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Articles 571 - 600 of 8616
Full-Text Articles in Psychology
From Heroic Imagination To Belonging-Focused Healing: A Tribute To Philip Zimbardo, Agnieszka Wilczynska
From Heroic Imagination To Belonging-Focused Healing: A Tribute To Philip Zimbardo, Agnieszka Wilczynska
Heroism Science
This article offers a reflective account of the Polish adaptation of the Heroic Imagination Project (HIP), a global educational initiative founded by Philip Zimbardo to promote everyday heroism through psychological awareness. As HIP took root in Poland, we developed a robust infrastructure of certified trainers, academic collaborators, and educational centers, reaching over 250 schools and 800 educators. Grounded in core psychological principles -- such as the bystander effect, social conformity, and prejudice -- the program empowered participants to resist negative social influences and cultivate moral courage. The experience also gave rise to Belonging Focus Therapy (BFT), a psychobiological and sociocultural …
Evaluating Generative Ai For Depression Diagnosis: Implications For Counselor Education And Supervision, Matthew Rensi, Chung-Fan Ni, Leo Gonzalez, Jr., Mindi Barta, Cass Dykeman, James Geisler
Evaluating Generative Ai For Depression Diagnosis: Implications For Counselor Education And Supervision, Matthew Rensi, Chung-Fan Ni, Leo Gonzalez, Jr., Mindi Barta, Cass Dykeman, James Geisler
Journal of Technology in Counselor Education and Supervision
This study evaluated the efficacy of three Generative AI tools—ChatGPT, Claude, and Gemini— in identifying Major Depressive Disorder (MDD) from 119 written clinical case descriptions. Each AI tool determined if cases met DSM-5 criteria for MDD. The results showed significant performance variations, with Gemini demonstrating an accuracy of 97%. These findings suggest the potential for AI assistance in clinical practice, while also underscoring the importance of professional judgment. The implications for counselor education include opportunities to integrate AI tools into training programs, particularly in courses on psychopathology and clinical skills. Educators can use these tools to enhance students’ diagnostic skills …
Exploring The Environmental Impacts Of Telemental Health Counseling: Balancing Accessibility, Sustainability, And Climate Concerns, Daniel Bates, Greg Peterson, Vanessa Sinclair
Exploring The Environmental Impacts Of Telemental Health Counseling: Balancing Accessibility, Sustainability, And Climate Concerns, Daniel Bates, Greg Peterson, Vanessa Sinclair
Journal of Technology in Counselor Education and Supervision
In response to the COVID-19 pandemic, a nation-wide quarantine was mandated, which had a significant impact on the economy, healthcare, and lifestyle. It also dramatically changed the way mental health services were delivered. Many clinicians in private practice and at agencies rapidly transitioned the administration of mental health treatment to an online platform. The rapid upsurge of utilization of telemental health counseling (TMHC) yielded unexpected environmental benefits that have come to light by recent research. Some researchers shared concerns of TMHC efficacy compared to in-person counseling, however, other research comparing TMHC to in-person found comparable therapeutic outcomes. Research has also …
The State Of Telemental Health Training And Education In Cacrep-Accredited Counselor Education Master’S Programs, Jocelyn Novella, Davide Mariotti
The State Of Telemental Health Training And Education In Cacrep-Accredited Counselor Education Master’S Programs, Jocelyn Novella, Davide Mariotti
Journal of Technology in Counselor Education and Supervision
Despite the frequent use of telemental health (TMH) to deliver clinical mental health counseling, there are few specific guidelines for the teaching of this important topic in CACREP-accredited counselor education programs. This study examined TMH training and education in master’s-level CACREP-accredited counselor education programs by surveying CACREP liaisons (n = 62). The results were analyzed using frequencies, and questions were cross-tabulated with basic information about the programs’ faculty, students, and method of teaching. Results will inform current practices in the training of counselors in this expanding delivery system.
Evaluating Counseling Skills Through Language Style Matching: A Computer-Aided Text Analysis Of Suicide And General Counseling Transcripts, Chung-Fan Ni, Justin Jacques, Charles Silber, Cass Dykeman
Evaluating Counseling Skills Through Language Style Matching: A Computer-Aided Text Analysis Of Suicide And General Counseling Transcripts, Chung-Fan Ni, Justin Jacques, Charles Silber, Cass Dykeman
Journal of Technology in Counselor Education and Supervision
This pilot study applies Computer-Aided Text Analysis (CATA) to examine Language Style Matching (LSM) in counseling transcripts, offering a novel metric for counselor education and supervision. Analyzing 50 suicide-focused and 100 general counseling sessions using LIWC-22 software, we found high LSM scores in both contexts (suicide-focused: M = 0.906; general: M = 0.903). Bayesian analysis provided moderate evidence (BF01 = 5.048) in support of the null hypothesis, indicating no significant difference between the two session types. The consistently high LSM suggests counselors effectively build strong alliances and align with client goals across topics. LSM analysis provides an objective measure of …
Computational Thinking As A Novel Framework For Enhancing Cognitive Organization In Older Adults With Cognitive Frailty (Letter To The Editor), Daisuke Akiba
Publications and Research
As aging populations grow, especially in high-income nations, the burden of dementia-related care continues to escalate both economically and socially. In response, this article introduces Computational Thinking (CT) as a novel, non-pharmacological framework to support cognitive organization in older adults experiencing cognitive frailty. Though CT has gained traction in fields like PK-16 education, including special education, for enhancing executive function and problem-solving, it has not yet been applied to geriatric- or memory-care contexts. This perspective proposes that CT’s core components (i.e., decomposition, pattern recognition, abstraction, and algorithmic thinking) may align with residual cognitive strengths in mild-to-moderate dementia, offering a strengths-based, …
Need Frustration And Poor Mental Health Among Collegiate Athletes: The Indirect Role Of Ruminative Thinking, Alanni N. Brown, Adrian J. Bravo, Stimulant Norms And Prevalence 2 (Snap2) Study Team
Need Frustration And Poor Mental Health Among Collegiate Athletes: The Indirect Role Of Ruminative Thinking, Alanni N. Brown, Adrian J. Bravo, Stimulant Norms And Prevalence 2 (Snap2) Study Team
Journal of Athlete Development and Experience
Vulnerability to negative mental health outcomes (i.e. anxiety and depression) among DI collegiate athletes may best be understood using Self Determination Theory (SDT) and the framework that need frustration impairs autonomy, competence, and relatedness. Need frustration may also relate to negative mental health symptoms via higher ruminative thinking, known to relate to both need frustration and poor mental health. The present study tested these two path models (i.e., SDT need frustration components [autonomy, relatedness, competency]-->rumination facets [problem-focused thoughts, counterfactual thinking, repetitive thinking, anticipatory thoughts]-->mental health problems (one for depression and one for anxiety as outcomes) among 341 collegiate …
Anxiety's Impact On Autism Spectrum Disorder Symtomology: An Investigation Into The Relationship Between Two Comorbities, Michaela Brown
Anxiety's Impact On Autism Spectrum Disorder Symtomology: An Investigation Into The Relationship Between Two Comorbities, Michaela Brown
LSU Doctoral Dissertations
Autism spectrum disorder (ASD) has been found to be frequently comorbid with many medical and psychological disorders, one of which is anxiety disorders. Research has shown that, when anxiety is present within ASD, various areas of the child’s functioning may be impacted, such as ASD symptom severity, emotional regulation skills, adaptability, social skills and daily living skills. The current study aimed to investigate this relationship of anxiety and ASD. First, within a sample of children and adolescents with ASD, the magnitude of the correlation between specific ASD symptoms parent-reported anxiety was compared to determine if certain ASD symptoms were more …
A Multidimensional Perspective Of Patterns Of Functioning And Well-Being, Lendi Nicole Joy
A Multidimensional Perspective Of Patterns Of Functioning And Well-Being, Lendi Nicole Joy
USF Tampa Graduate Theses and Dissertations
The Center for Behavioral Health Statistics and Quality estimates that 79.4% of U.S. adults will remain free from mental illness each year, but this does not necessarily mean they will enjoy positive psychological health and well-being. Well-being has been associated with positive outcomes such as greater health, longevity, work productivity, and increased social engagement. Thus, it is important for researchers to understand factors contributing to the development of well-being and optimal functioning. The current study used latent profile analysis to classify individuals based on their levels of well-being at ages 23 to 26 years and explored functioning indexes assessed when …
Evaluation And Expansion Of Posttraumatic Avoidance Assessment: Proposal Of A Novel Measure Of Posttraumatic Positive And Negative Experiential Avoidance For Use In Research And Clinical Practice, Marissa A. Yetter
Dissertations
Avoidance is a well-established mechanism in the development and maintenance of posttraumatic stress disorder (PTSD) and a central treatment target in gold standard evidence-based interventions. While traditionally defined as avoidance of trauma-related distressing thoughts, emotions, and reminders, emerging research highlights the need for a broader conceptualization of posttraumatic avoidance that includes both negative and positive emotional experiences. The current study aimed to explore an expanded conceptualization of clinically relevant posttraumatic avoidance using an experiential avoidance framework, a more generally defined unwillingness to remain in contact with distressing thoughts, feelings, memories, and other internal experiences. A sample of non-treatment seeking U.S.-based …
"Chatgpt Told Me To Say It": Ai Chatbots And Class Participation Apprehension In University Students, Daisuke Akiba
"Chatgpt Told Me To Say It": Ai Chatbots And Class Participation Apprehension In University Students, Daisuke Akiba
Publications and Research
The growing prevalence of AI chatbots in everyday life has prompted educators to explore their potential applications in promoting student success, including support for classroom engagement and communication. This exploratory study emerged from semester-long observations of class participation apprehensions in an introductory educational psychology course, examining how chatbots might scaffold students toward active and independent classroom contribution. Four students experiencing situational participation anxiety voluntarily participated in a pilot intervention using AI chatbots as virtual peer partners. Following comprehensive training in AI use and prompt design given to the entire class, participants employed systematic consultation frameworks for managing classroom discourse trepidations. …
The Virtual Kitchen Challenge: Psychometric Validation In Cognitively Healthy And Impaired Older Adults, Ross M. Divers
The Virtual Kitchen Challenge: Psychometric Validation In Cognitively Healthy And Impaired Older Adults, Ross M. Divers
LSU Doctoral Dissertations
Decline in everyday functioning is core diagnostic criteria for mild cognitive impairment (MCI) and dementia. While historically, MCI was considered a stage of generally persevered everyday functioning, it is now widely accepted that subtle though clinically meaningful changes in everyday function can be observed and are predictive of increased risk of future decline and conversion to dementia. Despite this, self and informant report questionnaires of everyday function largely fail to capture this subtle decline in those with MCI, while performance-based measures that may be able to capture this decline are rarely administered clinically due to their laborious administration. Performance-based measures …
Revalidation Of The Child Routines Questionnaire: Preschool, Christian Olivia Ledet
Revalidation Of The Child Routines Questionnaire: Preschool, Christian Olivia Ledet
LSU Doctoral Dissertations
The implementation of consistent, structured routines is considered a positive parenting practice that enhances child development and is a protective factor for developing externalizing behavior problems, particularly for preschool-age children as they learn to regulate their behavior. In recent years, electronic media consumption has increased among children of all ages, and excessive use is related to negative outcomes for children. Thus, a measure assessing routines of preschool children with items related to electronic media routines is important to further understand how routines affect children’s emotional and behavioral regulation and their interactions with their parents. The purpose of the current study …
Distinguishing Primary And Secondary Anomalous Self-Experience Using Momentary Variability, Michael D. Masucci
Distinguishing Primary And Secondary Anomalous Self-Experience Using Momentary Variability, Michael D. Masucci
LSU Doctoral Dissertations
Schizophrenia is associated with significant decreases in functioning and costly psychiatric hospitalization. However, it is frequently misdiagnosed due to phenotypic overlap with other disorders, and misdiagnosis can contribute to its functional and economic cost. Schizotypy and psychosis risk syndrome frameworks have been used to predict who will eventually develop schizophrenic psychosis, but accurate prediction caps at about 30% for individuals who are identified as “at risk” by these frameworks. Anomalous Self Experience (ASE), an alternative framework for understanding psychosis risk developed by phenomenological psychiatry, proposes that identifying fundamental alterations to sense of self are specific to schizophrenia and distinguish those …
Autism And Down Syndrome: An Examination Of The Baby And Infant Screen For Autism Traits In Toddlers With Down Syndrome, Celeste Tevis
Autism And Down Syndrome: An Examination Of The Baby And Infant Screen For Autism Traits In Toddlers With Down Syndrome, Celeste Tevis
LSU Doctoral Dissertations
Current research suggests that children with Down Syndrome (DS) are at an increased risk for autism spectrum disorder (ASD) compared to the general population. Detecting ASD early in children with DS is crucial to providing access to additional treatment services and supports that may be necessary. Despite a critical need to identify ASD as early as possible, diagnoses of ASD are often delayed in individuals with DS. It can be especially difficult for clinicians to differentiate between symptoms attributed to intellectual developmental disorder (IDD), a primary feature of DS, and possible ASD symptoms. Only two research studies have evaluated the …
Parents Of Adolescents On Electronic Use And Attention Deficit Hyperactivity Disorder: Parental Perspectives, Sleep, Internalization, Jessica Wiepking
Parents Of Adolescents On Electronic Use And Attention Deficit Hyperactivity Disorder: Parental Perspectives, Sleep, Internalization, Jessica Wiepking
Walden Dissertations and Doctoral Studies
ADHD in adolescents is a common diagnosis, with exposure to daily electronic use. There is strong evidence for a relationship between electronic use and ADHD in adolescents. However, there is a gap on electronic use, internalized feelings, and sleep behaviors in ADHD adolescents and how sleep behaviors might impact that relationship. ADHD has its core symptoms that impact the individual daily. These symptoms need to be taken into consideration when looking at internalized feelings and sleep behavior patterns. The theoretical framework that aligns with this study is the Dopaminergic Dysregulation Theory (DDT). This theory is a module that suggests that …
Attention Problems In Black Children Presenting To Pediatric Integrated Primary Care: Comorbidities And Gender Differences, Jaylynn A. Floyd, Heather A. Jones
Attention Problems In Black Children Presenting To Pediatric Integrated Primary Care: Comorbidities And Gender Differences, Jaylynn A. Floyd, Heather A. Jones
McNair Journal at VCU
Introduction: Attention-deficit/ hyperactivity-disorder (ADHD) is a neurodevelopmental disorder with a lifetime prevalence rate of 8.7% (Centers for Disease Control and Prevention, 2022). Numerous previous studies have exhibited how ADHD can be debilitating with both symptoms and impairments, but Black youth remain understudied (Green et al., 2024). To add, ADHD may present differently depending on one’s gender (Young et al. 2020), and bias has been shown to influence ratings of someone’s ADHD symptoms (Fairman et al., 2020). To combat these health disparities seen within the literature, this study aimed to describe attention problems in Black youth and to investigate whether attention …
Autism Care Continuum: Exploring Specialty Services Across The Lifespan Within U.S. Academic Medical Centers, Alexis Khuu
Autism Care Continuum: Exploring Specialty Services Across The Lifespan Within U.S. Academic Medical Centers, Alexis Khuu
Theses and Dissertations
Autistic people—particularly adults—experience high rates of co-occurring mental health problems and often report unmet service needs. Although several barriers to accessing quality care are well-documented, the broader landscape of autism-specific services across the lifespan remains under-researched. This two-part thesis aimed to address this gap by examining the availability of autism-specific services, as well as patterns in service utilization and associated costs, among autistic children and adults. The first study employed a systematic web-scraping protocol and data extraction procedure to identify and characterize autism specialty services offered by U.S. academic medical centers. This work revealed a general lack of autism specialty …
Investigating The Ecology Of The Homeless Court: The Promise Of Quasi-Experimental And Statistical Learning Methods, Dylan Wong
Theses and Dissertations
Interactions with the legal system are a crucial factor in maintaining homelessness. Difficulties in addressing legal issues are barriers to accessing services and finding employment and housing. Across the United States, the homeless court is an emerging legal program that has been developed to break this cycle, but they appear to face numerous capacity and coordination problems. Few empirical and systematic investigations have been conducted on homeless court programs. Further, previous studies of homeless courts focus their process and outcome measures on the priorities of the legal system. An investigation into the ecology, or environmental context, of homeless persons would …
Investigating Individual Variability In Autistic Identity And Its Moderating Effects On Mental Health And Quality Of Life, Sydney Richelle Terroso
Investigating Individual Variability In Autistic Identity And Its Moderating Effects On Mental Health And Quality Of Life, Sydney Richelle Terroso
Theses and Dissertations
The autistic community has long voiced the mental health of autistic adults as a key clinical and research priority. Autistic identity, or the recognition and embrace of core autistic traits as integral to an individual's identity as a whole, may be a potential target for therapeutic approaches aimed at supporting well-being and quality of life. The current study investigates individual differences in self-reported autistic identity scores by demographic factors and by features of autism and health history using online survey data from N=225 autistic adults. Additionally, with a subset of the participants who completed an interconnected study of current mental …
Social Comparison Target Selections As Health Information Preferences: Exploring Contextual Influences Among Women In Midlife With Elevated Risk For Cardiovascular Disease, Emmanuel Lapitan
Theses and Dissertations
Insufficient physical activity (PA) heightens the risk of chronic illnesses including cardiovascular disease (CVD), particularly among women in midlife with conditions such as hypertension. Behavioral interventions often use psychoeducation and skills training to increase PA, but how individuals interact with health-relevant information and how this relates to daily PA behavior is unclear. Health information preferences vary between individuals, but whether they vary for the same individual across contexts has been understudied. In particular, the role of contextual factors in predicting social comparison (i.e., evaluating oneself relative to others to obtain information about oneself) are not well understood. The purpose of …
Principal Component Analysis Of Emotion Related Concepts, Ana Kellermann Jimenez
Principal Component Analysis Of Emotion Related Concepts, Ana Kellermann Jimenez
Clinical Psychology Dissertations
Past research has established the overlap between several emotion-related factors, such as alexithymia, empathy, emotional intelligence, mindfulness, and mentalization. The aim of the present study was to analyze where these variables overlapped and how they related to different psychological and psychopathological variables. This was accomplished through the use of a Principal Component Analysis (PCA) and four canonical correlation models. The results indicated that there was an eight-component structure that included Alexithymia, Valuing Emotions, Mistrusting Emotions, Positive Reframe, Perspective-Taking, Empathetic Concern, Emotional Pessimism, and Avoiding Emotions. The internal reliability of the components ranged from adequate to excellent. The validity of the …
Examination Of An Experimental Paradigm Of Impaired Control Over Alcohol Use, Emily K. Junkin
Examination Of An Experimental Paradigm Of Impaired Control Over Alcohol Use, Emily K. Junkin
Psychology Theses & Dissertations
Alcohol use disorders peak during young adulthood with nearly 27% of individuals aged 18 to 30 meeting diagnostic criteria. Impaired control, or difficulty limiting alcohol use, has been identified as one of the earliest symptoms of an alcohol use disorder and is predictive of alcohol use severity. Despite the relevance of impaired control for identifying and preventing hazardous drinking behaviors, there is a dearth of research that exists on this critical risk factor. The current study tested an experimental paradigm of impaired control whereby participants self-administered alcohol following guidelines to limit consumption to a low level. It was hypothesized that …
Adapting A Personalized Normative Feedback Intervention For Graduate Student Drinkers, Faith Shank
Adapting A Personalized Normative Feedback Intervention For Graduate Student Drinkers, Faith Shank
Theses and Dissertations
On average, graduate students consume eight drinks per week, meeting criteria for heavy drinking and highlighting the need for a cost-effective intervention. The current study examined the efficacy of personalized normative feedback (PNF) for reducing heavy drinking in graduate students. Study 1 examined the feasibility and acceptability of the intervention content to inform a randomized controlled trial (RCT) of the intervention. Results from qualitative interviews with 13 graduate students who interacted with the intervention content preferred to receive feedback about peers enrolled in the same type of degree program. Study 2 was an RCT using PNF from peers with the …
The Lived Mental Health Experiences Of African American/Black Mothers With An Infant In The Neonatal Intensive Care Unit During Covid-19, Dr. Shewonyui S. Lurker
The Lived Mental Health Experiences Of African American/Black Mothers With An Infant In The Neonatal Intensive Care Unit During Covid-19, Dr. Shewonyui S. Lurker
Walden Dissertations and Doctoral Studies
African American/Black (AA/B) women are more likely than other women in the United States to give birth prematurely. Experiencing premature birth and infant hospitalization in the neonatal intensive care unit (NICU) during the COVID-19 pandemic may have negatively affected AA/B mothers’ mental health and led them to experience elevated rates of increased posttraumatic stress disorders, depression, anxiety, and postpartum depression. The purpose of this study was to understand the lived mental health experiences of AA/B mothers of infants in the NICU during COVID-19. Feminist theory provided a lens for understanding intersectionality in the experiences of AA/B mothers. Semistructured interviews were …
Outcomes Related To College Students' Attachment, Suzanne Vaccaro
Outcomes Related To College Students' Attachment, Suzanne Vaccaro
Psychology ETDs
Young adults aged 18-25 have the highest prevalence of mental health issues compared to adults over age 25. Mental health outcomes during emerging adulthood may be linked to early childhood variables, such as attachment, grounded in early caregiving, and adverse childhood experiences (ACEs) (Hughes et al., 2017; Waters & Roisman, 2019). The current study examined relationships between the attachment script assessment (ASA), a measure intended to elicit secure base script knowledge, indicative of secure attachment state of mind, ACEs, and mental health outcomes among a diverse sample of college students aged 18 to 25. Although results did not indicate relationships …
Gatekeeper Training As A Form Of Suicide Prevention: An Evaluation Of Applied Suicide Intervention Skills Training (Asist), Sarah E. Pardue-Bourgeois
Gatekeeper Training As A Form Of Suicide Prevention: An Evaluation Of Applied Suicide Intervention Skills Training (Asist), Sarah E. Pardue-Bourgeois
LSU Doctoral Dissertations
Applied Suicide Intervention Skills Training (ASIST) is the most widely used gatekeeper training (McAuliffe & Perry, 2007) and the literature examining its effects shows strong support for self-reported changes in attitudes and knowledge regarding suicide, and confidence to intervene with a person with thoughts of suicide (Gould et al., 2013; Shannonhouse et al., 2017a; Shannonhouse et al., 2017b; Shannonhouse et al., 2019). However, no research currently exists that investigates whether individuals trained in ASIST can provide the suicide-specific intervention skills post-training. Thus, the current study sought to extend the current literature by broadly investigating the following aims. Study aims investigated …
Relation Between Executive Functions, Ruminative Thinking Style, And Internalizing Symptoms In Neurodivergent Individuals., John Strom
Clinical Psychology Dissertations
Introduction: Neurodevelopmental disorders (NDD) are among the most common psychological disorders occurring in childhood (Bishop, 2010; Scandurra et al., 2019), and are commonly associated with a host of psychological challenges including deficits in executive functioning (Craig et al., 2016; Demetriou et al., 2019) as well as comorbid internalizing disorders such as depression and anxiety (Katzman et al., 2017; Kirsch et al., 2020; Simonoff et al., 2008). Research has suggested that executive function deficits may contribute to symptoms of depression and anxiety and that this relation may be mediated by ruminative thinking styles (Snyder et al., 2019; von Hippel et al., …
Invisible Intersections: Race, Adhd, And The Role Of Disciplinary Actions In Academic Outcomes, Miles Feller
Invisible Intersections: Race, Adhd, And The Role Of Disciplinary Actions In Academic Outcomes, Miles Feller
Clinical Psychology Dissertations
Race is a marginalized identity linked to significant achievement gaps for Black and Latino students in the USA (de Bray et al., 2019). These students experience higher rates of exclusionary school discipline (ESD) than White and Asian peers (Aud et al., 2010; de Bray et al., 2019), with suspensions correlating to lower academic performance (Del Toro & Wang, 2022; Wang et al., 2023; Owens & Hinshaw, 2016). Additionally, developmental disabilities like ADHD intersect with these issues; despite narrowing racial disparities in diagnoses (Cénat et al., 2022; Fairman et al., 2020), access to treatment remains uneven (Baglivio et al., 2017; Coker …
Impact Of Perceived Stress And Trait Resilience On Mental Health Outcomes Related To Traumatic Stress Exposure, Ken Safley
Clinical Psychology Dissertations
Traumatic stress exposure is common and associated with a range of adverse psychological outcomes, including anxiety, depression, and posttraumatic stress disorder (PTSD). These effects are cumulative, with increased exposure linked to greater psychological distress. However, there is considerable variability in how individuals respond to trauma, suggesting the influence of cognitive and dispositional factors. Cognitive models of PTSD highlight the role of stressor appraisals in the development of psychopathology, while individual differences in protective factors, such as trait resilience, may buffer these effects. The present study investigated whether perceived stress mediates the relationship between trauma exposure and psychological outcomes, and whether …