ABSTRACT This study aimed to determine the early literacy profiles of children with ASD. The study group consisted of 207 Turkish children diagnosed with ASD (M = 57.4, SD = 9.3) between 36 and 72 months. Receptive and expressive language skills were assessed using the Turkish Early Language Development Test (TELD-3), early literacy skills using the Test of Early Literacy (TEL) and print awareness using the Early Childhood Print Awareness Checklist (ECPAC). Nonverbal cognitive ability was measured with the Test of Coloured Progressive Matrices (CPM), and ASD severity was assessed using Childhood Autism Rating Scale (CARS). Data were analysed using Latent Profile Analysis (LPA), followed by descriptive and comparative analyses to examine differences across profiles and ASD severity levels. The LPA results revealed a three-profile structure. According to their age and developmental level, children in the first profile (40%) were categorised as performing at an average level in terms of early literacy skills, children in the second profile (44.7%) were categorised as low-performing, and children in the third profile (15.3%) were categorised as very low-performing. This study contributes to the literature by providing a data-driven, profile-based understanding of early literacy development in Turkish-speaking children with ASD within a transparent orthographic context.

This study aims to identify internal and external factors that influence the decline in the number of students in the Mathematics Education Study Program at PGRI Wiranegara University (UNIWARA). This study uses a quantitative approach with descriptive statistical analysis. The research subjects were all active students of the Mathematics Education Study Program at UNIWARA from the 2022–2024 cohorts, totaling 54 students, using total sampling techniques. Data were collected through Likert scale questionnaires, observations, and documentation, then analyzed using descriptive statistics through the calculation of mean values and percentages. The results showed that internally, the pedagogical quality of lecturers was in the fairly good category, but there were still weaknesses in academic management and supporting facilities, especially the stability of the lecture schedule and campus internet access. External factors included competition with other universities, more active and attractive promotional strategies, and consideration of tuition fees. Therefore, the decline in student enrollment is influenced by a combination of internal and external factors that require efforts to improve academic services and strengthen promotional strategies on an ongoing basis.

Effective communication, motivation, and self-efficacy are essential competencies for nursing students to deliver high-quality patient care. Educational strategies grounded in motivational theory, such as the ARCS model, may enhance these outcomes. This study aimed to examine the effects of an education program based on the ARCS motivational model on nursing students' communication skills, learning motivation, and academic self-efficacy. A mixed-method randomized controlled trial was conducted with sixty-four first-year nursing students randomly assigned to either an experimental group (n = 34), which received six hours of ARCS-based communication training, or a control group (n = 34), which received standard instruction. Quantitative data were collected pre- and post-intervention using validated instruments measuring communication skills, learning motivation, and academic self-efficacy. Qualitative data were obtained from reflective journals written by the experimental group and analyzed through inductive descriptive content analysis. The experimental group demonstrated significant improvements in ego-supportive language, active listening, and empathy (p < 0.05), whereas no significant change was observed in the I-language subscale. Only the experimental group showed significant increases in learning motivation and academic self-efficacy (p < 0.05), while the control group remained stable. Qualitative findings generated three overarching themes-Transformation in Communication, Motivation through ARCS, and Internalization and Development-which supported the quantitative results and illustrated enhanced emotional empathy, perceived relevance, and satisfaction. Education based on the ARCS motivational model significantly improved nursing students' communication skills, motivation, and self-efficacy. While affective and participatory competencies developed substantially, cognitive-reflective components may require extended or repeated interventions. The ARCS framework offers a robust pedagogical approach to fostering learner engagement and readiness in nursing education. Registered at ClinicalTrials.gov (NCT07004205 Registration date: 12.05.2025).

Disability is a major public health concern worldwide, particularly in sub-Saharan Africa, including East African countries (EACs), where its prevalence remains high. Effective planning for inclusive health services requires reliable data on prevalence and distribution of disability. However, EACs lack sufficient empirical data on the issue, hindering social services planning. This study aimed to examine socioeconomic and national disparities in reporting disability among individuals aged 5 to 95 years across five EACs. This study utilised secondary data from the most recent Demographic and Health Surveys (DHS), comprising a weighted sample of 216,420 individuals. The five EACs included were Democratic Republic of Congo, Rwanda, Malawi, Kenya and Tanzania. The dependent variable was disability status, while independent variables included demographic and socioeconomic factors. Descriptive analysis, chi-square test, and multivariable modified Poisson regression were employed to assess associations, with p-values < 0.05 indicating a significant factor. The overall prevalence of reporting disability in the five EACs, however, it varied across countries. was 15.4%. There was variation across countries; the highest prevalence (19.75%) recoded in Kenya and the lowest (9.94%) observed in the DRC. After controlling for other covariates, females (Adjusted prevalence ratio (APR);1.04;95%CI:1.35,1.80), individuals residing in rural areas (APR;1.10;95%CI:1.04,1.16), separated/widowed individuals (APR;1.27,95%CI:1.18,1.36), individuals from the poorest households (APR; APR;1.10; 95%CI: 1.04, 1.16), individuals who are covered by health insurance (APR;1.05;95%CI:1.01,1.09) and the female headed households (APR;1.14;95%CI:1.10,1.19) had higher prevalence ratio of reporting disability compared to their counterparts. Conversely, individuals from the Malawi had (APR;0.05;95%CI:0.40,0.67) lower prevalence ratio of people reporting disability compared to those who were from the DRC. In addition, there was interaction of age and education level in relation to disability. This implies that association between age and disability may be influenced differently depending on education level of an individual. This study highlighted a significant disability prevalence in EACs. Its associated factors included female gender, poorer economic households, rural areas and separation. There was interaction of age and education level on influencing disability. These findings emphasize the need for targeted interventions and further research into underlying mechanisms to improve support systems for vulnerable populations.

The sudden onset of the SARS-Cov-2 (COVID-19) pandemic disrupted access to in-person nutrition consultation and prompted the rapid adoption of telehealth by dietitians. This study investigates the use of telehealth among Lebanese Licensed Dietitians (LDs) during COVID-19, in the absence of national telehealth practical guidelines (TPG), and offers insights into its application amid overlapping crises including a pandemic, economic crisis, and infrastructure disruption in Lebanon. A cross-sectional study conducted in March 2023, using an anonymous 44-question online survey, distributed via the Lebanese Order of Dietitians and social media platforms. Participants: Ninety-four dietitians participated (98.9% female, mean(SD) age: 30.54(6.41) years); mean(SD) experience: 7.89(5.7) years). Most reported practicing clinical nutrition as their primary practice area (87.2%), primarily in weight management (84%). Main outcome: Measures included Dietitians' experience with telehealth, tools used in remote consultations, perceived barriers and facilitators, and perspectives on future application. Statistical analyses: Descriptive analysis (counts, frequencies) were analyzed using SPSS version 28. Telehealth use rose from 48.4% before COVID-19 to 97.8% during it. Commonly used platforms included WhatsApp (90.3%), Zoom (72.0%), and e-mails (41.9%). Reported barriers included bad internet connection (74.2%), patients preferring face-to-face consultation (61.3%), and patients unfamiliar with emerging videoconferencing technologies (33.3%). Benefits included scheduling and time flexibility (83.9%), decrease in practice-related costs (77.4%), and compliance with social distancing measures (53.8%). Most respondents acknowledged that Telehealth is needed (78.5%) and applicable in the Lebanese context (64.6%) and called for telehealth trainings (78.5%) and national TPG development (74.2%). This study recognizes the growing use of telehealth in Lebanon, underscoring the need for telehealth with national regulations and evidence-based guidelines. Despite limited infrastructure, LDs continued delivering care, emphasizing the urgency for secure and standardized frameworks to support ethical and sustainable digital health practice.

This study examines the influence of capital strengthening, corporate governance implementation, and risk management on financial performance and its implications for the business sustainability of PT BPR Rama Ganda Bogor during 2017–2024. The study is motivated by the critical need to integrate these three elements to maintain the stability and competitiveness of rural banks (BPR) amid global economic challenges, the pandemic, and increasing regulatory pressures. Financial performance is measured using CAR (Capital Adequacy Ratio), LDR (Loan to Deposit Ratio), NPL (Non-Performing Loan), and ROA (Return on Assets), while business sustainability is evaluated based on the bank’s ability to develop products, maintain customer trust, and comply with sustainable finance principles. Descriptive analysis indicates an average CAR of 21.36%, LDR of 90.01%, NPL of 11.30%, and ROA of 3.25%, reflecting adequate capital stability and sufficient liquidity but room for improvement in asset quality. Findings reveal that capital strengthening, corporate governance, and risk management collectively have a significant impact on financial performance. Furthermore, strong financial performance positively influences business sustainability, including regulatory compliance, expansion of sustainable credit portfolios, and maintenance of stakeholder confidence. The study emphasizes that the synergy between capital, governance, and risk management must be internalized integrally into organizational culture and strategy, enabling BPR to manage risks effectively, maintain profitability, and ensure long-term business continuity. The results provide strategic recommendations for BPR and similar microfinance institutions to optimize capital, governance, and risk management as foundations for growth and sustainable operations in an uncertain economic environment.

Transition services are of critical importance in equipping students with special needs for the future. Students with learning disabilities may experience greater challenges unless they receive specialized assistance. The aim of this study is to understand the challenges faced by a student with learning disabilities and her parent during the transition from primary to secondary education and to provide a framework for developing effective transition strategies. A case study design, one of the qualitative research methods, was adopted for the current study. In the study, which employed a purposive sampling method, the participants were a middle school student with learning disabilities, her parent, and the researcher. The data were gathered through a semi-structured interview form, the researcher’s field notes, and document analysis. Descriptive analysis was performed to analyze the research data. The findings illustrated that both the parent and the student with learning disabilities experienced ambiguities during the transition process, felt a lack of guidance in their career choices, and were psychologically exhausted. Furthermore, teachers and families should be encouraged to be more actively involved in the process, and psychological support should be provided. In the context of Türkiye, reviewing legal regulations and shaping educational policies according to the needs of students with learning disabilities is of primary significance.

Spiritual care occupies a special position in overall care and improving the quality of services provided to patients. However, China's higher nursing education is still in its infancy. The purpose of this research is to explore the heterogeneity of spiritual care competence of undergraduate nursing students in China. A multicenter cross-sectional design was employed. From July 2024 to February 2025, a convenience sample of 1,224 undergraduate nursing students was recruited from four nursing colleges in the Guanzhong region of Shaanxi Province, China. Data were collected using the Chinese versions of the Spiritual Care Competence Scale, the Spiritual Care Cognition Scale, and the Meaning in Life Questionnaire. Descriptive and correlational analyses were performed using SPSS version 27.0, while latent profile analysis and ordinal logistic regression were conducted using Mplus version 8.0. The mean total score for spiritual care competence was 77.61 ± 14.61. Latent profile analysis identified three distinct profiles: a low-competence group (47.1%, 62.3 ± 8.2), a moderate-competence group (42.1%, 79.6 ± 6.7), and a high-competence group (10.8%, 95.1 ± 7.9). The model demonstrated high classification accuracy, with an entropy value of 0.948, and the Lo-Mendell-Rubin likelihood ratio test (LMRT) was significant (p = 0.006). Spiritual care competence was significantly positively correlated with spiritual care cognition (r = 0.540) and sense of meaning in life (r = 0.479) (both p < 0.01). Ordinal logistic regression indicated that lack of clinical internship experience, distant teacher-student relationships, absence of humanistic care education, lower levels of spiritual care cognition, and lower sense of meaning in life were key predictors of membership in lower competence profiles. The spiritual care competence of undergraduate nursing students in China is underdeveloped and urgently needs to be improved. Their potential profiles can be divided into three categories, namely C1-low spiritual care competence, C2-medium spiritual care competence and C3-high spiritual care competence. Clinical internships, effective teacher-student mentoring, humanistic education, as well as individual spiritual cognition and sense of meaning in life, are key facilitators of competence development. It is recommended to integrate structured spiritual care training into undergraduate nursing curricula and to establish a systematic mentorship program.

Natural water sourced from spring-fed outlets in rural territories represents a resource with the potential to generate economic value when its management is articulated through a marketing approach focused on origin, trust, and perceived quality. In Panama—particularly in the province of Coclé—the presence of these natural water sources contrasts with weakly structured commercialization practices, which restrict their positioning in local markets dominated by industrial brands. The objective of this study is to analyze the marketing and commercialization strategies associated with natural spring water in rural areas of Coclé, identifying the factors that influence consumer trust, willingness to pay, and purchase intention, as well as the opportunities for cooperative-based commercialization models oriented toward local development. The research adopts an applied mixed-methods approach. The quantitative phase involves structured surveys administered to consumers and local retailers, while the qualitative phase incorporates semi-structured interviews with producers and key stakeholders within the value chain. Data analysis integrates descriptive statistics and thematic analysis from a territorial marketing perspective. The findings indicate that rural origin, perceived purity, and trust in the water source exert a stronger influence on perceived value than price. The study concludes that origin-based and territorial marketing strategies constitute a viable pathway to strengthen the sustainable commercialization of natural water and to support inclusive local economic development in rural contexts.

The use of school websites has been widely discussed in previous studies; however, research that specifically focuses on the development of school information service systems that are collaboratively managed through a multi-user approach remains relatively limited. Common problems include inactive school websites, lack of sustainable management, and content management centralized in a single administrator, which hinder the effectiveness of information services. This study aimed to develop a web-based information service system at SMK Negeri 1 Padang that is capable of integrating school information management in a centralized, structured, and collaborative manner. The study employed a software engineering approach using a Research and Development (R&amp;D) method with a Waterfall development model. Research participants included the administrative office, curriculum staff, teachers, the treasurer, and students, who were selected through purposive sampling. Data were collected through observations, structured and semi-structured interviews, and document analysis, then analyzed using qualitative descriptive and technical analysis. The results showed that the developed system was able to enhance the effectiveness of managing and delivering school information through the implementation of multi-user features, data integration, and the application of the Model–View–Controller architecture in the Laravel framework. These findings contribute to the development of educational information systems by emphasizing the importance of role-based access management in supporting schools’ digital transformation, while also providing a practical solution for improving transparency, accessibility, and the quality of information services for the wider community.

The study investigated the impact of credit risk management on the profitability of commercial banks in Ethiopia. The research adopted explanatory research design and a quantitative approach were employed. It used descriptive and inferential statistical analyses techniques. The population of this study includes 31 commercial banks that are working in Ethiopia, from which a purposive sample of ten leading banks were selected on the basis of their branch network and operational age. The study is panel from the period between 2013 and 2023. The Random effects Generalized Least Squares model was utilized as panel data regression analysis to test the impact of credit risk management factors on bank performance. The regression result shows that Non-Performing Loans were found to have a significant negative impact on bank profitability, which implies that a high level of non-performing loans decreases bank profitability, emphasizing the importance of effective credit risk management. Conversely, and contrary to conventional assumptions, both a higher Loan to Total Asset Ratio and Loan to Deposit Ratio were unexpectedly associated with decreased profitability, suggesting an optimal threshold for lending activity exists beyond which excessive loan expansion introduces detrimental liquidity and credit risks. In alignment with established financial principles, Capital Adequacy significantly enhanced bank performance, underscoring its crucial role in providing essential buffers against losses, maintaining stability, and fostering stakeholder confidence for sustainable returns. Bank size as measured by total assets is positively related to better performance but insignificance effect on it.

Background: The financing of health care is a key element to achieve Universal Health Coverage (UHC), although several households in Uganda are still at risk of financial burden due to the lack of adequate insurance coverage and low public funding. Therefore, this study analyzed the primary financing of health care options utilized by households living in urban areas in Iganga Municipality, the difficulties that have been encountered and household recommendations to improve the access to high-quality care. Methods: A cross-section household survey was conducted in Iganga Municipality between June 2024 and October 2025. All of the households in the municipality were randomly sampled and all data were collected electronically from the household head or the designated representative (greater than or equal to 18 years), including emancipated minors (15 to 18 years) who act as the household head. Descriptive and inferential statistical analyses were performed in STATA, including bivariate tests and multivariable logistic regression for predictors of reporting good perceived quality of care. Results: In total 403 households were included in the analysis. Approximately 58.2 percent of the households included in the sample were 18 to 35 years of age. Funding through public sources was the predominant (74.2 percent) primary financing method, followed by out-of-pocket (OOP) payments (23.8 percent) and private insurance and mixed financing methods were infrequent (1.0 percent each). For public funded households, quality was the most frequently reported challenge (47.5 percent), while for OOP funded households, affordability was the most frequently reported challenge (46.3 percent). Compared with public funding, OOP financing was an independent predictor of reporting good perceived quality of care (AOR equal to 2.52, 95 percent CI: 1.49 to 4.29) and higher household incomes (greater than UGX 1,000,000) also predicted good perceived quality (AOR equal to 2.61, 95 percent CI: 1.08 to 6.33). Conclusion: Households residing in urban areas primarily rely on public services with ongoing concerns regarding quality, while self-payment was related to perceived quality but was also associated with increased affordability challenges. Recommendations from households emphasized cost reductions or subsidies to reduce costs, increasing the strength of the health workforce, improving the facilities, and ensuring consistent availability of medicines and medical supplies.

Despite having a significant socio-economic impact on a country’s growth, one of the biggest contributors to waste generation is the construction sector, thus increasing the necessity for innovative construction waste management strategies. Lean Construction (LC) is a much-adopted methodology that helps manage construction waste efficiently. This study investigates the barriers to LC implementation in the UAE’s building construction sector, with a specific focus on its potential for effective construction waste management. Recognizing the urgent need to adopt sustainable practices in the face of escalating environmental concerns, the study employs a quantitative exploratory approach combining literature synthesis, expert validation, descriptive statistical analysis, Relative Importance Index (RII) ranking, and Partial Least Squares Structural Equation Modeling (PLS-SEM) to examine stakeholder perceptions across eight critical categories: Knowledge/Awareness, Attitude, Management, Government, Financial, Material/Resource, Technical, and Other contextual factors. The RII analysis ranks these barriers based on stakeholder responses, while the PLS-SEM approach models the strength and significance of their interrelationships within a validated structural framework. The findings reveal that while all eight categories significantly influence stakeholder perceptions, Attitude and Management factors exhibit the strongest impact, highlighting the importance of behavioral and organizational readiness in enabling LC adoption. The key deliverable of this research is a validated and empirically supported structural model that provides a strategic roadmap for overcoming resistance to LC implementation. By offering actionable insights into which barriers matter most and how they interact, the study equips policymakers, contractors, and industry stakeholders with evidence-based guidance to design targeted interventions. Ultimately, this research contributes to the growing discourse on sustainable construction by positioning LC as a viable pathway for reducing construction waste and improving efficiency in the UAE context.

Clinical training exposes nursing internship students to intense ethical challenges that may threaten their sense of meaning and contribute to psychological emptiness. Protective psychological and moral resources, such as purposefulness and moral resilience, may play a crucial role in mitigating this existential vulnerability. This study aimed to test a structural model examining the direct and indirect associations between purposefulness and psychological emptiness, with moral resilience as a mediating variable, among nursing internship students. A cross-sectional study was conducted among 215 nursing internship students in Tabriz, Urmia, and Ardabil, Iran. Data were collected using the Sense of Purpose Scale-Revised Persian Version (SOPS-2-PERS), the Rashed Moral Resilience Scale (RMRS), and the Psychological Emptiness Scale (PES). Descriptive and inferential analyses were performed using SPSS v14. Structural equation modeling (SEM) with bias-corrected bootstrap procedures (5000 resamples) was conducted in AMOS 24.0 to examine the hypothesized relationships. The proposed structural model demonstrated a good fit to the data. Purposefulness was positively associated with moral resilience, and moral resilience was negatively related to psychological emptiness. Although the direct association between purposefulness and psychological emptiness was negative, it did not reach statistical significance. Bootstrap analysis confirmed a significant indirect effect of purposefulness on psychological emptiness through moral resilience, indicating that the association was transmitted mainly via moral resilience. The findings suggest that moral resilience plays a key mediating role in the relationship between purposefulness and psychological emptiness. Enhancing students' sense of purpose may reduce psychological emptiness, primarily by strengthening moral resilience during clinical training. Not applicable.

Spatial Characteristics of Double Puncture in Dental Anesthetic Cartridges: A Descriptive Morphological Analysis of Procedural Puncture Patterns

Background: Early childhood motor development plays a critical role in shaping participation and quality of life for children diagnosed with autism spectrum disorder. Parental perspectives provide unique insights into barriers, facilitators, and the real-world impact of interventions. Objectives: This study applied qualitatively led an exploratory mixed-method design grounded in a biopsychosocial paradigm. The qualitative component captured parental narratives, while quantitative summaries were generated to identify consensus areas of motor challenges and environmental influences. This dual approach aimed to reveal both the diversity of lived experience and recurring patterns that may inform screening and intervention planning. Methods: Semi-structured interviews were conducted with 58 parents of preschool-aged children diagnosed with autism spectrum disorder in Hungary. Transcripts were analysed thematically, and through descriptive frequency summaries and exploratory chi-squared analyses of coded data. Results: Parents consistently reported fine and gross motor differences, with consequences extending to participation in family, school, and community contexts. Early diagnosis was seen as beneficial primarily when it facilitated access to supportive services. Environmental adaptations, such as inclusive playgrounds and adaptive tools, were perceived by parents as enhancing children’s opportunities to participate, while the lack of accommodations amplified difficulties. Interventions embedded in real-life contexts and actively involving families were viewed as most effective. Exploratory quantitative summaries indicated consensus on five key challenges, including pencil grip, small object manipulation, and playground participation. Conclusions: The findings demonstrate that motor development in autism spectrum disorder is best understood within a biopsychosocial framework linking individual abilities, environmental modifications, and social acceptance. By integrating qualitative and quantitative perspectives, this study illustrates how family experiences can inform the design of family-centred interventions and context-sensitive policies that foster meaningful participation.

This study examines the integration of Generative Artificial Intelligence (GenAI) into rubric-based qualitative assessment to strengthen authentic evaluation and complex thinking competencies in business education. Conducted at a graduate business school in Peru with 120 student portfolios, the research adopted a qualitative exploratory-documentary approach, complemented by a correlational analysis between human and AI evaluations to enhance the interpretive validity of the findings. A pilot subsample ( n = 12) was used for the correlational analysis comparing human and AI-assisted assessments, while descriptive analyses of complex thinking levels were conducted on the full sample ( n = 120) using the AI agent. The study employed the GPT-eComplex Assistant, a GenAI-based evaluator developed from ChatGPT and configured with the eComplex rubric, to identify recurring patterns, strengths, and areas for improvement without replacing human pedagogical judgment. The findings revealed that: (a) the GPT-eComplex Assistant closely mirrored human evaluators’ judgments, reinforcing consistency, traceability, and transparency, although still requiring teacher calibration; (b) the digital portfolio served as an authentic learning artifact to capture systemic and critical thinking, while showing limitations in the scientific dimension; (c) the use of GenAI for assessment in higher education remains incipient and under-researched, underscoring the need for empirical evidence and ethical guidelines; and (d) the responsible integration of GenAI demands active teacher mediation, ethical awareness, and institutional transparency, ensuring that technology complements rather than replaces pedagogical judgment. This study contributes a pedagogical strategy that combines formative portfolio assessment, AI-supported co-evaluation, and the AI-PROMPT Framework, offering a replicable model for embedding GenAI into authentic, reflective, and ethically grounded assessment practices in higher education. The results represent an innovative contribution by positioning GPT as a complementary tool in authentic assessment, reinforcing the central role of human judgment and opening new perspectives for AI-supported evaluation in the Ibero-American and beyond.

Chest pain is a frequent reason for evaluation at military treatment facilities in the deployed setting. Deployed persons are generally at low risk of coronary disease as the underlying cause for these symptoms; however, morbidity and mortality from acute coronary syndrome in an austere environment can be catastrophic. For theaters with access to computed tomography (CT), Coronary CT Angiography (CCTA) offers a diagnostic modality to effectively rule out this high-risk diagnosis in low to intermediate risk patients. The researchers present a descriptive analysis of CCTA use at a deployed Role 3 over a deployment rotation spanning 8 months. The researchers devised a CCTA protocol and delivered this diagnostic modality at a deployed Role 3 MTF. They included patients presenting with chest pain and stratified by the treating cleinician as intermediate risk given a history, electrocardiogram, age, cardiac risk factors, Troponin T, HEART score, and bedside echo when available. The CT scanner used by the researchers was a Siemens SOMATOM go, Top 128 slice, 70 cm bore, equipped with hardware to perform electrocardiography (ECG) gated studies and postprocessing. The researchers beta blocked patients to a target heart rate of 50-60 prior to each study, and administered a single 0.4 mg tab of sublingual nitroglycerin 4-7 minutes prior to starting angiography. They performed pre-angiography unenhanced CCTA to determine calcium score. Later, they performed ECG gated CCTA following intravenous (IV) contrast administration. The researchers performed four CCTA studies on symptomatic patients, each of whom also received a pre-angiogram CT calcium score. All four patients successfully completed the protocol. All four patients had a calcium score of 0. CCTA was low risk without any visible coronary disease for two patients and non-diagnostic for the remaining two patients. There was no major adverse event. One patient experienced a small volume IV access site infiltration at the end of the contrast bolus injection which did not limit that respective exam. The remaining patients did not experience any minor or major adverse events. The initial data of this study is proof of concept that CCTA is feasible for assessing intermediate risk patients presenting with acute chest pain in the deployed setting, to rule our coronary pathology. The researchers' initial evaluation shows promise and suggests that this is a useful modality to continue to utilize and study in this environment.

This study analyzes the production dynamics of two critical legume species in Turkey's agricultural production pattern-dry beans (Phaseolus vulgaris L.) and vetch (Vicia spp.)-for the 2020-2024 period, using high-resolution panel data from the Turkish Statistical Institute (TÜİK). The research examines indicators such as Sown Area, Harvested Area, Yield (kg/da), and Production Quantity (ton), with vetch further disaggregated by green fodder and seed production purposes and by Common, Hungarian, and Other species. Findings reveal a general contraction trend in the sown area for all products and species during the five-year period. The decrease of over 60% in the sown area for Other Vetch species is particularly noteworthy. In contrast, the increase in dry bean yield to 304 kg/da in 2024 and the rise in Hungarian vetch seed yield from 128 kg/da in 2020 to 204 kg/da in 2024 may suggest positive impacts from improvements in production technologies and adaptation strategies. The negligible difference (&lt;0.5%) between Sown Area and Harvested Area suggests no significant area loss occurred during the production processes. This study documents the structural transformation of strategic legume production under climatic and economic pressures and emphasizes the importance of area-based productivity increase for developing sustainable production policies, providing evidence crucial for evidence-based agricultural policy formulation.

Puzzles stimulate children to recognize relationships between parts and wholes, understand patterns and shapes, hone visual memory skills, practice cause-and-effect logic, and develop simple strategies through trial and error. This study aims to determine the cognitive abilities of children in the control group and the experimental group before and after being given learning using puzzle media. The type of research used is quantitative with quasi-experimental design or pseudo-experimental research. Using data collection techniques in the form of observations, tests, interviews, and documents. The data analysis used goes through two stages, namely descriptive statistical analysis and inferential analysis. Descriptive analysis is used to provide an overview of children's cognitive development, while inferential analysis is used to test hypotheses whether there is a significant difference between the experimental group (puzzle media) and the control group (conventional learning). The results showed that the gross motor development of children aged 5-6 years after participating in learning with fuzzle media in the experimental group could be said to be significant based on the results of the paired sample t test with a p-value smaller than the significance level of 5%. The gross motor development of children aged 5-6 years after participating in learning with conventional media can be said to be significant based on the results of the Wilcoxon Signed Rank test with a p-value greater than the significance level of 5%. Based on the results of the Independent Sample T-Test, it was found that the p-value was smaller than the significance level of 5%, so there was a significant difference in the cognitive development of children aged 5-6 years between the groups that participated in learning using fuzzle media and conventional media.