Cognitive Challenges Research Articles

Fundamental Ontology and Esoteric Metaphysics: How to settle the Question

How can we settle whether key metaphysical questions should properly be stated by relying on a substantial notion of metaphysical priority, like grounding or being metaphysically more fundamental than? Relatedly, how can we settle whether ontology should properly be seen as the disciple that studies either what there is or else only what there is fundamentally? Which way of thinking about ontology brings out its proper metaphysical significance? One challenge to giving notions like grounding or fundamentality key roles in metaphysics is that these notions are insufficiently clear, and that metaphysics tied to them turns into esoteric metaphysics. To make progress on these issues I propose a particular challenge—the cognitive function challenge—that needs to be met for metaphysics based on a substantial notion of priority not to turn into objectionable esoteric metaphysics. I also outline some reasons why other approaches that aim to establish such notions as legitimate for metaphysics fall short and how the cognitive function challenge might be met.

Bilingual Education and Cognitive Development: A Comparative Analysis of Early vs. Late Bilingual Learners

This study investigates the cognitive developmental differences between early and late bilingual learners, focusing on cognitive flexibility, memory, and executive functions. Early bilinguals, defined as individuals who acquire two languages before the age of five, demonstrated superior cognitive flexibility, faster information processing, and enhanced executive functions compared to late bilinguals, who began learning a second language after the age of ten. Despite certain cognitive challenges faced by late bilinguals, such as slower processing speed and lower cognitive flexibility, they exhibited stronger application of learning strategies, such as rehearsal and metacognitive techniques, to overcome these challenges. The study suggests that both early and late bilingual learners benefit from targeted educational strategies: fostering cognitive flexibility for early bilinguals and supporting memory and learning strategies for late bilinguals. The findings have significant implications for bilingual education and future research on the long-term effects of bilingualism on cognitive development.

Using a 'Students as Partners' model to develop an authentic assessment promoting employability skills in undergraduate life science education.

Authentic assessments (AA) include three principles, realism, cognitive challenge, and evaluative judgment, and replicate professional workplace expectations. Developing AA in undergraduate life science education is necessary to promote critical skill development and adequately prepare students for the workplace. Using a 'Students-as-Partners' (SAP) approach, five students, an educational developer and the instructor codeveloped an AA requiring students to utilize scientific literacy (SL) and critical thinking (CT) skills to develop a data extraction table and generate communication outputs for scientific and nonscientific audiences. Subsequently, the SAP-developed AA was completed by students (n = 173) enrolled in a fourth-year life sciences and pathophysiology course who completed an online survey providing feedback about their perceived development of critical skills and the relevance of the assignment to the workplace. The top transferable skills students reported the greatest growth in were SL (41.6%, n = 72), communication (34.7%, n = 60), CT (16.2%, n = 28), and problem-solving (7.5%, n = 13). Student self-assessed and instructor-assessed grades were positively correlated, wherein 60.6% of students assessed their AA grades below the instructor's assessment and 4.7% of students assigned themselves the same grade as the instructor. Students' perceived stress levels were (a)negatively correlated with assignment grades and feelings of enjoyment, hope and pride, and (b) positively correlated with feelings of anger, anxiety, shame, and hopelessness while working on the assignment. This study demonstrates the impact of AA on the student learning experience and the relevance of AA to help prepare students for life science careers.

Factors predicting the mathematics anxiety of adolescents: a structural equation modeling approach

IntroductionMathematics anxiety (MA) is a distinct negative emotional state or trait that individuals experience when confronted with mathematical problems in everyday life and academic contexts. This study aims to identify the key predictors of MA among secondary-level students in Bangladesh.MethodsUtilizing a quantitative cross-sectional research design, data were collected from 486 students across 89 institutions. Later, the data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM).ResultsThe findings revealed that math related negative past experiences (β = 0.241, t = 4.914, p < 0.001) and a perceived lack of teacher support (β = 0.234, t = 5.440, p < 0.001) significantly contribute to students’ low self-efficacy in mathematics. This low self-efficacy is further influenced by negative attitudes and test anxiety, ultimately leading to increased MA (β = 0.694, t = 22.695, p < 0.001). Additionally, cognitive challenges, particularly working memory difficulties, directly affect MA (β = 0.110, t = 2.659, p = 0.008). The study also found that negative attitudes (β = 0.347, t = 9.063, p < 0.001) and test anxiety (β = 0.251, t = 5.913, p < 0.001) independently exacerbate MA. Moreover, a lack of motivation in learning mathematics is directly influenced by this elevated level of MA (β = 0.384, t = 9.939, p < 0.001).DiscussionTaken together, the study proposes several key recommendations and policy implications to inform the development of synchronized policies by educational authorities aimed at combatting, reducing MA among secondary-level students in Bangladesh and similar contexts.

Cognitive flexibility in autism: How task predictability and sex influence performances.

While cognitive flexibility challenges are frequently reported in autistic individuals, inconsistencies in the findings prompt further investigation into the factors influencing this flexibility. We suggest that unique aspects of the predictive brain in autistic individuals might contribute to these challenges, potentially varying by sex. Our study aimed to test these hypotheses by examining cognitive flexibility under different predictability conditions in a sample including a similar number of males and females. We conducted an online study with 263 adults (127 with an autism diagnosis), where participants completed a flexibility task under varying levels of predictability (unpredictable, moderately predictable, and predictable). Our results indicate that as task predictability increases, performance improves; however, the response time gap between autistic and non-autistic individuals also widens. Moreover, we observe significant differences between autistic males and females, which differ from non-autistic individuals, highlighting the need to consider sex differences in research related to the cognition of autistic individuals. Overall, our findings contribute to a better understanding of cognitive flexibility and sex differences in autism in light of predictive brain theories and suggest avenues for further research.

The role of cognitive load on interlimb differences in motor coordination in older adults.

While the dominant hand has been shown to have performance advantages over the nondominant hand, these interlimb differences have found to be dependent on task and biomechanical demands. The dynamic dominance hypothesis suggests that the left hemisphere is specialized for the control of intersegmental dynamics while the nondominant right hemisphere is specialized for postural control, in right-handers. In a real-world scenario, however, cognitive challenges might be expected to modulate these specialized behaviors. Therefore, we hypothesized that with increased cognitive load, lateralized motor control processes would become even more asymmetrical. We recruited 16 right-handed older adults (11 females, 5 males; 65.88 years ± 1.99 SEM) to perform 170 trials of a unilateral reaching task with each of their hands on the Kinereach system. In each trial, participants rapidly committed to memory a set of pictorial instructions before identifying and reaching for the correct object on a screen. The complexity of the task increased over the course of the experiment. Our results demonstrated higher reaction times in the right compared to left hand (p = 0.0004). Movements became increasingly curved and erroneous with cognitive load, but interlimb differences in movement quality were absent. We found higher joint cocontraction in the right compared to left arm (p < 0.05), but these differences were unaffected by cognitive load. Hence, with the addition of a cognitive load, we observed asymmetries in reaction time but not in joint coordination or movement quality. This highlights the role of cognitive load in modulating limb/hemisphere specializations for control processes.

Caring Recommendations for Cancer-Related Cognitive Impairment in Older Patients With Cancer

Increasing average life expectancy has been accompanied by a steady increase in the number of older patients with cancer. Notably, age-related declines in cognitive function are further exacerbated by cancer-related cognitive impairment in this patient population. Therefore, cancer-related cognitive impairment in older patients with cancer has attracted increasing attention, and care recommendations for this population are needed. The diverse factors affecting cognitive function present significant challenges for clinical healthcare providers and researchers caring for this population. In this article, the current status of cognitive dysfunction and its related factors in older patients with cancer are introduced and recommendations for clinical care and future research are discussed based on empirical evidence to provide appropriate clinical care and develop future interventions for older adults with cancer.

경계선 지능 초등학생의 잠재적 개발을 위한 문화예술교육의 교육적 지원

The purpose of this study is to propose educational support that can help elementary students with borderline intelligence overcome cognitive and emotional limitations through arts and cultural education. To this end, we analyzed the impact and effects of arts and cultural education based on previous studies, exploring educational approaches that cater specifically to the needs of elementary students with borderline intelligence. The findings show that incorporating arts and cultural education elements into curriculum learning can alleviate cognitive, social, academic, and emotional challenges faced by students with borderline intelligence. Based on these results, we suggest implementing blended arts and cultural education support that integrates experiential arts activities into subject learning, thereby complementing the limitations of conventional education. Future research is anticipated to further analyze the potential improvements in cognitive abilities, academic outcomes, and social skills according to different grades and selected arts and cultural items for students with borderline intelligence.

Precarious Partnership: Student Perceptions of Generative AI in Post-Secondary Learning

Generative AI (GenAI) technologies offer both potent possibilities and significant risks for learning. As such, post-secondary learners require critical competencies for strategically regulating learning with AI. While student beliefs about GenAI impact their interactions and decisions, research of students’ perspectives is emergent. This study aimed to examine post-secondary students’ perceptions about the effective use of GenAI for learning. Participants were 125 undergraduate students at a university in Canada. Results indicated students were confident in their ability to use GenAI for learning, perceived GenAI to be effective for learning, and reported using GenAI in a wide range of academic tasks, particularly when faced with cognition and time management challenges. Finally, access to information, personalized learning support, new learning approaches, and time were considered benefits of GenAI. However, students expressed concerns about academic integrity, information accuracy, and the impact on personal learning. Implications for scaffolding learners’ development of skills for self-regulating interactions with AI critical for post-secondary and beyond are discussed.

Sleep deprivation in dementia comorbidities: focus on cardiovascular disease, diabetes, anxiety/depression and thyroid disorders.

Sleep disturbances are a significant concern in individuals with dementia, affecting their overall health and quality of life, as well as that of their family members and caregivers. Dementia, a progressive neurodegenerative condition marked by cognitive decline, often coexists with various comorbidities such as cardiovascular disease, diabetes, obesity, anxiety/depression and thyroid disorders. These comorbidities can further impair cognitive function and complicate the clinical management of dementia, making it essential to address them in a holistic manner. This review critically examines the complex interplay between dementia and its associated comorbidities, with a special focus on the prevalence and impact of sleep disturbances. Sleep problems in dementia patients are not only common but also contribute to a faster progression of cognitive decline and increased burden on caregivers. The article explores the mechanisms by which these comorbidities, including cardiovascular conditions and metabolic disorders, exacerbate sleep disturbances and cognitive impairment in dementia patients. By synthesizing recent research findings, the review highlights the importance of identifying and managing modifiable risk factors for sleep disturbances in dementia. Integrated treatment approaches that address both cognitive and sleep-related challenges are essential for improving patient outcomes. The review also underscores the need for further research to develop targeted interventions that can effectively manage sleep disturbances in dementia, thereby enhancing the quality of life for both patients and caregivers. Understanding the relationship between dementia, comorbidities, and sleep disturbances is crucial for the development of comprehensive care strategies. This review aims to inform healthcare professionals about the current state of knowledge and encourage the implementation of evidence-based practices in dementia care.

Associating EEG functional networks and the effect of sleep deprivation as measured using psychomotor vigilance tests

People are routinely forced to undertake cognitive challenges under the effect of sleep deprivation, due to professional and social obligations forcing them to ignore their circadian clock. However, low intra-individual and high inter-individual differences in behavioural outcomes are known to occur when people are sleep deprived, leading to the conclusion that trait-like differences to sleep deprivation could explain the differing levels of resilience. Within this study we consider if trait-like resilience to sleep deprivation, measured using psychomotor vigilance tests over a 40 h protocol, could be associated with graph metrics (mean node strength, clustering coefficient, characteristic path length and stability) calculated from EEG functional networks acquired when participants (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n=13$$\\end{document}) are well rested (baseline). Furthermore, we investigated how stability (the consistency of a participant’s functional network over time measured using 2-D correlation) changed over the constant routine. We showed evidence of strong significant correlations between high mean node strength, low characteristic path length and high stability at baseline with a general resilience to extended sleep deprivation, although the same features lead to vulnerability during the period of natural sleep onset, highlighting non-uniform correlations over time. We also show significant differences in the levels of stability between resilient and vulnerable groups.

Predictors of parental stress in families with gifted children: The role of cognitive and emotional challenges

This study examines the unique challenges of raising gifted children, focusing on two child-related risk factors for parental stress: cognitive asynchrony and stress management abilities. Path analysis revealed that poor stress management in children is associated with greater parental stress, as measured by the Difficult Child (DC) and Parent-Child Dysfunctional Interaction (PCDI) scales of the Parenting Stress Index. Cognitive discrepancies, particularly between Verbal Comprehension Index (VCI) and Processing Speed Index (PSI), were found to increase maternal stress but not paternal stress, highlighting a differential impact on parents. Additionally, the study identified a spillover effect, in which stress in one parent influences the other, amplifying family stress. These findings suggest that cognitive and emotional factors act as independent sources of stress, underscoring the need for interventions tailored to families of gifted children, with a focus on enhancing emotional competence to promote resilience and family well-being.

Refugee Caregivers' Perceptions of Using Mindfulness-Based Interventions to Support Coping Skills in Children with Disability in Jordan.

Background: Refugee children with disabilities are vulnerable to developing dysfunctional coping skills due to barriers in accessing health care services, including occupational therapy (OT). This study investigated the perceptions of refugee caregivers regarding the use of mindfulness-based interventions (MBIs) as a treatment for coping skills among their children with disabilities. Methods: A qualitative survey was used to analyse the coping mechanisms and access to services among refugee children with disabilities, as well as their caregivers' perceptions regarding the use of MBIs. The caregivers were recruited using convenience sampling from a database of individuals at the Al-Baqa'a refugee camp in Jordan via their community-based rehabilitation (CBR) centre. A demographic survey was sent to 156 refugees using WhatsApp. Refugees above the age of 18 years identifying as the caregivers of children with disabilities were eligible. Twenty-eight individuals completed the survey, and twenty-six were eligible. Open-ended questions asked about their child's struggles, supports, barriers to support, and perceptions of MBIs. The data were collected via Google Sheets. Three researchers coded the responses using a descriptive coding method and line-by-line analysis. Results: Five themes were derived from the responses: "Daily Challenges", "Support and Strategies", "barriers to accessing support", "MBIs: Caregiver Perceptions", and "MBIs: Barriers". The participants identified the behavioural, emotional, and cognitive challenges impacting their child's participation. Financial and environmental constraints, stigma, and timing were the reported barriers to services. The participants felt positive about the potential of MBIs to support their children. Conclusions: Overall, this study obtained foundational data to establish accessible mental health programmes for refugees with disabilities. Further research is needed to transcend the barriers and maintain MBI programmes in the community and the home settings.

Impact of Non-Pharmacological Cognitive Interventions on Real-World Daily Function in Children With Cancer: A Systematic Review.

Childhood cancer survivors (CCS) frequently experience cognitive challenges, which impact their ability to participate in functional activities. This systematic review examines the effects of nonpharmacological cognitive interventions on functional outcomes (e.g., activities of daily living). We systematically searched eight databases (e.g., PubMed, EMBASE) from 2012 to 2023. Two team members independently screened articles and extracted article, intervention, sample characteristics, and outcome data. We assessed intervention reporting with the Template for Intervention Description and Replication. Fourteen studies met inclusion criteria, representing 12 unique trials. Four of the six trials evaluating Cogmed, a computerized working memory training program, demonstrated functional benefits; small to large effects were observed for academic achievement (Cohen's d = 0.28-0.87) and decreased inattention in daily life (d = -0.36 and -0.98). Other interventions included exergaming, math or reading interventions, occupational therapy, and neurofeedback. Less than half of studies reported on intervention personalization (n = 5), fidelity assessment (n = 4), or cost (n = 1). Study heterogeneity limited our ability to meta-analyze results for functional outcomes. Limited evidence and gaps in quality of intervention reporting are barriers to addressing the cognitive challenges of CCS. Standardizing functional outcome measurement, identifying effective interventions, and improving the quality of intervention reporting could accelerate the translation of intervention research to clinical practice.

Effect of the ActivaMotricidad Program on Improvements in Executive Functions and Interpersonal Relationships in Early Childhood Education.

Background: The objective of this study was to analyze the impacts of a comprehensive physical exercise program with cognitive involvement during the school day on the executive functions and interpersonal skills of 5- and 6-year-old children. Methods: A total of 68 children participated in a 3-week pre-post intervention. Results: The results showed significant improvements in executive functions and interpersonal skills under the experimental conditions compared to the control group. These positive effects were observed to persist after a three-week follow-up. Conclusions: Therefore, the ActivaMotricidad program, which focuses on developing fundamental motor skills through cognitive, cooperative, and coordinative challenges, can serve as a useful and low-cost tool to achieve the objectives of comprehensive development and sustainability for children in early childhood education.

Authentic feedback

Authentic assessment calls for authentic feedback (Dawson et al., 2021). Authentic feedback promotes the development of capabilities that transfer effectively from university to the workplace. I showcase an innovative process to improve the feedback on an assessment task that simulates a real-life scenario to undergraduate finance students at the University of Sydney. Authentic feedback inspires students to engage in higher-order thinking, decision-making and problem-solving to resolve the feedback comments (Molloy et al., 2020). I schedule a series of pre-submission classes that are dedicated to debating the assessment task and required standards with students. Feedback can motivate students to evaluate their own work and incorporate the insights for better quality performance. I focus on developing students’ understanding of the criteria that concern practitioners. The impact of the process to deliver authentic feedback is reflected in students’ perceptions of the extent to which they were guided by helpful feedback on their learning. The context is an undergraduate third-year elective unit, Bank Financial Management, which the University of Sydney Business School offers to students as part of its Bachelor of Commerce program. The objective of the unit is to expose students to the management of financial risks in banks. The unit’s assessment includes a group assignment on cybersecurity preparedness. The assignment is based on a case prepared by Korinek and Allayannis (2022). The case is framed from the perspective of the chief information officer of a mid-sized financial institution that has experienced a massive and unprecedented cyberattack in which $450 million of customer funds were stolen. The objectives of the assignment are for students to recognise the frequency and tremendous costs of cyberattacks, devise an incident response plan to cyberattacks and understand the cyber regulatory regime in which corporations operate. The unit attracts more than 500 enrolments per year. I deploy strategies for students to engage productively in the kinds of feedback practices that take place in the workplace. The grading rubric describes qualities sought by employers. The pre-submission classes provide opportunities for students to debate the issues with their instructors and peers and to develop practical solutions. The instructions require students to write a business-style report and to treat a bank’s managers as their target audience for the report. The process relies upon the Canvas learning management system. The feedback is delivered through a series of discussions between students and educators. The feedback process has contributed to improvements in students’ impressions of the assessment task and the quality of the feedback itself. This poster fits within the conference theme of technology enhanced learning (TEL) pedagogies. To deliver authentic feedback, the instructors augment face-to-face teaching with TEL including through video recordings, video conferencing and online discussion forums. I outline the opportunities and threats to educational quality posed by using TEL applications to generate authentic feedback. By presenting and analysing an example from university teaching in finance, I demonstrate implications and issues arising from Dawson et al.’s (2021) framework for authentic feedback. Dawson et al.’s framework contains the five elements of realism, cognitive challenge, affective challenge, evaluative judgement and enactment. I apply the framework to a feedback process as a way of identifying its authenticity and guiding its adjustment in a more authentic direction.

The Funnel Transformative Model of Science Education

This theoretical paper proposes a model to address the multifaceted challenges of science education by integrating two evidence-based approaches: the Learner-Generated Digital Media (LGDM) projects framework and the Cognitive Acceleration through Science Education (CASE) framework. The Model is analogous to a funnel, with its wide top representing the broad field of science education and its narrow bottom symbolising transformative learning. It leverages LGDM’s self-regulation benefits and CASE’s structured five-stage approach – Concrete Preparation, Cognitive Conflict, Social Construction, Metacognition, and Bridging. The model categorises the complexity of science learning into six critical pillars: lack of conceptual understanding, cognitive challenges, language barriers, lack of hands-on learning, lack of robust assessments, and social issues. Applying the Funnel Model aims to develop cognitive skills, enhance learning strategies, and foster practical skills. This paper presents the Funnel Model and discusses a methodological approach to validation using Design-Based Research (DBR). The research plans to address three key questions to refine and enhance the Funnel Model in improving science education outcomes.

Design, Implementation, and Evaluation of a Training Package for Violence Prevention in Adolescents: Its Effect on Self-control and Social Skills

Background: Adolescence is a period marked by significant changes, during which individuals face major emotional, cognitive, and behavioral challenges. Violence remains a significant global concern, and factors such as self-control and social skills play a crucial role in reducing and managing adolescent violence. Objectives: This study aimed to design, implement, and evaluate a training package for violence prevention (TPVP) in adolescents and assess its impact on self-control and social skills among students in Isfahan. Methods: This study was conducted on sixty 13 - 15-year-old female students in Isfahan, Iran, during the 2022 - 2023 academic year. First, the TPVP was developed after reviewing relevant theories and existing training packages, then it was evaluated by a panel of faculty members from the Department of Social Medicine, psychiatrists, and clinical psychologists. The students were randomly divided into two groups: (1) an intervention group, and (2) a control group, with 30 students in each group. The intervention group received the TPVP and attended five training sessions. To assess social skills and self-control, the Inderbitzen and Foster Social Skills Questionnaire and the Tangney Self-control Questionnaire were administered to both groups before and three months after the intervention. Results: Sixty female students aged 13 - 15 participated in this study. The mean self-control score in the intervention group was significantly higher than in the control group after the intervention (46.33 ± 6.488 vs. 40.44 ± 7.307, P = 0.002). Prior to the training, there was no significant difference in social skills scores between the two groups. However, following the intervention, the mean social skills score in the intervention group was significantly higher than in the control group (118.38.726 vs. 102.913.468, P &lt; 0.0001). Conclusion: The violence prevention training package was effective in improving self-control and social skills among students. The study demonstrated that the implementation of a structured TPVP can enhance both self-control and social skills in adolescents.

Gender differences in internet gaming among university students: a discriminant analysis.

Research on gaming and gaming habits has predominantly focused on younger populations, particularly males. The main objective of this study was to analyze gender-based differences in gamer profiles, considering variables related to gaming habits and the gaming community. A total of 180 Spanish university students currently engaged in video gaming (M = 21.51 years, SD = 3.09, 57.4% male) participated in the study by completing an online questionnaire addressing gaming characteristics such as the age of onset, gaming hours, motives of gaming, and perceived toxicity in the video gaming community. The results revealed statistically significant gender differences in the age of gaming initiation, weekly gaming hours, community toxicity, and several gaming motivations, including customization, cognitive challenge, violent gratification, and social interaction. Linear discriminant analysis identified that higher scores in the age of initiation and customization, along with lower scores in violent gratification and community toxicity, formed the combination of predictor variables that most strongly distinguished between genders. Understanding these gender differences is essential for capturing current gaming trends and addressing the needs of diverse gamers. Finally, the potential clinical implications of these findings are discussed.

Mitochondrial DNA in plasma and long-term physical recovery of critically ill patients: an observational study

BackgroundPost-intensive care syndrome (PICS) poses a notable public health concern, with survivors of critical illness experiencing long-term physical, psychological, and cognitive challenges. Mitochondrial dysfunction has gained attention for its potential involvement in PICS. However, the long-term impact of mitochondrial status on patient recovery remains uncertain. A single-centre retrospective analysis was conducted in Leeuwarden, the Netherlands, between May and November 2019, within a mixed ICU survivor cohort. Patients were assessed for mitochondrial markers (mtDNA damage represented by the presence of mtDNA fragmentation and mitochondrial DNA levels evaluated by the ratio of mtDNA and nuclear DNA), clinical factors, and long-term outcomes measured by the physical functioning (PF) domain of health-related quality of life.ResultsA total of 43 patients were included in this study divided into recovery and non-recovery groups based on age-adjusted PF scores at 12 months post-ICU. Nineteen patients scored below these thresholds. No significant differences in mitochondrial markers between groups were identified. Furthermore, no significant correlations were found between mtDNA levels and mtDNA damage at baseline and 12 months with PF scores. However, mtDNA levels decreased over time in the recovery (p-value < < 0.01) and non-recovery groups (p-value < 0.01).ConclusionNo significant correlation was found between mitochondrial markers and physical functioning scores. This study underscores the multifactorial nature of PICS and the need for a comprehensive understanding of its metabolic and cellular components. While mitochondrial markers may play a role in PICS, they operate within a framework influenced by various factors. This exploratory study serves as a foundation for future investigations aimed at developing targeted interventions to enhance the quality of life for ICU survivors grappling with PICS.