Low Return Rate Research Articles

Use of a telehealth follow-up system to facilitate treatment and discharge of emergency department patients with severe cellulitis.

Novel long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with cellulitis who require intravenous antibiotics. Telehealth systems have shown success in remote management of dermatologic conditions; we implemented a telehealth follow-up program for patients diagnosed with cellulitis in the ED, treated with single-dose dalbavancin, and discharged. This was a prospective, multi-center observational study. Patients were included based on clinical criteria and ability to complete follow-up using a smartphone and enroll in an online care portal. We examined the rate of successful telehealth follow-up at 24- and 72-hour intervals from discharge. We also examined the ED return rate within 14days, reviewed any visits to determine cause of return, and for admission. 55 patients were enrolled. 54/55 patients completed at least one telehealth follow up encounter (98.2%). 13 patients (23.6%) had a return ED visit within 14days; no patients required admission for worsening cellulitis. Patient engagement in the telehealth program decreased over time; there was an approximately 11% decrease in engagement between the 24 and 72-hour follow-up call, and a 15% decrease in engagement between the 24 and 72-hour image upload. Patients over 65 had a lower rate of image upload (31%) than younger patients (80.6%). A telehealth follow-up system for discharged emergency department patients with cellulitis demonstrated high rates of engagement. In these patients who -may have otherwise required admission for intravenous antibiotics, telehealth-facilitated outpatient management resulted in a low ED return rate and no inpatient admissions for cellulitis.

Foot web pentosidine does not covary strongly with age in four species of wild seabirds

Age is an important parameter for a variety of ecological applications, including population viability analyses, contaminants monitoring and targeting of individuals for conservation. While many organisms can be aged by annual rings, dentition and other techniques (i.e., fish otoliths, clam growth rings, mammal tooth wear), there are no minimally invasive biomarkers for accurately aging birds in the wild. For the past century, banding has been the only way to identify a bird of known age, which requires continuous effort on a large scale with possibly low return rates. Recent studies have identified pentosidine as a potential biomarker of chronological aging in several bird species. To test this idea in four species of long-lived seabirds, we collected skin biopsies from the foot webs of previously banded, known-age seabirds: black-legged kittiwakes (Rissa tridactyla; 0-19 y old), Atlantic puffins (Fratercula arctica; 5-26 y old), razorbills (Alca torda; 0-15 d old) and thick-billed murres (Uria lomvia; 0-35 y old). Foot web samples were specifically chosen because this was the least invasive site for substantial skin biopsy. Samples were analysed with high performance liquid chromatography to quantify pentosidine levels. Collagen levels were estimated through hydroxyproline assays to normalize pentosidine content across individuals. Kittiwakes displayed a weak correlation (r2=0.20) between age and pentosidine/collagen. Puffins (adults only, r2=0.02), razorbills (chicks only, r2=0.08), and murres (adults, r2=0.04) did not show any associations with age. We concluded that pentosidine content in the foot web does not appear to be a reliable method for aging seabirds in the wild. An absence of change in pentosidine in the foot web with age is further evidence that long-lived seabirds may maintain physiological performance into old age.

Nitroglycerin for treatment of retained placenta: A randomised, placebo-controlled, multicentre, double-blind trial in the UK.

Retained placenta following vaginal delivery is a major cause of postpartum haemorrhage. Currently, the only effective treatments for a retained placenta are the surgical procedures of manual removal of placenta (MROP) and uterine curettage, which are not universally available, particularly in low- and middle-income countries. The objective of the trial was to determine whether sublingual nitroglycerin spray was clinically effective and cost-effective for medical treatment of retained placenta following vaginal delivery. A randomised, placebo-controlled, double-blind trial was undertaken between October 2014 and July 2017 at 29 delivery units in the UK (Edinburgh, Glasgow, Manchester, Newcastle, Preston, Warrington, Chesterfield, Crewe, Durham, West Middlesex, Aylesbury, Furness, Southampton, Bolton, Sunderland, Oxford, Nottingham [2 units], Burnley, Chertsey, Stockton-on-Tees, Middlesborough, Chester, Darlington, York, Reading, Milton Keynes, Telford, Frimley). In total, 1,107 women with retained placenta following vaginal delivery were recruited. The intervention was self-administered 2 puffs of sublingual nitroglycerin (800 μg; intervention, N = 543) or placebo spray (control, N = 564). The primary clinical outcome was the need for MROP, assessed at 15 minutes following administration of the intervention. Analysis was based on the intention-to-treat principle. The primary safety outcome was measured blood loss between study drug administration and transfer to the postnatal ward or other clinical area. The primary patient-sided outcomes were satisfaction with treatment and side-effect profile, assessed by questionnaires pre-discharge and 6 weeks post-delivery. Secondary clinical outcomes were measured at 5 and 15 minutes after study drug administration and prior to hospital discharge. There was no statistically significant or clinically meaningful difference in need for MROP by 15 minutes (primary clinical outcome, 505 [93.3%] for nitroglycerin versus 518 [92.0%] for placebo, odds ratio [OR] 1.01 [95% CI 0.98-1.04], p = 0.393) or blood loss (<500 ml: nitroglycerin, 238 [44.3%], versus placebo, 249 [44.5%]; 500 ml-1,000 ml: nitroglycerin, 180 [33.5%], versus placebo, 224 [40.0%]; >1,000 ml: nitroglycerin, 119 [22.2%], versus placebo, 87 [15.5%]; ordinal OR 1.14 [95% CI 0.88-1.48], p = 0.314) or satisfaction with treatment (nitroglycerin, 288 [75.4%], versus placebo, 303 [78.1%]; OR 0.87 [95% CI 0.62-1.22], p = 0.411) or health service costs (mean difference [£] 55.3 [95% CI -199.20 to 309.79]). Palpitations following drug administration were reported more often in the nitroglycerin group (36 [9.8%] versus 15 [4.0%], OR 2.60 [95% CI 1.40-4.84], p = 0.003). There were 52 serious adverse events during the trial, with no statistically significant difference in likelihood between groups (nitroglycerin, 27 [5.0%], versus placebo, 26 [4.6%]; OR 1.13 [95% CI 0.54-2.38], p = 0.747). The main limitation of our study was the low return rate for the 6-week postnatal questionnaire. There were, however, no differences in questionnaire return rates between study groups or between women who did and did not have MROP, with the patient-reported use of outpatient and primary care services at 6 weeks accounting for only a small proportion (approximately 5%) of overall health service costs. In this study, we found that nitroglycerin is neither clinically effective nor cost-effective as a medical treatment for retained placenta, and has increased side effects, suggesting it should not be used. Further research is required to identify an effective medical treatment for retained placenta to reduce the morbidity caused by this condition, particularly in low- and middle-income countries where surgical management is not available. ISRCTN.com ISRCTN88609453 ClinicalTrials.gov NCT02085213.

Coordination mechanism of dual-channel closed-loop supply chains considering product quality and return

The deficiency of green products from a quality perspective has attracted significant attention from consumers. The recurring explosions of smart cell phone batteries in recent years is why green products are deemed quality-deficient. However, few researchers has paid attention to this issue, and there is no consensus in the previous literature regarding the impact of returning defective products on vertical dual-channel management in closed-loop supply chains. According to past studies, there are two types of product returns: 1) defective item return and 2) waste product return. The model in our study is based on these two types. However, available studies are not based on this model. Second, we examine how closed-loop supply chain members determine the product quality and price in the presence of return on defective items. Based on our results, we design a revenue-sharing contract to motivate retailer's efforts in recycling waste products. Our paper demonstrates the effectiveness of the proposed coordination mechanism in mitigating retail price competitions and enhancing the total profit of dual-channel closed-loop supply chains, compared to non-coordination models. In addition, we also provide a practical managerial insight indicating that it may not be wise to pursue a low return rate for faulty products by making expensive quality improvements, and the increased quality may even worsen the entire supply chain in some scenarios.

Reverse Aftermarket Logistics in E-Commerce a Case Study in a Manaus Microenterprise

Logistics are of great importance in a globalized market. Supply chains are always in global competition, involving multiple countries and multiple companies. Direct Logistics is the process by which the products pass from the place of origin of the raw material to the final consumer. Aftermarket Reverse Logistics is required to resolve issues after products reach their final destination, and before consumption, but can also occur before, as is the case with e-commerce, due to problems in receiving ordering, packaging and shipping. Companies must always be prepared to respond quickly to this demand. Strict control of the entire process from order receipt to delivery to the consumer is required and this process needs to be integrated in real time. In the case study, of the orders sent, only about 3% present some problem, all of which are solved quickly. This result is the way the company handles each order, in constant communication with the customer, clarifying doubts and solving problems quickly. The result is the low return rate compared to other e-commerce companies, and the 100% resolution of cases, always valuing the satisfaction of their customers.

Psychosocial Barriers After Anterior Cruciate Ligament Reconstruction: A Clinical Review of Factors Influencing Postoperative Success.

Psychosocial factors arising after anterior cruciate ligament (ACL) injury may have a direct influence on an individual's decision to return to sport after ACL reconstruction (ACLR). While there is ample evidence to suggest that deficits in quadriceps strength, neuromuscular control, and clinical functional tasks exist after ACLR, the root and contribution of psychological dysfunction to an individual's success or return to sport after ACLR is still largely uncertain and unexplored. Given the discrepancy between successful functional outcomes and the percentage of athletes who return to sport, it is important to thoroughly address underlying factors, aside from physical function, that may be contributing to these lower return rates. Articles that reported on return to sport, psychological factors, and psychosocial factors after ACLR were collected from peer-reviewed sources available on Medline (1998 through August 2018). Search terms included the following: anterior cruciate ligament OR ACL AND return-to-sport OR return-to-activity, anterior cruciate ligament OR ACL AND psychological OR psychosocial OR biopsychosocial OR fear OR kinesiophobia OR self-efficacy, return-to-activity AND psychological OR psychosocial. Clinical review. Level 5. Psychosocial factors relative to injury are important components of the rehabilitation process. To fully understand how psychosocial factors potentially influence return to sport, an athlete's emotions, experiences, and perceptions during the rehabilitation process must be acknowledged and taken into consideration. Acknowledgment of these psychosocial factors allows clinicians to have a better understanding of readiness to return to sport from a psychological perspective. Merging of the current ACLR rehabilitation protocols with knowledge related to psychosocial factors creates a more dynamic, comprehensive approach in creating a positive and successful rehabilitation environment, which may help improve return-to-sport rates in individuals after ACLR.

Sea buckthorn berries Hippophae rhamnoides L. predict size and composition of a great tit population Parus major L

In seasonal environments variation in food abundance in the non‐breeding season is thought to affect songbird population dynamics. In a unique tit‐sea buckthorn berry system we can estimate the berry abundance and both the tit consumption and population dynamics. Six hundred nest boxes were available to great and blue tits Cyanistes caeruleus for breeding in spring and roosting in winter. We followed the dynamics including the recapture histories of individually marked great tits from 2008 to 2014. In each year we estimated 1) the winter sea buckthorn berry availability, 2) an index of berry consumption in December based on the colour of the faeces of roosting birds, 3) the number of breeding great and blue tits, 4) both recapture probability and the return rate of the great tits and 5) immigration rates. December berry abundance positively predicted the number of breeding pairs of both species in the subsequent season and great tit return rates in the second half of the winter. There was support for a sex specific berry effect on the adult return rate in the great tit: female return rate was associated less strongly to berry abundance than male return rate. This skewed the sex ratio of the local breeders in the following breeding season. Intriguingly, annual berry consumption in December was not related to berry abundance, and individuals consuming more berries tended to have slightly lower return rates. Reproductive rate was not related to berry abundance. There was hardly support for a relation between immigration rates of first year breeders and berry abundance. Taken together these results imply that berry stock not only affected population size but also the population composition through sex specific exchange with the surroundings. Since population density covaried with berry abundance, density dependent effects provide an alternative explanation for the patterns observed.

Recovery-channel selection in a hybrid manufacturing-remanufacturing production model with RFID and product quality

Due to the accelerated expansion of technology and improved living standards, the use of electronic products is increasing exponentially. Unfortunately, the improper disposal of used electronic products, such as cell phones, has resulted in rapid degradation of the environment and is, therefore, posing a great threat to human health. Meanwhile, proper recycling is also likely to generate high profits; thus, recycling of electronic products is a necessity of the time. However, the profitability of recycling and remanufacturing depends upon the return rate, which is very low in the cell phones industry. In this paper, we first identify the root causes of low return rate and, then, develop a novel Radio Frequency Identification (RFID) based return channel to increase the recycling rate. A dual-recovery-channel hybrid manufacturing-remanufacturing production model is proposed, which procure used products of different quality from both the traditional market-driven recovery channel as well as the new RFID based channel. A mathematical model is developed considering the cost of implementation and the design of the proposed RFID based recovery channel. Recovery-channel selection is studied, and results show that a hybrid collection strategy with 85% share of channel-1 and 15% of channel-2 is the optimal one. Moreover, the collection from the proposed RFID based channel increases as the demand increases. For the proposed RFID based system, reader sensing power is found more significant compared to the cost of readers. A numerical example is given with three different cases and impacts of different input parameters are studied to draw important results. Managerial insights are given to assist the designer of the system in some critical decisions.

Long-Term Solar Photovoltaics Penetration in Single- and Two-Family Houses in Switzerland

The Swiss energy strategy aims at increasing electricity generation from solar power by 2050, to fulfil Switzerland’s commitments in the Paris Agreement. However, the market of single- and two-family houses is characterized by low return rates for excess power injected to the grid, and the installation of rooftop solar photovoltaic (PV) is sensitive to financial incentives. We assess the drivers influencing the diffusion of rooftop solar PV systems until 2050, by employing an agent-based model. An agent is a single- or two-family house, and its decision to invest depends on the economic profitability of the investment, the agent’s income, environmental benefits (injunctive social norm), awareness and knowledge about the solar PV technology, and the impact of the social network (descriptive social norm). The model includes a synthetic population of agents, statistically equivalent to the true population. We also investigate the impact of different support policies, technology learning rates, electricity prices, and discount rates on the investment decision. We find that the concept of prosumer emerges, mainly via self-consumption strategies. The diffusion process of rooftop solar PV systems in single- and two-family houses gains momentum in the future. In the near-term, PV deployment is sensitive to the profitability of the investment, while after the year 2030, peer effects play an increasing role in the agents’ investment decisions.

No increased risk of transfusion-transmissible infections after tattooing, body piercing, or acupuncture among blood donors in the Netherlands.

In the Netherlands, needle-related events (NREs) including tattoos, piercings, and acupuncture are a reason for temporary blood donor deferral. This study aims to evaluate whether donors with recent NREs had a higher risk of transfusion-transmissible infections (TTIs) compared to donors without recent NREs. Data from 2006 through 2015 on all blood donation attempts in the Netherlands were collected. Multivariate regression models (for repeated measurements) were used to assess the associations between recent NREs and the acquisition of TTIs. Posttest counseling data were used to determine the most likely risk factor in TTI-positive new and repeat donors. Recent NREs were documented in 97,518 out of 9,266,036 (1.1%) donation attempts; 14,097 (14.5%) NREs resulted in NRE-based donor deferral. Recent NREs reported pre-donation were not associated with an increased risk for TTIs. A total of 29 out of 287 TTI-positive donors (11 repeat donors, 18 new donors) reported a recent NRE pre- and/or post-donation. Recent NREs, all needle-stick injuries, were the likely route of transmission in 12 out of 287 (4.2%) of TTI-positive donors. The donor health questionnaire (DHQ) identified only 1 out of 12 TTI-linked NREs. Non-return after NRE deferral, any deferral, or no deferral was 24, 15, and 5%, respectively. Recent tattoos, body piercings, or acupuncture were not associated with an increased risk for TTIs in Dutch donors. Given the lower return rates of donors following a temporary NRE-based deferral, we advocate ending blood donor deferral policies for acupuncture, tattooing, and body piercings, but not needle-stick injuries, in countries where these practices can be considered safe.

Food Web Analysis of Jordanelle Reservoir, Utah, USA: Where Do All the Rainbows Go?

Background:Reservoir communities in the intermountain west are typically dominated by a mix of introduced fishes. Due to the non-coevolved interactions present in these communities, energy flow and trophic interactions may not facilitate optimal growth and survival for all species. It is difficult to predict how well each species will survive in such novel communities. One such community is in Jordanelle Reservoir in northern Utah, USA. Recently, low survival and recruitment of stocked rainbow trout (Onchorhynchus mykiss) have been observed in Jordanelle Reservoir.Objective:We characterize the food web structure of the fish community in Jordanelle reservoir to infer competitive or predatory interactions that might lead to a poor return of stocked rainbow trout.Methods:We performed a stable isotope analysis on the fish community in Jordanelle Reservoir and carried out niche space analyses using the software package Stable Isotope Bayesian Ellipse (SIBER) in R.Results:Small rainbow trout exhibit high competitive overlap with brown trout (Salmo trutta), smallmouth bass (Micropterus dolomieu), and yellow perch (Perca flavescens). In addition, large brown trout and large smallmouth bass may feed heavily on small rainbow trout.Conclusion:Food web analysis suggests that rainbow trout encounter a highly competitive and potentially high predation environment in Jordanelle reservoir, leading to observed low return rates.

Effects of harness-attached tracking devices on survival, migration, and reproduction in three species of migratory waterfowl

BackgroundTracking devices have enabled researchers to study unique aspects of behavior in birds. However, it has become clear that attaching these devices to birds often affects their survival and behavior. While most studies only focus on negative effects on return rates, tracking devices can also affect the behavior under study, and it is therefore important to measure potential negative effects of tracking device attachment on the full range of behavioral aspects of birds. At the same time, we should aim to improve our current attachment methods to reduce these effects.ResultsWe used a modified harness to attach tracking devices to a total of 111 individuals of three goose species (Greater White-fronted Geese, Brent Geese, and Barnacle Geese) to study their migratory behavior. By creating control groups of birds marked with colored leg bands, geolocators, and/or neck collars, we were able to compare return rates, body condition, and migratory and reproductive behavior, thus allowing a much broader comparison than return rates alone. Birds with harness-attached tracking devices had lower return rates, which could partly be explained by increased rates of divorce, but is likely also the result of reduced survival induced by the harness and device. A comparison between Barnacle Geese equipped with harness-attached tracking devices and individuals fitted with geolocators attached to leg bands showed that birds equipped with tracking devices were only slightly delayed in timing of migration and reproduction and otherwise were not affected in reproductive output.ConclusionsWe argue that tracking devices can be used for studies on migration timing. Nevertheless, given the effect of tracking devices on survival and divorce rate, which may differ between sexes and species, we stress that researchers should carefully consider which birds to tag in order to reduce potential negative effects.

Net-chasing training improves the behavioral characteristics of hatchery-reared red sea bream (Pagrus major) juveniles

The low return rate of fish released for stock enhancement has often been attributed to hatchery-reared fish having inferior behavioral characteristics. We tried to improve the behavioral characteristic of red sea bream (Pagrus major) juveniles by using a net-chasing treatment. The fish were provided with 2 min of net chasing twice daily for 3 weeks, following which their behavioral characteristics (emergence from a start area, avoidance response to novel stimulus, and foraging following transfer between tanks) were individually tested and compared with a control group. A predator exposure test was then conducted using marbled rockfish (Sebastiscus marmoratus). Net-chased fish exhibited a shorter latency to emergence, a higher avoidance rate, and an earlier foraging time than the control fish, indicating that the net-chasing treatment may improve adaptability for environmental change and alertness to a novel object. The net-chased fish also exhibited a better survival rate than the control fish, with an odds ratio of 6.76. We suggest that net-chasing training represents an easy and efficient method for improving the behavior of fish for stock enhancement.

The intergenerational education spillovers of pension reform in China

Economic theory establishes that pension privatization weakens the link between old and young and so reduces the incentive to invest in public education in an economy with lower return rate of capital than growth rate of wage. However, empirical studies of the link change are few. In this paper, we investigate the effects of pension privatization and the central government’s subsidy to individual accounts on public education spending in a three-period overlapping generation model. And then, we take contemporary pension reforms in a number of Chinese provinces as offering natural experiment conditions. Using a difference-in-difference framework and 282 municipal districts panel data over years 1998–2009, we test the pension-education theoretical link change. Both our theoretical and empirical results confirm that pension privatization is adversely associated with local public spending on education in China. Private pension subsidies, moreover, magnify this effect. Our study supports the theoretical assertion and selective empirical findings of a negative intergenerational effect of pension privatization.

Increasing Athlete Knowledge of Mental Health and Intentions to Seek Help: The State of Mind Ireland (SOMI) Pilot Program

The present study had three aims, to determine: (a) whether providing a curriculum-based mental health awareness program to athletes increased knowledge of mental health and intentions to offer support; (b) whether the program increased resilience and well-being compared to a control group; and (c) the feasibility of the program. A total of 100 participants (Mage = 20.78; SD = 2.91; male = 59) either attended the program or were part of a control group. Participants completed questionnaires pre-, post-, and 3-months post-intervention, although there was a low participant return rate for the 3-month follow-up (n = 15). Participants were invited to take part in a focus group to explore program relevance. Knowledge of mental health and intentions to offer support increased for the intervention group, compared to the control. The program with some modification could be integrated into university sport courses to promote mental health awareness.

The impact of product returns on price and delivery time competition in online retailing

Abstract This paper studies price and promised delivery lead time (PDL) competition between two e-tailers in the context of e-commerce. Product returns are considered, which are affected by late and early delivery inaccuracies, i.e., the delay and early arrival of random actual delivery time relative to PDL. The goal is to examine whether the Nash Equilibrium exists in the competition, and to explore the impact of product returns on equilibrium solutions. We consider two cases where the sensitivities of the return rate to late delivery inaccuracy and early delivery inaccuracy are symmetric/asymmetric. The results suggest that (1) firms with lower basic return rates or lower return rate sensitivities, always quote higher prices and shorter PDLs; (2) it is not always profitable for firms whose competitors’ return parameters increase.

Time of Day and Hearing Aid Adoption.

To date, there is little understanding of how contextual factors may influence the decisions individuals make regarding the adoption of options for hearing rehabilitation. This explorative retrospective study investigated whether hearing aid adoption and return rates are associated with the time of the day at which an appointment takes place. The study sample consisted of 24,842 patients experiencing their first audiology appointment. It was observed that hearing aid adoption was significantly associated with appointment times whereby lower hearing aid adoption rates were observed at noon and 4 p.m. It was also observed that hearing aid return rates were significantly associated with appointment times whereby lower return rates were observed at noon and 4 p.m. In light of the methodology employed in the study, it is not possible to unequivocally determine why time of day is associated with hearing aid adoption and return rates. Several possible explanations for the patterns of associations are discussed. In light of previous research observing that hunger lowers risk tolerance and glucose consumption increases risk tolerance, the results are consistent with an interpretation based on risk-aversion resulting from hunger. To establish causality between hunger and decision-making in audiology, additional research employing experimental methodologies are necessary.

Informing future research for carriage of multiresistant Gram-negative bacteria: problems with recruiting to an English stool sample community prevalence study

ObjectivesThis study aims to highlight problems with recruiting to an English stool sample community prevalence study. It was part of a larger cross-sectional research to determine the risk factors for...

The effect of cormorant predation on newly established Atlantic salmon population

This study aimed to describe the effect of cormorant predation on newly established Atlantic salmon, Salmo salar, population in three nursery streams in the upper Elbe River basin (Czech Republic). Salmon have been annually stocked into the nursery streams since 1998 as part of a salmon reintroduction programme. Salmon parr density in nursery streams was 3–81 fish per 100 m2. Only thirteen adult salmon were observed in the study area during two years of research. Altogether 912 cormorant pellets were collected, 5482 diagnostic bones were analysed, and 3915 fish were identified in the diet. Cormorant diet was composed of 24 fish species from six families but no salmon were consumed. The salmon stocking programme produces a reasonable amount of smolts but return rates of adults are very low. The cause of low return rates is not cormorant predation on nursery streams but, most likely, a low survival rate on the passage downstream. We suggest that more studies should focus on monitoring of survival and return rates of salmon in the upper River Elbe to ensure that, in the future, the salmon reintroduction programme will be really successful.

A Physiological Signature of the Cost of Reproduction Associated with Parental Care.

Costs of reproduction are an integral and long-standing component of life-history theory, but we still know relatively little about the specific physiological mechanisms underlying these trade-offs. We experimentally manipulated workload during parental care in female European starlings (Sturnus vulgaris) using attachment of radios and/or wing clipping and assessed measures of workload, current breeding productivity, future fecundity, and survival (local return rate) in relation to treatment. Females with wing clipping and radio attachment paid a clear cost of reproduction compared with all other treatment groups: they had lower future fecundity and lower return rates despite having lower current breeding productivity. We then measured 13 physiological traits, including measures of aerobic/metabolic capacity, oxidative stress and muscle damage, intermediary metabolism and energy supply, and immune function. Our results show that the cost of reproduction in females with wing clipping and radio attachment was associated with lower oxygen-carrying capacity (lower hematocrit and hemoglobin levels), lower energy reserves (plasma nonesterified fatty acid and triglyceride levels), decreased immune function (lower haptoglobin levels), and elevated levels of oxidative stress (higher levels of dROMs [reactive oxygen metabolites] and lower levels of the endogenous antioxidant uric acid). Our study provides evidence that costs of reproduction involve a widespread decline in physiological function across multiple physiological systems consistent with long-standing ideas of cumulative "wear and tear" and allostatic load.