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2021

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Full-Text Articles in Psychiatry and Psychology

Mental Health Affects Of The Covid-19 Pandemic, Mia Kepler Apr 2021

Mental Health Affects Of The Covid-19 Pandemic, Mia Kepler

English Department: Research for Change - Wicked Problems in Our World

Over the past year worldwide everyone has experienced the Covid-19 pandemic in one way or another. As time evolves during the pandemic mental health is getting worse every day. People are experiencing feelings of loneliness and uneasiness. Mental health professionals are trying to find solutions to this major issue in today's society. Change is needed to prevent people's mental health from worsening during these unprecedented times and to help the people who are already suffering.


Positive Psychological Well‐Being And Cardiovascular Disease: Exploring Mechanistic And Developmental Pathways, Julia K. Boehm Apr 2021

Positive Psychological Well‐Being And Cardiovascular Disease: Exploring Mechanistic And Developmental Pathways, Julia K. Boehm

Psychology Faculty Articles and Research

Empirical research regarding the health benefits of positive psychological well‐being (e.g., positive emotions, life satisfaction, purpose in life, and optimism) has flourished in recent years, particularly with regard to cardiovascular disease. This paper reviews the state of evidence for well‐being's association with cardiovascular disease in both healthy individuals and those diagnosed with a disease. Prospective studies consistently indicate well‐being reduces cardiovascular events in healthy and, to a lesser extent, patient populations. Potential pathways that link well‐being with cardiovascular disease are discussed (including health behaviors, physiological processes, and stress buffering), although the existing evidence is mostly cross‐sectional which limits conclusions about …


Reducing Patient Risk For Suicidal Behaviors With A Safety Bundle Of Best Practices With Non-Psychiatric Patients, Olayemi Akindele Apr 2021

Reducing Patient Risk For Suicidal Behaviors With A Safety Bundle Of Best Practices With Non-Psychiatric Patients, Olayemi Akindele

Student Scholarly Projects

Practice Problem: Suicide is a public health condition that affects people globally. The increased suicidal behaviors of patients in a medical-surgical unit demanded an effective screening protocol to identify high-risk patients.

PICOT: In patients 18 years and older on a medical-surgical unit, does the implementation of the Columbia Suicide Severity Rating Scale (C-SSRS) tool and application of a Safety Bundle of Best Practices (SBBP) increase early identification of suicide risk with decreased patient self-harm behaviors, compared to the current standard practice of no assessment tool or safety bundle of best practices within 12 weeks?

Evidence: Ten studies served as evidence …


The Emotional Effects Of Mindfulness, Meditation, And Worldview, Jason Katz Apr 2021

The Emotional Effects Of Mindfulness, Meditation, And Worldview, Jason Katz

Honors Projects in Applied Psychology

Much research on mindfulness and meditation investigates the relationship between mindfulness practices and health in physiological, psychological, and neurological contexts and organizations have implemented mindfulness training programs, possibly after learning of the apparent benefits. Researchers should use caution when assessing the practice’s benefits and consider extraneous variables such as the possibility that meditators tend towards spirituality; theologians argue that underlying beliefs might contribute to mindfulness practitioners’ reactions to the physical and psychological changes that result from mindfulness practices. This study investigates if and how religious beliefs modify mindfulness’s emotional outcomes for Bryant University students. The findings suggest that mindfulness and …


Improving The Quality Of Care For Pediatric Psychiatric Patients In The Emergency Department, Joseph L. Greene Apr 2021

Improving The Quality Of Care For Pediatric Psychiatric Patients In The Emergency Department, Joseph L. Greene

Doctor of Nursing Practice Projects

Pediatric patients (17 years and younger) in mental health crisis are arriving in the emergency department in increasing numbers because there is a lack of mental health crisis care in the community setting. The emergency department is crowded, lacks a dedicated area for psychiatric patients that is quiet and safe, and staff are inadequately trained in psychiatric competencies. A quality improvement project was approved by Boise State IRB to train RNs in psychiatric competencies. Telepsychiatry provided timely evaluation by a qualified psychiatric provider. Patients’ perceived meaning of the ED visit was evaluated using the Patient Evaluation of Emotional Comfort Experienced …


An Interdisciplinary Approach: Schizophrenia Derails Heteronormative Expectations In Psychological Narratives 2021, Bobbie Jo Weaver Apr 2021

An Interdisciplinary Approach: Schizophrenia Derails Heteronormative Expectations In Psychological Narratives 2021, Bobbie Jo Weaver

Master's Theses

Required introductory psychology courses teach students a general and oversimplified version of the immense number of subfields within Psychology studies, much like introductory literature classes compress different genera throughout history into a miniscule number of “representative” texts. Nevertheless, these footholds generate an entryway into a whole new world of (specialized) exploration. Reading a text such as The Quiet Room: A Journey out of the Torment of Madness by Lori Schiller and Amanda Bennett provides a window for many students to crawl into one of Psychology’s darkest shadows, the field of abnormal psychology. Schiller’s non-fictional memoir, The Quiet Room, tells readers …


A Tour Of Gender Critical Literature: A Review Of Transgender Body Politics By Heather Brunskell-Evans, Az Hakeem Apr 2021

A Tour Of Gender Critical Literature: A Review Of Transgender Body Politics By Heather Brunskell-Evans, Az Hakeem

Dignity: A Journal of Analysis of Exploitation and Violence

No abstract provided.


Healthcare Altruism And Dysconscious Healthism In The Delivery Of Integrated Healthcare Services To Individuals Who Are Deaf, Hard Of Hearing, And Deafblind, Jaime A.B. Wilson, Michael John Gournaris Apr 2021

Healthcare Altruism And Dysconscious Healthism In The Delivery Of Integrated Healthcare Services To Individuals Who Are Deaf, Hard Of Hearing, And Deafblind, Jaime A.B. Wilson, Michael John Gournaris

JADARA

Healthcare altruism and dysconscious healthism are terms proposed to recognize the barriers to healthcare access faced by not only individuals with hearing loss but also all minority populations. The implications of an integrated healthcare model to provide services to individuals who are d/Deaf, hard of hearing, or DeafBlind (D/HH/DB) are explored. Unique insights are then offered regarding existing barriers to healthcare access and the next steps.


Lovingkindness Meditation Alters Sense Of Self In Non-Meditators, John Watt Apr 2021

Lovingkindness Meditation Alters Sense Of Self In Non-Meditators, John Watt

Undergraduate Research Symposium Podium Presentations

The COVID-19 pandemic and civil unrest have increased individuals’ stress, anxiety, and social isolation. In response, a resounding call has gone out for more resources to buffer the effects of this psychological burden. One free and accessible resource is meditation; lovingkindness meditation is particularly beneficial and increases positive emotionality, psychological well-being, prosocial behavior, and social connectedness. Meditation is theorized to confer these benefits through fostering an allocentric spatial frame of reference. An allocentric spatial frame of reference is a view of the self that extends beyond the boundary of the body and is accompanied by a heightened sense of connection …


Eds202 Psychological Foundations Of Secondary Education, Kelly Conover Apr 2021

Eds202 Psychological Foundations Of Secondary Education, Kelly Conover

Open Educational Resources

This syllabus was created for undergraduate students majoring in Secondary Education. The class topics and accompanying readings were organized to create a comprehensive overview of adolescent development as it relates to educators teaching adolescent students. The readings were picked specifically to encourage critical thinking and analysis of the class topics.


Case Study: Using A Contingency-Based Delay Procedure To Decrease Tantrums During Periods Of Delayed Reinforcement, Lindsey Snyder Apr 2021

Case Study: Using A Contingency-Based Delay Procedure To Decrease Tantrums During Periods Of Delayed Reinforcement, Lindsey Snyder

USF Tampa Graduate Theses and Dissertations

Functional Communication Training (FCT) involves reinforcing a functional communicative response (FCR) while placing problem behaviors on extinction (Carr & Durrand, 1985). When reinforcement for the FCR is delayed or unavailable, the individual’s problem behavior may return to previous levels (i.e., resurgence of previously reinforced problem behavior; Briggs et al., 2018) or the participant may exhibit emotional responding consistent with an extinction burst (Lerman & Iwata, 1996). A contingency-based delay procedure was introduced which increased the participant’s percentage of trials without tantrums and decreased the overall duration of tantrums.


1st Place Contest Entry: Psychogenic Non-Epileptic Seizures Disorder: Treatment After The Diagnostic Odyssey, Heather Andrini, Ashley Okhovat, Sydni Au Hoy Apr 2021

1st Place Contest Entry: Psychogenic Non-Epileptic Seizures Disorder: Treatment After The Diagnostic Odyssey, Heather Andrini, Ashley Okhovat, Sydni Au Hoy

Kevin and Tam Ross Undergraduate Research Prize

This is Heather Andrini, Ashley Okhovat, and Sydni Au Hoy's submission for the 2021 Kevin and Tam Ross Undergraduate Research Prize, which won first place. It contains thier essay on using library resources, a summary of their research project on psychogenic non-epileptic seizures (PNES) disorder, and their works cited list.

Heather, Ashley, and Sydni are juniors at Chapman University, majoring in Biological Sciences. Their faculty mentor is Dr. Gregory Goldsmith.


The Role Of Interior Design In The Psychotherapist's Office, Vincent Ylagan Apr 2021

The Role Of Interior Design In The Psychotherapist's Office, Vincent Ylagan

Senior Theses

A growing body of research in environmental and design psychology indicates that our surroundings can have subtle but significant effects on how we feel and think. One setting where thoughts and feelings are at the forefront of the work done is the psychotherapist’s office, where clients go to process stressors and learn strategies to overcome emotional difficulties. The current study aimed to investigate how therapists and clients view the therapist office and identify the features associated with the “ideal” therapist office. Therapists, current or past therapy clients, and individuals who have not been to therapy completed short surveys. Surveys asked …


Perceived Neighborhood Characteristics And Cognitive Function Among Older Adults: Examining The Role Of Depression, Allison Sullivan, Mph Apr 2021

Perceived Neighborhood Characteristics And Cognitive Function Among Older Adults: Examining The Role Of Depression, Allison Sullivan, Mph

Electronic Theses and Dissertations

Purpose: African American older adults have a greater risk of cognitive impairment compared to White older adults. While some research has established that neighborhoods are an important determinant of health, relatively little research has examined the relationship between perceived neighborhood characteristics and cognitive functioning among older adults. Moreover, little is known about how depression is implicated in the relationship between perceived neighborhood characteristics and cognitive functioning, and if racial differences exist. Thus, this thesis aims to determine the mediating and moderating role of depression in the association between perceived neighborhood characteristics and cognitive functioning in older African American and White …


The Prison Litigation Reform Act And The Physical Injury Requirement In The Context Of Transgender Inmates, Hunter Kravitz Apr 2021

The Prison Litigation Reform Act And The Physical Injury Requirement In The Context Of Transgender Inmates, Hunter Kravitz

Cardozo International & Comparative Law Review

The note examines the impact of the Prison Litigation Reform Act (PLRA) on transgender inmates, focusing on its physical injury requirement, which disproportionately bars access to justice for those with mental or emotional injuries. It highlights the ethical and constitutional concerns arising from the PLRA's application, particularly its unequal treatment of transgender inmates, and advocates for reforms to ensure equitable access to justice.


Cultural Identity Predicts Resilience In Maltreated Youth, Jordan Donohue, Janelle Salcedo, James Webster, Kinsey Ellis Apr 2021

Cultural Identity Predicts Resilience In Maltreated Youth, Jordan Donohue, Janelle Salcedo, James Webster, Kinsey Ellis

Undergraduate Research Symposium Posters

Literature suggests that a stronger sense of cultural identity predicts higher levels of resilience following a traumatic event. However, there are limited studies that examine this relationship in children. The present research analyzes the relationship between cultural identity and resilience in a sample of maltreated youth. Participants included youth (n=65) aged 11-17 years in Department of Family Services (DFS) custody following removal from their home after substantiated child maltreatment. Cultural identity and resilience were both assessed by the Nevada Child and Adolescent Needs and Strengths (NV- CANS). A linear regression indicated a significant predictive relationship between cultural identity and resilience, …


A Mediation Analysis Of Racial Microaggressions, Poor Coping Mechanisms And Mental Health, Janelle Ferraris, Andrea Galdamez, Aldo Barrita, Kristin Vierra Apr 2021

A Mediation Analysis Of Racial Microaggressions, Poor Coping Mechanisms And Mental Health, Janelle Ferraris, Andrea Galdamez, Aldo Barrita, Kristin Vierra

Undergraduate Research Symposium Posters

Microaggressions are daily slights and denigrations perpetrated towards marginalized individuals. These invalidations are perceived as significant stressors for marginalized people. The bulk of research on microaggressions indicates that these everyday slights can have a negative impact on mental health. The current study examines the relationship between microaggressions, detachment internalized racism, and negative mental health symptoms of depression, anxiety and depression. Specifically, regression analysis was used to investigate the hypothesis that both internalization and detachment mediate the effect of microaggressions on poor mental health symptoms for PoC. Results indicated that for PoC, microaggressions was a significant predictor of symptoms of both …


Epilogue: Reflections From International Mentors Of The Quality Improvement Training Programme In India, Karl Lorenz, Sydney Dy, Michelle Denatale, Michael W. Rabow, Odette Spruijt, Karen Anderson, Meera Agar, Jake Mickelsen, Nandini Vallath Apr 2021

Epilogue: Reflections From International Mentors Of The Quality Improvement Training Programme In India, Karl Lorenz, Sydney Dy, Michelle Denatale, Michael W. Rabow, Odette Spruijt, Karen Anderson, Meera Agar, Jake Mickelsen, Nandini Vallath

Research outputs 2014 to 2021

The article collates the narratives of experiences of the international faculty who mentored the quality improvement teams from India since 2017.


Sexual Violence And Suicide In Bangladesh, S M Yasir Arafat, Murad M. Khan Mar 2021

Sexual Violence And Suicide In Bangladesh, S M Yasir Arafat, Murad M. Khan

Department of Psychiatry

No abstract provided.


Using True Experiments To Study Culture: Manipulations, Measurement Issues, And The Question Of Appropriate Control Groups, Christine Ma-Kellams Mar 2021

Using True Experiments To Study Culture: Manipulations, Measurement Issues, And The Question Of Appropriate Control Groups, Christine Ma-Kellams

Faculty Research, Scholarly, and Creative Activity

Social group memberships are primarily studied in quasi-experimental contexts, but how can culture, class and gender be manipulated in true experimental designs? This review highlights the different empirical strategies that can be used to manipulate “culture” as it relates to race/ethnicity (activation of thinking styles, language, and priming of cultural constructs), class (social standing, group status, or perceived social status), and gender (role salience, gender identity, sex hormone administration). I review measurement issues related to manipulation checks and the problem of what construct is tapped by the manipulation, appropriate control groups, and intersectional identities or group memberships.


“It’S Pretty Hard To Make Friends Over A Zoom Meeting Room”: Understanding The Recreational Experiences Of Youth With Type 1 Diabetes During Covid-19, Ryan Malpaya, Rowan Williams Mar 2021

“It’S Pretty Hard To Make Friends Over A Zoom Meeting Room”: Understanding The Recreational Experiences Of Youth With Type 1 Diabetes During Covid-19, Ryan Malpaya, Rowan Williams

Undergraduate Research Symposium

Youth with diabetes frequently have limited access to traditional camps because of the need for accessible medical staff (Hill, E., 2019). COVID-19 has made it even more difficult for youth with type 1 diabetes to participate in any youth development programs due to the pandemic restrictions. During the pandemic, it is unknown if youth with T1D are able to engage in any recreational activities that may teach them resilience and independence in managing their medical condition. The purpose of this study was to see how youth with T1D cope in an altered recreation environment as a result of COVID-19

Using …


Evaluating The Use Of An Interdependent Group Contingency In Online Graduate Courses To Increase Engagement, Tiana Evans Mar 2021

Evaluating The Use Of An Interdependent Group Contingency In Online Graduate Courses To Increase Engagement, Tiana Evans

USF Tampa Graduate Theses and Dissertations

Enrollment in online academic programs has increased substantially in recent years (Allen & Seaman, 2011) and is especially relevant due to the COVID-19 pandemic (Khalil et al., 2020). Peer interaction and engagement opportunities are strategies associated with course satisfaction, test performance, and grades and should be incorporated into online courses (Conaway et al. 2005). Group contingencies have been commonly studied in face-to-face classrooms and have been found to be effective intervention in changing target behavior in elementary and secondary education settings (Barrish et al., 1969; Deshais et al., 2019; Harris & Sherman, 1973; Mitchell et al. 2015; Wiskow et al., …


Case Studies In Applied Behavior Analysis: Self-Management Package To Increase Walking Behavior And Class Pass Intervention To Decrease Off-Task Behavior, Michelle Wood Mar 2021

Case Studies In Applied Behavior Analysis: Self-Management Package To Increase Walking Behavior And Class Pass Intervention To Decrease Off-Task Behavior, Michelle Wood

USF Tampa Graduate Theses and Dissertations

Case Study 1: Sedentary lifestyles are part of an increasing problem of social significance in the United States. Behavioral interventions can be used to effect change in this area and the target behavior of increase can be physical activity. Multiple behavioral change techniques used within an umbrella of a self-management intervention package were utilized to increase physical activity, more specifically walking behavior, for one participant. The study results showed that the self-management intervention package was effective in increasing walking behavior for the participant, and future research is discussed.

  • Applying behavioral interventions to the area of physical activity can assist clinicians …


Alcohol Use In Tanzanians With Chronic Psychotic Disorders And Poor Medication Adherence, Emily Simon, Jennifer B. Levin, Carol Blixen, Michelle Aebi, Kristin Cassidy, Martha Sajatovic Mar 2021

Alcohol Use In Tanzanians With Chronic Psychotic Disorders And Poor Medication Adherence, Emily Simon, Jennifer B. Levin, Carol Blixen, Michelle Aebi, Kristin Cassidy, Martha Sajatovic

Faculty Scholarship

Background: The burden of chronic psychotic disorders (CPDs) in sub-Saharan Africa (SSA) is significant. Poorly medically adherent patients are more likely to have worse outcomes and require more resources. However, factors impacting effective treatment of CPD in this population are unclear. Aim: Examine the relationship between alcohol use and disease management and compare alcohol risk stratification between the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in poorly medication adherent Tanzanians with CPD. Setting: Muhimbili National Hospital and ambulatory clinics in Dar es Salaam, Tanzania. Methods: 100 Tanzanians with CPDs and suboptimal medication …


Evaluating The Use Of Behavioral Skills Training To Teach Substitute Caregivers To Identify Hazards, Carlos Abarca Mar 2021

Evaluating The Use Of Behavioral Skills Training To Teach Substitute Caregivers To Identify Hazards, Carlos Abarca

USF Tampa Graduate Theses and Dissertations

The leading cause of death for children across the world is unintentional injuries (UNICEF 2001). Hazards such as accessible pools, poisons, and small ingestible items are the leading causes of unintentional injuries. Behavioral interventions such as Project 12-Ways/Safe Care have been used to teach parents how to be proactive in structuring a home free of accessible hazards by teaching the parents to identify and remove hazards in their home. Though the Project 12-Ways/Safe Care model has over 30 years of literature supporting its efficacy, the model has not been tested with substitute caregivers who often play a critical role in …


Assessing Prompting And Prompt-Fading Strategies In Individuals With Autism Spectrum Disorder, Ashley L. Frankenfield Mar 2021

Assessing Prompting And Prompt-Fading Strategies In Individuals With Autism Spectrum Disorder, Ashley L. Frankenfield

USF Tampa Graduate Theses and Dissertations

Autism spectrum disorder (ASD) is characterized by restricted interests, repetitive behaviors, and deficits in social and communication skills. In order to help a person with ASD improve their communication skills, behavior analysts should place emphasis on teaching intraverbal skills. Each person has a unique learner history, meaning that different prompts and prompt-fading techniques will result in the most accurate and efficient mastery of intraverbal skills for different people. Assessments were used to identify each participant’s most efficient combination of prompt and prompt-fading procedures in order to maximize one’s potential for learning new skills. Participants’ most efficient prompt/prompt-fading combinations resulted in …


Modifications To The Healing Communities Study In Response To Covid-19 Related Disruptions, Scott T. Walters, Redonna K. Chandler, Thomas Clarke, Nabila El-Bassel, Lashawn M. Glasgow, Rebecca D. Jackson, Emmanuel A. Oga, Jeffery H. Samet, Sharon L. Walsh, Gary A. Zarkin Mar 2021

Modifications To The Healing Communities Study In Response To Covid-19 Related Disruptions, Scott T. Walters, Redonna K. Chandler, Thomas Clarke, Nabila El-Bassel, Lashawn M. Glasgow, Rebecca D. Jackson, Emmanuel A. Oga, Jeffery H. Samet, Sharon L. Walsh, Gary A. Zarkin

Behavioral Science Faculty Publications

No abstract provided.


Prior Sleep Problems And Adverse Post-Traumatic Neuropsychiatric Sequelae Of Motor Vehicle Collision In The Aurora Study, Thomas C Neylan, Ronald C Kessler, Kerry J Ressler, Gari Clifford, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Sarah D Linnstaedt, Laura T Germine, Sophia Sheikh, Alan B Storrow, Brittany E Punches, Kamran Mohiuddin, Nina T Gentile, Meghan E Mcgrath, Sanne J H Van Rooij, John P Haran, David A Peak, Robert M Domeier, Claire Pearson, Leon D Sanchez, Niels K Rathlev, William F Peacock, Steven E Bruce, Jutta Joormann, Deanna M Barch, Diego A Pizzagalli, John F Sheridan, Steven E Harte, James M Elliott, Irving Hwang, Maria V Petukhova, Nancy A Sampson, Karestan C Koenen, Samuel A Mclean Mar 2021

Prior Sleep Problems And Adverse Post-Traumatic Neuropsychiatric Sequelae Of Motor Vehicle Collision In The Aurora Study, Thomas C Neylan, Ronald C Kessler, Kerry J Ressler, Gari Clifford, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Sarah D Linnstaedt, Laura T Germine, Sophia Sheikh, Alan B Storrow, Brittany E Punches, Kamran Mohiuddin, Nina T Gentile, Meghan E Mcgrath, Sanne J H Van Rooij, John P Haran, David A Peak, Robert M Domeier, Claire Pearson, Leon D Sanchez, Niels K Rathlev, William F Peacock, Steven E Bruce, Jutta Joormann, Deanna M Barch, Diego A Pizzagalli, John F Sheridan, Steven E Harte, James M Elliott, Irving Hwang, Maria V Petukhova, Nancy A Sampson, Karestan C Koenen, Samuel A Mclean

Faculty, Staff and Students Publications

STUDY OBJECTIVES: Many patients in Emergency Departments (EDs) after motor vehicle collisions (MVCs) develop post-traumatic stress disorder (PTSD) or major depressive episode (MDE). This report from the AURORA study focuses on associations of pre-MVC sleep problems with these outcomes 8 weeks after MVC mediated through peritraumatic distress and dissociation and 2-week outcomes.

METHODS: A total of 666 AURORA patients completed self-report assessments in the ED and at 2 and 8 weeks after MVC. Peritraumatic distress, peritraumatic dissociation, and pre-MVC sleep characteristics (insomnia, nightmares, daytime sleepiness, and sleep duration in the 30 days before the MVC, trait sleep stress reactivity) were …


The Association Between Participation In Extracurricular Activities And Adolescent Mental Health, Michael Gottfried Mar 2021

The Association Between Participation In Extracurricular Activities And Adolescent Mental Health, Michael Gottfried

Seton Hall University Dissertations and Theses (ETDs)

A growing number of adolescents are affected by depression, anxiety, and suicide each year, with females experiencing higher rates than males. Meanwhile, the demand for students’ time is increasing, and many participate in more extracurricular activities. This study will help answer the questions, “to what extent does participation in school-sponsored extracurricular activities impact an adolescent’s mental health?”, “to what extent does this impact vary by the type of activity?”, and “to what extent do these outcomes vary by gender?” While other studies have considered each of these variables, none look closely at all three (participation, gender, and type of activity) …


Understanding The Traumatized Brain, Sam Marion, Elizabeth Marston Mar 2021

Understanding The Traumatized Brain, Sam Marion, Elizabeth Marston

National Youth Advocacy & Resilience Conference

Students who have experienced trauma are often in need of behavioral intervention due to challenging behaviors and reactivity. Understanding the body’s threat response system gives insight into these behaviors and allows for empathy within the interventions. This presentation will outline basic neuroscience theories, propose interventions focused on self-regulation, and demonstrate how adding basic elements to existing interventions can increase efficacy.