardo, Nicholas Whithorn, Maria Rosaria Anna Muscatello, Antonio Bruno, Maura Casablanca, Maria Catena Silvestri
Psychological Violence And Manipulative Behavior In Couple: A Focus On Personality Traits, Carmela Mento, Clara Lombardo, Nicholas Whithorn, Maria Rosaria Anna Muscatello, Antonio Bruno, Maura Casablanca, Maria Catena Silvestri
Journal of Mind and Medical Sciences
Psychological violence is characterized by systematic denigration and humiliation of the partner (victim). It is an insidious and manipulative behavior put in place to ensure that the victim begins to doubt themselves, and their own judgments, to the point of feeling confused and wrong. This behavior pattern is called Gaslighting and the personality traits are characterized by lack of empathy, psychopathy, narcissism and Machiavellianism. These three conditions are part of the so-called dark triad and distinguished by the lack of empathy. The aim of this study is to explore psychological aspects and consequences of Gaslighting phenomena. This systematic review was …
Social Supports For Adolescent And Young Adult Polycystic Ovary Syndrome Patients: A Scoping Review, Caitlin E. Mungall
Social Supports For Adolescent And Young Adult Polycystic Ovary Syndrome Patients: A Scoping Review, Caitlin E. Mungall
Western Libraries Undergraduate Research Awards (WLURAs)
Polycystic ovary syndrome (PCOS) is a chronic disorder with negative health consequences for millions of women. The paucity of research regarding interventions targeting the psychosocial symptoms of PCOS for adolescents and young adults (AYAs), susceptible to low self-esteem and depression, warranted this review. This paper provides an overview of research on the social supports currently available for AYAs and identifies areas where further research is required to elucidate their support needs. A scoping review methodology identified 15 studies that met inclusion criteria. Findings revealed that this is an emerging field of research and most included studies originated in North America. …
Centros De Inclusión Social Bajo Gestión Asociada Y La Salud Mental De Las Personas En Situación De Calle, Kien Phan
Independent Study Project (ISP) Collection
Esta investigación se enfoca en analizar las acciones del gobierno de la Ciudad Autónoma de Buenos Aires (CABA) para abordar la salud mental de las personas en situación de calle en 2023. Se examina el estado actual de esta población, identificando factores clave y evaluando las medidas gubernamentales. El marco teórico aborda determinantes sociales y derechos humanos, subrayando la importancia de cambios legislativos para abordar la falta de vivienda. La metodología combina análisis de datos gubernamentales, estudios previos y entrevistas con profesionales de Centros de Inclusión Social. Las organizaciones de la sociedad civil, como Cáritas y la Asociación Civil Isauro …
Utilization Of Wellness Practices For Burnout And Stress During Covid-19 Among An Interdisciplinary Cohort Of Emergency Healthcare Workers, Michael J. Zdradzinski, Sheri-Ann O. Kaltiso, Roslyn Seitz, Timothy P. Moran, Jennifer Clements, Sheryl L. Heron, Michelle D. Lall
Utilization Of Wellness Practices For Burnout And Stress During Covid-19 Among An Interdisciplinary Cohort Of Emergency Healthcare Workers, Michael J. Zdradzinski, Sheri-Ann O. Kaltiso, Roslyn Seitz, Timothy P. Moran, Jennifer Clements, Sheryl L. Heron, Michelle D. Lall
Journal of Wellness
Introduction: The Coronavirus Disease (COVID-19) introduced additional stress to the baseline occupational stressors of emergency care workers. The objectives of this study were to evaluate perceived stress and burnout and the utilization and perceived benefit of wellness practices among emergency healthcare workers (EHCWs), including: emergency physicians, advanced practice providers (APPs), nurses, and departmental administrative staff during the COVID-19 pandemic.
Methods: A cross-sectional 28-item electronic survey of EHCWs at three hospitals in a major United States city was used to measure participants’ utilization and perceived benefit of wellness practices, burnout (2-item measure), overall stress (perceived stress scale), and stress …
Improving Minors' Access To Treatment For Opioid Use Disorder: A Policy Analysis, Sara Jane Hamilton
Improving Minors' Access To Treatment For Opioid Use Disorder: A Policy Analysis, Sara Jane Hamilton
Master's Projects and Capstones
As the opioid epidemic continues to have devastating effects on our communities, medications to treat opioid use disorder (MOUDs) are severely underutilized especially for adolescents. Unlike adults, minors need parental approval before obtaining MOUDs presenting a key barrier to timely treatment. Being able to treat adolescents as soon as they are ready is critically important for people with OUD, and while cost and other barriers have been addressed in the literature, there is a paucity on how parental consent affects the accessibility of treatment. This paper aims to explore a potential policy in California that addresses the lack of access …
An Occupation Based Program: Supporting Mothers Through Pregnancy And Postpartum, Precious Barnett, Monica Watford, La'shandra Russell
An Occupation Based Program: Supporting Mothers Through Pregnancy And Postpartum, Precious Barnett, Monica Watford, La'shandra Russell
Summer 2023 Virtual OTD Capstone Symposium
This capstone project aimed to discover the effects of occupational therapy services with women who may experience or who are at risk for postpartum depression. Supporting Mothers Through Pregnancy and Postpartum is the developed capstone program. This program included occupation-based activities and resources to encourage occupational participation and engagement. This program used an integrative approach to support the participants of this project. This poster presentation includes background information regarding this population, the methods used to develop the program, program topic themes and goals, and links to view the program’s deliverables.
Examining The Association Between Emotional Intelligence, Meaning In Life, Stress, And Burnout Among Preâ??Medical Students In The United States, Nayla Paulina Paulina Bejarano Chacon
Examining The Association Between Emotional Intelligence, Meaning In Life, Stress, And Burnout Among Preâ??Medical Students In The United States, Nayla Paulina Paulina Bejarano Chacon
Open Access Theses & Dissertations
Background and significance: The Association of American Medical Colleges (AAMC) has estimated that by 2034 there will be a physician shortage of around 124,000 physicians. With burnout being one of the main drivers, it is crucial to assess it. Burnout is characterized by high levels of emotional exhaustion and cynicism and low levels of academic efficacy.There has been substantial research on burnout among healthcare providers across different levels of training; however, few studies have examined burnout among undergraduate students who wish to pursue a graduate degree in healthcare. Given the shortage of healthcare providers in the United States, it is …
Meet Me In The Middle: A Scoping Review On Understanding Adolescent Needs In Climate Communication, Gwendolyn Monica Hoff Anderson
Meet Me In The Middle: A Scoping Review On Understanding Adolescent Needs In Climate Communication, Gwendolyn Monica Hoff Anderson
Master's Projects and Capstones
The greatest effects of climate change are likely to be felt by youth. Young people are disproportionately affected by climate change due to their critical developmental stage and lack of power, and they experience both higher severity and prevalence of mental health issues related to climate change. Strong emotions have long been recognized as potential catalysts for action, or they may lead to paralyzing feelings of being overwhelmed. Climate communication is a critical tool to spark climate concern and encourage action. Activism, in turn, may help youth manage their anxiety about climate change. This scoping review examines emerging evidence on …
Strategies For Improving Mental Health And Wellbeing Used By Adults Ageing With Hiv From The Kenyan Coast: A Qualitative Exploration, Peter Mwangala, Ryan G. Wagner, Charles R. Newton, Amina Abubakar
Strategies For Improving Mental Health And Wellbeing Used By Adults Ageing With Hiv From The Kenyan Coast: A Qualitative Exploration, Peter Mwangala, Ryan G. Wagner, Charles R. Newton, Amina Abubakar
Institute for Human Development
Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing.
Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in …
Prenatal Care: Improved Attendance Through Text Messaging, Samareea Saunders
Prenatal Care: Improved Attendance Through Text Messaging, Samareea Saunders
Master of Science in Nursing Family Nurse Practitioner
No abstract provided.
Understanding Mental Health As Public Health, Christi M. Navarro
Understanding Mental Health As Public Health, Christi M. Navarro
Faculty Proceedings, Presentations, Speeches and Lectures
In this interactive workshop, we will utilize a multi-level public health framework to illustrate factors of risk and prevention that influence mental health and well-being. We will discuss shifting the narrative of mental health as an individual issue to the responsibility of society, culture, and environment. Participants will reflect on their role and level of influence in this model as well as their potential for action and positive impact.
Burnout: An Examination Of How Human Services’ Cultures Impact Person-Centered Care And Job Satisfaction, Ebony Webb
Burnout: An Examination Of How Human Services’ Cultures Impact Person-Centered Care And Job Satisfaction, Ebony Webb
Master's Projects and Capstones
In a world that demands the constant requirement of adaptability and technology, the need for ‘hands on the ground’ continues to persist, and perhaps even grow. This research project explores burnout in the healthcare and nonprofit settings, as a pre-existing and ongoing issue, that was brought to centre-stage during the Covid-19 pandemic. The researcher explores the intersections of burnout with workplace culture, person-centered care (PCC), sweat equity and duty-of-care, through expert interviews and literature reviews. Data collected provides an immediate understanding of current workplace cultures and environments for human service providers, in both healthcare and nonprofit sectors. While the data …
Rural Mental Health Care During A Global Health Pandemic: Addressing And Supporting The Rapid Transition To Tele-Mental Health, Shawnda Schroeder, Holly Roberts, Thomasine Heitkamp, Brandy Clarke, Heather J. Gotham, Erika Franta
Rural Mental Health Care During A Global Health Pandemic: Addressing And Supporting The Rapid Transition To Tele-Mental Health, Shawnda Schroeder, Holly Roberts, Thomasine Heitkamp, Brandy Clarke, Heather J. Gotham, Erika Franta
Indigenous Health Faculty Publications
The adoption of tele-mental health by mental health professionals has been slow, especially in rural areas. Prior to 2020, less than half of mental health agencies offered tele-mental health for patients. In response to the global health pandemic in March of 2020, mental health therapists across the U.S. were challenged to make the rapid shift to tele-mental health to provide patient care. Given the lack of adoption of tele-mental health previously, immediate training in tele-mental health was needed. This article describes collaborative efforts between two mental health technology transfer centers and one addiction technology transfer center in rural regions of …
The Impact Of The Deinstitutionalization Policies On Homelessness, Henrique Krigner
The Impact Of The Deinstitutionalization Policies On Homelessness, Henrique Krigner
Helm's School of Government Conference - American Revival: Citizenship & Virtue
Homelessness is a growing issue in America. In 2019 there were 567,715 homeless individuals in the United States, distributed in emergency shelters (63%) or residing unsheltered on streets (27%). In 2021, even though specialists argue that the Covid-19 restrictions greatly harmed an accurate counting, the total number of unsheltered homeless in America increased in 20%. Such increase became a central discussion not only to regular citizens and neighborhood associations, but it also became a great concern within the federal government which has been appropriating billions of dollars each year to “end homeless”.
Specialists point out that the growth of the …
Regulatory Implications Of Inadequately Designed Pimavanserin Drug Trials Published With Risk Of Bias On Expedited Regulatory Approval Processes, Benson Law
Electronic Thesis and Dissertation Repository
The objective of this retrospective critical appraisal study was to determine if the trials submitted to the Food and Drug Administration for the expedited approval of pimavanserin was of sufficient methodological quality to ascertain its safety and efficacy. After the general metrics of the trials were assessed, the Risk of Bias 2 tool and the PRagmatic Explanatory Continuum Indicator Summary tool were employed to evaluate the risk of bias and the design suitability of the trials. This study suggests that the decision to approve pimavanserin for the treatment of Parkinson’s Disease Psychosis failed to meet the threshold of evidence normally …
Impact Of Covid-19 Pandemic On Patients With Depression In Different Socioeconomic Status In Different Age Groups, Alexander Kowalski, Harsh Patel
Impact Of Covid-19 Pandemic On Patients With Depression In Different Socioeconomic Status In Different Age Groups, Alexander Kowalski, Harsh Patel
Rowan-Virtua Research Day
This study aimed to investigate the impact of COVID-19 on depression and how different age groups and socioeconomic classes were affected. The PHQ-9 survey was used to assess depression levels amongst 64 individuals of different age groups and socioeconomic statuses. Results indicated that the higher socioeconomic class had less impact on depression symptoms compared to lower socioeconomic classes. Younger age groups and lower socioeconomic classes were found to have a bigger impact on depression symptoms. However, the study acknowledges that numerous factors, such as lifestyle factors, financial stability, and social support, need to be considered while interpreting the results. Overall, …
Prevalence Of Disordered Eating In Female Athletes Of The New Jersey Athletic Conference, Desiree Brower, Joanna Petrides
Prevalence Of Disordered Eating In Female Athletes Of The New Jersey Athletic Conference, Desiree Brower, Joanna Petrides
Rowan-Virtua Research Day
Background: In 2018, the American Academy of Child and Adolescent Psychiatry published that, 1 out of every 10 adolescent females suffer from an eating disorder in the United States. Although it is known that eating disorders have an impact on the entire population, there are currently no studies on the prevalence of disordered eating in female athletes of the New Jersey Athletic conference (NJAC). This study aims to determine how many athletes in this population are affected.
Methods: This IRB-approved project utilized a survey-based approach to assess the prevalence of disordered eating among female athletes within the NJAC. To participate, …
Assessing The Need For Mental Health Screenings In A Student-Run Free Clinic And A Family Medicine Office, Sahil Parikh, Emily Forester, Alisha Basak, Jennifer Walpow, Rebecca Chae, Sahiba Gill, Tara Pellegrino
Assessing The Need For Mental Health Screenings In A Student-Run Free Clinic And A Family Medicine Office, Sahil Parikh, Emily Forester, Alisha Basak, Jennifer Walpow, Rebecca Chae, Sahiba Gill, Tara Pellegrino
Rowan-Virtua Research Day
Background: The US Preventive Services Task Force provides strong evidence that early screening helps identify depression in primary care settings, promotes intervention, and facilitates treatment. The Rowan Community Health Clinic (RCHC) in Lindenwold, NJ is a student-run free clinic who serves patients regardless of patient gender, race, income or insurance status. This study aims to determine if there is a need to build internal infrastructure at RCHC for depression and anxiety management.
Methods: This is an IRB-approved study that began in June 2021. Data was collected from Rowan Community Health Center and Rowan Family Medicine patients. Patients were administered mental …
Exploring Risk Factors For Major Depressive Disorder For Female Patients Aged 18 Or Older Living In Ocean County, New Jersey, James Mack
Rowan-Virtua Research Day
Background: The incidence and prevalence of major depressive disorder has been increasing worldwide, in the United States of America, and on a local level. The population of Ocean County, New Jersey, a predominantly Caucasian, female, middle-aged population, may be at increased risk of developing major depressive disorder.
Purpose: To explore the social determinants of health and risk factors for major depressive disorder for female patients aged 18 or older living in Ocean County, New Jersey.
Methods: This literature review mainly used PubMed and Scopus for journal articles and utilized governmental databases for additional population data.
Results: Analyses conducted on social …
An Investigation Of Resistance Training Behavior, Non-Specific Psychological Distress, And Perceived Barriers To Resistance Training In Self-Identifying Female Undergraduate Students, Jody Sobel
Master's Theses
The prevalence and severity of depression symptoms amongst college students, specifically female identifying undergraduate students, is worrisome. There is a great deal of research that suggests a relationship between exercise, specifically resistance training (RT), and mental health. That said, current literature suggests that many female identifying students are not engaging due to perceived barriers. This, perhaps because of the plethora of barriers one can perceive. The purpose of this study was multifold 1) to examine the prevalence and severity of non-specific psychological distress; 2) to determine if there were differences between Kessler 6 Non-Specific Psychological Distress Scale (K6) categories (i.e., …
Surviving The Stigma: Incorporating Mental Health Literacy To Increase Help-Seeking In California First Responders, Yvonne C. Newson
Surviving The Stigma: Incorporating Mental Health Literacy To Increase Help-Seeking In California First Responders, Yvonne C. Newson
Master's Projects and Capstones
First responders are at risk of developing mental health problems due to repeated exposure to traumatic incidents, increasing their chance of developing Post Traumatic Stress Disorder, substance abuse, suicidal ideation, and suicide. Unfortunately, first responders do not recognize that they may have a mental illness and are reluctant to seek help. This paper will discuss the prevalence of mental health problems among first responders and the barriers to their help-seeking. These barriers include the stigma around mental illness within the culture, the assessability of professional help, and the lack of mental health literacy regarding their well-being. Further discussion will focus …
The Impact Of Nutrition On The Mental And Physical Health Of Young Adults, Dareena El-Far
The Impact Of Nutrition On The Mental And Physical Health Of Young Adults, Dareena El-Far
WRIT: Journal of First-Year Writing
Upon close examination by nutritional professionals, concern has arisen regarding the typical contents of a young adult diet. In terms of the rate at which young adults choose to consume nutritionally-dense food items, the rate at which nutrition-deficient junk food items are chosen over the former is significantly higher. Among further examinations of this issue by researchers, it has become evident that the nutritional decisions made by young adults are increasingly associated with several social, commercial, mental, educational, and economic influences. As a consequence of these factors, research has uncovered a connection between the consumption of a poor diet and …
Wellness Review 2022, Part 2, Martin Huecker, Brian A. Ferguson, Jacob Shreffler
Wellness Review 2022, Part 2, Martin Huecker, Brian A. Ferguson, Jacob Shreffler
Journal of Wellness
Introduction: Similar to prior reviews, the Journal of Wellness editors searched the literature from the second half of 2022 for an interesting and impactful selection of publications on wellness in healthcare professionals.
Methods: Editors conducted a standard keyword search in Pubmed, focusing chiefly on large journals, interventional trials, and other prospective research. We included papers published between July 1, 2022 and December 31, 2022.
Literature in Review: Finding several hundred publications, we excluded editorials, reviews, and some smaller, less generalizable papers. A final 25 significant studies focusing on wellness in medical professionals were sorted into the following categories: logistics, creativity …
An Analysis Of Burnout And Wellness Of Healthcare Workers Based On Patient Population And Healthcare Worker Location, Spencer Brandenburg
An Analysis Of Burnout And Wellness Of Healthcare Workers Based On Patient Population And Healthcare Worker Location, Spencer Brandenburg
Undergraduate Theses
Healthcare workers, even with all of the positive work that they do, often suffer from increased burnout and decreased wellness/quality of life. This problem is not new and has been steadily worsening for many years, however, there are factors which impact burnout and wellness that have not been analyzed or have produced mixed results in prior burnout and wellness literature. There has been little to no research done on the impact of patient population demographics on burnout and wellness in healthcare workers, and the research analyzing the impacts of demographic healthcare worker location has consistently produced mixed results often based …
Physician Stress In The Era Of Covid-19 Vaccine Disparity: A Multi-Institutional Survey, Sarah Zahl, Debasis Mondal, David Tolentino, Jennifer A Fischer, Sherry Jimenez
Physician Stress In The Era Of Covid-19 Vaccine Disparity: A Multi-Institutional Survey, Sarah Zahl, Debasis Mondal, David Tolentino, Jennifer A Fischer, Sherry Jimenez
Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship
CONTEXT: Healthcare workers are at a high risk of infection during infectious disease outbreaks, such as the COVID-19 pandemic. Despite the availability of several vaccines against COVID-19, the absence of vaccination in patients and colleagues remains a continuous source of stress in healthcare workers. We conducted a survey of physician preceptors, both MDs and DOs, to explore the impact of differences in the patients' and colleagues' vaccination status on their well-being, stress, and burnout.
OBJECTIVES: The objective of this study is to determine whether exposure to unvaccinated patients and/or colleagues increases stress and burnout in physician preceptors by utilizing a …
Overview: Bias In-Bias Out In Data Science, Allison C. Augustus-Wallace
Overview: Bias In-Bias Out In Data Science, Allison C. Augustus-Wallace
School of Medicine Faculty Publications
DiscoverBMB, March 25 - 28, 2023, Seattle, WA
Peer-Supervision Of Nursing Professionals: A Shield Against Burnout, Kyle Gamache, Sarah Gamache, Joseph Robillard
Peer-Supervision Of Nursing Professionals: A Shield Against Burnout, Kyle Gamache, Sarah Gamache, Joseph Robillard
Journal of Wellness
Introduction: Burnout is a major risk in healthcare professions and is a significant contributor to the current nursing shortage. Strategies to combat burnout of healthcare professionals are in desperate need. The purpose of this project is to introduce the clinical peer supervision model as a method to alleviate burnout in nursing professionals.
Approach: Eight nurses from in-patient settings participated in a peer-supervision support group, modeled after existing European nursing and mental health provider-support protocols. To assess the effect of this intervention, qualitative data analysis was conducted on the transcripts of session and the results described. All participants reported statistically high …
The Effects Of Stigma Against Hiv And Tuberculosis On Patient Mental Health And Healthcare-Seeking Behavior In Dharamshala, Isabel Powell
The Effects Of Stigma Against Hiv And Tuberculosis On Patient Mental Health And Healthcare-Seeking Behavior In Dharamshala, Isabel Powell
Independent Study Project (ISP) Collection
HIV and tuberculosis are highly impactful diseases in India, causing severe morbidity, mortality, and suffering for millions. The stigmatization of these diseases unnecessarily exacerbates suffering for those afflicted and their families, compounding to the existing physical and emotional burden of diagnosis. Individual interviews with healthcare workers were conducted at Delek Hospital and the Tibetan Children’s Village in order to identify the existence and effects of stigma in the Tibetan refugee population in Dharamshala. Respondents reported an extremely high burden of tuberculosis in the community, complicated by the refugee status and unique infrastructural challenges of the population. The burden of HIV …