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The committee provided a written approval letter but did not issue a unique approval number for this study. All procedures were conducted in accordance with institutional guidelines, local regulations, and the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all adult participants. For pediatric participants, written informed consent was obtained from parents or legal guardians prior to data collection, and children provided verbal assent after age-appropriate explanations. Participation was voluntary, and participants could withdraw at any time. All data were anonymized, and no personally identifiable information was disclosed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"12909"}}