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Effects Of Coaching Interventions On Burnout And Mental Health Outcomes Among Collegiate Athletes: A Meta-Analysis, Natalie Mitchell

Cal Poly Humboldt theses and projects

This meta-analysis examined the effects of coaching interventions on burnout and mental health outcomes among collegiate athletes. Following PRISMA guidelines, literature published from 1980 onward was searched across SPORTDiscus, PsycINFO, PsycARTICLES, PubMed/MEDLINE, Web of Science, and ProQuest Theses & Dissertations. Studies were included if they assessed burnout, psychological well-being, or related mental health outcomes in collegiate athletes and investigated a coaching intervention. Twelve interventional studies met the inclusion criteria. Across studies, coaching interventions varied in structure, duration, sport context, and cultural setting, with most emphasizing intrapersonal strategies and emotional or mental health outcomes. Meta-analytic results indicated small, non-significant effects favoring …

Assessing The Effects Of Theta Transcranial Alternating Current Stimulation During Working Memory Performance On Theta-Gamma Phase Amplitude Coupling In Healthy Adults, Samantha M. Zimmer

UNF Graduate Theses and Dissertations

Transcranial alternating current stimulation (tACS) is an emerging form of noninvasive brain stimulation with substantial effects on behavior and brain function due to its ability to entrain endogenous neural oscillations. Working memory is a cognitive process that involves holding onto information that is no longer present in the environment and manipulating or reorganizing information for immediate use. Theta oscillations are critical for the functionality of the frontoparietal network and are involved in strengthening communication and coordination between frontal and parietal brain regions, especially during working memory processing. TACS applied at the theta frequency, targets theta oscillations, strengthens network communications, and …

Success Criteria: Sustainable Efficacy In Australian Farmer Groups, David K. Mckenzie, Janine Joyce, Kerstin K. Zander, Penelope A.S. Wurm, Kim M. Caudwell

Research outputs 2022 to 2026

Purpose: To examine the factors and processes that sustain the efficacy of farmer groups as extension intermediaries for influencing collective innovation, and knowledge co-creation and exchange. Design/Methodology/Approach: Data was collected from farmer interviews, focus groups, and the published digital documents of five farmer groups across SE Australia. A grounded theory mixed-methods approach was used for data collection and analysis, aided by Atlas software in constructing concepts and a concept map representing group processes. Findings: The ability of groups to influence farm innovation, and farmer learning and knowledge co-creation, depends on the group efficacy. Group identity in advancing farmer interests and …

A Qualitative Analysis Of Fitness Wearable Use And Embodiment, Lucas Brandt

Antioch University Dissertations & Theses

Wearable fitness technologies have become increasingly integrated into contemporary health and wellness culture, providing users with continuous access to physiological and behavioral data related to movement, sleep, stress, recovery, and overall health. Research has demonstrated that wearable devices can increase physical activity and support health behavior change (Ferguson et al., 2022; Koivisto & Hamari, 2019). Although less is known about how these technologies influence individuals’ lived experiences of their bodies. Understanding this relationship is particularly important given growing concerns regarding embodiment, self-surveillance, and the psychological effects of health-tracking technologies (Bergsland, 2017; Rapp, 2021). Drawing on theories of mind-body connection and …

The Effects Of Environmental Complexity On Brain Development And Personality Expression In Western Hognose Snakes, Gokulan Nagabaskaran

Theses and Dissertations (Comprehensive)

There is growing interest in snake cognition, personality, and welfare as more snakes are kept as pets, yet little research has been conducted. The effects of enrichment and environmental factors have been well documented in other taxa, and recent evidence suggests that snakes may benefit in similar ways. This dissertation investigated the impact of environmental and social enrichment on personality expression, personality stability, and brain development. Western hognose snakes (Heterodon nasicus) were used as the model species, as they are a popular choice in the pet trade. This allows the research to be readily translatable to husbandry practices of many …

Eeg Correlates Of Tactile Synchrony, Devon K. R. Gallagher

Theses and Dissertations (Comprehensive)

New research on the tactile system has suggested that cortical representations of body parts are not fixed, as previously thought, and are instead dynamically maintained through constant sensorimotor information and feedback. Within the somatosensory cortex (S1), the capacity for both permanent and temporary changes have been the topic of ongoing research. The current study aimed to corroborate whether 24 hours of a finger adhesion manipulation is sufficient to elicit behavioural and electrophysiological correlates from cortical reorganization of digit representations in S1, using a behavioural paradigm outlined by Kolasinski et al. (2016). Through electroencephalography (EEG) recording during a tactile discrimination task, …

Identifying The Physical Activity Promotion Practices Of Obstetricians And Gynecologists: Patients With Endometriosis And Polycystic Ovary Syndrome, Allison P. Herman

Theses and Dissertations (Comprehensive)

Despite efforts to promote physical activity, many females in Canada do not meet recommended physical activity guidelines. For individuals with gynecological conditions such as endometriosis and polycystic ovary syndrome (PCOS), physical activity may aid in symptom management and improve daily functioning. Healthcare settings, including obstetrics and gynecology, represent an area of opportunity to promote physical activity among this population. This thesis aims to understand the physical activity promotion practices of Ontario-based Obstetricians and Gynecologists (OBGYNs) to patients with endometriosis and/or PCOS. A cross-sectional online survey was conducted to explore OBGYNs promotional practices and perceived factors influencing their engagement in physical …

Biomechanical Integrity Of The Female Pelvic Floor: A Comparison Of Military And Civilian Women, Vladimir Egorov, Peter Takacs, Vincent Lucente, Heather Van Raalte, Joy A. Greer, Noune Sarvazyan

Department of Obstetrics & Gynecology Faculty Publications

Introduction

The health of the pelvic floor depends on the integrity of its muscles, connective tissue, ligaments, and their innervation. The female pelvic floor may be more vulnerable to repetitive heavy loads in a military environment than the male pelvic floor because of anatomical and physiological differences. The study aim was to identify and explore possible differences in the female pelvic floor conditions between active military and civilian women with similar demographics.To identify and explore possible differences in the conditions of the female pelvic floor between active military women and civilian women with similar demographics.

Materials and Methods

Military active …

Healthcare Provider Perspectives On A Clinical Decision Tool To Support Individualized Exercise Prescriptions And Discussions For Breast Cancer Survivors, Jinani Jayasekera, Oliver W. A. Wilson, Kaitlyn M. Wojcik, Eleanor M. Kerr, Rachelle Brick, David Berrigan, Jennifer Yeong-Shin Sheng, Takeo Fujii, Kathleen Thomas, Henri K. Parson, Padma Sheila Rajagopal, Richard L. Street Jr.

Department of Medicine Faculty Publications

Purpose: We evaluated healthcare providers' current knowledge, practices, and perspectives on a novel clinical decision tool (beta-version) to facilitate individualized exercise prescriptions and discussions in clinical settings.

Methods: We recruited healthcare providers who had treated or provided care to breast cancer survivors aged >= 35-years in the past 12 months. The participants were presented with a tool to provide individualized exercise recommendations considering women's individual, clinical, and contextual characteristics. Validated and reliable pre-existing instruments were used to survey providers' current knowledge, practices regarding exercise discussions, and perspectives on the beta-version (paper-draft) of the novel tool.

Results: The sample consisted of …

Impact Of Tactical Breathing On Marksmanship And Cognitive Function After Anaerobic Fatigue In Law Enforcement Personnel, Jackson D. Gilleland

College of Graduate Studies: Theses & Dissertations

Background: Tactical breathing is commonly used in law enforcement training to regulate stress, yet limited evidence exists regarding its acute effectiveness following physical fatigue. Purpose: To examine whether a brief tactical breathing intervention improves shooting performance and heart rate variability (HRV) following anaerobic fatigue in law enforcement officers. Methods: Thirty-eight officers completed baseline HR/HRV and a shoot/no-shoot scenario, followed by a maximal 500-m row and post-fatigue shooting. Participants were assigned to either a control group or a tactical breathing group, which received brief instruction and coaching before post-testing. Results: No significant between-group differences were observed for A-zone accuracy, shot time, …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Comparison Of 2000-Meter Row Prediction To Measured Vo2peak During Gxt, Andrew S. Ashley

College of Graduate Studies: Theses & Dissertations

BACKGROUND: Aerobic capacity is essential for the performance of military personnel and first responders. Traditionally, graded exercise tests (GXTs) with metabolic gas analysis have been the criterion-referenced method for assessing aerobic fitness. However, treadmill running and cycle ergometers may not fully reflect the whole-body demands required in tactical environments. Rowing-based assessments and the currently commercially available VO2max prediction formula are widely used across tactical organizations as practical field measures, and most tactical operators are considered inexperienced rowers, which has been minimally examined. PURPOSE: The purpose of this study is to compare measured VO2peak from a rowing GXT with estimated VO2max …

Examining Firefighter Perceptions Of Stress And Recovery Across A Shift And Engagement In Recovery Activities, Nathan T. Ebersole

College of Graduate Studies: Theses & Dissertations

The occupational demands of firefighting, such as fire suppression and rescue tasks, working in hazardous conditions, inconsistent sleep patterns, and exposure to traumatic events, can lead to work-related injuries, burnout, and feelings of isolation. To date, there is limited research on the impact of a single work-shift on firefighter perceptions of stress and recovery and the recovery activities that may influence these perceptions. Thus, the purpose of this study was to examine the effect of a single work-shift on firefighter perceptions of stress and recovery status as well as the recovery activities firefighters choose to engage in. Forty-three firefighters across …

Female Athletes’ Mental Health Help-Seeking Experiences: Understanding The Impact Of The Coach-Athlete Relationship And Coach Sex, Verena Zaisberger

College of Graduate Studies: Theses & Dissertations

Mental health help-seeking remains stigmatized in the world of sports (Cosh et al., 2024). Evidence suggests that female athletes may prefer to disclose vulnerable topics to individuals of the same sex (Keil et al., 2023), including help-seeking (O’Keeffe et al., 2022). However, no investigations have explored how coach sex or the coach-athlete relationship may influence female athletes help-seeking experiences. This is despite the importance of coaches in promoting and facilitating mental health services utilization (Bissett et al., 2020). To further understand this topic, the aim of this study was to explore what female athletes’ mental health help-seeking experiences are under …

Metabolic Syndrome Beyond Diagnostic Criteria: Population-Scale Integrative Metabolomics Characterization, Marwa Talal

Theses and Dissertations

Background: Metabolic syndrome (MetS) is a complex cluster of interrelated metabolic abnormalities associated with elevated cardiometabolic risk. While diagnosis is based on well-established five clinical criteria, these may overlook early or atypical metabolic alterations. Large-scale metabolomic profiling offers an opportunity to identify biochemical signatures of MetS beyond diagnostic bias and to evaluate their relative importance across different presentations of the syndrome.

Methods: Data from 117,147 UK Biobank participants were analyzed in a cross-sectional design. High-throughput NMR quantified 75 circulating metabolites, for. Univariate analyses, MetS subtype stratification, and elastic net models with SHAP interpretation were applied to assess feature …

Examining The Factor Structure And Subgroup Invariance Of The Deliberate Denial Of Disordered Eating Behaviors Scale, Lindsay Howard, Sage Hawn, Kayla D. Pitchford, Riley Mcgrath, Aubri Farniok, Arturo Sesma, Kristin E. Heron

Psychology Faculty Publications

The denial, concealment, or omission of disordered eating behaviors has received limited attention in the eating disorder literature, partly due to the lack of reliable and valid measures. This study re-examined the factor structure of the Denial of Disordered Eating Behaviors Scale (DDEBS-12) and tested measurement invariance across gender identity, racial identity, and levels of disordered eating in a non-clinical undergraduate sample (N = 3285). Confirmatory factor analyses did not support the original unidimensional structure. Instead, a seven-item model assessing denial of dietary restriction demonstrated the best fit and was renamed the DDEBS-restriction. The revised scale showed good internal consistency …

From Molecules To Minds: Integrative Multi-Omics In Psychiatry, Hossein Abbasi, Sage E. Hawn, Arash Javanbakht, Soraya Seedat, Kyle Bourassa, Sinead M. Sinnott, Antonia V. Seligowski, Sian Hemmings, Nathan A. Kimbrel, Alicia K. Smith, Leslie Brick, Divya Mehta

Psychology Faculty Publications

Psychiatric disorders are biologically complex conditions arising from interactions across genomic, epigenomic, transcriptomic, proteomic, metabolomic, and metagenomic layers. Single-omics approaches rarely capture more than a fraction of the variance in complex conditions, underscoring the importance of integrative multi-omics frameworks. This mini-review summarizes key methodologies and their application in psychiatric research, with a focus on systems-level integration of genomic risk scores, transcriptomic networks, and neuroimaging data to advance biological understanding of disorders such as depression, schizophrenia, and Alzheimer’s disease. We also outline the infrastructural requirements for effective multi-omics research, including standardized biobanking, Laboratory Information Management Systems, adherence to FAIR data principles, …

Best Practices For Using Biological Data In Psychological Research, Sage E. Hawn, Sinead M. Sinnott, Alicia K. Smith, Kyle Bourassa, Leslie Brick, Sian Hemmings, Soraya Seedat, Arash Javanbakht, Lauren Smith, Antonia V. Seligowski, Nathan A. Kimbrel, Divya Mehta, Hossein Abbasi, Erika Wolf

Psychology Faculty Publications

Advances in statistical techniques for analyzing biological data have driven the need for larger sample sizes, which are ultimately made possible through team science efforts. Findings from these efforts have led to a significant shift in approaches to biological data collection over the past decade, from traditional approaches relying on single measures or assays collected by individual investigators in small lab-based studies to high-dimensional methodologies embedded within large cohorts or multi-site studies. These recent large scale consortium efforts necessitate careful consideration across the full data pipeline, from pre-data generation and sample collection to processing and statistical analysis, while addressing challenges …

Michigan Academician Volume 50, Issue 2

Michigan Academician

Volume 50, Issue 2 - Abstract Issue

The Diagnostic Value Of Serum Ferritin In Telogen Effluvium, Sara Khaled Mohamed Elbasiouny, Marwa H. Elnagdy, Sherif R. Ismaeil, Fawzia A. Saafan

Mansoura Medical Journal

Background Telogen effluvium (TE) is a common cause of hair loss (HL) in females, characterized by diffuse HL. Iron deficiency has a significant relationship with emotional stress, and anxiety is another prevalent cause for HL. So, our aim was to evaluate the serum ferritin levels among TE patients, compared to healthy controls. Methods This case-control study was conducted on 100 subjects, and they were divided into 2 groups, group (A) included 50 patients with Telogen Effluvium and group (B) included 50 healthy normal volunteers matching for age and sex with the patients. Clinical examination of diffuse shedding and positive pull …

Assessment Of Serum Level Of Il-38 In Patients With Non-Segmental Vitiligo And Its Relation To Disease Severity, Zahraa Jafar Ahmed Altaitoon, Al-Shahat Farag Ahmed Sharaf, Hamdy Fouad A. Marzo, Mohammed Samir Sultan

Mansoura Medical Journal

Background: Vitiligo is a common autoimmune disorder (AID) characterized by extensive loss of melanocytes, causing depigmented skin patches. Interleukin-38 (IL- 38), an anti-inflammatory cytokine, has been linked to several autoimmune conditions, but its involvement in vitiligo hasn’t been confirmed. Aim: To measure serum IL-38 levels in patients with non-segmental vitiligo (NSV) and explores how these levels relate to disease severity and activity. Methods: We conducted a cross-sectional case-control study that included 40 patients with non-segmental vitiligo and 40 healthy individuals matched for age, sex, and BMI. Assessment of disease severity and activity was conducted by using the Vitiligo Area Scoring …

Quality-Of-Life Outcomes Of Tympanoplasty/Mastoidectomy Operations, Peter Shokr Meglaa, Ahmed Hemdan Eldeeb, Hisham Atef Abada, Yousef Kamel Shabana

Mansoura Medical Journal

Background: Chronic suppurative otitis media (CSOM) impairs quality of life (QoL) via otorrhea, hearing loss, and psychosocial effects, with surgery (tympanoplasty/mastoidectomy) as mainstay treatment despite limited patient-centered outcome data. This study aimed to evaluate QoL changes post-tympanoplasty/mastoidectomy in CSOM using validated tools.

Methods: This prospective study included 50 adults with CSOM at Mansoura University Hospitals. Pre/postoperative assessments included Chronic Otitis Media Outcome Test-15 (COMOT-15), Short Form-36 Health Survey (SF-36), Hearing Handicap Inventory for the Elderly-Screening (HHIE-S), Tinnitus Evaluation Questionnaire (TEQ), Situational Vertigo Questionnaire (SVQ), pure tone audiometry (PTA), and air-bone gap (ABG).

Results: PTA improved from 48.5±10.2 to 28.3±8.4 dB …

Comparative Study Between Serum Levels Of Interleukin-19 And Interleukin-38 In The Egyptian Patients With Non-Segmental Vitiligo, Reem Ahmed Al Maaddawy, Mohamed Kh. Selim, Ahmed Fawzi Ismail, Ahmad S. Hasan, Manar Ali Hassan

Mansoura Medical Journal

Background: The precise etiology of vitiligo remains unclear; nonetheless, it is predominantly regarded as an autoimmune disorder. This work aimed to compare serum levels of IL-19 and IL-38 between patients with non-segmental vitiligo (NSV) and healthy controls (HC). Patients and Methods: This study included 88 participants, evenly split into two groups: 44 individuals with non-segmental vitiligo and 44 healthy controls. Both groups underwent full history taking. The Vitiligo Area Severity Index (VASI) score and Vitiligo Disease Activity (VIDA) score were used to assess disease severity and activity. The levels of human IL-19 and IL-38 were also measured.

Results:Serum IL-38 …

Intelligence Quotient In Egyptian Children With Attention-Deficit/Hyperactivity Disorder, Yomna Sh. Abdrabouh, Zeinab A. Gomaa, Mohammed A. Elwasify, Ibrahem H. Elkalla

Mansoura Medical Journal

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) affects cognitive functioning in children, yet evidence remains limited in Middle Eastern populations regarding comprehensive IQ evaluation and associated clinical characteristics. This study aimed to assess verbal, non-verbal, and total IQ in Egyptian children with ADHD and examine their associations with sociodemographic, developmental, educational, and clinical factors while identifying factors associated with IQ classification.

Methods: A cross-sectional observational study enrolled 150 Egyptian children aged 6-12 years diagnosed with ADHD according to DSM-5 criteria with IQ above 80 at Mansoura University Hospital from February 2022 to October 2023. Intellectual functioning was evaluated using the Stanford-Binet Intelligence Scale, …

Ageing With Hiv: Epidemiological Transition, Biological Mechanisms, And The Impact Of Evolving Antiretroviral Therapy, Jude Eteneneng Enoh, Roland Tiagha Akah

Mansoura Medical Journal

The scale up of antiretroviral therapy (ART) has led to the evolution of HIV infection into a chronic condition, leading to a rapid growth in the number of older adults with HIV. This trend involves several biological, medical, and psychological challenges that go beyond conventional HIV treatment. The current mini-review provides a summary of recent data (2014 – 2026) regarding the changing epidemiology of HIV, biological aspects of ageing, and comorbidities and health systems associated with ageing.

Ageing is driven by persistent immune activation, inflammation, immune senescence, and microbial translocation, all of which accelerate biological ageing. These biological factors lead …

Perinatal Inflammation And Oxidative Stress Alter Adult Rat (Rattus Norvegicus) Motor Behavior, Alexander Young

Honors College Theses

Recent evidence in comparative animal models suggests that early life exposure to elevated inflammation (via LPS exposure) and oxidative stress (via acetaminophen exposure) may synergistically interact to alter typical neurodevelopmental trajectories, resulting in lasting effects on both behavior and gut-brain neurochemistry. The current study observed emotional and motor behaviors and collected fecal-boli to measure Tyrosine (TE) levels in male and female Long-Evans (Rattus norvegicus) rats. Subjects were either treated with [1] saline [2] lipopolysaccharide (LPS) to introduce an inflammatory state, [3] acetaminophen (APAP) to introduce oxidative stress, or [4] a dual-hit of both LPS + APAP on postnatal day (PD) …

Reduced Threat-Related Neural Efficiency: A Possible Biomarker For Pediatric Anxiety Disorders, Julia O. Linke, Reut Naim, Simona P. Haller, Parmis Khosravi, Beck Scheinberg, Meghan E. Byrne, Anita Harrewijn, Ellen Leibenluft, Melissa A. Brotman, Anderson M. Winkler, Daniel Samuel Pine

School of Medicine Publications

Objective: Pediatric anxiety disorders are common and predict adult psychopathology, yet current treatments, such as cognitive-behavioral therapy (CBT), produce lasting remission in less than 50% of affected youths. To support the search for improved, mechanistically grounded interventions, this study evaluated neural efficiency, defined as similarity in functional connectivity between a threat task and rest, as a potential biomarker. The study evaluated neural efficiency in relation to anxiety diagnosis and treatment response.

Methods: The authors compared 103 youths with an anxiety disorder diagnosis (mean age, 12.5 years [SD=2.91], 62% female) to 103 youths with no psychiatric diagnosis (mean age, 13.4 years …

Multisystem Predictors Of Dynamic Gait Stability Across Fall Risk In Older Adults, Ashwini Kulkarni, Neda Moghim, Ross Gore, Soumya Banerjee, Christopher K. Rhea, Brittany Samulski

Rehabilitation Sciences Faculty Publications

Gait stability arises from interactions between physiological, cognitive, and psychological systems, yet these domains are often assessed in isolation. This study examined multisystem predictors of anteroposterior margin of stability during walking (MoSAP) in community-dwelling older adults. Of 340 participants, 143 were retained after data quality screening (105 females; age: 70.8 ± 7.8 years). Participants completed the Physiological Profile Assessment (PPA), cognitive testing using Montreal Cognitive Assessment (MoCA), fear-of-falling evaluations using Modified Falls Efficacy Scale (MFES) and a biomechanical gait assessment during preferred and fast speeds. Participants were stratified into four PPA-based fall-risk groups: low, mild, moderate, and high risk. MoSAP …

Insect Farming Innovations: A Pathway To Self-Reliance In Agrifood Systems In Africa, Zewdu Abro, Menale Kassie, Dennis Beesigamukama, Shaphan Yong Chia, Ermias Engida Legesse, Subramanian Sevgan, Julius Ecuru, Chrysantus M. Tanga

All Peer-Reviewed Publications

Insect farming as an innovative approach to transforming agrifood systems

Insect farming has emerged as a transformative and sustainable approach to addressing the interconnected challenges of food insecurity, environmental degradation, and economic vulnerability in Africa’s agrifood systems. By converting organic waste into high-value products (protein-rich feed, frass fertilizers, and bioactive compounds), insect farming offers an efficient circular economy solution that bridges nutrition, livelihoods, and ecological resilience (Lalander et al. 2025; Mei et al. 2024; Barragán-Fonseca et al. 2022; Xia et al. 2021; Van Huis 2020; Barragán-Fonseca et al. 2017; Van Huis and Oonincx 2017; Yi et al. 2014). Almost all …

A Comprehensive Overview Of Neurophysiological Correlates Of Cognitive Impairment In Amyotrophic Lateral Sclerosis, Seyyed Bahram Borgheai, Brie E. Achorn, Alyssa H. Zisk, Sarah M. Hosni, Karl E. G. Richter, Frank S. Menniti, Yalda Shahriari

Computer Science Faculty Publications

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to the gradual loss of motor control, typically resulting in paralysis and death within 3 to 5 years of diagnosis. ALS shares neuropathological and genetic associations with fronto-temporal dementia (FTD), a neurodegenerative condition primarily impacting cognitive functions. These two conditions are increasingly viewed as manifestations of a single molecular disease process that affects distinct brain systems, impacting motor neuronal pathways in ALS and fronto-cortical functions in FTD. However, this simple dichotomy belies the complexity of these conditions. In particular, patients with primary motor ALS can also experience significant cognitive …