Young Children Research Articles

Diagnosis of Death Using Neurological Criteria in Children: The U.K. Experience, 2015-2023.

In the United Kingdom, the starting point for diagnosing and confirming death using neurologic criteria (DNC) is when death is suspected to have occurred following devastating brain injury in patients on an ICU who remain deeply comatose, have absent brainstem reflexes and are apneic with their lungs mechanically ventilated but in whom circulation and other bodily functions persist. In this report, we describe the U.K. experience of diagnosing DNC in children. Retrospective review of data collected by the U.K. National Health Service Blood and Transplant Potential Donor Audit. U.K. children from birth to younger than 18 years old with suspected DNC between April 1, 2015, and April 1, 2023. None. A total of 824 children were suspected of DNC and 565 of 824 (68.6%) proceeded to have testing. Overall, 393 of 565 (69.5%) of the tested patients were cared for on a PICU, 164 of 565 (29%) on an adult ICU, three of 565 (0.5%) on a neonatal ICU, and the other five of 565 (1%) in other locations. After testing, 548 of 565 (97%) were confirmed as having died using neurologic criteria. During 2020 to 2023, we estimate that DNC occurred in 6.2% of all PICU deaths. Of 393 of 565 children undergoing testing on the PICU, 15 were younger than 2 months, 45 between 2 months to 1 year, and 31 between 1 and 2 years. During the 8 years, 2015-2023, out of 824 children younger than 18 years old suspected of being dead using neurologic criteria, close to one-in-three did not proceed to formal testing. In 2020-2023, DNC in U.K. PICUs accounted for 6.2% of all death. Last, in young children up to 2 years old, the average experience of diagnosing and confirming DNC across each of the 30 U.K. PICUs was one patient every other year.

Moral, conventional, personal: reasons for action as dimensions of normativity

ABSTRACT Human life is infused with different kinds of normativity (e.g. instrumental, epistemic, conventional, moral). Different theorists have proposed vastly differing views on how to conceptualize the different kinds of normativity. Whereas social domain theorists have asserted that moral, conventional, and personal kinds of normativity constitute distinct thematic domains and are viewed as such even by young children, other theorists have denied that moral and nonmoral kinds of normativity are thematically distinguishable. The current paper proposes a third approach that may show a way out of the controversy. Instead of viewing normative issues as belonging to one or more distinct thematic domains, it would be more accurate, both philosophically and psychologically speaking, to recognize that any given action may be grounded in multiple, non-exclusive reasons for action. Moral, conventional, and personal reasons for action may be defined in terms of what one believes one can respectively justify to all rational interlocutors, particular social partners, and oneself. The three kinds of reasons for action may accordingly be visualized as dimensions of normativity that together comprise a three-dimensional coordinate “space of reasons.” To illustrate the dimensions approach, 16 examples are given of actions whose values vary independently on each of the three dimensions.

Seizures and First-Generation Antihistamines in Young Children

Seizures and First-Generation Antihistamines in Young Children

The Role of Chitinase 3-Like-1 (YKL-40) and Proinflammatory Biomarkers in the Pathogenesis of Pediatric Tick-Borne Encephalitis in a Polish Cohort.

Chitinase 3-like-1 (CHI3L1), also known as YKL-40, is a potential biomarker for neuroinflammatory conditions. It is upregulated in Alzheimer's disease, multiple sclerosis, and traumatic brain injury. However, its involvement in pediatric tick-borne encephalitis (TBE) has not been addressed yet. This study aimed to evaluate CHI3L1 and its relationship with other inflammatory cytokines, blood-brain barrier (BBB) integrity, immune response, and disease severity in pediatric patients with TBE. A total of 22 pediatric TBE patients hospitalized in Bialystok, Poland were included in this study. Participants were categorized as having meningoencephalitis (n=6) or meningitis (n=16). The integrity of the brain-blood barrier (BBB) was assessed using the albumin quotient (albQ). Biomarker indices were calculated to account for variations in BBB permeability. The concentrations of CHI3L1, CCL2, chemerin, CXCL2, IFN-γ, IL-1-β, IL-4, IL-6, IL-13, and TNF-α in both serum and CSF, were measured using the Luminex Multiplex Assay od admission and two weeks later when symptoms resolved. CSF and serum concentrations of CHI3L1 did not differ between the encephalitis and meningitis cases. After adjusting for BBB permeability, the CHI3L1 index was 2.4-fold lower in patients with encephalitis than in those with meningitis (P=0.008). There was a post-treatment reduction of CHI3L1, IL-6, and TNF-α CSF concentrations. We also found and improvement in BBB permeability in younger children but in older albQ remained abnormal. Correlation analysis revealed associations between CHI3L1 levels and pro-inflammatory markers, notably chemerin, IL-6, and TNF-α, across both clinical groups. Our findings suggest that CHI3L1 CSF levels reflect the inflammatory activity in pediatric TBE and may help to differentiate between meningoencephalitis and meningitis. The observed interactions between CHI3L1 and other cytokines underscore its potential involvement in inflammatory response to the virus. The prolonged disruption in BBB integrity in older children might reflect age-dependent differences in the severity of TBE. These insights advance our understanding of TBE pathogenesis in children and support further investigation of CHI3L1 as a biomarker for TBE diagnosis and management.

Universal free school meals and children’s bodyweight. Impacts by age and duration of exposure

We study the impact on children’s bodyweight of switching from means-tested to universal provision of nutritious free school meals in England. We exploit the roll-out of universal provision across Local Authorities to estimate effects at different ages and durations of exposure, based on nurse-collected, population-wide health data for state school children. Exposure to universal free lunches reduces obesity prevalence and BMI among children aged 4–5 and 10–11, but older children’s bodyweights are less responsive than younger children’s. We find tentative evidence that effects may be cumulative, as impacts are largest for those exposed to universal free school meals throughout primary school.

Frequency of Myocarditis in Children Presenting with Measles at Tertiary Care Hospital

Objective: To determine the frequency of myocarditis in children suffering from measles. Methodology: This cross-sectional study was conducted in the Pediatrics Unit C, MTI Lady Reading Hospital (LRH), Peshawar, from December 6, 2019, to June 5, 2020. A total of 96 patients, aged 1 month to 12 years, diagnosed with measles for more than a week were included. After obtaining ethical approval, written informed consent was taken from the parents. The frequency of myocarditis was assessed using electrocardiography and echocardiography. Data were analyzed using SPSS version 22. Results: The mean age was 6.6 ± 3.06 years. Of the patients, 47.9% were male and 52.1% were female. Most children (61.5%) belonged to a middle socioeconomic status. The study revealed that myocarditis was present in 7.3% of the children, with younger age groups (1-6 years) showing significant association (p=0.028). Myocarditis was more prevalent in children from poorer socioeconomic backgrounds (p=0.05). Conclusion: Myocarditis is a frequent complication of measles, especially in younger children from low socioeconomic backgrounds. Routine screening for myocarditis in children with measles may reduce associated morbidity and mortality.

Older Children Undergoing Inguinal Hernia Repair Have Higher Recurrence Rates Than Younger Children and Adults: A Nationwide Cohort Study

BackgroundHigh ligation is the standard practice for inguinal hernia repair in children while adults undergo a floor repair. There is limited data to guide recommendations on the age at which floor repair should be considered. This is a hypothesis-generating study to understand the correlation of age and other factors with inguinal hernia recurrence in children. Materials and MethodsChildren aged 6-17 years who underwent inguinal hernia repair by a pediatric surgeon between 2010-2022 were identified in the PearlDiver Mariner database, as were adults aged 18-25 years treated by an adult surgeon. Kaplan-Meier survival analysis and Cox proportional hazards modeling was used to determine the risk of hernia recurrence by age, sex, and obesity status. ResultsA total of 15,114 children and 20,863 adults were included. Children aged 16-17 years had a significantly increased five-year risk of hernia recurrence compared to children aged 6-10 years (2.5% vs 0.8%, adjusted hazard ratio [AHR]: 3.00, 95% confidence interval [CI]: 1.98-4.56) as well as compared to the adult group (2.5% vs 1.2%, AHR 1.90, 95% CI: 1.31-2.74). Obese males aged 14-17 years had the highest five-year rate of hernia recurrence of any group at 4.7%. ConclusionsChildren 16-17 years of age who underwent inguinal hernia repair with pediatric surgeons have an increased risk of hernia recurrence compared to younger children as well as compared to adults treated by general surgeons. We hypothesize that high ligations, commonly performed by pediatric surgeons, may be inappropriate in some groups of older children. Type of StudyCohort Level of EvidenceLevel III

MiR-124 in Neuroblastoma: Mechanistic Insights, Biomarker Potential, and Therapeutic Prospects

: Neuroblastoma, a malignancy predominantly affecting young children, originates from neural crest cells in the sympathetic nervous system. It primarily appears in the adrenal gland but can also affect nerve tissues in regions, such as the chest, neck, abdomen, and pelvis. Despite advancements in treatment, high-risk neuroblastoma patients often face poor prognoses, underscoring the need for ongoing research. This review paper examines the numerous factors responsible for neuroblastoma, emphasizing the importance of approaching the disorder with more strategic therapeutic methods. MicroRNAs, particularly miR-124, play critical roles in gene regulation and cancer pathogenesis. Abundant in the brain, miR-124 functions as a tumor suppressor by inhibiting cell growth, migration, and invasion and is often dysregulated in neuroblastoma. This study investigates the molecular functions of miR-124 in neuroblastoma, its potential as a biomarker, and its application in targeted therapy. MiR-124 regulates key pathways in neuroblastoma, including PI3K/AKT, TGF-β, and p53 signaling, impacting cell proliferation, apoptosis, and metastasis. The study also explores the promise of miR-124 as a biomarker for neuroblastoma through liquid biopsy, enabling non-invasive diagnosis and disease monitoring. Therapeutic strategies targeting miR-124 pathways show potential for overcoming chemotherapy resistance and improving treatment efficacy. The research underscores the significance of miR-124 in neuroblastoma, aiming to enhance early diagnosis, identify specific drug targets, and expand treatment options, ultimately improving patient outcomes.

The eACT study design and methods: A sequential, multiple assignment, randomized trial of A novel adherence intervention for youth with epilepsy

BackgroundEpilepsy is a common, chronic pediatric neurological condition predominately treated with anti-seizure medications (ASMs) to control or reduce seizures. Approximately 60 % of youth with epilepsy demonstrate suboptimal adherence to their ASM. This paper describes the methodology, recruitment, design, and baseline participant characteristics of a sequential, multiple assignment, randomized trial (SMART) designed to test the effectiveness of a behavioral health intervention to improve adherence in families of young children with epilepsy. MethodsUsing a two-stage SMART, youth ages 2–12 years old with newly diagnosed epilepsy and their families were enrolled. Following an 8-week run-in phase, families with ≤95 % adherence were randomized to control (education + automated digital reminders) or intervention (education + automated digital reminders + individualized feedback) arms. After three months, families in the intervention group who remained non-adherent (i.e., ≤ 95 %) were re-randomized to 1) continue with same intervention or 2) receive two telehealth problem-solving sessions with an interventionist over the next two months. Study measures were completed at baseline, 8-, 14-, and 20-months post-baseline. ResultsOf the n = 466 ethnically and racially diverse study participants, n = 268 participants were non-adherent and were randomized. The primary outcome was electronically monitored ASM adherence at post-intervention, while secondary outcomes included seizure freedom, health care utilization, and epilepsy-specific health-related quality of life. ConclusionsNovel aspects of the trial design (e.g., sequential, recruitment of racial and ethnic diverse youth), modifications to the protocol related to the COVID-19 pandemic and evolving socio-political and medical climate, as well as recruitment and retention challenges are discussed.ClinicalTrials.gov Number: NCT03817229

Associations of poor water, sanitation, and hygiene and parasite burden with markers of environmental enteric dysfunction in preschool‐age children infected with Schistosoma mansoni in Uganda

AbstractBackgroundEnvironmental enteric dysfunction (EED) is an acquired subclinical condition of the small intestine with lasting health implications for nutritional status, linear growth and development among children. EED is characterised by structural and functional changes to the gut barrier. There are no standardised diagnostic criteria, however, a number of biomarkers have been evaluated to capture EED domains. While the causes of EED are not fully understood, risk factors include poor water, sanitation and hygiene conditions and exposure to enteric pathogens. Very few studies have evaluated the impact of schistosomiasis on EED despite repeated intestinal damage from parasite eggs passing across the gut barrier.MethodsIn a cohort of 354 preschool‐aged children aged 12–47 months with Schistosoma mansoni infection recruited from the Lake Albert region of Uganda, we assessed exposure to water, sanitation and hygiene conditions and measured markers from each EED domain: intestinal inflammation (faecal calprotectin), epithelial damage (serum intestinal fatty‐acid binding‐protein), increased permeability (urine lactulose to mannitol ratio and faecal alpha‐1 antitrypsin) and microbial translocation (serum endotoxin core antibody).ResultsIn multivariable linear regression models, we found that children whose drinking water was sourced from Lake Albert had higher concentrations of intestinal fatty‐acid binding‐protein (β = 0.48, 95% CI 0.20–0.76, p < 0.001), and lack of toilet/latrine access was associated with higher concentrations of calprotectin (β = 0.48, 95% CI 0.18–0.78, p < 0.01). Higher schistosomiasis intensity (eggs per gram of stool) was associated with higher calprotectin (β = 0.10, 95% CI 0.02–0.17, p = 0.01), but not with other EED markers.ConclusionsFew studies have investigated schistosomiasis‐related morbidities in very young children infected with schistosomiasis. Our findings from Uganda show that poor water, sanitation and hygiene conditions and heavier schistosomiasis burden are associated with intestinal inflammation and damage, contributing to EED. Improved treatment coverage for preschool‐aged children infected with schistosomiasis may reduce the burden from EED and associated long‐term morbidities.

Effect of a youth-led early childhood care and education programme on children's development and learning in rural Sindh, Pakistan (LEAPS): a stepped-wedge cluster-randomised implementation trial.

In low-income and middle-income countries, an estimated 181·9 million (74·6%) preschool-aged children do not receive adequate nurturing care in health, nutrition, protection, learning, and responsive care, thus jeopardising their healthy development across the life course. Working alongside the health sector, multisectoral actions including social protection and education are necessary to achieve child health and development outcomes. Innovations are needed to expand access to high-quality early childhood care and education (ECCE) for young children and opportunities for youth development. Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) is a two-generation programme that trains female youth aged 18-24 years to deliver ECCE. We evaluated the effectiveness of LEAPS to improve children's school readiness when delivered at scale in rural Pakistan. We implemented a stepped-wedge cluster-randomised trial with three steps from Dec 3, 2018, to June 30, 2021. 99 villages (clusters) in four districts in rural Sindh, Pakistan, were randomly assigned (1:1:1) to introduce LEAPS across three steps. Eligible clusters were those that had a feeder primary school run by the National Commission for Human Development, a department of the Ministry of Federal Education and Professional Training; were safe; had space for a LEAPS preschool; could identify a female youth to deliver the ECCE service; and had not previously participated in the pilot study. Government partners trained female youth, aged 18-24 years, to provide community-based ECCE, enrolling up to 20 children, aged 3·5-5·0 years, per class. Population-based cross-sectional surveys were conducted at baseline and after each step for children who were eligible if they resided in the cluster, were aged 4·5-5·5 years at the time of the survey, and without any severe clinical health conditions or disability. The primary outcome was children's school readiness using the International Development and Early Learning Assessment (IDELA) composite score comprising emergent numeracy, emergent literacy, socio-emotional development, and motor skills. An intention-to-treat analysis was conducted, using linear mixed models accounting for clustering and the stepped-wedge design. The trial is registered with ClinicalTrials.gov (NCT03764436). LEAPS was implemented in 91 of 99 villages. In eight clusters, a LEAPS preschool could not be set up. For the intervention programme, the average enrolment of children in a LEAPS preschool was 19 (SD 3, range 12-20). A total of 3858 children (n=3852 with complete IDELA data) were assessed across the four survey rounds conducted between Jan 1, 2019, and March 31, 2021. LEAPS increased school readiness (standardised mean difference: 0·30 [95% CI 0·20-0·40]; p<0·0001) as compared with the control condition. LEAPS offers a scalable solution to expand access to high-quality ECCE and promote children's school readiness while providing employment for female youth in rural Pakistan and settings with similarly low ECCE participation. Dubai Cares; and Saving Brains, Grand Challenges Canada. For the Urdu translation of the abstract see Supplementary Materials section.

Toward ethical praxis in longitudinal research with children: Reflecting on ethical tensions in participatory research

The field of early foreign language learning research has witnessed an increasing trend to employ participatory methods, stemming from a paradigm shift in how children are viewed in research. In contrast to more traditional approaches that place children as the objects of research, children are considered active agents and participants in research with expert knowledge of their own lives. In this paper I discuss the ethical tensions that surfaced prior, during, and after a research project that employed participatory methods with young children. I reflect on how the methodology broadened understanding of emerging power differences in the researcher–participant relationship, such as how asymmetry in knowledge and participation alternate and manifest during a longitudinal project, engaging the researcher and the children in recurring negotiation of roles and power. While ethical considerations are often presented as a checklist with do's and don't’s for how to proceed, with this article I draw on experiences from my own project and aim to dismantle the complex and messy picture of the ethical process in research with young children. I argue that while the application of participatory methods in early foreign language learning research alleviates ethical tensions to an extent, such as by helping reduce epistemic and institutional power between the researcher and the participants, it is essential to report and reflect on the ethical weighing and reflection undertaken throughout the study as unequal power structures will remain regardless of method.

영유아를 둔 맞벌이 엄마의 여가 제약 경험에 관한 근거이론 연구

This study aims to comprehensively approach and understand the leisure activity experiences of working mothers with infants or toddlers, focusing on the changes and challenges that occur in their leisure time during the period of childbirth and caregiving. The sample for this study consisted of working mothers with infants and toddlers (under six years old), selected through theoretical sampling based on previous research. Data were collected from 14 participants through in-depth interviews, and the collected data underwent continuous expert review throughout the analysis process. Content analysis revealed 133 concepts, 31 subcategories, and 10 supercategories, leading to the development of a paradigm model. The causal conditions identified were 'absolute leisure constraints' and 'emotional changes after childbirth,' with the contextual condition being 'roles assigned in modern society.' The central phenomena were identified as 'expansion of passive leisure activities' and 'children's leisure activities becoming my leisure activities,' while the mediating condition was 'tolerance of leisure constraints.' The action/interaction strategies were 'leisure constraint negotiation' and 'changes in leisure activities,' leading to outcomes of 'second identity formation' and 'acceptance.' The core category of selective coding was defined as 'transition from a new mother to a true mother.' This study provides theoretical implications as a foundational analysis of the leisure constraints and experiences encountered by mothers of young children, as well as policy and practical implications that can inform the development of leisure policies aimed at encouraging childbirth among mothers with young children.

영유아 놀이성 관련 연구동향 분석: 2009-2023년 국내 학술지를 중심으로

This study aims to examine research trends related to playfulness in early childhood. To achieve this, a total of 224 papers published in domestic academic journals over the past 15 years (2009–2023) were analyzed, focusing on publication period, research methods, research topics, and results according to each topic. The findings indicate that the number of related studies was relatively low from 2009 to 2011 but showed a notable increase from 2012 onwards. In terms of research methods, quantitative research was the most common approach, with the majority of studies focusing on young children. Regarding data analysis, quantitative methods, particularly correlation analysis, were most frequently used. The research topics were categorized into six areas, with the effects of playfulness on early childhood development emerging as the most prominent focus. Finally, based on the analysis of key research outcomes and variables across topics, directions for future research were proposed.

Dysregulation Profile in Preschoolers with Autism Spectrum Disorder: An Italian Multi-Center Perspective

Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by social communication impairments and repetitive behaviors. Recent reports show that one in thirty-six 8-year-old children are autistic, signifying a considerable public health concern. According to previous studies, emotional dysregulation (ED) affects 50–60% of individuals with ASD and includes symptoms such as poor emotional control, heightened reactivity, and a low frustration tolerance. The main aims of the current study are to investigate the prevalence of ED among autistic preschoolers (below 6 years of age) and to assess the impacts of gender and intellectual disability on their emotional dysregulation profile. Methods: Data have been collected from three children’s research hospitals in Italy (IRCCS Stella Maris Foundation, Stella Maris Mediterraneo Foundation, and IRCCS Bambino Gesù). Parents of 825 autistic pre-schooled children (mean age: 39.68 months, SD: 10.51 months) completed a general questionnaire and the Child Behaviour Checklist (CBCL), a reliable caregiver-reported assessment tool which provides a dysregulation profile. Results: A total of 30% of the children displayed a severe-to-moderate ED (emotional dysregulation) profile, with these children exhibiting significantly higher emotional–behavioral problems compared to those without ED. Males with ED exhibited greater emotional reactivity than females with ED. However, no significant relationships were found between ED and age, autism severity (ADOS-2), or intellectual disability. Conclusions: The results underline the importance of early, tailored interventions to face emotional challenges in young children with ASD, potentially improving long-term outcomes for this population.

Analysis of Domestic Research Trends on the Parenting Involvement of Fathers with Young children

Analysis of Domestic Research Trends on the Parenting Involvement of Fathers with Young children

Sensitivity Pattern in Children Respiratory Bacterial Infections

Background: Bacterial respiratory infections are a major health concern, especially in underdeveloped and developing countries. This study aims to evaluate the prevalence of Gram-negative and Gram-positive bacteria in respiratory infections and assess the efficacy of antibiotics. Methods: A prospective, observational study was conducted from July 2010 to July 2011. Patients with respiratory infections were categorized by age, bacterial pathogen, disease type, and season of infection. Diagnostic methods, including throat swabs, blood cultures, and antibiograms, were used to identify pathogens and determine antibiotic resistance profiles. The infection rate was calculated using standard epidemiological formulas. Results: Gram-negative bacteria accounted for 84.7% of infections, with Acinetobacter baumannii (26.4%) being the most common pathogen. Gram-positive infections, primarily caused by Streptococcus pneumoniae (77%), were also prevalent. The highest infection rates were observed in the spring, particularly among children under one year and those aged 1-6 years. Pneumonia was the most common diagnosis (43.5%). Ampicillin resistance was widespread, but Acinetobacter baumannii, E. coli, and Klebsiella pneumoniae showed sensitivity to Sulbactam, Cefoperazone, and Piperacillin/Tazobactam. Conclusion: Acinetobacter baumannii was the predominant cause of respiratory infections, especially in young children and during spring. Ampicillin resistance was common, but Sulbactam, Cefoperazone, and Piperacillin/Tazobactam were more effective. These findings highlight the importance of targeted antibiotic therapy, particularly for Gram-negative bacterial infections.

The Effects of Picture Books-linked Mathematical Activities on Young Children’s Mathematical Diposition and Social Skills

The Effects of Picture Books-linked Mathematical Activities on Young Children’s Mathematical Diposition and Social Skills

Home literacy environment, language use, and proficiency: Bilingual profiles in young learners

Expanded research is needed on how the home environment shapes bilingual proficiency in young children exposed to a different language at home than in early childhood education and care settings. This study examined whether variation in language use with parents, language proficiency, and home literacy environments reflect bilingual profiles. Participants included 320 Norwegian dual language learners (aged 22–68 months) with diverse language backgrounds. Parental surveys assessed language use, first language (L1) proficiency and home literacy environment. Standardized tests assessed second language (L2) proficiency. Latent profile analysis revealed three profiles: (1) more L2 use, higher L2 proficiency and higher L2 home literacy environment; (2) more L1 use, higher L1 proficiency and lower home literacy environments for both languages; and (3) more L1 use, higher proficiency in L1 and L2, and higher home literacy environments for both languages. Profiles differed in L1 distribution, maternal residency length in Norway, and maternal education.

The Influence of Singing Activities on Children's Language Ability in the Pembina Siak Kecil State Kindergarten

Singing activities at the Pembina Siak Kecil State Kindergarten are an effective learning method in improving the language skills of young children. Through various song lyrics, children not only introduce new vocabulary, but also learn to construct simple sentences. With pleasant melodies and themes that are relevant to everyday life, singing activities facilitate children to remember new words more easily. In addition, this activity also supports the development of grammar and sentence structure, as well as encouraging social interaction among children, improving their communication and collaboration skills. With the support of teachers and parents, children feel more confident in language and are able to communicate better. Singing activities also stimulate children's cognitive abilities and improve motor skills through movements that are integrated with singing. Repetition of songs in class provides an opportunity for children to internalize new vocabulary effectively. Teachers play an important role in choosing songs that are appropriate to the child's developmental stage, so that each child can learn according to their level of ability. Overall, singing activities at the Pembina Siak Kecil State Kindergarten have a significant impact on children's language development, enrich vocabulary, and build a strong communication foundation for the future.