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Maternal, Child Health and Neonatal Nursing Commons™
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Articles 1 - 30 of 54
Full-Text Articles in Maternal, Child Health and Neonatal Nursing
Advancing Exclusive Breastfeeding Through Prenatal Education, Emr Optimization, And Community Partnership: A Champs National Quality Improvement Initiative, Heather Klein, Hannah Koepp
Advancing Exclusive Breastfeeding Through Prenatal Education, Emr Optimization, And Community Partnership: A Champs National Quality Improvement Initiative, Heather Klein, Hannah Koepp
InnovateHER Meeting 2026
CHAMPS National is a CDC-funded quality improvement initiative focused on improving exclusive breastfeeding rates, strengthening maternity care practices, and reducing racial disparities. This project implemented culturally responsive prenatal education, optimized EMR workflows, and strengthened community partnerships to support informed infant feeding decisions and improve breastfeeding equity.
A Planetary Health Approach To Address Food Insecurities In New Mexico, Mariah Kennell
A Planetary Health Approach To Address Food Insecurities In New Mexico, Mariah Kennell
Doctor of Nursing Practice Scholarly Projects
Food insecurity remains a persistent public health concern throughout New Mexico, impacting both rural and urban populations and contributing to significant health disparities. Limited access to affordable, locally sourced fresh foods exacerbates chronic disease burden and undermines community health. The purpose of this Doctor of Nursing Practice project was to conduct a comprehensive policy analysis to identify feasible state-level strategies to improve food access through strengthening local food systems. Using the Centers for Disease Control and Prevention POLARIS policy analysis framework, a structured evaluation of existing and potential state and community-level policies was conducted. The analysis incorporated stakeholder interviews with …
Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery
Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery
Journal of Appalachian Health
Introduction: Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.
Purpose: The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).
Methods: A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June – September 2021. The data were entered and analyzed from September 2022 – March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.
Results: About 32% of the …
Increasing Pediatric Hpv Vaccination Rates, Brooke A. Nicholas
Increasing Pediatric Hpv Vaccination Rates, Brooke A. Nicholas
Dissertations
Increasing Pediatric HPV Vaccination Rates
Abstract
Problem: The human papillomavirus (HPV) is a sexually transmitted infection that affects more than 80% of the population within the United States (Eisenhauer et al., 2020). HPV can develop into cervical, anogenital, and oropharyngeal cancers (Eisenhauer et al., 2020). About 4,000 individuals die from cervical cancer alone each year (O’Leary, 2022). The HPV vaccine, though recommended by the ACIP and AAP, is below national vaccination rates in comparison to other vaccines (O’Leary, 2022).
Methods: This quality improvement project is a non-randomized controlled trial that observed HPV vaccine dose completion rates for patients aged 9-14 …
Exercise As An Intervention For Postpartum Depression (Ppd), Kylie P. Mistretta
Exercise As An Intervention For Postpartum Depression (Ppd), Kylie P. Mistretta
Honors Scholar Theses
Objective: To illustrate the applications of exercise for preventing the development of postpartum depression (PPD) and addressing associated risk factors identified in the literature. Data Sources: PubMed and EBSCO: Academic Search Premier were accessed using the search terms exercise OR physical activity OR yoga AND postpartum depression OR postnatal depression. A secondary search of PubMed was conducted using the search terms exercise AND pregnancy AND depression OR gestational diabetes OR weight gain OR sleep quality.
Study Selection: Studies selected for inclusion were peer-reviewed, published after January 2012, written in English, and relevant to the PPD risk factors examined. Only clinical …
The Effects Of Medical Misinformation About Vaccines On Parents Of Pediatric Patients, Mya Izabela B. Emelia
The Effects Of Medical Misinformation About Vaccines On Parents Of Pediatric Patients, Mya Izabela B. Emelia
Nursing | Senior Theses
Abstract
Purpose
The purpose of this study is to evaluate the effectiveness of an educational intervention designed for parents of pediatric patients who are vaccine hesitant and its impact on childhood vaccination rates. This research proposal aims to assess whether targeted education addressing vaccine misinformation, safety concerns, and benefits influences parental decision-making and improves vaccine uptake.
Methods
Parents of pediatric patients will be recruited from pediatric clinics and community health centers. Participants will complete a baseline survey before receiving an educational intervention addressing vaccine misinformation, social media-driven misconceptions, and hesitancy. A post-intervention survey will then assess changes in vaccine hesitancy, …
Educating Nurses On Culturally Competent Intimate Partner Violence Care, Nicole Lee
Educating Nurses On Culturally Competent Intimate Partner Violence Care, Nicole Lee
Nursing | Student Research Posters
No abstract provided.
Quality Over Quantity: Doula Perspectives On Equity, Access, And Quality Of Care In Black Maternal Health Outcomes, Terry-Ann E. Lynch
Quality Over Quantity: Doula Perspectives On Equity, Access, And Quality Of Care In Black Maternal Health Outcomes, Terry-Ann E. Lynch
West Chester University Graduate Theses, Dissertations, and Final Projects
Black maternal mortality in the United States is a public health crisis. There are a plethora of reasons as to why maternal and fetal deaths disproportionately impact Black women. From a public health perspective, health disparities are an area of concern in marginalized communities, with Black maternal mortality being a risk factor. “According to the Centers for Disease Control and Prevention (CDC), in 2021, the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6)” Maternal Mortality Rates in the United States, 2021” …
Challenges And Barriers Faced By Healthcare Workers In Implementing Strategies To Reduce Teenage Pregnancy In Iligan City, Elise Janella A. Denila, Jydel Anne P. Dalangin, Wynne Nicole P. Englatiera, Dave William E. Almonia, Ian C. Abordo, Donna Belle P. Sumugat Rn, Man, Raymond M. Salvador
Challenges And Barriers Faced By Healthcare Workers In Implementing Strategies To Reduce Teenage Pregnancy In Iligan City, Elise Janella A. Denila, Jydel Anne P. Dalangin, Wynne Nicole P. Englatiera, Dave William E. Almonia, Ian C. Abordo, Donna Belle P. Sumugat Rn, Man, Raymond M. Salvador
Pacific Journal of Health
Aims: To investigate nursing strategies and their perceived barriers in reducing teenage pregnancy among barangays in Iligan City with high incidence of teenage pregnancy.
Study Design: This study uses qualitative, exploratory research design. This design is ideal for delving into complex issues and understanding phenomena in their real-world context.
Place and Duration of the Study: Iligan City Philippines, between September 2023 and May 2024
Methods: This study includes 6 healthcare workers experienced in handling teenage pregnancy and 25 teenagers who have experienced it. Participants were selected using purposive sampling to ensure they had relevant experiences. Data was collected through face-to-face, …
Prevalence Of Sickle Cell Trait And Needs Assessment For Uptake Of Sickle Cell Screening Among Secondary School Students In Kampala City, Uganda, Shamim Namukasa, Sarah Nakaziba, Grace Among, Lydia A Sasira, Posiano Mayambala, Joseph Atukwatse, Mary Namuguzi, Ahmed Sarki, Rose Maina
Prevalence Of Sickle Cell Trait And Needs Assessment For Uptake Of Sickle Cell Screening Among Secondary School Students In Kampala City, Uganda, Shamim Namukasa, Sarah Nakaziba, Grace Among, Lydia A Sasira, Posiano Mayambala, Joseph Atukwatse, Mary Namuguzi, Ahmed Sarki, Rose Maina
School of Nursing & Midwifery, East Africa
Background Sickle cell disease (SCD) is one of the most frequent and traumatizing genetic disease in Uganda, with the prevalence of the sickle cell trait (SCT) estimated at 13.3% leading to serious psycho-social and economic impact on the patients and their families.
Aim This study aimed to determine the burden of SCT and factors influencing the uptake of screening services among secondary school students in Uganda.
Methods We used an analytical cross-sectional design with a multi-stage sampling approach. A total of 399 students from four secondary schools in Kampala City were enrolled in this study. Data were gathered using semi-structured …
Doulas In Modern Health Care, Gabriella J. Lawrence
Doulas In Modern Health Care, Gabriella J. Lawrence
Soaring: A Journal of Undergraduate Research
This paper looks into whether the implementation of doulas by all hospitals would benefit mothers before, during, and after childbirth. Through previous research it is shown how traumatizing birth can be for mothers who don't feel that they have control within the labor and delivery room. High rates of augmentation, epidural anesthesia, and cesarean sections within hospitals are all causes of postpartum anxiety and depression among new mothers. By researching who a doula is and what they can do for mothers during childbirth, we can get a better understanding on how to prevent mental health disorders that are caused by …
The Impact Of Roe V. Wade Overturning On Women’S Access To Medical Abortions: Exploring Alternative Care Models, Gillie Mason
The Impact Of Roe V. Wade Overturning On Women’S Access To Medical Abortions: Exploring Alternative Care Models, Gillie Mason
Nursing | Student Research Posters
The Impact of Roe v. Wade Overturning on Women’s Access to Medical Abortions: Exploring Alternative Care Models
Medical abortion access is heavily influenced by state laws, with restrictive policies posing significant barriers for women seeking care. These barriers include limited local resources, travel burdens, and legal restrictions, which disproportionately affect marginalized populations. The Health Belief Model (HBM) highlights how individuals' perceptions of risks, benefits, and barriers shape their health decisions, making it an ideal framework for studying this issue (Rosenstock, 1974).
This research focuses on educating California-based providers to increase access to medical abortion services for patients in restrictive states. …
Feasibility Of Using Podcasts For Knowledge Dissemination To Reduce Health Disparities For Women Targeting Preventative Initiatives And Lifestyle Medicine Interventions, Kristin Stovern
Doctor of Nursing Practice Scholarly Project
The purpose of this feasibility project was to look at podcasts to shed light on the issues that affect the well-being of women with gender-based disparities in healthcare. Women face persistent obstacles when it comes to the quality of healthcare they receive. One of the barriers that has been ever-present is with failure of the medical system to rigorously study the effects of diseases and drugs on women or to fund studies on women’s health conditions. Implicit biases and lack of access to care inhibit the quality of healthcare. Collectively, these issues result in unnecessary sickness, disability, and decreased quality …
Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn
Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn
Master's Projects and Capstones
This quality improvement project aims to improve nurse education about Lovenox prophylaxis to reduce the risk of pulmonary emboli – post-discharge – amongst high-risk postpartum women who underwent vaginal and cesarean deliveries on the family baby unit. This project took place in a Family Baby/Postpartum Unit at Hospital SC. This unit has a total of 25 beds with an increased prevalence of pulmonary embolism following cesarean delivery. Nurses were given anonymous pre- and post-survey questionnaires and provided educational sessions with distributed handouts. A unit needs assessment was conducted using the 5 P’s. Out of the 72 nurses on the staff …
Breastfeeding In Public: A Review Of Literature And Service Learning Experience, Taylor Jehlik, Makenzie Carney
Breastfeeding In Public: A Review Of Literature And Service Learning Experience, Taylor Jehlik, Makenzie Carney
The Eleanor Mann School of Nursing Undergraduate Honors Theses
This article explores the perceptions and beliefs of first-time expectant mothers, their family members, and their social network about breastfeeding in public places. We used experience through Tiny Tusks and reviewed literature to get a better understanding of what social factors play a role in mothers' decisions to breastfeed in public.
Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll
Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll
Dissertations
Abstract
Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.
Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.
Results: Following implementation, Gardasil9 first dose uptake increased …
Medically Accurate Evidence-Based Sex Education And Abstinence-Only Sex Education: Impact On Teen Pregnancies In The United States, Nicole Chiu
Nursing | Senior Theses
The U.S. has funded abstinence-only programs to combat pregnancy rates for a long time. With numerous factors contributing to teen pregnancies, there have been a lot of ways that people have decided to try to decrease the number of teen pregnancies. For example, schools have either decided that they intend to fully educate their teenage students using medically accurate evidence-based sex education or come from a more conservative approach and give abstinence-only education. The objective of this investigation is to identify whether evidence-based sex education or abstinence-only sex education is more effective at combating teen pregnancy and abortion rates. This …
Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino
Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino
CURE Proceedings
As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …
Population-Based Linked Longitudinal Surveillance Of Pregnant People And Their Infants: A Critical Resource For Emerging, Re-Emerging, And Persistent Threats, Van T Tong, Kate R Woodworth, Erin Blau, Neha Shinde, Amanda Akosa, Suzanne M Gilboa, Dana Meaney-Delman
Population-Based Linked Longitudinal Surveillance Of Pregnant People And Their Infants: A Critical Resource For Emerging, Re-Emerging, And Persistent Threats, Van T Tong, Kate R Woodworth, Erin Blau, Neha Shinde, Amanda Akosa, Suzanne M Gilboa, Dana Meaney-Delman
Faculty, Staff and Student Publications
Public health emergencies, from Zika to COVID-19, have underscored the importance of addressing the needs of pregnant people and their infants. Recent events have underlined the critical role of mother-infant-linked longitudinal surveillance to characterize and assess the impacts of emerging, re-emerging, and persistent threats, including infectious diseases, on these populations. In partnership with state, local, and territorial health departments, CDC's National Center on Birth Defects and Developmental Disabilities activated the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) to capture information about pregnant people with laboratory-confirmed infection with SARS-CoV-2 (the virus that causes COVID-19) and their infants. SET-NET …
Childhood And Adolescent Obesity: Related Comorbidities And Interventions, Jasmine Wong
Childhood And Adolescent Obesity: Related Comorbidities And Interventions, Jasmine Wong
Nursing | Senior Theses
Background
The prevalence of childhood and adolescent obesity in the United States has steadily risen over the years and has become a public health concern. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Obese children and adolescents are at risk for poor health and poor quality of life. Furthermore, there are numerous comorbidities associated with childhood and adolescent obesity. While some of the associated diseases are acute, others can become chronic and result in lifelong conditions.
Objective
The purpose of the present thesis is to explore …
Parent And Child Anxiety Evaluated During An Early Period Of The Covid-19 Pandemic: A Mixed-Methods Study, Karla M. Abela, Darlene Acorda, Stanley Cron, Geri Lobiondo-Wood
Parent And Child Anxiety Evaluated During An Early Period Of The Covid-19 Pandemic: A Mixed-Methods Study, Karla M. Abela, Darlene Acorda, Stanley Cron, Geri Lobiondo-Wood
Journal of Patient-Centered Research and Reviews
Purpose: The objective of this study was to explore parent and child anxiety during the pandemic. Unlike previous pandemics, measures implemented to prevent the transmission of the SARS-CoV-2 virus have been much more limiting.
Methods: An explanatory convergent mixed-methods design was used to describe anxiety of children 9–17 years of age and their parents during August–October 2020. Adult and child versions of State-Trait Anxiety Inventory (STAI) were used to examine levels as measured on STAI’s state-anxiety subscale. Web-based interviews with a subset of patients were conducted qualitatively to analyze anxiety-related themes.
Results: A total of 188 parents …
First Generation Filipino Children And The Risk Of Childhood Obesity: Influence Of Screen Time, Krystal Joy Joy Ragasa
First Generation Filipino Children And The Risk Of Childhood Obesity: Influence Of Screen Time, Krystal Joy Joy Ragasa
Nursing | Senior Theses
Background: Obesity is an epidemic in the United States and among all Asian subgroups, Filipinos are particularly at a much higher risk. Obesity raises the risk of acquiring other health complications, especially for those who develop obesity at a younger age. Research has shown that children who engage in higher levels of screen time are more likely to become obese, resulting in screen time restrictions and recommendations. Additionally, rates of obesity are higher in immigrants. There is a gap in the explanation of screen time’s effect on childhood obesity for first generation Filipino children.
Aim: The purpose of the proposed …
Infant Car Seat Safety Education And Confidence Measure For Maternal-Child Nursing Students, Mariah A. Arnett
Infant Car Seat Safety Education And Confidence Measure For Maternal-Child Nursing Students, Mariah A. Arnett
Honors College Theses
Studies have shown that nursing students experience a greater-than-normal amount of anxiety and decreased clinical confidence when in settings involving infants and children, which is said to have a negative impact on the learning experience (Lassche, 2013; Moscaritolo, 2009). Patient education is a vital aspect of nursing, but one that the student nurse may not feel comfortable taking part in, either because of their lack of nursing experience or because of a lack of experience with infants and infant safety (Potter, 2020; Lassche, 2013). This project attempts to assess for a change in clinical confidence after providing a subject specific …
The Impact Of Outcomes On Depression Literacy In School-Age Children Who Received Depression Education, Loretta Q. Smith Aprn, Pnp-Bc, Bobby Bellflower Dnsc, Nnp-Bc, Faanp
The Impact Of Outcomes On Depression Literacy In School-Age Children Who Received Depression Education, Loretta Q. Smith Aprn, Pnp-Bc, Bobby Bellflower Dnsc, Nnp-Bc, Faanp
Doctor of Nursing Practice Projects
Purpose/Background Recognizing mental illness is crucial in adolescence. It is the second leading cause of suicide and death in children 10-19 years of age. Early identification and recognition of signs and symptoms could prevent progressive mental health illness in early childhood and adulthood. We are seeking to answer the PICO question: In adolescents between 10 and 19 years of age who are enrolled in school (P), how does receiving education on depression awareness (I) compared to not receiving education on depression awareness (C) affect depression scores (O)?
Methods This review was conducted on articles about adolescent children. These articles were …
The Relationship Of Child Health And Parenting Stress To Child Neurocognitive Development, Nancy Alise Farrell
The Relationship Of Child Health And Parenting Stress To Child Neurocognitive Development, Nancy Alise Farrell
Theses and Dissertations (ETD)
Problem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was …
Intention To Breastfeed: Breastfeeding Attitudes, Norms, Self-Efficacy, Social Support Network And Community Resources Of African American, Low-Income, Emerging Adult Women, Pregnant For The First Time, Sara E. Brown
Theses & Dissertations
African American (AA) women continue to have the lowest rates of breastfeeding. This continues to create a health disparity even though breastfeeding is extensively recognized in the scientific and health care communities as the optimal feeding choice for infants. This study examined the relationship between the external variables (social support network and community resources) and the explanatory variables (attitudes, norms, and perceived self-efficacy) and intention to breastfeed, for the AA, first time, low-income, emerging adult pregnant woman. The Integrated Behavior Model (IBM) was used as the theoretical framework to guide this study in better understanding the variables influencing breastfeeding intention. …
Tiny Tusks Internship: The Importance Of Breastfeeding Education In The Workplace, Gianna Hogan
Tiny Tusks Internship: The Importance Of Breastfeeding Education In The Workplace, Gianna Hogan
The Eleanor Mann School of Nursing Undergraduate Honors Theses
Breastfeeding education in public, especially in the workplace, is a concept that has a multitude of different perspectives. Research has shown that breastfeeding has many positive effects on mother and baby, that can be lessened due to the lack of breastfeeding support in various organizations. In this literature review, barriers to breastfeeding in the workplace were analyzed in order to understand the effects these barriers have on breastfeeding duration. In addition, this review helped emphasize the need for policies to be enacted in the workplace to better support breastfeeding mothers, and the impact these policies have on employee retention rates …
Knowledge, Attitudes, And Practices Of Adolescents Regarding Sexuality And Reproductive Issues In The Cordillera Administrative Region Of The Philippines, Eddieson Pasay-An, Judith Odanee G. Magwilang, Petelyne P. Pangket
Knowledge, Attitudes, And Practices Of Adolescents Regarding Sexuality And Reproductive Issues In The Cordillera Administrative Region Of The Philippines, Eddieson Pasay-An, Judith Odanee G. Magwilang, Petelyne P. Pangket
Makara Journal of Health Research
Background: This study investigates the knowledge, attitudes, and practices (KAP) concerning reproductive health (RH) and sexuality among in- and out-of-school adolescents in the Cordillera Administrative Region (CAR), Philippines.
Methods: Using a quantitative, cross-sectional approach, this study examined 739 in- and out-of-school adolescents who were recruited through snowball and simple random sampling.
Results: Statistically significant differences were noted in the knowledge, attitudes, and practices regarding sexuality based on age. Age was associated with knowledge, attitudes, and practices concerning RH. Educational attainment toward sexuality also caused statistically significant changes in knowledge, attitudes, and practices. The KAP regarding sexuality and …
Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams
Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams
Master's Projects and Capstones
Introduction
Perinatal substance use continues to be a major public health issue in women’s health. The purpose of this study was to determine the frequency of substance use screenings in care and assess how well the existing services in Marin County are serving the needs of pregnant and parenting women and identifying the gaps and/or weaknesses in current practice.
Methods
Data for this study was collected via semi-structured interviews with five professionals that worked at the local community clinic, hospital and a non-profit agency. Some questions were slightly modified to be configured toward the participant’s specific profession.
Results
Results from …
Contraceptive Methods In The United States: The Question Of Abortive Mechanisms, Tara Ferenczy
Contraceptive Methods In The United States: The Question Of Abortive Mechanisms, Tara Ferenczy
Senior Honors Theses
This thesis reviews the many methods of contraception available in the United States. Although society’s understanding of women’s health has become a major topic, there is still a significant deficit of information regarding how the accessible methods affect women’s bodies, specifically reproductive tissue. The thesis analyzes numerous contraceptive options focusing specifically on the mechanisms of action to determine whether options have abortifacient properties so that readers may develop educated opinions regarding medical and ethical uses. Information involving strengths and limitations of each technique and the effects on both the female body and the reproductive material assist in understanding the process …