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Articles 181 - 210 of 259
Full-Text Articles in Developmental Psychology
An Exploration Of The Effects And Clinical Presentations Of Premature Birth Within The Latinx Population, Diana Hill
An Exploration Of The Effects And Clinical Presentations Of Premature Birth Within The Latinx Population, Diana Hill
Dissertations
There are roughly ten percent, or 15 million, preterm births every year across the world. Therefore, it is vital to understand the impact on their development across cognitive, academic, socioemotional, and behavioral levels. A vast amount of research has shown that children who are born prematurely are more at risk of facing challenges across various areas of their development. However, the majority of the research samples have been limited within their scope, leaving behind a gap in research focused on specific subgroups within the population. By delving into the unique context of the Latinx population, this study endeavors to shed …
Relation Of Life Sciences Students’ Metacognitive Monitoring To Neural Activity During Biology Error Detection, Mei Grace Behrendt, Caron Clark, Mckenna Elliott, Joseph Dauer
Relation Of Life Sciences Students’ Metacognitive Monitoring To Neural Activity During Biology Error Detection, Mei Grace Behrendt, Caron Clark, Mckenna Elliott, Joseph Dauer
Department of Educational Psychology: Faculty Publications
Metacognitive calibration—the capacity to accurately self-assess one’s performance—forms the basis for error detection and self-monitoring and is a potential catalyst for conceptual change. Limited brain imaging research on authentic learning tasks implicates the lateral prefrontal and anterior cingulate brain regions in expert scientific reasoning. This study aimed to determine how variation in undergraduate life sciences students’ metacognitive calibration relates to their brain activity when evaluating the accuracy of biological models. Fifty undergraduate students enrolled in an introductory life sciences course completed a biology model error detection task during fMRI. Students with higher metacognitive calibration recruited lateral prefrontal regions linked in …
Psychological Distress And Behavioral Vigilance In Response To Minority Stress And Threat Among Members Of The Asian American And Pacific Islander Community During The Covid-19 Pandemic, Andrew S. Franks, Rin Nguyen, Y. Jenny Xiao, Dena Abbott
Psychological Distress And Behavioral Vigilance In Response To Minority Stress And Threat Among Members Of The Asian American And Pacific Islander Community During The Covid-19 Pandemic, Andrew S. Franks, Rin Nguyen, Y. Jenny Xiao, Dena Abbott
Department of Educational Psychology: Faculty Publications
Stigmatization, hostility, and violence towards the Asian American and Pacific Islander (AAPI) community have increased sharply during the COVID-19 pandemic. It is important to conduct research to promote understanding of the effects of such stigmatization on the AAPI community. Accordingly, the present study used a combined minority stress and integrated threat framework to examine whether factors related to AAPI identity would moderate the relationship between stigmatization/threat associated with AAPI identity and increased psychological distress and behavioral vigilance. AAPI individuals were recruited online from both Turk Prime and Reddit and completed measures of perceived stigmatization; integrated threat; depression, anxiety, and stress; …
Growing Through Adversity: The Relation Of Early Childhood Educator Post-Traumatic Growth To Young Children’S Executive Function, Caron A. C. Clark, Holly Hatton-Bowers, Kimia Akhavein, Sarah Rasby, Gilbert R. Parra
Growing Through Adversity: The Relation Of Early Childhood Educator Post-Traumatic Growth To Young Children’S Executive Function, Caron A. C. Clark, Holly Hatton-Bowers, Kimia Akhavein, Sarah Rasby, Gilbert R. Parra
Department of Educational Psychology: Faculty Publications
Introduction: Early childhood educators (ECEs) play a critical role in supporting the development of young children’s executive functions (EF). EF, in turn, underpins lifelong resilience and well-being. Unfortunately, many ECEs report adverse childhood experiences (ACEs) that may compound high stress levels associated with an emotionally and physically demanding profession. ACEs have well-established negative implications for adult well-being and may dampen ECEs’ capacities to engage in emotionally responsive interactions with children. However, many individuals who experience ACEs also report post-traumatic growth experiences that foster empathy, self-determination, and resilience. Such post-traumatic growth may equip teachers with skills to engage in responsive …
Impact Of Covid‑19 On Food Security And Diet Quality In Chilanga District, Zambia, Shela Sridhar, Janella Kang, Joyce Makasa, Sally Bell‑Cross, Isabel Madzorera, Ethan Zulu, Davidson H. Hamer
Impact Of Covid‑19 On Food Security And Diet Quality In Chilanga District, Zambia, Shela Sridhar, Janella Kang, Joyce Makasa, Sally Bell‑Cross, Isabel Madzorera, Ethan Zulu, Davidson H. Hamer
Department of Child, Youth, and Family Studies: Faculty Publications
Introduction Food security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs.
Methods We conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether …
Indicators Of Community Physical Activity Resources And Opportunities And Variation By Community Sociodemographic Characteristics: A Scoping Review, Ann E. Rogers, Michaela A. Schenkelberg, Peter Stoepker, Danielle Westmark, Deepa Srivastava, David A. Dzewaltowski
Indicators Of Community Physical Activity Resources And Opportunities And Variation By Community Sociodemographic Characteristics: A Scoping Review, Ann E. Rogers, Michaela A. Schenkelberg, Peter Stoepker, Danielle Westmark, Deepa Srivastava, David A. Dzewaltowski
Department of Child, Youth, and Family Studies: Faculty Publications
Objective: This scoping review synthesizes studies examining community-level variability in physical activity resource (assets) and opportunity (organized group physical activity services) availability by community sociodemographic characteristics to describe methodologies for measuring resources/opportunities, indicators characterizing availability, and associations between community-level sociodemographic characteristics and availability.
Methods: A systematic search was conducted in MEDLINE, CINAHL, PsycINFO, and Scopus for literature through 2022. Eligible studies quantitatively examined measures of physical activity resource/opportunity availability by community-level racial, ethnic, and/or socioeconomic characteristics within geospatially defined communities. Extracted data included: community geospatial definitions, sociodemographic characteristics assessed, methodologies for measuring and indicators of community physical activity …
A Descriptive Study Of Namibian Child Sex Offenders, Ndeyapo Emma Nafuka
A Descriptive Study Of Namibian Child Sex Offenders, Ndeyapo Emma Nafuka
Walden Dissertations and Doctoral Studies
The sexual abuse of children is a worldwide traumatic event with potential for adverse long-term physical and psychological consequences. There has been a plethora of research in the Western societies that examined offenders of child sexual abuse. Due to a number of methodological limitations, the findings of these studies cannot be used to effectively explain African offenders of child sexual abuse. This study employed a quantitative non-experimental, descriptive research approach method to examine the demographic and criminological characteristics of adult men who sexually abused children in Namibia. The data were collected by reviewing 183 files of Namibian male offenders incarcerated …
Religion And Spirituality In Psychotherapy: A Personal Bedrock Of Faith, Edward Shafranske
Religion And Spirituality In Psychotherapy: A Personal Bedrock Of Faith, Edward Shafranske
Psychology Division Scholarship
Personal beliefs and values conjoin with professional training to influence clinical practice. This article examines the role of religion and spirituality (R/S) through the lens of the author’s personal experiences and illustrates the confluence of faith, belief, identity, and practice in professional life. An autobiographical “glimpse” introduces the author’s formative experiences as a Roman Catholic and illustrates how religious narratives furnished conceptions of suffering, forgiveness, and transcendence that contributed to authentic hope for the client. Although often seemingly silent, R/S may influence psychotherapy practice. Clinical supervision provides a context to examine these personal factors.
Neurobiology And Treatment Of Relationships, Harvey Joanning
Neurobiology And Treatment Of Relationships, Harvey Joanning
University Faculty and Staff Publications
This paper presents a neurobiological theory of how intimate human relationships develop over the life span. It begins with an exploration of affective neuroscience, the study of emotions, and applies these concepts to the stages of relationship development. It goes on to explore the role of neurobiology in parenting, family life, divorce, and death of a spouse. Therapeutic interventions appropriate to each stage of relationship development are also explored. Every attempt is made to make this theory scientifically sound by basing the concepts described on published scientific research. “Hard science” has been differentiated from “clinical lore.” The reader is invited …
Social Emotional Development Of Rural Alaska Native And American Indian Maltreated Children, Tiffany Renee Chenery
Social Emotional Development Of Rural Alaska Native And American Indian Maltreated Children, Tiffany Renee Chenery
Walden Dissertations and Doctoral Studies
No abstract provided.
The Effects Of Parent’S History Of Childhood Maltreatment On Child Maltreatment Behaviors And Relationship Quality, Randi Crabtree
The Effects Of Parent’S History Of Childhood Maltreatment On Child Maltreatment Behaviors And Relationship Quality, Randi Crabtree
Walden Dissertations and Doctoral Studies
No abstract provided.
فعالية برنامج إرشادي قائم على مهارات العقل والجسم في تحسين مستوى الأمل لدى مريضات سرطان الثدي بمحافظة غزة, Diba M. Zain
فعالية برنامج إرشادي قائم على مهارات العقل والجسم في تحسين مستوى الأمل لدى مريضات سرطان الثدي بمحافظة غزة, Diba M. Zain
Journal of the Association of Arab Universities for Research in Higher Education مجلة اتحاد الجامعات العربية للبحوث في التعليم العالي
هدف المقال إلى معرفة مدى فعالية برنامج إرشادي باستخدام مهارات العقل والجسم، لتحسين مستوى الأمل لدى مريضات سرطان الثدي، واستخدمت الدراسة المنهج شبه التجريبي، وتكونت عينة الدراسة من (20) امرأة مصابة بسرطان الثدي، اللاتي يخضعن للعلاج في مستشفى الصداقة التركي بمدينة غزة، حيث تم تقسيم عينة الدراسة إلى مجموعتين متساويتين: مجموعة تجريبية، ومجموعة ضابطة. وقد استخدمت الباحثة مقياس الأمل إعداد سنايدر، وبرنامج لتحسين مستوى الأمل إعداد الباحثة، وقد أظهرت نتائج الدراسة وجود فروق دالة إحصائيًا عند مستوى دلالة (a=0.05) بين متوسطات درجات المجموعة التجريبية ونفسها في التطبيقين القبلي والبعدي على مقياس الأمل لصالح التطبيق البعدي، ووجود أثر كبير للبرنامج في …
2024, Camp Research Forum Book Of Abstracts, American Camp Association
2024, Camp Research Forum Book Of Abstracts, American Camp Association
ACA National Camp Research Forum Abstracts
This book includes 29 abstracts that will be presented at the 2024 American Camp Association (ACA) Research Forum to be held during the ACA annual conference from February 5-9 in New Orleans, LA. Abstracts have been grouped into similar areas and will be presented across five verbal sessions and one poster session.
International Consensus On Sleep Problems In Pediatric Palliative Care: Paving The Way, Anna Mercante, Judith Owens, Oliviero Bruni, Magda L. Nunes, Paul Gringras, Shirley Xin Li, Simonetta Papa, Ulrika Kreicbergs, Joanne Wolfe, Boris Zernikow, Ana Lacerda, Franca Benini, Pediatric Sleep And Palliative Care Group
International Consensus On Sleep Problems In Pediatric Palliative Care: Paving The Way, Anna Mercante, Judith Owens, Oliviero Bruni, Magda L. Nunes, Paul Gringras, Shirley Xin Li, Simonetta Papa, Ulrika Kreicbergs, Joanne Wolfe, Boris Zernikow, Ana Lacerda, Franca Benini, Pediatric Sleep And Palliative Care Group
Journal Articles: Munroe-Meyer Institute
OBJECTIVE: Sleep problems constitute a common and heterogeneous complaint in pediatric palliative care (PPC), where they often contribute to disease morbidity and cause additional distress to children and adolescents and their families already facing the burden of life-threatening and life-limiting conditions. Despite the significant impact of sleep problems, clinical evidence is lacking. The application of general pediatric sleep recommendations appears insufficient to address the unique challenges of the PPC dimension in terms of disease variability, duration, comorbidities, complexity of needs, and particular features of sleep problems related to hospice care. Therefore, we initiated an international project aimed at establishing a …
Epigenetics And Character Virtue Development, David S. Moore
Epigenetics And Character Virtue Development, David S. Moore
Pitzer Faculty Publications and Research
Current understandings of epigenetics offer some insights into the developmental origins of character virtues. Research on epigenetics has demonstrated that phenotypes depend on both genomic and non-genomic information for their development, and such is true for the development of character virtues as well. This conclusion offers significant support for the Developmental Systems perspective. Although researchers have not yet studied the role of molecular epigenetic factors in the development of character, the field of behavioral epigenetics has revealed how such factors contribute to psychological and other behavioral phenotypes in general. In particular, behavioral epigenetics research can highlight the plasticity of human …
The Influence Of School Policies On Black Students' Mental Health, Ama Ogyaa Boateng
The Influence Of School Policies On Black Students' Mental Health, Ama Ogyaa Boateng
Mahurin Honors College Capstone Experience/Thesis Projects
When educators target Black students’ hair through school policies, they inadvertently target their racial identity, causing harm to their mental health (Joseph- Salisbury & Connelly, 2018). While previous research has looked at the relationship between a school’s racial climate and Black students’ mental health (Mattison & Aber, 2007), this research study explored the mental health of Black adults who have experienced racial discrimination or racial microaggressions, in relation to hair and dress codes, as Black students in the K-12 school system.
A retrospective survey was used to explore the experiences that Black young adults had in the K-12 school system …
How Do Babies Come To Know What Babies Know?, David S. Moore, David J. Lewkowicz
How Do Babies Come To Know What Babies Know?, David S. Moore, David J. Lewkowicz
Pitzer Faculty Publications and Research
Elizabeth Spelke’s What Babies Know is a scholarly presentation of core knowledge theory and a masterful compendium of empirical evidence that supports it. Unfortunately, Spelke’s principal theoretical assumption is that core knowledge is simply the innate product of cognitive evolution. As such, her theory fails to explicate the developmental mechanisms underlying the emergence of the cognitive systems underlying that knowledge.
Attachment 101: How Early Bonds Affect Our Adult Lives, Megan Elizabeth Apfelberg
Attachment 101: How Early Bonds Affect Our Adult Lives, Megan Elizabeth Apfelberg
ENGS 15.11: Design and Education
This class explores the four main attachment styles–secure, avoidant, resistant (ambivalent) and disorganized–and how they impact our adult relationships. The lesson will utilize mini-lectures to explain the four attachment styles and provide frameworks for improving relationships based on attachment. Through interactive discussions and a case study activity, students will build skills to assess their own attachment styles and strategies to improve their relationships.
Proteomic Profiles Of Cytokines And Chemokines In Moderate To Severe Depression: Implications For Comorbidities And Biomarker Discovery, Kathleen T. Watson, Jennifer Keller, Caleb M. Spiro, Isaac B. Satz, Samantha V. Goncalves, Heather Pankow, Idit Kosti, Benoit Lehallier, Adolfo Sequeira, William E. Bunney, Natalie L. Rasgon, Alan F. Schatzberg
Proteomic Profiles Of Cytokines And Chemokines In Moderate To Severe Depression: Implications For Comorbidities And Biomarker Discovery, Kathleen T. Watson, Jennifer Keller, Caleb M. Spiro, Isaac B. Satz, Samantha V. Goncalves, Heather Pankow, Idit Kosti, Benoit Lehallier, Adolfo Sequeira, William E. Bunney, Natalie L. Rasgon, Alan F. Schatzberg
Psychology Division Scholarship
Objective: This study assessed the proteomic profiles of cytokines and chemokines in individuals with moderate to severe depression, with or without comorbid medical disorders, compared to healthy controls. Two proteomic multiplex platforms were employed for this purpose. Metods: An immunofluorescent multiplex platform and an aptamer-based method were used to evaluate 32 protein analytes from 153 individuals with moderate to severe major depressive disorder (MDD) and healthy controls (HCs). The study focused on determining the level of agreement between the two platforms and evaluating the ability of individual analytes and principal components (PCs) to differentiate between the MDD and HC groups. …
Examining The Impacts Of A Relational Savoring Intervention On Parental Reflective Functioning And Children’S Emotion Regulation Across Time, Megan Blackard
Examining The Impacts Of A Relational Savoring Intervention On Parental Reflective Functioning And Children’S Emotion Regulation Across Time, Megan Blackard
CGU Theses & Dissertations
The ability to regulate emotions is an important competency that enables goal attainment and maintenance of satisfying interpersonal relationships throughout life. Key to the development of healthy emotion regulation is the sensitivity of the caregiver. One internal mechanism underlying parents’ ability to be sensitive is parental reflective functioning, the ability to understand a child as having a complex inner world of thoughts, feelings, and beliefs that serve as the basis for the child’s behaviors. Strong parental reflective functioning allows parents to understand the needs behind children’s behavior and respond sensitively to meet those needs. The sensitive parenting that depends on …
What Removal Causes Are Most Common For Children In Foster Care? Are There Discrepancies Across Age Groups?, Elise Woodliff
What Removal Causes Are Most Common For Children In Foster Care? Are There Discrepancies Across Age Groups?, Elise Woodliff
Social Work Theses - Archive
Although there has been recent focus on child welfare to prevent removals, little literature has examined reasons children are removed among diverse developmental stages. The present study explores the multifaceted demographics of children in the foster care system in order to recognize who is being affected by what removal causes. The purpose of this study is to better understand the foster care system to target interventions and screenings for children under eighteen years of age in the United States. Quantitative measures were used to analyze statistics that were made available through the Adoption and Foster Care Analysis and Reporting System. …
Profiles Of Satisfaction And Frustration Of Undergraduate General Chemistry Students’ Basic Psychological Needs At The Beginning And End Of The Semester, Cara E. Worick
Theses and Dissertations--Educational, School, and Counseling Psychology
The early college years represent an adjustment period characterized by motivational destabilization and academic and career-related uncertainty for many STEM majors (Robinson et al., 2019). Although students who begin college less academically prepared than their peers are at greater risk of struggling in introductory STEM courses, many still struggle in these courses despite adequate academic preparation (Perez et al., 2014). Self-determination theory proposes that motivation, optimal functioning, and psychological well-being occur through the satisfaction, as opposed to the frustration, of three basic psychological needs for autonomy, competence, and relatedness (Ryan & Deci, 2020). Although many studies in educational settings demonstrate …
Examining The Relationship Between Puberty And Trauma Symptomatology, Justina M. Harsche
Examining The Relationship Between Puberty And Trauma Symptomatology, Justina M. Harsche
College of Graduate Studies: Theses & Dissertations
This study sought to examine the relation between puberty and trauma symptomatology in young adults. More specifically, does it matter what developmental period one is in when trauma occurs? Additionally, geographical region was examined as it relates to receiving and reporting mental health services and later trauma symptoms. Using data from 362 students at Georgia Southern University, multiple analyses were conducted. A Moderation Analysis where adverse events served as the predictor, trauma symptomatology as the outcome variable, and the developmental period in which the trauma occurred as the moderator was conducted. The interactions for this hypothesis were not significant. However, …
Identifying Youth Appeals In Alcohol Alternative Social Media Content Through Framing, Melina Oneal
Identifying Youth Appeals In Alcohol Alternative Social Media Content Through Framing, Melina Oneal
West Chester University Master’s Theses
Proposed regulations for alcohol advertising prevent beverage companies from targeting people under the legal drinking age. However, similar regulations for alcohol alternative beverages are less explored, which could allow alcohol alternative products to create awareness for alcoholic beverages among youth. Alcohol alternatives beverages, including no-alcohol and low-alcohol products, are increasing in popularity and can function as compliments to alcoholic products to decrease the total alcohol volume consumed or as substitutes for alcoholic products. Framing theory can be operationalized through the Content Appealing to Youth Index, an index of content elements found in research literature to be appealing to youth, to …
The Behavioral Origins Of Phylogenic Responses And Ontogenic Habits, W. David Stahlman, Kenneth J. Leising
The Behavioral Origins Of Phylogenic Responses And Ontogenic Habits, W. David Stahlman, Kenneth J. Leising
Psychological Science Articles
An examination of innate behavior and its possible origins suggests parallels with the formation of habitual behavior. Inflexible but adaptive responses-innate reflexive behavior, Pavlovian conditioned responses, and operant habits-may have evolved from variable behavior in phylogeny and ontogeny. This form of "plasticity-first" scientific narrative was unpopular post-Darwin but has recently gained credibility in evolutionary biology. The present article seeks to identify originating events and contingencies contributing to such inflexible but adaptive behavior at both phylogenic and ontogenic levels of selection. In ontogeny, the development of inflexible performance (i.e., habit) from variable operant behavior is reminiscent of the genetic accommodation of …
Healing Through The Struggle: Sociopolitical Empowerment As Context For Youth Thriving, Manijeh Fe Mahmoodzadeh Azadi
Healing Through The Struggle: Sociopolitical Empowerment As Context For Youth Thriving, Manijeh Fe Mahmoodzadeh Azadi
CGU Theses & Dissertations
Young people from marginalized groups are impacted by structural and societal injustice yet are systematically prevented from participating in processes that disrupt oppressive systems (Camino & Zeldin, 2002). Because social justice requires the inclusion of marginalized groups in sociopolitical processes, programs and initiatives intended to reduce these barriers to civic and social changemaking have become popular (Ginwright, 2018). In order to meaningfully support youth resistance, those who are positioned to collaborate with young people must be informed about youths’ experiences of oppression and the processes and implications of their sociopolitical empowerment. This explanatory sequential mixed-methods study used quantitative and qualitative …
Bird’S Nest Drawing: Exploring The Attachment Of Left-Behind Children In China, Ziyi Su
Bird’S Nest Drawing: Exploring The Attachment Of Left-Behind Children In China, Ziyi Su
Expressive Therapies Dissertations
To explore the attachment of left-behind children (LBC), this mixed-methods study analyzed the Bird’s Nest Drawings (BND) and narratives from 117 fourth graders from Shaanxi and Gansu, China. Overall, the BND of LBC showed less secure-attachment features. These distinctions can be seen in several pictorial elements, and manifest differently across gender groups and rural versus urban groups. Drawings and narratives revealed eight underlying themes of absence, longing, and support from parent and peer attachment. Children creatively communicated complex emotions and attachment experiences through the metaphor of the bird’s nest, ranging from abandonment, loneliness, and vulnerability, to coping, hope, and resilience. …
Analysis Of Current Treatment In Addressing Head-Directed Self-Injurious Behavior, Reid Wieczorek
Analysis Of Current Treatment In Addressing Head-Directed Self-Injurious Behavior, Reid Wieczorek
Schultz-Werth Award Papers
The many negative effects of brain damage have been well studied, and some populations are at a higher risk for this type of injury, such as athletes and soldiers. In response, research has led to the development of increased head protection solutions, such as helmets. However, this is not the case for all at-risk populations of head trauma, specifically individuals who engage in headdirected self-injurious behavior. This study was conducted to assess the ways in which BCBAs treat clients who engage in this behavior. The results yielded information on some key client demographics and different treatment strategies used to intervene …
Examining The Relation Between Anthropomorphism And Theory Of Mind, Noah Paulson
Examining The Relation Between Anthropomorphism And Theory Of Mind, Noah Paulson
Undergraduate Theses, Professional Papers, and Capstone Artifacts
Two ways people think about the mental state of others is through anthropomorphism and theory of mind. Anthropomorphism is the attribution of human-like capacities to non-human entities, such as ascribing mental and internal states (Waytz et al., 2013). Theory of mind is the ability to infer and understand other people’s mental states, such as beliefs, desires, intentions, and knowledge (Doherty, 2011). We predicted these two concepts are associated, and this prediction was assessed through the research outlined here. The current study examined potential associations between children’s (N=82; 5-8 years old) anthropomorphism, parent-reported theory of mind, and parent-reported social …
How The Lockdown Of Covid-19 Influenced The Neurocognitive And Psychosocial Development Of Preschoolers, Kay Picson
How The Lockdown Of Covid-19 Influenced The Neurocognitive And Psychosocial Development Of Preschoolers, Kay Picson
Nursing | Senior Theses
COVID-19 caused schools to turn to online learning through platforms such as Zoom or Google Meet. The influence and effects caused by the transition to online lessons and quarantine were seen across all patient populations and demographics, but none more so than preschool children, who are regarded as one of the more vulnerable populations due to their susceptibility to change. This research aims to fill gaps in the existing literature by evaluating the similarities and differences of the neurocognitive and psychosocial development of preschoolers exposed to the pandemic and those who were not. This study involves a comparative cohort approach …