Browsing by Subject "Mixed methods"

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Characterization of the peripheral artery disease symptom experience
(2013-08) Schorr, Erica Nicole
Background: Claudication is the most commonly recognized symptom of PAD. It is classically described as an aching, cramping, painful, or tired feeling in the buttock or leg muscles. However, classic claudication is only reported in 7.5% to 33% of patients with PAD. Symptoms beyond classic claudication have been reported and suspected as being part of the symptom experience, but have not been validated as directly relating to changes in calf tissue oxygenation during exercise and subsequent recovery. Objective: The purpose of this study was to characterize the symptom experience of individuals diagnosed with PAD. Specific aims were to: (a) understand the symptom experience of individuals with PAD through in-depth qualitative interviews, and (b) simultaneously evaluate calf tissue oxygenation and self-reported symptoms experienced during treadmill exercise and throughout recovery. Method: Adults experiencing lower extremity symptoms during exercise due to underlying PAD were asked to participate. They were asked to: (a) complete a semi-structured interview to report their symptoms and describe their symptom experience in detail; (b) use a numeric rating scale (NRS) (0 to 5) to rate their symptoms during exercise and recovery; (c) provide descriptions of their symptom(s) during exercise and recovery; and (d) wear a near-infrared spectroscopy device to obtain information on tissue oxygenation during the exercise and recovery phases. Data were analyzed using content analysis, exploration of individual graphical trajectories, grouping trajectories, and multilevel modeling to examine the relationship between self-reported symptoms and calf tissue oxygenation. Results: A total of 40 participants were enrolled in this study. Participants were predominately Caucasian males. The average age of participants was 67.55 years (SD 9.18). Six themes emerged from 27 participant interviews: symptom descriptors, maintaining equilibrium, temporal fluctuations, the role of exercise, the perceived impact on QOL, and disease presence and treatment. During interviews, participants provided 24 symptom descriptors in 10 lower extremity locations. During treadmill exercise, participants provided 22 symptom descriptors in eight lower extremity locations. Under static and dynamic conditions, classic and `atypical' descriptors were used to describe discomfort in typical and `atypical' lower extremity locations. During three successive bouts of treadmill exercise, the largest drop in calf tissue oxygenation occurred between the start of exercise and the onset of symptom(s). During recovery, calf tissue re-saturation occurred steadily between maximum discomfort (i.e., a rating of 5 out of 5) and full symptom recovery. Individual changes in tissue oxygenation were related to total exercise time, baseline calf tissue oxygenation, exercise and recovery ratings, disease severity, and body-mass index. Conclusions: This study provides a preliminary understanding of the relationship between subjective symptom reporting and calf tissue oxygenation with a variety of PAD risk factors and individual characteristics. Continued research is necessary to validate `atypical' participant symptom reporting and broaden the currently accepted PAD symptom locations and descriptors. Despite the under-reporting of `atypical' symptoms compared to classic claudication, they do exist and they are no less important for the early detection, diagnosis, and treatment of PAD to minimize the impact of this painful, debilitating, and deadly disease.
Comparing Preservice and Early Career Teachers' Perceptions of Elementary Music Teacher Education Practices: A Mixed Methods Study
(2018-01) Choi, Jung Won
Elementary school music experiences have been shown to be influential for lifelong music engagement, and sound music teacher education would be the most effective way to provide positive school music experiences to students in elementary schools. In spite of this importance, many countries have different elementary music education and music teacher education practices based on their cultural values and educational priorities. The purpose of this study is to compare music teacher education practices for elementary schools in South Korea with those in the upper Midwest region of the United States by investigating preservice and early career elementary music teachers’ perceptions of their own music teacher education programs, self-perceptions of competence, and their suggestions for improvement. This Sequential Explanatory Mixed Methods study, which involved survey data in Phase I and interviews in Phase II, attempts to unravel the reasons behind these teachers’ perceptions and to approach a middle ground for elementary school music teacher education by recommending some practical ways to improve in two very distinctive contexts. The quantitative and qualitative results reveal that US teachers were mostly satisfied with their training, while the majority of the Korean teachers expressed great disappointment. Teachers in both countries expressed some degree of concern regarding the grade level preparation and appreciated their training courses and student teaching practicum when those were practical and related to pedagogy. In addition, their experiences in university courses and student teaching were greatly dependent on course instructors and cooperating teachers they met. In terms of a level of confidence in music teaching, the US teachers showed higher levels of confidence than did the Korean teachers, and their levels of confidence were highly related to their perceptions regarding the institutional performance addressing knowledge and skills that are necessary and relevant to the music teachers’ needs. Participants, regardless of their teaching experience level and their satisfaction, agreed that teachers who have enough music training and proper understanding of elementary school children should teach music in elementary schools, although the current status of each country was different, and the degrees of agreement were varied. In addition, while many US teachers wanted to have a prescribed curriculum as a guideline to ensure effective music teaching, every single Korean respondent preferred to have a prescribed curriculum, revealing the long educational convention and the current situation. Teachers in the US especially critiqued insufficient elementary school level consideration and practicality in their program. Their perceptions revealed the weaknesses in training elementary music specialists under the choral/instrumental track system for broad K-12 certification. On the other hand, although training in Korea was targeted to the elementary school level, the Korean music education major does not seem to function effectively to train elementary school level experts due to a lack of enough music expertise, practicality, and pedagogical support. Based on the teachers’ suggestions for improvement, some realistic remedies were proposed to find a middle ground such as enhancing music methods courses in terms of pedagogical content and practicality, increasing interrelation between the field experiences and university training courses, utilizing veteran elementary music teachers as music education faculty and cooperating teachers, and offering more accessible and organized professional development opportunities to elementary in-service teachers. The ultimate beneficiary of these improvements would be elementary school children who would have increased chances of getting a quality music education in their early and critical years.
Do Words Really Matter: A Mixed Methods Grounded Theory Study Of Student Conduct Codes And Campus Racial Climate Data
(2020-05) Barnes, Anne
Among the most bedeviling problems on college campuses today is whether and how an inclusive campus racial climate and freedom of expression can co-exist in a complementary manner. Public universities must adhere to the First Amendment, just as the rest of society does; the difficulty they face is the balance between protecting the right to free and open expression and creating a positive racial climate for their many students of differing backgrounds. There are few limitations on freedom of speech and expression, but universities do not want to appear as though they do not take seriously accusations of racial bias and discrimination, nor that racism and racial microaggressions are acceptable. At the heart of the issue is how to allow legally protected speech to exist on a campus while simultaneously ensuring civil rights of historically underrepresented students, staff, and faculty. Historically, this is where student conduct codes have been utilized, as speech cannot be regulated legally in the same way that conduct can. This mixed methods grounded theory study explored the current discussion around campus racial climate in relation to freedom of speech, examining both legal and policy positions, and sought to understand the relationship between the specific verbiage and themes used in student conduct codes and students’ perceptions of campus racial climate on an individual campus. This analysis of student conduct codes, mission statements, legal cases, and data from the undergraduate Student Engagement in the Research University survey revealed that: a) student conduct codes remain focused on punishment, not student development; b) institutions continue to employ overly legalistic language in student conduct codes; c) student conduct codes do not reflect mission statement values; and d) the absence or presence of diversity discussion in student conduct codes shares a relationship with student perceptions of campus racial climate.
The effects of brain injury and talker characteristics on speech processing in a single-talker interference task.
(2011-08) Krause, Miriam Ottilie
People who have experienced traumatic brain injury (TBI) often report increased difficulty processing speech than they experienced before their injuries; and this difficulty is not always accompanied by impaired performance on standardized tests of language, auditory processing, or other cognitive factors. Unfortunately, there is a paucity of research directly addressing this issue. Prior studies have mostly focused on measures of characteristics such as attention (e.g. Schmitter-Edgecombe & Nissley, 2000), dichotic listening (e.g. Meyers, Roberts, Bayless, Volkert, & Evitts, 2002), and masking release (e.g. Krause, Nelson, & Kennedy, 2009) in people with TBI. All of these factors may play their part in functional listening tasks, but separately they cannot capture the complex task of speech processing (e.g. Wilson 2003). The goal of this dissertation is to build on existing work to explore and compare the issue of speech processing after brain injury across several levels: sentence repetition with single-talker interference, using targets spoken by native- and non-native-accented speakers of English; standardized testing of cognition and auditory processing; and semi-structured interviews about participants’ subjective experiences with complex speech processing. This study comprised two experiments. The purpose of Experiment 1 was to demonstrate the effects of simulated peripheral hearing loss on performance on the sentence repetition task. Participants in Experiment 1 were 30 healthy young adults, 15 of whom completed the sentence repetition task with stimuli that were filtered with a 1400 Hz low-pass filter to simulate peripheral hearing loss. The other 15 participants completed the task with unfiltered stimuli. The purpose of Experiment 2 was to compare adults with and without TBI on the (unfiltered) sentence repetition task, and included 13 people in each participant group. Groups were matched for age, education, and estimated verbal IQ within each experiment. Dependent variables for the sentence repetition task were accuracy and subjective effort. Participants in Experiment 2 also completed a battery of standardized tests and a semi-structured interview about their subjective experiences with speech processing. Results of Experiment 1 showed that the filtered group was less accurate and reported greater effort than the unfiltered group, and the filtered group showed greater effects of speaker accent. Results of Experiment 2 demonstrated that the TBI group had poorer accuracy than controls, but not significantly higher effort. As predicted, the TBI group also reported more subjective difficulty with complex speech processing than healthy controls, but there was no direct correlation between interview reports and accuracy on the sentence repetition task. Comparisons between the TBI group of Experiment 2 and the filtered group of Experiment 1 suggest that, although the TBI group did show impaired performance on the speech processing task, their performance was not consistent with the peripheral auditory effects that were modeled in Experiment 1. This suggests that the speech processing difficulty experienced by people with TBI cannot be explained by bottom-up processing (e.g. energetic masking) alone. Further research is needed in order to better understand the nature of speech processing problems after TBI, the ultimate goal of which is to be able to develop therapies and strategies that will allow people with TBI to communicate successfully even in difficult circumstances.
The factors that affect science teachers' participation in professional development
(2013-05) Roux, Judi Ann
Scientific literacy for our students and the possibilities for careers available in Science, Technology, Engineering, and Mathematics (STEM) areas are important topics for economic growth as well as global competitiveness. The achievement of students in science learning is dependent upon the science teachers' effectiveness and experienced science teachers depend upon relevant professional development experiences to support their learning. In order to understand how to improve student learning in science, the learning of science teachers must also be understood. Previous research studies on teacher professional development have been conducted in other states, but Minnesota science teachers comprised a new and different population from those previously studied. The purpose of this two-phase mixed methods study was to identify the current types of professional development in which experienced, Minnesota secondary science teachers participated and the factors that affect their participation in professional development activities. The mixed-methods approach s utilized an initial online survey followed by qualitative interviews with five survey respondents. The results of the quantitative survey and the qualitative interviews indicated the quality of professional development experiences and the factors which affected the science teachers' participation in professional development activities. The supporting and inhibiting factors involved the availability of resources such as time and money, external relationships with school administrators, teacher colleagues, and family members, and personal intrinsic attributes such as desires to learn and help students. This study also describes implications for science teachers, school administrators, policymakers, and professional development providers. Recommendations for future research include the following areas: relationships between and among intrinsic and extrinsic factors, science-related professional development activities within local school districts, the use of formal and informal professional development, and the needs of rural science teachers compared to urban and suburban teachers.
Identity Integration in Emerging Adulthood: A Longitudinal Investigation of Well-Being and Psychological Outcomes
(2019-06) Nelson, Sarah C.
This study applies the theoretical framework for identity integration presented by Syed and McLean (2016) to a longitudinal and mixed methods investigation of the process and content of contextual identity integration in emerging adults at four time points over the first three years of college (N = 189, Mage at wave one = 18.70). A unique application of Little’s (2015) Personal Projects Analysis was used to address five weaknesses of past investigations of contextual identity integration by exploring identity integration at the second tier of personality: characteristic adaptations. Results suggested two unique processes: contextual identity integration and contextual identity disintegration. For the majority of participants contextual identity integration decreased across the first three years of college. Concurrent associations suggested complex associations between psychological health, contextual identity integration and disintegration. Taken together with coding of the content of these integrative processes, findings suggest the significance of interpersonal connection to contextual identity integration, as well as the importance of novel approaches to the measurement of identity integration.
Listening language and student interaction in online writing spaces
(2014-05) Oleksiak, Timothy
This dissertation responds to the concerns rhetoric and composition teachers have with student interaction in online writing spaces. Specifically, the study conducted here is part of a recent conversation regarding the way students listen in online environments. This dissertation explores listening from a rhetorical perspective. Current frameworks for online interaction center largely on reducing three types of conflict: flaming, lurking, and low/non-participation. As a response to the challenge of how to proceed in light of these online conflicts, this dissertation offers "listening language" as one solution. Drawing upon the works of Wayne Booth, Sharon Crowley, Jacqueline Jones Royster, and Krista Ratcliffe, I argue that listening language becomes an approach to online interaction that students and teachers may use in three distinct online spaces: asynchronous discussion forums, virtual peer reviews, and a final narrative analysis assignment that is uploaded to a graded drop box. Listening approaches like the one I develop have the potential to transform the way individuals interact with each other from a position of mastery and argumentative superiority to one of mutual exploration and exchange. This dissertation is guided by the following research questions: Does exposure to pedagogy based on listening language a) change students' attitudes about the relationship between listening and writing and b) their online discourses? Are there differences between the online discourses of students who have been exposed to a pedagogy based on listening language and those who have not? If so, how can those differences be characterized? Taken together, these questions help researchers interesting in listening and online writing instruction understand some of the ways listening happens in online spaces.To assess the impact of a pedagogy based on the principles of listening language, I use a mixed methodology for data collection and analysis. This study was conducted on two sections of first-year writing at a large, mid-western research university during the Spring 2013 semester. I created a sequential design that begins with a quasi-experiment data collection process followed by rhetorical analysis of student texts generated through the duration of the study. This study also uses statistical analysis of an original pretest/posttest survey results that are a part of the quasi-experimental research design. Sentence-level and whole-paper rhetorical analysis were also conducted on student-written texts collected during this study.The findings suggest that listening language does impact student attitudes toward listening. Though there are differences between the written texts of students in treatment and control groups, neither group makes use of listening language's entrance and exit moves. This study also finds that hedging and qualifying are the most frequent ways students acknowledge troubles others may have with listening to their ideas. Moreover, students acknowledge troubles with listening most frequently during peer reviews rather than in discussion forums or the narrative analysis assignment.
Mixed methods analysis of multicultural identity and psychological help seeking beliefs in college students.
(2012-06) Walter, Jeffrey Paul
Research on the psychological help-seeking beliefs and behaviors of college students has provided evidence for differences among students based on demographic factors, with different variables being salient for different cultural groups. This mixed methods study focuses on understanding how common psychological help-seeking variables, including the role of one's social network, predict help-seeking beliefs, while triangulating these results with students' responses to questions about psychological help-seeking. Two hundred sixty-nine students from an urban, nonresidential, state university in the Midwest participated in the study, completing a questionnaire comprised of 2 scales, several demographic questions, and a variety of open-ended questions about seeking psychological help. Cultural dimensions of sociorace, gender and social class were combined to examine students' beliefs about psychological services by multicultural identity. Differences were found between groups when contrasting students who had previously sought help and those who had not previously sought help and also when contrasting European American and Racial/Ethnic Minority students. These differences were understood in light of qualitative responses which emphasized both the importance of being familiar with what psychological services have to offer and the confidence that psychological services could be helpful to someone from a similar cultural background. Suggestions for psychological professionals are discussed.
Mixed Methods analysis of multicultural identity and psychological help seeking beliefs in college students.
(2012-03) Walter, Jeffrey P.
Research on the psychological help-seeking beliefs and behaviors of college students has provided evidence for differences among students based on demographic factors, with different variables being salient for different cultural groups. This mixed methods study focuses on understanding how common psychological help-seeking variables, including the role of one's social network, predict help-seeking beliefs, while triangulating these results with students' responses to questions about psychological help-seeking. Two hundred sixty-nine students from an urban, nonresidential, state university in the Midwest participated in the study, completing a questionnaire comprised of 2 scales, several demographic questions, and a variety of open-ended questions about seeking psychological help. Cultural dimensions of sociorace, gender and social class were combined to examine students' beliefs about psychological services by multicultural identity. Differences were found between groups when contrasting students who had previously sought help and those who had not previously sought help and also when contrasting European American and Racial/Ethnic Minority students. These differences were understood in light of qualitative responses which emphasized both the importance of being familiar with what psychological services have to offer and the confidence that psychological services could be helpful to someone from a similar cultural background. Suggestions for psychological professionals are discussed.
A mixed methods investigation of flow experience in the middle level instrumental music classroom
(2014-08) Clementson, Casey Jill
ABSTRACT:A Mixed Methods Investigation of Flow Experience in the Middle Level Instrumental Music Classroom Casey J. Clementson - University of Minnesota Flow theory (Csikszentmihalyi, 1990) has potential to frame research on the quality of a student's experience in the classroom. The purpose of this mixed method study was to explore selected factors that may impact a student's frequency of flow experiences in a middle school band and how these flow experiences may relate to achievement and enjoyment. A convergent parallel mixed methods design was employed in which quantitative and qualitative data were collected concurrently, analyzed separately, and then merged. Quantitative data were collected in the form of repeated surveys of students in four classrooms; the qualitative method of inquiry was a case study of an eighth grade band. Results of a hierarchical linear modeling (HLM) analysis indicated that the factors of type of activity, self-determination, and a match between teacher and student perception of a student's self-efficacy were significant predictors of the balance between challenge and skill, or the flow channel. Results from the qualitative data analysis suggested that the teacher and students bring their own values, beliefs, and needs to create an overall band culture. The intent of the band culture is to create intrinsically motivated musicians. A continuum of flow opportunity was theorized; students move back and forth along the continuum based on their individual development. Merged data indicated convergence and divergence between the quantitative and qualitative data. Further research to explore developmentally appropriate and meaningful measures of flow for middle school students is recommended, along with expanding the sample when studying flow experiences (with quantitative, qualitative, or mixed methods designs).
The new landscape of Korean higher education: institutional and personal factors influencing intercultural competence.
(2009-08) Jon, Jae-Eun
This dissertation research examines the impact of institutional and personal factors on the development of Korean university students' intercultural competence in Korean higher education. It is based on the context of significant change in demographics within Korean higher education from a rapidly increasing influx of international students, as well as emergent diversity within Korean society. For these purposes, this research employed a two-phase mixed-methods design, in which the quantitative and qualitative data were collected and analyzed. The quantitative results from correlation, regression, and path analyses demonstrate that an institutional factor--participation in intervention programs that bring Korean and international students together in a structured and supportive environment --plays an important role in promoting Korean students' intercultural interactions with international students, as well as developing their intercultural competence. One personal factor in particular-- intercultural interaction--has a direct influence on higher levels of intercultural competence. On the other hand, the institutional factor and another personal factor--prior international experience-- contribute indirectly to intercultural competence by influencing intercultural interaction itself. The qualitative findings from in-depth interviewing describe the nature of intercultural interactions between Korean and international students in terms of: the experience of developing intercultural friendship; the importance of reciprocity in these relationships; and the value of having a shared experience among students. Not only do these findings provide empirical support for the theoretical orientation in this research--the contact hypothesis--but they also provide empirical evidence for the concept of "Internationalization at Home" (Wächter, 2003) by demonstrating the benefits of internationalization for domestic students who remain in their home countries. It particularly emphasizes understanding and promoting mutually beneficial relationships between mobile and non-mobile students in relation to the internationalization of higher education. Furthermore, this research carries important implications for Korean society in educating college students to live and work with culturally diverse people in its emergent multicultural milieu. Lastly, this research presents suggestions for policy and practice for higher education institutions to implement in developing intervention programs for student intercultural interaction and intercultural competence development.
Professionalization of Program Evaluation: A Comparative Mixed Methods Case Study of Canada and the United States
(2020-06) Ayoo, Sandra
Professionalization of evaluation means different things to different people across the globe. This study explored the professionalization of program evaluation in Canada and the United States of America (US) using sociological models of professionalism as the guiding framework for assessing the level of maturity of program evaluation as a field of professional practice. Five concepts identified by the model were used to develop a professionalism assessment tool for program evaluators (PAToPE) to measure the behavioral attributes of professionalism: professional autonomy, expertise, ethical dispositions, innovation and research, and credentialing. Data for the study were collected using a sequential mixed-methods approach starting with interviews of 27 evaluators and a test of the measurement instrument in an online survey to a random sample of 1,000 American Evaluation Association (AEA) members and 573 Canadian Evaluation Society (CES) members from the 2017 membership directory. The results of the study suggest that credentialing is the major difference between Canada and the US and that Canada is perceived to be more advanced in the professionalization of evaluation than the US. The empirical information also suggests that program evaluators demonstrate professionalism differently by country, place of work, gender, credentialed evaluator status, level of skills, level of education, age, and years of evaluation practice. The study concludes with implications and recommendations for professional associations, evaluation practice, and future studies.
Quality of life among Native American cancer survivors: Approaching harmony and balance after cancer
(2019-05) Bastian, Tiana
Introduction: Studies centered on understanding quality of life (QoL) among Native American cancer survivors are underrepresented in the literature. This knowledge gap presents a risk of underestimating and failing to adequately address the true burden of cancer in this population. Purpose: The purpose of this study was to gain a person-centered, comprehensive understanding of factors that influence QoL among Native American cancer survivors and how they manifest in survivors daily lives. Methods: We used a convergent mixed methods design to analyze data from 831 QoL surveys and 52 interviews with geographically and clinically diverse samples of Native cancer survivors. We employed latent class analysis (LCA) to identify “classes” of survivors with similar response patterns across physical, mental/emotional, social, and spiritual QoL domains (quantitative) and thematic analysis to identify themes of advice survivors’ had for other Native survivors and how that advice reflected survivors’ experiences and QoL after diagnosis (qualitative). Findings from the quantitative and qualitative studies were integrated to identify “meta-themes” of factors that influence QoL after cancer and how those factors operate in the context of survivors’ daily lives. Results: LCA identified four classes of survivors with unique QoL profiles: Positive QoL (42%); Well, overwhelmed (30%); Mildly burdened (17%); and Poor QoL (12%). We identified four meta-themes from our integrated analysis: 1) Culture: Value systems and spirituality are benchmarks for evaluating the cancer experience; 2) Years since diagnosis: Treatment and non-treatment related mechanisms influence healing over time; 3) Geographical context impacts access to medical and cultural resources for healing; and 4) Perceived control over cancer: Gaining control through self-advocacy and support. Discussion: Ignoring heterogeneity and contextual influences on QoL underestimates and misspecifies needs of many Native survivors. Conclusion: Interventions to support Native cancer survivors must support the whole person on their path to establishing harmony and balance after cancer.
Resilience and adaptation in the face of the COVID-19 pandemic: Complex mixed methods research of adults in Minnesota and Hong Kong
(2023-05) Chan, Athena Chung Yin
The COVID-19 pandemic has led to escalating family conflicts while limiting resources previously available to cope with stress. The mechanisms underlying resilience in the pandemic largely remain a black box. This dissertation aims to generate a holistic understanding of the trajectories of resilience capacity in response to complex acute-onset and chronic stress associated with the pandemic. My proposed Multisystemic Resilience Framework, a conceptual framework, illuminates resilience as a developing capacity changing over time. Informed by and empirically examining the framework, this dissertation employed complex mixed methods design targeting adults living with family members in Western cultures (i.e., Minnesota) and Eastern cultures (i.e., Hong Kong) over the first two years of the pandemic. Study 1 used a sequential, explanatory mixed-methods design to generate a fuller understanding of resilience capacity as manifested by individual and family resources, cumulative pandemic-related stressors, and mental health of adults. Structural equation modeling was used to examine the moderating roles of coping resources in each region, while qualitative content analysis elucidated the quantitative findings. Coping resources predicted around one-third of the variance in perceive resilience capacity during the early outbreak of pandemic in each region. Different individual and family coping resources were protective of adult mental health when facing high levels of pandemic-related stressors. The qualitative findings illuminated the situation-specific and culture-specific coping strategies utilized by participants. Study 2 used a critical realism paradigm to deepen the understanding of resilience mechanisms under specific contextual conditions throughout the pandemic. These resilience mechanisms, involving family hardiness, distress tolerance, and cognitive flexibility, offered insights into ways that individuals and families cope with complex stressors involving competing priorities. The study elucidated ways that individuals balanced family togetherness, family roles and responsibilities with their personal sense of safety from the infectious nature of COVID-19. Overall, this complex mixed methods research provides significant theoretical, methodological, and empirical contributions to our current understanding of resilience mechanisms within sociocultural contexts. While these empirical findings align with existing psychological treatments, the findings are suggestive of the need for culturally-tailored interventions to effectively ameliorate the negative impacts of a global pandemic and future related crises.

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