Abstract

The changing racial and ethnic demographics in the United States school-age population is a defining phenomenon of its educational system. Classrooms across the country are a microcosm of the expanding cultural diversity in society. This growing demographic of students of color extends to students in low-incidence disability groups: deaf or hard of hearing (DHH), blind or visually impaired (BVI), or deafblind (DB) children (see Table 1 for definitions). Slightly more than 50% of DHH and DB students and approximately 40% of BVI students are children of color. The largest group is Latinx/Hispanic, followed by Black, Hawaiian/Pacific Islander, children of two or more races, and Native American/Alaskan American (National Center on Deaf-Blindness, 2020; National Center for Education Statistics, 2020).
Keywords and Language Use
Throughout the article, we intentionally use inclusive and positive terms when referring to disability and racial/ethnic groups and individuals within these groups. To this end, we have used identity-first language because it demonstrates respect for the preferences of the DB, BVI, and DHH communities. We use the gender-inclusive term “Latinx” to refer to people who identify as Latin American. Also, throughout the article, content specific to a single population has been intentionally reordered within paragraphs to demonstrate that the needs of BVI, DHH, and DB students are equal.
DHH, BVI, and DB students reflect a diversity of cultural and linguistic backgrounds different from most specialized education professionals working with them. For DB students, 85% to 91% of teachers are White (Correa-Torres & Bowen, 2016). Similarly, the majority of teachers working with DHH students are White, female, and hearing (Correa-Torres & Bowen, 2016). Furthermore, the sign proficiency of DHH teachers and the sign systems they use vary; a large percentage of these professionals are not fluent in American Sign Language (ASL; Baker & Scott, 2016; Sims & Thumann, 2007). Although no official national count exists, the last published survey of Orientation and Mobility specialists and Teachers of the Visually Impaired (TVIs) found more than 85% of the professionals were White non-Hispanic (Correa-Torres & Durando, 2011). Thus, there is a dramatic mismatch between the racial identities of students with sensory disabilities and the personnel who serve them.
A greater understanding of and responsiveness to the increasing cultural and linguistic diversity among DHH, BVI, and DB students is critical for the educators who serve them. To that end, this introductory article on culturally sustaining pedagogy (CSP) with DHH, BVI, and DB students from culturally and linguistically diverse (CLD) backgrounds (a) reviews the need for CSP, including how racial, disability, and other marginalizing identities intersect and impact the educational experiences and outcomes of these students, and (b) describes three ways educators can practice CSP in their work with these students and their families: critical self-reflection, personalized literacy, and collaborative partnerships with CLD families. Vignettes adapted from our own experiences as teachers and researchers illustrate instructional strategies exemplifying core CSP tenets and practices.
The Need for Culturally Sustaining Pedagogy
Founded on decades of prior asset frameworks emphasizing the need for teaching and learning that integrated students’ diverse cultural backgrounds, CSP advances educational spaces that not only affirm the rich and complex languages, literacies, and cultural ways of students from CLD backgrounds but also actively seeks to maintain them. CSP also acknowledges that culture is dynamic, and CLD youth often craft new linguistic and cultural practices from the interplay of their families’ heritage and their contemporary experiences with other cultures (Alim & Paris, 2017). Furthermore, in its critical stance that counters curriculum and instruction norms in U.S. schools reflecting White, middle-class, monolingual cultural norms, CSP “fosters cultural pluralism as a part of schooling for positive social transformation” (Alim & Paris, 2017, p. 2).
Intersecting Identities
Particularly relevant to the concerns of DHH, BVI, and DB youth, CSP recognizes that disability and other marginalizing identities shape people’s lived experiences and subject them to intersecting forms of systemic discrimination. For example, early identification of deafblindness remains a problem (Anthony, 2016), as does misidentification of another disability. Inaccurate disability identification creates barriers to disability identity development. It is important educators recognize culture as integral to their DHH, BVI, or DB students’ experiences of exclusion and oppression as students with disabilities. It is not enough for educators to focus solely on their students’ disability-specific learning needs; they must also connect students’ intertwined cultural identities and related lived experiences to prevent futher educational inequality.
Role of Ableism
Bogart and Dunn (2019) defined ableism as “stereotyping, prejudice, discrimination and social oppression toward people with disabilities” (p. 651). The presence of disability is often seen as the individual’s dominant personal characteristic, without regard to society’s responsibility for creating environments and interactions that are inclusive and appreciative of differences as assets. Ableism, like racism, limits access to resources and opportunities (Shallish et al., 2020). For example, DHH students who use sign language may encounter educators or others who view its use negatively and may consider it inferior to spoken language (Cripps et al., 2016). Because of this, these students may experience a power differential when using sign language with persons who are hearing. Humphries (1977) described this as audism and defined it as a person who is hearing feeling superior to a person who is DHH because of their ability to hear. Lane (1992) expanded on this definition, adding audism is a way to dominate or exercise authority over the Deaf community.
Due to their communication and mobility support needs, DB individuals are particularly vulnerable to ableist, gatekeeping practices of hearing and sighted individuals. For example, others may not inform them fully about the environment or interpret all aspects of a conversation that hearing and sighted individuals would observe. The combined bias of hearing and sighted individuals toward individuals who are DB is known as audvism (Wolsey, 2018).
Through adopting a CSP mindset, educators of DHH, BVI, and DB students can focus on facilitating learning opportunities that simultaneously counter ableism and raise the expectations of their CLD students by affirming and sustaining students’ cultural realities (Alim & Paris, 2017; Waitoller & Thorius, 2016).
Emergent Bilinguals
DHH, BVI, and DB students who are emergent bilinguals, also referred to as English language learners, represent a culturally diverse population with educational needs informed by factors such as immigration status, length of time in the United States, and their educational experiences in their country of origin (Milian, 2001). There is little research to guide teachers on how to best serve DHH, DB, and BVI students who are emergent bilinguals and their families (Correa-Torres & Bowen, 2016; Topor & Rosenblum, 2013), but there are relevant considerations for each group. For example, many DB and BVI learners have additional disabilities and are prelinguistic, making hands-on experiences essential to meaning-making in their home language and English. DHH students increasingly live in homes where a language other than English is spoken (Pizzo, 2016), potentially creating multiple language needs, such as the signed and spoken/written language of their native country as well as ASL and spoken/written English. Furthermore, many in the Deaf community—even those with American heritage—view themselves as members of a linguistic minority (i.e., users of ASL; Ahmad et al., 2002) and prefer a bilingual/bicultural educational approach.
Racialized Achievement Disparities
Similar to the broader education population, the impact of intersecting, marginalizing identities for DHH, BVI, and DB students appears in racialized achievement disparities. Reading achievement is one area where evidence of these gaps has been found. In a national, longitudinal study of school-age students with disabilities, White DHH, BVI, and DB students who met the study’s standardized test screening criteria, which included basic skills in either print or braille literacy, were found to have a mean reading passage comprehension score of 10 points more than Black students and 8 points higher than Latinxs/Hispanics. Additionally, White students read an average of 14 to 17 words per minute faster than Black students (Blackorby et al., 2007). Disparities related to the intersectionality of race and gender are also evident in educational attainment data for DHH students. Although 94.1% of White hearing students complete high school, the percentage drops to 86.9% for White deaf students, 77.8% for Black deaf students (compared to 88.5% for Black hearing students), and 71.2% for Black Latinx deaf students. Similar trends persist for postsecondary degrees, and more Black deaf women attain a college degree than Black deaf men (Garberoglio et al., 2019). In deafblindness, the national child count provides exit data on students ages 14 years and older, but information on outcomes by race is not included (National Center on Deaf-Blindness, 2020).
Culturally Sustaining Pedagogy: Theory to Practice
Dis/ability Critical Race Studies (DisCrit), a theoretical framework grounded in the assumption that racism and ableism work interdependently to produce inequities in the special education system, provides a critical approach to understanding systemic barriers and challenges experienced by DHH, DB, and BVI students from diverse backgrounds. Countering ethnocentric and ableist views of social groups that do not reflect dominant views of normalcy, DisCrit advances a strengths-based approach to the education of CLD students with disabilities (Annamma et al., 2018). We see DisCrit as a necessary conceptual building block from which educators can understand and engage in CSP with DHH, DB, and BVI students. CSP values cultural and linguistic pluralism in schools and emphasizes the importance of creating equitable learning opportunities for students in general and special education settings. The practices of critical self-reflection, personalized literacy, and collaboration with CLD families as presented here represent culturally sustaining practices that can be readily implemented by educators of DHH, DB, and BVI students.
Critical Self-Reflection
As John Dewey said, “We do not learn from experience. We learn from reflecting on experience.” (Coutts, 2019). To encourage reflection, educators should develop a culture of reflective practice (Hall & Simeral, 2017). This involves getting in touch with one’s own cultural frames of reference (Hammond, 2016) and building their background knowledge of students’ cultures. It is unreasonable to think educators can be knowledgeable about all of the cultures and languages represented by their students simply by reading about them or attending workshops. Rather, educators need to engage in cultural humility, the ability to acknowledge when they do not know something about a culture. When educators do this, they begin the process of accessing resources to enhance their practice (De Jesús, 2008). Moreover, these resources can foster reflection, helping educators to understand the world from different perspectives (Swanwick et al., 2014). Table 2 provides resources that support educators in developing cultural competencies for effectively working with CLD students and families.
Resources for Developing Cultural Competencies
The goal of teacher reflective practice is to challenge assumptions, beliefs, and practices and to then engage in new practices that better support equitable opportunities for student learning and well-being. All teachers and students have multiple, intersecting identities, socially constructed over time, influencing what they know and how they construct knowledge (Martin & Van Gunten, 2002). Reflective practice includes consideration of the teacher’s positionality in relationship to their students’ identities, relative to power and privilege. Knight (2011) described positionality as “contextualized subjectivity based on social dimensions such as race, class, or gender” (p. 49), each with its own history of influences. Ability and disability are additional social dimensions to be considered.
Positionality may be examined by teachers and their students in either a written form, such as positionality statements, or through dialogue with others (Relles, 2016). Although positionality statements are associated with qualitative research and the preservice preparation of teachers, inservice teachers may find them helpful to reflect on their growth as culturally sustaining educators. These statements may be shared with colleagues to support dialogue about the influence of their frames of reference on their teaching. Table 2 provides resources that support educators in developing critical reflexivity on their positionality and cultural frame of reference (Hammond, 2015).
Relles (2016) suggested teachers model and engage students in three types of dialogues about positionality: on action, in action, and for action (p. 313). She defined on action as when teachers comment or create conversation about biases that occurred in the past, including comments relevant to realizations about their own biases in previous interactions. An example would be correcting a DHH student’s sign and then later realizing the student was using Black ASL (BASL). Later, the teacher communicates the mistake to the student. Positionality in action occurs when teachers or students recognize a bias when it occurs. Imagine a classroom peer infantilizing a BVI student who is also CLD by offering more help than is needed. The teacher could encourage the BVI student to communicate, “I can do it myself” rather than accept unwanted help. Positionality for action is grounded in an understanding of existing biases, with a focus on creating a more equitable classroom (or other environment) for the future. This could include discussions between adult service organizations and BVI, DHH, or DB young adults about how to recognize and break down barriers to transition opportunities caused by intersecting forms of oppression. Figure 1 provides key educator strategies for critical self-reflection and collaborative action to integrate CSP into their practice.

Critical self-reflection and culturally sustaining pedagogy action steps
Mr. Stith is an itinerant teacher of the deaf. Keisha is one of his high school students. She is Black and Deaf. She attends her neighborhood school and has a sign language interpreter for her classes. In Keisha’s AP Social Studies class, she was given an assignment to analyze the cultural background of a movie character and compare it with her own cultural background. To get Keisha started, Mr. Stith asked her to reflect on her cultural background. She mentioned several cultures influencing her. First, her parents, grandparents, and an older brother are Deaf. Her grandparents attended a Black school for the deaf in Alabama, where they learned BASL. Second, she identifies with Black culture, and her family celebrates occasions unique to this culture, such as Juneteenth. Third, her older sister is hearing. Thus, Keisha interacts with hearing culture every day at home and school. Keisha said a few students in her classes are interested in sign language, but she wished the school would offer an ASL course for students and staff so she could directly communicate with more people.
Mr. Stith asked Keisha if there were any movie characters she wanted to analyze for this project. She mentioned seeing the movie CODA about a young girl, Ruby Rossi, who is a child of deaf adults. He had seen the movie, too. Keisha said Ruby’s character reminded her of her older sister, specifically how they both alternated between hearing culture and Deaf culture. She said her sister frequently interprets for their family just like Ruby did for hers. While many of her experiences were similar to Ruby’s family, she highlighted one key difference: Ruby’s family was White.
As Mr. Stith reflected on what Keisha said, he realized the school was not as supportive and inclusive of students who are CLD with disabilities as he thought. He valued Keisha’s lived experiences and pondered how his positionality could be impacting her (i.e., reflection on action). He was unaware of the existence of BASL (i.e., reflection in action). He thought this would be a great topic for his Professional Learning Community, including other teachers of students who are DHH in the district. They could discuss ways to integrate BASL into the curriculum and even invite Keisha’s grandparents as guest speakers. He also planned to discuss with the principal offering an ASL course for students and staff (i.e., reflection for action).
Personalized Literacy
Culturally sustaining literacy instruction is an asset-based approach that affirms multiple languages, literacies, and communication forms as strengths, not deficits. The dominant language and literacy practices in schools may conflict with practices in the home and community, calling on teachers to create a literacy curriculum respecting multiple cultural identities (Nuñez et al., 2021). Literacy instruction that is culturally sustaining counters prevailing deficit perceptions about the language and literacy practices of CLD learners with disabilities and provides learning contexts where their cultural, language, and literacy practices are supported. The instructional team can build on each student’s linguistic, cultural, experiential, and familial assets by both individualizing and personalizing literacy instruction. The purpose of individualization is to “maximize every child’s opportunities for optimal learning” (McCormick et al., 2003, p. 212) and includes the provision of equipment, materials, technologies, and related services required by each learner to ensure full participation in the curriculum. In contrast, personalization focuses on reflecting the learner’s lived experiences, offering opportunities to include each student’s language and culture in the curriculum.
Experience Books
Experience books (also known as experience stories) are one form of personalized literacy that can capture the values, language, family traditions, and storytelling practices of CLD families. These personalized texts may depict a special event (e.g., a holiday celebration) or a daily event (e.g., a self-care routine) in the life of the learner. Janes and Hermani (2001) found young children of color and their caregivers preferred personalized texts and that these texts evoked higher levels of positive emotions during reading sessions. The creation of experience books requires input from family members about shared experiences in the home and community. Ideally, the learner shares an experience with someone who can support the co-construction of a book about that experience (Bruce et al., 2008). The learner and family member or other individual gather materials to include in the book and then co-construct the pages, which may include photos, drawings, print and/or braille labeling, and objects representing the shared experience.
When preparing the experience book, it is important to honor the principle of saliency, which means selecting materials for the book that match the child’s perspective of the experience. This includes observing which objects are handled by children who are BVI or DB (Cushman, 2016). Thus, the experience partner must be attuned to the learner’s attentional and emotional responses while not allowing their hearing, vision, or perspectives about the experience to dominate the selection of materials for the experience book. The narrative on each page reflects language and concepts relevant to the learner. For linguistic students, this involves using their own words and expressions without “correcting” language not expressed in White Mainstream English (Baker-Bell, 2020). This is an act of affirming and sustaining the learner’s home language practices. For emergent bilingual children, the narrative should include their first language and English. This bilingual approach gives the learner the opportunity to read and listen to their personalized narrative in their preferred language while also providing a literacy experience in their emergent new language.
The shared reading of experience books supports meaning-making, vocabulary development, memory building, and positive interactions, which are linked to literacy development (Bruce, Janssen, & Bashinski, 2016; Janes & Hermani, 2001). During shared reading of the experience book, the reading partner and learner may bring the book to life by reenacting parts of the narrative. This additional engagement makes room for dramatization, storytelling, and other extension activities in the classroom context that affirm the learners’ cultural and linguistic practices. Teachers can facilitate a home-school connection with this enriching literacy process by inviting a family member to class to be a guest reader of the experience book, with the teacher providing English translation as needed. This activity can generate class discussion about the experience shared, with the family member serving as a guest reader providing valued insights.
Story Boxes
Story boxes are collections of objects supporting engagement, vocabulary acquisition, and comprehension of a literacy event (Collins, 2009). Usually, they relate to a book, which may be commercially produced or an experience book about a lived experience (Ferrell et al., 2014). The selected objects are an important substitution for illustrations for BVI and DB learners (Cushman, 2016). The pairing of object handling with naming of the objects supports English learners to master new vocabulary (Collins, 2009). Story boxes can also be used to enhance storytelling or oral retelling of a book, with the child using the objects to reenact a shared experience or events in a book (Bruce et al., 2008).
Ideally, children should be exposed to culturally diverse books that authentically reflect their worlds and expose them to different experiences (Coleman, in press). If a story book includes pictures of objects that are not as commonly used in the child’s home, the corresponding story box might include objects more culturally appropriate and familiar to the learner. The adult reader then supports the learner to make connections between the object in the story box and the objects or text in the story book. It is important for BVI and DB students to have sufficient time handling the objects to support recognition. DHH, BVI, and DB learners require adults to consider how best to integrate the child’s expressive and receptive communication forms (e.g., visual or tactile sign language, braille, and objects) within the sharing of the story box. Please refer to the resource list (Table 2) for additional information on personalized literacy lessons.
“Ideally, children should be exposed to culturally diverse books that authentically reflect their worlds and expose them to different experiences.
Ms. Connor is a second-year teacher in a self-contained classroom serving first and second graders with multiple disabilities, situated within a public school. The school is located in a racially, culturally, and linguistically diverse neighborhood. Over the summer, Ms. Connor moved into the neighborhood, knowing she had much to learn from this community. It is late September, and Ms. Connor has been informed that Miguel, a new student who is DB, is joining her classroom. Miguel and his family recently immigrated from Mexico. Ms. Connor’s university preparation was in teaching students with intellectual disability but did not include content on students who are DB.
In preparation for her new student, Ms. Connor contacted her state DB project and was provided with resources on literacy, including how to make experience books. In talking with Miguel’s mother, she learned some of his happiest moments are spent listening to musical instruments played by family members and feeling the vibrations produced. His mother remarked these experiences often inspire Miguel to talk, in contrast to the school records describing him as nonverbal. She also shared the names of some of the instruments used in their family, including the guiro and castanets.
Ms. Connor was able to obtain some of the instruments his mother mentioned, and she learned how to say their names in Spanish. Ms. Connor and Miguel co-created several experience book pages following a class activity with two of the instruments. One page had a detachable castanet that he could remove and play. The second page was more complex. Ms. Connor used a ridged piece of cardboard to represent the ridges on the guiro, being careful to allow time for him to touch the ridges on the representation and then the ridges on the guiro. Ms. Connor included text in Spanish and English. Ms. Connor noticed most of Miguel’s verbal approximations were in Spanish. She affirmed his language by repeating his approximations. She knew it was important to encourage his verbalizations. She also knew she needed to learn more about how to incorporate his emergent language and literacy skills in his home language into her teaching.
Collaborating With Culturally Diverse Families
Although parent participation is a statutory requirement of special education in the United States, many families, especially those whose cultural and social capital is not valued in the education system, experience systemic barriers to meaningful collaboration with school professionals (Lalvani, 2015; Rossetti et al., 2017, 2020; Stanley, 2015; Zagona, et al., 2019). Common deterrents to participation among CLD families include communication gaps due to poor or nonexistent translation and interpretation services for those whose preferred language is not English (Benedict, 2003; Rossetti et al., 2020); deficit views of CLD families, particularly those who are poor or working class (Harry, 2008; Wilt & Morningstar, 2018); lack of recognition of cultural differences in views of disability and the relationships between teachers and parents (Antony & Banks-Joseph, 2010; Cummings & Hardin, 2017); negative past experiences with schools (Benedict, 2003); teachers’ limited knowledge about educating or supporting children with disabilities, such as those who are DHH (Robles, 2016) or DB (Correa-Torres & Bowen, 2016); economic constraints impacting access to child care and transportation (Correa-Torres & Bowen, 2016); and professional practices in formal conferences preventing parent participation (Kurth et al., 2020; Zagona et al., 2019).
With their own critical reflexivity and awareness of these systemic barriers as a starting point, educators can engage in strong partnerships with CLD families who face these challenges in navigating the special education system. Effective mindsets and practices for this work include (a) cultural reciprocity, (b) asset-based family engagement, and (c) co-constructed advocacy, which Harry and Ocasio-Stautenberg (2020) described as a “commitment to work with parents rather than on their behalf” (p. 8).
Cultural reciprocity is a multistep process in which educators examine their own professional and personal values, identify differences between their beliefs and the families’ beliefs, and work collaboratively with families to determine the most effective way of adapting professional interpretations or recommendations to the family’s value system (Harry et al., 1999). Cultural reciprocity is built on strengths-based views of CLD families (Guardino & Cannon, 2016). This means the families’ language, cultural values, and ways of being are affirmed and used to support their children’s education. For example, teachers must ensure that CLD families receive communications about their child’s performance as frequently as other families and in a form that is accessible and preferred by them. Curricular decisions, including the selection of instructional materials, should also reflect this cultural reciprocity (Correa-Torres et al., 2020).
“CSP is fundamentally a justice-oriented mindset that goes beyond implementing a set of strategies.
Consideration of individual family circumstances is essential for culturally sustaining family engagement. In conjunction with cultural reciprocity, educators should contextualize instruction by building on the background knowledge and cultural assets of CLD learners and families (Guardino & Cannon, 2016). It is important for practitioners to learn the strengths of diverse families rather than focus solely on their perceived needs (Harry & Ocasio-Stoutenberg, 2020). As Dote-Kwan et al. (2009) emphasized in their study of early intervention strategies with blind children, educators should develop strategies that “fit with parents’ priorities, values, and routines” and do not reinforce stereotypes of CLD families (p. 540). Figure 2 highlights components of asset-based engagement with CLD families.

Engaging with culturally and linguistically diverse families
Educators can also support CLD parents by valuing the knowledge and experience base that shapes their advocacy needs and co-creating responses that address these needs (Harry & Ocasio-Stautenberg, 2020). This process of co-constructing advocacy with CLD families requires practitioners to understand how families’ intersectional identities shape their advocacy preferences. It is also important for practitioners to decenter their professional roles to remove the power imbalance between them and parents. Promising co-advocacy practices identified by Harry and Ocasio-Stautenberg (2020) include but are not limited to (a) caregiver-initiated supports, such as providing information and suggestions about their child’s disability and related needs to teachers and therapists; (b) practitioner-initiated supports, such as regular communication, guidance, and encouragement; and (c) family and community-initiated supports from individuals who can support families at school meetings.
Call to Action
Although self-reflection, personalized literacy, and asset-based family engagement provide a good starting point for educators to improve their work with CLD students, CSP is fundamentally a justice-oriented mindset that goes beyond implementing a set of strategies. Educational professionals must also recognize systemic inequities among DB, DHH, and BVI students, such as racialized achievement and opportunity disparities, and advocate for change. This starts with a demand for routine disaggregation of educational achievement data by race for each of these disability groups. A critique of the curriculum, curricular materials, and instructional methods is also required. DB, DHH, and BVI students from diverse backgrounds need disability-specific instruction that does not erase their cultural realities. This calls on educators and special education curriculum developers to incorporate representations of the rich and varied experiences of diverse communities in the educational materials they use or create.
“DB, DHH, and BVI students from diverse backgrounds need disability-specific instructionthat does not erase their cultural realities.
Although educators of any cultural background can effectively teach and support CLD families and students, there is a pressing need for more professionals of color trained to work with DB, DHH, and BVI students. (Cannon & Luckner, 2016; Mason, 2000) There is also a need for increased preservice training and professional development related to cultural diversity (Bruce, Ferrell, & Luckner, 2016; Conroy, 2005; Correa-Torres & Durando, 2011; Milian, 2000; Smith-Warshaw & Crume, 2020). Given that the teacher workforce is overwhelmingly composed of White women and the school curriculum is dominated by Eurocentric cultural norms, educators can improve their practice with DHH, BVI, and DB students from diverse backgrounds by reflecting on their own positionality and learning about the cultures and lived experiences of Black, Latinx, Indigenous, and other students of color.
Beyond instructional practice, educators can demonstrate their alignment with the justice and equity concerns of culturally sustaining practice by serving as role models who take responsibility to address, rather than ignore or minimize, discriminatory acts that CLD learners who are BVI, DHH, and DB may experience. Furthermore, educational professionals can help facilitate student connections with CLD adults who are DHH, BVI, and DB. These individuals can serve as role models and supporters for students navigating some of the same challenges and barriers both in and out of school that they once experienced. Through these cross-generational relationships, students can develop a better understanding of their own intersectional experiences and build strong, positive self-identities as youth of color with disabilities.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
