The Importance of Diagnostic Vigilance Amid Cultural Barriers in Pediatric Oncology: A Case of Atypical B-ALL

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Pediatric cancers have the ability to spread rapidly, however, they also respond well to chemotherapy, and can have incredible success rates when diagnosis and intervention are implemented early. This case report describes an unusual presentation of B-ALL in a patient whose treatment was initially delayed due to barriers of cultural origin. The child initially presented with high fevers and vomiting, with mild abdominal distention and tenderness. With concern for sepsis or the need for surgical intervention, the pediatrician urged the family to proceed to a tertiary care center for further workup. The family felt these processes were unnecessary and felt that he would recover at home with over-the-counter medications. As the boy remained ill, emergency care was sought, and further investigations revealed a diagnosis of B-cell acute lymphoblastic leukemia. With this case report, we examine the importance of diagnostic vigilance amongst physicians to ensure a prompt and accurate diagnosis, while remaining mindful of cultural factors that may complicate clinical assessment and compliance.

Antecedents of Perceived Usefulness in the Continuance Usage Intention of QRIS Merchant Services: An Empirical Study of Users in Solo City, Indonesia

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This study aimed to investigate the antecedents of perceived usefulness in the continuance usage intention of QRIS merchant services in Solo City, drawing upon the Expectation Confirmation Model (ECM) and extending it with facilitating conditions and perceived risk. The cross-sectional survey data from 201 merchants using QRIS in Solo City and analyzed it using Smart-PLS. This study showed that confirmation significantly impacts perceived usefulness but does not directly affect satisfaction, indicating that the influence of confirmation on satisfaction operates through the mediating mechanism of perceived usefulness. Satisfaction emerges as the primary driver of continuance usage intention, confirming its central role in post-adoption behavior. Facilitating conditions significantly enhance perceived usefulness, while perceived risk diminishes it. Perceived usefulness significantly influences satisfaction but does not directly affect continuance usage intention. The mediating analysis revealed that perceived usefulness fully mediates the confirmation-satisfaction relationship, while satisfaction does not mediate the perceived usefulness-continuance intention relationship. The results of this study confirmed the substantial role of cognitive and affective factors in shaping continuance usage intention. This research contributes to the development of theory by validating the relationships drawn from the Expectation Confirmation Model, and the novelty is the introduction of facilitating conditions and perceived risk as antecedents of perceived usefulness in the ECM framework. The research findings provide some practical implications and valuable insights for QRIS service providers, policymakers, and merchants in the environmental condition where technological and economic changes may occur at any time without certainty.

Enhancing Customer Satisfaction through Talent Management and Innovative Work Behavior: The Mediating Role of Operational Performance in Reducing Lightning-Induced Claims in a Telecommunication Tower Company

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This study examines the effect of talent management and innovative work behavior on customer satisfaction through operational performance in reducing lightning-induced claims at XYZ Company in Area 1 Sumatra. A quantitative approach with a causal and cross-sectional research design was employed. The population consisted of 11,260 operational sites, from which 400 sites were selected using the Slovin formula. The unit of analysis was the operational site, while the units of observation included managerial representatives and customer representatives. Data were collected using a structured questionnaire measured on a five-point Likert scale and analyzed using Partial Least Squares Structural Equation Modeling (SEM-PLS). The results show that talent management has a positive and significant effect on operational performance and innovative work behavior. Operational performance also has a positive and significant effect on customer satisfaction. However, innovative work behavior does not directly affect operational performance or customer satisfaction. The direct effect of talent management on customer satisfaction is significant but negative, indicating that internal talent practices do not automatically improve customer satisfaction unless they are translated into better operational outcomes. Furthermore, operational performance significantly mediates the relationship between talent management, innovative work behavior, and customer satisfaction. These findings emphasize that customer satisfaction in lightning-induced claim management is more effectively improved through reliable operational performance supported by strong talent management and structured innovation practices.

Consumer Preferences for Purchasing Local Fruits at The Farmers Market Supermarket in Palembang City

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Fruit consumption in Palembang City remains below the World Health Organization (WHO) recommendation and has not reached an optimal level. Meanwhile, the increasing availability of imported fruits creates competition and affects consumer preferences toward local fruits. This study aims to identify the attributes influencing consumer preferences, analyze the dominance of physical and non-physical attributes, and examine the effect of imported fruit presence. A quantitative survey was conducted involving 100 respondents selected through accidental sampling. Data were analyzed using the Fishbein multi-attribute model, multiple linear regression, and path analysis. The results show that freshness, taste, and price are the main attributes shaping consumer attitudes. The attitude score (Ao) is categorized as high (101.167 or 67.44%), indicating that stronger positive attitudes are associated with higher consumer preferences for local fruits. Regression analysis reveals that product attributes significantly influence preferences, with physical attributes as the dominant factor. Meanwhile, the presence of imported fruits does not have a significant effect. These findings indicate that consumer preferences are mainly driven by product attributes and attitudes, suggesting that improving the quality of local fruits is essential to enhance their competitiveness.

Explainable Pneumonia Detection in Chest X-Rays: A Comparative Study of CNNs and Vision Transformers

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Pneumonia is a leading cause of global mortality, especially among children and the elderly, and chest radiography (CXR) remains the most widely used modality for its diagnosis. While deep learning has reached or exceeded radiologist-level performance on this task, the resulting models are still treated as opaque black boxes, which is a critical barrier to clinical deployment. In this work, we present a comparative and interpretable computer-aided-diagnosis (CAD) framework for pneumonia detection that combines three modern image-recognition backbones—a convolutional ResNet-50, a Swin Transformer (Swin-T), and a modernised convolutional network (ConvNeXt-T)—with Gradient-weighted Class Activation Mapping++ (Grad-CAM++) explanations. The three backbones were fine-tuned on the public Kermany chest X-ray dataset using a class-balanced training subset, weighted cross-entropy and an early-stopping protocol, and then evaluated on the held-out test set of 624 images. The Swin-T backbone achieved the best overall performance with a test accuracy of 95.51%, an F1-score of 0.95 and only 11 false negatives out of 234 normal cases, outperforming both ResNet-50 (93.11%) and ConvNeXt-T (88.94%). Grad-CAM++ heatmaps generated from the convolutional and transformer feature maps consistently localised on the affected pulmonary regions, providing radiologically plausible visual evidence for each prediction. Compared with five recent state-of-the-art pneumonia detectors, our Swin-T-based pipeline reaches a competitive accuracy while delivering layer-faithful visual explanations, supporting its use as a transparent decision-support tool in clinical workflows.