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"Mathur, Gaurav"
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An approach designed to fail deaf children and their parents and how to change it
The matter of raising and educating deaf children has been caught up in percepts of development that are persistently inaccurate and at odds with scientific research. These percepts have negatively impacted the health and quality of life of deaf children and deaf people in general. The all too prevalent advice is to raise the child strictly orally and wait to see what happens. Only when the child is seriously behind is a completely accessible language – a sign language – introduced, and that is far too late for protecting cognitive health. The medical profession, along with others, needs to offer parents better advice and better supports so that neither the children nor their parents wait and watch as the oral-only method fails. All must take responsible action to assure an approach that succeeds.
Journal Article
Language acquisition for deaf children: Reducing the harms of zero tolerance to the use of alternative approaches
Children acquire language without instruction as long as they are regularly and meaningfully engaged with an accessible human language. Today, 80% of children born deaf in the developed world are implanted with cochlear devices that allow some of them access to sound in their early years, which helps them to develop speech. However, because of brain plasticity changes during early childhood, children who have not acquired a first language in the early years might never be completely fluent in any language. If they miss this critical period for exposure to a natural language, their subsequent development of the cognitive activities that rely on a solid first language might be underdeveloped, such as literacy, memory organization, and number manipulation. An alternative to speech-exclusive approaches to language acquisition exists in the use of sign languages such as American Sign Language (ASL), where acquiring a sign language is subject to the same time constraints of spoken language development. Unfortunately, so far, these alternatives are caught up in an \"either - or\" dilemma, leading to a highly polarized conflict about which system families should choose for their children, with little tolerance for alternatives by either side of the debate and widespread misinformation about the evidence and implications for or against either approach. The success rate with cochlear implants is highly variable. This issue is still debated, and as far as we know, there are no reliable predictors for success with implants. Yet families are often advised not to expose their child to sign language. Here absolute positions based on ideology create pressures for parents that might jeopardize the real developmental needs of deaf children. What we do know is that cochlear implants do not offer accessible language to many deaf children. By the time it is clear that the deaf child is not acquiring spoken language with cochlear devices, it might already be past the critical period, and the child runs the risk of becoming linguistically deprived. Linguistic deprivation constitutes multiple personal harms as well as harms to society (in terms of costs to our medical systems and in loss of potential productive societal participation).
Journal Article
Deaf Children Need Rich Language Input from the Start: Support in Advising Parents
Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation.
Journal Article
Need for Invasive Meningococcal Disease Prevention Through Vaccination for Young Children in the Americas
Background: Invasive meningococcal disease (IMD) is an uncommon but potentially life-threatening condition, resulting in life-long sequelae or death in up to 20% of cases. Most IMD cases are caused by Neisseria meningitidis serogroups (Men) A, B, C, W, X, and Y. The highest IMD incidence is among children < 5 years of age (YOA). We reviewed IMD epidemiology data and existing national immunization programs (NIP) in the Americas and identify unmet needs to decrease IMD burden in young children. Methods: Using national surveillance data and published literature from 2006 to 2024, we evaluated the IMD burden and national vaccination strategies for children < 5 YOA in the Americas, focusing on Canada, the United States, Brazil, Chile, Argentina. Results: The highest IMD incidence was among infants, followed by children 1–4 YOA, with MenB infections predominating in both age groups. Chile has both MenACWY (2014) and MenB (2023) infant vaccination in its NIP. Argentina and Brazil’s NIPs include MenACWY (2017) and MenC (2010) vaccinations for infants, respectively. In Canada, MenC (2002) vaccination is recommended at 1 YOA (replaced by MenACWY in 2024 in Manitoba); MenB vaccination is selectively recommended. In each country, the incidence of IMD caused by vaccine-preventable serogroups decreased following the introduction of the respective meningococcal vaccination in the NIP. Conclusions: Comprehensive meningococcal vaccination programs in the Americas have the potential to reduce the IMD burden in children < 5 YOA. National recommendations and NIPs could reduce IMD burden by offering equitable access to protection against IMD, aligning with the WHO roadmap to defeat meningitis by 2030.
Journal Article
Comparison of serum sodium and potassium levels in patients with senile cataract and age-matched individuals without cataract
Aim: The study was to analyze mean serum sodium and potassium levels in cataract patients and age-matched individuals without cataract. Methods and Materials: It was a prospective case-control study. Individuals more than 50 years of age who attended our ophthalmic center in the year 2007-2010 were grouped into those having cataract and those without cataract. Mean serum sodium and potassium levels in the cataract groups were calculated and compared with the control group. Statistical software SPSS14 was used for statistical analysis. Results: Mean serum sodium levels in cataract group was 135.1 meqv/l and 133 meqv/l in the control group. Mean potassium was 3.96 meqv/l in the case study group and 3.97 meqv/l in controls. Mean sodium levels among cases were significantly higher than control group. No difference was seen in the PSC group and control. The difference in mean potassium among the two groups was statistically insignificant. Conclusion: Diets with high sodium contents are a risk factor for senile cataract formation and dietary modifications can possibly reduce the rate of progression cataract.
Journal Article
4CMenB Vaccination to Prevent Meningococcal B Disease in Vietnam: Expert Review and Opinion
An advisory board meeting was held with experts in Vietnam (Hanoi, August 2022), to review the evidence on invasive meningococcal disease (IMD) epidemiology, clinical management, and meningococcal vaccines to reach a consensus on recommendations for meningococcal vaccination in Vietnam. IMD is a severe disease, with the highest burden in infants and children. IMD presents as meningitis and/or meningococcemia and can progress extremely rapidly. Almost 90% of deaths in children occur within the first 24 h, and disabling sequelae (e.g., limb amputations and neurological damage) occur in up to 20% of survivors. IMD patients are often hospitalized late, due to mild and nonspecific early symptoms and misdiagnosis. Difficulties related to diagnosis and antibiotic misuse mean that the number of reported IMD cases in Vietnam is likely to be underestimated. Serogroup B IMD is predominant in many regions of the world, including Vietnam, where 82% of IMD cases were due to serogroup B (surveillance data from 2012 to 2021). Four component meningococcal B vaccine (4CMenB) is used in many countries (and is part of the pediatric National Immunization Program in 13 countries), with infant vaccination starting from two months of age, and a 2 + 1 dosing schedule. Experts recommend 4CMenB vaccination as soon as possible in Vietnam, starting from two months of age, with a 2 + 1 dosing schedule, and at least completing one dose before 6 months of age.
Journal Article
Effects of sign language experience on categorical perception of dynamic ASL pseudosigns
We investigated effects of sign language experience on deaf and hearing participants’ categorical perception of minimal manual contrast stimuli that met key criteria of speech perception research. A continuum of meaningless dynamic stimuli was created with a morphing approach, which manipulated videorecorded productions of phonotactically permissible pseudosigns differing between American Sign Language (ASL) handshapes that contrast on a single articulatory dimension (U—V: finger-spreading). AXB discrimination and AXB categorization and goodness ratings on the target items were completed by deaf early (native) signers (DE), deaf late (nonnative) signers (DL), hearing late (L2) signers (HL), and hearing nonsigners (HN). Categorization and goodness functions were less categorical and had different boundaries for DL participants than for DE and HL participants. Shape and level of discrimination functions also differed by ASL experience and hearing status, with DL signers showing better performance than DE, HL, and especially HN participants, particularly at the U end of the continuum. Although no group displayed a peak in discrimination at the category boundary, thus failing to support classic categorical perception, discrimination was consistent with categorization in other ways that differed among the groups. Thus, perception of phonetic variations underlying this minimal sign contrast is systematically affected by language experience.
Journal Article
Short-term results of intravitreal dexamethasone implant (OZURDEX ® ) in treatment of recalcitrant diabetic macular edema: A case series
Dexamethasone Posterior-Segment Drug Delivery System is a novel, biodegradable, sustained-release drug delivery system (OZURDEX(®)) for treatment of macular edema following retinal vein occlusion and posterior uveitis. However, its potential role in management of diabetic macular edema has not been reported yet.
The aim was to evaluate the safety and efficacy of (OZURDEX(®)) in patients with recalcitrant diabetic macular edema (DME).
A retrospective, interventional case series from a tertiary eye care center in India is presented. Inclusion criteria comprised patients presenting with recalcitrant DME, 3 or more months after one or more treatments of macular laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (VEGF) injections. Exclusion criteria included history of corticosteroid-responsive intraocular pressure (IOP) rise, cataract extraction, or other intraocular surgery within 3 months. The main outcome measure was visual acuity at 1 and 4 months after OZURDEX(®) injection. Secondary outcome measures included change in central macular thickness on Optical coherence tomography (OCT) and changes in IOP following intravitreal OZURDEX(®) implant. Of 18 eyes (17 patients) with recalcitrant diabetic macular edema that underwent OZURDEX(®) implant, three eyes (two patients) had follow-up of more than 3 months post-injection.
Mean age of patients was 56 years. Mean duration of diabetes mellitus was 16.6 years. Systemic control of DM was good as assessed by FBS/PPBS and HbA1c. The pre-operative mean central macular thickness was 744.3 μm and improved to 144 and 570 μm at months 1 and 4, respectively. Preoperative mean BCVA was 0.6 logMAR units and improved to 0.3 and 0.46 logMAR units at month 1 and 4, respectively. The mean follow-up was 4.3 months (range 4-5 months).
OZURDEX(®) appears efficacious in management of recalcitrant diabetic macular edema. The results of the ongoing POSURDEX(®) study will elaborate these effects better.
Journal Article
Assessing fracture mechanics in thermally treated, uniaxial loaded grouted non-persistent medium-hard rock: a digital image correlation and FracPaQ analysis
Dynamic loading along the rock joints from factors such as thermal loads, excavation, and seismic wave velocity further exacerbates susceptibility. It is crucial to restore the strength of such rock masses using appropriate techniques to enhance the stability of slopes and tunnels and mitigate future distress and damage. This study investigates the impact of uniaxial loading on the peak strength and fracture propagation behaviour of non-persistent rock masses subjected to temperatures from 100 °C to 400 °C. These parameters have been examined in jointed samples (i.e., prepared by dental plaster (DP) with joint at 30° inclinations to the horizontal in the middle of the specimen) and filled with grouts using (i) cement, (ii) sand-cement mortar (in a 1:3 ratio) and bio-concrete (SCB) mix, and (iii) epoxy resin. The results reveal that grouting can mitigate the presence of defects in any rock mass. Without heat-treated specimens with epoxy grout are more effective than those with cement and SCB mix grout. The study also clearly delineates the effects of temperature variation on the strength behaviour of both un-grouted and grouted specimens. The strain field of samples without subjected to heat treatment varies from 0.01 to 0.25, 0.05 to 0.55, 0.02 to 0.14 and 0.01 to 0.1 in un-grouted, SCB mix, cement and epoxy grouted, respectively. In un-grouted specimens, strain increases with higher thermal treatments, transitioning from tensile to far-field failure modes. When grouting is introduced, an increase in strain is observed. In specimens grouted with SCB mix, shear cracks dominate up to 250 °C, after which far-field cracks appear. In cement-grouted specimens, far-field cracks are observed up to 200 °C, followed by a transition to tensile failure mode. However, far-field failure mode in epoxy grouted specimens initiates from the onset of thermal treatments, starting at 100 °C. The detailed observations on crack propagation along un-grouted and grouted specimens is made via Digital Image Correlation (DIC) and FracPaQ analysis. The DIC technique enables precise measurement of strain distribution and deformation, while FracPaQ provides detailed analysis of fracture networks and orientations.
Journal Article