In November 1998, the Hawaii and Alaska electorates voted to amend their state constitutions so that same-sex marriages would not have to be recognized. Rather than end the controversy surrounding same-sex marriages, the passage of these amendments will only spur more litigation, because the referenda themselves implicate constitutional guarantees and because amending a state constitution cannot lessen federal constitutional protections. Since same-sex marriages promote many of the same individual and state interests that opposite-sex marriages do, states will be unable to justify their same-sex marriage bans if those rationales are closely examined. When challenged, the recent constitutional amendments in Hawaii and Alaska may well be held unconstitutional by the state supreme courts on federal constitutional grounds, although ultimately the United States Supreme Court will likely be asked to resolve the relevant issues.

Suppose that state same-sex marriage bans are held not to violate federal constitutional guarantees, but that one state nonetheless recognizes such unions. The other states will be permitted to refuse to recognize marriages celebrated in that state only if certain conditions have been met. Contrary view notwithstanding, the law of nature exception will not apply in this case. Further, even the Defense of Marriage Act will likely not afford states the right to refuse to recognize any and all same-sex marriages validly celebrated in sister states.

In September 2014, the French government entrusted Tobie Nathan with the task of counselling radicalized young people who had been drawn to jihadism and in this book he recounts his experiences of some of the young people he met and counselled. He describes what he heard, felt and perceived in his encounters with these young people and their loved ones as he tried to understand the forces running through them and tried to grasp what their fate held in store for them. In so doing, he shows that the history of radicalizations is not the history of 'natures' but of metamorphoses - an unpredictable journey, with moments of immobility punctuated by sudden intoxication at the thought of other futures. It is a history of wandering souls who find themselves unable to form a narrative of origin and in thrall to harmful forces but who may find a way home one day. This deeply humane and engaging book will be of great interest to everyone concerned with the issue of radicalization and with the deep and growing challenges our societies face in accommodating difference.

Classical political economy rests on the assumption that the market and the family are overlapping and mutually dependent realms, dominated in turn by economic men and domestic women. Brian Cooper explores the role of economic theory in 'normalizing' the family in the first half of the nineteenth century. Drawing on a wide range of sources - novels, books on etiquette and statistical sources, as well as works of economics - the book examines the impacts of these different forms on contemporary debate.

eBook available with sample pages: 0203441850

Expand your knowledgewith theories and concepts that may challenge your assumptions about sexual attraction Human sexuality can be better understood by knowing how sexual psychologies may have evolved throughout the ages. Handbook of the Evolution of Human Sexuality presents a detailed examination of human sexuality, the assumptions about concepts and terms pertaining to sexuality, and the latest theories on the evolution of human sexual attraction. Leading experts explore various aspects of evolutionary theory, with a focus on Evolutionary Psychology (EP). Discussions include mate preferences, mating behavior, mate signaling, pheromones, and same-sex attraction. This comprehensive source also presents three groundbreaking theories of the evolution of same-sex attraction. Handbook of the Evolution of Human Sexuality takes current assumptions about human sexuality, explains each in turn, and then offers fresh perspectives on conventional concepts of sexual orientation. This extensive resource provides ample evidence to argue that researchers should investigate sexual relationships based on a person's characteristics such as personal traits, complementary roles/status, sexual acts, or situational context rather than simply the sex of the partner. The book provides a discussion of evolutionary theory, evolution of human sexual culture, evolution of sexual pleasure, and detailed analysis of assumptions about sexual orientation. The text is carefully referenced. Some of the topics explored by Handbook of the Evolution of Human Sexuality include: links to non-human primate sexual behaviors and the emergence of human (sexual) nature EP research on consensual adult human sexual behaviors studies of evolved male and female mating strategies, mate preferences, and sexual psychologies a brief history of the theory of evolution ancient culture, archeology, and an overview of premodern human sexuality evolutionary history of sexual pleasure human mating strategies development of mate preferences sexual signals, such as distinctive physical features, material wealth, etc. theories of the evolution of same-sex sexual attraction and behavior Primatologist Paul Vasey's observations of female Japanese macaques and their female-female sexual encounterswith an examination of human male-male behavior evolutionary history of female-female affectional bonding with a new theory on the behavior evolutionary history of male-male sexual behaviorwith intriguing thoughts on why it happened evolutionary history of pheromones as chemical messengers much more Handbook of the Evolution of Human Sexuality is an important, thought-provoking resource perfect for evolutionary psychologists, sexologists, educators, researchers, scholars, and graduate students.

Families of children with special health needs frequently cite difficulties in their communications with physicians and other medical professionals. Indeed, parents of high-risk, chronically ill, and disabled infants often regard interactions with health care providers as one of the most stressful parts of their early experiences with their children.

This volume was designed to present a variety of medical education approaches used to overcome this problem. After providing an overview of some of the difficulties faced by physicians and families of children with special health needs in their interactions with one another, the volume examines a number of useful medical education models. The models and viewpoints presented include those of physicians, early intervention professionals, professionals with backgrounds in education, psychology, and sociology, and parents. This volume is invaluable to those involved in designing and evaluating medical education approaches, and those developing public policy for children and the family.

Much has been made of the complex social arrangements that girls and women navigate, but little scholarly or popular attention has focused on what friendship means to men. Drawing on in-depth interviews with nearly 400 men, therapist and researcher Geoffrey L. Greif takes readers on a guided tour of male friendships, explaining what makes them work, why they are vital to the health of individuals and communities, and how to build the kinds of friendships that can lead to longer and happier lives. Another 120 conversations with women help map the differences in what men and women seek from friendships and what, if anything, men can learn from women's relationships. The guiding feature of the book is Greif's typology of male friendships: he dispels the myth that men don't have friends, showing that men have must, trust, just,and rust friends. A must friend is the best friend a man absolutely must call with earthshaking news. A trust friend is liked and trusted but not necessarily held as close as a must friend. Just friends are casual acquaintances, while rust friends have a long history together and can drift in and out of each other's lives, essentially picking up where they last left off. Understanding the role each of these types of friends play across men's lives reveals fascinating developmental patterns, such as how men cope with stress and conflict, how they seek and offer help, how notions of masculinity shape their relationships (platonic and romantic), and how their friends can keep them active and happy. Through the lively words of men themselves, and detailed profiles of men from their twenties to their nineties, readers may be surprised to find what friendships offer men-as well as their families and communities-and are sure to learn what makes their own relationships tick.

The author presents a large comparative database derived from ethnographic and architectural research in Southeast Asia, Egypt, Mesoamerica, and other areas; proposes new methodologies for comparative analyses of houses; and critically examines existing methodologies, theories, and data. His work expands on and systematizes comparative and cross-cultural approaches to the study of households and their environments to provide a firm foundation for this emerging line of study.

When adoptions fail to happen, the effects can be devastating on children and the families who chose to adopt them What if you were an adopted child and someone tried to remove you from the family you had grown to love? In the last twenty years, changes in laws, judicial decisions, social welfare practices, and the availability of American children for adoption have led to an increase in disrupted adoptions. When Adoptions Go Wrong: Psychological and Legal Issues of Adoption Disruption examines the psychological and forensic aspects of adoption with an emphasis on how negative events can affect children and the families that choose to adopt themand how you can prevent those events from happening. When Adoptions Go Wrong is a comprehensive resource on the causes of interrupted adoptions, including changing profiles of adoptive parents who have new reasons for wanting to adopt. With the help of detailed case examples, this powerful book explores the impact of disruptions on the children, the legal issues of determining in whose best interests decisions are made, and possible methods of reducing the negative affects of those decisions on the children. It also stresses how important it is, for the professionals involved, to be aware of child development in the adoption process. Topics discussed in When Adoptions Go Wrong include: children's rights legal rights of gays to adopt tribal rights (Native Americans) open adoption individual state laws concerning adoption the media's coverage of child custody cases types of adoption the Baby Jessica case the Evan Scott case the Internet Twins inadequate social services family court and much more When Adoptions Go Wrong also suggests legislative measures to create uniformity in the way states handle adoption issues to help natural and adoptive parents in making difficult decisions. The book is invaluable for psychologists, judges and lawyers, social workers, and prospective adoptive parents.

When adoptions fail to happen, the effects can be devastating on children and the families who chose to adopt them What if you were an adopted child and someone tried to remove you from the family you had grown to love? In the last twenty years, changes in laws, judicial decisions, social welfare practices, and the availability of American children for adoption have led to an increase in disrupted adoptions. When Adoptions Go Wrong: Psychological and Legal Issues of Adoption Disruption examines the psychological and forensic aspects of adoption with an emphasis on how negative events can affect children and the families that choose to adopt themand how you can prevent those events from happening. When Adoptions Go Wrong is a comprehensive resource on the causes of interrupted adoptions, including changing profiles of adoptive parents who have new reasons for wanting to adopt. With the help of detailed case examples, this powerful book explores the impact of disruptions on the children, the legal issues of determining in whose best interests decisions are made, and possible methods of reducing the negative affects of those decisions on the children. It also stresses how important it is, for the professionals involved, to be aware of child development in the adoption process. Topics discussed in When Adoptions Go Wrong include: children's rights legal rights of gays to adopt tribal rights (Native Americans) open adoption individual state laws concerning adoption the media's coverage of child custody cases types of adoption the Baby Jessica case the Evan Scott case the Internet Twins inadequate social services family court and much more When Adoptions Go Wrong also suggests legislative measures to create uniformity in the way states handle adoption issues to help natural and adoptive parents in making difficult decisions. The book is invaluable for psychologists, judges and lawyers, social workers, and prospective adoptive parents.

This study presents a theoretical and practical discussion of the changes that have occurred between men and women and how the sexes relate to one another from social, political, and ethical perspectives. Not only do men and women reflect different gender roles through communication, but they are also impacted by communication about gender, especially from the media. Gender differences in communication have gained political importance due to the increasingly relevant issues of sexual harassment and political correctness. These social and political changes have influenced our value systems and have given the study of gendered communication an ethical importance. Payne argues that religious ideology is an important aspect of gendered development and that biological, psychological, social, and cultural phenomena also affect sex roles.

This volume will appeal to scholars and students in the communications disciplines as well as psychologists and sociologists. Organized around three major themes--the construction of the gendered self, the differences between men and women as they relate to one another through language, power, and nonverbal communication, and the effects of gendered communication in leadership and the media--this work covers much ground on the topic of communication between the sexes.

This three-volume collection focuses on writings by and about cross-dressing women from the early nineteenth century up until the beginning of World War II. In so doing, it provides a new perspective on one of the most decisive periods in the history of feminism.

The anthology brings together for the first time key texts from the sexological and the literary realms, as well as newspaper articles, letters and photographs, which document the phenomenon of cross-dressing women in nineteenth- and early twentieth-century British culture. The collection also includes translations from European texts that impacted on British understandings of cross-dressing during this time.

A fascinating work, each of the volumes is introduced separately with a critical essay, and is divided thematically to include sections devoted to theories, fictions and fictionalisations, and lives. Together, these volumes make available important source material for the history of feminism.

This handbook provides a meaningful overview of topical themes within family sociology as an academic field as well as empirical realities in various societal contexts across Europe. More than sixty prominent European scholars' original texts present the field's main theoretical and methodological approaches in addition to issues such as families as relationships, parental arrangements, parenting practices and child well-being, family policies in welfare state regimes, family lives in migration, and family trajectories. Presenting cutting-edge research on findings, theoretical interpretations, and solutions to methodological challenges, it is a timely tool for researchers, teachers, students, and family practitioners who wish to familiarise themselves with the state of family sociology in Europe.

A book that dispels the myths about those who prefer to go beyond vanilla sex Sadomasochism: Powerful Pleasures is a comprehensive exploration of the entire sexual subculture that lies on the cutting edge of society. The mental health professions and society have marginalized people who practice sadomasochism (SM).This interdisciplinary collection dispels myths surrounding SM, bringing together leading scholars from the fields of sexology, psychology, sociology, and medicine, alongside queer studies and sexual minority advocacy. Experts such as Thomas S. Weinberg, PhD, Susan Wright, MA, Margaret Nichols, PhD, Odd Reiersol, PhD, Svein Skeid, Rebecca F. Plante, PhD, Niklas Nordling, MPsych, and N. Kenneth Sandnabba, PhD, among other stellar authorities, reveal research findings, clinical data, and critical thinking about sexuality that lies beyond vanilla. To gain a broader understanding of human sexuality, the study of SM is crucial for what it reveals about us as sexual beings. The text discusses the results of research into practitioners' behaviors and perspectives, the prevalence of SM behaviors in today's culture, and stresses the need for greater tolerance and understanding. The realization of SM desires and their acceptance are explored in detail. This unflinching look at the world and the people of SM will guide scholars and lay people alike into a more sensitive, sex-friendly viewpoint of the people society calls kinky. Sadomasochism: Powerful Pleasures answers questions such as: What is the nature of SM relationships? What are the values and motives of SM participants? How do mental health professionals regard and treat SM practitioners? Should sadomasochism continue to be classified as a mental illness? What is the legal status of SM and what are the consequences of discrimination against SM practitioners? Does increasing visibility of SM imagery decrease stigma or create added problems? What can ordinary lovers learn from those we have marginalized about the farther reaches of human erotic potential? Sadomasochism: Powerful Pleasures is valuable, insightful reading for mental health professionals, students, sex educators, sex counselors, sex therapists, sex researchers, sexual health workers, sociologists, sexual minority groups, and anyone interested in learning more about the sexual pleasures that lie beyond the traditional.

Find out what it's like to be young, African-American . . . and a father Voices of African-American Teen Fathers is an insightful look at adolescent pregnancy and parenthood through the eyes of fathers aged 14 to 19. This unique book features candid interviews with thirty teens who talk about doing what I got to dohandling their responsibilities as best they can given their perceptions, limitations, and life experiences. Teens talk about how and why they became fathers, how they handle being a parent, their perceptions of fatherhood, the relationships they have with their parents and the mothers of their children, and how they deal with the everyday struggles, demands, and concerns they face. Nearly one million girls between the ages of 15 and 19 become pregnant each year in the United States and most of the available research on adolescent parenthood focused on them. We know little about African-American adolescent fathers or about their perspectives on the cultural and socioeconomic conditions that define their experience. Voices of African-American Teen Fathers provides an understanding of these young fathers on their own terms and suggests theoretical frameworks, assessment tools, and effective interventions to develop a plan of action to help African-American adolescent fathers fulfill their roles. Helpful appendixes, including an interview guide and biographies of the particpants, are included, as are six tables that make complex information easy to access and understand. Voices of African-American Teen Fathers examines tough issues, including: intimate, amicable, or antagonistic relationships with their children's mothers relationships with their own mothers and fathers racism and discrimination child support loss of independence transportation problems drugs socioeconomic issues and much more Voices of African-American Teen Fathers is an invaluable resource for counselors, family educators, social service organizations, community practitioners, and social scientists.

Gain a better understanding of the special therapeutic issues and needs of GLBT families In terms of research, GLBT families constitute a neglected segment of society. Gender and sexual orientation can make the issues in family studies even more difficult to work through. An Introduction to GLBT Family Studies tackles a challenging research topic by presenting noted experts examining the latest information on the newest type of family studiesGLBT families. This groundbreaking text explores a wide range of unique problems faced by nontraditional families, as well as issues common to traditional families that need to be approached with a GLBT perspective. Though homophobia and heterosexism constantly influence GLBT families, these factors do not necessarily overwhelm the dynamic of their basic family unit. Issues present in many traditional families are found when researching GLBT families. An Introduction to GLBT Family Studies spotlights the issues, research, and future trends that provide a foundation for the study of GLBT families. This breakthrough volume focuses not only on the obvious unique factors within GLBT families, but also on the elements encountered within families that are present regardless of sexual orientation and gender, such as physical and emotional abuse. Expert contributors present research findings on family pattern issues relating to parent-child relationships, child development, sibling relationships, family structure, intimate relationships, stepfamilies, alternative family structures, and extended family relationships. Each chapter is extensively referenced and offers possibilities for further research. An Introduction to GLBT Family Studies discusses family studies topics such as: the impact of the family of origin life course perspective transgender identity issues and the family when a spouse comes out as gay, lesbian, or bisexual a study of lesbian couples adapting genogram techniques in therapy research comparing siblings of different sexual orientations studies of patterns of responses to parental reactions to learning their offspring are gay, lesbian, or bisexual the polyamory structure to some gay men's familial relationships same-sex marriages and legalized relationships gay male couples' roles in today's society the impact of heterosexism on working with same-sex relationships research on long-term lesbian couples An Introduction to GLBT Family Studies is a valuable reference for academic researchers in family studies, marriage and family therapy, social work, and counseling; educators, upper division undergraduate and graduate students; and anyone interested in better understanding GLBT family studies.

This lively collection of essays presents a range of innovative research on the history of the private sphere in Liberal and Fascist Italy, with a particular focus on sexuality, gender and race - all aspects which have received scarce attention in much of the existing historiography. It includes articles on foundlings and their mothers, the role of midwives, changing attitudes to sexuality, adultery trials, the Fascist persecution of homosexuals, debates about divorce and (going beyond Italy to its empire) the treatment of mixed race children and their mothers in Eritrea. Key themes of this collection include the contrasting attitudes of the Liberal and Fascist governments to the role of the state in the private sphere, the influence of the Church and the impact of new 'scientific' and medical approaches to maternity, sexuality and demography.

Make your marriage and family programs more relevant by making them cross-culturally sensitive International Family Studies: Developing Curricula and Teaching Tools offers a collection of innovative ideas and resources for educators who wish to enhance the international content of their human development and family science curriculum. Contributors share their experiences of transforming department commitments, modifying existing and/or creating new courses, developing stimulating exercises and projects, capitalizing on existing faculty development programs to enhance educators' own international understanding, partnering with universities overseas, and utilizing existing institutional structures to incorporate international study-abroad opportunities and internships for students. The book presents teaching tools and techniques, specific resources, and theoretical models for use in family studies, human development, and social science programs. International Family Studies: Developing Curricula and Teaching Tools promotes cross-cultural competence and global understandingessential ingredients for the success of future family professionals. The book is devoted to fostering knowledge and skills critical for breaking down barriers and expanding cultural knowledge in an effort to better prepare students to work with ethnically and culturally diverse families. International Family Studies: Developing Curricula and Teaching Tools examines: planning, implementing, and evaluating an innovative diversity curriculum knowledge and skills needed to work effectively with ethnically and culturally diverse families teaching techniques that can be incorporated in the classroom to enhance greater cultural understanding the use of student group presentations, technology, and books projects to teach about culturally diverse families issues of cultural competence, cultural sensitivity, and respect for diversity experiential opportunities abroad for students and faculty and much more International Family Studies: Developing Curricula and Teaching Tools is an essential resource for educators training the next generation of family professionals.

Both nationally and internationally, the south Indian state of Kerala has been an object of study for its matrilineal kinship organization among some communities, as well as its achievements in education, literacy, and life expectancy for women against a weak economic base. Nonetheless, scholars have drawn attention to a paradox in Kerala's model of development, namely women's deteriorating social position in Kerala and the rise in violence against women. Against this backdrop, this book explores the intersections of gender, sexuality, marriage, family and kinship as related to the matrilineal Nayar community in Kerala. Chapters unravel the interplay between the triple categories of gender, power and social development as they play out at the micro, meso, and macro levels of society, probing the ways in which Nayar women practice agency. Ultimately, the authors explore how the strength of the Nayar community can be used as a case study toward circumventing the prevailing gender paradox and re-imagine a more liberated, empowered and self-reliant woman not only in Kerala, but in India at large. This book will be of interest to scholars in sociology, gender studies, and development studies, particularly those with a focus on South Asia.

The father-son relationship is the most important male relationship. Owing to the concept of privacy that surrounds family life in Arab societies, it has been shrouded in silence. Drawing on insights from psychology, sociology, anthropology, religion, history, and literature, Dalya Cohen-Mor unravels the mysteries of this relationship in Arab families. She argues that Arab men are both the beneficiaries and victims of the prevailing patriarchal system and that many male privileges and key components of the traditional code of masculinity warp Arab men and society. The author draws on recent events in the Middle East, especially the Arab uprisings of 2011, to illustrate the young generation's desire for freedom from all forms of oppression, whether paternal authority, the patriarchal family, or an autocratic regime. A groundbreaking work, Fathers and Sons in the Arab Middle East is essential reading for students and scholars across the humanities and social sciences and for all those interested in the Arab Middle East.

"Leading family sociologist David Morgan revisits his highly influential 'family practices' approach in this new book. Exploring its impact, and how it has been critiqued, Morgan shows the continued relevance of the approach with reference to time and space, the body, emotions, ethics and work/life balance"--

As the rich have got richer and households have become busier, demand for commoditized household services has increased. While much is known about maids and nannies, this book is distinctive in focusing on masculinized domestic services. Through two case-studies - Polish handymen in the UK and the households that employ them and Mexican jardineros in the USA - the book demonstrates how, by outsourcing, householders can mitigate the "father time-bind" arising from tensions between new expectations for involved fathering, economic expectations regarding working hours, and a highly gendered and neo-liberal social policy regime, and shows how the consequences of this reaches beyond the households into the lives of the migrant men who work for them. Through the focus on male domestic work, the book identifies distinctly gendered understandings of domestic work and care, and shows how these influence the differential economic value of and emotional attachment to different forms of domestic work, and the gendered identities of those supplying and buying these services. In doing so, the book reveals much about the dynamic and varied understandings of masculinity.

This book provides a comprehensive overview of the process of building healthy early social and emotional relationships with infants from a developmental perspective. The book synthesizes current research on the contextual influences of attachment, family relationships, and caregiving practices on social-emotional development. Chapters examine the processes of socioemotional development-particularly in relationships with parents, other family members, and peers-and identify areas for promoting healthy attachments and resilience, improving caregiving skills, and intervening in traumatic and stressful situations. Chapters also present empirically-supported intervention and prevention programs focused on building early relationships from birth through three years of age. The book concludes with future directions for supporting infant mental health and its vital importance as a component of research, clinical and educational practice, and child and family policy. Topics featured in this book include: The effect of prenatal and neonatal attachment on social and emotional development. The impact of primary relationships and early experiences in toddlerhood. Toddler autonomy and peer awareness in the context of families and child care. Supporting early social and emotional relationships through The Legacy for Children (TM) Intervention. How to build early relationship programming across various cultures. Building Early Social and Emotional Relationships with Infants and Toddlers is a must-have reference for researchers, clinicians and professionals, and graduate students in the fields of infant mental health, developmental psychology, pediatrics, public health, family studies, and early childhood education.

Making home explores the figure of the orphan child in a broad selection of contemporary US novels by popular and critically acclaimed authors Barbara Kingsolver, Linda Hogan, Leslie Marmon Silko, Marilynne Robinson, Michael Cunningham, Jonathan Safran Foer, John Irving, Kaye Gibbons, Octavia Butler, Jewelle Gomez and Toni Morrison. The orphan child is a continuous presence in US literature, not only in children's books and nineteenth-century texts, but also in a variety of genres of contemporary fiction for adults. Making home examines the meanings of this figure in the contexts of American literary history, social history and ideologies of family, race and nation. It argues that contemporary orphan characters function as links to literary history and national mythologies, even as they may also serve to critique the limits of literary history, as well as the limits of familial and national belonging. -- .

For anyone studying childhood or families a consideration of the state may not always seem obvious, yet a good critical knowledge of politics, social policy and social theory is vital to understanding their impacts upon families' everyday lives. Accessibly written and assuming no prior understanding, it shows how key concepts, including vulnerability, risk, resilience, safeguarding and wellbeing are socially constructed. Carefully designed to support learning, it provides students with clear guidance on how to use what they have read when writing academic assignments alongside questions designed to support the develop of critical thinking skills. Covering issues from what the family is within a multicultural society, through issues around poverty, social mobility and life-chances, this book gives students an excellent grounding in matters relating to work with children and families. It features: * 'using this chapter' sections showing how the content can be used in assignments; * tips on applying critical thinking to books and articles - and how to make use of such thinking in essays; * further reading.

Sex is bad. Unprotected sex is a problem. Having a baby would be a disaster. Abortion is a sin. Teenagers in the United States hear conflicting messages about sex from everyone around them. How do teens understand these messages? In Mixed Messages, Stefanie Mollborn examines how social norms and social control work through in-depth interviews with college students and teen mothers and fathers, revealing the tough conversations teeangers just can't have with adults. Delving into teenagers' complicated social worlds Mollborn argues that by creating informal social sanctions like gossip and exclusion and formal communication such as sex education, families, peers, schools, and communities strategize to gain control over teens' behaviors. However, while teens strategize to keep control, they resist the constraints of the norms, revealing the variety of outcomes that occur beyond compliance or deviance. By proving that the norms existing today around teen sex are ineffective, failing to regulate sexual behavior, and instead punishing teens that violate them, Mollborn calls for a more thoughtful and consistent dialogue between teens and adults, emphasizing messages that will lead to more positive health outcomes.