Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Selective Retention Of Birdshot Pellets In The Rearfoot: A Case Demonstrating Tissue Preservation And Functional Recovery, Yasim Zafar, Steven Bolton, Alexandria Armstrong, Hooman Mir

School of Podiatric Medicine - Student Research

Level of Evidence: III (Case Study)

Statement of Purpose: Gunshot wounds to the foot pose a unique surgical dilemma—whether to pursue aggressive foreign body removal or to preserve soft tissue integrity. This case highlights the management of a birdshot injury to the rearfoot where selective non-removal of pellets near the neurovascular bundle led to complete healing and full functional recovery. The purpose is to emphasize tissue preservation over aggressive exploration in complex ballistic foot injuries.

Case Study: A 26-year-old female sustained a birdshot gunshot wound to the right rearfoot. Multiple small entry wounds were noted on the posterior and plantar …

The Role Of Magnesium Supplements In The Management And Prevention Of Headache Disorders, Tatum Schroeder

Libraries Undergraduate Research Award (LURA) Winners

Much of the global population suffers from headache disorders like migraine. Because there are so many triggers and unknown explanations for migraine, it can be hard to find effective treatments for it. There are some studies that point to inflammation as either a cause or result of headache disorders; therefore, it is natural that we should explore the possibility of inflammation reducing factors when considering treatment options. The factor being explored in this review is magnesium supplementation, which has been shown to reduce inflammation by decreasing the amount of calcitonin-gene-related-peptide (CGRP) in circulation. There is a clear link between migraine …

Cell-Free Mitochondrial Dna (Mtdna) Triggers Vascular Dysfunction Via Toll-Like Receptor 9 (Tlr9)-Dependent Activation Of Inflammasomes, Mohin Amin

Senior Theses

Hypertension is the leading global risk factor for mortality and is closely associated with vascular inflammation and dysfunction. Damaged mitochondria release cell-free mitochondrial DNA (cf-mtDNA), which activates toll-like receptor 9 (TLR9). The binding of TLR9 to mtDNA activates the NLRP3 inflammasome pathway, promoting the release of pro-inflammatory cytokines via gasdermin D (GSDMD), therefore worsening inflammation. However, the mechanisms linking mitochondrial injury to inflammation-induced vascular dysfunction remain unclear. We hypothesize that cf-mtDNA triggers TLR9-dependent NLRP3 inflammasome activation contributing to vascular and endothelial dysfunction. To assess that, adult male C57BL/6 were exposed to 28 consecutive days of chronic unpredictable stress (CUS) or …

Free Versus In Situ Right Internal Mammary Artery As A Conduit In Coronary Artery Bypass Surgery: A Meta-Analysis, Yuta Kikuchi, Tomoki Sakata, Tomonari Shimoda, Shinichi Fukuhara, Junichi Shimamura, Makoto Hibino, Tsuyoshi Kaneko, Hiroo Takayama, Hisato Takagi, Michel Pompeu Sa, Toshiki Kuno

Department of Medicine Faculty Papers

OBJECTIVES: There is debate regarding the optimal choice for a second conduit in coronary artery bypass grafting. The right internal mammary artery (RIMA) is commonly employed as a second conduit; however, it is unclear whether the free (fRIMA) or in situ (isRIMA) configuration yields superior outcomes. We performed a systematic review and meta-analysis to compare clinical outcomes between fRIMA and isRIMA as the second conduit.

METHODS: A comprehensive search of PubMed (MEDLINE), EMBASE, and CENTRAL was performed through May 2025 to identify studies comparing outcomes in patients undergoing coronary artery bypass grafting with either fRIMA or isRIMA as a second …

Evaluating Forearm Strength Variability In Collegiate Tennis Players Over The Course Of A Competitive Season, Jeffrey Williams, Payton Jensen, Kevin Laudner

Clinical Practice in Athletic Training

The muscles of the forearm undergo routine, forceful, and repetitive contractions while playing tennis and may experience adaptive changes that can precede injury. An understanding of forearm strength profiles of tennis players following a competitive season would assist clinicians’ evidence-based management of the forearm’s readiness for training, competition, and return-to-sport participation. Therefore, the purpose of this study was to explore the effects of a competitive tennis season on forearm strength among collegiate tennis athletes. A prospective, case-series design was used to examine a convenience sample of 15 asymptomatic NCAA Division I tennis players (males = 10, height = 182.88 [SD …

Prescribed Aerobic Exercise And Sport-Related Concussion Recovery: A Validation Case Series, Lacy L. Chapel, Tamara C. Valovich Mcleod

Clinical Practice in Athletic Training

Active rehabilitation, including prescribed sub-symptom threshold aerobic exercise implemented during the acute phase of recovery after sport-related concussion, has been shown to facilitate recovery and reduce the risk of persisting postconcussion symptoms. The purpose of this validation case series was to evaluate currently available external evidence regarding the effects of prescribed aerobic exercise interventions on recovery after sport-related concussion. For this study, the patient population included college athletes diagnosed with a sport-related concussion who participated in at least 5 days per week of supervised, prescribed aerobic exercise, based on graded aerobic exercise testing and heart rate threshold. Our study findings …

Quality Of Athletic Training Services For Lower Extremity Injuries, Katie Sniffen, Michael Rozier, Katherine Stamatakis, Paula Buchanan, Janet E. Simon, Leslie Hinyard

Clinical Practice in Athletic Training

The use of patient-reported outcomes in athletic training is inconsistent, limiting the ability to communicate service quality and value to key stakeholders. The objective of this study is to calculate meaningful quality outcome measures for athletic training services for lower extremity injuries in high school student-athletes. Data were collected from a subset of the National Athletic Treatment, Injury and Outcomes Network Surveillance Program and a convenience sample of high school student-athletes with patient-reported outcome measures for lower extremity time-loss injuries. Failure-toprogress proportions (FTPPs) were calculated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) for knee/thigh injuries and the Foot …

Comfort Level Of Collegiate Student-Athletes In Opposite And Same-Gender Patient/Provider Relationships In Athletic Training, Samantha Dickie, Yashu Tang, Sydney Nelson, Emily Madrak

Clinical Practice in Athletic Training

Gender-based comfort in patient-provider relationships is a vital aspect of athletic training care. As the profession continues to evolve—particularly with a growing number of women athletic trainers (ATs) and progression of athletic training curriculum—it is essential to understand how gender dynamics influence the comfort of collegiate athletes when receiving care. This cross-sectional survey study examined how athlete comfort varies when treated by same- versus opposite-gender ATs in general patient care and in pathology-based scenarios. Ninety-six collegiate student-athletes (62.5% female) with the mean age of 20.26 (SD 1.7) years from NCAA and NAIA institutions completed the Gender Comfort with Athletic Trainer …

Acute Management Of A Hamate Fracture In A Collegiate Baseball Player: A Disablement Model Case Study, Kayleigh A. De Koker, Cory E. Barton, Lindsey E. Eberman

Clinical Practice in Athletic Training

The purpose of this disablement model case study was to outline a collegiate baseball player with an isolated hamate fracture including the injury evaluation, diagnosis, and acute management. During a tournament game, the collegiate career of the patient ended abruptly following an injury sustained while at bat. The patient attempted to bat again but encountered significant difficulty due to the increasing pain in his hand. Consequently, the athletic trainer was called out for an on-field examination. The patient presented with no edema or ecchymosis but severe pain in the hypothenar eminence. This patient also presented with decreased grip strength with …

Suture Augmentation With Ucl Repairs In Baseball Pitchers As An Alternate To Reconstructions: An Evidence-To-Practice Review, Kayleigh A. De Koker, Kenneth E. Games

Clinical Practice in Athletic Training

An injury to the ulnar collateral ligament (UCL) is sustained through repetitive valgus motions, increasing in prevalence across all levels of baseball due to the increasing workload demands placed on the medial elbow in pitching. Traditionally, UCL tears have been managed through reconstructions followed by a lengthy rehabilitation process. In recent years, the UCL repair with suture augmentation has gained favor given the enhanced patient and clinician outcomes in return-to-play timelines, decreased medial gapping, improved Kerlan Jobe Orthopedic Clinic (KJOC) scores, and long-term functionality. Utilizing 4 databases (MEDLINE, Embase Cochrane library, Science Direct, and Scopus), literature was obtained addressing the …

Recurrent Urinary Tract Infections In An Elite Level Diver: A Disablement Model Case Study, Matt O'Sullivan, Dominique M. Stevens, Lindsey E. Eberman

Clinical Practice in Athletic Training

This article presents a case of complicated and recurrent pyelonephritis, an infection of 1 or both kidneys, in an elitelevel diver. Urinary tract infections (UTIs) are among the most common outpatient infections in the United States; most are uncomplicated and resolve without significant mortality or morbidity. However, UTIs have the potential to present significant clinical challenges if the UTI becomes complicated or recurrent. Additionally, recurrent UTIs can carry a significant burden to both the individual patients and the larger healthcare system. The current paper reviews the epidemiological literature surrounding UTIs, the significant impact they have on a patient’s health-related quality …

Comparison Of Vibrating And Non-Vibrating Foam Roller On Hamstring Range Of Motion, Rakhoon Sung, Portia B. Resnick, Karen G. Roos, Mimi Nakajima

Clinical Practice in Athletic Training

Tightness in the distal hamstring is a common complaint among active individuals. While a foam roller is used to release muscle tension, there are limited studies about the effect using a vibrating foam roller (VFR) on hamstring flexibility and knee range of motion (ROM). For this reason, the purpose of the research was to compare the effect of a VFR and nonvibrating foam roller (NVFR) on hamstring flexibility and knee ROM in active college students. It was hypothesized that there would be more improvement in hamstring flexibility and knee ROM with a VFR than an NVFR. A randomized controlled trial …

A Review Of Mentorship And Recruitment Strategies For Minority Athletic Training Students, Dariana M. Brown

Clinical Practice in Athletic Training

The underrepresentation of minority athletic trainers remains a critical issue, affecting both the profession and the quality of patient care. While patient demographics continue to diversify, the athletic training workforce has not kept pace, leading to potential communication barriers, mistrust, and inadequate culturally competent care. This review examines whether culturally tailored mentorship programs and targeted recruitment initiatives improve retention, career satisfaction, and diversity in athletic training compared to standard methods. By analyzing studies on underrepresented minority students in athletic training, the review highlights key institutional barriers and systemic factors impacting recruitment and retention. Findings suggest that tailored mentorship and supportive …

What Are The Current Risks For Patients Associated With Technology Related Perfusion Practices: A Scoping Review, Jessica Steel

Student Works

Background: Advancements in medical technology, particularly in perfusion practices such as ECMO and heart-lung bypass, have improved patient care but also introduced novel risks. Technological errors—ranging from hardware malfunctions to software failures and AI model inaccuracies—can directly threaten patient safety.

Objective: To identify current trends and risks associated with technology in perfusion practices and synthesize evidence on the frequency, nature, and outcomes of technology-related errors.

Results: Evidence indicates substantial deficiencies in medical devices, predictive models, and health IT systems. AI-based predictive models frequently failed to detect critical health deterioration, missing 66% of injuries in some in-hospital mortality simulations. Adverse events …

Pre-Operative Antiplatelet Therapy Is Associated With Increased Risk Of Periprosthetic Joint Infection Following Total Shoulder Arthroplasty, Muhammad Hamza Ilyas, Mohammad Daher, Viraj Deshpande, Adam Lindsay, Joseph A. Abboud, Hafiz F. Kassam

Rothman Institute Papers

Background Antiplatelet therapy is widely prescribed for the prevention and management of cardiovascular disease and for mitigation of thromboembolic risk. However, its impact on post-operative periprosthetic joint infection (PJI) following total shoulder arthroplasty (TSA) remains poorly defined.MethodsA retrospective cohort study was conducted using the TriNetX US Research Network. Propensity score matching was performed to balance demographics, body mass index, and Charlson Comorbidity Index variables. The primary outcome was the incidence of PJI at 90 days, 6 months, and 1 year. Secondary outcomes included post-operative medical and surgical complications. Comparative risk was quantified using risk ratios with 95% confidence intervals. Subgroup …

Deep Brain Stimulation For Psychiatric Disorders: A Systematic Review Of Molecular Imaging With Pet, Shiv Patil, Alexander Gerlach, Fnu Jeevika, Raj Patel, Emily Christner, Jaskeerat Gujral, Om H. Gandhi, Milo Writer, Nicholas M. Wang, Anastasia Kopylova, Satoria A. Zagorski, Cyrus Ayubcha, Thomas Werner, Abass Alavi, Mona-Elisabeth Revheim

Student Papers, Posters & Projects

BACKGROUND: Deep brain stimulation (DBS) is an evolving technique for the treatment of various psychiatric disorders refractory to conventional pharmacotherapy. Neuroimaging with positron emission tomography (PET) has an important role in the planning, delivery, and post-surgical monitoring of DBS. This study aims to determine the clinical relevance of PET as a biomarker of disease status and response to DBS for patients with psychiatric disorders.

METHODS: We performed a systematic review of the PubMed, Web of Science, and Scopus databases to identify original research studies that applied PET to study the effects of DBS for patients with psychiatric conditions (major depressive …

Gene-Agnostic Therapeutic Strategies For Inherited Retinal Diseases: Neuroprotection And Immunomodulation, Lucas W. Rowe, S. Patricia Becerra, Robert E. Maclaren, Robert L. Avery, Charles C. Wykoff, Allen C. Ho, Carl D. Regillo, Dean Eliott, Andrew Osborne, Katie M. Binley, Thomas A. Ciulla

Wills Eye Hospital Papers

Background/Objectives: Inherited retinal diseases (IRDs) represent a genetically heterogeneous group of disorders caused by mutations in over 280 genes with more than 3100 identified variants. While gene-specific replacement therapies have achieved landmark success with voretigene neparvovec (Luxturna) for biallelic RPE65-associated retinal dystrophy, developing individual therapies for each genetic subtype remains impractical. This review examines gene-agnostic therapeutic approaches utilizing neuroprotection and immunomodulation that target common pathophysiological mechanisms shared across multiple IRD genotypes. Methods: We reviewed the literature on neuroprotective and immunomodulatory gene therapy strategies for IRDs, focusing on neurotrophic factors and complement system modulation. Results: Neuroprotective approaches delivering neurotrophic factors—including pigment …

Artificial Intelligence-Enhanced Cardiac Point-Of-Care Ultrasound: A Prospective Single-Arm Study, Lior Fisher, Michael Fiman, Yuval Yarkoni, Ella Segal, Boris Fishman, Kobi Faierstein, Noa Rubin, Adiel Am-Shalom, Howard Amital, Qiong Zhao, Smadar Kort, Praveen Mehrotra, Ehud Schwammenthal, Robert Klempfner, Eyal Zimlichman, Ehud Raanani, Elad Maor

Division of Cardiology Faculty Papers

OBJECTIVE: To evaluate the clinical utility of combining artificial intelligence (AI) with handheld focused cardiac ultrasound (FoCUS) performed by noncardiologist physicians in clinical care settings.

PATIENTS AND METHODS: In this prospective, single-arm study conducted from July 1, 2022, through December 31, 2023 (ClinicalTrials.gov NCT05455541), 660 adult patients presenting to the emergency department or internal medicine wards were assessed with handheld ultrasound devices enhanced by AI algorithms. These algorithms provided automated analysis of ventricular function, valvular disease, pericardial effusion, and inferior vena cava size. Participating physicians received focused training and performed examinations either in response to clinical suspicion or as part …

Automated Abdominal Aortic Calcification And Trabecular Bone Score Independently Predict Incident Fracture During Routine Osteoporosis Screening, Abadi K. Gebre, Marc Sim, Syed Zulqarnain Gilani, Afsah Saleem, Cassandra Smith, Didier Hans, Siobhan Reid, Barret A. Monchka, Douglas Kimelman, Mohammad Jafari Jozani, John T. Schousboe, Joshua R. Lewis, William D. Leslie, Joshua R. Lewis

Research outputs 2022 to 2026

Abdominal aortic calcification (AAC), a marker of subclinical cardiovascular disease, has previously shown to be associated with low BMD and fracture. However, it remains unclear whether AAC is associated with trabecular bone score (TBS), a gray-level textural measure, or whether it predicts fracture risk independent of this measure. Here, we examined the cross-sectional association of AAC scored using a validated machine learning algorithm (ML-AAC24) with TBS, and their simultaneous associations with incident fractures in 7691 individuals (93.4% women) through the Manitoba BMD Registry (mean age 75.3 yr). The association between ML-AAC24 and TBS was tested using generalized linear regression. Cox …

Nano Zinc Oxide Against Bacteria Isolated From Burn Infection, Mohammed Jaafar Al-Anssari, Mohammed Sahib Al-Hamami, Hayder Razzaq Al-Ameedee, Rabab Abdul Razzaq Kasema, Hawraa Majid Mahdi

Al-Bahir

Pseudomonas aeruginosa is a type of bacteria that is found commonly in the environment, like in soil and in water. This bacteria can cause infections in the blood, lungs (pneumonia), or other parts of the body after surgery. These bacteria are constantly finding new ways to avoid the effects of the antibiotics used to treat the infections they cause. Zinc oxide nanoparticles' (ZnO-NPs') or Nano zinc oxide antibacterial properties have drawn a lot of attention from around the world, especially since nanotechnology has been used to create particles in the nanometer range. Because of their larger specific surface area and …

Increasing Utilization Trends Of Robotic Assistance In Orthopaedic Surgery, Anish K. Ponna, Alec Giakas, Anthony A. Khoudary, Spencer N. Uggla, Sina Ramtin, Yousef A. Soliman, Asif M. Ilyas

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: Robotic-assisted surgeries in orthopaedics have increased, particularly in hip and knee arthroplasty and spine surgeries. This study evaluates national utilization trends of robotic-assisted orthopaedic surgeries and demographic and geographic distribution of patients undergoing these surgeries.

METHODS: A retrospective cohort study was conducted on patients who underwent total hip arthroplasty, total and partial knee arthroplasty, or spine arthrodesis from 2017 to 2023 using the TriNetX database. Relevant International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes identified patients who underwent a primary surgery with a corresponding robot-assisted code on the same day. Temporal trends in procedural volume were …

Interview With Orca Award Winner David Hage, Unl Chemistry; Drug-Protein Interactions, Mark Griep, David Hage

UNL ORCA Interview Series

Prof. David Hage was awarded the ORCA in 2018. He was born in La Crosse, Wisconsin, and earned a bachelor’s in chemistry at the University of Wisconsin in La Crosse. Next, he earned a doctorate from Iowa State University and did postdoctoral work at the Mayo Clinic in Rochester, Minnesota. In 1989, he joined UNL as an assistant professor of chemistry and quickly rose through the ranks. He has won many awards and, for the past 13 years, has been the James Hewet University Professor of Chemistry. Allow me to share some remarkable facts about Dave before we get into …

Design Of Experiments Based Reversed-Phase High-Performance Liquid Chromatography Method For Estimation Of Metformin And Glimepiride In Combined Dosage Forms, Neela Manish Bhatia, Rachana Patil, Harinath More, Rutuja Dattatray Chougale

The Thai Journal of Pharmaceutical Sciences

Background: The present study aimed to systematically develop and validate a robust, rapid, and stability-indicating reversed-phase high-performance liquid chromatography (RP-HPLC) method for the simultaneous estimation of metformin and glimepiride in fixeddose combination tablets. Method development was guided by a design of experiments (DoE) approach using the Box-Behnken design (BBD) to ensure optimal analytical performance.
Materials and Methods: Chromatographic separation was achieved on a Cosmosil C18 column using an optimized mobile phase of acetonitrile and water (80:20, v/v) adjusted to pH 3.5. The flow rate was 1 mL/min, and detection was performed at 221 nm. The BBD approach systematically evaluated the …

Transcranial Alternating Current Stimulation As An Adjuvant For Nonfluent Aphasia: A Proof-Of-Concept Study, Lynsey M. Keator, Lisa Johnson, Roger Newman-Norlund, Kyler Spell, Samaneh Nemati, Leigh Ann Spell, Dirk B. Den Ouden, Christopher Rorden, Julius Fridriksson

Department of Speech-Language Pathology Faculty Papers

Effective rehabilitation tools are essential for improving language outcomes in chronic aphasia. Speech entrainment is a behavioral treatment that has shown promise in enhancing speech output in nonfluent aphasia, potentially by acting as an external mechanism to synchronize anterior and posterior language regions in the left hemisphere. Transcranial alternating current stimulation has been hypothesized to enhance functional connectivity between brain regions by amplifying endogenous oscillations. This proof-of-concept study explored whether high-definition tACS (HD-tACS) could improve speech fluency in nonfluent aphasia when paired with speech entrainment. In a double-blind, pseudorandomized study, 1 mA of HD-tACS at 7 Hz was applied to …

Assessment Of Early Breast Cancer Response To Chemotherapy With Ultrasound Radiomics, Swapnil Dolui, Basak Dogan, Corinne Wessner, Jessica Porembka, Priscilla Machado, Bersu Ozcan, Nisha Unni, Maysa Abu-Khalaf, Flemming Forsberg, Kibo Nam, Kenneth Hoyt

Department of Medical Oncology Faculty Papers

Objective: This prospective study investigated the use of H-scan ultrasound (US) imaging as a novel component of a multiparametric radiomic analysis framework for characterizing human breast cancer response to neoadjuvant chemotherapy (NAC) before and early after treatment initiation. Methods: Thirty breast cancer patients scheduled for NAC were scanned using a clinical US system (Logiq E9, GE HealthCare) equipped with a 9L-D linear array transducer. Radiofrequency (RF) data was obtained at baseline (pre-NAC) and after 10% and 30% of the complete dose of chemotherapy. The RF data was analyzed by a bank of 256 frequency-shifted bandpass filters to form H-scan US …

Henri Nouwen: Theologian, Caregiver - How Do His Writings Support Informal Caregivers?, Dr. Julie Yonker

University Faculty Publications and Creative Works

•Analyze the Impact and Visibility of Informal Caregivers   •Evaluate Henri Nouwen’s Theological Framework for Caregiving   •Develop Practical Support Strategies for Faith Communities

Whole-Blood, Concentrated, And Micro–Dose Del Nido Cardioplegia In Adult Cardiac Surgery: A Scoping Review, Christian Iulianelli

Student Works

1. A.     Background/Introduction: Del Nido cardioplegia was originally developed for pediatric cardiac surgery to provide prolonged myocardial protection with a single-dose strategy. Its adoption in adult cardiac surgery has led to multiple modified formulations, including whole-blood, concentrated, and bloodless strategies. Given expanding clinical use and variation in technique, a structured mapping of the adult evidence base is warranted.
2. B.     Methodology: This scoping review followed PRISMA-ScR guidance. PubMed and CINAHL were searched, yielding 88 records. After duplicate removal and screening, 18 studies met inclusion criteria. Data were charted on study design, cardioplegia formulation, patient population, myocardial biomarkers, arrhythmias, renal outcomes, transfusion requirements, …

Evolving Solutions For Red Blood Cell Preservation, Ali Alkafaji, Charles A. Elder, Mohammad Zaidi, Kavin Parthiv, Michael A. Menze

The Cardinal Edge

In emergencies such as natural disasters, armed conflicts, or during outer space missions, the availability of transfusable blood can mean the difference between life and death. Red blood cells (RBCs) must be stored at +4 ± 2 °C and have a shelf life of just 42 days, which makes maintaining a stable blood supply during adverse conditions extraordinarily challenging. This challenge was especially apparent during the COVID-19 pandemic when hospitals faced severe blood shortages. Freeze-drying, or lyophilization, offers a promising avenue to extend the shelf life of RBCs for transfusion during crises. However, a significant hurdle in dry preservation is …

Sound, Speech, And Synapses: Rebuilding The Brain Through Neuroplasticity, Sireen Khader

The Cardinal Edge

No abstract provided.

Evaluating Assistive Technology-Mediated Hepatitis B Education On At-Risk Behaviours Among In-School Adolescents With Hearing Impairment In Oyo State, Nigeria, Suen. E. Olalekanmi, J. O. Odelola, O. O. Isaiah

The 2026 Assistive Technology for Persons with Intellectual and Physical Disabilities Conference

Background: Adolescents with hearing impairment experience heightened vulnerability to health risks, largely due to limited access to accurate, accessible, and comprehensible health information. Communication barriers often restrict their understanding of disease prevention, resulting in inadequate health literacy and increased engagement in behaviours that may expose them to preventable infections such as HB. Despite the availability of effective vaccines and preventive measures, HB remains a significant public health concern in Nigeria. This situation underscores the urgent need for researchers, educators, and healthcare professionals to develop and prioritise inclusive health education strategies that address the unique communication needs of adolescents with hearing …