To evaluate the impact of deep learning reconstruction (DLR) on MRI productivity at a tertiary care academic hospital, and to validate a previously published Monte Carlo-based forecast of the productivity enhancement potential of DLR. Scanner log data were analyzed for two periods: pre-DLR adoption (January-October 2023, six scanners) and post-DLR (January-October 2025, five scanners). Examination and sequence durations were obtained from the Siemens Healthcare Teamplay platform. Observed changes were compared with capacity increases predicted by earlier Monte Carlo simulations. The impact of shortened scan durations across different scanner utilization levels was further evaluated using a simulation. Finally, four radiologists assessed image quality to identify potential clinical limitations of DLR. Optimized scanners demonstrated a total reduction between 4.8 and 11.1min (11.5-27.2%) in sequence duration and 5.0-10.7min (9.5-21.2%) in total examination time. Despite operating with one fewer scanner in 2025 (six scanners before DLR adoption, 5 scanners after), the mean hourly throughput of the entire fleet decreased by only 6.4%, indicating improved productivity per scanner. Notably, this throughput was achieved while DLR deployment and protocol optimization were still in progress, underscoring the substantial productivity benefit even at a partial implementation stage. DLR deployment was associated with improved MRI suite productivity, enabling nearly pre-DLR throughput despite operating with one fewer scanner. The results demonstrate the utility of DLR in improving MRI productivity and support the predictive accuracy of simulation-based health technology assessment. Nevertheless, unpredictable performance, particularly in neuroimaging, where artifacts in T2-weighted sequences and reduced quality in contrast-enhanced studies were observed, limits the applicability of DLR and underscores the need for rigorous quality assurance.

Over-testing Galactomannan in patients with hematological malignancies: A retrospective analysis from a tertiary care university hospital in Türkiye.

Effective personal money management is increasingly challenged by expense leakage, which refers to the gradual and often unnoticed loss of money through unused subscriptions, repeated small transactions, and irregular spending behavior. Most existing budgeting tools focus on summarizing expenses after they occur and provide limited support for identifying hidden or inefficient spending patterns. The primary aim of this project is to assist individuals in managing their finances more effectively by detecting and reducing unnecessary expenses. This project presents a Personal Expense Leakage Detection and Budget Optimization system developed using Python and machine learning techniques, employing a dual-layer unsupervised learning framework in which the Isolation Forest algorithm is used to identify abnormal transactions such as unexpected charges and billing inconsistencies, while K-Means clustering groups frequent low-value transactions that may be overlooked individually but have a significant cumulative impact. The system further incorporates features such as identification of unused recurring subscriptions, prediction of end-of-month balance based on current spending trends, analysis of behavioral spending patterns to reduce impulsive purchases, and visualization of the long-term financial impact of small recurring expenses. Experimental evaluation using synthetic transaction data demonstrates that the proposed system is more effective than traditional rule-based budgeting methods in detecting hidden spending patterns, indicating that the integration of machine learning and behavioral analysis into personal finance tools can significantly improve money management, reduce financial waste, and support longterm financial stability.

Abstract—India received $125 billion in inward remittances in 2023, making it the world's largest recipient of migrant worker transfers. The bulk of these flows traverse traditional channels — SWIFT-based bank wires, money transfer operators such as Western Union, and informal hawala networks — that charge between 5% and 12.66% of transfer value and require one to five business days for settlement. Stablecoin rails, operating on blockchain networks such as Tron (USDT) and Stellar (USDC), complete transfers in seconds at fees below one US dollar, offering a structural cost advantage of four to thirteen times over conventional banking. Yet widespread adoption in India faces compounding barriers: an unresolved regulatory framework under the Foreign Exchange Management Act, persistent last-mile cash-out deficits affecting 52% of the rural population, and the Reserve Bank of India's explicit concern that dollar-pegged stablecoin adoption could trigger currency substitution and erode monetary sovereignty. This paper compares stablecoin rails against traditional remittance channels across cost, speed, and accessibility dimensions; examines India's current regulatory environment; and analyses the financial inclusion implications of stablecoin-based remittance for India's 13 million overseas workers and their rural households. The findings suggest that stablecoins offer meaningful efficiency gains for high-value, urban-recipient corridors, but face structural constraints that limit their near-term applicability to India's financially excluded population without targeted regulatory and infrastructure interventions. Keywords: stablecoin, remittance, India, financial inclusion, USDT, USDC, RBI, CBDC, FEMA, dollarisation

Background and aims: Colonoscopy remains as an invaluable diagnostic and therapeutic tool used for the screening and evaluation of colonic pathologies. Periodic endoscopic screening allowing for early detection and removal of pre-malignant lesions, resulting in significant overall decreased incidence and mortality from colorectal cancer. Despite its added costs, artificial intelligence (AI) has been increasingly utilized in the field of endoscopy, boasting benefits of improving adenoma detection rates while reducing endoscopists’ mental fatigue intra-procedurally. As such, further evaluation of the financial impact of such AI-usage in screening colonoscopies was performed to assess if routine use of AI-guidance in screening colonoscopies was justifiable. Methods: This study conducted a cost effectiveness analysis of the GI Genius™ CADx Intelligent Endoscopy Module (US-DG-2000309, 2021 Medtronic) system in our local Singaporean tertiary public healthcare institution. A decision tree model was used to calculate Incremental Cost Effectiveness Ratio (ICER), comparing cancer-related costs for patients who underwent conventional colonoscopy versus colonoscopy with AI guidance. Results: With a calculated ICER value of 0.72, our study suggests that AI-assisted colonoscopy was indeed cost effective. Quality-Adjusted Life Years (QALY) values derived for each subgroup of patients further demonstrated overall improved quality of life reported by patients who underwent AI-assisted colonoscopy, as compared to conventional colonoscopy. Conclusion: Our study supports the incorporation of AI guidance into routine colonoscopic evaluation in view of increased cost effectiveness and improved overall quality of life achieved. However, further studies and analysis must be undertaken before reliably determining the cost-effectiveness of AI on regional or international scales.

ABSTRACT Nonprofit Community Development Financial Institution loan funds (CDLFs) occupy a distinct position in efforts to address place-based inequality, channeling capital to underserved communities while maintaining financial sustainability. CDLFs were developed based on an integrated hybrid ideal in which social and commercial logics are inseparable in organizational identity and operations. Yet CDLFs face growing pressure from funders, regulators, and third-party rating systems to demonstrate “impact” through output-focused metrics, raising a central question: how do Community Development Loan Funds interpret evaluation and outcome measurement requirements, allocate responsibility for measurement work, and make tradeoffs among financial, operational, and social impact priorities in practice? Drawing on interviews with 39 CDLF leaders, we examine the factors that affect evaluation and outcome measurement practices. We find that CDLFs experience pressure through three mechanisms: (1) funder-driven compliance demands that prioritize outputs, (2) organizational cultures that define “the work” as lending rather than community development, and (3) organizational design choices in hiring, incentives, and technology that center on banking logic. These dynamics shape how place-based development capital is allocated and justified, with implications for accountability to borrowers in underserved neighborhoods. A field-level mechanism we term collective vulnerability helps explain persistence, because rigorous outcome measurement threatens individual organizational legitimacy.

Despite kidney transplantation being the gold-standard treatment for end-stage renal disease, organ donation rates remain low. This study examined public perceptions and barriers to kidney donation to guide future efforts in Singapore. An online survey on kidney donation knowledge and attitudes was distributed via FormSG. Categorical data were presented as counts and percentages, and chi-square tests were used for categorical comparisons. Of the 633 respondents, 91% were Singaporeans, 55.8% were female, 20.7% had medical background, 81.6% had university education and 59.5% had a household income >SGD 8000. While 94.3% were familiar with the term 'kidney transplantation', only 70% knew about Human Organ Transplant Act (HOTA), with higher awareness among older adults (P < 0.01), those with a medical background (P < 0.01) and higher-income groups (P = 0.01). Only 25.1% correctly identified organs covered by HOTA and 82.8% incorrectly believed the next of kin could refuse donation after brain death. Overall, 66.7% of respondents were willing to donate, with greater willingness among postgraduates (P = 0.02) and Hindus (P < 0.01); the strongest motivator was the relationship to the recipient (80.5%), while key deterrents were health concerns (49.6%) and financial impact (25.9%). Most (75.2%) incorrectly thought donor surgery was open rather than laparoscopic. Willing donors perceived higher transplant success rates (73.2% vs. 65.7%, P < 0.01) but underestimated actual success (85%-99%, P < 0.01). Our study identified several knowledge gaps about kidney transplantation, including HOTA provisions, donor nephrectomy approach, recovery period and long-term donor health outcomes. Sociocultural and economic factors influence the willingness to donate, necessitating targeted interventions to improve awareness and address misconceptions.

Abstract Introduction The pre-registration trainee pharmacy technician (PTPT) apprenticeship is a two-year programme established in 2020 to deliver the NHS pharmacy technician workforce expansion programme. In 2024, an acute London teaching hospital secured funding and innovated to deliver a PTPT-led medicines stock management service. Aim To observe PTPT time spent on different medicines management activities, and to determine the financial impact. Methods Prospective cohort study at an acute London teaching hospital, using direct observations and cost of returned medicines. Observations took place over two months and were co-designed and conducted by two research interested PTPTs using a work sampling tool, iterated through piloting. Seven wards of varying specialties (including care of the elderly, cancer haematology, theatres, acute medicine, and critical care unit), were selected from sixteen wards served by the PTPTs. PTPTs who served these seven wards were observed, with activities recorded every five minutes across observation slots of up to two hours and categorised into three main groups: ward work, dispensary work, and other. Approximate time spent on each activity was calculated as a proportion of the total number of observation hours. PTPTs provided written consent for the observations and self-reported demographics, such as age, sex, and experience (time in months) using an online survey. Financial impact was assessed based on direct cost of returned medicines as well as overall profile of stock holding for the observed areas. Results Twelve PTPTs (10 female, 2 male; mean age 33.4 ± 12.29 years and experience ranging 3 months to 15 months, median 9 months) were observed across 100 hours and 33 minutes. Observations took place in the morning and afternoon. Each observer monitored one PTPT at a time on multiple occasions (ranging 1–10 observations/PTPT observed). A total of 1320 activities were recorded across 56 observations, with a mean observation time of 1 hour 47 minutes. The most time was spent on ward work (59%, 59.5 hours), specifically ordering stock medications (28%, 28.2 hours) and putting stock away (9.5%, 9.5 hours), followed by dispensary work (26%, 26 hours), specifically transmitting ward stock orders to pharmacy stores (5.7%, 5.7 hours) and daily briefings with other PTPTs (5%, 5.1 hours). The remaining time involved other activities (15%, 14.9 hours), which included protected time for professional development activities (1%, 1.1 hours), breaks (3.5%, 3.5 hours) and travelling between work areas (10%, 10.3 hours). Financial returns show a direct cost saving through medicines returned by the PTPTs as well as optimised medicines stock holding by expiry date checking and avoiding overstocking in the clinical area. Conclusion This service evaluation demonstrates the contribution of PTPTs in improved and effective stock medicines management in clinical areas. Limitations include potential observer effect; observations being conducted at fixed times and other factors affecting medicines returns. Further work is in progress to quantify the financial impact, as well as wider assessment of the value of the service to the clinical teams.

Abstract: This study examines the financial impact of climate and environmental risks on salt manufacturing units in Thoothukudi, a major salt-producing region in India. The research adopts an analytical approach using primary data collected from salt manufacturers and workers. Statistical tools such as descriptive analysis, correlation, and regression were applied to evaluate the relationship between climate variability and financial performance indicators. The findings reveal a strong positive relationship between climate risks—particularly unseasonal rainfall and extreme weather events—and revenue volatility, operational cost escalation, and infrastructure damage. Regression results indicate that climate-related variables significantly predict financial instability in the sector. The study highlights that environmental risks such as pollution and microplastic contamination also pose emerging threats to marketability. The research concludes that climate risk is not only an environmental concern but a critical financial determinant, emphasizing the need for adaptive strategies aligned with SDG 13 (Climate Action). Keywords: Climate Risk, Financial Impact, Salt Industry, Thoothukudi, Sustainability, SDG 13, Environmental Risk

Financial toxicity refers to the objective and subjective financial burden incurred due to medical treatment. It is an increasingly recognised consequence of cancer and its treatment. Cervical cancer patients have been reported as having high rates of financial toxicity in international literature, with local experience suggesting that this is also the case in New Zealand. We aimed to measure the prevalence and severity of financial toxicity in patients undergoing radiation treatment for cervical cancer at Wellington Blood and Cancer centre (WBCC), and how existing sources of support were used. A mixed methods prospective study was conducted at WBCC. Patients were recruited into two study groups: cervical cancer treatment and 'comparison'. Qualitative data was collected via semi-structured interviews with 10 patients from the cervical cancer treatment group. Interviews explored the financial impact of treatment and strategies used to cope with this. Inductive thematic analysis was used to interrogate and analyse qualitative data. Quantitative data is presented elsewhere. Ten participants completed semi-structured interviews. Six themes were identified: (i) costs associated with cancer treatment, (ii) impact of cancer treatment on financial situation, (iii) strategies to cope with changes in financial situation due to treatment, (iv) stress related to cancer treatment, (v) sources of financial assistance and other sources of support, and (vi) factors which influence the financial impact of cancer treatment. Financial toxicity was identified as an additional burden for many participants undergoing cervical cancer treatment. Improving information provided, accommodation facilities and access to existing supports could help lessen this and better support patients having this type of treatment.

ABSTRACT The Goods and Services Tax (GST), implemented in India on July 1, 2017, represents one of the most significant tax reforms since India's independence, subsuming over 17 central and state indirect taxes into a unified, destination-based taxation system. Micro, Small and Medium Enterprises (MSMEs), which collectively contribute approximately 30% to India's GDP, employ over 110 million people, and account for 40–45% of total exports, have been profoundly affected by this transformation. This study analyses the impact of GST on the financial performance of MSMEs in India over the period 2021–2025, using secondary financial data from five representative MSME companies. Employing trend analysis, common size analysis, comparative analysis, and profit and loss analysis, the study evaluates key financial parameters, including profitability, liquidity, cost structure, working capital management, and compliance costs. The findings reveal that while GST has imposed significant short-term compliance burdens—particularly on smaller enterprises—its long-term net financial impact is positive, with most companies demonstrating improved profitability, reduced debt, expanding asset bases, and stronger internal reserves. The study identifies digital adoption and efficient working capital management as key differentiators of GST performance outcomes and concludes with policy recommendations for the government and strategic suggestions for MSME owners to maximise the benefits of the GST regime. Keywords: GST, MSMEs, Financial Performance, Input Tax Credit, Compliance Costs, Profitability, Working Capital, India

Various studies have examined how early retirement and reduced retirement contributions, both voluntarily and involuntarily, have affected workers, in general, due to COVID-19. This paper discusses and highlights specific financial impacts for employees due to early retirement. Evaluations based on standard actuarial methods are described and quantitatively presented. These evaluations show that early retirement has a more severe impact on older age employees. As expected, early retirement has a higher retirement income reduction for those with a high salary-asset ratio, since early retirement reduces the overall contribution to the retirement plan. Furthermore, we show that a reduced contribution overall impacts the retirement annual income uniformly regardless of age, and it more severely impacts those who plan to work longer than those who plan to retire soon. We also found that early retirement has a similar reduction impact on both fixed dollar amount contribution and fixed percentage of salary contribution mechanisms.

Purpose: To evaluate the financial impact of monotherapy with intravitreal (IVT) bevacizumab and compare it with a combined approach of panretinal photocoagulation (PRP) and IVT bevacizumab for the treatment of retinopathy of prematurity in the United States. Methods: Data from 122 eyes of 71 infants initially treated with IVT bevacizumab monotherapy (Group 1) or IVT bevacizumab with PRP (Group 2) were collected. The direct cumulative costs of examinations, PRP, IVT bevacizumab, examinations under anesthesia, fundus photography, and fluorescein angiography were reported. The costs for each service or procedure were extrapolated from Centers for Medicare & Medicaid Services. The physician, facility, and total costs of each service were calculated for both groups when using Avastin vials or bottles. Results: Following the ideal American Academy of Pediatrics guidelines, the mean number of inpatient and outpatient examinations for Group 1 infants was 12.10 and 10.74, respectively, and was 9.97 and 2.12 for Group 2 infants, respectively. The average cost billed for all examinations and procedures was $5045.34 in Group 1 and $4349.92 in Group 2 when using Avastin vials. The largest share of total treatment costs in Group 1 was from subsequent inpatient visits, amounting to $1164.04 (23.07%). In contrast, the largest share of costs in Group 2 was for PRP, which totaled $1656.13 (38.07%). Conclusions: This study highlights that, compared with combined treatment of IVT bevacizumab and PRP, the direct cost of treating infants with IVT bevacizumab monotherapy is marginally increased and requires significantly more visits.

Metacarpal fractures are common injuries that are frequently managed with repeated radiological follow-up, although the clinical value of routine imaging is uncertain. The aim of this study was to evaluate the frequency and clinical impact of follow-up imaging in patients with metacarpal fractures treated operatively or non-operatively, and to quantify the associated financial and environmental impact. This retrospective study evaluated adult patients with metacarpal fractures treated non-operatively or operatively at a Dutch level 2 trauma center between 2017 and 2022. Radiology reports and medical records were reviewed to assess whether follow-up imaging led to treatment modification. Additionally, the corresponding financial and environmental impact was calculated. A total of 2342 patients were included (median age 32years; 28% female). Among initially non-operatively treated patients (n = 1978), 1.1% (n = 22) required conversion to surgery. The overall cost associated with this 1% conversion amounted to €230,000, with an estimated environmental impact of 2711kg CO₂-eq. Among operatively treated patients (n = 386), postoperative imaging rarely prompted re-operation (0.3%, n = 1). The total costs associated with 0.3% re-operation were €171,000 and an associated environmental impact of 1801kg CO₂-eq. Together, the impact equals almost one trip around the world by car. Routine radiological follow-up after the initial decision for operative or non-operative treatment in metacarpal fractures provided minimal clinical benefit. A symptom-driven approach may optimize care while reducing unnecessary financial and environmental burden. Level IV.

Type 2 diabetes mellitus (T2DM) imposes a growing economic burden in Ghana, yet evidence on its financial impact is limited. This study assessed the economic burden of T2DM among patients receiving outpatient care at Ho Teaching Hospital. A cross-sectional cost-of-illness study was conducted between July and December 2024 among 118 T2DM patients. Data were collected using a structured questionnaire developed from a literature review and expert input and administered by trained student nurses. Monthly costs were estimated, and catastrophic health expenditure (CHE) was assessed using the budget share method at 10%, 25%, and 40% income thresholds, applying the 2024 national monthly minimum wage as a proxy. Logistic regression was used to identify predictors of CHE. Most respondents (88.98%) were enrolled in the National Health Insurance Scheme (NHIS). The mean monthly cost of care was USD21.25, with direct medical costs (USD18.71) accounting for 88% of total expenditure, largely driven by medications (67.17%). Indirect costs due to productivity losses were minimal (USD0.40), although patients spent considerable time traveling (3.2 h) and at the facility (2.4 h) per visit. CHE prevalence was high: 100% at the 10% threshold, 95.76% at 25%, and 88.14% at 40% based on total costs. Older age (40-59 years), unemployment, and lack of tertiary education significantly increased CHE risk, while NHIS enrollment reduced risk at higher thresholds. Despite high NHIS coverage, T2DM care at Ho Teaching Hospital places a substantial financial burden on patients, with widespread catastrophic expenditure. Expanding NHIS benefits for tertiary diabetes services and reducing time and transport costs are essential to lessen the economic impact of T2DM in Ghana.

Abstract This study investigates the economic and health effects of heat waves in Dhaka City to understand how different social strata experience heat waves. A mixed-methods strategy, involving quantitative and qualitative methods, was applied to accomplish the research goals. A semistructured questionnaire survey was administered through face-to-face interviews with 100 respondents, until the saturation point was reached. It was supplemented by three interviews for case studies and two focus group discussions (five–six participants each). Chi-square tests and cross tabulations were done to find the significance level among the data, which supported the qualitative outcome. The study finds that the economically marginalized group experiences more health and economic impacts of heat waves. About half (54%) of the economically marginalized people ( N = 40) face reduced income, and 86.21% of them missed working days during heat waves. Based on the financial impact metrics used in this study, there is a negligible impact on the high-net-worth individual and 41% of median-income households ( N = 50) see income reduction. Economically marginalized people face more serious health impacts like dehydration, fever, irritability, asthma, heat exhaustion, and rashes. They adopt various coping strategies to manage heat stress, such as drinking more water, taking frequent showers, using wet or soaked cloths, and spending time outside their overcrowded rooms. High-net-worth people face irritability and heat exhaustion. Contextual analysis reveals that inequality in urban facilities (access to open spaces, water and electricity supply, and public toilets) increases the vulnerability of economically marginalized residents in heat waves. To improve the conditions, the study emphasizes community-based adaptation measures that consider vulnerabilities of different social classes to improve the situation.

Hotel kitchens, often the heart of food operations, generate significant amounts of waste and consume considerable resources, posing critical challenges to sustainability. This theoretical paper explores how Robotics, Artificial Intelligence, and Service Automation (RAISA) technologies can enable sustainable, zero-waste kitchen operations in the hotel industry. Through a narrative literature review, the paper identifies innovative RAISA tools such as AI-powered inventory systems, smart appliances, and robotic chefs that reduce food waste, energy use, and operational inefficiencies. Despite the potential of RAISA in hotel kitchens, not many hotels adopt RAISA. Key barriers to RAISA adoption, such as high costs, lack of training, resistance to change, and technological integration challenges, are critically analysed. This paper proposes two conceptual models: one positioning RAISA as an enabler of the triple bottom line: people, planet, and profit, and another advocating internal and external stakeholder collaboration for successful RAISA adoption. The paper concludes by highlighting the need for future research to empirically validate the environmental and financial impact of RAISA, develop new metrics, and create accessible business models. This work contributes to both theory and practice by linking RAISA adoption to the UN Sustainable Development Goals and offering practical roadmaps for hotel managers and policy-makers.

Autistic individuals across the spectrum have diverse rehabilitation and support needs. Systematic data on the cost of care for autism is unavailable in low- and middle-income countries, yet such information is essential to understand the financial burden on families. The current study is a preliminary attempt aimed to estimate the cost incurred by families of autistic children and adolescents attending a tertiary care centre in urban India. The adapted Children and Adolescents Economic Resources Questionnaire was administered to 80 families seeking autism-specific services. Direct medical, non-medical costs and indirect costs, including time and productivity costs, were estimated by parent self-report. The sample consisted predominantly of preschool- and middle-childhood-aged children coming to a premier referral centre, from various geographical locations in the country and with different profiles of support needs and interventions received. Preliminary findings showed that major expenses involved diagnostic and early intervention services, schooling and centre-based rehabilitation. Among direct non-medical costs, education and childcare costs were the highest. In the absence of universal health coverage, approximately 71.25% of families exceeded the threshold of spending >10% of their monthly income on healthcare, amounting to catastrophic out-of-pocket expenditures. Our study contributes preliminary findings as a first step in the cost-of-care studies on autism in India. Future studies should include a larger sample size, robust methods of cost estimation and a mixed-methods design to capture economic impact on families.Lay abstractPeople with autism have different needs when it comes to support and treatment. In many countries without universal health coverage, getting proper care can be expensive and difficult for families to afford. There isn't much information about how much autism care costs in low- and middle-income countries. This study looked at how much families spend on caring for their autistic children in the Indian context. The adapted Children and Adolescents Economic Resources Questionnaire was administered to 80 families of children with autism seeking services at a tertiary care centre. Results showed that families spent the most on diagnosis, early intervention, education and childcare. A significant proportion of families incurred catastrophic out-of-pocket expenditures on a regular basis. The preliminary findings highlight the financial impact on families.

Cancer-related financial toxicity has been recognized as a growing survivorship issue, even in high income countries with established social welfare systems. However, data on the financial impact of head and neck cancers, particularly oral cavity carcinoma (OSCC), remain scarce in Germany. This study aims to quantify the financial burden experienced by OSCC patients following surgical and/or multimodal treatment within the German healthcare system. We conducted a prospective, cross-sectional study at a single university hospital. Patients with OSCC undergoing oncological follow-up were included. Financial toxicity was measured using the Financial Index of Toxicity (FIT) questionnaire along with 11 additional items addressing changes in income, employment, rehabilitation, and social participation. 101 patients with OSCC were included. The mean overall FIT score was 23.8 (SD 15.9), indicating a moderate financial burden. Subscores revealed a financial stress score of 10.8 (SD 16.9), a financial strain score of 33.6 (SD 19.5), and a lost productivity score of 22.8 (SD 31.2). Patients with advanced tumor stages (UICC III/IV) showed higher financial toxicity, particularly in the domains of lost productivity and strain. Additional socioeconomic items revealed reduced household income and significant difficulties in returning to work or accessing rehabilitation. Our study provides the first structured assessment of financial toxicity in OSCC patients within the German healthcare system. Even in a publicly funded health system, substantial financial distress occurs-particularly in patients with advanced-stage disease and impaired speech function. These findings underscore the need for systematic financial risk screening and the development of German-specific assessment tools to address the socioeconomic burden in cancer care.

The paper discusses the relation between Environmental, Social and Governance (ESG) performance and financial performance of the both the industries which are highly polluting in regards to profitability, market value, cost burden and risk reduction. It is analyzed in a quantitative form which is based on secondary data and the firms are divided into high, medium and low ESG performers. The results indicate that the percentage of high, medium and low ESG companies is 38, 42 and 20 respectively that implies that the industries are in a transitional stage of environmental scanning with ESG. The results indicate that there is a positive correlation between the ESG performance and profitability with the high ESG firms that reported an average of 18 proportion of profit margin compared to 14 and 10 proportion of profit margin of medium and low ESG firms respectively. Similarly, high ESF companies (22) relative to medium (16) and low (11) have greater growth in market values because of the preference of sustainable companies by investors. However, the realization of ESG is associated with the high-cost burden because ESG related costs increase by 26 percent that is greater than the revenue increase in the short term of 19%. The paper also mentions that, ESG plays a role in risk management, with high ESG firms having a smaller risk (30 percent) when compared to medium and low ESG firms (22 and 14 percent, respectively). In addition, the ESG ranks with a long-term financial impact (24) that is two times as much as its short-term impact (12), and this will serve to demonstrate its strategic importance. Overall, the findings suggest that, despite the fact that ESG investments may create short-term profitability, it has much to offer to the long-term financial performance, growth, and minimization of risks in highly polluting sectors.