Cervical RadiculopathyNCT07906847
Correlation Between Forward Head Posture and Executive Functions in Cervical Radiculopathy
An observational study of Cervical Radiculopathy and Forward Head Posture, run by Cairo University at 1 site in Egypt.
Trial summary
PURPOSE: This study aims to: Investigate the relationship between Forward Head Posture (FHP), Pain Intensity and executive functions in patients with Cervical Radiculopathy (CR). Investigate whether the severity of Forward Head Posture (FHP) is correlated with the degree of executive dysfunction in this population. Read more about this study
- Who is it for?
- Ages 25 to 44 years
- Conditions the study is for
- Cervical Radiculopathy, Forward Head Posture
- How many people
- 80 participants
- Where
- 1 siteEgypt
- Study dates
- Oct 2026to Jan 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 to 44 years
- All sexes
- No healthy volunteers
- Adult
Study population: Adult patients aged 25 to 44 years of both sexes with chronic (more than 3 months) unilateral cervical radiculopathy due to disc prolapse at the C5-C6 or C6-C7 level, with pain radiating to one upper extremity. Diagnosis is established by a physician through clinical examination using provocative tests such as the Spurling test and/or confirmed by cervical spine MRI. Participants will be recruited from the Faculty of Physical Therapy, Kafrelsheikh University, and private clinics, and allocated into two groups according to the presence of forward head posture: Group A (FHP group) with a craniovertebral angle below 50°, and Group B (non-FHP group) without forward head posture. The age range corresponds to the normative age category used by the CogniFit platform for interpreting cognitive scores.
Who may be able to join
- • Patients diagnosed as cervical radiculopathy due to disc prolapse at the level of C5-C6 or C6-C7 for more than 3 months with pain that radiated to only one upper extremity (unilateral) (Menna Allah Badwy et al., 2025)
- Patients in (FHP group) will have forward head posture with a craniovertebral angle less than 50° (Abu-Ghosh et al., 2024)
- Participants aged 25-44 years will be included in this study, as this age range corresponds to the normative age category used by the CogniFit assessment platform for cognitive score interpretation. (Cognitive Assessment Battery (CAB), 2026)
Who cannot join
- • Patients with cervical myelopathy
- Acute cervical radiculopathy
- Neck pain without radiculopathy
- Previous cervical surgery
- Patients who have entrapment neuropathies in the upper limbs
- Any tumors or infections involving the cervical spine
Show all 10Show fewer
- A history of other neurological disorders
- Cervical trauma
- Participants use medications that may significantly affect cognitive function (e.g., sedatives)
- Participants with a Mini-Mental State Examination score of less than 24
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Egypt1 site
Faculty of Physical Therapy, Cairo University
Giza, Giza Governorate
About this study
Official title: Correlation Between Forward Head Posture and Executive Functions in Patients With Cervical Radiculopathy: A Cross-Sectional Study
PURPOSE:
This study aims to:
Read more
- Investigate the relationship between Forward Head Posture (FHP), Pain Intensity and executive functions in patients with Cervical Radiculopathy (CR).
- Investigate whether the severity of Forward Head Posture (FHP) is correlated with the degree of executive dysfunction in this population.
BACKGROUND:
Forward head posture (FHP) is a condition characterized by anterior translation of the head, resulting in sagittal plane misalignment of the cervical spine. It has become increasingly common in the digital era due to prolonged screen use and sedentary lifestyles. Previous studies have reported that this altered posture and the associated mechanical load on the cervical spine may be correlated with deficits in executive functions, including attention, processing speed, and working memory in older adults.
Executive function refers to higher-order cognitive processes responsible for goal-directed behaviour, such as maintaining and manipulating information in short-term memory and selecting task-relevant information. The prefrontal cortex (PFC) plays a central role in regulating these functions through its extensive neuroanatomical connections with multiple cortical and subcortical brain regions, allowing it to participate in several neural networks involved in cognitive control.
Recent evidence suggests that cognitive dysfunction may arise not only from localized lesions within these networks but also from degenerative or functional alterations affecting their integrity.
HYPOTHESES:
- There will be no significant association between Forward Head Posture (FHP), Pain Intensity and executive functions in patients with Cervical Radiculopathy.
- There will be no significant correlation between the severity of Forward Head Posture and the degree of executive dysfunction in this population.
RESEARCH QUESTION:
Is there an association between Forward Head Posture (FHP), Pain intensity and executive dysfunction in patients with Cervical Radiculopathy (CR)?
- Conditions
- Cervical Radiculopathy, Forward Head Posture
- Keywords
- Forward Head Posture, Cervical Radiculopathy, Executive Functions, Cognitive Function, Craniovertebral Angle, Neck Pain
- Medical subject headings
- Radiculopathy, Neck Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Cervical Radiculopathy with Forward Head Posture | Patients diagnosed with cervical radiculopathy who have forward head posture (e.g., craniovertebral angle below the cutoff value). They will be assessed for executive functions. | |
| Cervical Radiculopathy without Forward Head Posture | Patients diagnosed with cervical radiculopathy without forward head posture. They will be assessed for executive functions. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Cognitive inhibition assessed by CogniFit Stroop Test
Cognitive inhibition will be assessed using CogniFit's Stroop test, a digitized replica of the original task. The participant is asked to press the spacebar (go action) only if the color name on the screen is printed in the matching color, and to refrain from pressing (no-go) if the color of the letters does not match the printed color name. Performance on the test will be recorded as the outcome score.
Measured: Baseline (single assessment session at enrollment)
Mental flexibility assessed by CogniFit Trail Making Test (TMT)
Mental flexibility will be assessed using CogniFit's Trail Making Test, a digitized replica of the original task. It consists of two parts. In Part A, participants see numbers inside circles and tap them in ascending order. In Part B, participants see both numbers and letters and must alternate between them in ascending sequence (e.g., 1-A-2-B). The test should be completed as quickly as possible, with faster completion times indicating better performance.
Measured: Baseline (single assessment session at enrollment)
Working memory assessed by CogniFit Digit Span Test
Working memory will be assessed using CogniFit's Digit Span Test, a digitized replica of the task of the same name. The participant is required to remember and reproduce increasingly longer number sequences that appear one at a time on the screen. The test begins with a two-number sequence.
Measured: Baseline (single assessment session at enrollment)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 Oct 2026
- Study startOct 2026 (estimated)
- Primary completionJan 2027 (estimated)
- Study completionJan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (47)Papers the sponsor has linked to this study.
- Other trials for Cervical RadiculopathyStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Other
- Time perspective
- Cross-sectional
- Enrolment
- 80 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Naira Abd El-Mohimen Kamel El-Sayed Ata, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07906847
- Sponsor's protocol ID
- P.T.REC/012/006656
- Status last verified
- Oct 2026
- First submitted
- 26 Oct 2026
- Last updated
- 30 Oct 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008 May;13(2):148-54. doi: 10.1016/j.math.2006.11.002. Epub 2007 Mar 23.
PubMed 17368075Wilhelm O, Hildebrandt A, Oberauer K. What is working memory capacity, and how can we measure it? Front Psychol. 2013 Jul 24;4:433. doi: 10.3389/fpsyg.2013.00433. eCollection 2013.
PubMed 23898309Watanabe, N. (2021). Response of Prefrontal Cortex to Executive Function Tasks in Early Childhood: An Exploratory Case Study for Childcare. International Journal of Psychological Studies, 13(3), 12. https://doi.org/10.5539/IJPS.V13N3P12
Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int. 2024 Jan 23;16(1):210-225. doi: 10.3390/neurolint16010014.
PubMed 38392955Thoomes EJ, Scholten-Peeters GG, de Boer AJ, Olsthoorn RA, Verkerk K, Lin C, Verhagen AP. Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review. Eur Spine J. 2012 Aug;21(8):1459-70. doi: 10.1007/s00586-012-2297-9. Epub 2012 Apr 25.
PubMed 22531897Terkawi AS, Tsang S, AlKahtani GJ, Al-Mousa SH, Al Musaed S, AlZoraigi US, Alasfar EM, Doais KS, Abdulrahman A, Altirkawi KA. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017 May;11(Suppl 1):S11-S18. doi: 10.4103/sja.SJA_43_17.
PubMed 28616000Suleiman, K., Al-Hadid, L., & Duhni, A. (2012). Psychometric Testing of the Arabic version of the Pittsburgh Sleep Quality Index (A-PSQI) among Coronary Artery Disease Patients in Jordan. Journal of Natural Sciences Research Www.Iiste.Org ISSN, 2(8). www.iiste.org
Stern A, Malik E, Pollak Y, Bonne O, Maeir A. The Efficacy of Computerized Cognitive Training in Adults With ADHD: A Randomized Controlled Trial. J Atten Disord. 2016 Dec;20(12):991-1003. doi: 10.1177/1087054714529815. Epub 2014 Apr 22.
PubMed 24756172Sharma, S., & Rawat, V. (2023). The Importance of Body Posture in Adolescence and its Relationship with Overall Well-being. Indian Journal of Medical Specialities, 14(4), 197-205. https://doi.org/10.4103/INJMS.INJMS_29_23
Sen A, Tai XY. Sleep Duration and Executive Function in Adults. Curr Neurol Neurosci Rep. 2023 Nov;23(11):801-813. doi: 10.1007/s11910-023-01309-8. Epub 2023 Nov 14.
PubMed 37957525Saleh AA, Alkholy RSAEHA, Khalaf OO, Sabry NA, Amer H, El-Jaafary S, Khalil MAEF. Validation of Montreal Cognitive Assessment-Basic in a sample of elderly Egyptians with neurocognitive disorders. Aging Ment Health. 2019 May;23(5):551-557. doi: 10.1080/13607863.2018.1428936. Epub 2018 Feb 9.
PubMed 29424560Puig-Divi A, Escalona-Marfil C, Padulles-Riu JM, Busquets A, Padulles-Chando X, Marcos-Ruiz D. Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. PLoS One. 2019 Jun 5;14(6):e0216448. doi: 10.1371/journal.pone.0216448. eCollection 2019.
PubMed 31166989Patwardhan AG, Khayatzadeh S, Havey RM, Voronov LI, Smith ZA, Kalmanson O, Ghanayem AJ, Sears W. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J. 2018 Feb;27(Suppl 1):25-38. doi: 10.1007/s00586-017-5367-1. Epub 2017 Nov 6.
PubMed 29110218Oakley PA, Moustafa IM, Haas JW, Betz JW, Harrison DE. Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison. J Clin Med. 2024 Apr 8;13(7):2149. doi: 10.3390/jcm13072149.
PubMed 38610914Mylonas K, Tsekoura M, Billis E, Aggelopoulos P, Tsepis E, Fousekis K. Reliability and Validity of Non-radiographic Methods of Forward Head Posture Measurement: A Systematic Review. Cureus. 2022 Aug 5;14(8):e27696. doi: 10.7759/cureus.27696. eCollection 2022 Aug.
PubMed 35935117
Study at a glance
From the registry record, last updated by the sponsor on 30 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Correlation Between Forward Head Posture and Executive Functions in Patients With Cervical Radiculopathy: A Cross-Sectional Study
- ClinicalTrials.gov ID
- NCT07906847
- Acronym / sponsor ID
- P.T.REC/012/006656
- Conditions
- Cervical Radiculopathy, Forward Head Posture
- Keywords
- Forward Head Posture, Cervical Radiculopathy, Executive Functions, Cognitive Function, Craniovertebral Angle, Neck Pain
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 80 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- Oct 2026 (estimated)
- Primary completion
- Jan 2027 (estimated)
- Study completion
- Jan 2027 (estimated)
- First posted
- 30 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
PURPOSE:
This study aims to:
- Investigate the relationship between Forward Head Posture (FHP), Pain Intensity and executive functions in patients with Cervical Radiculopathy (CR).
- Investigate whether the severity of Forward Head Posture (FHP) is correlated with the degree of executive dysfunction in this population.
BACKGROUND:
Forward head posture (FHP) is a condition characterized by anterior translation of the head, resulting in sagittal plane misalignment of the cervical spine. It has become increasingly common in the digital era due to prolonged screen use and sedentary lifestyles. Previous studies have reported that this altered posture and the associated mechanical load on the cervical spine may be correlated with deficits in executive functions, including attention, processing speed, and working memory in older adults.
Executive function refers to higher-order cognitive processes responsible for goal-directed behaviour, such as maintaining and manipulating information in short-term memory and selecting task-relevant information. The prefrontal cortex (PFC) plays a central role in regulating these functions through its extensive neuroanatomical connections with multiple cortical and subcortical brain regions, allowing it to participate in several neural networks involved in cognitive control.
Recent evidence suggests that cognitive dysfunction may arise not only from localized lesions within these networks but also from degenerative or functional alterations affecting their integrity.
HYPOTHESES:
- There will be no significant association between Forward Head Posture (FHP), Pain Intensity and executive functions in patients with Cervical Radiculopathy.
- There will be no significant correlation between the severity of Forward Head Posture and the degree of executive dysfunction in this population.
RESEARCH QUESTION:
Is there an association between Forward Head Posture (FHP), Pain intensity and executive dysfunction in patients with Cervical Radiculopathy (CR)?
Study design
- Observational model
- Other
- Time perspective
- Cross-sectional
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Cervical Radiculopathy with Forward Head Posture | – | –Patients diagnosed with cervical radiculopathy who have forward head posture (e.g., craniovertebral angle below the cutoff value). They will be assessed for executive functions. |
| Cervical Radiculopathy without Forward Head Posture | – | –Patients diagnosed with cervical radiculopathy without forward head posture. They will be assessed for executive functions. |
Who may qualify
- Ages
- 25 to 44 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
- Study population
- Adult patients aged 25 to 44 years of both sexes with chronic (more than 3 months) unilateral cervical radiculopathy due to disc prolapse at the C5-C6 or C6-C7 level, with pain radiating to one upper extremity. Diagnosis is established by a physician through clinical examination using provocative tests such as the Spurling test and/or confirmed by cervical spine MRI. Participants will be recruited from the Faculty of Physical Therapy, Kafrelsheikh University, and private clinics, and allocated into two groups according to the presence of forward head posture: Group A (FHP group) with a craniovertebral angle below 50°, and Group B (non-FHP group) without forward head posture. The age range corresponds to the normative age category used by the CogniFit platform for interpreting cognitive scores.
Key inclusion criteria (3 listed)
- • Patients diagnosed as cervical radiculopathy due to disc prolapse at the level of C5-C6 or C6-C7 for more than 3 months with pain that radiated to only one upper extremity (unilateral) (Menna Allah Badwy et al., 2025)
Key exclusion criteria (10 listed)
- • Patients with cervical myelopathy
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Cognitive inhibition assessed by CogniFit Stroop Test
Time frame: Baseline (single assessment session at enrollment)
Cognitive inhibition will be assessed using CogniFit's Stroop test, a digitized replica of the original task. The participant is asked to press the spacebar (go action) only if the color name on the screen is printed in the matching color, and to refrain from pressing (no-go) if the color of the letters does not match the printed color name. Performance on the test will be recorded as the outcome score.
Mental flexibility assessed by CogniFit Trail Making Test (TMT)
Time frame: Baseline (single assessment session at enrollment)
Mental flexibility will be assessed using CogniFit's Trail Making Test, a digitized replica of the original task. It consists of two parts. In Part A, participants see numbers inside circles and tap them in ascending order. In Part B, participants see both numbers and letters and must alternate between them in ascending sequence (e.g., 1-A-2-B). The test should be completed as quickly as possible, with faster completion times indicating better performance.
Working memory assessed by CogniFit Digit Span Test
Time frame: Baseline (single assessment session at enrollment)
Working memory will be assessed using CogniFit's Digit Span Test, a digitized replica of the task of the same name. The participant is required to remember and reproduce increasingly longer number sequences that appear one at a time on the screen. The test begins with a two-number sequence.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 30 Oct 2026.
- Background: PubMed 17368075Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008 May;13(2):148-54. doi: 10.1016/j.math.2006.11.002. Epub 2007 Mar 23.
- Background: PubMed 23898309Wilhelm O, Hildebrandt A, Oberauer K. What is working memory capacity, and how can we measure it? Front Psychol. 2013 Jul 24;4:433. doi: 10.3389/fpsyg.2013.00433. eCollection 2013.
- BackgroundWatanabe, N. (2021). Response of Prefrontal Cortex to Executive Function Tasks in Early Childhood: An Exploratory Case Study for Childcare. International Journal of Psychological Studies, 13(3), 12. https://doi.org/10.5539/IJPS.V13N3P12
- Background: PubMed 38392955Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int. 2024 Jan 23;16(1):210-225. doi: 10.3390/neurolint16010014.
- Background: PubMed 22531897Thoomes EJ, Scholten-Peeters GG, de Boer AJ, Olsthoorn RA, Verkerk K, Lin C, Verhagen AP. Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review. Eur Spine J. 2012 Aug;21(8):1459-70. doi: 10.1007/s00586-012-2297-9. Epub 2012 Apr 25.
- Background: PubMed 28616000Terkawi AS, Tsang S, AlKahtani GJ, Al-Mousa SH, Al Musaed S, AlZoraigi US, Alasfar EM, Doais KS, Abdulrahman A, Altirkawi KA. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017 May;11(Suppl 1):S11-S18. doi: 10.4103/sja.SJA_43_17.
- BackgroundSuleiman, K., Al-Hadid, L., & Duhni, A. (2012). Psychometric Testing of the Arabic version of the Pittsburgh Sleep Quality Index (A-PSQI) among Coronary Artery Disease Patients in Jordan. Journal of Natural Sciences Research Www.Iiste.Org ISSN, 2(8). www.iiste.org
- Background: PubMed 24756172Stern A, Malik E, Pollak Y, Bonne O, Maeir A. The Efficacy of Computerized Cognitive Training in Adults With ADHD: A Randomized Controlled Trial. J Atten Disord. 2016 Dec;20(12):991-1003. doi: 10.1177/1087054714529815. Epub 2014 Apr 22.
- BackgroundSharma, S., & Rawat, V. (2023). The Importance of Body Posture in Adolescence and its Relationship with Overall Well-being. Indian Journal of Medical Specialities, 14(4), 197-205. https://doi.org/10.4103/INJMS.INJMS_29_23
- Background: PubMed 37957525Sen A, Tai XY. Sleep Duration and Executive Function in Adults. Curr Neurol Neurosci Rep. 2023 Nov;23(11):801-813. doi: 10.1007/s11910-023-01309-8. Epub 2023 Nov 14.
- Background: PubMed 29424560Saleh AA, Alkholy RSAEHA, Khalaf OO, Sabry NA, Amer H, El-Jaafary S, Khalil MAEF. Validation of Montreal Cognitive Assessment-Basic in a sample of elderly Egyptians with neurocognitive disorders. Aging Ment Health. 2019 May;23(5):551-557. doi: 10.1080/13607863.2018.1428936. Epub 2018 Feb 9.
- Background: PubMed 31166989Puig-Divi A, Escalona-Marfil C, Padulles-Riu JM, Busquets A, Padulles-Chando X, Marcos-Ruiz D. Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. PLoS One. 2019 Jun 5;14(6):e0216448. doi: 10.1371/journal.pone.0216448. eCollection 2019.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Cervical Radiculopathy and Forward Head Posture, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 30 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Naira Ata (+201155490429, naierakamel3@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Cognitive inhibition assessed by CogniFit Stroop Test (time frame: Baseline (single assessment session at enrollment)). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07906847, which also lists 47 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Oct 2026.