Memory Improves Dramatically Between 1 and 2 Months of Age and Then Again by 36 Months.

The early years of life are characterized by dramatic developmental changes. Within this important time period lies the transition from newborn to childhood. Sleep is one of the primary activities of the encephalon during early development and plays an important role in healthy cognitive and psychosocial development in early life. This paper volition beginning review the normal sleep characteristics and their development in neonates and children, including architecture of sleep, evolution of a healthy sleep rhythm in early childhood, sleep recommendations and cultural disparity, too as important factors for establishing a salubrious sleep design during the first years of life, such as regular and consistent bedtime routine, safe and comfortable slumber environment, and appropriate sleep onset associations. This paper then provides recent updates of evidence of the effects of sleep on early brain development, peculiarly on learning and memory, emotional regulation, and general cognitive development through behavioral and neurophysiological studies. As regards the machinery, many experimental slumber deprivation studies in animals and adults take attempted to explain the underlying mechanisms of sleep on cognition and the emotional encephalon. Future studies are expected to delineate the effects of sleep on encephalon structural and functional networks in the developing brain with the marked evolution of image acquisition approaches and the novel analysis tools for infants and young children in recent years.

© 2020 S. Karger AG, Basel

Cardinal Messages

• Sleep pattern changes dramatically in early on childhood.

• Establishing a healthy slumber pattern in early on life is very important for child evolution.

• Sleep plays a critical role in learning and memory, emotional regulation, and related encephalon construction evolution.

Sleep and Early Brain Evolution

The early years of life are characterized by dramatic developmental changes. Within this important time period lies the transition from newborn to babyhood [ane]. Slumber is one of the primary activities of the brain during early development and as well plays an of import role in healthy cognitive and psychosocial development in early life [2]. This newspaper will first review the normal slumber characteristics and their development in neonates and children, followed by contempo updates of the evidences of the effects of sleep on early encephalon development, especially on retentiveness functions and emotional control.

Normal Sleep and Its Development in Neonates and Children

Definition and Architecture of Sleep

Sleep is divers as a behavioral land characterized by reduced motor activity, decreased interaction with the external environment, a specific posture (e.chiliad., lying down, eyes closed), and easy reversibility. The architectural organisation of slumber refers to the coordination of contained neurophysiologic systems into three distinct functional states: non-rapid eye movement (NREM) slumber, rapid eye movement (REM) sleep, and wakefulness. Each state is distinctly associated with a discrete design of brain electric action [3].

NREM slumber is believed to role primarily equally a restful and restorative sleep phase. NREM slumber also represents a fourth dimension period of relatively low brain activity during which the regulatory capacity of the brain continues to exist active and body movements are preserved. Using electroencephalogram, NREM sleep is conventionally subdivided into 3 stages (stages 1, 2, and 3), which roughly parallel a depth of sleep continuum, with arousal thresholds generally the lowest in phase 1 and highest in stage 3 sleep (stage iii sleep is likewise chosen slow-moving ridge sleep [SWS] or deep slumber). NREM sleep is usually associated with minimal or fragmentary mental activity.

REM slumber, also called "dream" sleep, is characterized past desynchronized cortical activity with depression-voltage and high-frequency electroencephalogram. REM is typically thought to play a office in consolidating and integrating memories equally well as in the development of the central nervous organisation – both maintaining and establishing new connections particularly during the time period of early brain evolution [iv]. The mental activity of human REM sleep is associated with dreaming. The other important feature of REM sleep is the absenteeism of skeletal muscle tone, meaning that people cannot motility their body and limbs when they have brilliant dreams.

NREM and REM slumber alternate in cycles throughout the night, which is chosen ultradian rhythm [four]. The relative proportion of REM and NREM sleep per bicycle changes over night, and phase iii NREM sleep (known equally deep slumber) dominates the first 1/iii of the dark, while REM slumber dominates the concluding tertiary. In other words, the percentage of deep sleep declines and REM sleep increases over the course of the night.

The Development of a Healthy Sleep Rhythm in Early on Childhood

The slumber patterns change with age during the outset years of life. The characteristics of sleep-wakefulness states during early development originate from the residue-activity cycles in the fetus and the early months after birth. Sleep states are categorized as active sleep, placidity sleep, and indeterminate sleep in very immature babies. By the second half of the outset year, quiet sleep gradually transitions into NREM sleep, which could be further divided into 3 stages every bit outlined higher up. Meanwhile, the active sleep characterized by frequent musculus twitches and grimaces turns into REM slumber. After 6 months of historic period, the electronical patterns of NREM and REM sleep progressively resemble those seen in adults [v].

Early on childhood life is a critical time period when normative transition of sleep-wakefulness patterns occurs, which is characterized past nighttime sleep consolidation and daytime sleep discontinuation. Starting from newborn babies to preschool children, 24-h slumber duration declines dramatically by decreasing both daytime and nighttime sleep amounts. Peculiarly, diurnal sleep gradually declines, while the extent to which nighttime slumber decreases is less remarkable during this period of time. Newborns (0–three months) do not have an established cyclic rhythm, and day/night reversal is common in the first few weeks after birth [half-dozen]. The regular rhythm of periods of sleepiness and alertness emerges by two–3 months of age and becomes more nocturnal between the age of 4 and 12 months [7]. While children go along to take daytime naps between 1 and 4 years of age, the number of naps decreases from 2 naps to 1 nap past 18 months on average, and this typically stops past the historic period of 5 years [8].

Not but sleep duration but also slumber compages and sleep bike change with age. The proportion of REM slumber dramatically decreases from birth (50% of slumber) through early childhood into adulthood (25%). The proportion of deep slumber peaks in early childhood and then decreases over the lifespan. The ultradian cycle, which means the nocturnal cycle of sleep stages, is nigh 50 min in infancy and gradually increases to an developed level, about 90–110 min, by school historic period [5].

Sleep Recommendations and Cultural Disparity

In a clinical setting, one of the most common questions from parents is "what is healthy slumber for children?" By and large, salubrious slumber requires adequate duration, appropriate timing, expert quality, regularity, and absence of sleep disturbances or disorders [9]. Although genetics plays an important office in the private variability of sleep need, many healthy sleep practices can help children to achieve age-appropriate amounts of slumber with good quality from the very beginning of their life. To develop scientifically audio and practical recommendations for slumber duration, the National Sleep Foundation (NSF) in the United states of america convened a multidisciplinary expert panel to evaluate the latest scientific evidence, including a consensus and voting process in 2015 [10, xi]. Later, the American University of Sleep Medicine and American University of Pediatrics (AAP) issued like recommendations for slumber duration in the pediatric population [12, xiii]. The only deviation of the contempo guideline is that the 2 organizations did not include recommendations for infants younger than iv months erstwhile owing to a wide range of normal variations in duration and patterns of sleep and insufficient testify of their associations with health outcomes. In 2017, the NSF published evidence-based recommendations and guidance to the public regarding indicators of adept sleep quality for children nether 5 years of age [14], which are summarized in Table 1. Notwithstanding, it is worth noting that even though the normative sleep duration values are helpful and inform what constitutes the norm and what is considered outside the norm for a given historic period, these references provide norms at the population level standpoint and need to be individualized for each patient in the clinical setting [xv].

Table 1.

The recommended amount of sleep and sleep quality for children under v years old by the National Slumber Foundation in the USA [ten, xi, 15]

The culture milieu is of importance for the understanding and evaluation of child sleep duration and patterns [16]. We recently systematically reviewed 102 studies with 167,886 children aged 0–3 years from 26 different countries beyond the world. Our results indicated that an apparent cross-cultural disparity of the sleep parameters already exists in early childhood [17]. Specifically, the predominantly-Asian (PA) toddlers had a shorter sleep duration and more frequent night wakings when compared to their predominantly-Caucasian (PC) peers under three years of historic period. Only the cultural difference of total sleep elapsing is not exactly the same across age groups. The total sleep elapsing of the PA cohort was more than that of the PC samples in the starting time iii months of life but dropped below the PC samples beyond 3 months of life. More than importantly, information technology seems that the PA children are not built-in with a shorter sleep duration and the intersection of the slumber duration trajectories betwixt the PA and PC children occurs around three months old (Fig. 1a, b). We believe that parental sleep-setting behaviors contribute largely to the observed disparity of the sleep parameters betwixt the PA and PC children. For instance, parental dark involvement and nightly bedtime routine volition play a major part in a babe's sleep [xviii-20]. Mindell et al. [19, 20] studied cultural differences of parental sleep settings for many years and indicated that children from the PA regions were much more likely to exist engaged with their parents, to partake in maladaptive activities (for example, inappropriate sleep associations including rocking, nursing, and swinging) and were less likely to have a consistent bedtime routine than those from the PC regions. Trends of night sleep elapsing for the PC regions showed rapid changes over the first 3–6 months earlier stabilizing to a plateau, whereas nighttime sleep duration for the PA regions exhibited a slight modify beyond different states in early life with an increase initially, followed by a subtract. The cross-cultural disparities of the age-related trends for sleep parameters over the beginning 3 years of life tin be found in Figure i.

Fig. ane.

Cantankerous-cultural disparities of the developmental trajectory (weighted by sample size) for slumber parameters over the first three years of life. Grey dots correspond the samples. The orangish line represents the trajectory bend fitted by the data from the Asian region samples; the nighttime blue line represents the non-Asian region samples; and the red dashed line represents all samples. a Total sleep duration. b Nighttime slumber duration. c Daytime sleep duration. d Number of night wakings. e Bedtime in the evening. f Waketime in the morn [17].

Important Factors for Establishing a Healthy Slumber Design during the Outset Years of Life

Positive sleep practices (known equally "sleep hygiene") are essential for establishing a salubrious sleep pattern during the first years of life. Thus, it is recommended that parents start promoting skilful sleep hygiene past establishing a prophylactic and comfortable sleep environment, a regular bedtime routine, and an advisable slumber onset association starting from infancy, and throughout babyhood [21].

Regular and Consistent Bedtime Routine

Having a regular and consistent bedtime routine is i of the critical steps to achieve good sleep hygiene and yield health benefits to young children. It provides them a sense of predictability and security and helps with activeness transitions. Bedtime routines deliver external clues to children that sleep is coming and assist them in preparing for sleep mentally past being both predicable and calming. A bedtime routine should involve the same 3–4 calming and relaxing activities every dark in the same order, e.g., warm bath, reading stories, singing lullabies, and listening to soft music. A pictorial representation of the bedtime activities is recommended for children at a younger age or developmentally delayed.

Condom and Comfortable Slumber Surround

Maintaining a safe and comfortable sleep environment could promote adequate sleep quantity and quality. Usually, a comfortable sleep environment should be at-home, quiet, dark, and with cooler temperatures. Prevention of accidental suffocation and strangulation are central considerations, especially for immature babies. The crib mattress should provide a firm sleeping surface and fit tightly in the crib. Removal of all pillows and stuffed toys from the crib is recommended. The AAP recommends that the baby should exist placed on his or her back to sleep at dark and during naptime every bit bear witness has shown that sleeping in a prone position significantly reduces the risk of sudden infant expiry syndrome [21]. In addition, the sleep surround around babies should be a "fume-free zone."

Appropriate Sleep Onset Associations

Sleep onset associations are those conditions that are present at the time of sleep onset as well as in the night post-obit night arousals. The "inappropriate" or problematic slumber onset associations refer to the weather where infants require parental interventions, e.m., being rocked or fed. Infants with inappropriate sleep onset associations have been shown to be vulnerable to developing frequent dark wakings. In gild to avoid developing inappropriate sleep onset associations, the most of import sleep behavior for a given babe to learn is the ability to self-soothe and fall comatose independently [22]. Specifically, putting infants to bed when they are drowsy just yet awake and leaving them to go from drowsy to asleep on their own is a recommended approach for infants to develop appropriate sleep onset associations. Transition objects, such as blankets, dolls, and stuffed animals, could besides help young children to foster independence and self-soothing to autumn asleep.

Avoiding Media Exposure

It has been widely reported that immature children have been exposed to significantly more media over the past few decades, and media exposure can negatively impact children's sleep duration and quality and may lead to sleep difficulties [23, 24]. Media (such equally smartphones, iPad, and desktop and laptop computers) volition non only interfere with a relaxed state required for sleep initiation, but too suppress the normal evening surge in melatonin and alter the slumber-wake cycle via calorie-free exposure. Parents are strongly encouraged to remove TVs and electronic devices from the child's sleeping environment.

Regular Daily Schedule of Activities with Appropriate Stimulations

Babies should be encouraged to develop a consistent historic period-advisable schedule of slumber, outdoor activities, and mealtime to help regulating the internal clock and synchronize the sleep-wake cycle. For example, getting daily exposure to the lord's day especially in the morning and avoiding direct low-cal exposure in the evening could appropriately regulate melatonin secretion to further promote slumber regulation. Evidence accumulated during recent years suggests that mealtimes can also affect the sleep-wake bicycle [25].

Sleep and Early Brain Development

Learning and Retention

Sleep has been implicated to play a disquisitional function in retention functions of the adult brain and is thought to favor the "off-line" processing of new memories [26]. Two types of sleep take been shown to be associated with different memory processing. The role of NREM sleep, particularly SWS, is reactivation of the hippocampal-neocortical circuits activated during a waking learning period, while REM sleep is responsible for the consolidation of the new learning into long-term memory [27]. While the same information is informative about our understanding of the roles of sleep in adult memory office, how slumber benefits children's memory remains largely unknown.

It is explicit that the means through which children learn are very different from those of adults. Children rely more on rote learning other than knowledge-based learning, which is mutual in adults [28]. Wilhelm et al. [29] establish that school-age children showed greater slumber-dependent extraction of explicit (or declarative) knowledge of the rules that govern an implicit procedural task than do adults. They further suggested that at least some of the differences in how children and adults process newly acquired information effect from age-dependent differences in the forms of sleep-dependent processing applied to such memory. Pisch et al. [30] investigated whether the peculiarly high inter-individual differences in infant sleep duration and fragmentation are indicative of cognitive developmental trajectories examined past eye-tracking over a prolonged time catamenia. They found that children spending less fourth dimension awake during the nighttime in early life were associated with improve performance of a working memory task. Although several physiological explanations could business relationship for the observed improved functioning, it is highly plausible that the increased deep sleep (SWS) duration during the night in children is one of the main reasons.

Not only the whole night sleep but also daytime nap is related to declarative memory functioning. The benefit of daytime nap on memory was too observed in infants and toddlers. Hupbach et al. [31] institute that fifteen-calendar month-old infants who had napped within four h of linguistic communication exposure remembered the general grammatical pattern of the language 24 h later, while the infants without napping showed no bear witness of remembering anything about linguistic communication. More importantly, their results were confirmed by another research team which reported that nap facilitated generalization of word meanings, every bit indicated past event-related potentials [32]. Some other report by Seehagen et al. [33] found that having an extended nap (≥thirty min) within 4 h of learning a set of object-action pairings from a puppet toy enabled 6- and 12-month-one-time infants to retain their memories of new behaviors over a 4- and 24-h delay. These findings support the view that infants' frequent napping may play an essential function in establishing long-term memory.

Ii studies examined the effects of daytime nap on recognition tasks and generalization of word meanings in preschoolers and confirmed the positive function of slumber in explicit retentivity consolidation [34, 35]. However, these results were not consistent with those reported by another study, which plant that wakefulness (not sleep) promotes generalization of word meanings in children 2.v years old [36]. Horváth et al. [35] speculated that the contrasting findings from these studies could be explained by 2 reasons. One possible reason is the developmental changes in the preferred slumber-dependent memory consolidation beyond early childhood. However, many studies in adults have also reported sleep-dependent generalization. Thus, it is plausible that other factors may take contributed to the observed inconsistent results, including, but not limited to, the change in groundwork color and texture, the requirement of pointing in Werchan's chore, or the circadian furnishings. Boosted studies focusing on the potential benefits of daytime nap on cognitive development in children will be needed.

Sleep does non only play of import roles in learning and memory, only information technology tin can too stimulate creative thinking. It is widely believed that sleep plays a role in the flashes of insight, for case. The Nobel Prize winner Loewi reported that he woke up with the essential idea for an experiment confirming the principle of chemical neurotransmission. The famous German chemist Kekule spoke of his keen cosmos of band-like structure of benzene and said that he had discovered the ring shape of the benzene molecule subsequently having a daytime nap. Nevertheless, the hypothesis of sleep stimulating artistic thinking was not proven until a well-designed study was conducted by a German language grouping, which showed that sleep, by restructuring new memory representation, facilitates extraction of explicit knowledge and insightful behavior [37]. Since then, a few studies take further explored the clan between sleep, especially REM sleep, and creative behaviors [38-xl]. Nevertheless, in contrast to the ample prove linking slumber and retention part, the relationship between sleep and artistic thinking has non been widely studied and confirmed, most likely attributed to the challenges of a well-defined method of investigating insight/creative thinking [41], especially in immature children.

Emotional Regulation

Sleep plays a disquisitional part in mental health and psychosocial aligning beyond the lifespan. A growing body of research has suggested that inadequate slumber leads to more negative and less positive emotions [42]. In addition, the bear on of sleep on side by side-twenty-four hour period mood/emotion is thought to exist especially afflicted by REM sleep [43]. During REM sleep, a hyperlimbic and hypoactive dorsolateral prefrontal activation and a normal function of the medial prefrontal cortex may explain its adaptive function in coping with emotional events [43].

Actually, the effects of sleep on emotional regulation could be traced back to the neonatal period. It is noteworthy that active (or REM) slumber accounts for the biggest portion of a child's sleep, and information technology is likely to subserve crucial emotional function [44]. It was observed that the neonatal smiles, peculiarly Duchenne smiles, which involve lip corner raising with cheek raising, tend to predominate in active sleep compared to during wakefulness or other sleep states, suggesting a potential tie to early on constituents of emotion [45]. An imaging study of three- to 7-month-old infants revealed specific brain regions responding to emotional man vocalizations during sleep, including the orbitofrontal cortex and insula [46]. Not only REM sleep, simply also slumber structure and placidity slumber (NREM sleep) contribute to children's emotional part. A longitudinal cohort report of premature infants found that premature infants with sleep state transitions characterized by shifts between placidity sleep and wakefulness at gestational age 37 weeks exhibited the best emotional and cerebral development in subsequently childhood, contrary to other 2-land transition patterns [47]. We recently used eye-tracking technology to study the clan between sleep and circadian rhythm characteristics with waking social cognitions in 12-month-former infants, specially face processing – an important predictor for social-emotional functions. Nosotros found that infants' face scanning patterns were related to several sleep- and circadian-related parameters, such as sleep quantity, sleep quality, circadian stability, cyclic amplitude, and circadian phase [48].

A systematic review has examined the clan between sleep duration and a broad range of health indicators in children aged 0–iv years, where emotional regulation was 1 of the important outcomes [2]. Overall, a shorter sleep elapsing was associated with poorer emotional regulations (13/25 studies), and amid these studies, 2 randomized studies (both randomized cantankerous-over trails with high quality of evidence) showed better self-regulation strategies and emotional responses in the routine sleep versus the slumber restriction conditions [44, 49].

Many experimental slumber impecuniousness studies in animals and adults have attempted to explicate the underlying mechanisms of sleep on the emotional brain [42, 43, l]. In item, noninvasive imaging approaches have been widely employed to potentially shed light on our understanding of the underpinnings linking sleep and emotional control. Neuroimaging studies in adults reported that slumber impecuniousness was associated with a lx% greater magnitude of activation of the amygdala and a 3-fold greater amygdala activation volume between groups [51]. The diminished amygdala-prefrontal connectivity was also found after sleep impecuniousness, suggesting a lack of cerebral control over emotional brain areas [51]. Finally, a functional magnetic resonance imaging study investigating the result of sleep loss on the emotional brain network establish that sleep deprivation amplifies reactivity throughout the mesolimbic reward encephalon network in response to positive emotional pictures [52].

General Cognitive and Encephalon Structure Development in Children

Apart from the studies focusing on slumber and retentivity and emotional development in young children, several studies take examined the relationship betwixt slumber and general cognitive evolution or language evolution in infants and toddlers. One study revealed that a greater number of awakenings later on sleep onset measured via sleep actigraphy recordings among 10-month-old infants were negatively correlated with the scores of the Bayley Scales of Infant and Toddler Development second edition (BSID-II) Mental Evolution Index (MDI) [53]. Gibson et al. [54] too establish that 11- to 13-calendar month-sometime infants who had either greater sleep efficiency or longer proportions of sleep at night measured by sleep actigraphy data were associated with better cognitive problem-solving skills as measured by the Ages and Stages Questionnaire. Recently, we examined the clan betwixt nighttime awakenings and cognitive development in a large-scale customs sample of infants and toddlers from eight provinces across China and found that frequent nighttime awakenings reported by caregivers are associated with a lower MDI in BSID-I in toddlers betwixt 12 and 30 months [55]. A longitudinal twin study assessed the association between slumber-wake consolidation at 6, eighteen, and 30 months and language skills at 18, 30, and threescore months and found that a poor sleep consolidation during the commencement two years of life may be a run a risk gene for linguistic communication learning in later childhood [56].

In adults, many studies have reported that sleep patterns and bug are associated not only with brain functions merely also with structural properties of the brain, specially the gray matter volumes [57-59]. Just very little is known about how slumber affects the developing encephalon from the structure perspective, and the only few studies all nerveless imaging data from children older than 5 years sometime [sixty-64].

Recently, one study investigated the prospective associations between slumber disturbances throughout early on childhood and brain morphology at 7 years of age [lx]. They found that sleep disturbances from historic period 2 years onwards were associated with smaller grey thing volumes. The global tendency of this phenomenon as well showed meaningful regional specificity. Children with sleep disturbances were associated with thinner cortex in the dorsolateral prefrontal surface area, which may reflect effects of slumber disturbances on brain maturation [sixty]. All the same, ane of the major limitations of this written report is the use of a cross-sectional pattern, making it difficult to dominion out opposite causality. That is, rather than being a consequence of sleep disturbances, encephalon morphology may underlie childhood sleep problems. Two studies explored the relationship between grey thing density and obstructive sleep apnea (OSA), which is one of the most common slumber disorders in babyhood [61, 62]. Chan et al. [61] found that children with moderate-to-severe OSA had a meaning grey matter book arrears in the prefrontal and temporal regions (Fig. two). A similar finding was also reported in Philby et al.'s [62] study where significant grey matter volume reductions were observed in OSA children throughout regions of the superior frontal and prefrontal, and superior and lateral parietal cortices. Fifty-fifty though these ii studies of OSA children could farther back up the furnishings of sleep on brain structural evolution, the mechanisms of OSA and general sleep disturbance, for case dyssomnia, on cortical development might be very dissimilar. Reduction of grey thing volume in pediatric OSA children could exist the upshot of slumber fragmentation as well as hypoxic harm to the encephalon [65].

Fig. 2.

Maximum intensity projection (MIP) of the statistical map showing areas of grey matter deficits in patients with moderate-to-astringent obstructive sleep apnea. The MIP is projected on a drinking glass brain in 3 orthogonal planes. Corresponding encephalon regions: C1, left superior frontal gyrus; C2–4, correct superior frontal gyrus; C5, left occipital gyrus; C6, correct supramarginal gyrus; C7, left superior temporal gyrus [61].

Non only sleep problems merely as well sleep duration could impact cortical maturation. Taki et al. [64] analyzed the correlation between slumber elapsing and cortical evolution in 290 school-anile children and adolescents, which are the most vulnerable populations suffering from sleep impecuniousness. They found that the regional grayness matter volumes of the bilateral hippocampal body likewise equally the correct dorsolateral prefrontal cortex were positively correlated with sleep duration during weekdays. It has been speculated that children with more than slumber problems could be delayed in reaching peak cortical thickness or advanced on the maturation curve of the prefrontal cortex [66].

Although there is abundant prove from behavioral and neurophysiological studies suggesting that sleep affects infants' cognitive and emotional development, at that place is lack of bear witness from imaging studies in this population, largely limited past the difficulties of imaging nonsedated children and the lack of assay tools tailored to very young children. Nevertheless, with the marked evolution of image acquisition approaches and the novel assay tools for infants and young children [1], we tin expect more studies delineating the furnishings of sleep on brain structural and functional networks in young children.

Disclosure Statement

The writing of this article was supported by Nestlé Nutrition Institute, and the author declares no other conflicts of interest.

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Author Contacts

Fan Jiang, Department of Developmental and

Behavioral Pediatrics, Pediatric Translational Medicine Institute

Shanghai Children's Medical Center, Shanghai Jiao Tong University

School of Medicine, 1678 Dongfang Road, Shanghai 200127 (PR Prc)

fanjiang@shsmu.edu.cn

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Article / Publication Details

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Received: March 28, 2020
Accepted: April 07, 2020
Published online: June nineteen, 2020
Issue release date: June 2020

Number of Print Pages: x
Number of Figures: two
Number of Tables: 1

ISSN: 0250-6807 (Impress)
eISSN: 1421-9697 (Online)

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