Digital Commons Network^™

Swept Into The Crisis: A Phenomenological Study Of Staff And Adaptive Leadership During The Pandemic, Alexandra Deremer

Electronic Theses and Dissertations

Beginning in the fall of 2020, the pandemic created unparalleled challenges as schools reopened following extended closures, requiring school communities, with staff at every level, to rapidly adapt to evolving protocols, expanded job responsibilities, and ongoing uncertainty. This phenomenological study explored how building staff, such as custodians and teachers, perceived the leadership behaviors exhibited by principals during the implementation of COVID-19 disinfecting mandates and changes to school operations. Using Heifetz et al.’s (2009) adaptive leadership framework as a foundation, the intent of this research was to address three specific research questions that centered on staff perceptions of administrators’ response plans …

Vaccination-Related Applications And Health Care Professionals' Observed Changes In Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Survey, Manali Desai, Shreela Sharma, Joel Fokom-Domgue, Robert Yu, Wenyaw Chan, Onyema G Chido-Amajuoyi, Charles Darkoh, Sanjay Shete

Faculty, Staff and Student Publications

Background: Digital tools are known to promote public health interventions such as vaccine delivery. The recommendation that health care professionals (HCPs) use vaccination-related mobile apps or web-based applications has contributed to improving vaccine awareness and acceptance in the United States. The state of Texas, which has one of the lowest human papillomavirus (HPV) vaccination rates, has seen a significant increase in HPV vaccine hesitancy, particularly during the COVID-19 pandemic.

Objective: This study aimed to examine the association between changes in HPV vaccine hesitancy observed by HCPs among patients in Texas and promotion of vaccination-related applications at the health care facilities …

Exploring Spike-Dependent And Ace2-Independent Sars-Cov-2 Interactions With Salivary Epithelial Cells In The Absence Of Ace2, Caitlynn M L Barrows, Thaise C Geremias, Simon Young, Mary C Farach-Carson

Faculty, Staff and Student Publications

Salivary gland infection by SARS-CoV-2 requires viral entry via routes and mechanisms that remain unresolved. This study examined the expression of the angiotensin-converting enzyme 2 (ACE2) receptor in salivary tissues and basal cell-derived human salivary progenitor cells (hS/PCs), an unstudied potential entry point for SARS-CoV-2. Multiple detection modalities, including immunocytochemistry, Western blotting, flow cytometry and RT-PCR, demonstrated a consistent lack of ACE2 protein and transcript in both tissue specimens and primary salivary epithelial cells. Antigen retrieval at pH 9 was determined to be optimal for immunodetection protocols, yet ACE2 remained undetectable. Small intestine tissue served as a positive control, confirming …

An Equity-Based And Culturally Responsive Bill Of Rights For Early Childhood Students Of Color With Exceptionalities, Evette Simmons-Reed, Michelle Frazier Trotman Scott, Gloria Tardash, Mildred Boveda, Donna Y. Ford

Perspectives on Early Childhood Psychology and Education

The COVID-19 pandemic exacerbated existing disparities in early intervention (EI) and early childhood special education (ECSE) services for culturally and linguistically diverse (CLD) disabled children, exposing critical gaps in access, services and support. systemic inconsistencies in implementation, training, and funding, remain barriers limit opportunities for CLD students to benefit, despite the aims of the Individuals with Disabilities Improvement Act (IDEA). To address these inequities, this manuscript proposes an expanded and updated Culturally Responsive Equity-Based Bill of Rights for EI and ECSE. Building upon Ford and colleagues' (2018) work, this revised document extends protections to children aged zero to five, emphasizing …

Feasibility Of Decentralized Real-World Monitoring Of Sars-Cov-2 Booster Vaccines And Covid-19 Outcomes In Myeloma, William A Wood, Mark A Schroeder, Ravi Vij, Et Al.

2020-Current year OA Pubs

Patients with multiple myeloma have an elevated risk of severe complications from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) infection. To demonstrate proof of concept for a pandemic preparedness and response network, the American Society of Hematology Research Collaborative Multiple Myeloma Program developed a prospective, decentralized study within a site-based provider network. In the COVID-19 outcomes in myeloma and the impact of vaccines (COSMIC) study, patients provided consent, permitted electronic health record data collection, completed patient-reported outcomes at baseline, day 30, and day 180 through an electronic study portal, and were compensated for participation. Clinicians at participating sites facilitated …

Job Decisions To Leave A Hospitalist Group Among Millennial Hospitalists Born In Or After 1982: A Survey Based Study, Maria Carolina Musri, Flora Kisuule, Sean Tackett, Amteshwar Singh

Journal of Community Hospital Internal Medicine Perspectives

High turnover among millennial hospitalists, who constitute a large proportion of early-career physicians, remains a concern. Using purposeful sampling, we surveyed 136 millennial hospitalists to understand what factors influence their decisions to leave a hospital medicine group. Family reasons (81%) and geographical location (80%) were the factors most commonly identified as important influences on decisions to leave. While these factors may be non-modifiable to a large extent, these findings underscore the importance of identifying such needs at the time of recruitment. Institutional reputation was ranked the least frequently influencing factor, when millennial hospitalists contemplate leaving a hospital medicine group. Understanding …

Making Sense Of Hospitalization: An Interpretative Phenomenological Analysis Of Covid-19 Patients’ Psychological Experiences In Indonesia, Mira Wahyu Kusumawati, Heni Dwi Windarwati, Setyawati Soeharto

The Qualitative Report

While previous research has probed into the experiences of COVID-19 patients during isolation in hospitals, little is known about their psychological experiences and the meaning of such experiences. To address the gap,this study was designed to explore the psychological experiences of patients who were confirmed positive for COVID-19 while undergoing isolation in hospitals. Using a phenomenological approach, we recruited 19 COVID-19 survivors who were confirmed positive for COVID-19 in the first six months of the pandemic entering Indonesia, located in Madiun Regency, East Java Province, Indonesia. We conducted face-to-face semi-structured interviews with health protocols and analysed the data using the …

Beyond The Bug: How The Covid-19 Pandemic Exposed Longstanding Systemic Failures In The United States Workforce And Economy, Abbey M. Markley

Honors Theses

The purpose of this thesis is to investigate and discuss how longstanding systemic failures in the United States exacerbated the effects the COVID-19 pandemic had on the American economy, essential healthcare workers, and overall public trust in institutions. A review of the existing literature surrounding this topic and the subsequent results of various studies were used to compose this thesis. The United States has a painful lack of worker protections and tends to view members of its workforce as expendable, even in times such as pandemic when they are deemed essential. Healthcare workers in particular faced increasing threats to their …

Trauma, Memory, And Decision-Making: How Covid-19 Shaped Autobiographical Memories And Risky Decision-Making In Young Adults, Rachel Seo

Student Theses

Autobiographical memory is a critical component of the memory process that guides future behaviors by relying on past personal experiences connected to major public events. This decision-making process is heavily influenced by trauma exposure and post-traumatic stress disorder (PTSD) symptoms, as they may guide individuals to riskier behaviors. The COVID-19 pandemic represents a global traumatic stressor that contributed to shifts in behavioral outcomes post-pandemic. Despite research showing associations between memory accessibility, traumatic symptoms, and decision-making, there is limited research on health-related behaviors and post-pandemic behavioral outcomes in individuals with high trauma exposure specifically from the pandemic. The present study investigates …

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

International Spillover: How External, Global Events Such As Brexit And Covid-19 Have Impacted Housing Prices Within The Republic Of Ireland, Allie Riggs

Undergraduate Honors Thesis Collection

The housing market in Ireland has experienced such a great crisis in recent history that over a third of residents have considered moving to a more affordable country (Hogg, 2024). While a number of both causes and potential solutions have been analyzed in regard to this national crisis, I hypothesize that there has been a greater shock from external, global events in the COVID-19 pandemic and Brexit. In performing a regression on secondary data while controlling for macroeconomic factors that impact the housing market, I have identified a positive, significant association between these two exogenous shocks and their impact on …

The Impact Of Covid-19 On Spine Surgery: Temporal Trends In Complications And Patient-Reported Outcomes Across A Statewide Cohort, Ali Mehaidli, Richard Easton, Ahmad Almaat, Gary George, Alqasim Elnaggar, Victor Chang, Doris Tong, Jad Khalil, Kevin Taliaferro

Conference Presentation Abstracts

Introduction: The COVID-19 pandemic caused major disruptions in elective surgical care, including spine surgery, due to widespread hospital restructuring and resource limitations. Although previous studies have examined surgical volumes and safety during the pandemic, limited data exist on how outcomes varied across multiple phases of the pandemic, especially in real-world, multicenter spine surgery populations. Material and Methods: This retrospective cohort study used data from the Michigan Spine Surgery Improvement Collaborative (MSSIC) to compare outcomes in patients undergoing lumbar or cervical spine surgery across four COVID-19 timeframes: pre-COVID (1/2019-2/2020), onset-COVID (3/2020-9/2020), active-COVID (10/2020-2/2022), and post-COVID (3/2022- 12/2022). Patient demographics, surgical characteristics, …

Prevalence And Determinants Of Fully Vaccinated Status For Covid-19 Among Pregnant Women In Brazil, Ghana, Kenya, And Pakistan, Vaishnavi Mathur, Jessica Schue, Berhaun Fesshaye, Prachi Singh, Emily Miller, Caroline Badzi, Emefa Modey, Marleen Temmerman, Ferdinand Okwaro, Renato Souza

Centre of Excellence in Women and Child Health

Maternal immunization provides essential maternal and fetal protection for several infectious diseases. The variability in vaccination guidelines for pregnant women across countries and through the course of the COVID-19 pandemic influenced the perception of both the general public and broader health care systems towards COVID-19 vaccination in pregnancy and moreover shaped the accessibility and decision-making trajectory of pregnant women to become fully vaccinated. As part of a larger multi-country, mixed-methods study, the purpose of this cross-sectional analysis is to assess what factors are associated with pregnant women being fully vaccinated for COVID-19 in Brazil, Ghana, Kenya, and Pakistan. In each …

An Integrated Framework For Early Detection And Transmissibility Assessment Of Emerging Variants In Wastewater, Xingwen Chen, Tin Phan, Wei Lin Lee, Katie Clark, Steven F Rhode, Samantha Brozak, Bruce Pell, Tsultrim Palden, Mats Leifels, Anna Gitter, Yang Kuang, Stefan Wuertz, Janelle Thompson, Kristina D Mena, Eric J Alm, Fuqing Wu

Faculty, Staff and Student Publications

Tracking the emergence of new viral variants is critical for epidemic preparedness, but remains challenging because variants typically circulate at low prevalence during the early phase of outbreaks. Here, we present an integrated framework that combines sensitive variant detection in wastewater with quantitative assessment of transmissibility through dynamic epidemic modeling. Using the SARS-CoV-2 Omicron variant as a proof of concept, we developed a novel nested allele-specific RT-qPCR assay (NAS-PCR) that achieved a thousand-fold increase in sensitivity compared with allele-specific RT-qPCR (limit of detection: 0.5 copies/μl). NAS-PCR detected Omicron in wastewater samples from the Greater Boston area starting in September 2021, …

Long Covid Persistence And Surveillance Gaps Across 58 Us Hospitals, Jiazi Tian, Alaleh Azhir, Matthew Decaro, Ngan Chau, Jonas Hügel, Michele Morris, Jingya Cheng, Pedram Fard, Ingrid V Bassett, Douglas S Bell, Elmer V Bernstam, Shyam Visweswaran, Jeffrey G Klann, Shawn N Murphy, Hossein Estiri

Faculty, Staff and Student Publications

Importance: Surveillance of postacute sequelae of SARS-CoV-2 infection (PASC) depends on diagnostic coding systems that capture fewer than one-half of affected individuals, rendering millions invisible to health systems and policymakers.

Objective: To quantify the gap between true PASC burden and diagnostic code-based estimates, determine the proportion representing chronic disease, and characterize organ system heterogeneity and temporal trends across diverse populations.

Design, setting, and participants: This retrospective cohort study used electronic health record data from 58 hospitals and affiliated clinics in 4 US regions, from 2017 to 2025. Adults (aged ≥18 years) with laboratory-confirmed SARS-CoV-2 infection or a COVID-19 diagnosis code …

Teachers’ Perceptions Of Social-Emotional Learning Of Special Education Middle School Students, Stephen Thurman

Doctoral Dissertations and Projects

The purpose of this hermeneutic phenomenological study was to understand the influence COVID-19 and related shutdowns had on middle school special education students' social-emotional learning based on teachers lived experiences at a middle school in north Georgia. At this stage in the research, the influence COVID-19 and related shutdowns had on middle school special education students' social-emotional learning was generally defined as how student social-emotional learning has changed since the COVID-19 pandemic. The theory guiding this study was social cognitive theory, as this theory closely aligns with the topic of the importance of social-emotional learning and how students attain social-emotional …

Capitalizing On Crisis: A Statistical Analysis Of Federal Funding And The Surge In White-Collar Criminal Activity During The Covid-19 Pandemic, Lee R. Gibson

Doctoral Dissertations and Projects

The COVID-19 pandemic ushered in a new era that has forever changed how people work, communicate, and socialize. The pandemic also brought one of the most significant influxes of financial assistance to individuals, businesses, educational institutions, and state and local governments that has ever been seen. This massive infusion of cash, which was orchestrated and managed by the federal government, was instituted in a manner that provided quick relief with little ability for oversight, resulting in every assistance program experiencing high rates of fraudulent activity. This project aims to understand if the levels of white-collar crime increase during a disaster, …

A Phenomenological Study On The Experiences Of Educators As Mentors For Homeless And Highly Mobile Students In A Rural Community, Tracy Dawn Mcpheron

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study is to explore how educators perceive an implemented mentoring program in which they will serve as mentors of homeless and highly mobile students in a rural school district. The mentoring program will include educators working as mentors to students coded as homeless through the McKinney-Vento Act for Homeless Education. The educators participating in the mentoring program will be the participants in this study. The participants will include middle school (6th-8th grade) through high school (12th grade), teachers, counselors, librarians, the district’s homeless liaison, and the federal programs coordinator for an East Tennessee school …

Covid Minds: A Thematic Review Of The Pandemic On Neural Mechanisms And Political Polarization, Madison Jeffries

Honors Projects

This paper analyzes how the COVID-19 pandemic influenced political polarization in the United States by examining the interactions between social system disruption, psychological stress, and underlying neurological behaviors. While previous research has extensively discussed pandemic's influence on public health and societal breakdowns, studies fail to examine how these disruptions shaped political divisions. This study synthesizes interdisciplinary literature on pandemic-induced stressors and analyzes factors, including institutional mistrust and social isolation, and how these experiences shape political behavior and perspectives. Applying research from psychology and neuroscience, the paper argues that prolonged exposure to pandemic-related stressors changed neurological and behavioral patterns in response …

Examining Nurse Burnout During The Covid-19 Pandemic: Causes And Mitigation Strategies, Melanie Sena

Honors Projects

Nurse burnout is a multidimensional occupational syndrome that predates the COVID-19 pandemic, yet the pandemic served as a catalyst that intensified its scope and severity in ways that the healthcare system was profoundly ill-equipped to manage. Characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, burnout among nurses accelerated dramatically between 2020 and 2022 as clinical workloads surged, personal protective equipment remained scarce, and moral distress became a near-universal experience across care settings. This review examines the primary systemic and individual contributors to nurse burnout during COVID-19, explores the consequences of burnout for both nurses and patients, …

Testimonios De Una Estudiante De Doctorado: Regaining Joy In Graduate School Through Research-Practice Partnerships, Sophia Piral Lee

The Qualitative Report

Through an epistolary critical autoethnography and Latina and Chicana feminist framework, I explore the question of how international graduate students of color can overcome cultural, linguistic, ethnoracial, and social class isolation on predominantly white campuses and in college towns. By writing a letter to my mother (one of my methods for survival in academia), I share my challenges as a Guatemalan, first-time mom, first-generation college student, international student, and non-English native speaker in graduate school during and after the COVID-19 pandemic. At the same time, this writing helps me recognize how I overcame my isolation and regained my joy and …

First Covid-19 Vaccination Rates Among Pregnant Tennessee Women By Month Of Conception And Urbanization Level: March 2021 – November 2021, Claudia Valenzuela, Anne K. Driscoll, Elizabeth Harvey, Heather Wingate

Journal of Appalachian Health

Introduction: Throughout the pandemic, COVID-19 vaccination coverage was lower for the general population living in rural counties than in urban counties. In Tennessee (TN), COVID-19 vaccinations became available to pregnant women in March 2021. Little is known about rates of COVID-19 vaccination in pregnancy during the pandemic, or whether these rates changed or differed by urbanization level.

Purpose: The purpose of this study is to describe COVID-19 vaccination rates among pregnant women in TN by month of conception and urbanization level.

Methods: COVID-19 vaccination data from the TN Immunization Information System and the TN Surveillance for Emerging Threats to Mothers …

Black Essential Workers Experiences With Long-Term Covid-19 Symptoms, Jeremiah Cedric Campbell

Doctorate in Kinesiology

The purpose of this dissertation study was to understand the perceived effects of long-term COVID-19 on Black essential workers at the height of the pandemic and overall impact on mental health. The researcher interviewed 19 Black essential workers from Texas, across economic sectors (e.g., healthcare, sanitation), and who experienced long COVID symptoms. Findings centered across four themes: asking for help during the pandemic, COVID symptoms, being Black, and mental health. Using a theoretical approach incorporating critical race theory and social determinants of mental health, findings revealed the ways systemic racism affected these Black essential workers. This research can inform culturally …

Rethinking Consumer Data And Behavior, Nicole J. Olynk Widmar, Michael L. Smith, Erin Robinson

Purdue University Press Books

Today’s food and agricultural consumers are driven by more than just price—they are influenced by trust, values, and perceptions that are often difficult to measure. Rethinking Consumer Data and Behavior explores what truly shapes consumer choices and how businesses can respond effectively.

This book utilizes research on loyalty, risk, sustainability, and ethical considerations, revealing how these factors influence purchasing decisions in ways traditional data often misses. It examines consumers’ willingness to pay for local and organic products, the impact of food labeling and safety messaging, and the surprising role of sensory cues such as appearance and taste. The book also …

An Examination Of Hiring Practices And Employee Retention Today Compared With Pre-Pandemic Characteristics In Orthodontics, Logan Passey Dds, Msd, Bhavna Shroff Dds, M.D.Sc., Mpa, Christina B. Philips Dds, Msd, Caroline K. Carrico Ph.D., Steven J. Lindauer Dmd, M.D.Sc, Daniel R. Hawkins Dmd, Siddharth Chiang Dds

Virginia Dental Journal

The COVID-19 pandemic resulted in a fundamental shift in the labor market, leading to unprecedented job losses. Between February and April 2020, approximately 22.2 million jobs were lost nationwide. Notably, dentistry was among the top ten industries impacted, accounting for 555,000 of those job losses. When positions were reopened, only 76% of all employees across all industries returned to work by August 2020.

As the COVID-19 pandemic dramatically disrupted workforce stability, particularly within dental practices, effective talent management emerged as a critical strategy for rebuilding and sustaining the dental workforce. Talent management is of increasing importance in today’s labor market, …

Challenges In The Ethical Review Process Of Covid-19 Related Research At Hrec-Tumed, Thailand, Wilaiwan Chimkhong, Thana Khawcharoenporn, Pacharapan Surapolchai

Asian Medical Journal and Alternative Medicine

Objective: To explore the challenges encountered in the ethical review process and timeline of COVID-19 related research at the Human Research Ethics Committee of Thammasat University (Medicine) (HREC-TUMED), Thailand, focusing on submission characteristics, review outcomes, and committee adaptations.

Materials and Methods: This retrospective descriptive study analyzed COVID-19 research protocols submitted to HREC-TUMED between June 2020 and July 2022. Protocols were evaluated for research types, investigator affiliations, funding sources, review types, and timeline metrics, using descriptive statistics.

Results: A total of 89 COVID-19 related research protocols were submitted to HREC-TUMED, with the majority originating from faculty investigators (64%). Most protocols underwent …

Factors Related To Self-Care Behaviors Among Older Adults For Communicable Disease (Cd) Protection In The Eastern Economic Corridor (Eec) Of Thailand: A Case Study Of Covid-19, Surasingha Sombat Suranartwatchawong, Sane Saengngoen, Supaporn Sudnongbua

Journal of Health Research

Background: The impact of COVID-19 is particularly severe for older adults, who represent the most vulnerable demographic. Using COVID-19 as a case study, this research investigates the factors influencing self-care behaviors for preventing communicable diseases (CD) among older adults in the EEC.

Methods: The study with a cross-sectional design involving 387 older adults aged 60 years was conducted between January and March 2025. The questionnaire was valid and reliable based on objective congruence (IOC) index and Cronbach’s alpha coefficients. Data analysis utilized both descriptive and inferential statistics.  Frequency, percentage, standard deviation, and multiple linear regression analysis were employed …

Strategic Resource Management In Pandemics: Integrating Capacity Planning With Non-Pharmaceutical Interventions For Covid-19, Ozlem Cosgun, Eyyub Kibis, Ali Dag, Burak Cankaya

Department of Information Management and Business Analytics Faculty Scholarship and Creative Works

The COVID-19 pandemic underscored the urgent need for integrated healthcare resource planning to manage patient surges and reduce mortality. This study presents a novel optimization-based framework that jointly considers healthcare capacity planning and non-pharmaceutical interventions (NPIs), including mask mandates, social distancing, and quarantining. The framework extends traditional compartmental models by distinguishing patient categories—such as hospitalized non-ventilator patients, ventilated patients, and ICU admissions—within a mixed-integer programming (MIP) structure that remains computationally tractable. Applied to the COVID-19 outbreak in New York City, the model optimizes the allocation of hospital beds and ventilators while minimizing deaths. Results show that combining high-effectiveness NPIs with …

Acute Myocardial Infarction In Medicare Beneficiaries During And After The Covid-19 Pandemic, Jonah M Graves, R J Waken, Fengxian Wang, Rishi K Wadhera, Jose F Figueroa, E John Orav, Osvaldo J Laurido-Soto, Karen E Joynt Maddox

2020-Current year OA Pubs

IMPORTANCE: During early months of the COVID-19 pandemic, presentations for acute myocardial infarction (AMI) declined significantly, and outcomes worsened. However, the full extent and long-term sequelae of changes in AMI epidemiology during the pandemic remain uncertain, as does whether these patterns differed by rurality.

OBJECTIVE: To describe the epidemiology of AMI-related hospitalizations, interventions, and outcomes among Medicare beneficiaries throughout the COVID-19 pandemic, focusing on differences in urban and rural populations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included all Medicare fee-for-service beneficiaries with AMI between January 1, 2018, and December 31, 2023, in the analysis. Data were analyzed from …

Partisan Differences In Risk-Taking In A Simulated Pandemic, Jan K. Woike, Sebastian Hafenbrädl, Patricia Kanngiesser, Ralph Hertwig

School of Psychology

Responses to COVID-19 in the United States were split along partisan political lines throughout the pandemic. People on the political left tended to take the medical threat more seriously and were more likely to adopt preventive health behaviors than those on the political right, resulting in clear differences in state-level policies and health consequences. Here, we examine the origins of these differences, investigating whether they are based on interindividual differences or in party dynamics. Two groups of participants (N=819), who had voted either for Donald Trump or Hillary Clinton in 2016, played the Transmission Game. Players made repeated decisions in …