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Pharmacists play a vital role in ensuring that controlled substances (CS) are used safely and appropriately and may refuse to dispense a CS prescription as part of this responsibility. Such decisions, while often appropriate, can have unintended consequences for patients. Despite this, little is known about how pharmacists navigate CS dispensing decisions and how they communicate refusals to patients. To qualitatively describe pharmacists' decision-making process and communication strategies when declining CS prescriptions. Semi-structured interviews were conducted with 11 pharmacists recruited from the Texas State Board of Pharmacy Registry between March 2023 and April 2024. Data were analyzed using Braune and Clarke's thematic analysis approach. Patient characteristics, professional values, practice environment, prescribing clinician relationships, regulatory oversight, stigma, safety concerns, and gaps in training were identified as important contextual influences on decision-making. Participants also described employing risk management practices to mitigate perceived dispensing risks, including verifying prescriptions and conducting due diligence, seeking external guidance, and documenting patient interactions. Three strategies for communicating denial were identified: transparent and constructive denial, tactful evasive responses, and deceptive denial. Additionally, employer policies were noted to play a role in guiding how pharmacists implemented risk management practices and communicated refusals to patients. Pharmacists' decisions to decline CS prescriptions are complex and influenced by multiple contextual and risk management considerations that require balancing professional judgment, regulatory responsibilities, and patient-centered care. Future research is needed to better understand how these factors shape dispensing decisions and to inform interventions that support safe dispensing practices and optimal patient care.
Papain and Fucoidan are extracted enzymes that have gained recognition across food industry, pharmaceutical and digestive applications, but their comparative effects on Biliary flow rate and electrolytes are not known. Hence, this study compared the effects of papain and fucoidan on Biliary flow rate and electrolytes. Twenty (20) male albino Wistar rats weighing between 100g and 150g were divided into 4 groups of 5 animals each as follows: Group I (Control group) were administered normal saline and had access to food and water ad libitum. Group II (Papain group) were administered with 800mg/kg body weight of the stock solution of papain and were allowed free access to food and water. Group III (Fucoidan group) was given 800mg/kg body weight of the stock solution of fucoidan plus food and water. Group IV (Metoclopramide group) was administered with 30mg/kg body weight of Metoclopramide stock solution plus food and water ad libitum. The administration lasted for a duration of 28 days. Bile was collected from the liver (hepatic duct) and was analyzed for bile flow rate and its composition. The results showed that papain significantly increased biliary sodium and chloride, reduced bicarbonate levels, and had no significant effect on bile flow rate compared to the control group. Fucoidan significant effect on Biliary sodium, chloride and bile flow rate when compared to the control group. These results conclude that the two compounds have regulatory, but not stimulatory effects on biliary secretion, which proves their hepatoprotective and stabilising effects.  Keywords: fucoidan, Papain, bile flow rate, biliary electrolyte.   Short running title: Modulation of Fucoidan and Papain on Biliary Parameter.
This paper studies the macroenvironmental consequences of AI adoption in a balanced annual panel of 30 advanced economies (EU-27, the US, UK and Japan) over 1995-2020. We examine both territorial (production-based) and consumption-based CO2 emissions to account for trade-embedded carbon, and we assess adaptation capacity using the ND-GAIN readiness index. AI is measured using an AI capital stock indicator capturing tangible and intangible AI-related assets. Empirically, we estimate fixed-effects models with Driscoll-Kraay standard errors and strengthen causal interpretation for the emissions outcomes using an IV-2SLS design that instruments domestic AI with geography-filtered patenting shocks from major global innovation hubs. We then use panel local projections to trace the dynamic responses of emissions and climate readiness to unexpected AI-growth shocks. The results show that higher AI stock is associated with lower emissions, and the IV estimates support emissions-reducing effects in medium-run stock specifications. The dynamic evidence is more nuanced: territorial emissions rise after an AI-growth shock, peak around the medium-run horizon, and then ease, while consumption-based emissions decline more persistently. AI shocks are also followed by steady improvements in climate readiness. Together, the findings suggest that AI can support decarbonisation and resilience in advanced economies, but its environmental payoff depends on the deployment path and the energy system that absorbs AI-related demand.
Ethmalosa fimbriata, a key small pelagic species underpinning food security and livelihoods along the West African coast, warrants a robust stock assessment due to concerns of overexploitation. This study synthesizes multi-fleet catch records (1970-2021) and unstandardized catch per unit effort (CPUE) data (1995-2017) from the Eastern Central Atlantic (ECAO) to evaluate the northern stock using four surplus production models: the catch-only (CMSY) and abundance-only (AMSY) maximum sustainable yield models, the Bayesian state-space model (BSM) and the Just Another Bayesian Biomass Assessment (JABBA) model implementing Schaefer, Fox and Pella-Tomlinson functions. The objective was to evaluate model predictive accuracy and stock status to provide evidence-based management advice. From the results, CMSY indicated 2021 biomass (B) was marginally above the sustainable limit (B/BMSY ≈ 1.03) with current fishing mortality (F) near FMSY, while AMSY and BSM both indicated ongoing depletion (B/BMSY ≈ 0.56-0.81) and overfishing (F/FMSY >1.0). JABBA's Schaefer model, demonstrating superior fit (root-mean-square error = 16.9%, Deviance Information Criterion = -382.7) over Fox and Pella-Tomlinson models, estimated 2021 biomass at 9% below BMSY and fishing mortality at 59% above FMSY. Fox and Pella-Tomlinson models yielded similar biomass trajectories but were less precautionary. Projections indicate that only Schaefer-based total allowable catches (TACs) below 100,000 t would stabilize biomass; higher quotas risk continued decline. Despite limitations including incomplete catch data and reliance on unstandardized indices, results underscore the urgency for precautionary catch limits, regional coordination and improved compliance to ensure sustainability. This study offers a transferable assessment framework for data-limited fisheries and supports evidence-based policy for the conservation of E. fimbriata and food-security resilience in West Africa.
Conversion of a failed bipolar hemiarthroplasty to total hip replacement (THR) is technically demanding because of acetabular erosion, scarred soft tissues, compromised bone stock and instability risk. Superadded culture-positive infection further complicates implant selection, antibiotic strategy and follow-up surveillance. A 35-year-old male with previous tuberculous meningitis and bilateral avascular necrosis underwent right bipolar hemiarthroplasty in 2016 and left THR in 2019. He later presented with persistent right hip pain and restricted movement. He underwent conversion of the failed right bipolar hemiarthroplasty to THR. Early recurrent instability required a second revision using a long uncemented revision stem, cerclage fixation for an intraoperative proximal femoral fracture and a dual mobility construct. During the infection/revision course, intraoperative culture was positive for Klebsiella pneumoniae. The patient received 6 weeks of intravenous ceftazidime-avibactam and aztreonam. Serial CRP/high-sensitivity c-reactive protein values were 2.92, 239.79, 150.25, 379.13 and 24.43 mg/L, while erythrocyte sedimentation rate values were 6, 103, 103, 75, and 22 mm/h on June 19, 2025, June 25, 2025, June 30, 2025, July 04, 2025 and July 29, 2025, respectively. This case highlights the layered challenges of conversion THR in a young patient: acetabular reconstruction, instability control, intraoperative femoral fracture management, culture-positive Gram-negative infection and biochemical monitoring after debridement and targeted antibiotics. RésuméLa conversion d’une hémiarthroplastie bipolaire échouée en remplacement total de la hanche (RTH) est techniquement exigeante en raison de l’érosion acétabulaire, des tissus mous cicatriciels, du stock osseux compromis et du risque d’instabilité. Une infection surajoutée à culture positive complique davantage le choix de l’implant, la stratégie antibiotique et la surveillance du suivi. Un homme de 35 ans, ayant des antécédents de méningite tuberculeuse et de nécrose avasculaire bilatérale, a bénéficié d’une hémiarthroplastie bipolaire droite en 2016 et d’un RTH gauche en 2019. Il a ensuite présenté une douleur persistante de la hanche droite avec limitation des mouvements. Il a subi une conversion de l’hémiarthroplastie bipolaire droite échouée en RTH. Une instabilité précoce récidivante a nécessité une seconde révision avec une longue tige de révision non cimentée, une fixation par cerclage pour une fracture fémorale proximale peropératoire et une construction à double mobilité. Au cours de l’évolution infectieuse/de révision, la culture peropératoire était positive pour Klebsiella pneumoniae. Le patient a reçu six semaines de ceftazidime-avibactam et d’aztréonam par voie intraveineuse. Les valeurs sériées de CRP/protéine C-réactive hypersensible étaient de 2,92, 239,79, 150,25, 379,13 et 24,43 mg/L, tandis que les valeurs de vitesse de sédimentation érythrocytaire étaient de 6, 103, 103, 75 et 22 mm/h les 19 juin 2025, 25 juin 2025, 30 juin 2025, 4 juillet 2025 et 29 juillet 2025, respectivement. Ce cas souligne les défis multiples de la conversion en RTH chez un jeune patient : reconstruction acétabulaire, contrôle de l’instabilité, prise en charge d’une fracture fémorale peropératoire, infection à bacille Gram négatif à culture positive et surveillance biologique après débridement et antibiothérapie ciblée.
Forest ecosystems are vital to the global carbon cycle, yet their long-term aboveground carbon (AGC) dynamics remain uncertain. Here, we integrate multi-source satellite observations with probabilistic deep learning models to reconstruct a harmonized, uncertainty-aware global forest AGC record from 1988 to 2021 at 0.25∘. We find that, although global forests sequestered 6.2 PgC, moist tropical and boreal forests have progressively transitioned toward carbon sources since the early 2000s. Tropical AGC variability became increasingly negatively correlated with atmospheric CO2 growth rates (r = - 0.63 in 2011-2021), suggesting tropical forests increasingly modulate the global carbon cycle. In the Brazilian Amazon, the contribution of intact forests to the year-to-year variations in AGC losses increased from 33% in the 1990s to 76% in the 2010s. Our findings highlight the vulnerability of carbon stocks in key biomes and provide a benchmark to track emerging sink-source shifts under anthropogenic climate change.
Influential voices long dismissed individual differences as irrelevant to negotiation research. Recent calls to examine the process in its full complexity invite a renewed look at personality in negotiation. We take stock of the evidence using three complementary lenses: When does personality matter across contexts, outcomes, and phases? With whom does personality matter in interaction, including partner and fit effects? How should researchers design studies and measures that can recover stable personality effects in interdependent settings? Across these lenses, recent advances suggest that trait effects are most detectable in phase-proximal behaviors (e.g., initiation and preparation), are frequently contingent on counterparts and situational affordances, and may be especially worthwhile to examine for subjective, relational, and reputational outcomes that shape what happens after agreement. Methodologically, designs that separate actor, partner, and relationship components and capture trajectories rather than endpoints are especially informative. We outline future directions aligned with phase-specific theory, dyadic mechanisms, and innovative methods. We highlight emerging tools, including computational measurement and agent-based paradigms, that should accelerate cumulative progress.
The UK NHS faces increasing pressure to diminish its carbon footprint, with fluorinated anaesthetic agents representing a significant source of direct greenhouse gas emissions. Several NHS trusts retain substantial quantities of unused stock and waste volatile anaesthetics (VAs), particularly desflurane, requiring appropriate disposal. However, a crucial unquantified aspect is the endpoint destruction routes and associated emissions for accumulated desflurane stock and waste anaesthetics. We developed a mathematical model accompanied by an open-source Python-based application programming interface (API) to estimate equivalent carbon emissions and their climate impacts across disposal pathways. Stochastic modelling also estimates uncertainties of input parameters and their effects on model predictions. User-defined input parameters in the API allow practitioners to model specific destruction pathways. We identified high-temperature incineration in clinical waste streams as the most likely route, which, compared with release, shows reductions of more than 70% in equivalent emissions. Model predictions suggest that plasma destruction has the highest potential for reducing equivalent carbon emissions, to less than 5% from all waste fluorinated VAs by reducing the formation of products of incomplete combustion, with an associated reduction in climate impact. Crucial work still needs to be done to validate theoretical estimates, accurately assess the formation of products of incomplete combustion from fluorinated VAs under varying destruction conditions, and evaluate the feasibility of implementing the assessed waste streams.
Acute respiratory distress syndrome (ARDS) is defined by severe hypoxaemia and bilateral pulmonary infiltrates, yet clinical outcomes are not determined by gas exchange alone. Increasing evidence suggests that right ventricular (RV) dysfunction is a frequent and clinically relevant complication, reflecting the combined effects of pulmonary vascular injury and mechanical ventilation. In this narrative review, we examine the mechanisms through which inflammatory lung injury, pulmonary vascular dysfunction, and mechanical ventilation contribute to RV-pulmonary arterial uncoupling. We discuss how hypoxic vasoconstriction, microvascular thrombosis, endothelial dysfunction, hypercapnia, driving pressure, intra-abdominal pressure, transpulmonary and transdiaphragmatic pressures, and inappropriate PEEP together increase pulmonary vascular load beyond the adaptive capacity of the RV. Extracardiac factors, including fluid accumulation, venous congestion, and abdominal-thoracic interactions, further influence RV loading conditions but are often under-recognised in ARDS. We also review the clinical features of acute cor pulmonale and its association with increased mortality. We emphasise the importance of systematic bedside assessment integrating echocardiography, invasive haemodynamics, ventilatory variables, while acknowledging the limitations of current biomarkers and diagnostic tools. Finally, we discuss the therapeutic implications of RV dysfunction, outlining how ventilatory management, fluid strategy, vasoactive support, prone positioning, and extracorporeal life support can be informed by RV physiology. Recognition of RV dysfunction can improve physiological assessment and individualised cardiopulmonary management in ARDS.
The iliopsoas tenotomy aims at correcting the impaired hip extension that compromises patients' ability during gait, creating discomfort during postural transfers and prolonged sitting. The standard, open approach adopted for neurological disorders requires general anesthesia and sutures, with considerable odds of adverse events, such as nerve injuries, pain, and infections. To date, percutaneous release interventions have been done only on cadavers or adult patients with orthopaedic conditions. In this article, we introduce the ultrasound-guided minimally invasive approach in neuro-orthopaedics procedure for the iliopsoas tenotomy, a percutaneous release combining ultrasound-guidance and mini-invasiveness. This technique offers several advantages: reduced length of surgery, no surgical incisions, use of local anesthesia, and the possibility of visualizing the surgical target during the entire process, thus minimizing complications. It is especially useful for patients where open surgery is not recommended, such as those with extensive scarring in the abdominal region caused by previous interventions or those with a high probability of additional surgeries during their lifetime. Moreover, rehabilitation can start on day 1 after surgery and may considerably reduce recovery time.
Obesity and diabetes are risk factors for developing osteoarthritis and associated with worse outcomes following total hip (THA) and total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1as) improve glycaemic control and promote weight loss. The aim of this study was to assess the impact of GLP-1a treatment on 90-day surgical complications following THA and TKA. A systematic review was undertaken according to PRISMA guidelines. Studies were included if they reported at least one outcome of interest following primary THA or TKA. In all the studies which were included, a GLP-1a was prescribed for the management of type 2 diabetes mellitus or for weight loss in obese patients. The primary outcome was the 90-day surgical complication rate in the combined THA and TKA cohort. The 90-day surgical complications were defined as: periprosthetic joint infection (PJI), wound dehiscence, periprosthetic fracture (PPF), haematoma, nerve injury, or surgical site infection (SSI). Secondary outcomes included 90-day medical complications and readmission rates, all-cause revision, healthcare costs, and length of stay. A total of 78 studies were reviewed, and ten matched cohort studies with a total of 96,356 patients (30,350 THAs and 66,606 TKAs) were included. The mean age of the patients was 61.9 years; 60.1% female (n = 57,939). Two studies had a serious risk of overall bias and eight had a moderate risk. The confidence of evidence according to the GRADE assessment was very low for all but one outcome measure (healthcare cost: moderate). The rate of 90-day surgical complications was lower in the GLP-1a cohort (pooled risk ratio (RR) 0.73). The use of a GLP-1a lowered the 90-day medical complications and readmission rates (RR 0.78 and RR 0.79 (I2 = 61.6%), respectively). At two years, the revision rate ranged from 1.7% to 3.3% for the GLP-1a cohort and 1.7% to 4.5% for the controls. Sub-group analysis showed a stronger association in the THA group, in which the use of a GLP-1a was associated with significantly lower rates of 90-day surgical complications (RR 0.63), 90-day medical complications (RR 0.55), and 90-day readmissions (RR 0.82). In contrast, the use of a GLP-1a in the TKA group was only sigificantly associated with a lower 90-day readmission rate (RR 0.77). GLP-1a treatment before THA and TKA potentially reduces the 90-day surgical and medical complications and 90-day readmission rates in high-risk diabetic and obese patients. The use of a GLP-1a may also be associated with substantial cost savings.
Conventional dendritic cells (cDCs) can be activated by pathogen signals and inflammation to drive T cell immunity to infection, but they can also undergo "homeostatic activation" at steady state. However, homeostatically activated cDCs closely resemble those activated by microbial or viral stimuli, hindering their study. Here, we identify the chemokine receptor CXCR4 as a specific marker of homeostatically activated cDCs across mouse tissues. CXCR4 is induced in cDCs in the steady state but not following stimulation with Toll-like receptor agonists or type I interferons. In tumors, CXCR4 expression or a gene signature derived from mouse spleen CXCR4hi cDCs marks the so-called "mregDCs" that have acquired tumor-derived material. Notably, the gene signature derived from mouse spleen CXCR4hi cDCs further identifies mregDCs in human cancers. Thus, CXCR4 distinguishes homeostatic from inflammatory cDC activation programs, providing a means to identify and study this cDC state in both physiological and pathological contexts.
Pediatric posttraumatic stress disorder (PTSD) is a debilitating condition that is associated with significant functional impairment, diagnostic complexity, and limited evidence-based treatment options. Among its core features, trauma-related sleep disturbances-particularly nightmares-are highly prevalent, profoundly impairing, and contribute to the chronicity and severity of the disorder. Prazosin, a selective alpha1-adrenergic antagonist, has demonstrated efficacy in adults for reducing nightmares and improving sleep, but pediatric data remain limited. This case report describes an adolescent male patient with chronic PTSD who achieved full symptomatic remission and functional recovery with prazosin monotherapy. The patient had previously failed to respond to multiple psychotropic classes, including antidepressants, mood stabilizers, and antipsychotics. After initiating prazosin and titrating to 3 mg nightly, he experienced rapid and sustained resolution of nightmares, improvement in sleep quality, and overall reduction of PTSD symptomatology. His UCLA Child/Adolescent PTSD Reaction Index scores declined from 61 to 11 over 20 weeks. This case is contextualized within a narrative review of the pediatric prazosin literature, and highlights pharmacologic rationale, safety considerations, and clinical utility. The findings underscore the central role of sleep disturbances as a pivotal treatment target in pediatric PTSD and support further research into prazosin's therapeutic potential in this population.
Norovirus is a leading cause of acute gastroenteritis (AGE) in the United States and is associated with substantial healthcare utilization, including risk of hospitalization. The extent to which underlying medical conditions contribute to this risk is not well understood. This retrospective cohort study analyzed adults with incident medically attended all-cause AGE or cause-specified norovirus AGE episodes identified via International Classification of Diseases, Tenth Revision, Clinical Modification between July 1, 2022 and June 30, 2024 in Optum's deidentified Clinformatics® Data Mart Database (Optum® CDM). Generalized estimating equations estimated adjusted risk ratios (aRRs) and confidence intervals (CIs) for acute hospitalization within 3 days of AGE diagnoses. Of 1 705 514 all-cause AGE and 5805 norovirus AGE cases, 11.3% and 44.6%, respectively, were hospitalized within 3 days of their episode. Hospitalization risk was higher for patients with cardiovascular disease (CVD) (all-cause AGE aRR: 1.67 [95% CI, 1.64-1.69]; norovirus AGE aRR: 1.37 [1.22-1.54]), blood disorders, chronic respiratory disease, and chronic kidney disease. Relative to individuals without underlying conditions, hospitalization risk was higher for those with ≥2 conditions (all-cause AGE aRR: 2.02 [95% CI, 1.98-2.07]; norovirus AGE aRR: 1.79 [1.50-2.14]), exceeding the risk among those with 1 condition. Relative risk of acute hospitalization associated with presence of underlying conditions was higher among adults aged 18-64 years than among those ≥65 years. Underlying conditions, notably CVD and ≥2 underlying conditions, significantly increased the risk of acute hospitalization, which was elevated among adults aged 18-64 years.
Clozapine was (1) first introduced in Austria and Switzerland in 1972, (2) associated with 8 Finnish deaths due to agranulocytosis in 1975 (almost leading to its withdrawal), and (3) approved in the United States (US) for treatment-resistant schizophrenia in 1989 (resulting in a worldwide resurrection). This article reviews the 1960s/1970s trials published in German that brought about the first approval of clozapine; they are not included in PubMed and received no attention in previous historical articles. Prior historical manuscripts and the references of identified articles provide us with 13 early trials published in German. The first was unsuccessful. Randomization, double-blindness, and control antipsychotic agents were used in 1 of 10 single-center trials and a multicenter trial. Most trials focused on schizophrenia. The efficacy of clozapine in (1) mania was proposed by Angst in the Swiss trials, and (2) aggression across psychiatric diagnoses by an Austrian trial. These trials did not discuss titrations; a study by Blum and Mauruschat focused on physiological changes and first identified fever in the absence of infection during clozapine titrations (called benign hyperthermia in the US). These limited early trials leading to the introduction of clozapine in the 1970s in German-speaking countries produced many unresolved issues. Our discussion reviews the most important aspects that were clarified but not completely resolved in later years, including (1) risk of agranulocytosis, (2) titration and dosing, and (3) indications. Further clarifications and advances are limited by the lack of funding, as clozapine is a generic drug.
A multicomponent vaccine targeting seasonal influenza and coronavirus disease 2019 (COVID-19) may reduce disease burden by providing simultaneous protection in a single injection. We report findings from Part 1 (Japan) of a phase 3, Asia-Pacific, randomized, observer-blind study evaluating immunogenicity, reactogenicity, and safety of mRNA-based multicomponent vaccine mRNA-1083, combining influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens. Participants aged ≥50 years were randomized (1:1) to receive mRNA-1083 + placebo or Japan-licensed influenza hemagglutinin (HA) vaccine + mRNA-1273. Overall, 2022 participants were randomized, and 2013 received study intervention. At Day 29, mRNA-1083 elicited noninferior immune responses versus active comparators for all evaluated influenza strains and SARS-CoV-2. Among high-risk participants (aged ≥65 years and 60 to <65 years with ≥1 comorbidity), noninferiority of mRNA-1083 was demonstrated for comparator-matched influenza strains and SARS-CoV-2. In the overall study population, mRNA-1083 demonstrated superiority for the comparator-matched influenza strains and for SARS-CoV-2. At Day 181, immune responses remained above baseline and were comparable to or numerically higher than those elicited by active comparators. Most solicited adverse reactions were grade 1 or 2. There were no cases of myocarditis or pericarditis, and no reported serious adverse events or deaths related to study intervention. Overall, mRNA-1083 demonstrated an acceptable safety profile, eliciting noninferior and superior immune responses against influenza and SARS-CoV-2 in the high-risk and overall study population, respectively. Immune responses were maintained through 6 months post-vaccination. These findings support mRNA-1083 as a single-dose approach to seasonal vaccination against influenza and SARS-CoV-2 in adults ≥50 years. ClinicalTrials.govidentifier: NCT06694389 (https://clinicaltrials.gov/study/NCT06694389).
We propose simple and double acceptance sampling investment indicators designed to determine the acceptance or rejection of financial securities for investment based on a tolerable threshold assessed through historical data. These indicators alleviate the burden of including underperforming securities in a portfolio and determine the optimal sample size required for decisions at a given significance level. Both the investment indicators are defined to address the perspectives of buyers and sellers of securities. The proposed double acceptance sampling-based indicator extends the simple sampling-based indicator, offering equivalent information with a smaller sample. Furthermore, we develop a generalized mean-variance portfolio optimization model that includes the buyer's risk and entropy-based uncertainty in decision-making for selected securities. The applicability of these indicators and the model's generalizability are illustrated using DJIA 30 index stocks, showcasing reduced portfolio size while producing equivalent or higher portfolio returns as compared to the Markowitz model.
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Artificial intelligence (AI) is reshaping healthcare, and forensic medicine and nursing are no exception. From automated wound pattern analysis to natural language processing (NLP) in medicolegal documentation, AI tools are entering a field situated at the intersection of clinical care, legal accountability, and human rights. This systematic review with narrative synthesizes contemporary clinical, forensic, and AI ethics literature to examine current and emerging applications of AI in forensic practice, with particular attention to injury interpretation, postmortem interval estimation, forensic imaging, survivor documentation, and medicolegal reporting. Forensic nursing practice, including sexual assault nurse examiner (SANE) programs, domestic violence assessment, and paediatric abuse evaluation, is a central focus. The review critically evaluates ethical risks associated with deploying algorithmic decision-making in high-stakes forensic contexts where outputs may influence criminal outcomes and judicial proceedings. Issues of algorithmic bias, chain-of-custody integrity, explainability, and the potential displacement of clinical judgment are examined alongside practical considerations for implementation. Given the still-emerging forensic-specific evidence base, this review draws selectively on adjacent clinical disciplines while emphasizing the distinct medicolegal demands of forensic practice. Responsible integration of AI, the review concludes, requires interdisciplinary governance, equity-stratified validation, and preservation of the clinician-examiner's primary interpretive authority.