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Full-Text Articles in Rehabilitation and Therapy

The Other Visual Acuity, Paul B. Freeman Od Oct 2026

The Other Visual Acuity, Paul B. Freeman Od

Optometric Clinical Practice

Editorial


The Long-Term Effects Of Covid-19 On Pulmonary Function, Emily Russell, Chris Russian, Kevin Collins Sep 2026

The Long-Term Effects Of Covid-19 On Pulmonary Function, Emily Russell, Chris Russian, Kevin Collins

Internet Journal of Allied Health Sciences and Practice

Background: The COVID-19 pandemic has resulted in millions of hospitalizations and significant long-term health consequences. While acute COVID-19 symptoms are well-documented, the long-term pulmonary effects remain incompletely understood, particularly in patients with mild or asymptomatic infections. This review examines the long-term effects of COVID-19 on pulmonary function, including spirometry, lung volumes, diffusion capacity, and related outcomes such as exercise capacity and quality of life. Methods: A comprehensive literature search was conducted using CINAHL Ultimate, Google Scholar, and PubMed databases, yielding 10 articles for review (6 cohort studies, 3 review articles, and 1 systematic review and meta-analysis). Studies were assessed for …


Systematic Review Of Sports Safety Best Practice Implementation In Non-Scholastic Youth Sport Organizations, Katie Sniffen, Hayley J. Root, Richelle M. Williams Sep 2026

Systematic Review Of Sports Safety Best Practice Implementation In Non-Scholastic Youth Sport Organizations, Katie Sniffen, Hayley J. Root, Richelle M. Williams

Internet Journal of Allied Health Sciences and Practice

Purpose: Non-scholastic youth sports organizations offer competitive and recreational activities to millions of children each year but lack centralized oversight for health and safety policy. Despite the benefits of sport participation, there are inherent risks, including cardiac-, concussion-, heat-, and musculoskeletal-related conditions. Therefore, it is important to understand how youth sports safety policies are implemented in non-scholastic youth sport organizations. This systematic review aimed to synthesize the current literature on the implementation of youth sports safety policies in non-scholastic youth sport organizations in the United States. Methods: A computerized search of Cochrane, CINHAL, Ovid Medline, Web of Science, and Scopus …


Breaking The Cycle: From Victimization To Offending Through The Lens Of Human Services, Colette R. Penalosa Aug 2026

Breaking The Cycle: From Victimization To Offending Through The Lens Of Human Services, Colette R. Penalosa

Master of Arts in Human Services

The victim-offender overlap challenges the common view that victims and offenders are separately labeled by recognizing that both groups have experienced significant childhood trauma, physical, emotional, and psychological abuse, neglect, and other adverse childhood experiences (ACEs). Current research implies these experiences can increase the risk of offending as they all influence cognitive and behavioral development while leaving criminal behavior undetermined. The purpose of this capstone is to analyze the relationship between childhood victimization and offending from a human service perspective; analyzing the pathways a victim takes on the road to offending. Research conducted will focus on exploring the victim-offender overlap, …


"It's Probably Like A Web": Complex Relationships Between Pain And Mental Health Among Bisexual+ Women With Chronic Pain, Aster Harrison, Mansha Mirza Jul 2026

"It's Probably Like A Web": Complex Relationships Between Pain And Mental Health Among Bisexual+ Women With Chronic Pain, Aster Harrison, Mansha Mirza

Department of Occupational Therapy Faculty Papers

INTRODUCTION: Bisexual+ women experience higher rates of both mental illness and chronic pain when compared to either straight or lesbian women. Their experiences of the relationship between their mental health and chronic pain remain underexplored. This article presents an intersectional Interpretive Phenomenological Analysis of the experiences of six bisexual+ women with chronic pain.

METHODS: Each woman completed two semi-structured interviews. Interviews were analyzed with Interpretive Phenomenological Analysis, beginning with in-depth case study analysis of each person's interviews before moving to comparison across cases.

RESULTS: Results indicated a complex web of multidirectional relationships between mental health and chronic pain. These relationships …


Exercise Self-Efficacy And Physical Wellness In A Worksite Wellness Program: Exploring Factor Structure And Perceptions, Micah B. Mcglathery Jul 2026

Exercise Self-Efficacy And Physical Wellness In A Worksite Wellness Program: Exploring Factor Structure And Perceptions, Micah B. Mcglathery

Dissertations

Exploring Perceptions of Exercise Self-Efficacy and Physical Wellness in a Worksite Wellness Program

Abstract

Worksite wellness programs are increasingly adopted to address insufficient exercise participation and other health-related behaviors that put employees at risk of chronic disease. Although quantitative outcomes are well-documented, there is limited research exploring how employees perceive these programs' impact on personal behavior change, particularly in relation to exercise self-efficacy. Guided by the Social Cognitive Theory and the Exercise is Medicine initiative, this study qualitatively investigates employee perceptions of a worksite wellness program’s influence on physical wellness and confidence to exercise. A phenomenological approach using semi-structured interviews …


Clinical Corner: Pearls From Local Dentists Jul 2026

Clinical Corner: Pearls From Local Dentists

West Michigan District Dental Society Bulletin

"Clinical Corner: Pearls from Local Dentists" is a section of the WMDDS Bulletin where local dentists share clinical wisdom for fellow practitioners. This edition's topics include Behavior Guidance in Pediatric Dentistry, occupational pain, and occupational hearing loss


Benefits Of Pet Friendly Work Environments On Physical, Mental, And Social Health Of Office Workers: A Systematic Review, Ahmed Radwan, Jenna Keeman, Tristan Hunzinger, Owen Wilson, Shayla Seymour Jul 2026

Benefits Of Pet Friendly Work Environments On Physical, Mental, And Social Health Of Office Workers: A Systematic Review, Ahmed Radwan, Jenna Keeman, Tristan Hunzinger, Owen Wilson, Shayla Seymour

People and Animals: The International Journal of Research and Practice

Background: Pet-friendly workplace initiatives are increasingly common, yet the empirical evidence for benefits to office workers’ physical, mental, and social health is scattered and heterogeneous.

Objective: To synthesize evidence on health-related outcomes associated with pet-friendly work environments for office and desk-based workers, and to appraise the current level of evidence.

Methods: A PRISMA-guided systematic search (2014–2024) was conducted in PubMed, PsycINFO, MEDLINE, OVID, CINAHL, and Google Scholar. Two reviewers independently screened titles/abstracts and full texts, extracted data, and appraised study quality using the Critical Appraisal Skills Program (CASP) checklists. Outcomes were coded and synthesized narratively within three domains: physical, mental, …


Refining Of An Online Rotator Cuff Related Pain Screening Tool (Orcs): A Mixed Methods Refinement Study, Andrew J. Smythe, Rhiannon Whale, Melanie Farlie, Peter Malliaras Jun 2026

Refining Of An Online Rotator Cuff Related Pain Screening Tool (Orcs): A Mixed Methods Refinement Study, Andrew J. Smythe, Rhiannon Whale, Melanie Farlie, Peter Malliaras

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study is to refine an online rotator cuff related shoulder pain screening tool. Method: A mixed methods item-refinement study was used. The original tool was designed through expert opinion and informal literature review. In this study the original tool was refined over three rounds of cognitive interviews totalling 39 participants. The screening tool consisted of two sections, red flag screening followed by rotator cuff related shoulder pain differential diagnostic items. Results from each round of interviews were summarised and informed a nominal group research panel review process to modify items and develop a finalised version …


(Re)Claiming Homeplace: Dance As Embodied Resistance & Healing For Health & Spatial Justice, Preeya G. Kannan Jun 2026

(Re)Claiming Homeplace: Dance As Embodied Resistance & Healing For Health & Spatial Justice, Preeya G. Kannan

University Honors Theses

This thesis argues that dance functions as both an upstream public health intervention and a form of radical spatial resistance; creating healing, agency, and belonging among historically marginalized communities. Drawing on bell hooks' concept of homeplace, Jasbir Puar's assemblage theory, Nancy Krieger's eco-social theory, and Katherine McKittrick's Black geographies, I position the body as both an ecological and political landscape shaped by histories of colonialism, racial capitalism, displacement, and resilience.

Through this community-based participatory research study, Homeplace, I explore dance as a form of social prescription that centers liberation rather than pathology. Movement is often reduced in public health discourse …


Fall Risk And Lower Extremity Strength In Diabetic And Non-Diabetic Older Adults: A Comparative Cross-Sectional Study, Maimoona Shahid, Yasha Sajjad, Shumail Fatima, Ayesha Tuba, Wajida Perveen, Asim Raza Jun 2026

Fall Risk And Lower Extremity Strength In Diabetic And Non-Diabetic Older Adults: A Comparative Cross-Sectional Study, Maimoona Shahid, Yasha Sajjad, Shumail Fatima, Ayesha Tuba, Wajida Perveen, Asim Raza

Internet Journal of Allied Health Sciences and Practice

Purpose: Many studies have been conducted on falls in individuals older than 60 years of age with diabetes, so the current study focused on comparing and contrasting the fall risk and lower extremity strength in diabetic and non-diabetic people of 50 years of age and above and early identification of fall risk. Methods: This comparative cross-sectional study recruited 210 older adults 50 years of age and older from community dwelling areas. Thirty-one (31) participants were healthy and free of diabetes, while 179 of the same age range were diagnosed with diabetes mellitus. The study was conducted over a period of …


Beyond Stabilization: Biological Healing, Structural Exclusion, And The Recovery Gap After Border-Fall Trauma At The U.S.-Mexico Border, Julia Robinson May 2026

Beyond Stabilization: Biological Healing, Structural Exclusion, And The Recovery Gap After Border-Fall Trauma At The U.S.-Mexico Border, Julia Robinson

Undergraduate Honors Theses

This honors thesis examines the biochemical, ethical, and public health consequences of insufficient post-operative follow-up care for undocumented immigrants injured in border falls. Discussing pathways of inflammation resolution, wound healing, and bone remodeling, this thesis argues that recovery depends on tightly regulated molecular and cellular processes that are highly vulnerable to disruption without continued monitoring and rehabilitation (Loi et al., 2016; Maruyama et al., 2020). When follow-up care is absent, these processes can be predicted to derail, leading to infection, impaired healing, and permanent disability (Chung & Sohn, 2025; Howard et al., 2020; Kruidenier et al., 2018). Framed through principles …


Exploring Lifestyle Habits Between Gamers And Non-Gamers: A Survey-Based Approach, Janavi Sathappan May 2026

Exploring Lifestyle Habits Between Gamers And Non-Gamers: A Survey-Based Approach, Janavi Sathappan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Video gaming is a prevalent and meaningful occupation for a growing number of young adults, yet its relationship to health behaviors is inconsistent and unclear in literature. This cross-sectional survey-based study examined the differences in nutritional pattens, sleep hygiene, and physical activity between self-identified gamers and non-gamers in a sample of young adults aged 18-34. Recruitment occurred primarily through the University of Nevada, Las Vegas and associated networks. Participants were asked to complete the Mini Eating Assessment Tool, Sleep Hygiene Index, and the International Physical Activity- Short Form. Data was analyzed using Mann-Whitney U tests and Pearson’s chi-square tests, and …


Multiple Interest Holder Perspectives Of The True Grit Sci Residential Program: A Mixed Methods Program Evaluation, Keara Mcnair May 2026

Multiple Interest Holder Perspectives Of The True Grit Sci Residential Program: A Mixed Methods Program Evaluation, Keara Mcnair

Seton Hall University Dissertations and Theses (ETDs)

Young adults with spinal cord injury (SCI) face significant challenges during the transition to adulthood, including barriers to independence, community participation, and psychosocial adjustment (Ingimarsdóttir et al., 2023; Zebracki et al., 2010). Current rehabilitation models in the United States prioritize short-term physical recovery and offer limited support for the developmental and contextual needs that shape long-term outcomes after SCI, particularly during transitions from inpatient rehabilitation to the community (Anderson et al., 2024; Bryden & Gran, 2024). Community-based programs may help address these gaps, though few have been rigorously evaluated using implementation science frameworks that attend to health equity, contextual influences, …


Developing A Health Education Program For Adults Reentering The Community After Incarceration, Tiffany Ayame Kinugawa-Larsen May 2026

Developing A Health Education Program For Adults Reentering The Community After Incarceration, Tiffany Ayame Kinugawa-Larsen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Justice-impacted adults often experience challenges in confidently managing their health due to limited autonomy, disrupted health routines, and limited access to health education during incarceration. Studies have shown that incarcerated adults have a higher likelihood of developing chronic health issues, yet have limited access to resources that promote health and well-being after release from incarceration. Given that health management falls within the scope of occupational therapy (OT), the profession is positioned to promote health and well-being by applying OT principles that emphasize individualized, holistic care tailored to a justice-impacted population during community reintegration. A 5-week health education program grounded in …


The Influence Of Prosthetic Obturators On Quality Of Life In Individuals With Maxillectomy Defects, Minseok Kim May 2026

The Influence Of Prosthetic Obturators On Quality Of Life In Individuals With Maxillectomy Defects, Minseok Kim

Oral Health

Abstract

Introduction: In recent years, there has been a growing focus on understanding the impact of oral cancer on patients' quality of life. Prosthetic rehabilitation techniques, such as maxillary obturators, often in conjunction with reconstructive surgery, have emerged as interventions to address the challenges posed by post-maxillectomy abnormalities.

Objective: This study aims to systematically review and evaluate the effectiveness of maxillofacial prosthetic rehabilitation using obturators in enhancing the quality of life of patients following maxillectomy.

Methodology: Systematic review of identified literature spanning the timeframe from 2000 to 2020 was used. The comprehensive search encompassed widely recognized databases including PubMed, …


Nurturing Beginnings, Madison K. Hanson May 2026

Nurturing Beginnings, Madison K. Hanson

Occupational Therapy Capstone Presentations

Early intervention for postpartum mothers and their infants plays a critical role in supporting long-term health outcomes for both members of the dyad. Maternal well-being is closely linked to a child’s development, and challenges such as stress, physical changes, and undiagnosed postpartum depression can disrupt bonding, parenting, and early skill development. Because the transition to motherhood is complex, consistent support and interventions are essential for both mom and baby. Strengthening public education and improving developmental screening practices can help ensure mothers and infants are receiving needed support early in life. Nurturing Beginnings worked to bridge the service gaps between healthcare …


Care Without Barriers: Dei And Cultural Competency In Athletic Training Education Programs, Sydney Hotz May 2026

Care Without Barriers: Dei And Cultural Competency In Athletic Training Education Programs, Sydney Hotz

Graduate Theses, Dissertations, and Capstones

In the field of athletic training, cultural competency is a topic that is highly under-researched. Athletic trainers (ATs) are healthcare professionals who provide care in a variety of settings, including secondary schools, where their patient population often includes student-athletes experiencing adverse social determinants of health and barriers to healthcare access. Only since 2022 has the governing body of athletic training education mandated that programs include cultural competency and DEI education in their programs, and to this day does not require programs to report adherence and methods of implementation. A quantitative, cross-sectional analysis was conducted to assess the relationship between cultural …


Defining Success In Collegiate Recovery Programs: A Systematic Review, Brooke Trogdon, John B. Moore May 2026

Defining Success In Collegiate Recovery Programs: A Systematic Review, Brooke Trogdon, John B. Moore

The Corinthian

Background: The transition to higher education is a critical period for emerging adults. Often marked by increased substance use experimentation due to a variety of internal and external factors. This group faces a heightened risk of developing substance-related health issues, necessitating targeted intervention and prevention efforts. Purpose: To systematically review and define key indicators of success for collegiate recovery programs (CRPs) that support students in recovery from substance use disorders (SUDs). Methods: Following PRISMA guidelines, a comprehensive search was conducted using GALILEO and Google Scholar databases. Articles were appraised using the JBI critical appraisal tools. Results: CRPs provide a supportive …


An Ot Educational Program For Individuals With Upper And Lower Limb Amputations, Laurie R. Spinks Mrs, Cassandra Nelson Apr 2026

An Ot Educational Program For Individuals With Upper And Lower Limb Amputations, Laurie R. Spinks Mrs, Cassandra Nelson

Spring 2026 OTD Capstone Symposium

An OT approach to reducing prosthetic abandonment with an accessible guide to promote self sufficiency and community connections for individuals with amputations.


Occupational Therapy For Maternal Pelvic Floor And Mental Health: A Holistic Approach To Recovery, Diana S. Theodore Apr 2026

Occupational Therapy For Maternal Pelvic Floor And Mental Health: A Holistic Approach To Recovery, Diana S. Theodore

Student Capstone Papers

Maternal pelvic floor dysfunction (PFD) is highly prevalent yet often underrecognized in occupational therapy practice, despite its significant impact on mental health, daily function, and quality of life. Many postpartum women experience symptoms such as urinary incontinence, pain with intimacy, and pelvic organ prolapse, which are frequently normalized or left untreated. Occupational therapy practitioners often have limited training in addressing the complex relationship between pelvic floor function and maternal mental health, contributing to gaps in care. The purpose of this capstone project was to develop a comprehensive handbook for occupational therapy students and practitioners integrating pelvic floor function and maternal …


Community-Based Program To Support The Occupational Needs Of Middle Eastern Refugee Women Transitioning Into Western Society, Zuha A. Mohammad, Cassandra Nelson Apr 2026

Community-Based Program To Support The Occupational Needs Of Middle Eastern Refugee Women Transitioning Into Western Society, Zuha A. Mohammad, Cassandra Nelson

Spring 2026 OTD Capstone Symposium

Middle Eastern refugee women resettling in Western societies often experience barriers that disrupt participation in meaningful occupations, including language barriers, unfamiliar systems, financial challenges, and social isolation. These challenges can limit independence and community participation during the resettlement process. Occupational therapy is well-positioned to address these barriers through culturally responsive, occupation-based interventions.

This capstone project developed and implemented a community-based program designed to support Middle Eastern refugee women during early resettlement. The program focused on key areas including system navigation, financial literacy, home safety, stress management, self-advocacy, and community engagement. Educational sessions and practical activities were used to promote skill …


Changes In Activity Levels Observed In Elementary Grade Levels., Kelsie R. Harvey Apr 2026

Changes In Activity Levels Observed In Elementary Grade Levels., Kelsie R. Harvey

2026 Honors Symposium

Background: Physical activity is important for children, recess is a great opportunity for physical activity, however, little is known how physical activity during recess changes throughout a school year, which is important for identifying key potential intervention points.  Purpose: To determine how physical activity of elementary students changes throughout the school year. Methodology: This is a research-based, longitudinal, observational study design. Through local observations at a nearby elementary school, we can analyze the activity levels of elementary students. Trained research assistants conducted systematic research observation using SOPLAY (System for Observing Play and Leisure Activity in Youth) method. SOPLAY measures the …


Empowerment Of Patients Through Sexual Wellness Programming, Carly M. Busby Apr 2026

Empowerment Of Patients Through Sexual Wellness Programming, Carly M. Busby

OTD Capstone Projects

Abstract:

This doctoral capstone project was completed in collaboration with Dr. Jenny Archer with Archer Physical Pelvic Floor Therapy. This project highlights empowerment of Dr. Archer and her team through administrative tasks and empowerment of clientele through education materials. The primary deliverable of my project is a six week ‘course,’ addressing pelvic pain through evidence-based therapy practices. Other deliverables include education materials that cover an expanse of pelvic floor and pregnancy related topics. The prominent goal of this capstone project was empowerment through education.


The Mommy Wine Culture: A Scoping Review Using The Person-Environment-Occupational Model., Sabina Khan Apr 2026

The Mommy Wine Culture: A Scoping Review Using The Person-Environment-Occupational Model., Sabina Khan

Student Dissertations

Maternal alcohol use as a coping response to parenting-related stress has received growing attention in public health and psychology but remains underexplored within occupational therapy. This gap limits understanding of how daily role demands, environmental pressures, and individual vulnerabilities combine to shape drinking as a functional coping behavior. This dissertation aimed to identify and synthesize factors associated with maternal alcohol use in the context of parenting stress and interpret these determinants using the person–environment–occupation model. A scoping review was conducted following the Arksey and O’Malley framework and reported according to PRISMA-ScR guidelines. Five databases were systematically searched without date or …


Program Development For Maternal Mental Health During The Transition To Motherhood, Lindsey A. Lindsley, Cassandra Nelson Apr 2026

Program Development For Maternal Mental Health During The Transition To Motherhood, Lindsey A. Lindsley, Cassandra Nelson

Spring 2026 OTD Capstone Symposium

The transition to motherhood can be both rewarding and challenging, with many women experiencing increased vulnerability to postpartum depression (PPD). This capstone project focused on developing and implementing a six-week maternal mental health program designed to support postpartum women through education, occupational engagement, and peer connection. Grounded in the Model of Human Occupation (MOHO), the program used a hybrid format combining in-person and virtual sessions to improve accessibility. Program outcomes were evaluated using surveys, the Occupational Self Assessment (OSA), and participant feedback. Participants demonstrated increased knowledge of postpartum mental health, greater confidence in their maternal roles, and improved ability to …


Occupational Therapy For People With Internet Gaming Disorder: A Concept Paper, Samuel R. Bender, Steven Gerardi Apr 2026

Occupational Therapy For People With Internet Gaming Disorder: A Concept Paper, Samuel R. Bender, Steven Gerardi

Spring 2026 OTD Capstone Symposium

Internet Gaming Disorder (IGD) is associated with occupational imbalance and disrupted routines, contributing to challenges in occupational participation and performance. Due to there being a gap in occupational therapy-based research and guidance for people with IGD, this capstone project focused on the development of a concept paper informed by The Model of Human Occupation (MOHO) that frames problematic video gaming as an occupational issue. The concept paper organizes assessment strategies, identifies problems, outlines intervention ideas, and discusses potential next steps for assisting people with IGD within occupational therapy. This capstone project is intended to help current occupational therapists more effectively …


Start With What They Know: Using Motivational Interviewing To Create A Cooking Class, A Culinary Intervention For Teens (Autistic And Non-Autistic), Gwendolyn S. Tedder Apr 2026

Start With What They Know: Using Motivational Interviewing To Create A Cooking Class, A Culinary Intervention For Teens (Autistic And Non-Autistic), Gwendolyn S. Tedder

LEND Trainee Presentations

Autistic teens are at greater risk for having heart disease and diabetes as adults. Food particularity, sensory issues, fixed mindset, and anxiety over trying new things can slow down their interest in preparing food for themselves. Nurturing basic cooking skills and gently encouraging trying new foods would provide more nutritional options to teens as they move into adulthood. A cooking class preceded by Motivational Interviewing (MI) developed further interest in preparing food afterward in teens, both autistic and non-autistic, and in trying new foods for autistic teens with food concerns.


Lessons Learned From The Implementation Of A Pragmatic Trial Evaluating Non-Pharmacological Approaches To Dementia Care In Us Nursing Homes, Carin Wong, Catherine V. Piersol, Felicia Chew, Cara Lekovitch, Victoria Shier, Mike Morris, Jenny Martínez, Julie Britton, Natalie E. Leland Apr 2026

Lessons Learned From The Implementation Of A Pragmatic Trial Evaluating Non-Pharmacological Approaches To Dementia Care In Us Nursing Homes, Carin Wong, Catherine V. Piersol, Felicia Chew, Cara Lekovitch, Victoria Shier, Mike Morris, Jenny Martínez, Julie Britton, Natalie E. Leland

Department of Occupational Therapy Faculty Papers

RATIONALE: The consistent delivery of effective evidence into nursing home practice has been shown to enhance quality of care and residents' outcomes. Pragmatic trials enable the evaluation of efficacious interventions in a real-world context, including care of residents living with Alzheimer's Disease and Related Dementias (ADRD). Yet, there are limited pragmatic trials conducted in nursing homes and even less evidence on the strategies to successfully conduct such research in this setting.

OBJECTIVE: To identify the lessons learned from a pragmatic trial and provide recommendations for future successful studies in United States (US) nursing homes.

METHODS: Drawing on a case example …


Multi-Dimensional Research Appraisal: A Holistic Approach To Evidence-Informed Practice, John Damiao Mar 2026

Multi-Dimensional Research Appraisal: A Holistic Approach To Evidence-Informed Practice, John Damiao

Translational Science in Occupation

The field of occupational therapy (OT) and healthcare in general have made great strides in enhancing their scientific rigor through study methodologies that prioritize internal validity. However, concerns regarding reproducibility and replicability in research have cast doubt on traditional evidence-based models. This paper critically examines the limitations of an over-reliance on internal validity in evidence reviews and advocates for a multi-dimensional approach to evidence-based practice. By integrating methodological holism, contextual analysis, and a critical appraisal of external validity, this approach provides practitioners with a more nuanced and applicable framework for decision-making. The implications for research credibility and clinical confidence are …