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Full-Text Articles in Social and Behavioral Sciences

Sociopolitical Crisis And The Rise Of A Social Justice Superintendent In Charlottesville, Sara Lourdes Epperly Dec 2020

Sociopolitical Crisis And The Rise Of A Social Justice Superintendent In Charlottesville, Sara Lourdes Epperly

Educational Foundations & Leadership Theses & Dissertations

This qualitative case study examined one school superintendent’s handling of a sociopolitical crisis event over the course of its phased unfolding. A review of literature in the fields of both crisis management and social justice educational leadership supplied a conceptual lens for viewing the case. Key concepts from the crisis management literature included staged intervention, organizational learning, and transformative leadership. Key concepts from the literature of social justice educational leadership included criticality, inclusion, relationshipbuilding, and capacity-building. The study methodology involved the conduct of 17 interviews and collection of more than 100 related documents. Analysis of the data supported a series …


The Relationship Between Virginia Title 1 Spending And Minority Male Graduation Rates: A Longitudinal Study, Anastacio B. Marin Dec 2020

The Relationship Between Virginia Title 1 Spending And Minority Male Graduation Rates: A Longitudinal Study, Anastacio B. Marin

Educational Foundations & Leadership Theses & Dissertations

Over the past two decades, education funding in the United States has been redistributed to schools that lack sufficient financial resources to meet the needs of students (Boyle & Lee, 2015). The No Child Left Behind (NCLB) Act of 2001, the reauthorized Elementary and Secondary Education Act (ESEA), was enacted to increase academic accountability and achievement throughout the nation’s public-school systems. Nationwide, there is a persistent achievement gap between historically marginalized students and their affluent peers. This gap is evident in the Commonwealth of Virginia when measuring student proficiency on End of Course Assessments (EOCAs). For schools serving a large …


Concept Maps As Sites Of Rhetorical Invention: Teaching The Creative Act Of Synthesis As A Cognitive Process, Amy Lee Marie Locklear Dec 2020

Concept Maps As Sites Of Rhetorical Invention: Teaching The Creative Act Of Synthesis As A Cognitive Process, Amy Lee Marie Locklear

English Theses & Dissertations

Synthesis is one of the most cognitively demanding practices novice writers must undertake, and research demonstrates that first-year students’ synthesis writing practices result in more knowledge telling rather than knowledge creation and transforming. Pedagogies used to teach synthesis often focus on developing text-building strategies but lack explicit instruction on the more cognitively demanding conceptualizing behavior. To explore alternative pedagogies and heuristics, this study looks beyond composition scholarship to incorporate studies in neuroeducation and rhetoric to define synthesis as an ongoing, generative act of cognitive invention, effectively shifting pedagogical focus from text-centered product to student-centered cognitive processes that inform development of …


A Systemic Review And Meta-Analysis Of Psychoeducational Groups For The Treatment Of Psychopathology Resulting From Child Sexual Abuse, Alexis Lynnette Wilkerson Dec 2020

A Systemic Review And Meta-Analysis Of Psychoeducational Groups For The Treatment Of Psychopathology Resulting From Child Sexual Abuse, Alexis Lynnette Wilkerson

Counseling & Human Services Theses & Dissertations

It is estimated that 16% of men and 26% of women have experienced child sexual abuse (CSA), and studies have shown a strong association with long-term psychosocial consequences. The use of psychoeducational groups with survivors of CSA has been found to produce favorable outcomes; however, no meta-analyses have been conducted on studies assessing the use of psychoeducational groups to treat victims of CSA. The purpose of this systematic review and random-effect meta-analysis was to examine the efficacy of psychoeducational groups for the treatment of psychopathology subsequent to child sexual abuse (CSA) by addressing the following research questions (1) Are psychoeducational …


District Promotion Policies For Students With Disabilities: Examining Principal Interpretation And Implementation, Latoya Exum Floyd Dec 2020

District Promotion Policies For Students With Disabilities: Examining Principal Interpretation And Implementation, Latoya Exum Floyd

Educational Foundations & Leadership Theses & Dissertations

The number of students receiving special education services have steadily increased in the United States over the past decade. Students with disabilities (SWD) historically score lower on high stakes tests, and they require considerations beyond academic achievement for promotion. The growing number of SWD and accountability measures included in district promotion policies has resulted in a wide range of principal interpretation of district promotion policies. A principal’s interpretation of district promotion policies affects the district’s high school graduation and dropout rates. Therefore, unclear promotion policies can lead to inconsistent interpretation; which can lead to greater retentions and dropouts for SWD …


The Relationship Between The Earning Of Career And Technical Industry Credentials And The Virginia Economy, Anjanette Mcfadden Hendricks Dec 2020

The Relationship Between The Earning Of Career And Technical Industry Credentials And The Virginia Economy, Anjanette Mcfadden Hendricks

Educational Foundations & Leadership Theses & Dissertations

Nationally, the labor market is calling out for workers to fill the increasing number of job vacancies, but those qualified, skilled, and able to fill them are limited in supply or retiring in large numbers. As America’s key industries offer high salaries in return for candidates with the necessary skills and credentials to fill their vacancies, the skills learned and third-party industry credentials earned in secondary Career and Technical Education (CTE) programs seem to make a perfect fit for the student, employer, and the economy. However, unlike the favored US educational model of the four-year degree, the continued outdated perception …


Designing For The One-Shot: Building Consensus On Design Processes For Academic Librarians, Kirsten Hostetler Dec 2020

Designing For The One-Shot: Building Consensus On Design Processes For Academic Librarians, Kirsten Hostetler

STEMPS Theses & Dissertations

Academic librarians have long been responsible for teaching information literacy competencies on college campuses, even as many are hesitant to accept the title of teacher. With inadequate instructional design preparation and one-shot sessions serving as a popular, if limited, instructional medium, librarians’ design processes are often developed on the job and infrequently explored in the literature. Previous research has examined specific design models and instructional strategies, but no studies were found that determined how academic librarians select and implement these design decisions within the unique context of a one-shot.

The purpose of this study was to describe academic librarians’ design …


A Meta-Analysis Of Group Treatment Outcomes For Veterans With Substance Use Disorders, Robert “Tony” Dice Dec 2020

A Meta-Analysis Of Group Treatment Outcomes For Veterans With Substance Use Disorders, Robert “Tony” Dice

Counseling & Human Services Theses & Dissertations

Group therapy is commonly used in the treatment of substance use disorders (SUD). Many studies exist related to the efficacy of group interventions for veterans with SUDs. A meta-analysis and systematic review of the literature addressing the use of group therapy, specifically psychoeducational groups, cognitive behavioral therapy (CBT) groups and support groups, in the treatment of SUDs with veterans was conducted. The following questions guided the research: What are viable treatment outcomes for psychoeducational, CBT, and support groups of veterans with SUDs? and What are the measures that capture outcomes related to psychoeducational, CBT, and support groups of veterans with …


Defying The Odds: The Resilience Of African American Youth In The Face Of Differential Treatment In The Classroom, Frank R. Wood Jr. Dec 2020

Defying The Odds: The Resilience Of African American Youth In The Face Of Differential Treatment In The Classroom, Frank R. Wood Jr.

Sociology & Criminal Justice Theses & Dissertations

In the education system, African American youth are confronted by deficit-based narratives of intellectual inferiority and defiance that inform teaching pedagogies, curricula, and classroom management strategies, such as school discipline practices. In light of available research documenting the deleterious effects of low expectations and treatment by teachers on the academic outcomes of African American youth, this body of knowledge also underscores the importance of racial socialization and positive perceptions of school bonding in safeguarding the academic achievement and success of African American youth. However, the lack of criminological inquiry into the complex associations between perceptions of differential treatment by teachers, …


A Multiple Case Study Investigating Principles Of Design And Implementation Of Operational Safety Plans For Crises At Colleges, Universities, And Affiliated Institutions, Antonio Passaro, Jr. Dec 2020

A Multiple Case Study Investigating Principles Of Design And Implementation Of Operational Safety Plans For Crises At Colleges, Universities, And Affiliated Institutions, Antonio Passaro, Jr.

Educational Foundations & Leadership Theses & Dissertations

In the wake of the 2007 Virginia Tech tragedy, the Virginia state legislature mandated that all college-affiliated institutions create an operational safety plan for natural and manmade crises. Previous empirical research has mostly focused on documenting faculty and students’ perceptions of campus safety, preparations for manmade crises over natural disasters, and enhancing specific aspects of emergency responses for future incidents. Thus, design and implementation “best practices” for higher education operational safety plan protocols is an understudied, yet burgeoning area of inquiry. To address this literature gap, a comparative case study of five institutions was conducted using a novel document analysis …


Property, Wealth, Race, And Power: An Introduction To Critical Resource Theory, Andrew Whitfield Aug 2020

Property, Wealth, Race, And Power: An Introduction To Critical Resource Theory, Andrew Whitfield

Educational Foundations & Leadership Theses & Dissertations

School funding inequality is an issue that has plagued America and the Commonwealth of Virginia for years (Owings & Kaplan, 2020). Understanding the role that funding plays in education is one that is of extreme importance today This study explored the relationship between income inequality and how education is funded. This study follows a quantitative study approach using correlational methods. This study takes multiple facets from Critcal Theory, Critical Race Theory, and Resource Dependency Theory to introduce a new theory, Critical Resource Theory The results indicated there is a practically significant relationship between income inequality and education funding. These findings …


Quasi-School Leaders: The Lived Experiences Of High School Counseling Directors And Their Role In Schools, Andrea Cherice Simon Aug 2020

Quasi-School Leaders: The Lived Experiences Of High School Counseling Directors And Their Role In Schools, Andrea Cherice Simon

Educational Foundations & Leadership Theses & Dissertations

The aim of this study is to explore the lived experiences of high school counseling director’s and how their principal and district school counseling supervisor shape their experiences as leaders. The role of high school counseling director’s is increasingly complex, unique, and oftentimes misunderstood. They are often viewed as leaders and change agents in student’s overall success due to their unique skill levels in advocacy and collaboration (Kaffenberger, Murphy, & Bemak, 2006; McMahon, Mason, Daluga-Guenther, & Ruiz, 2014; Young, Millard, & Kneale, 2013). However, principal’s and district school counseling supervisors are key players in defining the role and responsibilities of …


Counselor Education Doctoral Students’ Research Self-Efficacy: A Concept Mapping Approach, Zahide Sunal Aug 2020

Counselor Education Doctoral Students’ Research Self-Efficacy: A Concept Mapping Approach, Zahide Sunal

Counseling & Human Services Theses & Dissertations

Research self-efficacy (RSE) is a key concept not only for counselor educators as successful researchers but also for the advancement of counselor education field. In the literature, researchers have studied multiple factors (e.g., research interest, productivity) to understand the complex nature of RSE phenomenon. Despite being informative, these studies only focused on partial aspects of the multilayered RSE, showing methodological and conceptual limitations. Particularly, we do not have a holistic understanding of RSE and the interrelated relationship among the factors informing RSE. In the current study, the researcher used a mixedmethods design, Concept Mapping (Kane & Trochim, 2007) to explore …


Alcohol Use And Drinking-Related Eating Restriction Behaviors Among College Students, Peter Preonas Aug 2020

Alcohol Use And Drinking-Related Eating Restriction Behaviors Among College Students, Peter Preonas

Psychology Theses & Dissertations

The combination of eating restrictions and alcohol use is a prevalent problem on college campuses. Some students engage in eating restrictions prior to drinking to limit their overall caloric intake or to enhance intoxication effects. To date, limited research suggests that drinking-related eating restriction behaviors are associated with additional and unique health risks relative to high-risk drinking or eating restrictions alone. As such, additional research examining this unique, risky set of behaviors is warranted. Consequently, the present study aimed to address gaps in the literature by further examining the risks associated with drinking-related eating restrictions and testing trait factors related …


Mindfulness And Its Impact On Adaptive Coping And Psychological Well-Being: An Intervention For Undergraduate Students, Charles Bradley Freligh Aug 2020

Mindfulness And Its Impact On Adaptive Coping And Psychological Well-Being: An Intervention For Undergraduate Students, Charles Bradley Freligh

Psychology Theses & Dissertations

The concept of mindfulness has been shown to positively impact psychological well-being, and one application of mindfulness-based interventions has been the development and implementation of courses specifically for college students, a population that has been shown to be particularly vulnerable to the negative impacts of stress. While these interventions have displayed beneficial outcomes, the mechanisms of how mindfulness exerts its impact remain unclear. One potential mechanism of mindfulness’ enhancement of well-being may be through its cultivation of an adaptive coping style in which an individual becomes more likely to approach and investigate stressors rather than avoid them. In this study, …


Trust Issues: A Case Study Of The Relationship Between Trust And Reform Implementation, Courtney R. Wilson Aug 2020

Trust Issues: A Case Study Of The Relationship Between Trust And Reform Implementation, Courtney R. Wilson

Educational Foundations & Leadership Theses & Dissertations

Reform creation and implementation tends to focus on the mechanics needed to ensure intended outcomes are achieved. School relationships are affected by the tension caused by reform implementation. Research suggests trust among teachers and between teachers and their administrator affects the way teachers make sense of, implement, and use new reform efforts. Given the demands reforms place on schools, trust has the potential to impact and encourage the implementation of reform and the maintenance of relationships. A qualitative case study method was used to decipher the impact trust plays in the implementation of reform. The concept of trust is used …


International Student Recruitment, Retention, And Transfer Efforts At Top Community Colleges Hosting International Students In The United States, Alejandra Diaz-Rangel Aug 2020

International Student Recruitment, Retention, And Transfer Efforts At Top Community Colleges Hosting International Students In The United States, Alejandra Diaz-Rangel

Educational Foundations & Leadership Theses & Dissertations

The number of international students enrolled at community colleges across the U.S. has significantly shifted in recent years. As a result, higher education institutions across the country have developed and integrated rationales for attracting and retaining international students to their campuses. The purpose of this research study was to examine international student recruitment, retention, and transfer efforts taking place at community colleges in the U.S. The data that influence the international student recruitment, retention, and transfer plans set forth by community colleges in the U.S. was collected from decision makers at 15 U.S. higher education institutions through the means of …


Investigating The Impact Of The Fava Well-Being Protocol On Perceived Stress And Psychological Well-Being With At-Promise High School Students, Renee L. Fensom Aug 2020

Investigating The Impact Of The Fava Well-Being Protocol On Perceived Stress And Psychological Well-Being With At-Promise High School Students, Renee L. Fensom

Counseling & Human Services Theses & Dissertations

An elevation in stress levels can be caused by many contributing factors, which can ultimately interfere with the learning of young people. Fortunately, an increase in well being can help promote resilience, creating a buffer to stress. Therefore, the current study investigated the influence of a positive psychology intervention aimed at lowering perceived stress and increasing well-being among at-promise students. The theoretical framework for this study was based on Ryff’s Model of Psychological Well-Being (PWB). The specific intervention used was the Well-being Therapy School Protocol developed by Fava and associates, based off of Carol Ryff’s Model of PWB (Fava, 2016). …


Critical Language Awareness Pedagogy In First-Year Composition: A Design-Based Research Study, Megan Michelle Weaver Aug 2020

Critical Language Awareness Pedagogy In First-Year Composition: A Design-Based Research Study, Megan Michelle Weaver

English Theses & Dissertations

In this design-based research (DBR) study, I collaborated with two first-year composition (FYC) instructors in designing and implementing Critical Language Awareness (CLA) pedagogy to promote students’ linguistic consciousness while strengthening and enhancing their postsecondary writing skills. I designed and implemented this study by drawing on a critical theory of language, informed by literature on language ideologies (Silverstein, 1979; Irvine & Gal, 2000; Kroskrity, 2010) and raciolinguistics (Flores & Rosa, 2015; Alim, 2016), and a critical theory of pedagogy, informed by literature on critical pedagogy (Freire, 1970, 1973; Giroux, 2011) and critical race pedagogy (Ladson-Billings & Tate, 1995; Lynn, 1999). After …


Student Success Coaching In Virginia Community Colleges, Angela Lawhorne Aug 2020

Student Success Coaching In Virginia Community Colleges, Angela Lawhorne

Educational Foundations & Leadership Theses & Dissertations

Community college students face many barriers when they start college, especially if they are from first-generation families, are low-income, or identify as a minority. Retention and completion for these at-risk students are relatively low compared to those with higher socioeconomic backgrounds (Bettinger & Baker, 2014). To improve these statistics and promote academic persistence, some Virginia Community College System (VCCS) colleges have implemented student success coaching under the Chancellor’s College Success Coach Initiative (VCCS, 2011). This entails not only assisting students with academic coaching, but also with career, financial, and personal matters that may affect their academic success. The researcher sought …


Development And Validation Of The Students With Learning Disabilities School Counselor Self- Efficacy Scale: A Psychometric Study, Rawn Alfredo Boulden, Jr. Apr 2020

Development And Validation Of The Students With Learning Disabilities School Counselor Self- Efficacy Scale: A Psychometric Study, Rawn Alfredo Boulden, Jr.

Counseling & Human Services Theses & Dissertations

School Counselors play an important role in the success of all students. The American School Counselor Association (ASCA) and the Council for The Accreditation of Counseling And Related Educational Programs (CACREP) emphasizing the importance of school counselors in supporting the diverse needs of all students. Despite the efforts of the aforementioned association and accrediting body, the verdict is mixed regarding school counselors’ self-efficacy to counsel and support students with learning disabilities. This quantitative study aimed to develop and validate the Students with Learning Disabilities School Counselor Self-Efficacy Scale, an instrument that assesses school counselors’ belief in their ability to counsel …


Virginia Standards Of Accreditation: A Case Study Of Sensemaking And Policy Implementation In A School District, Shana Nicole Remian Apr 2020

Virginia Standards Of Accreditation: A Case Study Of Sensemaking And Policy Implementation In A School District, Shana Nicole Remian

Educational Foundations & Leadership Theses & Dissertations

The purpose of this paper is to explore the relationship between how school leaders at both the district and school level make sense of a policy change and how that understanding affects implementation. Specifically, this study explores how different factors affect individual sensemaking and the effect that has on policy implementation. Using an embedded case study methodology, data were collected through sixteen, semi-structured interviews. Additionally, field observations and document analysis were conducted to triangulate the data. Data were coded and analyzed to determine three major categories--policy ambiguity, internal and external factors, and communication. These three categories were integrated to form …


Impact Of School Librarians On Elementary Student Achievement, Lois D. Wine Apr 2020

Impact Of School Librarians On Elementary Student Achievement, Lois D. Wine

Teaching & Learning Theses & Dissertations

The purpose of this study was to determine if there is evidence that a full-time certified school librarian, trained and licensed based on state requirements, impacts fourth grade and fifth grade student scores on reading and/or mathematics end-of-year state achievement tests. Following over 30 years of school library impact studies, primarily correlational and qualitative studies, the school library field continues to have a lack of strong evidence of school librarian impact. This quasi-experimental matching design was conducted to determine if students who had full-time certified school librarians attained higher achievement scores than students who did not have full-time certified school …


Physical Education Teachers' Attitudes Towards Teaching Zumba To Children With Disabilities, Evelina C. Brandon Apr 2020

Physical Education Teachers' Attitudes Towards Teaching Zumba To Children With Disabilities, Evelina C. Brandon

Human Movement Sciences & Special Education Theses & Dissertations

The purpose of this study was to examine the attitudes of physical education teachers toward teaching Zumba to children with disabilities during physical education classes. Sixty-two physical education (PE) teachers (Mean Age = 42.13, 15 males, 47 females) participated in this cross-sectional survey design study. The survey data was analyzed using Pearson correlation methods, independent t tests, and the Cronbach’s coefficient technique to measure correlation, variance between participants, and the reliability and validity of the survey. Findings indicated that physical education teachers believed that teaching students Zumba in PE class would be beneficial and effective for students with disabilities. This …


Measuring The Additive Effects Of Multimedia Social Cue Principles On Learners’ Cognitive Load, Emotions, Attitude, And Learning Outcomes, Smruti J. Shah Apr 2020

Measuring The Additive Effects Of Multimedia Social Cue Principles On Learners’ Cognitive Load, Emotions, Attitude, And Learning Outcomes, Smruti J. Shah

STEMPS Theses & Dissertations

Multimedia principles are developed and employed to design effective multimedia instructions that foster learning. Specifically, multimedia principles such as personalization, voice, and embodiment principles are developed based on social cues to promote deep learning. Most researchers in the past have investigated the individual effects of these principles on learning. The goal of the present study was to investigate the additive effects of these abovementioned principles on learners’ perceived cognitive load, emotions, attitude, and learning outcomes (i.e. retention and transfer of knowledge). Sixty college students participated in this study. Participants were asked to complete two short instructional modules and a short …


Using The Question-Answer Relationship Strategy To Improve Listening Comprehension In Young Children With Autism Spectrum Disorder, Lisa A. Phalen Apr 2020

Using The Question-Answer Relationship Strategy To Improve Listening Comprehension In Young Children With Autism Spectrum Disorder, Lisa A. Phalen

Communication Disorders & Special Education Theses & Dissertations

A well-established research base indicates that many children diagnosed with autism spectrum disorder (ASD) experience deficits in reading comprehension skills. There is currently limited research which examines the relation between the communication and language impairments in ASD and emergent literacy skills in early childhood. Listening comprehension has been identified as one emergent literacy skill closely linked to reading comprehension development. The purpose of the study is to examine the effects of the question-answer relationship strategy (QAR) and QAR cue cards as a shared book reading intervention package on the listening comprehension skills of children with ASD. A single-subject concurrent multiple-baseline …


Neglected Cultural Outcomes That Impact Hispanic-Serving Institution Policymaking, Amanda Kate Burbage Apr 2020

Neglected Cultural Outcomes That Impact Hispanic-Serving Institution Policymaking, Amanda Kate Burbage

Educational Foundations & Leadership Theses & Dissertations

The Higher Education Act (HEA) Title V is designed to expand opportunities, increase attainment, and enhance institutional quality and stability of Hispanic-Serving Institutions (HSIs). The assessment of Title V goals relies on enrollment, retention, and graduation rates which reflect organizational outcomes that policymakers prioritized without deference to student population, institutional mission, and funding levels. Title V policymakers do not currently consider the ways HSIs centralize the racialized experiences of students and institutions do not uniformly collect or report cultural outcome data despite its relevancy to Hispanic student success.

The purpose of this study was to draw on criteria identified in …


Cultural Capital, Habitus, College Persistence And Graduation Among Black Immigrant-Origin Undergraduates: A Basic Interpretive Qualitative Study, Erica M. Richards Chew Apr 2020

Cultural Capital, Habitus, College Persistence And Graduation Among Black Immigrant-Origin Undergraduates: A Basic Interpretive Qualitative Study, Erica M. Richards Chew

Educational Foundations & Leadership Theses & Dissertations

Black immigrant-origin students are a significant sub-population of the total Black college student population, and they are persisting and graduating more frequently than Black U.S.-origin students. This study explored cultural capital and habitus and how they shaped the college persistence and graduation of Black immigrant-origin undergraduates and alumni from four-year postsecondary institutions. A basic interpretive qualitative design, guided by cultural capital theory, was used to explore thirteen Black-immigrant-origin students’ and graduates’ perspectives in-depth; and to describe their subjective meanings, actions, and social contexts from their point of view. Participants grew up with a habitus of achievement that came from the …


Service Learning And The Experiential Learning Cycle In Elementary School, Brittney D. Rose Apr 2020

Service Learning And The Experiential Learning Cycle In Elementary School, Brittney D. Rose

Teaching & Learning Theses & Dissertations

There has been an increase in interest in service learning in the past decade (Kuh et al., 2017). However, there has been less attention given to service learning in elementary school, particularly to service learning that does not focus on academic outcomes for the students (Scott & Graham, 2015). This qualitative instrumental case study utilized focus groups with fifth grade students, interviews with educators, education specialists and a nonprofit representative, and observational notes to explore students’ and educators’ experiences as they participated in a service learning project in conjunction with a nonprofit organization. Findings indicate that specific collaborative practices, such …


Comparison Of Motor-Enhanced And Visual-Enhanced Interventions For Grammar In Young Children With Developmental Language Disorder, Alisha P. Springle Apr 2020

Comparison Of Motor-Enhanced And Visual-Enhanced Interventions For Grammar In Young Children With Developmental Language Disorder, Alisha P. Springle

Communication Disorders & Special Education Theses & Dissertations

Up to 7.6% of children demonstrate a developmental language disorder (DLD), which can persist through adulthood, causing difficulty with academic achievement, social relationships, and financial stability. Grammar development, as a hallmark of DLD, is an important area of need for these children. Existing grammar interventions do not clearly distinguish the sensory input techniques that meet these children’s neurobiological instructional needs. This adapted alternating treatment design study implemented intervention using systematic paired visual and verbal and systematic paired motor, i.e. standardized gestures, and verbal sensory input techniques. A moderate-strong functional relation between intervention techniques using motor supports on grammatical outcomes in …