Digital Commons Network^™

Effects Of Natural Products On Inflammation, Riley Ann Nadler

Graduate Theses/Dissertations

Chronic inflammation is characterized by infiltration of inflammatory cells such as macrophages and lymphocytes into the tissue where they produce inflammatory cytokines that contribute to tissue damage. Worldwide, 3 out of 5 people die due to chronic inflammatory diseases like cardiovascular diseases, obesity, diabetes, and cancer. Since it is well-documented that diet and metabolism are key mediators of inflammation, I investigated the effects of dietary lectins on inflammatory cytokine production and the ability of sodium pyruvate, a metabolite, to decrease inflammation. In chapter 1, I examined the effect that lectins from either Triticum vulgaris (common wheat) or Phaseolus vulgaris (common …

Exploring Late Adopter Motivation: A Corona Virus (Covid-19) Vaccine Quality Improvement Project, Brandi D. Giles

MUSC Theses and Dissertations

Lower than ideal COVID-19 vaccination rates are problematic nationally. As of March 4th, 2022 65% of eligible Americans were fully vaccinated (CDC, 2022). South Carolina fell below the national rate with only 57% of eligible South Carolinians were fully vaccinated at the same time period (SCDHEC, 2022). Both rates are below the national goal that was set for nation of 70% of eligible Americans being fully vaccinated by July 4th, 2021. This project aimed at exploring the motivation of individuals who would be considered late adopters. It was found that motivation to become vaccinated was varied and personal. The conclusion …

Characterizing Introductions Of Sars-Cov-2 To The U.S. Virgin Islands Using Pathogen Genomic Surveillance, Kendall Billig

Public Health Theses

Pathogen genomic surveillance systems have proven invaluable throughout the course of the global COVID-19 pandemic. Despite this, genomic surveillance programs are under-resourced or nonexistent in regions with reduced access to advanced public health tools, like the Caribbean. In this study, we documented and evaluated the establishment of a genomic surveillance system in the U.S. Virgin Islands during 2021, and used data from the program to place the story of COVID-19 in the U.S. Virgin Islands in a global context. We constructed a phylogenetic tree and conducted phylogeographic analyses to estimate the timing and geographic origin of the most recent common …

Readability Of Covid-19 Parental Guidance Documents, Amber M. Gordon B.S, Kurustun S. Musick B.S., Alison R. King Ph.D., Ccc-Slp, Lsls Cert. Avt, Erin Stehle Wallace Ph.D., Ccc-Slp

The Journal of Special Education Apprenticeship

The purpose of this study is to examine the readability levels of the state departments of education guidance documents regarding COVID-19 protocols for families of students receiving special education services. The authors searched the 50 states and the District of Columbia’s departments of education websites for their COVID-19, special education, parental guidance documents for the 2020-2021 school year. Parental guidance documents were available from 90% (46/51) of the department of education websites with 61% (31/51) of those documents specifically designed for parents of children receiving special education services. The researchers used the Flesch Reading Ease (FRES) to analyze the reading …

Uncertainty, Scarcity And Transparency: Public Health Ethics And Risk Communication In A Pandemic, Abigail Lowe, Teck Chuan Voo, Lisa M. Lee, Kelly K. Dineen Gillespie, Christy Feig, Alva O. Ferdinand, Seema Mohapatra, David Brett-Major, Matthew K. Wynia

Journal Articles: Epidemiology

Communicating public health guidance is key to mitigating risk during disasters and outbreaks, and ethical guidance on communication emphasizes being fully transparent. Yet, communication during the pandemic has sometimes been fraught, due in part to practical and conceptual challenges around being transparent. A particular challenge has arisen when there was both evolving scientific knowledge on COVID-19 and reticence to acknowledge that resource scarcity concerns were influencing public health recommendations. This essay uses the example of communicating public health guidance on masking in the United States to illustrate ethical challenges of developing and conveying public health guidance under twin conditions of …

Cultivating Community Stewards: Wellbeing, Belonging, And The Campus Garden, Katherine Clay

West Chester University Master’s Theses

This thesis seeks to prepare college students for adulthood by understanding them as “whole” people, multi-faceted and knowledgeable in their own right. Using the campus garden as a vehicle, participants will engage with surface-level health concepts, the campus environment, and their wider community to develop practical skills, social support systems, and a sense of civic engagement. As participants learn the skills to manage their own wellbeing in times of external stress, they will come to understand themselves as belonging to a community and in turn, develop an investment and commitment to their communities as community stewards. My intervention, The Ivy …

Social Support, Self-Esteem, And Levels Of Stress, Depression, And Anxiety During The Covid-19 Pandemic, Candace Ying Tsai

Scripps Senior Theses

The COVID-19 pandemic resulted in unprecedented disruptions to daily routines and social connections, which negatively impacted the mental health and well-being of many. Unsurprisingly, the most utilized coping strategy during the pandemic involved social support. However, those low in self-esteem seem to question others’ positive regard and continued acceptance, and overall perceive others’ behavior more negatively than those with high self-esteem (Murray, Holmes, et al., 1998). The proposed correlational study will examine the effects of social support and self-esteem on stress, anxiety, and depression during the COVID-19 pandemic, as well as investigate whether one’s self-esteem affects the influence that social …

A Qualitative Report Of The Perceptions Of The Covid-19 Pandemic From Collegiate Student-Athletes, Dylan C. Rowe, Zachary K. Winkelmann, Shawn M. Arent, Michelle A. Arent, Alexa J. Chandler, Nancy A. Uriegas, Toni M. Torres-Mcgehee

Faculty Publications

CONTEXT: The COVID-19 pandemic led to an abrupt disruption in access to services and personnel for collegiate student-athletes in the spring and summer of 2020. We sought to identify the effects of this unprecedented change by examining the psychological well-being, changes to normal routines, and return-to-play considerations of current student-athletes in order to guide support for both current and future student-athletes who may face similar situations. METHODS: We utilized a phenomenological approach to interview a purposeful sample of eighteen collegiate student-athletes (7 males, 11 females; mean age = 20 years) from across the United States. The participants were interviewed using …

Analyzing The Academic Achievement Of Secondary Virtual Learners During The Covid-19 Pandemic: A Mixed Methods Case Study, Christina Kaye Board

Dissertations and Theses

Secondary students from a mid-sized school district in the rural Midwest who had chosen an asynchronous learning environment during the COVID-19 pandemic were analyzed to determine predictors of academic achievement and perceptions of their learning during the pandemic. An explanatory, mixed methods case study was conducted to sequentially analyze quantitative data and qualitatively analyze their experiences. Archival data from 288 students [F(7, 281) = 20.87, p < .001] was used predict grade point average (GPA) during virtual learning (M = 2.43, SD = 0.89) using a multiple linear regression (R2 = .326). This study was done to determine what factors help educators understand the variables that aide in student achievement while virtual learning. Predictor variables included race/ethnicity, sex, socioeconomic status, grade level, past attendance, past GPA, and number of parents/guardians in the home. Significant predictors were grade level, past GPA (M = 3.05), and sex. The focus of the qualitative research was on access to technology, digital literacy, attitude, motivation, and social connectedness prior to, during, and post-virtual learning. Four themes emerged. Results from this study suggest that schools should consider the type of virtual environment they provide, instructional design that includes social interaction, and professional development for staff prior to implementation of a virtual learning environment to increase achievement.

An Issue Of Concern: Unique Truncated Orf8 Protein Variants Of Sars-Cov-2, Sk. Sarif Hassan, Vaishnavi Kodakandla, Elrashdy M. Redwan, Kenneth Lundstrom, Pabitra Pal Choudhury, Tarek Mohamed El-Aziz, Kazuo Takayama, Ramesh Kandimalla, Amos Lal, Ángel Serrano-Aroca, Gajendra Kumar Azad, Alaa A.A. Aljabali, Giorgio Palù, Gaurav Chauhan, Parise Adadi, Murtaza Tambuwala, Adam M. Brufsky, Wagner Baetas-Da-Cruz, Debmalya Barh, Vasco Azevedo, Nikolas G. Bazan, Bruno Silva Andrade, Raner José Silva, Vladimir N. Uversky

Molecular Medicine Faculty Publications

Open reading frame 8 (ORF8) shows one of the highest levels of variability among accessory proteins in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Disease 2019 (COVID-19). It was previously reported that the ORF8 protein inhibits the presentation of viral antigens by the major histocompatibility complex class I (MHC-I), which interacts with host factors involved in pulmonary inflammation. The ORF8 protein assists SARS-CoV-2 in evading immunity and plays a role in SARS-CoV-2 replication. Among many contributing mutations, Q27STOP, a mutation in the ORF8 protein, defines the B.1.1.7 lineage of SARS-CoV-2, engendering the second wave of …

Shell Disorder Models Detect That Omicron Has Harder Shells With Attenuation But Is Not A Descendant Of The Wuhan-Hu-1 Sars-Cov-2, Gerard Kian-Meng Goh, A. Keith Dunker, James A. Foster, Vladimir N. Uversky

Molecular Medicine Faculty Publications

Before the SARS-CoV-2 Omicron variant emergence, shell disorder models (SDM) suggested that an attenuated precursor from pangolins may have entered humans in 2017 or earlier. This was based on a shell disorder analysis of SARS-CoV-1/2 and pangolin-Cov-2017. The SDM suggests that Omicron is attenuated with almost identical N (inner shell) disorder as pangolin-CoV-2017 (N-PID (percentage of intrinsic disorder): 44.8% vs. 44.9%—lower than other variants). The outer shell disorder (M-PID) of Omicron is lower than that of other variants and pangolin-CoV-2017 (5.4% vs. 5.9%). COVID-19-related CoVs have the lowest M-PIDs (hardest outer shell) among all CoVs. This is likely to be …

Would New Sars-Cov-2 Variants Change The War Against Covid-19?, Elrashdy M. Redwan, Fatma Elrashdy, Alaa A.A. Aljabali, Wagner Baetas-Da-Cruz, Debmalya Barh, Adam M. Brufsky, Sk. Sarif Hassan, Kenneth Lundstrom, Ángel Serrano-Aroca, Kazuo Takayama, Murtaza M. Tambuwala, Bruce D. Uhal, Vladimir N. Uversky

Molecular Medicine Faculty Publications

The scientific, private, and industrial sectors use a wide variety of technological platforms available to achieve protection against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), including vaccines. However, the virus evolves continually into new highly virulent variants, which might overcome the protection provided by vaccines and may re-expose the population to infections. Mass vaccinations should be continued in combination with more or less mandatory non-pharmaceutical interventions. Therefore, the key questions to be answered are: (i) How to identify the primary and secondary infections of SARS-CoV-2? (ii) Why are neutralizing antibodies not long-lasting in both cases of natural infections and post-vaccinations? …

Bayesian Molecular Dating Analyses Combined With Mutational Profiling Suggest An Independent Origin And Evolution Of Sars-Cov-2 Omicron Ba.1 And Ba.2 Sub-Lineages, Naveen Kumar, Rahul Kaushik, Ashutosh Singh, Vladimir N. Uversky, Kam Y. J. Zhang, Upasana Sahu, Sandeep Bhatia, Aniket Sanyal

Molecular Medicine Faculty Publications

The ongoing evolution of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has resulted in the recent emergence of a highly divergent variant of concern (VOC) defined as Omicron or B.1.1.529. This VOC is of particular concern because it has the potential to evade most therapeutic antibodies and has undergone a sustained genetic evolution, resulting in the emergence of five distinct sub-lineages. However, the evolutionary dynamics of the initially identified Omicron BA.1 and BA.2 sub-lineages remain poorly understood. Herein, we combined Bayesian phylogenetic analysis, mutational profiling, and selection pressure analysis to track the virus’s genetic changes that drive the early evolutionary dynamics of …

Non-Verbal Communication, Anxiety, Behavioral Changes Within Covid Regulatory Changes, Sydney Stack, Olivia Mccracken

Communication Senior Capstones

In the current era of education and social communication shifting into a virtual world the students entering the early elementary education system have experienced something that is new to all of us. Within the last two and a half years life as we have known it has vastly shifted. Virtual learning and communication, which is not something that is new, but something that was scarce prior to the Covid-19 pandemic is now the “new normal.” For many of the students affected, this way of learning has shaped much of their educational career. Changes like these are affecting areas of development …

Beyond Compulsory Licensing: Pfizer Shares Its Covid-19 Medicines With The Patent Pool, Chenglin Liu

Faculty Articles

On March 15, 2022, the United States, European Union, India, and South Africa reached an agreement on the waiver of intellectual property rights (IP rights) for COVID-19 vaccines. The waiver agreement has rekindled the debate on the balance between IP rights protection and equitable access to medicines during a public health crisis. India, South Africa, and other developing countries maintain that a waiver was the only way to make vaccines affordable and accessible. Leading pharmaceutical companies argue that the waiver will stifle innovation and make lifesaving medicines less accessible. Both sides have seemingly overlooked Pfizer's voluntary agreement with the Medicines …

Yoga, Stress, And College Students During The Covid-19 Pandemic: A Mixed Methods Study, Lori Klein

West Chester University Doctoral Projects

College students have experienced exponential increases in stress and mental health concerns that continued to rise during the global coronavirus pandemic. Yoga is a popular, well-regarded method for improving psychological wellbeing, and this study explored how students’ perceived stress improved during a semester-long introductory yoga course upon returning to in-person instruction after a period of remote learning as a result of coronavirus restrictions. This study used an explanatory sequential mixed method design to first measure perceived stress scores and then compare this data to student-reports of wellbeing. College students (n = 121) enrolled in 8 sections of Yoga 1 completed …

The Pandemic Dilemma: A Mixed-Methods Study Of Student-Centered Science Education In The Covid-19 Pandemic, Jennifer Slavick

West Chester University Doctoral Projects

The purpose of this explanatory sequential mixed-methods study was to determine how student-centered instruction shifted and what dilemmas teachers experienced in enacting science instruction as they worked through the COVID-19 pandemic. A modified Draw-A-Science-Teacher-Test was used to examine teachers’ perceived instruction during the Fall of 2019, Fall of 2020, and Fall of 2021. Scores on this modified checklist were compared to determine differences in instruction year-to-year, across grade-bands, and to find trends in instruction concerning student demographics. Interviews were conducted with a subset of teachers in the study to learn more about the dilemmas they faced as their attempted science …

Trauma-Informed Educational Practices In The Middle School Classroom During The Covid-19 Pandemic, Loralynne Yost

West Chester University Doctoral Projects

This collective case study used a mixed methods approach to examine how Trauma-Informed Educational Practices (TIEP) manifest in the middle school classroom. This study is important due to the trauma students experienced during the COVID-19 pandemic. Teacher participants had district training in trauma-informed practices prior to this study.

Teacher participants took an initial survey to capture their conceptualization and perceived usage of the TIEP in the classroom. Teachers then used TIEP in their classrooms for two weeks. Teachers kept a checklist of which of the TIEP they used each day and commented on the context for the use of the …

Distance Education Under Duress: A Case Study Of Exchange Students’ Experience With Online Learning During The Covid-19 Pandemic In The Republic Of Korea, William H. Stewart, Patrick R. Lowenthal

Educational Technology Faculty Publications and Presentations

COVID-19 caused universities around the world to transition overnight to some type of remote learning or online format. The way this occurred, though necessary, was a departure from the standards and norms of traditional distance education and was a drastic change for the majority of faculty and students who had no prior experience with remote, blended, or online learning. This case study was conducted in the Republic of Korea with 15 international exchange students who found themselves forced to take distance education courses on an empty campus during the COVID19 pandemic. Themes of isolation and loneliness, diverse learning experiences, little-to-no …

Transportation Barriers To Care Among Frequent Health Care Users During The Covid Pandemic, Abigail L. Cochran, Noreen C. Mcdonald, Lauren Prunkl, Emma Vinella‑Brusher, Jueyu Wang, Lindsay Oluyede, Mary Wolfe

Community and Regional Planning Program: Faculty Scholarly and Creative Activity

Background: Transportation problems are known barriers to health care and can result in late arrivals and delayed or missed care. Groups already prone to greater social and economic disadvantage, including low-income individuals and people with chronic conditions, encounter more transportation barriers and experience greater negative health care consequences. Addressing transportation barriers is important not only for mitigating adverse health care outcomes among patients, but also for avoiding additional costs to the health care system. In this study, we investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users.

Methods: A web-based survey was …

Data Analytics For Crisis Management: A Case Study Of Sharing Economy Services In The Covid-19 Pandemic, Bahri Haciibrahimoglu

Selected Full Text Dissertations, 2011-

This dissertation study aims to analyze the role of data-driven decision-making in sharing economy during the COVID-19 pandemic as a crisis management tool. In the twenty-first century, when applying analytical tools has become an essential component of business decision-making, including operations on crisis management, data analytics is an emerging field. To carry out corporate strategies, data-driven decision-making is seen as a crucial component of business operations. Data analytics can be applied to benefit-cost evaluations, strategy planning, client engagement, and service quality. Data forecasting can also be used to keep an eye on business operations and foresee potential risks. Risk Management …

School Provided Speech-Language Therapy Plans Amid The Coronavirus Pandemic And Correlating Provider Attitudes, Zabia Evans

OUR Journal: ODU Undergraduate Research Journal

As the Coronavirus pandemic continues to be a threat for those of all ages, schools were a main concern when discussing how we should attempt to return to our “normal” lives. A considerable amount of speech therapy is done in schools, and speech-language pathologists nationwide are also being impacted by the changes during this school year. This research examined many aspects of providing speech therapy during the 2020-2021 school year, beginning with introductory statistics concerning the number of children participating in each session, the instruction styles, and grade levels taught. Respondents answered a set of questions concerning their attitudes towards …

A Lost Generation: Perpetual Education Insecurity Among The Rohingya, Robin E. Al-Haddad, Kendra L. Duran, Saleh Ahmed

Global Studies Faculty Publications and Presentations

Education security exists when every child has equal access to quality education. Rohingya refugee children suffer widespread rates of education insecurity both in their home country, Myanmar and in their host country, Bangladesh. While the right to education is recognized in several human rights instruments, access to education is not ubiquitous, making the ability to achieve this right challenging for many Rohingya. Government restrictions on accredited education, COVID-19 related school closures, failures in launching a pilot of the Myanmar curriculum, and recent government plans to relocate refugees to Bhasan Char Island have created a ‘lost generation’ of Rohingya youth. This …

Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection: A Case Series From A 12-Month Longitudinal Occupational Cohort, Christina D. Mack, Caroline Tai, Robby Sikka, Yonatan H. Grad, Lisa L. Maragakis, Nathan D. Grubaugh, Deverick J. Anderson, David Ho, Michael Merson, Radhika M. Samant, Joseph R. Fauver, James Barrett, Leroy Sims, John Difiori

Journal Articles: Epidemiology

Findings are described in 7 patients with severe acute respiratory syndrome coronavirus 2 reinfection from the National Basketball Association 2020-2021 occupational testing cohort, including clinical details, antibody test results, genomic sequencing, and longitudinal reverse-transcription polymerase chain reaction results. Reinfections were infrequent and varied in clinical presentation, viral dynamics, and immune response.

Severe Acute Respiratory Infection-Preparedness: Protocol For A Multicenter Prospective Cohort Study Of Viral Respiratory Infections, Radu Postelnicu, Avantika Srivastava, Pavan K. Bhatraju, Mark M. Wurfelc, George L. Anesi, Martin Gonzalez, Adair Andrews, Karen Lutrick, Vishakha K. Kumar, Timothy M. Uyeki, Perren J. Cobb, Leopoldo N. Segal, David Brett-Major, Janice M. Liebler, Christopher J. Kratochvil, Vikramjit Mukherjee, M. Jana Broadhurst, Richard Lee, David Wyles, Jonathan E Sevransky, Laura Evans, Douglas Landsittel

Journal Articles: Epidemiology

OBJECTIVES: Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity.

DESIGN: Prospective cohort study.

SETTING: Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals …

Firm Resources, Strategies, And Survival And Growth During Covid-19: Evidence From Two-Wave Global Surveys, Sheng Fang, Chorching Goh, Shaomin Li, L. Colin Xu

Management Faculty Publications

This study examines how firms have made strategic choices and performed during the COVID-19 pandemic. Drawing on the organizational resources and strategic change literature, it uses World Bank Enterprise Surveys and the COVID-19 Follow-up Enterprise Surveys to examine how different endowments in organizational resources affected firm performance as measured by their survival status and sales growth, and how these resources interact with and affect strategic responses in the supply of inputs, response to changing demand, liquidity management, and innovation. The results indicate that larger firms, firms with foreign or state ownership, and subsidiary companies performed better during the pandemic by …

Gender-Specific Psychological And Social Impact Of Covid-19 In Pakistan, Fauziah Rabbani, Hyder Ali Khan, Suneel Piryani, Areeba Raza Khan, Fahad Abid

Community Health Sciences

Background: COVID-19 has rapidly spread across the world. Women may be especially vulnerable to depression and anxiety as a result of the pandemic.
Aims: This study attempted to assess how gender affects risk perceptions, anxiety levels and behavioural responses to the COVID-19 pandemic in Pakistan, to recommend gender-responsive health policies.
Methods: A cross-sectional online survey was conducted. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale, and questions on their risk perceptions, preventive behaviour and information exposure. Multiple logistic regression analysis was used to assess the effects of factors such as age, gender and …

Ochrona Zdrowia I Gospodarka. Przegląd Współczesnych Problemów Systemu Opieki Zdrowotnej, Józef Haczyński, Zofia Skrzypczak

Monografie/Monographs

Monografia porusza problematykę związaną z szeroko pojętym zarządzaniem w opiece zdrowotnej. Jest to kolejna publikacja naukowa będąca pokłosiem cyklu konferencji pod tytułem OCHRONA ZDROWIA I GOSPODARKA. Niniejsza książka porusza kwestie konsekwencji niepożądanych społecznie zachowań i zjawisk dla systemu opieki zdrowotnej i gospodarki, pozycji pacjenta w systemie ochrony zdrowia, problemom zarządzania placówkami opieki zdrowotnej czy zewnętrznym uwarunkowaniom oddziaływania na zdrowie publiczne i system opieki zdrowotnej. Monografia poświęcona jest pamięci prof. dr hab. Kazimierza Rycia, wybitnego ekonomisty, naukowca, jednego z inicjatorów powołania na Wydziale Zarządzania Uniwersytetu Warszawskiego, Centrum Zarządzania w Ochronie Zdrowia oraz redaktora naukowego wszystkich dotychczas opublikowanych monografii z tej serii. …

Iranian Parents' Perceptions On Physical Activity For Their Children With Autism Spectrum Disorder During The Covid-19 Pandemic, Sarvin Salar, Justin A. Haegele, Hassan Daneshmandi

Human Movement Studies & Special Education Faculty Publications

Purpose: The COVID-19 pandemic is a remarkable health crisis that enforced most people to stay at home and quarantine for a period of time and seems to be having negative impacts on physical activity and mental health worldwide. Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder with a deficit in social interaction characteristics, relationships, and stereotyped behaviors. This study examined Iranian parents’ perceptions of physical activity for their children with ASD during the COVID-19 pandemic.

Methods: In this study, an explanatory qualitative methodology was used and data were collected via semi-structured phone interviews. The samples included 40 Iranian parents (aged …

Assessment Of The Impact Of The Lockdown On The Use Of Medications For Chronic Diseases In The State Of Goa, Sayed Sf, Dias A, Viegas M

Manipal Journal of Medical Sciences

Background: The COVID-19 pandemic came as a shock to citizens globally and those dependent on medications for chronic conditions were hit the hardest during the long lockdowns. This study aims to assess how the medications for chronic conditions in the state of Goa were impacted and the change in practices and attitude towards purchase and compliance.

Methods: It was a cross sectional study conducted on 264 participants from various parts of Goa, a state on the western coast of India. Data was collected using an online questionnaire using Google forms which involved closed and open ended questions assessing attitude, compliance …