Caregiver reactions to babbling organize turn-taking interactions: Facilitative effects of vocal versus non-vocal responses.

Turn-taking interactions are foundational to the development of social, communicative, and cognitive skills. In infants, vocal turn-taking experience is predictive of infants' socioemotional and language development. However, different forms of turn-taking interactions may have different effects on infant vocalizing. It is presently unknown how caregiver vocal, non-vocal and multimodal responses to infant vocalizations compare in extending caregiver-infant vocal turn-taking bouts. In bouts that begin with an infant vocalization, responses that maintain versus change the communicative modality may differentially affect the likelihood of further infant vocalizing. No studies have examined how caregiver response modalities that either matched or differed from the infant acoustic (vocal) modality might affect the temporal structure of vocal turn-taking beyond the initial serve-and-return exchanges. We video-recorded free-play sessions of 51 caregivers with their 9-month-old infants. Caregivers responded to babbling most often with vocalizations. In turn, caregiver vocal responses were significantly more likely to elicit subsequent infant babbling. Bouts following an initial caregiver vocal response contained significantly more turns than those following a non-vocal or multimodal response. Thus prelinguistic turn-taking is sensitive to the modality of caregivers' responses. Future research should investigate if such sensitivity is grounded in attentional constraints, which may influence the structure of turn-taking interactions.

Early Real-World Patient and Staff Experience with an Intracanalicular Dexamethasone Insert.

Purpose: To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA®), hereafter referred to as DEX, after cataract surgery as well as staff/practice integration of DEX relative to eyedrops. Patients and Methods: This was a cross-sectional survey study of 23 cataract practices in the United States. Respondents were patients and practice staff who had experience with DEX following cataract surgery. Both patients and practice staff completed an online survey. Descriptive statistics summarized the survey responses to portray the experience of the respondents. Results: Surveys were completed by 62 patients and 19 practice staff. Almost all patients (93%) were satisfied or extremely satisfied with DEX. Patients highly preferred DEX (93%) to topical steroid drops (7%) based on past experiences with topical steroid drops. Most practice staff (95%) were satisfied or highly satisfied with DEX, reporting a 45% reduction in time spent educating patients on postoperative drop use and a 46% decrease in time spent addressing calls from pharmacies regarding postoperative medications. Conclusion: Incorporating the DEX insert into clinical practice in cataract surgery practices can improve patient adherence, while potentially providing significant savings to practices in terms of time spent educating patients and responding to patient and pharmacy call-backs.

Developmental cascades of vocal turn-taking connect prelinguistic vocalizing with early language.

Conversational turn-taking is ubiquitously found in caregiver-infant interactions, and robustly predictive of infant communicative development. Over the first year, infants take quick adult-like vocal turns with caregivers. Many studies have documented the consistency of caregiver responsiveness and its influence on infant rapid language growth. However, few have examined how caregiver responsiveness facilitates extended vocal turn-taking in real-time with infants over the first year. The influence of prelinguistic vocal turn-taking on the emergence of language has also been under-investigated. We analyzed free-play sessions of 30 caregivers and their infants at both 5 and 10 months, and obtained infant language outcomes at 18 months. We examined the developmental consistency (group-level continuity and dyad-order stability) and change of infant volubility, caregiver responses to babbling in vocal, non-vocal and multimodal modalities, and the influence of modality on caregiver-infant vocal turn-taking. Caregiver contingent responsiveness to infant babbling at 5 months predicted vocal turn-taking at 10 months. Developmental increases in prelinguistic vocalizing and vocal turn-taking from 5 to 10 months predicted infant language outcomes at 18 months. At both 5 and 10 months, caregiver vocal responses were more effective in extending turn-taking than non-vocal or multimodal responses. In summary, prelinguistic vocal turn-taking, facilitated by caregiver vocal responsiveness, is positively related to the emergence of early language.

Curiosity constructs communicative competence through social feedback loops.

One of the most important challenges for a developing infant is learning how best to allocate their attention and forage for information in the midst of a great deal of novel stimulation. We propose that infants of altricial species solve this challenge by learning selectively from events that are contingent on their immature behavior, such as babbling. Such a contingency filter would focus attention and learning on the behavior of social partners, because social behavior reliably fits infants' sensitivity to contingency. In this way a contingent response by a caregiver to an immature behavior becomes a source of learnable information - feedback - to the infant. Social interactions with responsive caregivers afford infants opportunities to explore the impacts of their immature behavior on their environment, which facilitates the development of socially guided learning. Furthermore, contingent interactions are opportunities to make and test predictions about the efficacy of their social behaviors and those of others. In this chapter, we will use prelinguistic vocal learning to exemplify how infants use their developing vocal abilities to elicit learnable information about language from their social partners. Specifically, we review how caregivers' contingent responses to babbling create information that facilitates infant vocal learning and drives the development of communication. Infants play an active role in this process, as their developing predictions about the consequences of their actions serve to further refine their allocation of attention and drive increases in the maturity of their vocal behavior.

Effects of Punctal Occlusion on Ocular Itching and Conjunctival Redness Associated with Allergic Conjunctivitis.

PURPOSE: Punctal occlusion using punctal plugs has been successfully used to treat the signs and symptoms of dry eye disease. However, the effects of punctal occlusion on the symptoms of allergic conjunctivitis (AC) have been less well documented. There is some concern among clinicians that punctal occlusion may make signs/symptoms of allergic conjunctivitis worse by trapping allergens on the eye. The objective of this post hoc analysis was to address this question and thus assess the effect of punctal occlusion alone on ocular itching and conjunctival redness associated with AC. METHODS: This was a pooled post hoc analysis of three randomized, double-blind, placebo insert-controlled clinical trials in subjects with AC. Enrolled subjects were generally healthy adults with ocular allergies and a positive skin test reaction to perennial and/or seasonal allergens. The study used a modified version of the traditional conjunctival allergen challenge (CAC) model, which included multiple, repeated allergen challenges following placement of the intracanalicular insert. Subjects were rechallenged on Days 6, 7 and 8; Days 13, 14 and 15; and Days 26, 27 and 28. RESULTS: The data set included 128 subjects that were administered placebo. Baseline mean (SD) ocular itching and conjunctival redness scores were 3.52 (0.44) and 2.97 (0.39), respectively. On post-insertion Days 7, 14 and 28, mean itching scores were 2.62, 2.26 and 1.91, respectively, representing 26%, 36% and 46% itching reductions, respectively (p < 0.001). On Days 7, 14 and 28, mean conjunctival redness scores were 1.98, 1.90, and 2.08, respectively, representing 33%, 36%, and 30% redness reductions, respectively (p < 0.001). CONCLUSIONS: Based on this post hoc pooled analysis, punctal occlusion with a resorbable hydrogel intracanalicular insert did not worsen ocular itching or conjunctival redness in this patient population.

Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy.

PURPOSE OF REVIEW: To discuss common reasons for nonadherence and review existing and emerging options to reduce nonadherence with ocular medical therapy and optimize therapeutic outcomes. RECENT FINDINGS: Nonadherence can arise from patient-related issues (e.g. physical, cognitive) and healthcare-related issues (e.g. cost, access to care). Multiple strategies have been developed and evaluated to overcome these barriers to adherence. Identifying nonadherence and its cause(s) facilitates the development of strategies to overcome it. SUMMARY: Many common causes of nonadherence can be mitigated through a variety of strategies presented.

Learning how to learn from social feedback: The origins of early vocal development.

Infants' prelinguistic vocalizations reliably organize vocal turn-taking with social partners, creating opportunities for learning to produce the sound patterns of the ambient language. This social feedback loop supporting early vocal learning is well-documented, but its developmental origins have yet to be addressed. When do infants learn that their non-cry vocalizations influence others? To test developmental changes in infant vocal learning, we assessed the vocalizations of 2- and 5-month-old infants in a still-face interaction with an unfamiliar adult. During the still-face, infants who have learned the social efficacy of vocalizing increase their babbling rate. In addition, to assess the expectations for social responsiveness that infants build from their everyday experience, we recorded caregiver responsiveness to their infants' vocalizations during unstructured play. During the still-face, only 5-month-old infants showed an increase in vocalizing (a vocal extinction burst) indicating that they had learned to expect adult responses to their vocalizations. Caregiver responsiveness predicted the magnitude of the vocal extinction burst for 5-month-olds. Because 5-month-olds show a vocal extinction burst with unfamiliar adults, they must have generalized the social efficacy of their vocalizations beyond their familiar caregiver. Caregiver responsiveness to infant vocalizations during unstructured play was similar for 2- and 5-month-olds. Infants thus learn the social efficacy of their vocalizations between 2 and 5 months of age. During this time, infants build associations between their own non-cry sounds and the reactions of adults, which allows learning of the instrumental value of vocalizing.

Immature Vocalizations Simplify the Speech of Tseltal Mayan and U.S. Caregivers.

What is the function of immature vocalizing in early learning environments? Previous work on infants in the United States indicates that prelinguistic vocalizations elicit caregiver speech which is simplified in its linguistic structure. However, there is substantial cross-cultural variation in the extent to which children's vocalizations elicit responses from caregivers. In the current study, we ask whether children's vocalizations elicit similar changes in their immediate caregivers' speech structure across two cultural sites with differing perspectives on how to interact with infants and young children. Here, we compare Tseltal Mayan and U.S. caregivers' verbal responses to their children's vocalizations. Similar to findings from U.S. dyads, we found that children from the Tseltal community regulate the statistical structure of caregivers' speech simply by vocalizing. Following the interaction burst hypothesis, where clusters of child-adult contingent response alternations facilitate learning from limited input, we reveal a stable source of information that may facilitate language learning within ongoing interaction.

Early Real-World Physician Experience with an Intracanalicular Dexamethasone Insert.

Purpose: To describe the early real-world experience of physicians with an intracanalicular dexamethasone insert (DEX) in patients undergoing cataract surgery and to capture the clinical impact of adopting this therapy. Patients and Methods: 23 United States sites including Ambulatory Surgical Center Setting (ASC) and Outpatient Clinical settings. Respondents were physicians who had early experience with DEX in cataract surgery patients. This was a Phase 4 experiential cross-sectional survey study comprised of 3 sequential online physician surveys. Descriptive statistics summarized the surveys' responses to determine the early impressions of the respondents. Results: Forty-two physicians completed surveys. On average, physicians reported feeling comfortable administering DEX after placing 3 inserts (mean 2.7; standard deviation 1.9). Most physicians (92%) were satisfied with DEX, and all physicians (100%) reported that DEX improved patient compliance. Most physicians (62.5%) indicated they would highly prefer DEX over traditional steroid eyedrops for the management of post-surgical inflammation and pain. Conclusion: The surveys exploring the early use of DEX suggest that DEX is a clinically effective treatment with a rapid initial learning curve and integrates well into clinical use. Physicians had a very positive early experience with DEX, including comfort with insertion and satisfaction. DEX shows promise as a primary treatment choice of physicians for ocular inflammation and pain following cataract surgery by offering patients a hands-free innovative therapy that delivers a preservative-free steroid to the ocular surface over approximately 30 days.

Ocular benzalkonium chloride exposure: problems and solutions.

Preservatives in multidose formulations of topical ophthalmic medications are crucial for maintaining sterility but can be toxic to the ocular surface. Benzalkonium chloride (BAK)-used in approximately 70% of ophthalmic formulations-is well known to cause cytotoxic damage to conjunctival and corneal epithelial cells, resulting in signs and symptoms of ocular surface disease (OSD) including ocular surface staining, increased tear break-up time, and higher OSD symptom scores. These adverse effects are more problematic with chronic exposure, as in lifetime therapy for glaucoma, but can also manifest after exposure as brief as seven days. Multiple strategies are available to minimize or eliminate BAK exposure, among them alternative preservatives, preservative-free formulations including sustained release drug delivery platforms, and non-pharmacological therapies for common eye diseases and conditions. In this paper, we review the cytotoxic and clinical effects of BAK on the ocular surface and discuss existing and emerging options for ocular disease management that can minimize or eliminate BAK exposure.

Evolving the capacity for socially guided vocal learning in songbirds: a preliminary study.

Socially guided vocal learning, the ability to use contingent reactions from social partners to guide immature vocalizations to more mature forms, is thought to be a rare ability known to be used only by humans, marmosets and two unrelated songbird species (brown-headed cowbirds and zebra finches). However, this learning strategy has never been investigated in the vast majority of species that are known to modify their vocalizations over development. We propose a novel, preliminary evolutionary modelling approach that uses ecological, reproductive and developmental traits to predict which species may incorporate social influences as part of their vocal learning system. We demonstrate our model using data from 28 passerines. We found three highly predictive traits: temporal overlap between sensory (memorization) and sensorimotor (practice) phases of song learning, song used for mate attraction, and social gregariousness outside the breeding season. Species with these traits were distributed throughout the clade, suggesting that a trait-based approach may yield new insights into the evolution of learning strategies that cannot be gleaned from phylogenetic relatedness alone. Our model suggests several previously uninvestigated and unexpected species as likely socially guided vocal learners and offers new insight into the evolution and development of vocal learning. This article is part of the theme issue 'Vocal learning in animals and humans'.

The many functions of vocal learning.

The capacity to learn novel vocalizations has evolved convergently in a wide range of species. Courtship songs of male birds or whales are often treated as prototypical examples, implying a sexually selected context for the evolution of this ability. However, functions of learned vocalizations in different species are far more diverse than courtship, spanning a range of socio-positive contexts from individual identification, social cohesion, or advertising pair bonds, as well as agonistic contexts such as territorial defence, deceptive alarm calling or luring prey. Here, we survey the diverse usages and proposed functions of learned novel signals, to build a framework for considering the evolution of vocal learning capacities that extends beyond sexual selection. For each function that can be identified for learned signals, we provide examples of species using unlearned signals to accomplish the same goals. We use such comparisons to generate hypotheses concerning when vocal learning is adaptive, given a particular suite of socio-ecological traits. Finally, we identify areas of uncertainty where improved understanding would allow us to better test these hypotheses. Considering the broad range of potential functions of vocal learning will yield a richer appreciation of its evolution than a narrow focus on a few prototypical species. This article is part of the theme issue 'Vocal learning in animals and humans'.

Plasma Pharmacokinetic Parameters of Dexamethasone Following Administration of a Dexamethasone Intracanalicular Insert in Healthy Adults.

PURPOSE: Intracanalicular dexamethasone insert is a resorbable sustained-release polyethylene glycol-based hydrogel insert delivering a 0.4 mg tapered dose of dexamethasone for up to 30 days to the ocular surface. It is FDA-approved for treating inflammation and pain after ocular surgery. It has also been studied for ocular surface diseases such as allergic conjunctivitis. This study assessed the plasma pharmacokinetic (PK) parameters of dexamethasone following intracanalicular insertion. PATIENTS AND METHODS: Study subjects (N=16) were healthy adults. A dexamethasone insert was unilaterally placed into the canaliculus, and blood samples were obtained for analysis 1 hour prior to insertion and 1, 2, 4, 8, 16, 24 hours and 4, 8, 15, 22 and 29 days after insertion. Safety analyses included slit lamp and dilated fundus examinations, best corrected visual acuity, intraocular pressure (IOP) and adverse events (AEs). RESULTS: Plasma results were below the lower limit of quantitation (LLOQ) at all time points in five subjects (31.3%). Among subjects with quantifiable plasma concentrations, Cmax was <1 ng/mL (range, 0.05 to 0.81 ng/mL), AUC0-last ranged from 0.13 to 7.18 h∙ng/mL, and Tmax ranged from 4.0 to 163.0 hours. Mean (SD) IOP increased from 16.3 (1.4) mmHg at baseline to 19.3 (3.2) at Day 22 but returned to baseline after treatment. No changes occurred in dilated fundus, punctum, or visual acuity examinations. CONCLUSION: The dexamethasone 0.4 mg insert results in minimal systemic exposure following intracanalicular administration.

Phase 3 Randomized Study of Efficacy and Safety of a Dexamethasone Intracanalicular Insert in Patients With Allergic Conjunctivitis.

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of a dexamethasone intracanalicular ocular insert for the treatment of allergic conjunctivitis. DESIGN: Multicenter, randomized, double-masked, placebo-controlled, Phase 3 clinical trial. METHODS: Subjects with allergic conjunctivitis were randomized 1:1 to receive a dexamethasone insert or a placebo insert in both eyes and were evaluated using a modified version of the conjunctival allergen challenge (CAC) model. After inserts were placed in office, a series of 4 closely spaced post-insertion CACs were conducted at weeks 1, 2, and 4 across approximately 30 days. Primary efficacy endpoints, assessed at week-1 CAC-day 8, were reported by subjects of ocular itching at 3, 5, and 7 minutes post CAC and investigator-evaluated conjunctival redness at 7, 15, and 20 minutes post CAC. RESULTS: For the primary endpoints, dexamethasone inserts showed statistically significantly lower mean ocular itching scores than placebo at all time points (P <.001), with differences favoring dexamethasone inserts over placebo (0.86, 0.98, and 0.96 units at 3, 5, and 7 minutes, respectively) and statistically significantly lower conjunctival redness scores at 20 minutes (P <.05) but not at 7 or 15 minutes (P ≥.05). Results also showed statistically significantly less itching and conjunctival redness at 31 and 29 of 33 other time points, respectively (P <.05). There were no serious adverse events; 1 subject had elevated intraocular pressure in both eyes. CONCLUSIONS: Data presented in this study demonstrate the potential for a single, physician-administered dexamethasone intracanalicular insert to provide relief of ocular itching for up to 4 weeks in subjects with allergic conjunctivitis, while maintaining a favorable safety profile.

The role of personality traits in pair bond formation: pairing is influenced by the trait of exploration.

In species with long-term pair bonds, such as zebra finches, evaluating the quality of potential mates is critically important. Courtship is an opportunity to evaluate information from dynamic behavioural cues. Personality traits, as stable individual differences in behaviour, could predict the quality of a potential mate. How might personality traits influence mate choice? We examined the influence of several personality traits, including exploration, aggression, and social preference, on pair formation in zebra finches. We provided birds with a variety of potential mates and allowed them to select a pair partner. Our semi-naturalistic mate choice paradigm allowed birds to observe social information over an extended period, simulating the challenges of social evaluation that birds encounter in the wild. We found that pairing is influenced by personality, with birds selecting mates similar to them in exploration. The partner's exploration score relative to their own was more important than the absolute exploration score.

Dropless cataract surgery: modernizing perioperative medical therapy to improve outcomes and patient satisfaction.

PURPOSE OF REVIEW: Advances in pharmacology offer freedom from topical medical therapy without compromise of anti-inflammatory and antimicrobial coverage in the perioperative period. In this review, we describe the basis for dropless cataract surgery with the goal of improving outcomes and the patient experience. RECENT FINDINGS: Phacoemulsification outcomes depend largely on surgeon skill but also on adherence to a complex multidrug regimen of perioperative anti-inflammatory and antimicrobial therapy to prevent sight-threatening complications such as cystoid macular edema or endophthalmitis. Successful administration of this regimen can be limited by noncompliance, difficulty administering eye drops, bioavailability, and side effects, among others. The recent development of sustained-release formulations of dexamethasone - one an intracanalicular insert and the other an intraocular suspension - can provide sustained tapering doses of dexamethasone while reducing or eliminating the need for anti-inflammatory eye drop therapy. Similarly, mounting evidence compellingly demonstrates that intracameral antibiotic use intraoperatively is at least as effective as topical antibiotics in preventing endophthalmitis. SUMMARY: Sustained-release dexamethasone coupled with intracameral antibiotics at the time of phacoemulsification can provide antimicrobial and anti-inflammatory prophylaxis without the need for topical eye drop medications. This approach has the potential to improve compliance with therapy, visual acuity outcomes, and the overall patient experience.

Punctum and canalicular anatomy for hydrogel-based intracanalicular insert technology.

Aim: Despite advances in cataract surgery, postoperative ocular inflammation and pain occurs. To address compliance issues with topical corticosteroid administration, a hydrogel-based dexamethasone insert was developed for intracanalicular administration. The objective is to understand the anatomy to best administer the insert and learn how the anatomy and hydrogel properties help retain the insert in the canaliculus over time. Materials & methods: Human cadavers (n = 5) were dissected to assess dimensions of punctum and canaliculus as part of drug discovery and development. Results & conclusions: Mean measures for punctal diameter was 0.5 ± 0 mm and vertical canaliculi length was 2.4 ± 0.5 mm and width was 1.6 ± 0.5 mm. Vertical canalicular width was larger than the punctal opening, a critical understanding for placing and retaining intracanalicular inserts.

The Origins of Social Knowledge in Altricial Species.

Human infants are altricial, born relatively helpless and dependent on parental care for an extended period of time. This protracted time to maturity is typically regarded as a necessary epiphenomenon of evolving and developing large brains. We argue that extended altriciality is itself adaptive, as a prolonged necessity for parental care allows extensive social learning to take place. Human adults possess a suite of complex social skills, such as language, empathy, morality, and theory of mind. Rather than requiring hardwired, innate knowledge of social abilities, evolution has outsourced the necessary information to parents. Critical information for species-typical development, such as species recognition, may originate from adults rather than from genes, aided by underlying perceptual biases for attending to social stimuli and capacities for statistical learning of social actions. We draw on extensive comparative findings to illustrate that, across species, altriciality functions as an adaptation for social learning from caregivers.

The ecology of prelinguistic vocal learning: parents simplify the structure of their speech in response to babbling.

What is the function of babbling in language learning? We examined the structure of parental speech as a function of contingency on infants' non-cry prelinguistic vocalizations. We analyzed several acoustic and linguistic measures of caregivers' speech. Contingent speech was less lexically diverse and shorter in utterance length than non-contingent speech. We also found that the lexical diversity of contingent parental speech only predicted infant vocal maturity. These findings illustrate a new form of influence infants have over their ambient language in everyday learning environments. By vocalizing, infants catalyze the production of simplified, more easily learnable language from caregivers.

Comparing statistical learning across perceptual modalities in infancy: An investigation of underlying learning mechanism(s).

Statistical learning (SL), sensitivity to probabilistic regularities in sensory input, has been widely implicated in cognitive and perceptual development. Little is known, however, about the underlying mechanisms of SL and whether they undergo developmental change. One way to approach these questions is to compare SL across perceptual modalities. While a decade of research has compared auditory and visual SL in adults, we present the first direct comparison of visual and auditory SL in infants (8-10 months). Learning was evidenced in both perceptual modalities but with opposite directions of preference: Infants in the auditory condition displayed a novelty preference, while infants in the visual condition showed a familiarity preference. Interpreting these results within the Hunter and Ames model (1988), where familiarity preferences reflect a weaker stage of encoding than novelty preferences, we conclude that there is weaker learning in the visual modality than the auditory modality for this age. In addition, we found evidence of different developmental trajectories across modalities: Auditory SL increased while visual SL did not change for this age range. The results suggest that SL is not an abstract, amodal ability; for the types of stimuli and statistics tested, we find that auditory SL precedes the development of visual SL and is consistent with recent work comparing SL across modalities in older children.