Implementation Challenges Research Articles

The Urgency of Restorative Justice Regarding Customary Criminal Violations: Harmonization Between Customary and National Criminal Laws

<p class="TableParagraph"><em>Indonesia is rich in cultural and traditional diversity, including a variety of customary laws in different regions. Conflict often arises between customary laws and national criminal laws. Restorative Justice is an important approach to resolving this conflict, with a focus on reconciliation rather than punishment. This research aims to understand the implementation of Restorative Justice in the Indonesian context, identify its positive and negative impacts, and contribute valuable insights to international discussions on legal conflicts in culturally diverse societies. Normative legal research methods and document analysis are used for this study. The findings suggest that the implementation of Restorative Justice in resolving violations of customary criminal laws in Indonesia has the potential to enhance harmony between customary and national criminal laws. Necessary steps include establishing a dedicated restorative justice judicial system, involving local communities, fostering collaboration between authorities of customary and national criminal laws, and conducting extensive public education. However, it is crucial to consider both the positive outcomes, such as community relationship restoration and reduced burdens on the criminal justice system, and the negative impacts, including potential justice disparities and implementation challenges. Therefore, the integration of restorative justice needs to be carefully aligned with principles of justice, respect for customary culture, and the protection of the rights of vulnerable victims and offenders.</em></p>

Climate Smart Agriculture in Kenya's ASALS: Gaps and Barriers in Policy Development and Implementation

This paper presents an evaluation of the gaps and barriers in policy development and implementation with regard to Climate Change in Kenya's arid and semi-arid lands (ASALS). In spite of concerted efforts and considerable attention accorded to the climate change effects in the region, there is little improvement. Through a desktop review of previous studies and policy documents, this paper examines the mitigation measures proposed and interrogates the practicality of these measures as well as the gaps and challenges in formulation and implementation. The ASALS are the most hit by climate change, and they make up 89% of the country's landmass and are home to approximately 20 million people, which translates to 38% of the Kenyan population. The region is also home to 60% of the country's livestock, and the considerable contribution of livestock to global warming is justification enough to focus on Climate Smart Agriculture in the ASALS. The region is predominantly rural, and for their livelihoods, the farmers rely on rain, which has become unreliable due to climate, hence the persistent food insecurity. Policies have been formulated to address mitigation, adaptation, and food security with outcomes such as improving yields, growing net returns, lessening the emission of Green House Gases, boosting input use and efficiency, enhancing resilience, and improving gender and social inclusion. Understanding the constraints in the implementation of Climate Smart Agriculture (CSA) practices would be useful in improving policy formulation and intervention planning. The findings of this study reveal gaps and barriers in the formulation and implementation of CSA policies stemming from lack of awareness, which is responsible for the low adaptability levels, nature of land ownership in the ASALS, cultural factors, poor coordination between stakeholders and inadequate funding for CSA projects

Investigating the barriers facing corporate social responsibility in the built environment: Ghana’s perspective from a qualitative approach

Purpose Several organisations dedicate a portion of their budget and business websites to corporate social responsibility (CSR) events. This illustrates the significance attached to CSR events. In Ghana, a social disconnection may exist between the community and the construction sector. Therefore, this research aims to investigate the benefits of CSR in the construction industry, the implementation challenges and measures to enhance CSR in the Ghanaian built environment.Design/methodology/approach The qualitative technique was adopted using an extensive review of literature supported by structured interviews and analysed by context analysis. The participants include ministry and municipal directors, contractor associations, unions and institutions of engineers. The study achieved saturation.Findings Findings reveal that the construction industry’s CSR impacts the community’s social behaviour and has economic and environmental significance. The absence of government implementation policy and finance constraints were identified as Ghana’s major CSR implementation challenges. Also, besides the government instituting a mandatory policy on CSR in the industry, findings suggest that stakeholders, especially players in the industry and policymakers, should form an integral part of the CSR decisions.Practical implications Findings will support and recommend holistic measures to mitigate CSR implementation hindrances and encourage CSR via a central government's mandatory policy in the Ghanaian built environment.Originality/value Besides most studies used questionnaires, the contribution deduced shows that construction companies' management could use the knowledge from this study and involve all the relevant stakeholders when undertaking CSR activities. Also, the study would fill the scarcity of relevant materials concerning CSR in Ghanaian construction sector.

Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos

BackgroundCommunity-based health programmes have been a cornerstone of primary care in Laos for decades. The study presented here aimed to document prospects for the development of current programmes, considering perceptions about health and health care priorities in the communities, implementation challenges, the policy landscape and opportunities associated with the availability of new technologies.MethodsThe research design primarily involved qualitative in-depth interviews with stakeholders (n = 35) responsible for the planning, management, or implementation of community-based care in Laos at different levels of the health system. These included health managers at central departments or institutes of the Ministry of Health, provincial health departments, district health offices, heads of health centres, village health volunteers, community representatives, and international stakeholders.ResultsThere was consensus that service delivery is still a challenge in many areas, due to geographic inaccessibility of health facilities, communication barriers, health-seeking behaviour, trust, and gender discrimination, particularly among ethnic minorities. In these settings, community health workers have the potential to extend the reach of the formal health system, acting as cultural brokers across sectors of society, ethnicities, and worldviews. To maximise impact, planners need to carefully consider the implementation model, financing arrangements, health system integration, and changing health priorities in the communities.ConclusionsThis study examined challenges to, and opportunities for, the expansion and health system integration of community-based care in Laos. Further development and horizontal integration of community-based care remains a complex financing and governance challenge, although the renewed emphasis on primary care and the ongoing process of decentralisation provide a favourable policy environment in the country to sustain and potentially expand existing programmes.

Unlocking e-commerce potential: micro and small enterprises strike back in the food and beverage industry

PurposeThe recent pandemic period (COVID-19), while negatively impacting many companies, has contributed to the growth and adoption of online platforms such as marketplaces and e-commerce. This environment has led many companies, which previously acted only through offline channels, to adopt new technologies and online channels and develop new e-commerce strategies. Small and micro enterprises are most vulnerable due to their limited resources and lack of capabilities. For this reason, the main objective of this paper is to unveil the e-commerce implementation capabilities that micro and small enterprises should build and the challenges they must face when managing an e-commerce strategy.Design/methodology/approachThe authors adopted an inductive qualitative research design approach focused on multiple case studies. The firms operate in the food and beverage industry.FindingsThe findings identify several e-commerce implementation capabilities that micro and small enterprises operating in the food and beverage industry should build to manage e-commerce strategies. These are related to outsourcing management, multichannel management, time management, internal stock management and marketplace choice. Moreover, the paper identifies key e-commerce implementation challenges these firms must cope with. These regard distribution management, potential loss of control, fresh product management and lack of resources, time and capabilities.Originality/valueThis research shows that proper capacity management in the implementation of micro and small enterprises e-commerce strategies is critical to achieving efficient results and preventing challenges that threaten such strategies. The research offers guidelines and frameworks for micro and small enterprises to understand how to manage e-commerce and face its challenges.

Challenges Encountered by Grade 10 Teachers in Implementing Selective Learning for Enhancing Learning Interest in Rural Schools in South Africa

Given the existing teaching and learning challenges in South Africa’s Basic Education system, selective learning will likely encounter implementation challenges as a method of enhancing effective learning interest in schools. Teachers have identified ineffectiveness and negative attitudes as some of the curriculum’s implementation challenges in the past and present. Against this background, this study explored the challenges that Grade 10 teachers encounter when implementing selective learning in schools. A qualitative research methodology was adopted for the study through the grounded theory approach. It utilized grounded theory as a research design and interpretive paradigm to guide the researcher. Data was collected using semistructured interviews as a data collection instrument. The sample consisted of eight teachers as participants from rural and urban high schools in the Mangaung District in Free State Province in South Africa. The study adopted purposive sampling techniques to select participants. Participants were qualified and experienced teachers with teaching qualifications and more than two years of teaching experience. The data was analysed using thematic analysis as a method of analysis. The thematic results revealed that teachers experience various challenges in implementing selective learning to enhance effective learning interest among Grade 10 learners. These include lack of adaptation, confusion, lack of teachers’ training, and shortage of resources. This study concludes that selective learning could be a helpful tool for enhancing compelling learning interest in South African schools regardless of the implementation challenges. Keywords: Selective learning, Learning Interest, Grade 10 Teachers, Shortage of Resources, Grade 10 Learners

Challenges in Implementing Environmental Laws and Policies in India

This study explores the implementation challenges of environmental laws and policies in India. It reveals the difficulties and problems associated with breaking environmental laws and regulations in India. This study's primary goal is to list the several obstacles India must overcome in order to put environmental laws and policies into effect. A review of the literature of this study provides other points and topics that are aimed to be discussed. The importance of maintaining rules, issues for violating the rules, challenges faced during implementation, and strategies that may help mitigate the problems are discussed. Some theories may help to solve the issues. People are surveyed using the primary data collecting approach in order to obtain general data. Primary data is gathered from non-manipulable sources that do not exist. The data was analysed using the primary quantitative research approach. The secondary data were gathered from various books, newspapers, journals, and articles on Google Scholar. Thirteen questions and fifty-five surveys to gather people's opinions have been analysed using the SPSS program. A thorough explanation is dotted with statistical data. The difficulties encountered, parallels and divergences between the findings and the literature study are discussed. Demand for natural resources and food supplies is another effect of overpopulation. Humans must use natural resources in order to satisfy their needs. Amidst all of this, it is also evident that regulations and limits are ineffective because individuals are not abiding by them. Ultimately, it may be said that corruption, overpopulation, ignorance, and poor education are the key reasons for India's difficulties in implementing environmental laws and policies.

A hybrid approach to resolve ambiguity in new product development

Improving technological innovation (TI) capabilities is an integral component of government policies aimed at improving the competitiveness of small and medium enterprises (SMEs). This study aims to address implementation challenges arising from the use of Qualitative Forecasting Method (QFM) in new product development programs and proposes a novel method to aid decision makers (DMs) in their decision-making process. To tackle this issue, a hybrid method is proposed, incorporating Fuzzy Delphi method (FDM), Fuzzy Analytic Hierarchy Process (FAHP), Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS), and Multi-Choice Goal Programming with utility function (MCGP-U), while introducing prospect theory as a novel approach. is proposed. The proposed method offers several advantages, including effective early planning, accurate identification of key success factors (KSFs), selection of the most suitable project leader, and estimation of the most reasonable resource investment, all of which are critical factors for success in TI for enterprises. The research results show that (1) the proposed method reduces project execution time by 20% compared to the original manual planning, (2) it facilitates the acquisition of KSFs using a rational approach to ensure project success, and (3) it increases the financial returns of the company by 17% compared to the company’s forecast. In summary, this paper makes a significant contribution to practical applications and additionally contributes to decision-making field by introducing prospect theory into the proposed hybrid method.

Sustainable paramylon production from food waste by Euglena gracilis using a waste-based cell immobilisation technique

Microalga represents a promising platform for numerous valuable bioproducts, but the production cost and efficiency remain major challenges for the industrial implementation. In this study, the production of paramylon (polysaccharides) from microalga Euglena gracilis using food waste hydrolysate and cell immobilisation cultivation was assessed. Synthetic medium supplemented with food waste hydrolysate proved to be a feasible option and achieved the paramylon productivity of 1.46 g/L/day in the heterotrophic (HT) cultivation. In addition, waste-based supporting materials were investigated for cell immobilisation cultivation, and waste sponge demonstrating good cell viability and paramylon productivity with maximum of 2.22 g/L/day was achieved using the synthetic medium in HT condition. However, sugarcane bagasse was not suitable for E. gracilis immobilisation as it induced serious cell lysis and oxidative stress under heterotrophic cultivation. The subsequent utilisation of the hydrolysate-based medium coupled with waste-based cell immobilisation cultivation resulted in the paramylon productivity of 1.77 g/L/day, demonstrating a promising fermentation strategy for sustainable and efficient paramylon production. This study serves as a noteworthy example of producing microalgal metabolites from the food waste hydrolysate using waste-based cell immobilisation technique. Overall, our findings provide valuable insights into green and sustainable production of microalgal biorefineries, and contributes to the advancement of the circular bioeconomy.

Flicker Noise in Resistive Gas Sensors-Measurement Setups and Applications for Enhanced Gas Sensing.

We discuss the implementation challenges of gas sensing systems based on low-frequency noise measurements on chemoresistive sensors. Resistance fluctuations in various gas sensing materials, in a frequency range typically up to a few kHz, can enhance gas sensing by considering its intensity and the slope of power spectral density. The issues of low-frequency noise measurements in resistive gas sensors, specifically in two-dimensional materials exhibiting gas-sensing properties, are considered. We present measurement setups and noise-processing methods for gas detection. The chemoresistive sensors show various DC resistances requiring different flicker noise measurement approaches. Separate noise measurement setups are used for resistances up to a few hundred kΩ and for resistances with much higher values. Noise measurements in highly resistive materials (e.g., MoS2, WS2, and ZrS3) are prone to external interferences but can be modulated using temperature or light irradiation for enhanced sensing. Therefore, such materials are of considerable interest for gas sensing.

Overview of Retention Strategies for Medical Doctors in Low- and Middle-Income Countries and Their Effectiveness: Protocol for a Scoping Review.

The global shortage and maldistribution of health care workers, especially medical doctors, pose a significant threat to achieving the United Nations' sustainable development goal 3 of ensuring well-being and healthy lives for all. Low- and middle-income countries (LMICs) are disproportionately affected by this crisis, with a high rate of brain drain from rural to urban areas, as well as to high-income countries. Various retention strategies have been implemented in different settings and organizations. However, their effectiveness remains underexplored, particularly in LMICs. We aim to review the available retention strategies for medical doctors in LMICs and to determine the effectiveness of the various strategies. This review aims to compile relevant research findings on this issue to generate a thorough summary of all the retention strategies practiced in LMICs and, more importantly, to provide the current state of evidence of the effectiveness of these strategies in retaining medical doctors in countries with limited resources and high disease burden. The structured framework given by Arksey and O'Malley will serve as the basis for conducting this scoping review. A comprehensive search strategy will be conducted across 4 electronic databases (PubMed, EBSCOHost, Scopus, and ScienceDirect). A systematic approach following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be executed to search, screen, review, and extract data from studies that meet predefined inclusion criteria. Data encompassing bibliographical information, study location, retention strategies, influencing factors, and outcomes (effectiveness) will be obtained from the selected studies using standardized data extraction. Endnote and Microsoft Excel will be used for reference management and removal of duplicate studies. A narrative synthesis will be performed after categorizing and analyzing all the extracted data to identify recurrent themes. This ongoing review will generate a comprehensive compilation of retention strategies implemented in LMICs to prevent brain drain among medical doctors. Data extraction is currently in progress, and completion is expected by early 2024. Themes regarding the types of strategies, influencing factors, and outcomes will be synthesized. The findings will highlight effective retention strategies, gaps, and challenges in implementation for the benefits of future research. By identifying common barriers and facilitators, this review will provide insights into enhancing the policies and initiatives for doctor retention in LMICs. This scoping review explores the retention strategies practiced in LMICs and attempts to identify effective strategies from existing research. By evaluating the barriers and challenges that influence the effectiveness of these strategies, policymakers and health care leaders can strive to obtain balanced and optimal health human resources in their respective organizations and countries. Malaysian National Medical Research Register (NMRR) ID-23-01994-OGW; https://nmrr.gov.my/research-directory/ac4f5b88-8619-4b2b-b6c7-9abcef65fdcd. DERR1-10.2196/52938.

VARPA: In Silico Additive Screening for Protein-Based Lighting Devices.

Protein optoelectronics is an emerging field facing implementation and stabilization challenges of proteins in harsh non-natural environments, such as dry polymers, inorganic materials, etc., operating at high temperatures/irradiations. In this context, additives promoting structural and functional protein stabilization are paramount to realize highly performing devices. On one hand, trial-error experimental assays based on previous knowledge of classical additives in aqueous solutions are effort/time-consuming, while their translation to water-less matrices is uncertain. On the other hand, computational simulations (molecular dynamics, electronic structure methods, etc.) are limited by the system size and time. Herein, ligand-binding affinity and atomic perturbations to create a day-fast computational method combining Vina And Rosetta for Protein Additives (VARPA) to simulate the stabilization effect of sugars for the archetypal enhanced green fluorescent protein embedded in a standard dry polymer color-converting filter for bio-hybrid light-emitting diodes is merged. The VARPA's sugar additive prediction trend for protein stabilization is nicely validated by thermal and photophysical studies as well as lighting device analysis. The device stability followed the predicted enhanced stability trend, reaching a 40-fold improvement compared to reference devices. Overall, VARPA can be adapted to a myriad of additives and proteins, driving first-step experimental efforts toward highly performing protein devices.

Gender-responsive budgeting implementation challenges: evidence from South Korea

PurposeThe purpose of this research is to further the understanding of how to implement gender-responsive budgeting (GRB) systems. The author explores whether GRB reforms might benefit from integration into a performance-oriented budgetary structure and whether GRB's equity orientation is linked to additional implementation challenges.Design/methodology/approachThis research follows a qualitative case study of South Korea guided by a predetermined research framework and built from extensive documentation, archival records and expert interviews.FindingsGRB’s integration into a performance framework can be burdensome, and the equity orientation of GRB results in additional implementation challenges, such as higher vulnerability to the political context and active resistance from public officials.Originality/valueThis research shows that integrating GRB with performance systems may require overcoming significant administrative obstacles. Also, GRB’s equity orientation is linked to a higher vulnerability to the political cycle and active resistance from civil servants.

Challenges of integrating patient safety into nursing curricula: An integrative literature review

Introduction The World Health Organization's Multi-Professional Patient Safety (PS) Curriculum (WHO-MPSC) was introduced in 2011, which made PS content easily available for nursing educators to integrate into their own curricula. With the exception of a few developed countries that have their own PS frameworks, many countries have yet to fully integrate PS concepts in pre-licensure healthcare education. The literature reveals numerous challenges when attempting to integrate new patient safety (PS) concepts. Due to the lack of updated synthesis and appraisal of these challenges, a synthesis of findings from the literature was deemed timely and significant. Hence, a literature review was carried out to comprehensively understand the challenges. Methods An integrative review was conducted by searching electronic databases for the years 2011–2022. The Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE databases and Google Scholar were searched. The search terms were barriers, challenges, nursing students and PS education. Results Twenty reviews met the inclusion criteria. Through this review, investigators were able to identify 5 major categories of challenges (educators’ characteristics, administration, programme structure, curriculum, theory–practice gap) and 17 individual challenges of PS education implementation. Conclusion The theory-practice gap, curriculum development, and programme structure are areas that should be targeted by curriculum developers in nursing education. Furthermore, it was revealed that there is a need for further research on topics such as resistance to change and individual innovativeness among nurse educators.

Revolutionizing diagnostic pathology: The emergence and impact of artificial intelligence—what doesn't kill you makes you stronger?

This study explored the integration and impact of artificial intelligence (AI) in diagnostic pathology, particularly dermatopathology, assessing its challenges and potential solutions for global health care enhancement. A comprehensive literature search in PubMed and Google Scholar, conducted on March 30, 2023, and using terms related to AI, pathology, and machine learning, yielded 44 relevant publications. These were analyzed under themes including the evolution of deep learning in pathology, AI's role in replacing pathologists, development challenges of diagnostic algorithms, clinical implementation hurdles, strategies for practical application in dermatopathology, and future prospects of AI in this field. The findings highlight AI's transformative potential in pathology, underscore the need for ongoing research, collaboration, and regulatory dialogue, and emphasize the importance of addressing the ethical and practical challenges in AI implementation for improved global health care outcomes.

Examination of the role of the rotating nursing department in the training of nursing staff based on SWOT analysis.

The implementation of the rotation system in the Chinese medical industry has achieved significant results. The present study aims to 1) explore the strengths, weaknesses, opportunities and challenges of rotational nursing department implementation and 2) provide references for developing nursing staff's competencies in leadership, performance evaluation, quality of care, communication in relationships and human resources. A total of 16 rotational nursing department staff members from a tertiary tuberculosis specialist hospital in Beijing were interviewed, and the interview data were analysed using a strengths, weaknesses, opportunities and threats analysis and class analysis. The advantages of the rotational nursing department included: (1) stimulating the nursing staff's enthusiasm and creativity; (2) strengthening the communication and collaboration between departments; (3) improving the detailed management of nursing quality; and (4) enhancing the nursing staff's comprehensive abilities. The disadvantages included: (1) the design of the rotation programme focusing on practice; (2) a lack of personalisation; and (3) imperfect performance assessment of the rotating staff. Opportunities included: (1) deepening the connotation of nursing job management and (2) developing the construction of nursing discipline and the need for personal career development and value realisation. Threats included the lack of a sound rotation management model to draw on. A rotational nursing department is conducive to enhancing the competence of nursing staff in management positions and providing new ideas for hospitals to select and train nursing management talents. By taking full advantage of the benefits of vertical nursing management, designing personalised rotation training programmes, building a diversified learning and training platform and developing a positive performance incentive mechanism is recommended to fully engage the role of rotation in nursing management talent training.

Spare parts management in industry 4.0 era: a literature review

PurposeSpare Parts Management (SPM) and Industry 4.0 has proven their importance. However, employment of Industry 4.0 solutions for SPM is at emerging stage. To address the issue, this article is aimed toward a systematic literature review on SPM in Industry 4.0 era and identification of research gaps in the field with prospects.Design/methodology/approachResearch articles were reviewed and analyzed through a content-based analysis using four step process model. The proposed framework consists of five categories such as Inventory Management, Types of Spares, Circularity based on 6Rs, Performance Indicators and Strategic and Operational. Based on these categories, a total of 118 research articles published between 1998 and 2022 were reviewed.FindingsThe technological solutions of Industry 4.0 concepts have provided numerous opportunities for SPM. Industry 4.0 hi-tech solutions can enhance agility, operational efficiency, quality of product and service, customer satisfaction, sustainability and profitability.Research limitations/implicationsThe review of articles provides an integrated framework which recognizes implementation issues and challenges in the field. The proposed framework will support academia and practitioners toward implementation of technological solutions of Industry 4.0 in SPM. Implementation of Industry 4.0 in SPM may help in improving the triple bottom line aspect of sustainability which can make significant contribution to academia, practitioners and society.Originality/valueThe examination uncovered a scarcity of research in the intersection of SPM and Industry 4.0 concepts, suggesting a significant opportunity for additional investigative efforts.

Exploring the engagement behaviours of Smile4life practitioners: lessons from an evaluation of the national oral health improvement programme for people experiencing homelessness in Scotland.

Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness, aimed at reducing oral health inequalities experienced by this population. This study forms part of an evaluation of how the Smile4life intervention was being implemented within Scottish NHS Boards. The aim was to investigate the influence of the Smile4life intervention upon the engagement behaviours of Smile4life practitioners. Focus groups were conducted with Smile4life practitioners, to provide an insight into how the Smile4life intervention affected their skills, attitudes and experiences while interacting with people experiencing homelessness and their services providers. A purposive sample of oral health practitioners, including dental health support workers, oral health promoters/educators, and oral health improvement coordinators working in three NHS Boards were invited to take part. One focus group was conducted in each of the three NHS Boards. The focus groups were audio-recorded and transcribed. The COM-B model of behaviour was used as a framework for analysis. Eleven Smile4life practitioners took part in the focus groups. All had first-hand experience of working with the Smile4life intervention. The average focus group length was 67 min. Working on the Smile4life intervention provided the Smile4life practitioners with: (i) the capability (physical and psychological), (ii) the opportunity (to establish methods of communication and relationships with service providers and service users) and (iii) the motivation to engage with Third Sector homelessness services and service users, by reflecting upon their positive and negative experiences delivering the intervention. Enablers and barriers to this engagement were identified according to each of the COM-B categories. Enablers included: practitioners' sense of responsibility, reflecting on positive past experiences and success stories with service users. Barriers included: lack of resources, negative past experiences and poor relationships between Smile4life practitioners and Third Sector staff. The Smile4life programme promoted capability, provided opportunities and increased motivation in those practitioners who cross disciplinary boundaries to implement the Smile4life intervention, which can be conceptualised as "boundary spanning". Practitioners who were found to be boundary spanners often had a positive mindset and proactive attitude towards the creation of strategies to overcome the challenges of implementation by bridging the gaps between the NHS and the Third Sector, and between oral health and homelessness, operating across differing fields to achieve their aims.

Tailored risk assessment and forecasting in intermittent claudication.

Guidelines recommend cardiovascular risk reduction and supervised exercise therapy as the first line of treatment in intermittent claudication, but implementation challenges and poor patient compliance lead to significant variation in management and therefore outcomes. The development of a precise risk stratification tool is proposed through a machine-learning algorithm that aims to provide personalized outcome predictions for different management strategies. Feature selection was performed using the least absolute shrinkage and selection operator method. The model was developed using a bootstrapped sample based on patients with intermittent claudication from a vascular centre to predict chronic limb-threatening ischaemia, two or more revascularization procedures, major adverse cardiovascular events, and major adverse limb events. Algorithm performance was evaluated using the area under the receiver operating characteristic curve. Calibration curves were generated to assess the consistency between predicted and actual outcomes. Decision curve analysis was employed to evaluate the clinical utility. Validation was performed using a similar dataset. The bootstrapped sample of 10 000 patients was based on 255 patients. The model was validated using a similar sample of 254 patients. The area under the receiver operating characteristic curves for risk of progression to chronic limb-threatening ischaemia at 2 years (0.892), risk of progression to chronic limb-threatening ischaemia at 5 years (0.866), likelihood of major adverse cardiovascular events within 5 years (0.836), likelihood of major adverse limb events within 5 years (0.891), and likelihood of two or more revascularization procedures within 5 years (0.896) demonstrated excellent discrimination. Calibration curves demonstrated good consistency between predicted and actual outcomes and decision curve analysis confirmed clinical utility. Logistic regression yielded slightly lower area under the receiver operating characteristic curves for these outcomes compared with the least absolute shrinkage and selection operator algorithm (0.728, 0.717, 0.746, 0.756, and 0.733 respectively). External calibration curve and decision curve analysis confirmed the reliability and clinical utility of the model, surpassing traditional logistic regression. The machine-learning algorithm successfully predicts outcomes for patients with intermittent claudication across various initial treatment strategies, offering potential for improved risk stratification and patient outcomes.

Unveiling the potential of redox electrolyte additives in enhancing interfacial stability for Zn-ion hybrid capacitors

Zinc-ion hybrid capacitors (ZICs) that combine the characteristics of metal-ion batteries and supercapacitors are emerging to fulfill high energy-power demands. The objective of this study is to address the challenges in the practical implementation of metallic zinc for ZICs. In this work, we explore redox molecules based on anthraquinone compounds as electrolyte additives for the interfacial engineering of Zn anodes. The results reveal that the additives enable favorable solvation of Zn2+ through metal ion-ligand coordination. The redox additives improve the lifespan of Zn//Zn cells from 50 to 1600 cycles at 2 mA cm−2 and 1 mAh cm−2 due to the suppression of parasitic reactions and the mitigation of by-product formations. The redox properties of additives strengthen the pseudocapacitive behavior of the ZICs, enabling efficient interfacial charge and mass transfer. The redox-enhanced device manifests an increased capacity of 195.0 mAh g − 1 with improved cycling stability, compared to that of 149.6 mAh g − 1 for the additive-free electrolyte. The universal strategy, based on the synergistic effects of redox additives, is demonstrated by a collection of molecules with similar structures. This work unveils a conceptually new approach that utilizes redox additives to formulate advanced electrolytes for aqueous energy storage.