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Articles 1 - 30 of 33
Full-Text Articles in Mental Disorders
Improving Medication-Enhanced Psychotherapy Options For Ptsd: The Potential Of Oxytocin As A Treatment For Hypervigilance In Women With A History Of Childhood Sexual Abuse And Related Ptsd, Elianna Bavuso
AUCTUS: The Journal of Undergraduate Research and Creative Scholarship
Childhood sexual abuse (CSA) is a notable public health concern, affecting a significant proportion of girls in high-income countries. A considerable number of CSA survivors develop Post-Traumatic Stress Disorder (PTSD) by adolescence, which is often considered to be a lifelong disorder with severe emotional and social consequences. Women with CSA-related PTSD display hypervigilance, which is characterized by significantly increased fear network activity and poor top-down control over the amygdala. This meta-analysis examines the potential of intranasal oxytocin (OT) as a treatment for hypervigilance symptoms in women with CSA-related PTSD. The evidence reviewed suggests that intranasal oxytocin can help normalize the …
Investigation Of Brain Function And Structural Development As Risk Factors Of Suicidal Thoughts And Behaviors, Yi Zhou
Theses and Dissertations
Background: Identifying risk factors for suicidal thoughts and behaviors, especially causal ones, will be imperative to improving screening and treatment interventions. To identify replicable brain-based risk factors, there is increasing evidence indicating the need for large sample sizes, in the hundreds to thousands, in order to achieve a sufficient level of statistical power to detect them. Furthermore, longitudinal studies of brain and behavioral factors will be essential to understanding how suicide develops, especially the transition from suicide ideation to attempt. While experimental studies may not be feasible or ethical, genetically informed methods for testing evidence for causation are an alternative …
Opioid System's Potential Involvement In Ketamine's Cognitive And Antidepressant-Like Effects In Rats, Fan Zhang
Theses and Dissertations
Depression stands as one of the most pervasive mental health challenges worldwide, including the United States. Conventional antidepressants typically display a delayed onset of therapeutic action (4-8 weeks) and lack efficacy in a substantial portion of patients (over 40% of depressed patients are treatment-resistant). The dissociative anesthetic ketamine, which is a glutamatergic N-methyl-D-aspartate (NMDA) antagonist, has emerged as a promising novel treatment due to its rapid and prolonged antidepressant effects, and it is especially beneficial for treatment-resistant depression. Nevertheless, the precise neurochemical mechanisms underlying ketamine’s antidepressant properties remain elusive, hampering the development of safer and more efficacious treatments. The present …
Pmh Connect, English (Greyscale For Printing), Sara W. Moyer, Patricia Kinser
Pmh Connect, English (Greyscale For Printing), Sara W. Moyer, Patricia Kinser
School of Nursing Publications
Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …
School Division Policies Related To Suicide Prevention And Response, David Naff, Fatemah A. Khawaji, Morgan Meadowes, Jill Flynn, Meg Sheriff, Lauren Powell, Lisa Gwyn, Tameka Burroughs, Jean Samuel
School Division Policies Related To Suicide Prevention And Response, David Naff, Fatemah A. Khawaji, Morgan Meadowes, Jill Flynn, Meg Sheriff, Lauren Powell, Lisa Gwyn, Tameka Burroughs, Jean Samuel
MERC Publications
Suicide is one of the leading causes of death among youth age 10-19, and is an increasing concern in the wake of COVID-19. K-12 schools are crucial spaces for offering mental health support to students, and can implement policies to help prevent suicidal thoughts and behaviors. This MERC research and policy brief focuses on education policy related to suicide prevention and response. It is structured to answer five questions: 1) What are recent trends in youth suicide? 2) What does research show about school division policies that are effective in suicide prevention and response? 3) What policies in Virginia and …
Sustaining Breaths For Restorative Rest: A Preliminary Evaluation Of Sleep, Mental Health, And Cognitive Function Following Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea, Elliottnell Perez
Theses and Dissertations
Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that produces repetitive obstruction or collapse of the upper airway. Positive airway pressure (PAP) therapy is the gold standard treatment for OSA. Hypoglossal nerve stimulation (HNS) is considered an alternative treatment for patients who are unable to tolerate PAP therapy. The purpose of the study was to examine sleep, mental health, and cognitive health outcomes before and after HNS to determine its viability as an alternative treatment.
Methods: The study utilized a single-group, pretest-posttest design. Objective and subjective sleep was measured using actigraphy, sleep diary, and questionnaires. Objective and subjective …
Family-Based Support As Social Determinants Of Health Protective Factor On Depression Of Parents Of Children With Autism Spectrum Disorder, Bisola E. Duyile
Family-Based Support As Social Determinants Of Health Protective Factor On Depression Of Parents Of Children With Autism Spectrum Disorder, Bisola E. Duyile
Theses and Dissertations
All parents experience challenges in their caregiving roles (Barańczuk & Pisula, 2020). However, parents raising a child/children with disabilities experience different social barriers (Oliver, 1996) that may also contribute to additional stressors in their caregiving role (Tomeny, 2016). Although these parents, on average, have reported greater symptoms of depression than parents of typically developing children, research shows that parents who reported receiving social support had lower symptoms of depression and stress (Das et al., 2017; Singh et al., 2017). Through the social determinants of health (SDOH) framework (ODPHP, 2022), the present study investigated informal/family-based support and its protective impact on …
Exploration Of Dimensional Structure Of Major Psychiatric Disorders Reveals Relationship With Substance Use And Personality, Noah Berley
Theses and Dissertations
Objective: Using a mixture of statistical techniques like structural equation modeling, confirmatory, and exploratory factor analyses, we aimed to determine the genetic factor structure among Externalizing, Internalizing, and Psychotic spectrum disorders through methods that evaluate GWAS-based correlations. Additionally, a subsequent factor analysis based on the most suitable psychiatric model was conducted to understand how non-clinical behavioral traits align with this factor structure.
Methods: Publicly available GWAS summary statistics for twelve major psychiatric disorders, six substance use measures and two personality domains were incorporated into structural equation models. Using the GenomicSEM software package, GWAS-based correlations were estimated between all twelve disorders …
Effects Of The Selective Gsk3b Inhibitor, Tideglusib, On Ethanol Consumption, Anxiety-Like Behavior, Taste Preference, And Downstream Proteins, Sam Gottlieb, Douglas Bledsoe, Jessica L. Maltman, Alanna Morgan, Jennifer T. Wolstenholme, Michael F. Miles
Effects Of The Selective Gsk3b Inhibitor, Tideglusib, On Ethanol Consumption, Anxiety-Like Behavior, Taste Preference, And Downstream Proteins, Sam Gottlieb, Douglas Bledsoe, Jessica L. Maltman, Alanna Morgan, Jennifer T. Wolstenholme, Michael F. Miles
Graduate Research Posters
Background: We have shown modulations in glycogen synthase kinase 3 beta (GSK3B) abundance or activity regulate ethanol consumption, suggesting potential as a therapeutic target for alcohol use disorder (AUD). Here we report the GSK3B inhibitor tideglusib’s actions on ethanol consumption, basal behaviors, and modulation of GSK3B targets.
Methods: C57BL/6J males and females received i.g. 200mg/kg tideglusib, except drinking-in-the-dark (males;100mg/kg i.p.). Drinking-in-the-dark (DID): Mice given 20% ethanol 4-hours, 4-days/week x 3 weeks and then i.p. tideglusib or vehicle x 4 days in a Latin Square design with ethanol consumption measured daily. Light/Dark Box: Mice gavaged with tideglusib or vehicle …
Examination Of Common And Rare Variant Genetic Architecture Of Psychiatric Disorders, Mohammad Ahangari
Examination Of Common And Rare Variant Genetic Architecture Of Psychiatric Disorders, Mohammad Ahangari
Theses and Dissertations
Psychiatric disorders are often heterogenous in their manifestation and genome-wide association studies have identified many common risk variants involved in their polygenic architectures with varying degrees of pleiotropy. In recent years, large-scale biobanks have also begun sequencing the genome of their participants to elucidate the role of rare risk variation in the genetic architecture of complex phenotypes, including psychiatric traits. This dissertation sought to better understand the role of both common and rare risk variation in the genetic architecture of psychiatric disorders with a particular focus on schizophrenia and alcohol problems. In the first three analyses, we focused on characterizing …
The Association Of Menthol Cigarette Use With Any Mental Illness (Ami) And Serious Mental Illness (Smi) Among Us Smoekrs, Augustus White
The Association Of Menthol Cigarette Use With Any Mental Illness (Ami) And Serious Mental Illness (Smi) Among Us Smoekrs, Augustus White
Graduate Research Posters
ABSTRACT
Background: Mental illness affects 1-in-5 adults in the United States (US). Previously, those with mental illness have been shown to be 70% more likely to smoke cigarettes than the general population. However, little is known regarding whether the use of menthol cigarettes (one of only two available “characterizing flavors” of cigarettes) might impact the association between tobacco use and mental illness. Such information is critical in light of the disproportionately high rate of use of menthol cigarettes observed among African American smokers, as well as to inform recent legislative proposals that seek to ban the sale of menthol cigarettes. …
Strengthening Mental Health Diagnostic Detection In Integrated Primary Care, Julia Brechbiel
Strengthening Mental Health Diagnostic Detection In Integrated Primary Care, Julia Brechbiel
Theses and Dissertations
Primary care behavioral health (PCBH) is crucial for providing mental health treatment to underserved, minority, and uninsured populations. There is a lack of knowledge about accurate mental health diagnoses at PCBH. Underdetection of mental health symptoms has the potential to worsen racial and socioeconomic disparities. Using an expert review process, I developed an abbreviated diagnostic clinical interview (ADCI) for integrated primary care. Next, patients (N = 82) completed the interview after attending PCBH appointments. According to the interview, 63.4% of participants met criteria for a diagnosis, while 64.7% received a diagnosis from their provider. A large portion of patients …
College Students’ Perceptions Of Popular Diets And Orthorexia Nervosa, Madison W. Weinstock
College Students’ Perceptions Of Popular Diets And Orthorexia Nervosa, Madison W. Weinstock
Theses and Dissertations
Data suggest that individuals’ purported dietary patterns influence others’ perceptions of them. However, few studies have investigated how adherence to specific popular diets might influence these perceptions. This study investigated female undergraduates’ (n = 463) perceptions of vignette characters described as adhering to specific dietary practices perceptions of a vignette character in a sample of 463 female undergraduates. Characters described as adhering to a Clean Eating diet were viewed most positively, followed by individuals on the Ketogenic diet or nondieters. Characters following an Intermittent Fasting diet, and those with Orthorexia Nervosa were viewed most negatively. These findings support the …
Effects Of (R,S)-Ketamine And (2r,6r)-Hydroxynorketamine: A Preclinical Study, Remington Rice
Effects Of (R,S)-Ketamine And (2r,6r)-Hydroxynorketamine: A Preclinical Study, Remington Rice
Theses and Dissertations
In 2017, 7.1% of US adults were diagnosed with depression, and 50% of patients received medication to treat their depression. Depression can cause severe interruptions in an individual's cognitive functioning and behaviors like sleeping, eating, working, and socializing. Unfortunately, approximately 40% of patients do not respond to treatment with monoaminergic medications (e.g. Prozac) and therapeutic effects may be delayed 2-8 weeks. Due to these therapeutic shortcomings, faster acting and more efficacious treatments are needed. Recent preclinical findings indicate potential for glutamatergic drugs like (R,S)-ketamine and (2R,6R) hydroxynorketamine to produce more rapid and longer-acting therapeutic effects. The antidepressant effectiveness of (R,S)-ketamine …
Examination Of The Relations Among Demographics, Pre-College Interpersonal Trauma, Posttraumatic Stress Disorder And Disordered Eating, Arin L. Larsen, Kaitlin Bountress Phd, Ananda B. Amstadter Phd
Examination Of The Relations Among Demographics, Pre-College Interpersonal Trauma, Posttraumatic Stress Disorder And Disordered Eating, Arin L. Larsen, Kaitlin Bountress Phd, Ananda B. Amstadter Phd
IRBEH/Spit for Science Publications and Presentations
No abstract provided.
Evaluation Of A New Trauma-Related Drinking To Cope Measure: Latent Structure And Heritability, Sage E. Hawn, Steven H. Aggen, Danielle Dick, Ananda B. Amstadter Phd
Evaluation Of A New Trauma-Related Drinking To Cope Measure: Latent Structure And Heritability, Sage E. Hawn, Steven H. Aggen, Danielle Dick, Ananda B. Amstadter Phd
Graduate Research Posters
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur, share latent genetic risk, and are associated with many negative public health outcomes. Via a self-medication framework, trauma-related drinking to cope (TRD), an unexplored phenotype to date, may help explain why these two disorders co-occur, thus serving as an essential target for treatment and prevention efforts. This study sought to create a novel measure of TRD and to investigate its indirect influences on the association between PTSD and AUD, as well as its potential shared molecular genetic risk with PTSD in a genetically-informative study of college students. A sample …
The Impact Of Posttraumatic Stress Disorder On Peripheral Vascular Function, Jennifer B. Weggen, Kevin P. Decker, Ryan S. Garten
The Impact Of Posttraumatic Stress Disorder On Peripheral Vascular Function, Jennifer B. Weggen, Kevin P. Decker, Ryan S. Garten
Graduate Research Posters
The physiological manifestations of posttraumatic stress disorder (PTSD) have been associated with an increase in risk of cardiovascular disease (CVD) independent of negative lifestyle factors. Peripheral vascular dysfunction may be a mechanism by which PTSD increases CVD risk via increases in oxidative stress, inflammation, and/or sympathetic nervous system activity. PURPOSE: This study sought to examine peripheral vascular function in those with PTSD compared to age-matched controls. METHODS: Eight individuals with PTSD (5 women, 3 men; age 22 ± 2 years), and sixteen healthy controls (CON; 10 women, 6 men, 23 ± 2 years), participated in the study. Leg vascular function …
Translational Insights Into The Genetic Etiology Of Mental Health Disorders: Examining Risk Factor Models, Neuroimaging, And Current Dissemination Practices, Jessica L. Bourdon
Translational Insights Into The Genetic Etiology Of Mental Health Disorders: Examining Risk Factor Models, Neuroimaging, And Current Dissemination Practices, Jessica L. Bourdon
Theses and Dissertations
Psychiatric genetics is a basic science field that has potential for practical application and effective translation. To date, translational frameworks utilized by this field have been linear (e.g., sequential) in nature, focusing on molecular genetic information. It is proposed that non-linear (e.g., socio-ecological) frameworks are a better way to immediately translate non-molecular genetic information. This dissertation explored the translation of psychiatric genetic information in two ways. First, a survey was sent to academic stakeholders to assess the state of the science regarding the translation of genetic information to the clinical care of mental health disorders. Findings from this indicate a …
An Investigation Of Neurological Soft Signs As A Discriminating Factor Between Veterans With Post-Traumatic Stress Disorder, Mild Traumatic Brain Injury, And Co-Occurring Post-Traumatic Stress Disorder And Mild Traumatic Brain Injury, David J. Rothman
Theses and Dissertations
While multiple Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans suffer from mild Traumatic Brain Injury (mTBI), Post-traumatic Stress Disorder (PTSD), and co-morbid mTBI and PTSD, there remains difficulty disentangling the specific symptoms associated with each disorder using self-report and neurocognitive assessments. We propose that neurological soft signs (NSS), which are tasks associated with general neurologic compromise, may prove useful in this regard. Based on our review of the literature we hypothesized that individuals with PTSD would present with a greater number of NSS than controls or individuals with mTBI. Further, we hypothesized a synergistic effect, such that individuals with …
Shared Genetic And Environmental Influences On Fear, Anxiety, Posttraumatic Stress, And Brain Morphometry, Chelsea Sawyers
Shared Genetic And Environmental Influences On Fear, Anxiety, Posttraumatic Stress, And Brain Morphometry, Chelsea Sawyers
Theses and Dissertations
Anxiety disorders (ADs) and stress-related disorders are some of the most common psychiatric disorders in the United States. Like other c0mplex psychiatric illness, genetics and neuroimaging research has focused on understanding their underlying neurobiology. Areas within the fear-network play important roles in threat perception, fear conditioning/learning, cognitive processing, and modulation of fear responses including contextual modulation and extinction and have been implicated in ADs as well as stress disorders such as posttraumatic stress disorder (PTSD). The primary gap in the current search for underlying biological mechanisms is in whether biomarkers associated with disorders share genetic influences with the disorders they …
Using Mathematical Models Of Biological Processes In Genome-Wide Association Studies Of Psychiatric Disorders, Amy Cochran
Using Mathematical Models Of Biological Processes In Genome-Wide Association Studies Of Psychiatric Disorders, Amy Cochran
Biology and Medicine Through Mathematics Conference
No abstract provided.
A Study Of Media Portrayal Of Schizophrenics To Understand How Stigma Associated With Schizophrenia May Be Reversed, Rainielle M. Cua
A Study Of Media Portrayal Of Schizophrenics To Understand How Stigma Associated With Schizophrenia May Be Reversed, Rainielle M. Cua
UROP Posters
The news media are one of the most influential sources of information regarding mental illness. Media coverage on schizophrenia, one of the most stigmatized mental illnesses, tends to be negative, focusing on high risks of violence, failure, and unpredictability. Such perceptions may cause a detrimental impact on the mentally ill and cause them to internalize a stigmatizing stereotype and hinder the public’s understanding of mental illness. I studied how media portrayal in newspaper coverage of schizophrenics has evolved to discover how nonfiction media representation has affected people’s perceptions and attitudes towards schizophrenics and to propose an implementable solution to reduce …
Drinking Motives Underlying Internalizing And Externalizing Pathways To Alcohol Misuse In College Students, Jeanne Savage
Drinking Motives Underlying Internalizing And Externalizing Pathways To Alcohol Misuse In College Students, Jeanne Savage
Theses and Dissertations
Alcohol misuse, including heavy episodic use and negative consequences, is a major public health concern and a particular problem among college students. The etiology of alcohol misuse is not well resolved, with multiple and often contradictory factors implicated in its development. Genetic factors influence alcohol misuse but few specific genes have been identified. A potential reason for these challenges is that alcohol misuse is phenotypically and genetically heterogeneous; that is, there are multiple causal pathways underlying its development. Previous typologies have suggested that distinct internalizing and externalizing pathways are involved, with corresponding differences in profiles of personality, temperament, and comorbid …
The Dual Faces Of Misery, Arden Moscati
The Dual Faces Of Misery, Arden Moscati
Theses and Dissertations
Major Depression (MD) and Generalized Anxiety Disorder (GAD) are psychiatric disorders that arise from dysfunction of the core human capacities for emotion. Sapience is inextricably bound up with the potential for feelings of regret, worry and concern. When these emotions lead to clinically significant impairment or distress, they may result in one or both of the disorders of MD and GAD. The occurrence of MD and GAD in the same person, known as comorbidity, is remarkably high; substantially higher than would be expected by chance.
MD and GAD have been studied since the mid-20th century, resulting in a substantial …
Sleep Disturbances And Depression: The Role Of Genes And Trauma, Mackenzie J. Lind
Sleep Disturbances And Depression: The Role Of Genes And Trauma, Mackenzie J. Lind
Theses and Dissertations
Sleep disturbances and insomnia are prevalent, with around 33% of adults indicating that they experience at least one main symptom of insomnia, and bidirectional relationships exist with common psychopathology, particularly major depressive disorder (MDD). However, genetic and environmental (e.g., traumatic event exposure) contributions to the etiology of these phenotypes are not yet well understood. A genetically informative sample of approximately 12,000 Han Chinese women aged 30-60 (50% with recurrent MDD) was used to address several gaps within the sleep literature. Sleep disturbances were assessed in all individuals using a general item addressing sleeplessness (GS). A sleep within depression sum score …
The Effect Of Pre-Deployment Physiology As A Predictor Of Post-Traumatic Stress Disorder Among A Sample Of United States Army National Guard And Reserve Soldiers, David J. Rothman
The Effect Of Pre-Deployment Physiology As A Predictor Of Post-Traumatic Stress Disorder Among A Sample Of United States Army National Guard And Reserve Soldiers, David J. Rothman
Theses and Dissertations
Potential risk factors for development of Post-Traumatic Stress Disorder (PTSD) are still unclear. One potential risk factor for the development of PTSD is an individual’s cardiovascular reactivity and recovery in response to stressor tasks. The current study was conducted with 763 Army National Guard and Army Reserve soldiers. Participants completed a stressful induction along with self-report measures prior to deployment. Post-deployment, self-report measures were completed to assess PTSD symptomatology and experiences related to deployment and combat. Multiple regression was used to determine the ability of blood pressure response to stress to predict PTSD symptoms immediately and one-year after return from …
Subjective Measures Of Mz And Dz Twins During Anxiety-Provoking Tasks, Sravya Uppalapati
Subjective Measures Of Mz And Dz Twins During Anxiety-Provoking Tasks, Sravya Uppalapati
UROP Posters
Temporary anxiety is a healthy response to stress; however, continuous anxiety can threaten an individual’s day-to-day living by eliciting negative responses. In the study, monozygotic 84 (MZ) and 153 dizygotic (DZ) adolescent twins pairs, ages 15 to 20 years, participated in anxiety-provoking tasks and subjective experiences of anxiety were measured using subjective units of distress (SUDS). The twin participants were recruited through the Mid-Atlantic Twin Registry (MATR) at Virginia Commonwealth University. The twins participated in a carbon dioxide (CO2) breathing task and a trier social stress task (TSST). The study aims were to evaluate the relationship between anxiety-provoking …
The Relationship Between Exercise And Depression And Anxiety In College Students, Joshua Frank, Dr. Amy Adkins, Nathan Thomas, Dr. Danielle Dick
The Relationship Between Exercise And Depression And Anxiety In College Students, Joshua Frank, Dr. Amy Adkins, Nathan Thomas, Dr. Danielle Dick
UROP Posters
The literature shows an inverse association between exercise and mental disorders. The aim of this study is to further elaborate on this association with regards to exercise and its relationship with anxiety and depression in a college sample. The subject group focused on seniors in the Spit for Science data set which incorporated a total of 821 students. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) to estimate the overall metabolic equivalents (MET’s) each student spent in walking, moderate, or vigorous activity levels in the previous week. Sum scores were used to measure depression and anxiety. Overall,the …
Functional Characterization Of Rai1 In Zebrafish, Joshua S. Beach
Functional Characterization Of Rai1 In Zebrafish, Joshua S. Beach
Theses and Dissertations
Smith-Magenis Syndrome (SMS; OMIM #182290) is a multiple congenital abnormality and intellectual disability (ID) disorder caused by either an interstitial deletion of the 17p11.2 region containing the retinoic acid induced-1 (RAI1) gene or a mutation of the RAI1 gene. Individuals diagnosed with SMS typically present characteristics such as ID, self-injurious behavior, sleep disturbance, ocular and otolaryngological abnormalities, craniofacial and skeletal abnormalities, neurological and behavioral abnormalities, as well as other systemic defects and manifestations. Previous work by Vyas in 2009 showed temporal expression of rai1 in zebrafish embryos as early as 9 hpf. We hypothesize that there is maternal …
Chronic Behavioral And Cognitive Deficits In A Rat Survival Model Of Organophosphate Toxicity, Beverly Huang
Chronic Behavioral And Cognitive Deficits In A Rat Survival Model Of Organophosphate Toxicity, Beverly Huang
Theses and Dissertations
Organophosphates (OPs) are a major class of pesticides and nerve agents that elicit acute toxicity by inhibiting acetylcholinesterase (AChE), the enzyme responsible for the degradation of the neurotransmitter acetylcholine in the central and peripheral nervous systems. Acetylcholine accumulation following extensive AChE inhibition leads to an acute cholinergic syndrome characterized by autonomic dysfunction, involuntary movements, muscle fasciculations, respiratory distress, and seizures. Despite their classification as moderate to highly toxic, OP pesticides are the most widely used class of insecticides in the U.S., and are even more commonly used worldwide. Additionally, there is a growing concern that OP nerve agents could be …