Psychiatry and Psychology Commons^™

Effect Of Relaxation Intervention On Stress Levels And Cognitive Skills In Professional Students, Sandhra Sabu, Ravikiran Kisan, . Swapnali

Digital Journal of Clinical Medicine

Background: Medical Professional training is likely to encounter a variety of hassles and stress in relation to the developmental tasks associated with transition from school life to professional college life. The vast syllabus, peer competition for academic performance, continuous evaluation, and long duration of the training makes medical education stressful. Many students feel a need to relieve stress and it is a necessity to equip students with proven techniques to reduce stress and cope up with the situation. Proper cognitive functioning has been found to be an important factor for academic performance.

Methods: The present study is a cross …

Among Us: Impostor Syndrome And Barriers To Black Success, Deshayla M. Strachan

Cardozo Journal of Equal Rights & Social Justice

Black women are going places-but they're not going into the practice of law. While law schools are becoming more diverse, the legal profession is not. The lack of diversity in the legal profession, coupled with existing implicit bias, causes heightened Impostor Syndrome in women, especially Black women, as well as women from other underrepresented groups. The harder the impostor feelings hit, the more difficult it is to retain women of color in the legal profession. Emotions associated with Impostor Syndrome (e.g., feelings of insufficiency) begin upon entry into the legal profession, as many roadblocks prevent marginalized groups from gaining admission …

Adolescent Loneliness During The Covid-19 Pandemic: The Role Of Pre-Pandemic Risk Factors, Hena Thakur, Morgan Stutts, Jae Wan Choi, Jeff R Temple, Joseph R Cohen

Faculty, Staff and Student Publications

The COVID-19 pandemic is a global mental health crisis that disproportionately impacts adolescents. Loneliness is a particularly salient pandemic psychosocial outcome to understand; however, research to date on this outcome is sparse and largely cross-sectional. In response, we examined pre-pandemic risk factors for pandemic loneliness. Further, we examined how risk may differ based on key demographics, and whether mediation or moderation models best explained potential disparities in experiencing loneliness. Self-reported, pre-pandemic mental health, trauma exposure, and family conflict survey data were collected at Wave 1 in a diverse sample of 369 adolescents (54.5% female, 45.5% male; 30.1% White; 30.9% Black; …

Association Between Brain Similarity To Severe Mental Illnesses And Comorbid Cerebral, Physical, And Cognitive Impairments, Yizhou Ma, Mark D Kvarta, Bhim M Adhikari, Joshua Chiappelli, Xiaoming Du, Andrew Van Der Vaart, Eric L Goldwaser, Heather Bruce, Kathryn S Hatch, Si Gao, Ann Summerfelt, Neda Jahanshad, Paul M Thompson, Thomas E Nichols, L Elliot Hong, Peter Kochunov

Faculty, Staff and Student Publications

Severe mental illnesses (SMIs) are often associated with compromised brain health, physical comorbidities, and cognitive deficits, but it is incompletely understood whether these comorbidities are intrinsic to SMI pathophysiology or secondary to having SMIs. We tested the hypothesis that cerebral, cardiometabolic, and cognitive impairments commonly observed in SMIs can be observed in non-psychiatric individuals with SMI-like brain patterns of deviation as seen on magnetic resonance imaging. 22,883 participants free of common neuropsychiatric conditions from the UK Biobank (age = 63.4 ± 7.5 years, range = 45–82 years, 50.9% female) were split into discovery and replication samples. The regional vulnerability index …

Depression And Insomnia Among Healthcare Professionals During Covid-19 Pandemic In Ethiopia: A Systematic Review And Meta-Analysis, Aragaw Asfaw Hasen, Abubeker Alebachew Seid, Ahmed Adem Mohammed

Faculty, Staff and Student Publications

INTRODUCTION: Healthcare professionals play a great role in the struggle against COVID-19. They are highly susceptible to COVID-19 due to their responsibilities. This susceptibility directly affects their mental health status. Comprehensive evidence on prevalence of depression and insomnia during this pandemic is vital. Thus, this study aims to provide the pooled prevalence of depression and insomnia, and their associated factors during the COVID-19 pandemic.

MATERIALS AND METHODS: This systematic review and meta-analysis follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies were searched from PubMed, Cochrane Library, CrossRef, African Journals Online and Google Scholar databases from …

Poor Sleep Quality And Suicidal Ideation Among Pregnant Women During Covid-19 In Ethiopia: Systematic Review And Meta-Analysis, Aragaw Asfaw Hasen, Abubeker Alebachew Seid, Ahmed Adem Mohammed

Faculty, Staff and Student Publications

INTRODUCTION: COVID-19 has profoundly impacted the mental health and well-being of pregnant women worldwide. In Ethiopia, the poor sleep quality and suicidal ideation among pregnant women has increased due to the COVID-19 pandemic. This study aimed to provide comprehensive evidence on the prevalence and associated factors of poor sleep quality and suicidal ideation among pregnant women during COVID-19 in Ethiopia.

MATERIALS AND METHODS: This study is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation. Data were searched from PubMed, Google Scholar, and African Journals Online from the occurrence of the COVID-19 pandemic to February 2023. …

Sulforaphane Improves Cognitive Function Administered Following Traumatic Brain Injury, Jackson W S Gasperecz, Elizabeth Baumler, Leila Wood, Jeff R Temple

Faculty, Staff and Student Publications

As the second leading cause of death among Americans aged 10 to 34, suicide is a serious public health concern. One potential predictor of suicidality is dating violence (DV) victimization, such as any physical, psychological, or sexual abuse by a current or former intimate partner. However, little longitudinal data exists on the relationship between suicidal ideation and DV. To address this gap in knowledge, we leverage data from two years of our longitudinal study

Within Subject Cross-Tissue Analyzes Of Epigenetic Clocks In Substance Use Disorder Postmortem Brain And Blood, Brenda Cabrera-Mendoza, Laura Stertz, Katherine Najera, Sudhakar Selvaraj, Antonio L Teixeira, Thomas D Meyer, Gabriel R Fries, Consuelo Walss-Bass

Faculty, Staff and Student Publications

There is a possible accelerated biological aging in patients with substance use disorders (SUD). The evaluation of epigenetic clocks, which are accurate estimators of biological aging based on DNA methylation changes, has been limited to blood tissue in patients with SUD. Consequently, the impact of biological aging in the brain of individuals with SUD remains unknown. In this study, we evaluated multiple epigenetic clocks (DNAmAge, DNAmAgeHannum, DNAmAgeSkinBlood, DNAmPhenoAge, DNAmGrimAge, and DNAmTL) in individuals with SUD (n = 42), including alcohol (n = 10), opioid (n = 19), and stimulant use disorder (n = 13), and controls (n = 10) in …

Validation Of The Brazilian Portuguese Version Of The Quick Inventory Of Depressive Symptomatology And Self-Report (Qids-Sr16) For The Brazilian Population, Lucas Bandinelli, Julia Luiza Schäfer, Bruno Kluwe-Schiavon, Rodrigo Grassi-Oliveira

Faculty, Staff and Student Publications

OBJECTIVES: To evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria that assesses the severity of depression symptoms, in the Brazilian population.

METHODS: Participants were 4,400 Brazilians over the age of 15 years recruited for an online survey assessing depressive symptoms during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. The internal consistency, construct validity, and convergent and discriminant validity of the QIDS-SR16 were evaluated.

RESULTS: The model tested was considered an adequate fit to the …

Non-Pharmacological Treatment-Related Changes Of Molecular Biomarkers In Major Depressive Disorder: A Systematic Review And Meta-Analysis, Courtney L Irwin, Patrícia S Coelho, Bruno Kluwe-Schiavon, Anabela Silva-Fernandes, Óscar F Gonçalves, Jorge Leite, Sandra Carvalho

Faculty, Staff and Student Publications

BACKGROUND: Major depressive disorder (MDD) is a serious mood disorder and leading cause of disability. Despite treatment advances, approximately 30% of individuals with MDD do not achieve adequate clinical response. Better understanding the biological mechanism(s) underlying clinical response to specific psychopharmacological interventions may help fine tune treatments in order to further modulate their underlying mechanisms of action. However, little is known regarding the effect of non-pharmacological treatments (NPTs) on candidate molecular biomarker levels in MDD. This review aims to identify molecular biomarkers that may elucidate NPT response for MDD.

METHODS: We performed a systematic review and a multilevel linear mixed-effects …

Processing Speed – A Potential Candidate Cognitive Endophenotype For Bipolar Disorder, Mirona Letitia Dobri, Taya Prince, Alexandre Paim Diaz, Giovana B Zunta-Soares, Sudhakar Selvaraj, Rodrigo Machado-Vieira, Thomas D Meyer, Marsal Sanches, Jair C Soares

Faculty, Staff and Student Publications

BACKGROUND: Bipolar disorder (BD) is a chronic multifactorial disorder that presents with cognitive impairment as one of its main features, in patients as well as in their first-degree relatives. However, the profile of cognitive dysfunction in BD patients and their relatives is not yet well defined. Various neurocognitive deficits have been proposed as endophenotypes for BD. In the present study, we explored the susceptibility to neurocognitive deficits in BD patients and their siblings compared to healthy controls.

METHOD: A sample consisting of patients diagnosed with BD (

RESULTS: Compared to healthy controls, BD patients and their unaffected siblings showed deficits …

Non-Canonical Pathways In The Pathophysiology And Therapeutics Of Bipolar Disorder, Rodrigo Machado-Vieira, Alan C Courtes, Carlos A Zarate, Ioline D Henter, Husseini K Manji

Faculty, Staff and Student Publications

Bipolar disorder (BD) is characterized by extreme mood swings ranging from manic/hypomanic to depressive episodes. The severity, duration, and frequency of these episodes can vary widely between individuals, significantly impacting quality of life. Individuals with BD spend almost half their lives experiencing mood symptoms, especially depression, as well as associated clinical dimensions such as anhedonia, fatigue, suicidality, anxiety, and neurovegetative symptoms. Persistent mood symptoms have been associated with premature mortality, accelerated aging, and elevated prevalence of treatment-resistant depression. Recent efforts have expanded our understanding of the neurobiology of BD and the downstream targets that may help track clinical outcomes and …

Reproductive Coercion Victimization And Associated Mental Health Outcomes Among Female-Identifying Young Adults, Emily A Muñoz, Ryan C Shorey, Jeff R Temple

Faculty, Staff and Student Publications

Reproductive coercion is a serious public health problem. Victimization has been associated with poor mental health outcomes, including symptoms of posttraumatic stress disorder (PTSD) and depression in clinical and college samples. We build on these findings by examining the association between reproductive coercion victimization and mental and behavioral health outcomes, including depression, PTSD symptoms, anxiety, and drinking behaviors in a diverse community-derived sample of female-identifying young adults (mean age = 20; SD=.72). Participants (n = 368) were originally recruited as part of a study on dating violence in seven Texas public high schools. Participants completed an online study that …

Editorial: Sleep, Vigilance & Disruptive Behaviors, Osman S. Ipsiroglu, Gerhard Klösch, Rosalia C. Silvestri, Susan M. Mccabe, Georg Dorffner, Thomas C. Wetter, Luci Wiggs

Research outputs 2022 to 2026

The Frontiers in Psychiatry Research Theme of Sleep, vigilance, and disruptive behaviors has two aims: first, to promote the understanding of the connections between vigilance and disruptive daytime behavior in the context of sleep deprivation and, second, to explore how naturalistic observations and pattern recognition can play a role in furthering our understanding of these connections. . . .

"I Just Want To Be Me, Authentically": Identity Shifting Among Racially And Ethnically Diverse Young Adults, Aerika Brittian Loyd, Dulce Wilkinson Westberg, Lenisha Williams, Marisha Humphries, Alan Meca, Julie Carmen Rodil

Psychology Faculty Publications

Identity shifting represents a common but complex social, behavioral, and cognitive phenomenon. However, some forms of identity shifting originate in response to structural, institutional, and interpersonal marginalization enacted on lower status groups, such as people of color in the United States. The current study investigated ways young adults from diverse ethnic/racial groups discussed shifting to fit in with White Americans (a dominant group) in the United States and their own ethnic/racial group (a minoritized group) and elucidated self-reported motivations for shifting. Participants consisted of 764 young adults (ages = 18–23) recruited from two large public universities in the Southeast and …

Changes In Mental Health As A Predictor Of Cannabis Coping Motives And Consequences: Examining The Impact Of Covid-19 Among College Students, Rebecca Dunaief, Adrian Jorge Bravo, James Henson

Psychology Faculty Publications

Objective: Cannabis use is common among college students and many students use cannabis to cope with negative affect. The COVID-19 pandemic was a particularly stressful time for college students. Subsequently, the present study compared college students who reported increases in anxiety/depression symptoms since COVID-19 stay at home orders to those who reported no change in anxiety/depression symptoms on cannabis coping motives, use frequency, and negative consequences. Specifically, we examined whether self-reported changes (i.e., group that indicated increases) in poor mental health during COVID-19 were associated with problematic cannabis use via higher cannabis coping motives. Method: College students (analytic n = …

Genetic Associations Between Alcohol Phenotypes And Life Satisfaction: A Genomic Structural Equation Modeling Approach, Kaitlin E. Bountress, Shannon E. Cusack, Sage E. Hawn, Andrew Grotzinger, Daniel Bustamante, Robert M. Kirkpatrick, Howard J. Edenberg, Ananda B. Amstadter

Psychology Faculty Publications

Alcohol use (i.e., quantity, frequency) and alcohol use disorder (AUD) are common, associated with adverse outcomes, and genetically-influenced. Genome-wide association studies (GWAS) identified genetic loci associated with both. AUD is positively genetically associated with psychopathology, while alcohol use (e.g., drinks per week) is negatively associated or NS related to psychopathology. We wanted to test if these genetic associations extended to life satisfaction, as there is an interest in understanding the associations between psychopathology-related traits and constructs that are not just the absence of psychopathology, but positive outcomes (e.g., well-being variables). Thus, we used Genomic Structural Equation Modeling (gSEM) to analyze …

Refining An Ecological Momentary Assessment Study Of Binge Eating Among Sexual Minority And Heterosexual Young Women: A Mixed Methods Pilot Study, Kristin E. Heron, Charlotte A. Dawson, Cassidy M. Sandoval, Lauren V. Butler, Abby L. Braitman, Alison Cerezo, Robin J. Lewis

Psychology Faculty Publications

Background: Ecological momentary assessment (EMA) is used to capture daily lived experiences, states, and environments. Although EMA is commonly used in behavioral health research, there remains a dearth of literature on how researchers account for design considerations of EMA techniques when designing studies. The goal of this formative mixed methods study was to elicit feedback on EMA study procedures and materials from the target populations for a larger study about binge eating among sexual minority and heterosexual young women, in which data are collected entirely remotely.

Methods: Sexual minority (n=12) and heterosexual (n=9) women ages 18–30 who binge ate took …

Criterion Validity Of Protective Behavioral Strategies For Alcohol Consumption Among College Students, Abby L. Braitman, Amy Stamates, Melissa Colangelo, Sarah J. Ehlke, Jordan Ortman, Kristin E. Heron, Kate B. Carey

Psychology Faculty Publications

Background: Protective behavioral strategies (PBS), or behaviors used to reduce harm associated with alcohol use, are often associated with lower levels of alcohol consumption, lower engagement in high-risk drinking behaviors, and fewer alcohol-related consequences. Although the majority of studies have found significant associations between higher PBS use and lower consumption or consequences, some studies have found nonsignificant or even positive associations. One explanatory hypothesis is that the mixed findings are due to differential content in PBS measures. Objectives: The current study examined the criterion validity of two widely-used PBS measures, the PBSS and the SQ. In a multi-institution online …

Covid-19 Impact On Latinx Families Within The Rva Breathes Program, Abigail Poulston, Robin S. Everhart, Ph.D, Sarah C M Morton

UROP Posters

RVA Breathes is a community-based asthma intervention program that aims to reduce asthma disparities among 5 to 11-year-old children in Richmond, Virginia. Prior to the pandemic, Latinx children faced greater disparities in asthma treatment and morbidity than non-Latinx White children. During the pandemic, there is evidence to suggest that these disparities may have been further exacerbated. Specifically, research shows that COVID-19 health disparities among Latinx individuals arose due to social inequities, such as poverty, living conditions, lack of access to health care, language barriers, and employment. The current study provides an overview of responses from 20 Latinx caregivers to pandemic-related …

The Role Of The Nlrp3 Inflammasome In Alzheimer's Disease, Ethan S. Terman

UROP Posters

This study examines the consequences of Alzheimer’s in rat and mice test subjects. The goal is to identify the effects of certain NLRP3 inhibiting drugs and to see if there are any noticeable effects in regards to impeding the pathological development of Alzheimer’s disease. The results are visualized by implementing the immunohistochemical process to identify neurodegeneration in the brain and to assess the expression levels of amyloid beta as an indicator of Alzheimer’s pathology. Other tests are also conducted on these transgenic mice to gauge cognitive functioning levels during the onset of their disease, those being behavior tests, but not …

Effects Of Combined Ethanol And Nicotine Administration On Delay Discounting In Male And Female Sprague-Dawley Rats, Rebecca Lillian Chalme

Graduate Theses, Dissertations, and Problem Reports (ETD)

Ethanol (EtOH) and nicotine (NIC) are among the most commonly used and co-used drugs in the world. Co-use occurs in people who use one or both drugs chronically, but also in people who only consume one or both drugs acutely, often in a “bingeing and chipping” pattern. Given that each drug on its own has previously been shown to affect impulsive choice in delay-discounting procedures, with some indication that drug effects could vary by sex, the purpose of the present experiments was to investigate effects of combined EtOH and NIC at a range of dose combinations on delay discounting in …

Effects Of Ethanol And Nicotine Co-Administration On Risky Choice In Rats, Erin E. Wylie

Graduate Theses, Dissertations, and Problem Reports (ETD)

Individuals often engage in the comorbid use of alcohol (ethanol) and nicotine, leading to further-escalated health consequences than the use of either drug in isolation. Given the poor health outcomes resulting from the combined administration of ethanol and nicotine, some of which may be due to increased risky choice, more basic research is needed to better characterize drug/dose interactions on risky choice. Probability-discounting procedures involve a series of discrete choices between a smaller, certain reinforcer (i.e., a safer choice) and a larger, increasingly uncertain reinforcer (i.e., a riskier choice). Probability-discounting procedures allow for the assessment of …

Racial Differences In Depression Indicators Before And After 2008 Financial Crisis In A Sample Of Older Adults, Angelina E. Jackson

College of Graduate Studies: Theses & Dissertations

The present study was designed to examine patterns of mental health outcomes in older Black and White adults after the national 2008 financial crisis. The data was acquired from the University of Michigan Health and Retirement Study, a publicly available dataset. This longitudinal study has obtained data from a representative sample of approximately 20,000 older adults in America, aged 55 and older. The hypotheses were (1) rates of mental health indicators related to symptoms of depression will increase after the 2008 financial crisis and (2) that increase will be significantly higher in Black respondents compared to White respondents. The analysis …

Autonomy Versus Support: Self-Reliance And Help-Seeking For Mental Health Problems In Young People, Amelia Ishikawa, Debra Rickwood, Emily Bariola, Navjot Bhullar

Research outputs 2022 to 2026

Purpose:

Many young people with mental ill-health do not seek support, and developmental growth in self-reliance may be a barrier to help-seeking. Increasing autonomy is a positive developmental task for youth and a key aspect of resilience. This study examined the influence of perceived social support and resilience on the previously unexamined relationship between self-reliance and intentions to seek help from informal, professional, and self-help sources for mental health problems.

Methods:

An online survey was completed by a representative Australian community sample of 5,203 young people aged 12–25 years (half female), in May–June 2020.

Results:

Path analysis showed the hypothesised …

Neuroanatomical Correlates Of The Late Positive Potential In Youth With Pediatric Bipolar Disorder, Alessio Simonetti, Marijn Lijffijt, Sherin Kurian, Johanna Saxena, Delfina Janiri, Marianna Mazza, Giulio Carriero, Lorenzo Moccia, Benson Mwangi, Alan C Swann, Jair C Soares

Faculty, Staff and Student Publications

BACKGROUND: The late positive potential (LPP) could be a marker of emotion dysregulation in youth with pediatric bipolar disorder (PBD). However, the neuroanatomical correlates of the LPP are still not clarified.

OBJECTIVE: To provide cortical and deep gray matter correlates of the LPP in youth, specifically, youth with PBD.

METHODS: Twenty-four 7 to 17 years-old children with PBD and 28 healthy controls (HC) underwent cortical thickness and deep gray matter volumes measurements through magnetic resonance imaging and LPP measurement elicited by passively viewing emotional faces through electroencephalography. T-tests compared group differences in LPP, cortical thickness, and deep gray matter volumes. …

Public Mental Health During And After The Sars-Cov-2 Pandemic: Opportunities For Intervention, Melissa M Karnaze, Brent M Kious, Lindsay Z Feuerman, Sarah Classen, Jill O Robinson, Cinnamon S Bloss, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

Importance: During the pandemic, the number of United States adults reporting clinically significant symptoms of anxiety and depression sky-rocketed, up from 11% in 2020 to more than 40% in 2021. Our current mental healthcare system cannot adequately accommodate the current crisis; it is therefore important to identify opportunities for public mental health interventions.

Objective: Assess whether modifiable emotional factors may offer a point of intervention for the mental health crisis.

Design setting and participants: From January 13 to 15, 2022, adults living in the United States were recruited via Amazon Mechanical Turk to complete an anonymous survey.

Main outcomes and …

The Potential Of Ketamine For Posttraumatic Stress Disorder: A Review Of Clinical Evidence, Anya Ragnhildstveit, Jeremy Roscoe, Lisa C Bass, Christopher L Averill, Chadi G Abdallah, Lynnette A Averill

Staff and Researcher Publications

Posttraumatic stress disorder (PTSD) is a devastating condition, for which there are few pharmacological agents, often with a delayed onset of action and poor efficacy. Trauma-focused psychotherapies are further limited by few trained providers and low patient engagement. This frequently results in disease chronicity as well as psychiatric and medical comorbidity, with considerable negative impact on quality of life. As such, off-label interventions are commonly used for PTSD, particularly in chronic refractory cases. Ketamine, an N-methyl-D-aspartate (NDMA) receptor antagonist, has recently been indicated for major depression, exhibiting rapid and robust antidepressant effects. It also shows transdiagnostic potential for an …

Biological Embedding Of Early Trauma: The Role Of Higher Prefrontal Synaptic Strength, Amanda J F Tamman, Lihong Jiang, Christopher L Averill, Graeme F Mason, Lynnette A Averill, Chadi G Abdallah

Staff and Researcher Publications

Background: Early trauma predicts poor psychological and physical health. Glutamatergic synaptic processes offer one avenue for understanding this relationship, given glutamate's abundance and involvement in reward and stress sensitivity, emotion, and learning. Trauma-induced glutamatergic excitotoxicity may alter neuroplasticity and approach/avoidance tendencies, increasing risk for psychiatric disorders. Studies examine upstream or downstream effects instead of glutamatergic synaptic processes in vivo, limiting understanding of how trauma affects the brain.Objective: In a pilot study using a previously published data set, we examine associations between early trauma and a proposed measure of synaptic strength in vivo in one of the largest human …

Protocol For The Promoting Resilience In Stress Management (Prism) Intervention: A Multi-Site Randomized Controlled Trial For Adolescents With Type 1 Diabetes, Maeve B O'Donnell, Samantha R Scott, Britney M Ellisor, Viena T Cao, Chuan Zhou, Miranda C Bradford, Catherine Pihoker, Daniel J Desalvo, Faisal S Malik, Marisa E Hilliard, Abby R Rosenberg, Joyce P Yi-Frazier

Faculty, Staff and Students Publications

BACKGROUND: Adolescents with type 1 diabetes (T1D) are at high risk for elevated diabetes distress, which greatly impacts diabetes management, glycemic outcomes and overall quality of life. Developing protective skills and "resilience resources" to navigate adversity and manage diabetes distress has high potential to help adolescents with T1D achieve optimal behavioral, psychological, and health outcomes. The "Promoting Resilience in Stress Management" (PRISM) program is a manualized, brief, skills-based intervention delivered over 6 months via two 45-60 min one-on-one sessions and a family meeting with a PRISM coach, and supplemented by booster calls and a digital app. This trial (PRISM versus …