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Full-Text Articles in Communication Sciences and Disorders

Incorporating Aac Training In Nursing Education Programs To Enhance Understanding Of Caring For Patients With Complex Communication Needs, Tessa Bradley May 2024

Incorporating Aac Training In Nursing Education Programs To Enhance Understanding Of Caring For Patients With Complex Communication Needs, Tessa Bradley

Honors College Theses

As healthcare professionals, nurses must be able to effectively communicate with their patients to ensure their health, safety, and comfort. However, this can be particularly challenging when it comes to patients with complex communication needs (CCN), where communication breakdowns can lead to sentinel events. Alternative and augmentative communication (AAC) can help those with CCN improve communication across various settings, including in healthcare. Unfortunately, there is a severe lack of training for nurses when it comes to communicating with patients with CCN and the use of AAC. Webb et al. (2024) investigated the effectiveness of a combined synchronous and asynchronous training …


Dementia Of The Alzheimer’S Type In Adults With Down Syndrome: Knowledge Among Graduate Students In Physical Therapy, Occupational Therapy, And Speech-Language Pathology., Abigail Regan Donaway May 2024

Dementia Of The Alzheimer’S Type In Adults With Down Syndrome: Knowledge Among Graduate Students In Physical Therapy, Occupational Therapy, And Speech-Language Pathology., Abigail Regan Donaway

Electronic Theses and Dissertations

This non-experimental study utilized a convenience sample (N = 322) to investigate graduate students in physical therapy (PT), occupational therapy (OT), and speech-language pathology’ s (SLP) knowledge of the connection between Down syndrome and dementia of the Alzheimer's type (DAT). Ninety-two-point-five percent of participants were female, and 79.80% were white. All participants completed a survey comprised of items relating to information about general knowledge (i.e. facts) of the association between DS and DAT, the signs/symptoms that occur in each stage of dementia of the Alzheimer’s type for people with Down syndrome, and familiarity regarding the diagnosis and care. Descriptive and …


Tongue-Tie: Impact On Oropharyngeal Function During Swallow., Kolbie A. Vincent May 2024

Tongue-Tie: Impact On Oropharyngeal Function During Swallow., Kolbie A. Vincent

Electronic Theses and Dissertations

Swallowing is an intricate process involving over 50 muscle pairs and numerous nerves, with dysphagia resulting from deficits in various stages (Hennessy & Goldenberg, 2016). Lingual restriction may adversely impact swallowing function, affecting bolus preparation, size, and overall efficiency. Tongue-tie can pose challenges to speech, chewing, and swallowing (Becker & Mendez, 2022; Chaubal et al, 2011; García-Pola, M. J., et al., 2002). This pilot study seeks to determine how tongue-tie affects swallowing function in an adult male, and whether surgical revision of a submucosal lingual tether leads to measurable changes in oropharyngeal swallow function. Results showed inconsistent changes in diameter …


Understanding Practitioner’S Perceptions Of Speech And Language Therapy Services In The Juvenile Justice System, Julia Buendgen May 2024

Understanding Practitioner’S Perceptions Of Speech And Language Therapy Services In The Juvenile Justice System, Julia Buendgen

Dissertations, Theses, and Projects

The purpose of this study was to gain more understanding of how individuals who work with the juvenile justice population understand language disorders and the scope of speech and language therapy services. In addition, this study explored potential supports for individuals working in this setting. This study consisted of twenty participants working in the juvenile justice system who completed a survey tool that was designed by the researcher to describe the participant's perceptions of speech-language pathology, current procedures, reported challenges, and potential areas in need of support. Participant knowledge of the scope of speech-language pathology varied among participants. The highest …


Intersectionality And The Experience Of Stuttering For Latinos In The U.S., Carolina Beita-Ell May 2024

Intersectionality And The Experience Of Stuttering For Latinos In The U.S., Carolina Beita-Ell

Theses, Dissertations and Culminating Projects

In research, intersectionality seeks to explore, reflect on, and validate variations in human experience. This study adopted an intersectional approach when contemplating the experience of stuttering for individuals living in the U.S. who identified as Latinx (Latino/Latina/Hispanic). Nine Latinx people who stutter (PWS) - six reported their gender as ‘male’ and three reported their gender as ‘female’, with a mean age of 41, from five U.S. states and Washington, D.C. - participated in the study. A mixed methods design, which consisted of semi-structured interviews conducted online using videoconferencing technology and an online survey that contained three quantitative measures as well …


Dyslexia Training: The Impact On The Perceptions And Knowledge-Base Of Pre-Professionals Preparing To Work In K-12 Educational Settings, Colby Fowler May 2024

Dyslexia Training: The Impact On The Perceptions And Knowledge-Base Of Pre-Professionals Preparing To Work In K-12 Educational Settings, Colby Fowler

Graduate Theses and Dissertations

This research explores the perceptions and understanding of dyslexia among first-year graduate students in speech-language pathology. Employing survey methodology, specifically a pre- and post-survey approach, this research investigates the attitudes and knowledge that the participants have in understanding and addressing dyslexia at the beginning of their graduate training. The study seeks to uncover the existing awareness, potential misconceptions, and the overall preparedness of these emerging professionals in dealing with individuals affected by dyslexia. Through a comprehensive survey analysis, the research aims to contribute valuable insights that can inform the development of targeted educational strategies and interventions within speech-language pathology programs, …


Talking About Aphasia: A Social Media Analysis Of What Individuals With Aphasia And Communication Partners Convey About Functional Discourse, Anna Williams May 2024

Talking About Aphasia: A Social Media Analysis Of What Individuals With Aphasia And Communication Partners Convey About Functional Discourse, Anna Williams

Graduate Theses and Dissertations

This study aimed to blend what we know about aphasia and functional communication. Specifically, how individuals with aphasia are functionalizing communication on the social media platform of YouTube. Extensive clinically significant literature exists on functional communication within speech-language pathology that provides practical guidance for clinical applications. Moreover, an emerging theoretical framework on functional communication and aphasia has sparked fresh insights, particularly from the perspective of individuals with aphasia. This perspective holds promise for exploring how individuals and their families leverage social media for functional communication. This study aims to integrate established clinical research findings on functional communication with the evolving …


A Mixed Methods Exploration Of Interoceptive Awareness In Adults Who Stutter, Hazel Malcolm May 2024

A Mixed Methods Exploration Of Interoceptive Awareness In Adults Who Stutter, Hazel Malcolm

Graduate Theses and Dissertations

Stuttering is commonly described as a disorder of speech fluency characterized by primary speech behaviors that are judged by external observers to be typical of stuttering, including part-word repetitions, prolongations, and blocks (i.e., silent prolongations or postural fixations). Despite wide use in the field of speech-pathology, definitions focusing on these ‘primary’ behaviors have also been criticized as ‘surface’ or ‘perceptual’ definitions that favor the experience of a listener over that of the speaker. Recent qualitative evidence suggests that, when asked, adults who stutter (AWS) instead define stuttering as an internal feeling or awareness of being ‘stuck’ that is surrounded by …


Investigating Self-Perception Of Speech And Motivation For Return To Intervention For Post Cochlear Implantation In Young Adults, Madison Henry May 2024

Investigating Self-Perception Of Speech And Motivation For Return To Intervention For Post Cochlear Implantation In Young Adults, Madison Henry

Electronic Theses and Dissertations

Introduction: Cochlear Implants (CI) are designed to address severe to profound hearing loss. When implantation occurs after language develops, it is referred to as post-lingual (PL) implantation. Currently, no interventions have been identified to address the communication challenges that young adults with PL-CIs may face after they complete post-CI rehabilitation services. This study analyzes if an individualized intervention plan is beneficial for a person with PL-CIs when experiencing changing communication demands in the transition to college or the workforce. Methodology: Baseline assessments were conducted; the results of which allowed for the establishment of four co-constructed goals. These goals were targeted …


The Deaf Experience In National Parks With An Emphasis On Rocky Mountain National Park, Madeline Dannewitz May 2024

The Deaf Experience In National Parks With An Emphasis On Rocky Mountain National Park, Madeline Dannewitz

Undergraduate Honors Theses

This research investigated the experiences of Deaf visitors to the Rocky Mountain National Park (RMNP). The little research available focuses on how the National Park Service and its workers interact with Deaf people. Conversely, this study investigated the experiences of Deaf people and their perspective regarding interacting with the park and its members. A study regarding Deaf visitors in Yosemite National Park found that many were invisible to its employees. The desire from the Deaf community and lack of research shows the significance of this study. This analysis is crucial to the human experience as quality of life is improved …


Evaluating Auditory Processing In Adolescents And Adults Following A Sports-Related Concussion, Kelsey Danielle Kiesz May 2024

Evaluating Auditory Processing In Adolescents And Adults Following A Sports-Related Concussion, Kelsey Danielle Kiesz

Doctoral Scholarly Projects & Capstones

Sports-related concussions (SRCs) have gained increasing attention in recent years due to the long-lasting effects. While concussions have been extensively studied, the impact on auditory processing in adolescents and adults remains an under-evaluated area within audiology. This gap in research is noteworthy as audiologists are well-positioned to conduct auditory processing disorder (APD) testing, and post-concussion auditory deficits fall within the scope of their practice. This study addresses the lack of consensus on concussion definitions, limited accurate prevalence data, and the absence of guidelines for assessing auditory processing in post-concussion individuals in the audiology field. The research aims to provide a …


Analyzing The Relationship Between Cannabis Use And Hearing Loss, Ashley Howe May 2024

Analyzing The Relationship Between Cannabis Use And Hearing Loss, Ashley Howe

Doctoral Scholarly Projects & Capstones

The purpose of this study was to assess the cross-sectional relationship between cannabis use and hearing thresholds to determine if cannabis use is associated with poorer hearing sensitivity while controlling for covariates and other risk factors in a large population-based data set. To answer this question, we analyzed audiometric hearing threshold data, drug use data, and covariate data from the U.S. National Health and Nutrition Examination Survey (NHANES) cycles. A total of 5,140 participants from 2009–2012 and 2015–2016 aged 20–59 years were included in the analyses. Univariable and multivariable main effects logistic regression models were used to compare cannabis use …


Ototoxicity Monitoring Protocols For Common Chemotherapeutics, Megan Pamela Kennedy May 2024

Ototoxicity Monitoring Protocols For Common Chemotherapeutics, Megan Pamela Kennedy

Doctoral Scholarly Projects & Capstones

Cancer is a major public health concern and is increasingly prevalent worldwide. Sung et al. (2021) states that there were 19.3 million new cases of cancer across the globe, and almost 10 million deaths related to cancer in 2021. Sung et al. (2021) also notes that the United States accounts for 8% of all global cases, with an average of 1.7 million new cases annually. The top five most common adult cancers in the United States include: (1) breast, (2) prostate, (3) lung and bronchus, (4) colorectal, and (5) invasive melanoma of the skin. These cancers can be treated with …


Otitis Media: Parental Perspectives And Support Needs, Jordan Marie Johnson May 2024

Otitis Media: Parental Perspectives And Support Needs, Jordan Marie Johnson

Doctoral Scholarly Projects & Capstones

Otitis media (OM) is an infection located within the middle ear space of the auditory system and is the most common cause of hearing loss in children. Hearing loss is the disruption of the perception of an auditory signal and is further classified as conductive, sensorineural, or conductive. The effect of hearing loss can also depend on the severity, time of onset, stability, and etiology. Impairment in auditory function is linked with poorer speech and language development, educational tasks, psychosocial skills, and quality of life. Therefore, identification of hearing loss in children should be done in a timely manner to …


The Implementation Of Music Within Communication Intervention And Its Effect On Communication Development, Rebecca Dunn May 2024

The Implementation Of Music Within Communication Intervention And Its Effect On Communication Development, Rebecca Dunn

Honors Theses

The purpose of this study was to evaluate how and under what circumstances licensed speech-language pathologists incorporate music within communication intervention and to better understand perceptions towards the incorporation of music within speech or language therapy. A survey was developed based on the review of related literature and then entered on the Qualtricsã server for data collection and analysis. Once IRB approval was secured, the survey was then disseminated via a Facebook group for licensed speech-language pathologists. The author used Qualtricsã to collect and analyze the data, which was then used to determine when and how music was …


Healthcare Provider’S Perceptions On Feeding Difficulties And Educational Practices In Infants With Neonatal Opioid Withdrawal Syndrome (Nows), Katelyn White May 2024

Healthcare Provider’S Perceptions On Feeding Difficulties And Educational Practices In Infants With Neonatal Opioid Withdrawal Syndrome (Nows), Katelyn White

Electronic Theses and Dissertations

This study examined healthcare professionals’ perceptions on feeding difficulties experienced by infants with NOWS, the involvement of SLP in care, knowledge and experience levels of professionals, and trends in education and follow up care. A 34-question survey was developed to obtain data from participants involved in the care of exposed infants using the secure webbased RedCap™ platform. Nonparametric inferential statistics and descriptive analysis were used to interpret data. Feeding difficulties in infants exposed were reported by all respondents with SLP involvement reported by 42.2%. Results found that 51.9% of respondents were confident in their ability to educate families about feeding …


The Role Of The Speech-Language Pathologist With Survivors Of Traumatic Brain Injury From Intimate Partner Violence And Providers’ Knowledge Of This Role, Nicolle Mcadams May 2024

The Role Of The Speech-Language Pathologist With Survivors Of Traumatic Brain Injury From Intimate Partner Violence And Providers’ Knowledge Of This Role, Nicolle Mcadams

Electronic Theses and Dissertations

Intimate partner violence occurs globally at alarming rates. Many experience adverse health impacts such as traumatic brain injury. Healthcare providers do not know the role of the speech-language pathologist, or the rehabilitation needs of survivors.

Aims: This scoping review aims to identify speech-language pathology services for survivors of intimate partner violence with a resulting traumatic brain injury, and knowledge of healthcare providers on the rehabilitation needs of this population. A search was completed in May to October 2023, resulting in a total of 13 articles reviewed.

Main contributions: Speech-language pathologists lack knowledge to provide services to intimate partner violence survivors …


“We Were The Best People To Do The Job”: Caregivers’ Reported Outcomes Of A Virtual Caregiver-Delivered Program For Autistic Preschoolers, Lauren Denusik, Danielle Glista, Michelle Servais, Jodi Friesen, Bj Cunningham Apr 2024

“We Were The Best People To Do The Job”: Caregivers’ Reported Outcomes Of A Virtual Caregiver-Delivered Program For Autistic Preschoolers, Lauren Denusik, Danielle Glista, Michelle Servais, Jodi Friesen, Bj Cunningham

Communication Sciences and Disorders Publications

Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers’ perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers’ perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words® (MTW) program.


We Were The Best People To Do The Job”: Caregivers’ Reported Outcomes Of A Virtual Caregiver-Delivered Program For Autistic Preschoolers, Lauren Denusik, Danielle Glista, Michelle Servais, Jodi Friesen, Janis Oram, Bj Cunningham Apr 2024

We Were The Best People To Do The Job”: Caregivers’ Reported Outcomes Of A Virtual Caregiver-Delivered Program For Autistic Preschoolers, Lauren Denusik, Danielle Glista, Michelle Servais, Jodi Friesen, Janis Oram, Bj Cunningham

PRECISe Preschool Speech and Language Publications

Background and aims: Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers' perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers' perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words® (MTW) program.

Methods: This study was a secondary analysis of data from individual interviews conducted with 21 caregivers who had …


Unlocking The Power Of Experiential Learning: Student Reported Changes Following Combined Nicu Instruction, Megan M. Black, Natalie A. Perkins, Valerie F. Mcdaniel Apr 2024

Unlocking The Power Of Experiential Learning: Student Reported Changes Following Combined Nicu Instruction, Megan M. Black, Natalie A. Perkins, Valerie F. Mcdaniel

Pacific Journal of Health

Purpose: This study aimed to assess the impact of in-person observation, in conjunction with didactic lectures, on students' perceived knowledge of speech-language pathology's (SLP) role and the roles of other healthcare professionals within the Neonatal Intensive Care Unit (NICU).

Method: Data for this study were initially collected for educational purposes and were later retrospectively analyzed with Institutional Review Board (IRB) approval. Ten participants who met the inclusion criteria underwent a didactic lecture on SLPs in the NICU followed by observing an SLP in action at a local NICU. Participants completed multiple surveys, allowing for a comparison of their perceived knowledge …


Evidence Based Practice Guidelines For The Pediatric Autistic Spectrum Disorder Population, Calvin Sparks Apr 2024

Evidence Based Practice Guidelines For The Pediatric Autistic Spectrum Disorder Population, Calvin Sparks

Doctor of Nursing Practice Scholarly Projects

Children with autism spectrum disorder (ASD), as well as caregivers, experience significant challenges in their interactions with healthcare providers in a clinical setting. This is primarily due to their issues with communication, social interaction, and sensory sensitivities to anesthetic treatment during premedication or preoperative environments. Due to these characteristics, it is important to maintain and update the current standards of care for children with ASD while utilizing evidence-guided strategies to provide a pre-operative assessment effectively. The pre-operative assessment is a critical component that renders impact throughout the surgical experience with the purpose of risk stratification, preparation of altering the normal …


Ua12/2/2 Talisman: Pulse, Wku Student Affairs Apr 2024

Ua12/2/2 Talisman: Pulse, Wku Student Affairs

WKU Administration Documents

Spring 2024 Talisman:

  • Hunter, Leah. Pulse
  • Muscutt, Carson. High on Bluegrass – Jordan Riehm
  • Meyers, Jeffrey. Science of Movement – Exercise Science
  • Murray, Debra. Pasture to Plate – Agriculture
  • Murray, Debra. Vegetarian Tortilla Soup
  • Coffee, Bobbi. Passion, Pain, Curiosity – Innovation Campus
  • Story, Miriam. Drafts of a Postcard (October 2023)
  • Johnston, Katelyn. Beyond Sound – Deaf
  • Hunter, Leah. One Good Week – Madison Weis
  • Alali, Cecilia. Crafted Cadence – Speech Team
  • Blankenship, Alisa. Loving You
  • Sandlin, Ellie. Here After – Death
  • Booth, Pandora. Rooted in Rhythm – Step Shows
  • Booth, Pandora. Horoscopes
  • Pulse Playlist


The Influence Of Cognition On Dysphagia In Adults With Severe Traumatic Brain Injury, Elizabeth Mcdonald Apr 2024

The Influence Of Cognition On Dysphagia In Adults With Severe Traumatic Brain Injury, Elizabeth Mcdonald

Student Academic Conference

Dysphagia leads to an increased risk of morbidity and mortality (Alhashemi, 2010), and individuals with severe traumatic brain injuries (TBIs) are at an extremely heightened risk of developing dysphagia. This paper identified the known links between cognition and dysphagia, specifically focusing on adults with severe TBIs. The Rancho Los Amigos Revised Scale (RLAS-R) was found to be the best predictive factor in the presence, severity, and resolution of dysphagia (Terré & Mearin, 2007; Terré & Mearin, 2009; Hansen et al., 2008). This information is vital for speech-language pathologists (SLPs) to understand due to their experience and expertise in treating disorders …


Impacts Of Socioeconomic Status On Language Development In Preschool Children, Denise Adriaansen Apr 2024

Impacts Of Socioeconomic Status On Language Development In Preschool Children, Denise Adriaansen

Student Academic Conference

According to Lee (2023), 37.9 million Americans are living in poverty. Poverty is associated with deficits in language, communication, and social skills. Language development is a crucial aspect of a child's development. Children who live in low-socioeconomic households have a higher prevalence of language impairments. This paper will explore the impact that socioeconomic status has on language development in preschool-aged children. It includes becoming knowledgeable on serving individuals that come from different backgrounds, including level of socioeconomic status. It is important for all individuals especially professionals who will serve this population to understand how level of socioeconomic status can affect …


The Psychosocial Effects Of Alaryngeal Speech Following A Laryngectomy, Jennifer Cloos Apr 2024

The Psychosocial Effects Of Alaryngeal Speech Following A Laryngectomy, Jennifer Cloos

Student Academic Conference

When an individual is unable to communicate using verbal speech, they can be given or introduced to a variety of alternative or augmentative options to help assist in their ability to communicate their wants and needs appropriately. In this paper the focus is on communication from those who have had a partial or total laryngectomy procedure and how the alteration of their means of communicative output affects their psychosocial health and well-being. This literature review breaks down what kind of care is expected for laryngectomees post-operation, options for communicative output following that procedure, how intensive surgeries and artificial voice options …


The Role Of High School Based Speech Language Pathologists In Transitioning Students With Autism Spectrum Disorder Into Professional Careers, Cameryn Maykut Apr 2024

The Role Of High School Based Speech Language Pathologists In Transitioning Students With Autism Spectrum Disorder Into Professional Careers, Cameryn Maykut

Student Academic Conference

Autism Spectrum Disorder (ASD) is widely known to be one of the fastest growing developmental disabilities in the United States. Due to the ever-increasing prevalence of ASD, it is essential for Speech-Language Pathologists (SLPs) to be educated on how to provide the highest quality of services to this population. This research paper aims to investigate the role of the high school based SLP while working with students with ASD during the transition from high school to vocational settings. Research was collected through compiling data from a variety of peer-reviewed scholarly sources, such as journals, articles, and organizations. Findings from the …


The Speech Language Pathologist's Role In Intervention For Parkinson's Disease, Jenna Lovaas Apr 2024

The Speech Language Pathologist's Role In Intervention For Parkinson's Disease, Jenna Lovaas

Student Academic Conference

This literature review explored the available intervention techniques utilized by Speech Language Pathologists (SLPs) when treating individuals with Parkinson's disease (PD). Parkinson's disease affects six million people worldwide and is expected to double by the year 2040. Deficits associated with PD manifest themselves into motor and non-motor symptoms that show varying benefit from pharmacological approaches alone. For this reason, SLPs provided comprehensive treatment approaches to address the challenges related to dysarthria, dysphagia, and cognitive linguistic skills. Treatment consisted of behavioral techniques, diet modifications, compensatory strategies, muscle strength training, and restorative training. While some techniques demonstrated benefit to more than one …


The Effect Of Melodic Intonation Therapy On Language Recovery In Patients After Stroke, Alie Rockey Apr 2024

The Effect Of Melodic Intonation Therapy On Language Recovery In Patients After Stroke, Alie Rockey

Student Academic Conference

This project is an examination of literature discussing the effects of Melodic Intonation Therapy (MIT) on language recovery in patients after stroke. The role of MIT after stroke is to encourage language recovery and promote overall well-being. Nine studies are summarized pertaining to the importance of MIT for individuals after stroke and the generalization of this approach. The existing literature supported MIT as a consistent intervention approach that positively impacted stroke and language recovery. Additionally, this review explored implementation options and the importance of each method. The importance for future research and synthesis is impactful across settings. Overall implications predict …


Best Practice Interventions For Individuals With Cleft Palate, Aleisha Johnson Apr 2024

Best Practice Interventions For Individuals With Cleft Palate, Aleisha Johnson

Student Academic Conference

Cleft palate and cleft lip with palate occur in every 1,700 and 1,600 births (ASHA, n.d.). Speech-language pathology intervention is often needed by individuals who have had a cleft palate; about 50% of individuals who have had a repaired cleft palate are referred to speech pathology services (Sand et al., 2022). According to Alighieri et al. (2021), there is a lack of clear procedures when administering treatment to individuals with repaired cleft palates. The purpose of this project is to identify best practice for speech therapy interventions for individuals with repaired cleft palates. This project reviews the traditional articulation approach, …


Understanding Practitioner’S Perceptions Of Speech And Language Therapy Services In The Juvenile Justice System, Julia Buendgen Apr 2024

Understanding Practitioner’S Perceptions Of Speech And Language Therapy Services In The Juvenile Justice System, Julia Buendgen

Student Academic Conference

The purpose of this study was to gain more understanding of how individuals who work with the juvenile justice population understand language disorders and the scope of speech and language therapy services. In addition, this study explored potential supports for individuals working in this setting. This study consisted of twenty participants working in the juvenile justice system who completed a survey tool that was designed by the researcher to describe the participant's perceptions of speech-language pathology, current procedures, reported challenges, and potential areas in need of support. Participant knowledge of the scope of speech-language pathology varied among participants. The highest …