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1 |
[record_id] |
Record ID |
text |
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2 |
[participant_id] |
Participant id |
text |
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3 |
[partiicipant_name] |
Participant name |
text |
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4 |
[age] |
Age |
text |
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5 |
[gender] |
Gender |
dropdown| 1 | * woman | | 2 | * man | | 3 | * Other | | 4 | * prefer not to say |
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6 |
[native_language] |
Native language
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text |
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7 |
[second_language] |
Second language
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text |
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8 |
[third_language] |
Third language
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text |
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9 |
[country_of_residence] |
Country of residence
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text |
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10 |
[city_town_of_residence] |
City/town of residence
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text |
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11 |
[country_of_birth] |
Country of birth |
text |
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12 |
[city_town_of_birth] |
City/town of birth
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text |
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13 |
[state_your_highest_complet] |
State your highest completed level of education
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dropdown| 1 | * Primary/Compulsory school | | 2 | * Secondary/High school | | 3 | * Adult residential college | | 4 | * Bachelor's degree | | 5 | * Master's degree | | 6 | * Doctoral degree |
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14 |
[how_well_do_you_think_your] |
How well do you think your sense of smell functions?
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dropdown| 1 | Very poor | | 2 | Poor | | 3 | Fairly good | | 4 | Good | | 5 | Very good |
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15 |
[how_well_do_you_think_your_2] |
How well do you think your sense of taste functions?
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dropdown| 1 | Very poor | | 2 | Poor | | 3 | Fairly good | | 4 | Good | | 5 | Very good |
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16 |
[how_well_do_you_think_your_3] |
Have you experienced a loss of smell during the past year?
(Not being able to smell things that normally have a scent)
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dropdown| 1 | Never | | 2 | Rarely | | 3 | Sometimes | | 4 | Often | | 5 | Always |
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17 |
[how_well_do_you_think_your_4] |
Have you experienced distortions of smells during the past year?
(Things smelling different than usual, like oranges smelling like manure)
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dropdown| 1 | Never | | 2 | Rarely | | 3 | Sometimes | | 4 | Often | | 5 | Always |
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18 |
[how_well_do_you_think_your_5] |
Have you experienced 'phantom smells' during the past year?
(Smelling something despite no obvious source nearby)
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dropdown| 1 | Never | | 2 | Rarely | | 3 | Sometimes | | 4 | Often | | 5 | Always |
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19 |
[do_you_have_any_serious_ne] |
Do you have any serious neurological or psychiatric conditions?
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yesno |
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20 |
[do_you_have_any_serious_ne_2] |
Have you been diagnosed with or suspect you have had a respiratory illness that affected your sense of smell?
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yesno |
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21 |
[have_you_experienced_any_o] |
Have you experienced any of the following changes in smell during or after recovering from your respiratory illness? (Check all that apply)
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checkbox| 1 | have_you_experienced_any_o___1 | Smells are weaker than before | | 2 | have_you_experienced_any_o___2 | Smells are different than before (odor quality has changed) | | 3 | have_you_experienced_any_o___3 | I smell things that aren't there (e.g., a burning smell with nothing burning) | | 4 | have_you_experienced_any_o___4 | My sense of smell fluctuates (comes and goes) | | 5 | have_you_experienced_any_o___5 | No |
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22 |
[which_of_the_following_ill] |
Which of the following illnesses affected your sense of smell?
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dropdown| 1 | * COVID-19 (suspected) | | 2 | * Influenza | | 3 | * Other viral illness (e.g., cold) | | 4 | * Strep throat (streptococcal bacteria) | | 5 | * Other bacterial illness | | 6 | * Other / don't know | | 7 | * None |
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23 |
[when_did_you_have_this_ill] |
When did you have this illness?
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dropdown| 1 | * Ongoing | | 2 | * 2-3 months ago | | 3 | * 4-6 months ago | | 4 | * 7-12 months ago | | 5 | * Over a year ago | | 6 | * I did not have an illness |
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24 |
[have_you_been_diagnosed_wi] |
Have you been diagnosed with or suspect you have had a respiratory illness that affected your sense of taste? |
yesno |
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25 |
[have_you_experienced_an] |
Have you experienced any of the following changes in taste during or after recovering from your respiratory illness? (Check all that apply) |
dropdown| 1 | * Tastes are weaker than before | | 2 | * Tastes are different than before (taste quality has changed) | | 3 | * I taste things that aren't there (e.g., a sweet taste with nothing in my mouth) | | 4 | * My sense of taste fluctuates (comes and goes) | | 5 | * No |
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26 |
[which] |
Which of the following illnesses affected your sense of taste? |
dropdown| 1 | * COVID-19 (suspected) | | 2 | * Influenza | | 3 | * Other viral illness (e.g., cold) | | 4 | * Strep throat (streptococcal bacteria) | | 5 | * Other bacterial illness | | 6 | * Other / don't know | | 7 | * None |
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27 |
[wg] |
When did you have this illness? |
dropdown| 1 | * Ongoing | | 2 | * 2-3 months ago | | 3 | * 4-6 months ago | | 4 | * 7-12 months ago | | 5 | * Over a year ago | | 6 | * I did not have an illness |
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28 |
[please_describe_the_odor_a] |
Section Header: Questions for each odor[Participants perform one training trial with one odor. The odor is presented using a scent pen held by the research assistant. After the odor is presented, the participant answers the following questions. The participants may smell the odor as many times as they wish while answering.]You will now perform one training session. [Participants are presented with a total of 30 odors. The odors are presented using a scent pen held by the research assistant. After each odor is presented, the participant answers the following questions. The participant may smell the odor as many times as they wish while answering]
Please describe the odor as freely and in as much detail as possible:
Which three words best describe the odor?
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text |
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29 |
[what_odor_is_it] |
What odor is it? |
text |
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30 |
[on_a_scale_from_0_not_at_a] |
On a scale from 0 (not at all pleasant) to 10 (very pleasant), how pleasant is the odor?
* Not at all pleasant
* Very pleasant
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slider (Min: 0, Max: 10)
Slider labels: 0(Not at all pleasant), , 10(Very pleasant)
Custom alignment: RH |
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31 |
[on_a_scale_from_0_very_ine] |
On a scale from 0 (very inedible) to 10 (very edible), to what extent does the odor comes from something edible?
* Very inedible
* Very edible
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slider (Min: 0, Max: 10)
Slider labels: 0( Very inedible ), , 10(Very edible)
Custom alignment: RH |
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32 |
[on_a_scale_from_0_not_dete] |
On a scale from 0 (not detectable) to 10 (very intense), how intense is the odor?
* Not detectable
* Very intense
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slider (Min: 0, Max: 10)
Slider labels: 0(Not detectable), , 10(very intense)
Custom alignment: RH |
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33 |
[on_a_scale_from_0_very_unf] |
On a scale from 0 (very unfamiliar) to 10 (very familiar), how familiar is the odor?
[Graphical scale from 0 to 10]
* Very unfamiliar
* Very familiar
|
slider (Min: 0, Max: 10)
Slider labels: 0(Very unfamiliar), , 10(Very familiar)
Custom alignment: RH |
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34 |
[on_a_scale_from_0_very_dif] |
Section Header: [An additional odor is presented for comparison]
Smell each odor and assess how well the two odors match each other.
[Present odor X first and odor Y second]
On a scale from 0 (very different) to 10 (very similar), how similar are the two odors?
* Very different
* Very similar
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slider (Min: 0, Max: 10)
Slider labels: 0(Very different ), , 10( Very similar)
Custom alignment: RH |
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35 |
[form_1_complete] |
Section Header: Form Status
Complete?
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dropdown| 0 | Incomplete | | 1 | Unverified | | 2 | Complete |
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