Search Results (1,818)

The purpose of this study is to explore how Zimbabwean firms use Environmental Management Accounting (EMA) and climate risk disclosure amid climate policy uncertainty and how managers perceive these practices as relevant to organisational resilience and long-term sustainability within a volatile institutional and macroeconomic context. The study was couched in the interpretivist research philosophy and adopted the inductive research approach. A case study research design, which aligns with a qualitative research design, was chosen for the study. The study employed in-depth interviews with management accountants, finance executives, and industry leaders across firms in Harare. The study adopted the cross-sectional time horizon and analysed data using thematic analysis to develop insights into the role of EMA and climate risk disclosure in times of policy uncertainty. The findings suggest that participants perceived climate policy uncertainty as influencing organisational efforts to reconfigure management accounting practices through greater environmental performance monitoring, adaptive budgeting, and scenario-based planning. The findings of this study suggest that organisational actors interpreted climate policy uncertainty as a condition requiring greater flexibility in budgeting, environmental monitoring, and strategic planning. Participants in this study associated EMA with improved environmental cost visibility and more adaptive approaches to investment appraisal and risk management under uncertain policy conditions. Similarly, participants perceived climate risk disclosure as increasingly crucial for strengthening organisational legitimacy, stakeholder confidence, and institutional credibility. While respondents linked sustainability-oriented accounting adaptation to broader organisational resilience and long-term sustainable growth aspirations, these relationships were understood through managerial perceptions and organisational experiences rather than as directly measurable macroeconomic outcomes. The study contributes to the sustainability accounting literature by providing qualitative, context-sensitive insights into how managers in an emerging economy interpret climate policy uncertainty and adapt EMA and climate risk disclosure practices within volatile institutional conditions. The study further contributes by integrating sensemaking theory and institutional theory to explain how organisational interpretations of uncertainty shape sustainability-oriented accounting adaptation and perceptions of organisational resilience. It is therefore recommended that the regulatory institutional pillar be strengthened to reduce uncertainty and enhance the EMA’s strategic adaptation. Full article

Viral hemorrhagic fevers (VHFs) are severe infectious diseases caused by RNA viruses of the families Arenaviridae, Filoviridae, Flaviviridae, and Hantaviridae, characterized by high morbidity, significant case fatality rates, and frequent diagnostic uncertainty in early disease stages. For military medical services, timely clinical recognition and laboratory confirmation are essential to guide patient management, prevent nosocomial transmission, and maintain operational continuity, particularly in endemic or resource-limited deployment settings. This review critically examines current diagnostic approaches to VHF-causative agents, emphasizing their use in clinical and field medical settings. The diagnostic process, from exposure through specimen collection, laboratory testing, and result interpretation is analyzed, including the use of molecular, serological, and antigen-based assays. Particular attention is given to deployable diagnostic platforms and their role in bridging the gap between frontline clinical suspicion and definitive laboratory confirmation. Biosafety requirements and infection prevention measures are discussed as integral components of clinical diagnostic workflows, aligned with guidance from the World Health Organization and the Centers for Disease Control and Prevention. Comparative analyses of virus-specific diagnostic timelines and laboratory requirements are presented to support differential diagnosis and clinical decision-making. Emerging technologies, including rapid molecular assays and genomic methods, are evaluated for their potential to improve early diagnosis and patient outcomes. This review highlights the central role of diagnostic readiness in clinical management of the VHFs and provides evidence-based considerations to support military clinicians facing high-risk febrile illnesses in operational environments. Full article

Dermatophytosis remains one of the most prevalent superficial fungal infections worldwide and is increasingly encountered as a persistent or difficult-to-treat syndrome. A major clinical problem is that apparent treatment failure is often attributed to antifungal resistance, although many cases are instead driven by diagnostic uncertainty, corticosteroid-modified disease, reinfection, inadequate exposure, poor adherence, and limited drug delivery within keratinized tissues. This narrative review was developed to clarify the distinction between true antifungal resistance and clinical recalcitrance, with particular attention to terbinafine-resistant Trichophyton species, Trichophyton indotineae, tinea incognito, onychomycosis, dermatophytoma, and high-barrier skin and nail infections. We synthesized peer-reviewed literature and guideline-level evidence addressing epidemiology, molecular mechanisms of resistance, clinical phenotypes of recalcitrance, diagnostic escalation, therapeutic decision-making, and antifungal delivery in keratinized tissues. The review contributes a dermatology-centered conceptual framework in which persistent dermatophytosis is interpreted through both microbiological resistance and modifiable recalcitrance drivers. This approach emphasizes confirmation of fungal disease when indicated, phenotypic and anatomic classification, avoidance of inappropriate corticosteroid combinations, optimization of dose, duration, vehicle, and adherence, measures to improve drug access and reduce protected fungal burden in high-barrier disease, and prevention of reinfection from reservoirs. The proposed framework may support more rational antifungal use and reduce unnecessary escalation; however, it is based on narrative synthesis rather than a systematic review or prospective validation. Additional studies are needed to determine how such structured clinical approaches affect clinical outcomes, relapse rates, antifungal exposure, and resistance emergence in real-world dermatology practice. Full article

Global retail e-commerce sales have surged, yet product fit uncertainty remains a significant challenge, leading to rising product return rates. To address consumer concerns about return shipping costs, major Chinese online retail platforms have introduced return shipping insurance (RSI). Retailers can choose between Retailer-RSI (RRSI), which is provided by the retailer, and Customer-RSI (CRSI), which is purchased by consumers. Despite these options, information asymmetry causes insurers to assess return rates with bias—referred to as managerial confidence bias. Consequently, platforms are increasingly partnering with insurers to enhance their RSI offerings. This study develops a game-theoretical model to examine the dynamics between a platform and an insurer, as well as the impact of managerial confidence bias on RSI strategies. Our analysis reveals that the platform–insurer relationship is crucial in determining the optimal RSI strategy. Under an independent insurer, RSI is viable only if the insurer underestimates product return rates (i.e., exhibits overconfidence bias); RRSI is preferred if the bias is sufficiently strong, whereas CRSI is chosen otherwise. In contrast, under a dependent insurer, CRSI is favored by the retailer only when its return handling costs are substantially high; otherwise, RRSI is preferred. Furthermore, RSI consistently increases consumer surplus by reducing return hassle costs while only mildly raising the product price. However, the independent insurer’s bias leads to its own profit loss, resulting in a “loss–win–win–win” scenario across stakeholders. In contrast, the dependent insurer, supported by platform subsidies, can yield a “win–win–win–win” outcome that aligns stakeholder interests and enhances long-term platform benefits. Full article

Micro- and nanoplastics (MPs/NPs) are ubiquitous environmental contaminants increasingly detected in air, food, drinking water, and human tissues, raising concerns about their potential long-term health effects. Accumulating evidence indicates that these particles can enter the human body, cross biological barriers, and elicit cellular and molecular responses relevant to disease development. This review synthesizes current mechanistic evidence linking MP/NP exposure to cardiovascular disease (CVD) and cancer, two leading global causes of morbidity and mortality that share interconnected pathogenic pathways. Key mechanisms include chronic inflammation, oxidative stress, gut microbiota dysbiosis, genotoxicity, and epigenetic alterations, all of which are widely implicated in both conditions. However, the available evidence is still largely derived from in vitro and animal studies, with limited human epidemiological data. Important uncertainties remain regarding real-world exposure characterization, dose–response relationships, and long-term clinical outcomes, underscoring the need for standardized analytical approaches, validated exposure and effect biomarkers, and large-scale longitudinal studies to clarify causal associations for both cancer and CVD. Taken together, current evidence suggests that MPs/NPs may represent emerging environmental contributors to shared pathogenic pathways linking CVD and cancer; however, establishing causality in humans will require well-designed longitudinal studies that integrate exposure assessment and clinical outcomes. Full article

Background/Objectives: Rehospitalization after traumatic spinal cord injury (SCI) is common, but binary or count summaries may obscure heterogeneity in timing, recurrence, frequency, and duration. We aimed to identify clinically interpretable rehospitalization burden profiles in the SCIMS 2021ARPublic dataset and examine descriptive associations with clinical correlates and participation outcomes. Methods: We analyzed Form I, Form II, and Record Status public-use files. Among 29,310 individuals with at least one non-lost follow-up interview, 28,745 with at least one non-missing rehospitalization indicator entered latent class analysis. Four prespecified indicators captured early, recurrent, frequent, and prolonged rehospitalization. Candidate two- through six-class models were compared using AIC, BIC, entropy, class size, posterior probabilities, and interpretability. Pairwise adjusted logistic models examined candidate clinical correlates in 10,407 participants with complete 2016+ follow-up data. Adjusted linear models examined CHART participation domains in 20,766–20,949 participants. Results: A four-profile solution was retained: low rehospitalization burden (59.8%), early/prolonged rehospitalization (18.9%), frequent/prolonged rehospitalization (7.7%), and high recurrent/frequent/prolonged burden (13.6%). UTI and pressure ulcer history showed the most consistent associations with burdened profiles. Severe pain and frequent sleep problems were associated with selected heavier-burden profiles, while depressive symptoms showed smaller and less precise associations. Sensitivity analyses supported structural stability while highlighting observation-time bias and classification uncertainty inherent to wave-based public-use data. Compared with the low-burden profile, burden profiles showed lower CHART scores, especially for mobility and occupation. Conclusions: Rehospitalization after traumatic SCI is heterogeneous. These utilization burden profiles summarize distinct observed patterns but require prospective validation before use in risk stratification or follow-up planning. Full article

Grounded in dynamic capability theory, this research examines the impact of AI-enabled logistics optimization (ALO) on logistics process efficiency (LPE) and sustainable supply chain performance (SSCP). It further explores the mediation of LPE and the moderation of environmental uncertainty (EU). A structured online questionnaire was distributed to 600 participants via stratified random sampling from June to December 2025, resulting in 380 valid responses, and was analyzed using structural equation modeling. The results include a significant influence of ALO on LPE and SSCP. In addition, LPE significantly affects SSCP and partially mediates the ALO–SSCP relationship. Additionally, the EU significantly moderates the ALO–SSCP relationship, identifying that ALO becomes more performance-related under a volatile and uncertain operational environment. The research is based on cross-sectional survey data with self-reported outcomes. Future research is recommended to employ longitudinal or multi-source research methods. It also suggested examining other mechanisms for dynamic capabilities (e.g., agility, resilience) across several sectors. The results of this research extend dynamic capability by elucidating when (under the EU) and how (via LPE) ALO transforms into SSCP. Full article

Polycyclic aromatic hydrocarbons (PAHs) represent a major class of ubiquitous environmental pollutants, posing significant risks to ecosystems and human health due to their persistence, toxicity, and potential for bioaccumulation. This review provides a comprehensive synthesis of current scientific knowledge on PAHs, integrating insights from chemical kinetics, environmental fate, and toxicological mechanisms. The fundamental structural chemistry of PAHs and its direct influence on their physicochemical properties and environmental properties are discussed. The major anthropogenic and natural sources of PAHs are detailed, alongside the chemical kinetics behind their formation during incomplete combustion and their transformation in environmental media. Unlike previous reviews that address PAH sources, remediation, or health effects as separate topics, this review uniquely traces the mechanistic continuum from molecular formation kinetics through physicochemical partitioning and environmental transport to toxicological endpoints, providing a causally linked framework for understanding how structural properties ultimately determine biological outcomes. A central focus is placed on the environmental fate and transport of PAHs across atmospheric, aquatic, and terrestrial compartments, highlighting processes such as gas–particle partitioning, sediment accumulation, and long-range transport. The review further elucidates the complex toxicological pathways of PAHs, including metabolic activation to reactive intermediates, DNA adduct formation, oxidative stress, and their roles in carcinogenesis and other systemic health effects. The analysis reveals strong scientific consensus on the carcinogenic mechanism of parent PAHs via CYP450-mediated metabolic activation to diol-epoxide intermediates while identifying critical areas of uncertainty: the current regulatory framework based on 16 priority PAHs underestimates total carcinogenic risk by a factor of 2–5, mixture toxicology remains poorly characterized, and dose–response relationships for non-cancer endpoints (cardiovascular, neurodevelopmental, immunotoxic) lack the quantitative data needed for robust risk assessment. Finally, human exposure pathways and health risk characterization approaches are discussed, highlighting the need for cumulative, mixture-based assessment frameworks. Full article

Milling stability prediction requires tool and workpiece dynamics and cutting force coefficients, and uncertainty in these inputs propagates to the predicted stability maps. This study experimentally evaluates sample partitioning for uncertainty reduction in milling stability when the workpiece dynamics are predicted using finite element analysis (FEA). The FEA-predicted workpiece natural frequency and modal stiffness differed from the tap-tested reference values by 4.9% and 14.3%, respectively, leading to different predicted stability maps. Initial candidate stability maps were generated by Monte Carlo simulation using the uncertain FEA-predicted workpiece modal parameters. The experimentally identified cutting force coefficients were also treated as uncertain inputs. Physical cutting tests on a constrained motion dynamometer system were then used to retain or reject candidate maps based on the observed stable/unstable outcomes. The candidate maps were reduced from 10,000 to 6 after five partitioning steps, and the retained maps moved toward the tap-tested reference stability map. These results demonstrate that sample partitioning can reduce uncertainty in FEA-based stability maps using a limited number of cutting tests. Full article

Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction, characterized by a substantial symptom burden, impaired quality of life, and increased healthcare use. Despite advances in diagnostic criteria and treatment strategies, many patients feel dismissed, inadequately informed, or uncertain about the nature and meaning of their symptoms; these experiences may undermine trust and reduce engagement with healthcare professionals. The aim of this narrative review is to synthesize clinical and ethical considerations and propose a patient-centered ethical framework for IBS management, positioning communication as a core therapeutic intervention. We highlight how validation, clear and non-stigmatizing explanations, transparency about uncertainty, and recognition of patient values can strengthen the therapeutic alliance, support relational autonomy, and enable shared decision-making. These elements can promote supported self-management and improve adherence to individualized dietary, behavioral, and pharmacologic strategies. In response to the central role of nutrition in IBS care, we further integrate dietary management into the ethical framework, addressing dietary assessment, first-line dietary advice, soluble fiber, the structured low-FODMAP approach, and the risks of excessive or unsupported food restriction. We further discuss how the incorporation of patient-reported outcomes (PROs) can translate patient priorities into measurable outcomes, monitor clinically meaningful changes over time, and reduce discrepancies between clinical assessment and patients’ lived experiences. Finally, we underscore the impact of stigma and uncertainty and provide practical communication approaches to support a stronger therapeutic alliance in IBS care. The integration of ethical communication, PROs, and nutrition-sensitive self-management may improve patient experience, strengthen adherence, and support individualized therapeutic strategies in IBS care. Full article

Cervical intraepithelial neoplasia grade 1 (CIN1) is usually managed conservatively, but uncertainty remains about the subsequent risk of clinically significant high-grade disease, particularly after repeated CIN1. We conducted a retrospective population-based cohort study using anonymized cervical cytology, HPV, and histopathology records from Northern Norway from 2011 to 2025. We described temporal trends in screening-related outcomes and estimated the 5-year risk of CIN3+ after histologically confirmed CIN1 diagnosed in a single calendar year or in two consecutive calendar years. Across 2011–2025, the annual datasets comprised 334,471 screening records; 35,796 had ASC-US+ cytology (10.7%), 29,723 had a positive HPV test (8.9%), 35,416 underwent biopsy (10.6%), and 7870 were diagnosed with CIN2+ (2.4%). HPV positivity increased from 0.9% in 2011 to 15.7% in 2025, whereas CIN2+ detection peaked at 3.1% in 2018 and declined to 1.8% in 2025. In person-based analyses, the 5-year risks after CIN1 diagnosed in a single calendar year versus two consecutive calendar years were 4.3% versus 3.4% for CIN3+, 0.2% versus 0.1% for cervical cancer, and 15.4% versus 14.3% for CIN2+. Repeated CIN1 was not associated with higher subsequent CIN3+ risk, supporting conservative, risk-based follow-up after CIN1 biopsy. Full article

Traditional evaluations of artificial intelligence (AI) systems in the dynamic, operator-dependent, and time-sensitive field of interventional radiology (IR), focusing solely on algorithmic performance, often fail to capture their real-world clinical impact. This narrative review aims to provide an overview of the current state of the art of AI integration in IR through human–AI interaction (HAI), while offering a critical perspective on their clinical integration, limitations, and future directions. A comprehensive survey of recent literature was performed, focusing on AI applications across procedural phases. The review emphasizes systems providing decision support, real-time procedural verification, and immersive interfaces (augmented and virtual reality), while critically evaluating determinants of effective clinical adoption. AI has shown preliminary potential to support operator performance in selected interventional radiology tasks, although most applications remain experimental, retrospective, or evaluated in phantom or preclinical settings. Potential benefits include structuring uncertainty in patient selection and procedural planning, supporting assessment of device positioning and treatment outcomes, and integrating AI-derived outputs into the operator’s spatial field through immersive technologies. The clinical utility of these systems appears to be influenced by human–AI interaction, with interpretability, workflow integration, and trust calibration representing key determinants of effective use beyond algorithmic accuracy alone. The potential value of AI in interventional radiology appears to derive from its integration into human decision-making rather than from standalone predictive performance alone. A human-centered, interaction-based model supports understanding current applications, address challenges, and guide the development of adaptive, real-time systems for dynamic procedural environments. Full article

Gestational Diabetes Mellitus (GDM) represents a significant public health concern due to its association with adverse maternal and neonatal outcomes, as well as elevated long-term metabolic risks. Its prevalence varies substantially depending on the diagnostic criteria used and the population studied. Women with GDM frequently experience heightened stress, anxiety, and uncertainty, underscoring the need for accessible information, counseling, and ongoing support to navigate glucose monitoring, dietary adjustments, and treatment regimens. Although clinical management has been extensively studied, research has largely focused on metabolic monitoring and therapeutic interventions, often underemphasizing prevention strategies, women’s informational needs, and maternal psychological well-being. Emerging evidence and international guidelines increasingly advocate for integrating these components into structured, woman-centered GDM care plans that actively involve families. Such approaches empower women to engage in self-management, enhance health literacy, support adherence to lifestyle and pharmacological interventions, and promote sustainable behavioral changes. This narrative review presents a comprehensive, holistic model of care across the perinatal continuum, emphasizing early risk identification, preventive strategies, and multidisciplinary coordination. Core elements include individualized antenatal education, empathetic communication, and family engagement, fostering self-efficacy, continuity of care, and integration of medical, educational, and psychosocial interventions. Equipping healthcare professionals with the competencies to deliver this holistic, woman-centered framework is essential to optimize maternal and neonatal outcomes and mitigate the long-term health consequences of GDM. Full article

Background: Microsatellite instability (MSI) and mismatch repair (MMR) deficiency are key predictive biomarkers for immune checkpoint inhibitors (ICIs) in metastatic colorectal cancer (mCRC). In real-world practice, however, diagnostic pathways often involve heterogeneous testing modalities, which may lead to discordant or inconclusive results. Methods: We conducted a retrospective study of patients with mCRC who underwent at least one MSI/MMR assessment between 2015 and 2025. Diagnostic modalities included IHC, tissue-based and liquid-based MSI testing. A predefined decision algorithm classified results as conclusive or inconclusive; discordant cases underwent adjudication that integrated a pathology review, molecular features, and technical considerations. Patients were ultimately assigned to definitive MSS or definitive MSI groups. Clinical characteristics, treatment patterns, and outcomes—particularly in relation to immunotherapy—were evaluated. Results: Among 727 evaluable patients, the MSI/MMR status was conclusive in 695 (95.6%) and inconclusive in 32 (4.4%). Inconclusive cases resulted from isolated MMR protein loss, heterogeneous or equivocal staining, inter-tumoral discordance, or discrepancies between tissue- and liquid-based assays. After adjudication, 54 patients (7.4%) were classified as definitive MSI and 673 (92.6%) as definitive MSS. Definitive MSI tumors were associated with female sex, right-sided primaries, high-grade histology, nodal involvement, and BRAF V600E mutations. Among the definitive MSI patients, 31 (57.4%) received immunotherapy, achieving a complete response rate of 48.4% and an overall response rate of 71.0%. Median PFS and OS were not reached in the definitive MSI group, whereas definitive MSS patients treated with ICIs experienced significantly poorer outcomes. Conclusive and adjudicated MSI groups demonstrated comparable responses to immunotherapy. Conclusions: In real-world practice, a meaningful proportion (4%) of mCRC patients experience inconclusive MSI/MMR assessment, with important clinical implications. Both technical and biological factors contribute to diagnostic uncertainty. Integrating orthogonal testing modalities and applying structured adjudication improves classification accuracy and ensures appropriate access to immunotherapy. Full article

Introduction: Teprotumumab (Tepezza^®), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols. Full article