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BACKGROUND: Previous research among diverse patient populations suggests that healthcare staff routinely do not talk about sexuality with their patients even when such talks are highly indicated and relevant. AIM: In this study we sought to investigate how patients at outpatient anxiety clinics in Denmark experience sexual communication with healthcare staff and what barriers they encounter in this connection. METHODS: We employed a survey design from January 1, 2018, to June 30, 2019. In collaboration with 11 outpatient anxiety clinics in Denmark, patients with a primary diagnosis of panic disorder, social phobia, generalized anxiety, or obsessive-compulsive disorder were invited to participate in the study. The final sample included 272 patients. Survey questions were related to sociodemographic characteristics, sexual activity and dysfunctions, pharmacological treatment adherence, anxiety and depression symptoms, and experience with and barriers to sexual communication. For each participant, clinicians at the clinics provided the International Classification of Diseases, 10th revision, diagnostic codes, medications, and dosage. Study inclusion criteria were not having an organic disorder that may cause anxiety, not having a previous diagnosis of bipolar affective disorder or schizophrenia, and the ability to speak and read Danish. OUTCOMES: Outcomes included patients' experiences with and barriers to sexual communication with healthcare staff. RESULTS: In total, 61% of the patients in this sample group found it relevant to talk to healthcare staff about sexuality but only 28% of the study patients had done so, of whom 83% reported this communication to be a positive experience. The most frequently reported patient barriers to communication with healthcare professionals regarding sexual concerns were a belief that if sexual matters were relevant, the healthcare staff would bring it up (94%), fear of transgressing their own boundaries (94%), embarrassment (92%), and lack of knowledge as to how to start a conversation about sex (91%). CLINICAL IMPLICATIONS: The study results indicated a need for healthcare staff to routinely map out and address sexual matters in their clinical work with anxiety patients while bearing in mind the common patient barriers for this topic. STRENGTHS AND LIMITATIONS: This study included a large clinical outpatient sample of anxiety patients and an extensive survey. However, the results may not be generalizable across all anxiety patients or patients in general. CONCLUSION: The results of this study strongly indicate that a majority of anxiety patients find it both relevant and beneficial to discuss sexual matters with healthcare staff in connection with their anxiety treatment, and therefore healthcare staff should be educated and equipped to routinely address these matters while bearing in mind the most common patient barriers for conversations about sexuality.

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Introduction: Parents who do not feel responsible for parent-child sexual communication (PCSC) may be missing out on opportunities to engage in PCSC that has protective effects on children's sexual well-being. Using the theory of planned behavior and feminist theory, we explore how parents' PCSC attitudes and demographics are associated with perceptions of who is responsible for PCSC. Methods: Using data collected in December 2019 through January 2020 from parents of 6-11-year-olds, we ran chi-square tests, ANOVAs, and logistic regressions to determine how parent PCSC attitudes and other parental factors are associated with parent perceptions of who is responsible for PCSC. Results: The majority of parents saw themselves and/or a co-parent as primarily responsible for PCSC about facts and values. Bivariately, parents with higher scores of perceived positive PCSC outcomes, subjective norms, and self-efficacy were more likely to believe that they were solely responsible or shared an equal responsibility for PCSC. Multivariately, mothers and genderqueer parents, parents with the same gender as their child, and parents whose co-parent was less involved in parenting were more likely to report being solely responsible for PCSC. Conclusions: Most parents saw themselves or a partner as most responsible for PCSC; parent and child gender were the strongest determinants of parents' perceptions of PCSC responsibility. Policy Implications: These results suggest that it may be more effective for parent education to challenge and deconstruct traditional gender roles versus focusing on self-efficacy, norms, and perceived outcomes if we want to increase parents' perceived PCSC responsibility, especially within different-gender parent-child dyads.

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Male orchid bees are unique in the animal kingdom for making perfumes that function as sex pheromone. Males collect volatile chemicals from the environment in the neotropical forests, including floral and non-floral sources, creating complex but species-specific blends. Male orchid bees exhibit several adaptations to facilitate perfume collection and storage. When collecting volatile compounds, males apply lipid substances that they secrete from cephalic labial glands onto the fragrant substrate. These lipids help dissolve and retain the volatiles, similar to the process of 'enfleurage' in the traditional perfume industry. We investigated how the chemical composition of acquired perfume and labial gland secretions varied across the phylogeny of orchid bees, including 65 species in five genera from Central and South America. Perfumes showed rapid evolution as revealed by low overall phylogenetic signal, in agreement with the idea that perfume compounds diverge rapidly and substantially among closely related species due to their role in species recognition. A possible exception were perfumes in the genus Eulaema, clustering closely in chemospace, partly mediated by high proportions of carvone and trans-carvone oxide. Labial gland secretions, in contrast, showed a strong phylogenetic signal at the genus level, with secretions of Eufriesea and Exaerete dominated by fatty acids and Eulaema dominated by saturated acetates of chain lengths 12 to 16 C-atoms. Secretions of the majority of Euglossa were heavily dominated by one unsaturated long chain diacetate, (9Z)-Eicosen-1,20-diyldiacetate. However, we also identified few highly divergent species of Euglossa in four subclades (11 species) that appear to have secondarily replaced the diacetate with other compounds. In comparison with environment-derived perfumes, the evolution of labial gland secretion is much slower, likely constrained by the underlying biochemical pathways, but perhaps influenced by perfume-solvent chemical interactions.

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INTRODUCTION: Cervical cancer (CC) and its treatments impact various dimensions of quality of life (QoL), including physical, psychological, and sexual functioning. Sexual health, a crucial QoL aspect, is often compromised, highlighting the necessity for open sexual communication. MATERIALS AND METHODS: This study involved 60 women diagnosed with stage IIb-IIIa CC. The 36-Item Short Form Survey (SF-36) was used to measure physical and psychological components of QoL, the Female Sexual Function Index-6 (FSFI-6) to assess its sexual component, and the Sexual Communication Self-Efficacy Scale (SCSES) to diagnose communication confidence. Self-administered questions gauged patient-provider sexual communication. The results include quotes from participants, providing additional insight. RESULTS: Sexual communication self-efficacy and patient-provider communication correlated significantly with QoL components. Only 23.33% discussed sexual issues with their doctors. Participants' experiences highlighted the impact of cancer on sexuality and the need for tailored support. DISCUSSION: Post-diagnosis psychosexual changes emphasize the importance of communication in renegotiating sexual identity and needs. Effective communication is associated with improved QoL, highlighting the role of healthcare professionals in addressing psychosexual issues. Integrating PLISSIT and BETTER models provides a comprehensive approach to sexual communication in the cancer context. CONCLUSION: The study demonstrates the importance of sexual communication self-efficacy in QoL of CC patients and highlights the need for healthcare professionals to include sexual communication education in cancer care.

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Objective: The aim of this study was to investigate sexual communication as a mechanism involved in the link between emotion regulation and sexual functioning in a sample of adult women, also testing the moderating role of relationship status and age in this association. Method: 1344 sexually active cisgender women (aged 18-57, M = 27.34; SD= 6.484) were recruited from March 30, 2021, to April 12, 2021, through an online survey. From the initial sample, 1280 women were retained and included in the analysis. Participants were asked to respond to three self-report questionnaires: the Difficulties in Emotion Regulation Scale (DERS), the Communication subscale of the Sexual Satisfaction Scale for Women (SSS-W), and the Female Sexual Function Index (FSFI). Results: We found that sexual communication mediated the link between emotion regulation abilities and female sexual functioning. Moreover, we found that age, but not relationship status, moderated the association between emotion regulation and sexual communication, so that older women with difficulties in emotion regulation processes showed worse sexual communication abilities as compared to younger women. Conclusions: According to this study's results, clinicians and sexual therapists should carefully consider emotion regulation abilities and sexual communication as crucial factors in promoting women's sexual well-being.

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Recognition of sex pheromones released by heterosexual moths via sex pheromone receptors is key for establishing mating connections in moths. The day-flying moth Phauda flammans is an oligophagous pest in southern cities of China and Southeast Asian countries. Our previous study reported that male P. flammans can be attracted to two sex pheromone compounds [Z-9-hexadecenal and (Z, Z, Z)-9,12,15-octadecadienal] released by females in the field; however, the mechanism of olfactory recognition is not clear. In this study, two sex pheromone receptor genes (PflaOR29 and PflaOR44) were cloned. Among the different tissues, both PflaOR29 and PflaOR44 were highly expressed in the antennae of mated male adults. At different developmental stages, the expression levels of PflaOR29 and PflaOR44 were significantly greater in mated male adults than other stages. The fluorescence signals of PflaOR29 and PflaOR44 were mostly distributed on the dorsal side of the antennae, with a large number of trichoid sensilla. The results of the gene function of PflaOR29 and PflaOR44 based on a Drosophila empty neuron heterologous expression system indicated that PflaOR29 strongly responded to (Z, Z, Z)-9,12,15-octadecadienal but not to Z-9-hexadecenal, whereas PflaOR44 did not respond to the two sex pheromones. Our findings clarify the sex pheromone receptor gene corresponding to (Z, Z, Z)-9,12,15-octadecatrienal. These results provide essential information for analyzing the mechanism of sexual communication in diurnal moths and for identifying target genes for the development of efficient attractants.

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Parental communication about sex is an important aspect of sexual socialization. However, research has primarily focused on sexual communication's presence, frequency, or topics, with less research on the specific messages parents communicate. Further, few studies have differentiated between communication received before and after youth initiated sex. Therefore, in this paper, we coded open-ended survey responses to explore the sex-related messages young adults report receiving from their caregiver(s) before they began engaging in sex. As part of a larger study, 381 U.S. young adults (Mage = 21.0 years, SD = 2.0) completed an online survey and responded to an open-ended question about messages their caregiver(s) communicated before they began engaging in sex. Participants identified as cisgender women (62.2%), cisgender men (12.1%), and gender diverse (25.7%), and were primarily lesbian, gay, bisexual, queer, questioning, or otherwise non-heterosexual (LGBQ+; 70.6%) young adults. Through thematic analysis, we identified six themes for caregivers' sex-related messages: sex-restrictive, safety and consequences, no, negative, sex-positive, and informational messages. In addition, we found that messages varied by young adults' gender identity and sexual orientation. Our findings suggest that young adults may not receive proper education about healthy sexual relationships and demonstrate the need for interventions with caregivers, as well as sexual health resources for adolescents and young adults, particularly LGBTQ+ youth.

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College-age students are disproportionately impacted by sexually transmitted infections. Campus programs that reduce sexual violence have received recent investment, are increasingly common, and may offer a platform to increase condom use, but this has not yet been investigated. We explore this novel question through a secondary analysis of a randomized control trial of RealConsent, a web-based, sexual assault program for college women, on three college campuses. By estimating single and multiple-mediator models we examine the relationships between study assignment, the hypothesized mediators: self-efficacy to discuss safer sex, and clarity and assertiveness in sexual communication, and consistent condom use at follow-up. In the single mediator models, self-efficacy for safer sex communication (aOR: 1.11, 95% CI: 1.03-1.19, p = .004), assertiveness in sexual communication (aOR: 1.06, 95% CI: 1.02-1.11, p =.004), and clarity in sexual communication (aOR: 1.03, 95% CI: 1.00-1.05, p = .026) demonstrated significant direct effects on condom use. No statistically significant relationships between RealConsent and the mediators, nor indirect effects were found. In the multimediator model, there were no statistically significant associations identified. Self-efficacy, assertiveness, and clarity in communication about sex may have a positive impact on condom use but we did not find evidence that RealConsent impacted these mediators and thus no mediated effect was identified. Additional research is needed to develop and assess college-based sexual violence prevention programs that include an additional focus on skills specifically related to condom negotiation and use to understand if these widespread programs offer an efficient and effective platform to reduce the impact of sexually transmitted infections (STIs) among this high-risk population.

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Sexual communication functions as an important relational process expediating satisfying sexual experiences (Sprecher & Hendrick, 2004). Much of the existing literature on sexual communication concerning sexual pleasure biases verbal communication (Babin, 2012). This study adds to the existing research regarding patterns of communication surrounding sex and during sex through qualitative analysis. Further, this inquiry focused on participants' full histories, rather than their tendencies within any current relationship. We analyzed 78 qualitative interview transcripts from participants between the ages of 18 and 69. Participants reported a reluctance to communicate anything but pleasure, discomfort, or dislike during sex to avoid discouraging their partners. Though participants reported a perception that communicating pleasure served as encouragement and affirmation to their partners, most preferred to communicate pleasure nonverbally. Some participants reported a tendency to communicate pain or dislike verbally. Some preferred communication about sexual topics only before or after sexual activities. Participants shared that a high level of comfort with their partner increased sexual communication. How sexual partners communicate sex not only affects pleasure but can only affect intimacy between partners and health. This adds to the scant literature on nonverbal communication during sex and some people's preference for that style (Blunt-Vinti et al., 2019).

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Refusal communication is a dyadic process, with one person communicating a refusal and another person responding. To enhance our understanding of this process, we surveyed college students to assess their interpretation of their partners' responses when they declined vaginal-penile sexual activity. In an online survey, participants were prompted to describe their partners' reactions when participants refused their partner's vaginal-penile sex initiation. Through content analysis, three themes were present: (1) partner accepted the refusal, (2) partner experienced negative emotions, (3) partner ignored their refusals. Participants frequently reported their refusals were accepted. Sexual assault prevention initiatives should work to normalize refusal communication.

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This paper explores young people's experiences of puberty and their perspectives on parent-child sexual communication in rural northern KwaZulu-Natal. In-depth individual interviews, focus group discussions, and participatory visual research methodology were employed with 18 and 19-year-old young women (n = 30) and young men (n = 16) attending three primary health care facilities and a local high school in Jozini municipality. The findings suggest a complex interplay between unequal gender and socio-cultural norms that results in divergent puberty experiences and ambiguous and inconsistent patterns of parent-child sexual communication. Young people referred to their parents as gudlists, a local colloquialism for someone who is evasive, vague, ambiguous and indirect. Lack of open parent-child sexual communication hinders discussion of healthy sexuality, neglecting the sexual and reproductive health education and needs of young people. Reflective of their desire for change, young women in particular contest current parenting norms and suggest returning to cultural practices linked to traditional forms of courtship and sexual communication among young Zulu people.

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Psyllids, or jumping plant lice (Hemiptera: Sternorrhyncha: Psylloidea), are a group of small phytophagous insects that include some important pests of crops worldwide. Sexual communication of psyllids occurs via vibrations transmitted through host plants, which play an important role in mate recognition and localization. The signals are species-specific and can be used to aid in psyllid taxonomy and pest control. Several hypotheses have been proposed for the mechanism that generates these vibrations, of which stridulation, that is, friction between parts of the forewing and thorax, has received the most attention. We have investigated vibrational communication in the European pear psyllid species Cacopsylla pyrisuga (Foerster, 1848) using laser vibrometry and high-speed video recording, to directly observe the movements associated with signal production. We describe for the first time the basic characteristics of the signals and signal emission of this species. Based on observations and analysis of the video recordings using a point-tracking algorithm, and their comparison with laser vibrometer recordings, we argue that males of C. pyrisuga produce the vibrations primarily by wing buzzing, that is, tremulation that does not involve friction between the wings and thorax. Comparing observed signal properties with previously published data, we predict that wing buzzing is the main mechanism of signal production in all vibrating psyllids.

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BACKGROUND: According to socialization theory, parental sex education should lead to increased sexual literacy in adolescents. However, current data for Germany is lacking. RESEARCH AIM: Against this backdrop, the aim of the present study was to link for the first time the general conversations about sexuality in the family (research question 1, RQ1), and specifically parental contraception education (RQ2), with the sexual risk behavior of adolescents. MATERIALS AND METHODS: The database is the ninth wave of the representative survey "Youth Sexuality" conducted by the Federal Centre for Health Education in Germany (BZgA). Data from all sexually active 14- to 17-year-old adolescents in the sample who provided information on their sexual behavior and whose parents reported on their sex education behavior were analyzed (N = 357). To answer the two research questions, logistic regression analyses were carried out with four central characteristics of adolescent sexual behavior. RESULTS: The results showed that for both girls and boys conversations about sexuality in the family are positively correlated with (1) reached age of consent at first sexual intercourse, (2) a positive first sexual intercourse experience, (3) reliable contraception use, and (4) a low number of sexual partners (RQ1). The same pattern of results emerged for contraception education by parents (RQ2). DISCUSSION: The positive correlations between parental sex education and less risky adolescent sexual behavior need to be further investigated with respect to the underlying causal mechanisms.

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BACKGROUND: Individuals may find it challenging and discomforting to communicate about sex because they may lack the skills and efficacy necessary to communicate their sexual desires. When individuals do have opportunities to have such discussions about sex in open and comfortable settings, they may seek informational support (i.e., advice) from a close friend because of knowledge sharing and past experiences navigating sex-related concerns. AIMS: This research study used a communication theory-based quantitative analysis to examine how advice givers' prosocial behaviors influence their advice outcome messages during conversations about sex. METHODS: A total of 264 participants completed a survey developed based on the Integrated Model of Advice-Giving (IMA). Data were analyzed using structural equation modeling. RESULTS: Advice givers reported that their emotional supportive messages elicited better quality advice. Additionally, advice givers indicated that being attentive and understanding to others' feelings elicited better disclosures about their own sexual experiences. Structural equation modeling results suggested a good model fit for the theoretical model (comparative fit index [CFI] = .939, tucker-lewis fit index [TLI] = .931, root mean square error of approximation [RMSEA] = .056, 90% confidence interval: [.049, .063], and standardized root mean square residual [SRMR] = .082). CONCLUSIONS: This study highlights the theoretical and pragmatic implications of communication theory in sexual health education interventions.

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African American women are 10.8 times more likely to be diagnosed with HIV compared with White women. This descriptive study fills a gap by examining associations among social and contextual factors and sexual communication, condom use, and safer sex negotiation among African American women. Study participants between 18 and 25 years of age and who reported recent substance use were recruited from three North Carolina counties. A risk behavior survey was administered via audio computer-assisted self-interview, and logistic regression analyses were conducted to assess associations between social and contextual variables and condom use at last sex with a main partner. Education (AOR: 2.078; 95% CI: 1.214, 3.556), sexual communication with a main partner (AOR: 1.079; 95% CI: 1.050, 1.109), and condom use relationship scale (AOR: 1.059; 95% CI: 1.023, 1.098) were positively associated with condom use at last sex, whereas living with a main partner (AOR: 0.447; 95% CI: 0.210, 0.950) and the alcohol and drug problem scale (AOR: 0.971; 95% CI: 0.944, 0.998) were negatively associated with condom use (p < 0.05). The study findings show that among young African American women at risk for HIV, contextual and personal factors may influence condom use. A socio-ecological approach combining personal empowerment, interpersonal, structural, and biobehavioral strategies is necessary in implementing holistic gender-focused HIV prevention programs.

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BACKGROUND: Sexual communication is a common target in psychological treatments for vulvodynia, and associations with sexual function and distress, as well as pain intensity, have been demonstrated. However, structured observations of the communication patterns of couples with vulvodynia are lacking, as these are needed to guide treatment efforts. AIM: To explore (1) the sexual communication patterns in couples with vulvodynia in terms of observed communication quality (operationalized as validating and invalidating responses), self-reported sexual assertiveness, and self-disclosure and (2) associations between sexual communication quality and pain intensity. METHODS: In a case-control design with within- and between-group comparisons, 62 couples engaged in videotaped discussions about their sexual relationship. Trained coders assessed the discussions by rating sexual communication (validation and invalidation) according to a structured behavioral coding scheme. Group differences in sexual communication quality were examined with parametric and nonparametric tests. Dyadic associations among observed communication quality, self-rated sexual assertiveness, and self-disclosure were examined within the actor-partner interdependence model. Multiple regression was used to test the predictive value of partners' validation/invalidation on the pain intensity of the women with vulvodynia. OUTCOMES: Observed communication quality (ie, validation and invalidation), self-reported sexual assertiveness, self-disclosure, and pain intensity. RESULTS: Partners of women with vulvodynia were more invalidating toward their partners than those of women without pain. There were no significant differences in validating/invalidating communication between women in the 2 groups or in validation between partners. Partners' validating communication were significantly associated with women's lower pain intensity. The sexual communication patterns differed between couples with and without vulvodynia, and the associations between validating/invalidating responses and sexual assertiveness were stronger in the vulvodynia group than in the group without pain. Results on validation/invalidation and self-disclosure were inconclusive. CLINICAL IMPLICATIONS: The results indicate a need to direct treatment interventions toward couples' sexual communication quality (ie, levels of validation and invalidation). STRENGTHS AND LIMITATIONS: Strengths include systematic behavioral coding and dyadic analyses. Limitations include the cross-sectional design and self-selection of participants. CONCLUSION: This study demonstrated sexual communication patterns specific to couples with vulvodynia, and we conclude that validation and invalidation are important components of the sexual communication of couples with vulvodynia as they relate to sexual assertiveness, women's self-disclosure, and pain intensity.

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BACKGROUND AND AIM: Life satisfaction refers to the perceived satisfaction of individuals concerning various aspects of their lives. The present study investigated the predictive role of sexual-related determinants in life satisfaction among married women. METHODS: A cross-sectional study was conducted from August to November 2021. A total of 350 married women with at least six months of cohabitation with husbands were included in the study. The study utilized a multi-stage random sampling method from 10 comprehensive health centers in Qazvin, Iran. Scores on the Emotional Intimacy Questionnaire (EIQ), Dyadic Sexual Communication Scale (DSCS), Female Sexual Distress Questionnaire (FSDQ), Female Sexual Quality of Life Scale (FSQLS), Female Sexual Function Index (FSFI), and Life Satisfaction Scale (LSS) were assessed. Data were analyzed using univariable and multivariable linear regression models with a significance level of p < 0.05. RESULTS: The mean age of participants was 33.77 years (SD = 9.77) and they had been married for an average of 10.21 years (SD = 9.93). The mean scores on the LSS were 20.16 (out of 35; SD = 6.79). Based on the multivariable linear regression model adjusted for socio-demographic characteristics, the two strongest predictors of life satisfaction among Iranian married women were marital intimacy (ß = 0.49, p < 0.001) and sexual functioning (ß = 0.17, p = 0.009). Together, these variables explained 45% of variance in life satisfaction. CONCLUSION: Given that marital intimacy and sexual functioning were the most significant sexual-related determinants of life satisfaction among married women, designing and implementing interventions which increase women's marital intimacy and sexual functioning might improve married women's life satisfaction.

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Difficulties related to sexual desire discrepancy are among the most common complaints in people seeking help in therapy. The aims of the current study were to test a mediation model using a bootstrapping procedure where the quality of the dyadic sexual communication plays a key role in increasing or diminishing the degree of perceived sexual desire discrepancy through sexual satisfaction. An online survey was administered through social media to N = 369 participants involved in a romantic relationship, measuring the quality of dyadic sexual communication, sexual satisfaction, the degree of the perceived sexual desire discrepancy, and a series of relevant covariates. As expected, the mediation model showed that a better quality of dyadic sexual communication is related to a lower degree of perceived sexual desire discrepancy through increased sexual satisfaction (ß = -0.17, SE = 0.05, [95% CI = -0.27, -0.07]). The effect held over and above the effect of the relevant covariates. The theoretical and practical implications of the present study are discussed.

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OBJECTIVE: The aim of this study was to examine the reliability and validity of the Male Post-coital Affect Scale (MPAS), which was developed to assess positive post-coital feelings in men. METHODS: After a pilot study, we validated our scale on a sample of American heterosexual men, who answered our questionnaire on the internet through Amazon Mechanical Turk. We tested the reliability using internal consistency. The validity was examined by assessing content, face and construct validity by testing the association between our scale, the Experience in Close Relationships Scale and other instruments. RESULTS: A total of 484 volunteers were included in the study. Cronbach's α for the scale was 0.83. Our scale was negatively correlated with attachment avoidance, r(482) = -0.36, p < 0.001) and Perceived Stress Scale, r(482) = -0.18, p < 0.001, and positively correlated with sexual satisfaction, r(482) = 0.18, p < 0.001. CONCLUSION: The MPAS is a reliable and valid tool to assess positive post-coital feelings in men.

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Prior research suggests that parents, peers, and media are popular sources of sexual information and beliefs among emerging adults. Sex-positivity is an orientation toward sex that emphasizes open-minded beliefs and communication about varying sexual behaviors, preferences, and orientations. The current study investigated whether these sexual information sources were associated with emerging adults' endorsement of sex-positive and sexual orientation-related sexual scripts, and if these sources and scripts were associated with sexual communication among a sample of college students ages 18-22 (n = 341). Results indicate that learning from television was positively related to sex-positive sexual script endorsement, and that sex-positive scripts were associated with more positive sexual communication. An interaction also emerged between gender and learning from television on sex-positive script endorsement, and between gender and learning from social media on sexual orientation-related script endorsement. The implications of these findings are contextualized within emerging adults' sexual agency and behavior. Future directions of research are also discussed.