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Communication Sciences and Disorders Commons™
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Articles 91 - 120 of 154
Full-Text Articles in Communication Sciences and Disorders
The Perception Of Prosody In English-Speaking Children With Cochlear Implants: A Systematic Review, Grace R. Smith
The Perception Of Prosody In English-Speaking Children With Cochlear Implants: A Systematic Review, Grace R. Smith
Dissertations, Theses, and Capstone Projects
Objective: The goal of this paper was to systematically review literature in order to investigate the perception of prosody in English-speaking children with cochlear implants.
Methods: A comprehensive search utilizing various peer-reviewed databases accessible through the City University of New York (CUNY) Graduate Center Library was conducted to identify relevant studies. Inclusion criteria included studies that examined prosody perception in pre-and post-lingually deafened children with cochlear implants. Children who utilized unilateral, bilateral, and bimodal configurations of cochlear implants were therefore included in this search.
Results: 9 studies met the inclusion criteria for this systematic review. The findings …
Assisting Children With Velocardiofacial Syndrome Who Have Developmental Disabilities And Delays Associated With Speech, Communication, And Education, Mckenzie K. Holty
Assisting Children With Velocardiofacial Syndrome Who Have Developmental Disabilities And Delays Associated With Speech, Communication, And Education, Mckenzie K. Holty
Honors Thesis
Children with velocardiofacial syndrome (VCFS) have a variety of complex needs. Research shows that VCFS is characterized by a combination of medical problems, developmental delays, and learning disabilities, which vary from child to child. This syndrome also puts adolescents at a higher risk for developing psychiatric and psychotic disorders. The complexity of symptoms that can arise from VCFS can influence the ability of these children to communicate, socialize, and learn effectively. This literature review aims to discuss literature for caregivers, educators, and physicians to aid children effectively and understand their challenges relating to speech, communication, and education. This topic is …
Audiologic Clinical Practice Patterns: Infant Assessment, Ursula M. Findlen, Nicole D. Schuller
Audiologic Clinical Practice Patterns: Infant Assessment, Ursula M. Findlen, Nicole D. Schuller
Journal of Early Hearing Detection and Intervention
The purpose of the present study was to report the current clinical practice patterns for assessment of infants after a referred newborn hearing screening within the context of available guidelines and to examine how the advent of newer stimuli, technology, and/or instrumentation has changed clinical practice patterns for audiologic infant assessment. A mixed-method survey that included both quantitative and qualitative questions was disseminated to pediatric audiologists in 2017. Quantitative data were analyzed via descriptive statistics while qualitative questions were analyzed via content analysis and combined with associated quantitative data. Lastly, infant assessment test battery categorization was completed to ascertain the …
Neonatal Abstinence Syndrome And Infant Hearing Assessment: A Kids’ Inpatient Database Review, Liza Creel, Adam Van Horn, Alex Hines, Matthew L. Bush
Neonatal Abstinence Syndrome And Infant Hearing Assessment: A Kids’ Inpatient Database Review, Liza Creel, Adam Van Horn, Alex Hines, Matthew L. Bush
Journal of Early Hearing Detection and Intervention
Objective: Neonatal abstinence syndrome (NAS) has become an epidemic. This study assesses documented rates of failed newborn hearing screening (NBHS) or hearing loss diagnosis (HL) in NAS infants, and sociodemographic factors associated with abnormal inpatient hearing results.
Methods: The 2016 HCUP/KID national database was used to identify a weighted sample of infants with failed NBHS/HL during birth hospitalization. Independent variables included diagnoses of NAS/in-utero opioid exposure, HL risk factor presence and sociodemographic data. Univariate analyses and multivariate logistic regression were used to determine associations between NAS and abnormal hearing assessment.
Results:NAS infants had lower odds ratio (OR) of documented …
Reliability And Validity Of An Assessment Of Engagement In Nursing Home Residents During Bingocize®, Elizabeth Batson Apelt
Reliability And Validity Of An Assessment Of Engagement In Nursing Home Residents During Bingocize®, Elizabeth Batson Apelt
Masters Theses & Specialist Projects
Research suggests nursing home residents are often socially isolated and physically inactive despite overwhelming evidence that both social engagement and physical activity are crucial for healthy aging (Jones, Sung, & Moyle, 2018; Yen & Lin, 2018; Ice, 2002; Jansson et al., 2017). Bingocize® is a program that combines exercise and the game of Bingo to improve the quality of life, physical health, and social engagement of certified nursing facility (CNF) residents. The purpose of this study is to determine the level of social engagement displayed by CNF residents during Bingocize® using the Fun and Social Engagement Evaluation (FUSE). Reliability and …
Dementia: Types, What They Are And How They Differ, Jessica N. Schnetzer
Dementia: Types, What They Are And How They Differ, Jessica N. Schnetzer
Honors Thesis
Dementia: types, what they are and how they differ centers on the known and unknown complexities of dementia. Dementia is a very complex cognitive disease that consumes the brain, an organ of which we know very little about. Even so, this common disorder is actively being researched and is the topic of special interest of this thesis research. Described are Alzheimer’s disease, Creutzfeldt-Jakob disease, Frontotemporal dementia, Huntington’s disease, Korsakoff’s syndrome, Lewy body dementia, Parkinson’s dementia, and Vascular dementia, focusing on what they are, their specific risks, diagnosis, treatment, and their differing progressions. Guidance of this study provided by thesis director …
Collegiate Rugby Players' Knowledge Of Concussions, Julia E. Bell
Collegiate Rugby Players' Knowledge Of Concussions, Julia E. Bell
Student Theses and Dissertations
This investigation sought to discover if collegiate rugby players who have had a concussion were more knowledgeable about concussions than the players who had not had a concussion. The investigation also looked at the general amount of knowledge that the collegiate rugby players had about concussions, including the effects and prevention measures. This study was performed using a survey distributed to the Arkansas State University club rugby team. The survey consisted of several questions about concussions, the side effects of concussions, and players’ opinions on prevention and education of concussions. The data collection revealed that there were differing amounts of …
Improving Hearing Screenings With Tele-Otology, Ryan J. Miller, Joshua George-Lopez, Robert S. Hong Md, Phd
Improving Hearing Screenings With Tele-Otology, Ryan J. Miller, Joshua George-Lopez, Robert S. Hong Md, Phd
Medical Student Research Symposium
Introduction: The Lions Hearing Center of Michigan (LHC-MI) is an assistance program in Detroit that provides hearing aids to individuals in need. LHC-MI has provided thousands of hearing aids, but such efforts have been costly, requiring patients to make multiple appointments at multiple locations. To streamline this process, the LHC-MI is piloting a new program, titled “Hear Now! Detroit!”, that uses telemedicine to reach patients at community sites.
Purpose: To evaluate the feasibility of a hearing screening program that uses telemedicine to reduce the number of visits required to acquire hearing aids.
Methods: Teams of community volunteers were deployed to …
Pills And Spills: An Assessment Of Medications And Fall Risk In Older Patients, Kelly L. Covert, Courtney D. Hall
Pills And Spills: An Assessment Of Medications And Fall Risk In Older Patients, Kelly L. Covert, Courtney D. Hall
ETSU Faculty Works
No abstract provided.
Impact Of Nicu Design On Feeding-Related Outcomes In Preterm Infants, Emma Kate Calvert
Impact Of Nicu Design On Feeding-Related Outcomes In Preterm Infants, Emma Kate Calvert
Theses and Dissertations--Communication Sciences and Disorders
Many NICUs around the country are moving away from traditional open-bay designs in favor of single-family rooms (SFRs) as more is understood about the impact of the sensory environment on neurodevelopment in preterm infants. SFRs house one infant and their family for the length of the infant’s stay and are associated with improvements in numerous outcomes, including increased milk intake and weight gain and earlier transition to enteral feeding. Oral feeding remains a critical requirement for NICU discharge; however, the impact of NICU design on feeding outcomes remains unknown.
The purpose of this study was to compare feeding outcomes between …
The Contribution Of Frequency Discrimination Ability To Auditory Temporal Patterning Tests In Children, Ashley G. Flagge, Tara M. Davis, Victoria Henbest
The Contribution Of Frequency Discrimination Ability To Auditory Temporal Patterning Tests In Children, Ashley G. Flagge, Tara M. Davis, Victoria Henbest
Ashley Flagge Publications
Purpose: The Pitch Patterns Test (PPT) and Duration Patterns Test (DPT) are clinical auditory processing tests that evaluate temporal patterning skills based on pitch (PPT) or duration (DPT) aspects of sound. Although temporal patterning tests are categorized under the temporal processing domain, successful performance on the PPT also relies on accurate pitch discrimination. However, the relationship between pitch discrimination ability and temporal patterning skills have not been thoroughly evaluated. This study examined the contribution of pitch discrimination ability to performance on temporal patterning in children through the use of a pitch discrimination task and the PPT …
Development Of A Non-Invasive Device For Swallow Screening In Patients At Risk Of Oropharyngeal Dysphagia: Results From A Prospective Exploratory Study, Catriona M. Steele, Rajat Mukherjee, Juha M. Kortelainen, Harri Pölönen, Michael Jedwab, Susan L. Brady, Kayla Brinkman Theimer, Susan Langmore, Luis F. Riquelme, Nancy B. Swigert, Philip M. Bath, Larry B. Goldstein, Richard L. Hughes, Dana Leifer, Kennedy R. Lees, Atte Meretoja, Natalia Muehlemann
Development Of A Non-Invasive Device For Swallow Screening In Patients At Risk Of Oropharyngeal Dysphagia: Results From A Prospective Exploratory Study, Catriona M. Steele, Rajat Mukherjee, Juha M. Kortelainen, Harri Pölönen, Michael Jedwab, Susan L. Brady, Kayla Brinkman Theimer, Susan Langmore, Luis F. Riquelme, Nancy B. Swigert, Philip M. Bath, Larry B. Goldstein, Richard L. Hughes, Dana Leifer, Kennedy R. Lees, Atte Meretoja, Natalia Muehlemann
Neurology Faculty Publications
Oropharyngeal dysphagia is prevalent in several at-risk populations, including post-stroke patients, patients in intensive care and the elderly. Dysphagia contributes to longer hospital stays and poor outcomes, including pneumonia. Early identification of dysphagia is recommended as part of the evaluation of at-risk patients, but available bedside screening tools perform inconsistently. In this study, we developed algorithms to detect swallowing impairment using a novel accelerometer-based dysphagia detection system (DDS). A sample of 344 individuals was enrolled across seven sites in the United States. Dual-axis accelerometry signals were collected prospectively with simultaneous videofluoroscopy (VFSS) during swallows of liquid barium stimuli in thin, …
Procedural Memory Following Moderate-Severe Traumatic Brain Injury: Group Performance And Individual Differences On The Rotary Pursuit Task, Arianna Rigon, Nathaniel B. Klooster, Samantha Crooks, Melissa C. Duff
Procedural Memory Following Moderate-Severe Traumatic Brain Injury: Group Performance And Individual Differences On The Rotary Pursuit Task, Arianna Rigon, Nathaniel B. Klooster, Samantha Crooks, Melissa C. Duff
Communication Disorders Faculty Research
The impact of traumatic brain injury (TBI) on procedural memory has received significantly less attention than declarative memory. Although to date studies on procedural memory have yielded mixed findings, many rehabilitation protocols (e.g., errorless learning) rely on the procedural memory system, and assume that it is relatively intact. The aim of the current study was to determine whether individuals with TBI are impaired on a task of procedural memory as a group, and to examine the presence of individual differences in performance. We administered to a sample of 36 individuals with moderate-severe TBI and 40 healthy comparisons (HCs) the rotary …
Supporting Persons With Dementia In Communicating Their Care Preferences, Vanessa L. Burshnic
Supporting Persons With Dementia In Communicating Their Care Preferences, Vanessa L. Burshnic
USF Tampa Graduate Theses and Dissertations
Person-centered care is important to the quality of life of nursing home residents with dementia. Preference assessments enable person-centered care by documenting residents’ preferred activities. Residents with severe dementia are less likely to have a role in preference assessment due to communication challenges associated with the disease. External supports (visual and text cues) are effective in improving the communication of residents with dementia, but these cues are often not used in practice. Standard assessment (verbal questioning) places greater demands on short-term memory and attention, which are known deficits in dementia.
Applying a within-subjects design, this study evaluated two conditions (standard …
Exploring In Silence: Hearing And Deaf Infants Explore Objects Differently Before Cochlear Implantation, Mary K. Fagan
Exploring In Silence: Hearing And Deaf Infants Explore Objects Differently Before Cochlear Implantation, Mary K. Fagan
Communication Sciences and Disorders Faculty Articles and Research
Infant development has rarely been informed by the behavior of infants with sensory differences despite increasing recognition that infant behavior itself creates sensory learning opportunities. The purpose of this study of object exploration was to compare the behavior of hearing and deaf infants, with and without cochlear implants, in order to identify the effects of profound sensorineural hearing loss on infant exploration before cochlear implantation, the behavioral effects of access to auditory feedback after cochlear implantation, and the sensory motivation for exploration behaviors performed by hearing infants as well. The results showed that 9-month-old deaf infants explored objects as often …
The Quest For Self: Using Mandala Art In Reflective Practice Journaling, Kathleen Quinn
The Quest For Self: Using Mandala Art In Reflective Practice Journaling, Kathleen Quinn
Comparative Woman
This article is a nexus of research, personal journaling reflections, and mandala creation from the authors own journals and focuses on the use of Mandalas as part of a reflective practice journaling process. Attention to mandala usage within reflective practice considering depth interiority, engaging and sharing with others. The authors approach to mandala construction is included followed by an exercise for observation and assessment of mandalas. The structure for reflective practice helps shape transformational leaders, using expressive arts, narratives in journaling. This transformational Discovery pathway and narrative exercises can be used for creating professional learning communities. This form of reflective …
The Impact Of Stuttering On Development Of Self-Identity, Relationships, And Quality Of Life In Women Who Stutter, Charn Nang, Deborah J. Hersh, Katie Milton, Su Re Lau
The Impact Of Stuttering On Development Of Self-Identity, Relationships, And Quality Of Life In Women Who Stutter, Charn Nang, Deborah J. Hersh, Katie Milton, Su Re Lau
Research outputs 2014 to 2021
Purpose: The experiences of women who stutter have been underresearched. Clinicians have little guidance from the research literature on issues specific to women who stutter and are likely to have less clinical contact with this group than with men who stutter because of the higher prevalence of stuttering in men. This study explored the experiences of a small group of women who stutter with a particular focus on what the main current issues are and how gender may have influenced experiences with stuttering.
Method: This qualitative study involved recruitment of 9 women who stutter (aged 35-80 years) through a support …
Melodic Contour Identification And Speech Recognition By School-Aged Children, Michael P. Morikawa
Melodic Contour Identification And Speech Recognition By School-Aged Children, Michael P. Morikawa
Dissertations, 2014-2019
Using the Sung Speech Corpus (SSC), which encompasses a single database that contains musical pitch, timbre variations and speech information in identification tasks, the current study aimed to explore the development of normal-hearing children’s ability to use the pitch and timbre cues. Thirteen normal hearing children were recruited for the study ages ranging from 7 to 16 years old. Participants were separated into two separate groups: Younger (7-9) and Older (10-16). Musical Experience was taken into account as well. The Angel Sound ™ program was utilized for testing which was adopted from previous studies, most recently Crew, Galvin, and Fu …
A New Surgical Approach For O-C2 Fusion, Solving The Problem Of Dysphagia., M. Kathryn Mcclure
A New Surgical Approach For O-C2 Fusion, Solving The Problem Of Dysphagia., M. Kathryn Mcclure
Electronic Theses and Dissertations
The fusion of the second cervical vertebrae to the occipital bone (O-C2 fusion) for head stabilization can result in postoperative dysphagia and dyspnea, negatively impacting the patient’s quality of life. Currently, the O-C2 angle is used for head placement, which may not place the head neutrally. We hypothesize that aligning the external auditory meatus with midline of the C2 will reduce oropharyngeal stenosis, reducing dysphagia. One male patient with poor swallow quality of life who required a revision of a previous O-C2 surgery was evaluated via videofluoroscopy and completed the standard swallow quality of life questionnaire (SWAL-QOL) before and after …
Language Profiles Of Children Who Have Experienced Complex Trauma And Fetal Alcohol Spectrum Disorders, Christel G. Ciolino
Language Profiles Of Children Who Have Experienced Complex Trauma And Fetal Alcohol Spectrum Disorders, Christel G. Ciolino
Masters Theses
Children who experience maltreatment and children with Fetal Alcohol Spectrum Disorders (FASD) have similar neurological differences and are at risk for language impairments. However, limited research has been conducted to analyze their specific skill sets. To address this limitation, retrospective data from the Children’s Trauma Assessment Center of Southwest Michigan were analyzed. The linguistic profiles of 79 children with histories of varying numbers of traumatic experiences and comorbid FASD statues are compared in the areas of semantics, syntax, pragmatics, and social communication. Individuals had high pass rates on the CELF-5 Screening Test and high overall scores on the Pragmatic Protocol-Revised …
We Are The Medicine, Madalynn Wendland, Toni Speed
We Are The Medicine, Madalynn Wendland, Toni Speed
Interprofessional Education
We are all healers— to ourselves, each other and the world around us. Whether you are on the path of becoming a health professional, or have been in practice for a long time, this half-day workshop will help you to view healing from a holistic perspective that draws from the ancient traditions while respecting contemporary science.
Assessing Cognitive Abilities In High-Performing Cochlear Implant Users., Jake Hillyer, Elizabeth Elkins, Chantel Hazlewood, Stacey D Watson, Julie G Arenberg, Alexandra Parbery-Clark
Assessing Cognitive Abilities In High-Performing Cochlear Implant Users., Jake Hillyer, Elizabeth Elkins, Chantel Hazlewood, Stacey D Watson, Julie G Arenberg, Alexandra Parbery-Clark
Articles, Abstracts, and Reports
Despite being considered one of the most successful neural prostheses, cochlear implants (CIs) provide recipients with a wide range of speech perception performance. While some CI users can understand speech in the absence of visual cues, other recipients exhibit more limited speech perception. Cognitive skills have been documented as a contributor to complex auditory processing, such as language understanding; however, there are no normative data for existing standardized clinical tests assessing cognitive abilities in CI users. Here, we assess the impact of modality of presentation (i.e., auditory-visual versus visual) for the administration of working memory tests in high-performing CI users …
Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit, Sarah Thompson, Haley Pelletier, Barbara Bush Children's Hospital-Inpatient, Maine Medical Center, Suneela Nayak, Ruth Hanselman, Stephen Tyzik
Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit, Sarah Thompson, Haley Pelletier, Barbara Bush Children's Hospital-Inpatient, Maine Medical Center, Suneela Nayak, Ruth Hanselman, Stephen Tyzik
MaineHealth Maine Medical Center
Interdisciplinary patient rounding has been shown to improve patient and family satisfaction as well as reduce patient length of stay and readmission rates. In an acute care inpatient pediatric unit, baseline metrics demonstrated that 100% of the time, nursing was not included in these rounds thus resulting in sub optimal communication.
The goal of this performance improvement project was to attain increased nursing participation. Data collection demonstrated several reasons for lack of participation and corrective actions were instituted. After undertaking this KPI goal and utilizing operational excellence, 95% of the time, nurses were called to morning rounds with the medical …
Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman
Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman
MaineHealth Maine Medical Center
Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.
In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …
Speech Processing Approach For Diagnosing Dementia In An Early Stage, Roozbeh Sadeghian, J. David Schaffer, Stephen A. Zahorian
Speech Processing Approach For Diagnosing Dementia In An Early Stage, Roozbeh Sadeghian, J. David Schaffer, Stephen A. Zahorian
Faculty Works
The clinical diagnosis of Alzheimer’s disease and other dementias is very challenging, especially in the early stages. Our hypothesis is that any disease that affects particular brain regions involved in speech production and processing will also leave detectable finger prints in the speech. Computerized analysis of speech signals and computational linguistics have progressed to the point where an automatic speech analysis system is a promising approach for a low-cost non-invasive diagnostic tool for early detection of Alzheimer’s disease.
We present empirical evidence that strong discrimination between subjects with a diagnosis of probable Alzheimer’s versus matched normal controls can be achieved …
On Syntropy & Precognitive Interdiction Based On Wheeler-Feynman’S Absorber Theory, Florentin Smarandache, Victor Christianto, Yunita Umniyati
On Syntropy & Precognitive Interdiction Based On Wheeler-Feynman’S Absorber Theory, Florentin Smarandache, Victor Christianto, Yunita Umniyati
Branch Mathematics and Statistics Faculty and Staff Publications
It has been known for long time that intuition plays significant role in many professions and human life, including in entrepreneurship, government, and also in detective or law enforcement activities. Women are known to possess better intuitive feelings or “hunch” compared to men. Despite these examples, such a precognitive interdiction is hardly accepted in established science. In this letter, we discuss briefly the advanced solutions of Maxwell equations, and then explore plausible connection between syntropy and precognition.
Hypothesis Of K+-Recycling Defect Is Not A Primary Deafness Mechanism For Cx26 (Gjb2) Deficiency, Hong-Bo Zhao
Hypothesis Of K+-Recycling Defect Is Not A Primary Deafness Mechanism For Cx26 (Gjb2) Deficiency, Hong-Bo Zhao
Otolaryngology--Head & Neck Surgery Faculty Publications
K+-recycling defect is a long-standing hypothesis for deafness mechanism of Connexin26 (Cx26, GJB2) mutations, which cause the most common hereditary deafness and are responsible for >50% of nonsyndromic hearing loss. The hypothesis states that Cx26 deficiency may disrupt inner ear gap junctions and compromise sinking and recycling of expelled K+ ions after hair cell excitation, causing accumulation of K+-ions in the extracellular space around hair cells producing K+-toxicity, which eventually induces hair cell degeneration and hearing loss. However, this hypothesis has never been directly evidenced, even though it has been widely referred …
Signing To Maintain Joint Attention With Children With Down Syndrome, Rachel Dauer Burns
Signing To Maintain Joint Attention With Children With Down Syndrome, Rachel Dauer Burns
Masters Theses & Specialist Projects
The current study examined the role of two different methods of sign presentation on signed and spoken language acquisition of toddlers aged two to four years with Down syndrome (DS). The aim of this study was to determine if a method commonly used by native signers/Deaf mothers (referred to in this study as signing to maintain joint attention (SMJA)) was more effective than the method commonly used by hearing mothers and speech-language pathologists (referred to in this study as the triangular method of signing). Both methods were compared in a within-subject design for effects on the participants’ total number of …
The Slps Role In Caring For The Adult And Geriatric Populations, Courtney M. Andrews
The Slps Role In Caring For The Adult And Geriatric Populations, Courtney M. Andrews
ETSU Faculty Works
- Define the SLP role with patients commonly seen in primary care
- Duplicate SLP knowledge to help in primary care
- Evaluate the role of the SLP as part of the multidisciplinary team
Promotion Of Early Pediatric Hearing Detection Through Patient Navigation, Matthew L. Bush
Promotion Of Early Pediatric Hearing Detection Through Patient Navigation, Matthew L. Bush
Theses and Dissertations--Clinical and Translational Science
Congenital hearing loss is the most common neonatal sensory disorder and it is crucial to diagnose hearing loss as soon as possible after birth in order to facilitate rapid treatment. Universal standards of infant hearing healthcare dictate that infant hearing screening should be completed by one month of age and abnormal screening tests should be followed with definitive audiological testing by three months of age. Obtaining diagnostic testing can be complicated by limited access to care in rural areas, breakdowns in communication, lack of parental support, and poor coordination of care. There is no established method to address appointment non-adherence …