JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY最新文献

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Social Anxiety in University Students: Towards an Intentional Life-Skills Based Prevention Model 大学生的社交焦虑:走向基于生活技能的预防模式
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2023-10-10 DOI: 10.29245/2578-2959/2023/3.1282
Hannah Ali, Steve Joordens
{"title":"Social Anxiety in University Students: Towards an Intentional Life-Skills Based Prevention Model","authors":"Hannah Ali, Steve Joordens","doi":"10.29245/2578-2959/2023/3.1282","DOIUrl":"https://doi.org/10.29245/2578-2959/2023/3.1282","url":null,"abstract":"Research suggests that staying connected with people is very beneficial to our physical and mental well-being. Moreover, a lack of social connection is associated with poor mental and physical health, and lower overall well-being. For individuals with social anxiety, it is particularly difficult to cultivate social connections. Due to the prolonged period of social isolation during the COVID-19 pandemic, research suggests that social anxiety in university students has increased. This study employed a convergent parallel mixed method design and administered a self-reported questionnaire which included quantitative and qualitative questions. The questionnaire was administered to 301 undergraduate students to determine if feelings of social anxiety in students changed during and after the pandemic. This study also analyzed social anxiety levels across racial and ethnocultural demographics and assessed the cultural stigmas and barriers that may prevent students from accessing mental health services. Results from the quantitative analyses showed a significant difference in social anxiety scores before and after the pandemic. However, in our sample, feelings of social anxiety post-pandemic did not differ across race, or income which were our main variables of interest. In addition, there was a positive correlation between social anxiety scores and household income and fear of negative evaluation. The qualitative results showed that important barriers to accessing mental health services include fear of parents learning they are in therapy, cost of mental health services, language barriers, and concern that a therapist would not have cultural sensitivity. This study highlights the need for increased interventions to reduce social anxiety among students, and proposes a preventative approach we refer to as “Life-Skills Training” to address social anxiety.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"265 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135043711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mental health clinical exams’ evident adherence to industry standards for testing 心理健康临床检查明显符合行业测试标准
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2023-09-25 DOI: 10.29245/2578-2959/2023/3.1283
Benjamin E. Caldwell
{"title":"Mental health clinical exams’ evident adherence to industry standards for testing","authors":"Benjamin E. Caldwell","doi":"10.29245/2578-2959/2023/3.1283","DOIUrl":"https://doi.org/10.29245/2578-2959/2023/3.1283","url":null,"abstract":"The developers of clinical exams for US mental health licensure have faced significant recent criticism and calls for their exams to be paused or discontinued. Critics cite concerns over exams lacking evidence of validity, while they demonstrate strong evidence of racial and ethnic bias. Developers, in turn, argue that their exams are developed using accepted methods that conform with industry standards, specifically, the Standards for Educational and Psychological Testing.3 This manuscript challenges that assertion. Based on external research as well as developers’ own statements and publications, clinical exams for US mental health care licensure appear to deviate in important ways from both the letter and the spirit of the Standards. Clinical exams should be paused unless and until they are shown to be fair, equitable, valid, and more fully consistent with industry norms.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135867811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adolescent Woes? Approval Motivation, Test Anxiety, and the Role of Perceived Self-Control 青少年问题?认可动机、考试焦虑与感知自我控制的作用
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2023-09-20 DOI: 10.29245/2578-2959/2023/3.1278
Swati Y Bhave, Jill N Mota, Latika Bhalla, Shailaja Mane, Anuradha Sovani, Surekha Joshi
{"title":"Adolescent Woes? Approval Motivation, Test Anxiety, and the Role of Perceived Self-Control","authors":"Swati Y Bhave, Jill N Mota, Latika Bhalla, Shailaja Mane, Anuradha Sovani, Surekha Joshi","doi":"10.29245/2578-2959/2023/3.1278","DOIUrl":"https://doi.org/10.29245/2578-2959/2023/3.1278","url":null,"abstract":"The Association of Adolescents and Child Care in India (AACCI) conducts multicentric studies on youth behavior in India. Using openly accessible psychometric tools, the present study discusses the demographic-wise interrelationships between the Children’s Perceived Self-Control (PSC), Martin-Larsen Approval Motivation (AM), and Friedben’s Test Anxiety Scales (FTAS) administered to 712 students (Group-1: 10-14 yrs.; Group-II: 15-18 yrs.) from two Delhi-based schools. The survey-questionnaire included four demographic variables: age, gender, sibling status, and body mass index. Although mainstream literature has uniformly contented in favour of the benefits of PSC, one-way ANOVAs in the present study revealed that high PSC was associated with significantly high AM (F[2,709] =3.033, p =0.049), suggesting that people with high PSC may diligently weigh short- and long-term consequences, choosing behaviors that best align with their interests and enduringly valued goals. Further, this relationship was statistically significant for participants in the no siblings (p =0.005) and underweight groups (p =0.031). Participants with high PSC had the lowest FTAS scores; however, this relationship was not statistically significant. Lastly, AM and FTAS were negatively correlated (r =-0.216, p<0.01), especially for females, Group-II, and participants with siblings (r =-0.278, -0.292, and -0.244, respectively), clarifying distinct differences between AM and FTAS’ subscales. The implications of findings were shared with the school management to conduct customized interventions using the WHO’s Life Skills Education framework. The findings highlight the need for time-series interventional analysis to ascertain the direct and cumulative effects of intervention on the interrelationships between PSC, AM, and FTAS.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136379834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Increasing Diversity and Inclusion in Research on Virtual Reality Relaxation: Commentary on ‘Virtual Reality Relaxation for People with Mental Health Conditions: A Systematic Review’ 增加虚拟现实放松研究的多样性和包容性——《虚拟现实放松对精神疾病患者的系统评价》述评
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2023-08-25 DOI: 10.29245/2578-2959/2023/2.1281
Simon Riches, Deanna Fallah, Ina Kaleva
{"title":"Increasing Diversity and Inclusion in Research on Virtual Reality Relaxation: Commentary on ‘Virtual Reality Relaxation for People with Mental Health Conditions: A Systematic Review’","authors":"Simon Riches, Deanna Fallah, Ina Kaleva","doi":"10.29245/2578-2959/2023/2.1281","DOIUrl":"https://doi.org/10.29245/2578-2959/2023/2.1281","url":null,"abstract":"Simon Riches1,2,3*, Deanna Fallah3,4, Ina Kaleva5 1Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom 2Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom 3South London and Maudsley NHS Foundation Trust, London, United Kingdom 4School of Psychology, University of Surrey, Surrey, United Kingdom 5Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134932797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effectiveness of Mentalization-Based Treatment on Mindfulness and Perceived Social Support in Adolescents 心理化治疗对青少年正念和感知社会支持的影响
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2023-08-23 DOI: 10.29245/2578-2959/2023/2.1271
Sarah Bagherzadeh Jalilvand, Sedigheh Ahmadi
{"title":"The Effectiveness of Mentalization-Based Treatment on Mindfulness and Perceived Social Support in Adolescents","authors":"Sarah Bagherzadeh Jalilvand, Sedigheh Ahmadi","doi":"10.29245/2578-2959/2023/2.1271","DOIUrl":"https://doi.org/10.29245/2578-2959/2023/2.1271","url":null,"abstract":"Adolescence is a critical period marked by significant changes in social relationships and emotional development. In light of the importance of promoting mental health in this age group, this study aimed to investigate the effectiveness of a mentalization-based treatment intervention on mindfulness and perceived social support among female adolescents aged 12-15 years in Tehran. A pretest-posttest control group design was employed, with participants randomly assigned to either the intervention group, which received the mentalization-based treatment, or the control group, serving as a comparison for evaluating the intervention's effectiveness. The Mindful Attention Awareness Scale (MAAS) and the Multidimensional Scale of Perceived Social Support Questionnaire (MSPSS) were used to measure mindfulness and perceived social support, respectively. The mentalization-based treatment intervention focused on enhancing the participants' ability to understand and interpret their own and others' mental states, fostering empathy, and improving interpersonal relationships. Data analysis was performed using Multivariate Analysis of Covariance (MANCOVA) to assess the impact of the mentalization-based treatment on mindfulness and perceived social support in female adolescents. The results indicated a significant improvement in both mindfulness and perceived social support after the intervention (P < 0.01). In conclusion, the findings suggest that mentalization-based treatment holds promise as an effective approach to enhance mental health outcomes, particularly in promoting mindfulness and perceived social support in female adolescents. Future attention should be given to the implementation of this intervention to support the well-being of adolescents during this critical developmental stage.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135619482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Race, Socioeconomic Status, Health Locus of Control, and Body Mass Index 种族、社会经济地位、健康控制点和身体质量指数
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2023-08-21 DOI: 10.29245/2578-2959/2023/2.1279
Shervin Assari, Babak Najand
{"title":"Race, Socioeconomic Status, Health Locus of Control, and Body Mass Index","authors":"Shervin Assari, Babak Najand","doi":"10.29245/2578-2959/2023/2.1279","DOIUrl":"https://doi.org/10.29245/2578-2959/2023/2.1279","url":null,"abstract":"Background: This cross-sectional study aimed to investigate the complex interplay between socioeconomic status (SES), internal and external health locus of control, and body mass index (BMI) in a national sample of US adults. Given the unique challenges faced by Black individuals, it was hypothesized that the relationships between SES, internal and external health locus of control, and BMI would be weaker for Blacks compared to Whites. Methods: For this cross-sectional study, baseline data from the MIDUS Refresher sample, consisting of US adults, were analyzed. SES indicators such as income and education were examined as predictors of internal and external health locus of control. The analyses were conducted overall without and with race interactions. We also ran models within different racial groups. Results: Overall, 3198 participants entered our analysis who were White or Black. From this number, 2925 (91.5%) were White and 273(8.5%) were Black. In the pooled sample, high education and income were linked to higher internal and lower external health locus of control and lower BMI. The study revealed that the relationships between high SES indicators (income and education), internal health locus of control, and BMI were weaker for Black than White individuals. The study revealed that the relationships between high SES indicators (income and education) and external health locus of control was stronger for Black than White individuals. Conclusion: This study provides evidence for the complex interrelationships between SES, health locus of control, and BMI, while highlighting the role of race as a moderating factor. The findings suggest that the effects of SES on internal health locus of control is influenced by race, with weaker relationships observed among Black individuals compared to Whites.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135876411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Racial disparities in opioid use disorder and its treatment: A review and commentary on the literature 阿片类药物使用障碍及其治疗的种族差异:文献综述与评论
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2023-02-07 DOI: 10.29245/2578-2959/2023/1.1263
Sean Lynch, Faris Katkhuda, Lidia Klepacz, Eldene Towey, Stephen J. Ferrando
{"title":"Racial disparities in opioid use disorder and its treatment: A review and commentary on the literature","authors":"Sean Lynch, Faris Katkhuda, Lidia Klepacz, Eldene Towey, Stephen J. Ferrando","doi":"10.29245/2578-2959/2023/1.1263","DOIUrl":"https://doi.org/10.29245/2578-2959/2023/1.1263","url":null,"abstract":"Despite public interventions, the rate of opioid use disorder (OUD) continues to rise. In this focused review of the existing literature, the authors describe how increases in OUD, as well as opioid-related deaths, have occurred disproportionately among people of color. Black patients in particular are dying of overdose at an increased rate, however are less likely to receive any treatment for OUD. Additionally, Black patients are less likely to receive buprenorphine than White patients, but more likely to receive methadone. Potential causes of these disparities are discussed, as well as the impact of the COVID-19 pandemic, and the successes of several pilot programs.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"155 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136293335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association Between Depression and Recurrence of Peptic Ulcer Disease in Older Chinese Patients after Helicobacter Pylori Eradication: A Three-Year Study 幽门螺杆菌根除后中国老年患者抑郁与消化性溃疡复发的关系:一项为期三年的研究
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2019-08-01 DOI: 10.29245/2578-2959/2019/4.1181
Wenni Chen, Yu Yu, R. Xu, Hui Han, Gengzhen Chen
{"title":"Association Between Depression and Recurrence of Peptic Ulcer Disease in Older Chinese Patients after Helicobacter Pylori Eradication: A Three-Year Study","authors":"Wenni Chen, Yu Yu, R. Xu, Hui Han, Gengzhen Chen","doi":"10.29245/2578-2959/2019/4.1181","DOIUrl":"https://doi.org/10.29245/2578-2959/2019/4.1181","url":null,"abstract":"Results: PUD recurrence rate was higher in patients with self-reported depression (10.9%) than those without (6.2%). Apart from self-reported depression (OR 2.418 (1.232, 4.989), other significant predictors of PUD recurrence included H. pylori reinfection (OR 2.815 (1.198, 4.687), cigarette smoking (OR 2.318 (1.238, 4.862), excessive alcohol drinking (OR 2.287 (1.118, 4.677), high green tea consumption (OR 2.107 (1.025, 4.325), regular ingestion of acetaminophen (OR 2.273 (1.238, 4.218) and NSAIDs (OR 3.341 (2.174, 5.187), as well as regular (OR 3.372 (2.087, 5.298), occasional (OR 3.096 (2.032, 5.162), and infrequent aspirin consumption (OR 2.645 (1.218, 4.562). Similar results were yielded on the association between diagnosed depression and PUD recurrence.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128558280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Commentary: Association between Poor Sleep Quality and Subsequent Peptic Ulcer Recurrence in Older Patients with Mild Cognitive Impairment: Examining the Role of Social Engagement 评论:老年轻度认知障碍患者睡眠质量差与消化性溃疡复发之间的关系:社会参与的作用
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2019-05-01 DOI: 10.29245/2578-2959/2019/3.1179
Wenni Chen, Yewei Bao, Yu Yu, R. Xu, Shuyan Yang, Hui Han, Gengzhen Chen
{"title":"Commentary: Association between Poor Sleep Quality and Subsequent Peptic Ulcer Recurrence in Older Patients with Mild Cognitive Impairment: Examining the Role of Social Engagement","authors":"Wenni Chen, Yewei Bao, Yu Yu, R. Xu, Shuyan Yang, Hui Han, Gengzhen Chen","doi":"10.29245/2578-2959/2019/3.1179","DOIUrl":"https://doi.org/10.29245/2578-2959/2019/3.1179","url":null,"abstract":"","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114523399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
The Promise of Clinician-Delivered Cognitive Training for Children Diagnosed with ADHD 临床医生为诊断为多动症的儿童提供认知训练的前景
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Pub Date : 2019-05-01 DOI: 10.29245/2578-2959/2019/3.1180
A. L. Moore, C. Ledbetter
{"title":"The Promise of Clinician-Delivered Cognitive Training for Children Diagnosed with ADHD","authors":"A. L. Moore, C. Ledbetter","doi":"10.29245/2578-2959/2019/3.1180","DOIUrl":"https://doi.org/10.29245/2578-2959/2019/3.1180","url":null,"abstract":"Mainstream approaches to treating Attention Deficit Hyperactivity Disorder in children include stimulant medication such as methylphenidate and behavior therapy that target deficits in attention as well as inappropriate behaviors but do not sufficiently address the multiple cognitive deficits associated with the disorder. Deficits beyond attention have been identified in ADHD including working memory, long-term memory, and processing speed. As key elements of cognition and intelligence that contribute to thinking and learning, these are critical deficits found in children with ADHD that must be addressed. In this review, we discuss existing research on cognitive training interventions for ADHD and evaluate their ability to target these multiple cognitive deficits as well as their ability to promote self-efficacy, social cognition, and motivation during training. We describe research on LearningRx, a clinician-delivered cognitive training intervention and suggest that human delivery enhances motivation and promotes social cognition and self-efficacy while strengthening weak cognitive skills associated with ADHD in children.","PeriodicalId":366333,"journal":{"name":"JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130241365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
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