Psychiatry and Psychology Commons^™

Assessment Of Patient Satisfaction And Treatment Outcomes In Digital Smile Design Vs Conventional Smile Design: A Randomized Controlled Trial, Chetan Luniyal, Anuj K Shukla, Mayank Priyadarshi, Farah Ahmed, Nishu Kumari, Pinki Bankoti, Ramanpal S Makkad

Faculty, Staff and Student Publications

BACKGROUND: The esthetics of a smile holds significant importance in an individual's self-esteem and overall quality of life. In the realm of cosmetic dentistry, smile design has traditionally relied on conventional methods, but recent advances in technology have introduced digital smile design (DSD) as a promising alternative.

MATERIALS AND METHODS: In this randomized controlled trial, 150 adult patients seeking smile enhancement procedures were enrolled and randomly assigned to one of two groups: the DSD group or the conventional smile design group. The DSD group underwent smile design using digital technology, including intraoral scans, computer-aided design, and 3D simulations. Meanwhile, the …

Influence Of Zirconia/Glass Veneer Thickness And Implant Abutment Material On The Final Shade Of Implant Restorations, Nishu Kumari, Anuj K Shukla, Rohit Malviya, Aman Raj, Bhagyashree Sutaria, Lalima Kumari, Ramanpal S Makkad

Faculty, Staff and Student Publications

BACKGROUND: Achieving an optimal shade match for these restorations is crucial for aesthetic outcomes. The thickness of zirconia/glass veneer and the choice of implant abutment material play vital roles in determining the final shade of implant restorations.

MATERIALS AND METHODS: This study investigated the influence of zirconia/glass veneer thickness (0.5 mm and 1.0 mm) and implant abutment material (zirconia and titanium) on the final shade of implant restorations. A total of 60 identical implant restorations were fabricated and divided into four groups based on the combinations of veneer thickness and abutment material. The shade of each restoration was assessed using …

Investigating The Long-Term Success And Complication Rates Of Zirconia Dental Implants: A Prospective Clinical Study, Anuj Kishor Shukla, Mayank Priyadarshi, Nishu Kumari, Sonal Singh, Pallavi Goswami, Sparsh B Srivastava, Ramanpal S Makkad

Faculty, Staff and Student Publications

This study addresses the durability and complications of zirconia dental implants through a prospective clinical investigation. Zirconia implants are increasingly utilized in dental implantation, and a comprehensive understanding of their long-term performance is essential.

BACKGROUND: Zirconia dental implants have gained attention due to their biocompatibility and aesthetics. However, research on their extended success and complication rates is limited.

MATERIALS AND METHODS: A prospective clinical study involved the placement of 30 zirconia dental implants in patients requiring tooth replacement. The implants were followed up for five years. Success was defined as the implant remaining stable and functional. Complications, including peri-implant mucositis …

Racial Discrimination And Interpersonal Violence In Asian American Adolescents During The Covid-19 Pandemic, Yu Lu, Elizabeth Baumler, Leila Wood, Vi D Le, Shannon P Guillot-Wright, Jeff R Temple

Faculty, Staff and Student Publications

PURPOSE: Racial discrimination targeting Asians in the United States has increased sharply since the COVID-19 pandemic. Despite a well-established link with mental/physical health outcomes, little is known about how racial discrimination relates to interpersonal violence, particularly in adolescents. To address this gap in knowledge, we examined cross-sectional and longitudinal (1-year follow-up) associations between racial discrimination and interpersonal violence perpetration and victimization in Asian American adolescents in a large US city.

METHODS: Data from Waves 3 (2020) and 4 (2021) of a randomized clinical trial of a school-based violence prevention program were examined. We limited our sample to participants who identified …

Risk Factors For Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment, Monique R Pappadis, Leila Wood, Allen Haas, Jordan Westra, Yong-Fang Kuo, Charles P Mouton

Faculty, Staff and Student Publications

Using 100% Medicare data files, this study explored whether primary elder mistreatment (EM) diagnosis, EM type, and facility type were associated with 3-year mortality and 1-year unplanned hospital readmission among older patients diagnosed with EM with hospital discharge from 10/01/2015 through 12/31/2018 (n = 11,023). We also examined outcome differences between older patients diagnosed with EM and matched non-EM patient controls. Neglect by others was the most common EM diagnosis. Three-year mortality was 56.7% and one-year readmission rate was 53.8%. Compared to matched non-EM patient controls, older EM patients were at an increased risk of mortality and readmission. Among …

Safety And Academic Outcomes Of College Campus-Based Advocacy Services, Rachel J Voth Schrag, Elizabeth Baumler, Dixie Hairston, Cynthia Jones, Leila Wood

Faculty, Staff and Student Publications

Intimate partner violence (IPV), sexual assault, and stalking are consequential public health and safety issues with wide reaching impacts on emerging adults, including those on college campuses in the United States. In response to high rates of violence among college student populations, universities are developing campus-based advocacy (CBA) programs, which aim to support survivors of interpersonal violence through supportive connections, resource acquisition, and safety planning. However, little data exists related to their impact on key student-survivor outcomes. Thus, this study aims to understand (a) the approach CBA programs use to address safety and academic concerns of student-survivors, and (b) the …

Blood Epigenome-Wide Association Studies Of Suicide Attempt In Adults With Bipolar Disorder, Salahudeen Mirza, Camila N C Lima, Alexandra Del Favero-Campbell, Alexandre Rubinstein, Natasha Topolski, Brenda Cabrera-Mendoza, Emese H C Kovács, Hilary P Blumberg, Jenny Gringer Richards, Aislinn J Williams, John A Wemmie, Vincent A Magnotta, Jess G Fiedorowicz, Marie E Gaine, Consuelo Walss-Bass, Joao Quevedo, Jair C Soares, Gabriel R Fries

Faculty, Staff and Student Publications

Suicide attempt (SA) risk is elevated in individuals with bipolar disorder (BD), and DNA methylation patterns may serve as possible biomarkers of SA. We conducted epigenome-wide association studies (EWAS) of blood DNA methylation associated with BD and SA. DNA methylation was measured at >700,000 positions in a discovery cohort of n = 84 adults with BD with a history of SA (BD/SA), n = 79 adults with BD without history of SA (BD/non-SA), and n = 76 non-psychiatric controls (CON). EWAS revealed six differentially methylated positions (DMPs) and seven differentially methylated regions (DMRs) between BD/SA and BD/non-SA, with multiple immune-related …

Action-Outcome Delays Modulate The Temporal Expansion Of Intended Outcomes, Rohan R Donapati, Anuj Shukla, Raju S Bapi

Faculty, Staff and Student Publications

The phenomenon of intentional binding pertains to the perceived connection between a voluntary action and its anticipated result. When an individual intends an outcome, it appears to subjectively extend in time due to a pre-activation of the intended result, particularly evident at shorter action-outcome delays. However, there is a concern that the operationalisation of intention might have led to a mixed interpretation of the outcome expansion attributed to the pre-activation of intention, given the sensitivity of time perception and intentional binding to external cues that could accelerate the realisation of expectations. To investigate the expansion dynamics of an intended outcome, …

Sleep Attitudes As An Indirect Predictor Of Risk For Metabolic Syndrome In First Year College Students, Sophie Hirsch, Hannah Peach, Trudy L. Moore-Harrison, Philip Zendels, Aria Ruggiero, Jane F. Gaultney

Journal of Social, Behavioral, and Health Sciences

Background: Habit formation can be a challenge for first-year students. Research has suggested that regardless of sleep knowledge, favorable sleep attitudes predict better sleep.

Aim: Our aim was to investigate whether sleep attitudes directly or indirectly predicted risk for metabolic syndrome via sleep.

Method: Students completed self-report and physiological measures. Participants wore wristwatches to collect sleep data. Path analyses investigated the direct or indirect effect of sleep attitude on risk for metabolic syndrome via subjective sleep (sleep quality, duration, risk for apnea) and objective sleep (sleep efficiency, duration, subjective risk for apnea).

Results: In our subjective analysis that sleep attitudes …

Identifying Barriers To Mental Health Services Utilization For Black Youth In The United States: A Qualitative Study, Emily Stein, Matthew Hutnyan, Neely Myers

SMU Journal of Undergraduate Research

Mental health in Black communities and racial/ethnic disparities in mental health service utilization remain growing concerns. Evidence suggests that psychotic disorders may be more prevalent among Black individuals than white individuals and the Black community faces barriers to care that can negatively influence outcomes. To better understand these barriers, we interviewed mental healthcare providers (n = 11) and Black young adults with first-person experience of psychosis (n = 13) about the experiences of minority young adults with mental health treatment. We analyzed interview transcripts and, consistent with constructivist grounded theory methods, identified iterative patterns across individuals about barriers to care. …

Multiple Timescales Of Temporal Context In Risky Choice: Behavioral Identification And Relationships To Physiological Arousal, Hayley R. Brooks, Peter Sokol-Hessner

Psychology: Faculty Scholarship

Context-dependence is fundamental to risky monetary decision-making. A growing body of evidence suggests that temporal context, or recent events, alters risk-taking at a minimum of three timescales: immediate (e.g. trial-by-trial), neighborhood (e.g. a group of consecutive trials), and global (e.g. task-level). To examine context effects, we created a novel monetary choice set with intentional temporal structure in which option values shifted between multiple levels of value magnitude ("contexts") several times over the course of the task. This structure allowed us to examine whether effects of each timescale were simultaneously present in risky choice behavior and the potential mechanistic role of …

Overnight 1-Mg Dst Serum Cortisol In Various Stages Of Chronic Kidney Disease-Normative Data And Underlying Mechanisms, Robin Garg, Saba Samad Memon, Anurag Lila, Vijaya Sarathi, Priyanka Patil, Tukaram Jamale, Sreyashi Bose, Manjiri Karlekar, Virendra Patil, Nalini Shah, Tushar Bandgar

Faculty, Staff and Student Publications

CONTEXT: Data on the overnight 1 mg-dexamethasone suppression test (ONDST) in renal dysfunction are limited.

OBJECTIVE: We aim to determine the normative range of ONDST cortisol across chronic kidney disease (CKD) stages and reasons for its alteration.

METHODS: Prospectively, 180 CKD (30 each in G2-G5/5D) patients and 30 healthy controls underwent ONDST 8 Am serum cortisol (chemiluminescent immunoassay [CLIA]). In an exploratory cohort, 45 (15 each: G3b/G4, G5/G5D, and healthy controls) individuals' blood biochemistry for basal (8 Am) cortisol and adrenocorticotropin (ACTH), post-ONDST 8 Am dexamethasone, ACTH, cortisol (CLIA and liquid chromatography-tandem mass spectrometry), and 4 Pm cortisol was collected. …

Digital Phobia: An Inquiry For Mapping The Unseen Dimension Of New Digital Anxiety, The ‘Digiphobia’, Amarjit Kumar Singh ,Library Assistant, Md. Arshad Ali , Professional Assistant, Dr. Pankaj Mathur, Deputy Librarian,

Library Philosophy and Practice (e-journal)

Background: As technology continues to advance, individuals' interactions with digital platforms have become integral to daily life. Amidst this technological evolution, a novel concern emerges—Digital Phobia, hereafter referred to as “Digiphobia.” This phenomenon, although not previously explored in scholarly literature, necessitates an in-depth investigation due to its potential impact on individuals' well-being. Our research employs a two-step methodology to investigate its existence, implications, and manifestations.

Introduction: This research paper introduces and proposes the term "Digiphobia" as a comprehensive conceptualization of anxiety arising from interactions with digital spaces, applications, and environments. The proliferation of digital technologies has led to the emergence …

Multi-Site Benchmark Classification Of Major Depressive Disorder Using Machine Learning On Cortical And Subcortical Measures, Vladimir Belov, Tracy Erwin-Grabner, Moji Aghajani, Andre Aleman, Alyssa R Amod, Zeynep Basgoze, Francesco Benedetti, Bianca Besteher, Robin Bülow, Christopher R K Ching, Colm G Connolly, Kathryn Cullen, Christopher G Davey, Danai Dima, Annemiek Dols, Jennifer W Evans, Cynthia H Y Fu, Ali Saffet Gonul, Ian H Gotlib, Hans J Grabe, Nynke Groenewold, J Paul Hamilton, Ben J Harrison, Tiffany C Ho, Benson Mwangi, Natalia Jaworska, Neda Jahanshad, Bonnie Klimes-Dougan, Sheri-Michelle Koopowitz, Thomas Lancaster, Meng Li, David E J Linden, Frank P Macmaster, David M A Mehler, Elisa Melloni, Bryon A Mueller, Amar Ojha, Mardien L Oudega, Brenda W J H Penninx, Sara Poletti, Edith Pomarol-Clotet, Maria J Portella, Elena Pozzi, Liesbeth Reneman, Matthew D Sacchet, Philipp G Sämann, Anouk Schrantee, Kang Sim, Jair C Soares, Dan J Stein, Sophia I Thomopoulos, Aslihan Uyar-Demir, Nic J A Van Der Wee, Steven J A Van Der Werff, Henry Völzke, Sarah Whittle, Katharina Wittfeld, Margaret J Wright, Mon-Ju Wu, Tony T Yang, Carlos Zarate, Dick J Veltman, Lianne Schmaal, Paul M Thompson, Roberto Goya-Maldonado, Enigma Major Depressive Disorder Working Group

Faculty, Staff and Student Publications

Machine learning (ML) techniques have gained popularity in the neuroimaging field due to their potential for classifying neuropsychiatric disorders. However, the diagnostic predictive power of the existing algorithms has been limited by small sample sizes, lack of representativeness, data leakage, and/or overfitting. Here, we overcome these limitations with the largest multi-site sample size to date (N = 5365) to provide a generalizable ML classification benchmark of major depressive disorder (MDD) using shallow linear and non-linear models. Leveraging brain measures from standardized ENIGMA analysis pipelines in FreeSurfer, we were able to classify MDD versus healthy controls (HC) with a balanced accuracy …

The Image Of Schizophrenia In Spain's Healthcare System, Meghan Webb

CISLA Senior Integrative Projects

Schizophrenia affects thousands of people in Spain and is one of the most serious mental health disorders in existence. Despite its this characteristic, schizophrenia did not always get the proper attention it deserved within the country’s healthcare system. This was largely due to the influence that the Spanish government had, and continues to have, over the healthcare system, giving it the power to choose how the disorder was represented. Therefore, what does that mean for schizophrenia in Spain’s healthcare system today? This essay will explore the ways in which schizophrenia was represented in Spain’s healthcare system through an examination of …

Evaluating The Deductive Competence Of Large Language Models, Spencer M. Seals, Valerie L. Shalin

Psychology Faculty Publications

The development of highly fluent large language models (LLMs) has prompted increased interest in assessing their reasoning and problem-solving capabilities. We investigate whether several LLMs can solve a classic type of deductive reasoning problem from the cognitive science literature. The tested LLMs have limited abilities to solve these problems in their conventional form. We performed follow up experiments to investigate if changes to the presentation format and content improve model performance. We do find performance differences between conditions; however, they do not improve overall performance. Moreover, we find that performance interacts with presentation format and content in unexpected ways that …

Enhancing Cross-Modal Contextual Congruence For Crowdfunding Success Using Knowledge-Infused Learning, Trilok Padhi, Ugur Kursuncu, Yaman Kumar, Valerie L. Shalin, Lane Peterson Fronczek

Psychology Faculty Publications

The digital landscape continually evolves with multimodality, enriching the online experience for users. Creators and marketers aim to weave subtle contextual cues from various modalities into congruent content to engage users with a harmonious message. This interplay of multimodal cues is often a crucial factor in attracting users' attention. However, this richness of multimodality presents a challenge to computational modeling, as the semantic contextual cues spanning across modalities need to be unified to capture the true holistic meaning of the multimodal content. This contextual meaning is critical in attracting user engagement as it conveys the intended message of the brand …

Sympathetic-Cardiovascular Stress Reactivity In Adults With Major Depressive Disorder, Ashley Darling

Kinesiology Dissertations - Archive

Major depressive disorder (MDD) is a mood disorder characterized by persistently depressed mood and/or anhedonia that causes significant functional impairment in daily life. MDD affects nearly 15% of adults in their lifetime, and since 2019, prevalence estimates have increased up to ~30% in young adults (18-25 years old). In addition to its debilitating effects on daily functioning, epidemiological studies link MDD to ~3 times greater risk of cardiovascular disease (CVD), followed by accelerated CVD progression and mortality. Although the mechanisms contributing to MDD-CVD comorbidity are unclear, there is evidence of stress system dysfunction in adults with MDD.

Accordingly, the aim …

Unlocking Adolescent Mental Health: Exploring Social Determinants And Depression With The Social Ecological Model, Lauren B. Robins, Danielle Rodgers, Yusuf Barburoglu, Jasmine Griffith, Cearra L. Arnold

Counseling & Human Services Faculty Publications

Employing the robust framework of the Social Ecological Model (SEM) and drawing insights from the Social Determinants of Health (SDOH), this research sought to uncover the interplay between SDOH and mental health among adolescents. With a focus on depression, the study unraveled how various social determinants, both individually and collectively, shape the mental well-being of adolescents, leveraging the rich dataset provided by the National Survey of Children’s Health 2018. Utilizing advanced statistical techniques, the study revealed the predictive power of SDOH in understanding adolescent mental health. Results illuminate the significant influence of social determinants on depression, underscoring the imperative for …

A Neuroscience-Based Curriculum For Addiction Prevention For Fourth-Grade Students, Paola Andrea Benitez

Social Work Theses - Archive

Substance use is one of the main problems affecting adolescents and young adults. While the consumption of alcohol has decreased, the consumption of marijuana has increased rampantly due to youth's positive perception after being legalized in 24 states with no clear message of the many adverse effects this drug causes. Different approaches to prevention have been used throughout the years: scare-led tactics, socio-emotional learning skills, and neuroscience-based curriculums. Since substance use results from the conjunction of different biopsychosocial factors that lead to this relapsing brain disease, the solution should integrate different preventive solutions as well. Public policy, schools, social workers, …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

Differentially Unwell: On Mimi Khúc's "Dear Elia", Seo-Young J. Chu

Publications and Research

[...] Inviting readers to reclaim the stigma of unwellness and collectively to "tend to our unwellness, together," Khúc approaches unwellness as a crucial resource for subverting the "wellness and unwellness" dichotomy entirely. After all, the opposite of "wellness" is not "unwellness"; the opposite of "wellness" does not exist. The opposition itself is an artificial framework, one that reductively harms more than it dialogically helps. We need to move away from these simplistic dualisms, Khúc suggests, and towards more generous, trauma-informed epistemologies. [...]

Cognitive Functioning In Well-Controlled Asthma, Erin Walsh

West Chester University Doctoral Projects

Asthma is a common lung disease that impacts lung functioning through inflammatory based mechanisms. Past research suggests that decreased blood oxygenation due to asthma attacks may impair cognitive capabilities (Irani et al., 2017). Moreover, the observed differences in cognition between those with and without asthma may be associated with disease severity or asthma control respectively in asthma populations. The current study explored differences in cognitive functioning between college students with and without self-reported asthma. Sociodemographic data, self-reported asthma severity, and measures of asthma control were collected. The current study did not find significant differences in measures of cognitive efficiency between …

Psychological And Psychosocial Effects Of Contemplative Practices In The Athletic Population: A Systematic Review, Victoria Baker

West Chester University Master’s Theses

Mental health concerns in athletes are becoming a primary focus for institutions, companies, coaches, and more. An athlete carries an abundant load of stressors due to their lifestyle. The stressors can negatively impact an athlete by producing anxiety, depression, insomnia, and other mental health issues. Previous studies have found a connection between the use of contemplative practices on psychological and psychosocial effects in athletes, creating an opportunity to evaluate the research of contemplative practices in the athletic population. A systematic review was conducted using nine electronic databases. Seven studies were included in this review, each assessing how contemplative practices affect …

Examining Stigma In Rural Mental Health Care Settings: A Mixed Methods Approach, Lainie Krumenacker

Murray State Theses and Dissertations

More than half of Americans will be diagnosed with a mental illness in their lifetime (CDC, 2021), yet stigma towards mental health affects both patients and providers. Although programs exist to address stigma, improve cultural competency among providers, and educate families on the importance of support, facilities are often limited on programs they provide due to allocation of resources and funds. Without a shift in treatment and programing, stigma will continue to impact patient care and outcome.

This study explored stigma among mental health providers in rural communities, while exploring potential differences in treatment among patients due to race. Mental …

Identifying Youth Appeals In Alcohol Alternative Social Media Content Through Framing, Melina Oneal

West Chester University Master’s Theses

Proposed regulations for alcohol advertising prevent beverage companies from targeting people under the legal drinking age. However, similar regulations for alcohol alternative beverages are less explored, which could allow alcohol alternative products to create awareness for alcoholic beverages among youth. Alcohol alternatives beverages, including no-alcohol and low-alcohol products, are increasing in popularity and can function as compliments to alcoholic products to decrease the total alcohol volume consumed or as substitutes for alcoholic products. Framing theory can be operationalized through the Content Appealing to Youth Index, an index of content elements found in research literature to be appealing to youth, to …

A Validation Study Of The Occupational Depression Inventory In Poland And Ukraine, Krystyna Golonka, Karine O. Malysheva, Dominika Fortuna, Bożena Gulla, Serhii Lytvyn, Leon T. De Beer, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

This study examined the psychometric and structural properties of the Polish and Ukrainian versions of the Occupational Depression Inventory (ODI). We relied on two samples of Polish employees (NSample1 = 526, 47% female; NSample2 = 164, 64% female) and one sample of Ukrainian employees (NSample3 = 372, 73% female). In all samples, the ODI exhibited essential unidimensionality and high total-score reliability (e.g., McDonald’s omegas > 0.90). The homogeneity of the scale was strong (e.g., 0.59 ≤ scale-level Hs ≤ 0.68). The ODI’s total scores thus accurately ranked individuals on a latent occupational depression continuum. We found evidence of complete measurement invariance …

How The Lockdown Of Covid-19 Influenced The Neurocognitive And Psychosocial Development Of Preschoolers, Kay Picson

Nursing | Senior Theses

COVID-19 caused schools to turn to online learning through platforms such as Zoom or Google Meet. The influence and effects caused by the transition to online lessons and quarantine were seen across all patient populations and demographics, but none more so than preschool children, who are regarded as one of the more vulnerable populations due to their susceptibility to change. This research aims to fill gaps in the existing literature by evaluating the similarities and differences of the neurocognitive and psychosocial development of preschoolers exposed to the pandemic and those who were not. This study involves a comparative cohort approach …

Telehealth: A Rising Intervention For Latina Mothers Experiencing Prenatal And Postpartum Depression, Britney Gutierrez

Nursing | Senior Theses

Background: Postpartum depression (PPD) is high among Latina women but often goes unrecognized and untreated. Recognition and management of PPD in this population is crucial as PPD contributes to negative health effects on the mother and infant. Purpose: This research aims to look into telehealth to improve screening methods and treatment for Latina mothers through a Spanish mobile health application that will provide screening and education on PPD. Method: This mixed-method quality improvement study will include 300 participants from an OB-GYN and Pediatrics community clinic, > 18 years old, of Hispanic/Latino ethnicity, Spanish speaking, currently pregnant, or had a child within …

Identifying Patterns For Neurological Disabilities By Integrating Discrete Wavelet Transform And Visualization, Soo Yeon Ji, Sampath Jayarathna, Anne M. Perrotti, Katrina Kardiasmenos, Dong Hyun Jeong

Computer Science Faculty Publications

Neurological disabilities cause diverse health and mental challenges, impacting quality of life and imposing financial burdens on both the individuals diagnosed with these conditions and their caregivers. Abnormal brain activity, stemming from malfunctions in the human nervous system, characterizes neurological disorders. Therefore, the early identification of these abnormalities is crucial for devising suitable treatments and interventions aimed at promoting and sustaining quality of life. Electroencephalogram (EEG), a non-invasive method for monitoring brain activity, is frequently employed to detect abnormal brain activity in neurological and mental disorders. This study introduces an approach that extends the understanding and identification of neurological disabilities …