Search Results (866)

This paper examines the concept of the culture of space in early childhood education and care (ECEC), building on contemporary perspectives that understand space as an active factor in children’s development, learning, and socialization. The study aims to identify and define the dimensions of the culture of space in relevant interdisciplinary literature and to examine their representation in national and international strategic documents related to ECEC. The analysis is based on socio-constructivist perspectives, the phenomenology of space, the concepts of place identity and sense of place, and the Reggio Emilia approach. The findings indicate that the culture of space comprises interconnected physical, social, symbolic, cultural, digital, and pedagogical dimensions that shape children’s experiences and support belonging, identity formation, cultural awareness, spatial competences, and sustainable relationships with the environment. International policy documents published by OECD, UNESCO, and UNICEF emphasize that well-designed learning environments and sensitivity to cultural context are essential indicators of ECEC quality. Space should be understood as a culturally and pedagogically constructed medium that actively supports children’s development, identity formation, and community building. Full article

Marfan syndrome (MFS) is a connective tissue disorder classically associated with cardiovascular, musculoskeletal, and ocular manifestations. Neurological involvement is increasingly recognized and is most commonly related to spontaneous intracranial hypotension secondary to dural ectasia and cerebrospinal fluid (CSF) leakage. By contrast, idiopathic intracranial hypertension (IIH) is exceptionally rare in pediatric patients with MFS. We report the case of an 8-year-old girl with Marfan syndrome presenting with neck pain, diplopia, bilateral papilledema, and bilateral sixth cranial nerve palsy. Brain MRI demonstrated optic nerve tortuosity, distension of the perioptic subarachnoid spaces, and partial empty sella, while venous sinus thrombosis and spinal CSF leakage were excluded. Lumbar puncture confirmed markedly elevated CSF opening pressure (48 cmH₂O), consistent with IIH. CSF and plasma neurofilament light chain levels were elevated, whereas anti-MOG antibodies and autoimmune investigations were negative. The patient showed rapid clinical improvement following therapeutic CSF drainage and acetazolamide treatment. To the best of our knowledge, this represents only the second report of pediatric IIH associated with Marfan syndrome. Our patient developed idiopathic intracranial hypertension, an uncommon neurological manifestation in this condition. Through this case, we aim to highlight the diagnostic challenges, discuss the possible pathophysiological mechanisms underlying this rare association and emphasize the importance of considering intracranial hypertension in the differential diagnosis of children with Marfan syndrome presenting with neuro-ophthalmological symptoms. Full article

Adults, when talking to infants, adjust their communication across several dimensions, including acoustic, linguistic, and gestural characteristics. However, our knowledge of how these dimensions covary in this register adjustment remains limited. Our objective was to analyze the linguistic elements, gestures and acoustic features (speech rate, vowel space, prosody) of storytelling directed to 6-month-old infants in a multidimensional way. The storytelling of 92 mothers to their own children was investigated and compared to their communication with other adults. We analyzed the acoustic features, gestures, and the linguistic construction of their storytelling. Our results have shown that pointing and showing gestures were more common in infant-directed storytelling, just as interactive expressions unrelated to the story were. The correlation tests across dimensions revealed that infant-directed communication is multidimensional. The cross-dimensional analyses demonstrated that infant-directed communication, compared to adult-directed communication, exhibited more systematic multidimensional coordination. Mothers who used more gestures and interactive elements in their infant-directed communication also tended to modify the acoustic characteristics of their speech to a greater extent relative to their adult-directed speech. Full article

Teachers play a central role in shaping children’s early language environments through the way they speak. Child-directed speech (CDS), characterized by distinct acoustic and prosodic adjustments, has been shown to facilitate children’s phonetic perception and language learning. This study investigates how Mandarin-speaking kindergarten teachers adapt their speech when addressing children compared to adults. Speech samples were collected from 35 female teachers using interactive puppet-based scenarios featuring Peppa Pig and Xiong Da. Acoustic analyses focused on the corner vowels /a/, /i/, and /u/, examining mean fundamental frequency (F₀), F₀ range, the first (F₁) and second (F₂) formant frequencies, and vowel space area (VSA). Results revealed that, relative to adult-directed speech (ADS), teachers’ CDS showed significantly longer vowel durations for /a/, /i/, and /u/ (all p < 0.001, surviving Bonferroni correction). In addition, descriptive trends—which did not survive Bonferroni correction—were observed for wider F₀ range for /a/ (uncorrected p = 0.004), higher F₂ for /a/ (uncorrected p = 0.011), and higher mean F₀ for /u/ (uncorrected p = 0.002); these effects should be interpreted with caution and are not considered statistically significant in the present study. Vowel space area did not differ significantly between CDS and ADS. These findings indicate systematic adaptations in prosodic and temporal features—particularly duration and pitch variability—though not all acoustic measures showed significant changes. Beyond acoustic distinctions, the results underscore teachers’ active role in modulating their speech to support early language development. The study contributes to understanding how Mandarin-speaking kindergarten teachers acoustically adapt their speech to children and offers preliminary insights that may inform future research on teacher speech-training and early-childhood communication practices. Full article

Pediatric obstructive sleep apnea (OSA) is a common disorder associated with significant neurocognitive, behavioral, cardiovascular, and metabolic consequences. Although adenotonsillectomy remains first-line therapy for many children, residual OSA is common, particularly among those with obesity, craniofacial abnormalities, genetic syndromes, neuromuscular disease, or other forms of medical complexity. Continuous positive airway pressure (CPAP) is the standard non-surgical treatment; however, long-term effectiveness is frequently limited by poor tolerance and adherence. Heated high-flow nasal cannula (HFNC) therapy has emerged as a potential alternative for selected children with sleep-disordered breathing, particularly those who are unable to tolerate conventional positive airway pressure therapy. Unlike CPAP, HFNC delivers heated, humidified gas through an open nasal interface and may improve sleep-disordered breathing through a combination of flow-dependent positive airway pressure generation, dead-space washout, improved ventilatory efficiency, enhanced gas conditioning, and reductions in inspiratory resistance. However, the relative contribution of these mechanisms during sleep remains incompletely understood. Current clinical evidence consists primarily of physiological studies, retrospective cohorts, case series, and a limited number of prospective comparative studies. Collectively, these data suggest that HFNC can reduce obstructive respiratory events and improve oxygenation in selected pediatric populations, including children with persistent OSA, CPAP intolerance, medical complexity, and syndromic conditions. Nevertheless, important uncertainties remain regarding optimal patient selection, titration strategies, patient monitoring, long-term adherence and comparative effectiveness relative to CPAP. This review summarizes the physiological basis of HFNC therapy, critically appraises the current clinical evidence, discusses practical considerations related to adherence and implementation, and highlights key knowledge gaps and future research priorities. Overall, HFNC should be viewed as an alternative for selected children who cannot tolerate CPAP, rather than as a universal substitute for pressure-based therapy. Full article

High-flow nasal oxygen (HFNO) has become an increasingly important component of contemporary airway management, extending beyond its origins as a therapy for hypoxaemic respiratory failure to a versatile perioperative tool used across operating theatres, non-operating-room anaesthesia (NORA), and critical care settings. By delivering heated, humidified oxygen at high flow rates, HFNO provides a range of physiological benefits including reliable oxygen delivery, anatomical dead-space washout, low-level positive airway pressure, and facilitation of apnoeic oxygenation. This narrative review explores the physiological mechanisms underpinning HFNO and examines its evolving role in modern anaesthetic practice. The evidence supporting its use for preoxygenation, apnoeic oxygenation, postoperative respiratory support, procedural sedation, tubeless airway surgery, and management of the physiologically difficult airway is reviewed. Particular attention is given to high-risk populations, including patients living with obesity, obstetric patients, and children, as well as applications in a range of NORA environments. The review also examines key limitations and safety considerations, including hypercapnia, aspiration risk, airway obstruction, airway-fire hazards, human factors, and emerging concerns regarding environmental sustainability. While HFNO can improve oxygenation and increase the margin of safety during periods of physiological vulnerability, it should not be viewed as a substitute for definitive airway management or vigilant monitoring. HFNO represents a significant advance in physiology-centred airway management. Its greatest value lies not in routine application, but in thoughtful integration into broader airway safety strategies where meaningful physiological or patient-centred benefit is anticipated. Full article

Background/Objectives: Fibrous dysplasia (FD) is a benign fibro-osseous disorder characterized by the replacement of normal bone with fibrous tissue and immature woven bone, most commonly involving the craniofacial skeleton. It typically presents as an intraosseous lesion in children and young adults. Fibrous dysplasia may rarely present with predominant gingival involvement and minimal radiographic evidence of intraosseous disease. We report an unusual case of craniofacial fibrous dysplasia that clinically mimicked an exophytic gingival mass in the anterior maxilla of a middle-aged patient. Methods: A middle-aged patient presented with a slowly enlarging gingival mass extending from the right canine to the left central incisor region. After being lost to follow-up for approximately 4.5 years, the patient returned with increased swelling, pain, spacing of the anterior teeth, and functional impairment affecting mastication and speech. Clinical, radiographic, surgical, and histopathologic findings were evaluated. Surgical management included excision of the lesion, extraction of non-restorable teeth, and bone grafting under general anesthesia. Results: Radiographic examination demonstrated minimal osseous involvement without a clearly defined intraosseous expansile lesion. Histopathologic analysis revealed irregular curvilinear trabeculae of woven bone within a fibrous stroma containing bland spindle cell proliferation, consistent with FD. At the six-month follow-up, the patient remained asymptomatic without complications and was undergoing prosthetic rehabilitation with plans for future implant placement. Conclusions: FD may rarely present as a predominantly gingival lesion with minimal radiographic evidence of bone involvement, posing a diagnostic challenge. Recognition of this atypical presentation is important to avoid misdiagnosis and to facilitate appropriate management through comprehensive clinicoradiologic and histopathologic correlation. Full article

This study investigates a paradoxical association between parental beliefs about structured life (PBSL) and children’s play engagement. We conceptualize this association as the structure paradox: although structure is often viewed as potentially constraining free play, parents’ stronger endorsement of structured and organized everyday life may instead be positively related to children’s engagement in play. The sample included 299 parents (94% mothers) of typically developing 6-year-old children. Parent-reported measures included the Parent Play Beliefs Scale and single-item assessments of PBSL, children’s play engagement, and the presence of a dedicated play space at home. Data were analyzed using correlation, multiple regression, and mediation analyses. Results showed that PBSL was positively associated with children’s play engagement: parents who more strongly endorsed the importance of structured and organized everyday life reported higher levels of play engagement in their children. Parental play beliefs were not significantly associated with children’s play engagement. Among the examined family factors, the presence of a dedicated play space at home showed the strongest association with children’s play engagement. A significant positive indirect association was also found between PBSL and children’s play engagement via the presence of a dedicated play space at home. However, the observed direct and indirect associations involving PBSL were small in magnitude. These preliminary findings contribute to the understanding of PBSL and the organization of the home play environment as family factors associated with preschool children’s play engagement. For parents and teachers, the findings suggest that predictable daily routines, clear rules, and the inclusion of play in preschool children’s everyday routines may be associated with more sustained engagement in play. Full article

Urban residential outdoor spaces are increasingly affected by high temperatures, strong solar radiation, and uneven wind conditions, which influence residents’ outdoor activities and thermal comfort. This study proposes an evidence-based approach for the fine-grained design of residential outdoor activity spaces based on age-specific activity patterns and microclimatic conditions. Using 1096 valid questionnaires, field observations, and in situ microclimate measurements across four seasons, we quantified the activity patterns, temporal distributions, and spatial preferences of children, adolescents, adults, and older adults. Results reveal statistically significant age- and season-dependent differences in environmental preferences (Kruskal–Wallis H = 56.78, p < 0.001 for light priority; H = 26.81, p < 0.001 for thermal priority across age groups). Children and older adults exhibited sustained and widely distributed activities, whereas adolescents and adults showed more concentrated temporal patterns. In summer, activities shifted toward mornings and evenings to avoid heat, while in winter, activities peaked around midday and afternoon. Wind and light conditions were prioritized over thermal conditions across all seasons: in summer, 47.2% of respondents ranked wind first; in winter, 50.9% ranked light first. Tree shading consistently reduced air temperature, black globe temperature, and WBGT relative to open areas in every season, with the largest mean differences observed in spring (ΔT_g = 1.19 °C) and the largest instantaneous difference during summer early afternoon (ΔT_g = 1.51 °C at 13:00). Integrating these findings, this study proposes evidence-based design strategies, including optimized functional layouts, shading and ventilation features, sun-exposure management, and nighttime lighting, providing quantitative support for improving comfort, safety, and usability in residential outdoor spaces. Full article

Introduction: Mediastinal tumors in children are rare and heterogeneous, and their surgical management is challenging due to limited working space and proximity to critical structures. While thoracoscopy has expanded, technical limitations persist in complex mediastinal dissections. Robot-assisted surgery may address these limitations, but its role in pediatric mediastinal tumor resection is not well defined. This systematic review aims to synthesize the available evidence on robot-assisted resection of mediastinal tumors in children, focusing on patient selection, technical feasibility, perioperative outcomes, and available oncologic results. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251245437). PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library were searched up to 1 December 2025. Eligible studies included pediatric patients (0–18 years) undergoing robot-assisted resection of mediastinal tumors. Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers. Due to heterogeneity and lack of comparative data, a qualitative narrative synthesis was undertaken. Results: Fifteen studies were included, comprising retrospective case series and case reports, including 215 children, 149 (69.3%) of whom were derived from a single retrospective study. The most frequent indications were localized neurogenic tumors, predominantly in the posterior mediastinum. Robot-assisted surgery was consistently performed with curative intent. The da Vinci platform was used in all cases, with reproducible port-placement strategies adapted to tumor location and patient size. Conversion to open surgery occurred in 11 (5.1%) cases, mainly due to bleeding or limited exposure, with no emergency conversions reported. Reported perioperative complications were uncommon, although complication reporting was heterogeneous across studies. No perioperative deaths were reported. Two disease-related deaths occurred during follow-up in patients with recurrent Ewing sarcoma. Long-term oncologic outcomes could not be adequately assessed because of heterogeneous reporting and limited follow-up. Conclusions: Robot-assisted resection of mediastinal tumors in children appears feasible in carefully selected cases treated at experienced centers. Current evidence mainly supports its use for localized tumors with favorable anatomy, particularly in the posterior mediastinum, while long-term oncologic adequacy remains insufficiently defined. Full article

Background/Objectives: Children with congenital long QT syndrome (cLQTS) are at extremely high risk of torsades de pointes (TdP) and sudden cardiac death (SCD). Although the implantable cardioverter-defibrillator (ICD) is a cornerstone in SCD prevention, traditional transvenous ICDs are associated with venous access occupation, lead wear or fracture due to somatic growth, and difficulties with long-term lead revision or extraction. The extravascular ICD, which places the lead in the substernal extravascular space, has the potential to circumvent these lead-related complications. We report the experience of successful extravascular ICD implantation in a young child with drug-refractory cLQTS type 2 (cLQTS2). Methods: The clinical data of a 9-year-old boy with cLQTS2 were retrospectively analyzed. The patient carried a heterozygous KCNH2 variant (c.1810G>A, p.Gly604Ser) and had been on long-term oral propranolol and mexiletine. He presented with a cardiac arrest out of hospital during nocturnal sleep, was transferred to our hospital after successful cardiopulmonary resuscitation, and had TdP captured on ambulatory monitoring. Following multidisciplinary discussion, preoperative chest computed tomography (CT) assessment of the substernal anatomy, and informed consent, extravascular ICD implantation was performed on hospital day 11. The procedure involved the creation of a substernal tunnel via a subxiphoid incision, placement of the defibrillation lead in the anterior mediastinum with lead slack reserved for growth, and positioning of the pulse generator in a left axillary subcutaneous pocket. Intraoperative defibrillation testing succeeded with a single 30 J shock. Results: The postoperative recovery was uneventful without procedure-related complications. At the 2-month follow-up, device parameters were satisfactory and no inappropriate shocks had occurred. The corrected QT interval (QTc) decreased from 563 ms on admission to 522 ms. Ambulatory monitoring detected asymptomatic episodes of non-sustained ventricular tachycardia, but no ventricular fibrillation or syncope was observed. Venous access was fully preserved. Conclusions: In children with drug-refractory cLQTS2, the extravascular ICD provides defibrillation and antitachycardia pacing (ATP) while avoiding transvenous lead complications and preserving venous access. This case shows that with precise preoperative planning and lead redundancy, the device appears feasible and can be implanted without short-term complications in young children. Larger studies with longer follow-up are needed to evaluate long-term device performance. Full article

Background/Objectives: Optimal birth spacing plays an important role in supporting children’s growth and nutritional outcomes. However, evidence on the long-term effects of short birth intervals on stunting from childhood to adolescence in Indonesia is limited. This retrospective cohort study used longitudinal data from waves 3, 4, and 5 of the Indonesian Family Life Survey (IFLS) (2000, 2007, 2014) to examine the association between short birth intervals and stunting trajectories among Indonesian children. Methods: We analyzed 1401 children aged 0–59 months with complete anthropometric data using longitudinal data from IFLS waves 3, 4, and 5 (2000, 2007, 2014). Stunting was defined as a height-for-age z-score (HAZ) below −2 standard deviations (SDs) according to the WHO Child Growth Standards (2006) for children under five years and the WHO Growth Reference (2007) for children and adolescents. The impact of short birth intervals on stunting status was evaluated using multilevel binary logistic regression. Results: Stunting distribution showed significant improvement between 2000 and 2014. In 2000, 37.7% of children were stunted, which decreased to 33.9% in 2007 and nearly 25% in 2014. The majority of mothers (77.7%) gave birth between 20 and 35 years of age, while 12.7% gave birth too early (<20 years) and 9.6% gave birth too late (>35 years). In addition, 16.2% of parents had too many children (parity ≥ 4), and 6.8% had too close birth intervals (<24 months). Multilevel logistic analysis revealed that short birth intervals (odds ratio (OR) = 1.60–1.63) were significantly associated with stunting after adjusting for child, household, socioeconomic, and environmental factors. However, maternal age and parity were not significantly associated with stunted growth. Conclusions: Birth spacing is a critical risk factor for stunting in early childhood and remains significant as children age. Longitudinal analyses highlight the importance of sustained interventions targeting maternal health, education, and child nutrition to address stunting in Indonesia. Full article

Public open spaces are vital for sustainable urban land management, yet design processes often marginalize demographic extremes like children and the elderly. While generative artificial intelligence (GenAI) emerges as a bridge to democratize public space design, its inclusivity across varying cognitive and digital literacy levels remains unexamined. This study deploys an “extreme case sampling” approach within a Design-Based Research (DBR) framework. Using the Human–AI Hybrid Planning Interface Model (HAIHPIM), we contrast empirical data from a rural child cohort (aged 6–13, n = 12) and an urban senior cohort (aged 60–96, n = 6) in Northern Germany, combining qualitative participant evaluations with ethnographic observations. Findings reveal a profound divergence in spatial imagination. Children exhibit high creative output but face cognitive barriers in prompt formulation, whereas seniors circumvent digital interface constraints through narrative spatial knowledge and historical reference mapping. Rather than a definitive tool for spatial justice, GenAI functions as an exploratory boundary object. It makes the informal spatial needs of marginalized groups discursively visible and highlights the indispensable role of human mediation in adaptive land governance. Full article

Groundwater is vital to subsurface ecosystems and to maintaining water supplies for human and environmental needs. Heavy metal pollution of water bodies poses a significant threat to environmental health and human well-being. In this paper, a detailed spatiotemporal analysis of heavy metal pollution at a network of 35 sampling sites is presented for the summer, autumn, and winter seasons. The water samples were analyzed based on the concentration (μg/L) of eight priority metals, such as Lead (Pb), Mercury (Hg), Cadmium (Cd), Arsenic (As), Chromium VI (Cr-VI), Copper (Cu), Zinc (Zn), as well as Iron (Fe). Measuring contamination levels, identifying space hotspots, and explaining seasonal variations were the key tasks. The results show that Fe, Zn, and Cu concentrations are consistently high across seasons, with mean values ranging from 234.3 to 253.2 µg/L (Fe), 163.2 to 175.6 µg/L (Zn), and 107.0 to 109.2 µg/L (Cu), indicating a widespread geogenic or diffuse source. The most significant seasonal deviation was observed in the fall when there were unusually high levels of Cd and Hg, with mean concentrations reaching 0.476 µg/L and 0.312 µg/L, respectively, suggesting a strong seasonal contamination event or mobilization process. The spatial analysis showed that the locations (e.g., L6, L8, L10, L28, L29) exhibited common hotspots for different metals, with maximum concentrations reaching up to 793.3 µg/L (Fe), 602.3 µg/L (Zn), and 508 µg/L (Cu). Principal Component Analysis (PCA) effectively separated seasonal trends and classified metals into anthropogenic (Pb, Cd, Hg, Cr (VI)) and geogenic/diffuse (Fe, Zn, Cu) groups. The health risk assessment indicated no significant non-carcinogenic risk, although children are more vulnerable, while arsenic levels in winter approached the upper acceptable carcinogenic limit (up to 1.1 × 10⁻⁴). Overall, the study highlights the importance of multi-seasonal monitoring by capturing temporally abrupt contamination events and provides a novel integrated framework that combines seasonal analysis, spatial hotspot identification, and multivariate techniques, distinguishing it from conventional single-season or non-integrated studies. Full article

The paradigm shift in early childhood education from custodial care to development-centered environments underscores the importance of kindergarten indoor activity spaces. However, how spatial configuration influences children’s embodied behaviors remains underexplored, particularly in cold-arid regions of western China, where prolonged indoor periods amplify the significance of interior spatial quality. Integrating embodied cognition and affordance theories, this study develops a coupling framework linking spatial metrics with behavioral outcomes. A mixed-methods approach combined 196 parent and 36 teacher questionnaires with space syntax analysis across three typical kindergartens in Lanzhou, China. Visual Integration [HH] was positively correlated with physical movement (r = 0.52, p < 0.01) and negatively correlated with solitude (r = −0.52, p < 0.01); Connectivity was positively associated with sensory exploration (r = 0.42, p < 0.05). Coupling coordination degrees ranged from 0.689 to 0.856, revealing a “high coupling, imbalanced development” pattern, with privacy affordance as a notable shortfall in the wide-corridor typology. The older courtyard-style kindergarten surpassed the newly built one (0.856 vs. 0.838) despite lower facility quality. Parent satisfaction depended more on spatial richness (r = 0.61) than on facility quality (r = 0.47). Spatial configuration shapes embodied behaviors through layout-specific affordances. An evidence-based optimization framework is proposed for kindergarten design in cold-arid climate zones. Full article