Low Priority Research Articles

Prioritising non-native fish species for management actions in three Polish rivers using the newly developed tool-dispersal-origin-status-impact scheme.

Biological invasions are a major threat to global biodiversity, with freshwater ecosystems being among the most susceptible to the successful establishment of non-native species and their respective potential impacts. In Poland, the introduction and spreading of non-native fish has led to biodiversity loss and ecosystem homogenisation. Our study applies the Dispersal-Origin-Status-Impact (DOSI) assessment scheme, which is a population-level specific assessment that integrates multiple factors, including dispersal mechanisms, origin, status, and impacts, providing a nuanced framework for assessing invasion risks at local and regional levels. We used this tool to evaluate the risks associated with non-native fish species across three major Polish rivers (Pilica, Bzura, and Skrwa Prawa) and to prioritise them for management actions. Using DOSI, we assessed eight non-native species identified in the three studied rivers: seven in both Pilica and Bzura and four in Skrwa Prawa. The DOSI assessment scheme identified high variability in the ecological impacts and management priorities among the identified non-native species. Notably, species such as the Ponto-Caspian gobies exhibited higher risk levels due to their rapid spread and considerable ecological effects, contrasting with other species that demonstrated lower impact levels and, hence, received a lower priority for intervention. The adoption of the DOSI scheme in three major rivers in Poland has provided valuable insights into the complexities of managing biological invasions, suggesting that localised, detailed assessments are crucial for effective conservation strategies and highlighting the importance of managing non-native populations locally.

Enhancing port preparedness in Germany in the event of infectious diseases – a best practice study

Abstract Background The maritime sector is exposed to specific risks in the area of communicable diseases. In Germany, five ports are designated to enforce the International Health Regulations (IHR) and must have certain core capacities to respond immediately to cross-border health threats. A joint external evaluation conducted by the World Health Organization (WHO) revealed a need to reinforce central structures in Germany. The overarching objective of the study is to harmonize and consolidate the requisite capacities for maritime health security. Methods Qualitative interviews (n = 35) at baseline were conducted with various stakeholders, including port medical services, port authorities and other stakeholders. The parameters to be analysed included specific activities and interfaces during infectious incidents, experience with past infection incidents, training and exercise, and the need for action. Furthermore, a document analysis was conducted, during which the existing contingency plans and standard operating procedures were reviewed. Results In essence, the initial challenges posed by the COVID-19 pandemic have led to the establishment of well-defined procedures and interfaces between the various stakeholders involved. There is a necessity for enhanced interpersonal communication between the various stakeholders and the implementation of sustainable training practices. Furthermore, greater transparency and standardisation of regulations in international health emergencies is desired. Conclusions Given the infrequency of cross-border infection incidents on board ships, targeted preparation within stakeholders is often given a lower priority than other work priorities. The participatory study design is intended to develop comprehensive concepts in collaboration with the IHR ports in the ongoing project. Subsequently, these concepts will be tested in tabletop exercises and incorporated into training formats for public health actors. Key messages • The qualitative interview study at baseline revealed a substantial need for sustained communication and training practices among stakeholders for infectious disease preparedness in German IHR ports. • The document analysis revealed relevant differences in the extent and scope of contingency plans of German ports designated under the International Health Regulations.

Twelve Tips for Engaging Medical Students in Rural-Focused Research

Background The future of rural healthcare depends on training the future rural health workforce, and on rural health research that can guide clinical and policy decisions in rural spaces. Promotion of rural healthcare careers usually focuses on clinical aspects of care, and research may be seen as a lower priority. Supporting students to be involved in rural focused research offers the opportunity to broaden the pool of potentially rural interested students, and to develop research and scholarship skills and capacity in the future rural workforce. Aim and method We identify twelve tips that medical schools can adopt to foster medical student participation in research and promote student interest in rural healthcare and rural medical practice. These recommendations are based on a review of literature and our personal experience of conducting rural-focused research activities with medical students. Conclusion Through these twelve tips, we provide a practical framework for enhancing undergraduate medical student exposure to rural-focused research to foster research capacity. This has potential to inspire student interest in future rural medical practice and could contribute to alleviate workforce and research gaps in rural areas.

Development of a total quality management framework for the mobile network operations Centre

Telecommunication is one of the most fast-paced and rapidly changing sectors globally. This study develops a total quality management (TQM) framework for mobile network operation centres (NOC) to aid in network surveillance and fault management processes for a 5G transmission network. A systematic literature review was conducted using academic articles in journals and conference papers sourced from the EBSCOHost database. A fuzzy analytic hierarchical process (FAHP) was used as a multi-criteria decision-making tool to determine which criteria and factors are of the highest ranking for the development of the TQM framework. Data collection and control sheets were ranked higher, making them critical to the framework. This shows that, without good data, no problems can be identified, visualised, analysed, and solved and processes will not be improved. Process improvement is ranked last, showing it is of the lowest priority compared to the other criteria. This however, does not imply that in TQM it is of lower priority, as it is needed to keep meeting the needs of the customers. The framework includes how the TQM tools and techniques can be used in collecting, visualising, analysing, solving problems, and improving processes.

Defining Standards for Fluoroscopy in Gastrointestinal Endoscopy using a Delphi Methodology

Background and Study Aims The use of fluoroscopy in gastrointestinal endoscopy is an essential aid in advanced endoscopic interventions. However, it also raises concerns about radiation exposure. This study aimed to develop consensus-based statements for the safe and effective use of fluoroscopy in gastrointestinal endoscopy, prioritizing the safety and well-being of healthcare workers and patients. Methods A modified Delphi approach was employed to achieve consensus over three rounds of surveys. Proposed statements were generated in round 1. In the second round, panelists rated potential statements on a 5-point scale, with consensus defined as ≥80% agreement. Statements were subsequently prioritized in round 3, using a 1 (lowest priority) to 10 (highest priority) scale. Results Forty-six experts participated, consisting of 34 therapeutic endoscopists and 12 endoscopy nurses from six continents, with an overall 45.6% female representation (n=21). Forty-three item statements were generated in the first round. Out of these, 31 statements achieved consensus after the second round. These statements were categorized into General Considerations (n=6), Education (n=10), Pregnancy (n=4), Family Planning (n=2), Patient Safety (n=4), and Staff Safety (n=5). In the third round, accepted statements received mean priority scores ranging from 7.28 to 9.36, with 87.2% of statements rated as very high priority (mean score of ≥9). Conclusion This study presents consensus-based statements for the safe and effective use of fluoroscopy in gastrointestinal endoscopy, addressing the well-being of healthcare workers and patients. These consensus-based statements aim to mitigate the risks associated with radiation exposure while maintaining the benefits of fluoroscopy, ultimately promoting a culture of safety in healthcare settings.

Quadrotor Flight Envelope Protection with Trajectory and Yaw Tracking

This study proposes a reference governor control strategy to ensure that a quadrotor drone follows a planar trajectory while respecting the prescribed safety constraints. These constraints, including polynomial constraints accounting for aerodynamic and gyroscopic effects, were transformed into linear constraints using novel state-space augmentation. This allows for the design of a reference governor, which is designed to safeguard the drone’s flight envelope by adjusting the reference trajectory during trajectory tracking while also ensuring yaw tracking with lower priority than position tracking, especially when constraints are at risk of being violated. This study also presents simulations that illustrate the effectiveness of the proposed algorithms.

Evaluating cryptographic vulnerabilities created by quantum computing in industrial control systems

AbstractQuantum computing is expected to eventually be able to break the public‐key cryptography algorithms currently used throughout information technology (IT) infrastructure, undermining foundational tools used to maintain information security across the country's critical infrastructure. As these systems converge, the security posture of operational technology (OT) systems has to adapt to a new threat landscape and adopt some of the same security controls as those used in enterprise IT, especially cryptographic controls that rely on public‐key cryptography, which are ubiquitous in enterprise IT systems. Operators and manufacturers of industrial control systems (ICSs) and OT systems will need to understand and address the unique ways in which these systems will be vulnerable to adversaries equipped with quantum computers. We assessed quantum computing–facilitated cryptographic vulnerabilities in ICSs and OT systems to identify the issues in need of the most‐urgent attention from ICS and OT owners, operators, and manufacturers. Employing a modified consequence‐driven, cyber‐informed engineering process informed by literature review and analysis, we mapped protocols using or enabling cryptographic protections across common ICS network topologies as part of an assessment of how an attacker could cause harm, especially damaging physical consequences resulting from manipulation of cyber–physical systems, through the cryptographic compromise of ICS and OT networks and components. Our evaluation of identified and ranked risks to related control systems was also informed by relevant literature on ICS risk assessment and mitigation, cyber harms, and historical attacks on critical infrastructure. Using our analysis, we assessed the overall difficulty in mitigating risk from each of the identified vulnerability archetypes. The resulting analysis identified vulnerabilities associated with code‐signing processes as the highest priority for attention when updating systems for a postquantum future. This risk was followed by vulnerabilities associated with forged certificates for identification and vulnerabilities associated with forged session keys, identified as lower priorities but still of concern. Informed by our findings, we offer recommendations related to the protection of these vulnerabilities and the improvement of ICS security in developed systems.

Priority-based band sharing for secondary users in cognitive radio networks

To improve wireless spectrum utilization, cognitive radio networks (CRNs) allow secondary users (SUs) opportunistic access to the frequency bands owned by primary users (PUs), when such PUs are inactive. A fully distributed CRN architecture is quite favorable, as it does not require any centralized scheduling, nor does it require coordination between SUs via a common control channel. This can reduce cost and avoid single point-of-failure issues. However, uncoordinated access to the spectrum by competing SUs, if not done judiciously, can cause excessive collisions and limit performance, which can be detrimental to the usefulness of CRNs, especially if some SUs have urgent traffic to send. Hence, we present a novel protocol to support traffic with multiple classes of priority within a fully distributed CRN. In such protocol, competing SUs attempt to access the spectrum autonomously, but rationally, based on their priority level, opting to transmit their packets when it is beneficial to both the SU itself and also to the overall system performance. Simulations confirm that the proposed protocol achieves excellent overall network performance, while ensuring that higher priority packets experience higher throughput and smaller delay compared to lower priority packets.

Reclassification of Halomicroarcula saliterrae Straková et al. 2024 and Halomicroarcula onubensis Straková et al. 2024 into the genus Haloarcula, as Haloarcula saliterrae comb. nov. and Haloarcula onubensis comb. nov., respectively.

The haloarchaeal genera Halomicroarcula and Haloarcula, belonging to the family Haloarculaceae, order Halobacteriales, class Halobacteria, within the phylum Methanobacteriota, have previously exhibited significant phylogenetic and taxonomic overlaps. This issue was recently resolved by merging the two genera into a single genus, Haloarcula. However, Halomicroarcula saliterrae and Halomicroarcula onubensis were described almost simultaneously with the proposal to unify the genera Haloarcula and Halomicroarcula. Their names were validly published under the International Code of Nomenclature of Prokaryotes (ICNP) according to Validation List no. 217, alongside six Haloarcula species and the transfer of the existing Halomicroarcula species into the genus Haloarcula. Therefore a phylogenetic, phylogenomic, and comparative genomic analysis was carried out to clarify the taxonomic status of these two haloarchaeal species, Halomicroarcula saliterrae and Halomicroarcula onubensis, with lower priority than the six new species of the genus Haloarcula. Phylogenetic studies of 16S rRNA and rpoB' gene sequences, along with phylogenomic reconstructions using single-copy core-orthologous proteins, indicated that the two species clustered with the members of the genus Haloarcula. The overall genome relatedness indexes (OGRIs), comparative analyses of phenotypic features, and polar lipid profiles further supported their taxonomic reassignment as two separate species within the genus Haloarcula. Consequently, we propose the reclassification of Halomicroarcula saliterrae Straková et al. 2024 and Halomicroarcula onubensis Straková et al. 2024 into the genus Haloarcula, as Haloarcula saliterrae comb. nov. and Haloarcula onubensis comb. nov., respectively, in accordance with the ICNP.

A guide to protection schemes of synchronous generator-based electric grids

Ensuring the reliability of power systems remains a paramount concern for electrical utilities worldwide. The design and implementation of robust protection is crucial for mitigating faults and ensuring uninterrupted power supply. This paper encompasses the protection deployed in electrical utilities. A comprehensive analysis is conducted on the application protection scheme in practice for the protection of major power components. The reliability of protection schemes is enhanced by adopting the of dual & fast protection schemes on the critical power components for swift & reliable clearing of faults. Additionally, this article also investigates the protection strategies employed for slightly lower priority components, including high-speed main and low-speed backup protection schemes. A thorough review for the protection practices for synchronous power generation, transmission, and distribution has been conducted. In this article, the selection of specific protection schemes and the calculation settings for 600 MW synchronous generator-connected lines and transformers are discussed. Additionally, the limitations of traditional protection schemes in safeguarding inverter-based power systems are explored. The paper also highlights areas for future research in the protection of electrical equipment within evolving grid infrastructures. This study will provide valuable insights for researchers and practicing engineers in planning and implementing protection systems for electrical grids, ensuring high levels of reliability and resilience

Panzara River Watershed Prioritization Based on Geomorphometric and LULC Change Analysis using Geo-Spatial Techniques

Human activities can significantly influence the quality of water flowing from a watershed, either positively or negatively. As water moves through the system, these impacts accumulate, with all land-based activities having the potential to affect the water quality and quantity experienced by downstream stakeholders. Similarly, the actions of upstream landowners impact the water that flows across others' properties. Geospatial techniques like remote sensing and geographic information systems (GIS) are invaluable tools for analysing drainage patterns within a watershed and the associated changes in land use and cover. This study focuses on the Panzara river basin, a principal tributary of the larger Tapi river basin, situated in central India between the westward-flowing Godavari and Narmada river systems, which both ultimately discharge into the Arabian Sea. The study area spans latitudes from 20°42'0" N to 21°18'0" N and longitudes from 74°06'0" E to 75°00'0" E, covering a geographical area of 2,986.05 square kilometers with a perimeter of 570.51 kilometers. The watershed delineation was carried out using Shuttle Radar Terrain Mapper (SRTM) data with a 30-meter resolution. For land use and land cover (LULC) analysis, Landsat 5 TM C2L1 and Landsat 8 OLI/TIRS C2L1 datasets, both with 30-meter resolution, were utilized. The present study conducts a morphometric analysis and assesses LULC changes within the Panzara river basin between 2000 and 2021. Morphometric parameters such as linear parameters [Drainage density (Dd), Stream frequency (Fs), Mean bifurcation ratio (Rbm), Drainage texture ratio (Dt), Length of overland flow (Lo)] and areal parameters [Elongation ratio (Re), Circulatory ratio (Cr), Form factor (Rf), Compactness coefficient (Cc)] were used to prioritize sub-watersheds. Furthermore, the study classifies the observed LULC changes between satellite imagery datasets from 2000 and 2021, quantifying the percentage changes in the respective LULC classes across the sub-watersheds over the two decades. The overall accuracy of the LULC classification was 81.82% for 2000 and 88.88% for 2021, with Kappa coefficients of 0.772 and 0.85, respectively. In terms of prioritizing sub-watersheds, common sub- watersheds such as SW-1, SW-10, and SW-15 were classified under moderate priority, while SW-5, SW-8, and SW-14 were classified under the lowest priority. The results of this study, particularly the prioritization of sub-watersheds, can be instrumental for hydraulic engineers in planning and managing water resources in the Panzara river basin.

Large language model triaging of simulated nephrology patient inbox messages.

Efficient triage of patient communications is crucial for timely medical attention and improved care. This study evaluates ChatGPT's accuracy in categorizing nephrology patient inbox messages, assessing its potential in outpatient settings. One hundred and fifty simulated patient inbox messages were created based on cases typically encountered in everyday practice at a nephrology outpatient clinic. These messages were triaged as non-urgent, urgent, and emergent by two nephrologists. The messages were then submitted to ChatGPT-4 for independent triage into the same categories. The inquiry process was performed twice with a two-week period in between. ChatGPT responses were graded as correct (agreement with physicians), overestimation (higher priority), or underestimation (lower priority). In the first trial, ChatGPT correctly triaged 140 (93%) messages, overestimated the priority of 4 messages (3%), and underestimated the priority of 6 messages (4%). In the second trial, it correctly triaged 140 (93%) messages, overestimated the priority of 9 (6%), and underestimated the priority of 1 (1%). The accuracy did not depend on the urgency level of the message (p = 0.19). The internal agreement of ChatGPT responses was 92% with an intra-rater Kappa score of 0.88. ChatGPT-4 demonstrated high accuracy in triaging nephrology patient messages, highlighting the potential for AI-driven triage systems to enhance operational efficiency and improve patient care in outpatient clinics.

FP4.14 - The Efficacy of Performing A Quantitative Faecal Immunochemical Test (qFIT) As A Predictor of Colorectal Cancer Before A 2-Week Wait Referral

Abstract Aim 2-week wait (2ww) Colorectal cancer (CRC) referrals have risen along with increased use of colonoscopy, potentially exposing patients to repeated invasive investigation. Current guidelines recommend the use of quantitative faecal immunochemical testing (qFIT) in primary care to prioritise patients for investigation. This study aims to characterise 2ww CRC referrals in a London hospital. Method This is a retrospective quality improvement study, analysing primary care 2ww CRC referrals in October 2022 in a London hospital. Data collected included referral symptoms, completion of a qFIT prior to referral, previous exclusion of CRC, and subsequent investigation outcome. Results Of 173 patients referred on the CRC 2ww pathway in October 2022, 21% did not require further investigation. 16% of patients had undergone a colonoscopy within 12 months excluding CRC. Only 61% of referrals included a qFIT. 71% of these were qFIT positive, and 11% were diagnosed with CRC. The overall CRC detection rate was 2.2%, all with qFIT >200. The PPV of qFIT for CRC was 5%, and 53% for polyps. Conclusion 39% of this patient cohort were referred without qFIT. Those who are qFIT negative or have had CRC excluded in the past 12 months may not require investigation on a 2WW pathway, may be suitable for investigation with lower priority, and may not need invasive investigation at all. Although the use of qFIT has been nationally recommended to prioritise the urgency of investigation, this study suggests this has not been universally adopted. Wider use of qFIT before 2ww referral may guide the use of resources and aid diagnosis and management of patients with symptoms of CRC.

WP5.3 - Rejuvenating the golden patient protocol in a tertiary centre general surgical emergency theatre

Abstract Aims Poor patient flow and complex sub-specialty decision making discussions lengthened time to operation of lower priority operations e.g. appendicectomy/abscesses. By prioritising start times and registrar patient selection for low complexity cases/day case discharge, we rejuvenated the golden patient protocol (GPP) and assessed the implementation and impact of a novel GPP in a tertiary centre emergency list on surgical wait times and overall theatre flow. Methods The GPP was agreed between surgical/anaesthetic night registrars and theatre staff which took into consideration the urgency of the surgery, fitness of patient and anaesthetic/technical difficulties. Eligible patients were identified prior to 08:00 and scheduled as the first case of the day to be huddled and sent for by 08:30. Two cycles were conducted, one month before and after GPP introduction, using the trust theatre management system (TMIS). Results Time series analysis was conducted for patient sent-for, anaesthetic room entry, and procedure start times during both cycles. Results indicated a median decrease of 11-minutes in patient sent-for time (Cycle 1: 08:56, Cycle 2: 08:45) and a 12-minute reduction in median procedure start time (Cycle 1: 09:42, Cycle 2: 09:30). The proportion of low complexity cases performed first-on-list also increased by 22.5% (Cycle 1: 35.5%, Cycle 2: 58.0%). Conclusions This analysis demonstrates a positive change by starting theatre faster with lower complexity cases, developing surgical registrar independence, improving time to treatment without complex discussions delaying first send.

The Effect of a Separate Flow of Patients With Small Traumatic Injuries on Consult Time and Patient Satisfaction: A Retrospective Cohort Study During COVID-19 in the Emergency Department.

With emergency department (ED) crowding and high workloads burdening healthcare, efficient patient flow management becomes increasingly crucial. A significant portion of this crowding is attributed to patients with minor traumatic injuries. The objective of this study is to investigate to what extent a separate patient flow for patients with small traumatic injuries influences consult times and patient satisfaction. During COVID-19, patients with small traumatic injuries in the ED were redirected to an outpatient clinic (the Fracture Clinic). The Fracture Clinic was maintained for seven weeks during which the consult time and patient satisfaction were recorded for every individual. Retrospectively, the same procedure was followed for the seven weeks prior to the outbreak of COVID, with the regular procedure in place. In total, 922 patients were included in the research: 415 patients in the intervention group (Fracture Clinic) and 507 patients in the control group (ED group). The consult time in the Fracture Clinic (median = 30 min) is significantly lower compared to the ED group (median = 86 min) (U = 25,147.500, z = 19.9, p < 0.001). The overall consult in terms of patient satisfaction scored higher for the Fracture Clinic Group than the ED group (T[df] = -4.449 [479], p < 0.001). The Fracture Clinic resulted in shorter consult times and an increased patient satisfaction compared to the usual patient flow for patients with small traumatic injuries in the ED. These patients could be redirected to an outpatient clinical setting to improve efficiency in patient flow, while avoiding a negative impact from the triage system in which they usually are the lowest priority.

Risk Mitigation Strategies for Sustainable Poultry Supply Chain Management

The livestock sector is an important pillar in providing animal protein and sustaining the rural economy. However, the sector faces major challenges from environmental and socio-economic issues, such as climate change and environmental degradation, which can threaten its sustainability. Negative impacts such as environmental contamination can reduce production quality and quantity and increase supply chain operational costs. This study aims to identify effective risk mitigation strategies to reduce these negative impacts and improve the sustainability of supply chain management. Data were collected from laying duck farms and analyzed using the House of Risk (HOR) method with a Phase 1 and 2 approach. This approach allows the identification of the most critical risks and risk agents and mapping mitigation priorities. Key findings indicate that providing drugs or vaccines to prevent animal virus outbreaks is the highest priority mitigation strategy, while strategic policy decision-making has the lowest priority. Overall, 15 risks and 21 risk agents were identified. This study implies that the implementation of effective mitigation strategies can significantly reduce operational risks, strengthen the resilience of the livestock sector, and support the sustainability of supply chain management as a whole.

Research on the energy transition pathways of the transportation sector in the Guangdong–Hong Kong–Macao Greater Bay Area, China

Energy transitions is an effective way to achieve sustainable development in the transportation sector. To explore the pathways to energy transitions in the Guangdong–Hong Kong–Macao Greater Bay Area (GBA) transportation sector, the article evaluated the potential of energy savings and CO2 emission reduction of different measures in a quantitative way, based on the long-range energy alternatives planning (LEAP) platform. The marginal abatement cost curves are used to visually reflect the cost–benefit of these measures, and to develop cost-effective pathways to energy transitions. The results show that the measures of transportation modes adjustment and private cars regulating should be prioritized due to the potential of significant emission reduction with good cost-effectiveness. The measures of promoting electricity and hydrogen energy have large emission reduction potential, but only those for road traffic are cost-effective, and should be treated with a lower priority. Considering the high cost, the measures of promoting biofuel should be implemented as least priority. Moreover, the measures of liquefied natural gas (LNG) application have good cost-effectiveness, as opposed to limited CO2 emission reduction potential. It can only be used as a transitional fuel for the energy transitions. The findings and research methodology will provide theoretical support for the formulation of transportation energy transition pathways in the GBA and other regions.

A mixed-methods approach to assessing implementers’ readiness to adopt digital health interventions (RADHI)

BackgroundDespite being the primary setting for HIV prevention among men who have sex with men (MSM) since the start of the epidemic, community-based organizations (CBOs) struggle to reach this historically stigmatized and largely hidden population with face-to-face interventions. HIV researchers have readily turned to the internet to deliver critical HIV education to this group, with evidence of high effectiveness and acceptability across studies. However, implementation outside of research contexts has been limited and not well studied. We aimed to assess HIV CBOs’ readiness to adopt digital health interventions and identify contextual factors that may contribute to differing levels of readiness.MethodsWe recruited 22 CBOs across the US through a pragmatic request-for-proposals process to deliver Keep It Up! (KIU!), an evidence-based eHealth HIV prevention program. We used mixed methods to examine CBO readiness to adopt digital health interventions (RADHI). Before implementation, CBO staff completed a 5-item RADHI scale (scored 0–4) that demonstrated concurrent and predictive validity. We interviewed CBO staff using semi-structured questions guided by the Consolidated Framework for Implementation Research and compared RADHI score groups on determinants identified from the interviews.ResultsEighty-five staff (range = 1–10 per CBO) completed the RADHI. On average, CBOs reported moderate-to-great readiness (2.74) to adopt KIU!. High RADHI CBOs thought KIU! was a top priority and an innovative program complementary to their existing approaches for their clients. Low RADHI CBOs expressed concerns that KIU! could be a cultural mismatch for their clients, was lower priority than existing programs and services, relied on clients’ own motivation, and might not be suitable for clients with disabilities. Value, appeal, and limitations did not differ by RADHI group.ConclusionsWhile HIV CBOs are excited for the opportunities and advantages of digital interventions, additional pre-implementation and implementation support may be needed to increase perceived value and usability for different client populations. Addressing these limitations is critical to effective digital prevention interventions for HIV and other domains such as mental health, chronic disease management, and transitions in care. Future research can utilize our novel, validated measure of CBOs’ readiness to adopt digital health interventions.Trial registrationNCT03896776, clinicaltrials.gov, 1 April 2019.

The Key Factors for Improving Returns Management in E-Commerce in Indonesia from Customers’ Perspectives—An Analytic Hierarchy Process Approach

The rapid growth of e-commerce has led to an increase in the number of product returns in supply chains, which is both environmentally and economically challenging. E-commerce companies need to effectively manage product returns, as this has a direct impact on their reputation and consumer experience. Reducing returns is key to maintaining sustainable practices for online product sales. A significant increase in e-commerce transactions is also evident in Indonesia, which is the fourth largest country in the world. Despite the very large size of the market, research on e-commerce in the business-to-customer (B2C) market in Indonesia is underrepresented in the literature. The purpose of this paper is to identify key factors from the customer perspective that influence product returns in reverse logistics in Indonesian e-commerce. The novelty of this study stems from the focus on the customer perspective on product returns in the B2C market when shopping online and the spatial scope. Due to the uncertainty inherent in multi-criteria decision making, the analytic hierarchy process (AHP) method was used to rank factors and potential solutions derived from a critical literature review. As a result, the study provides a ranking of factors and alternatives for managing e-commerce returns in Indonesia. The results show that among Indonesian e-commerce customers, product quality (QP) was rated the highest, while (Pu) was rated the lowest. In terms of the alternatives that are the most suitable for improving the customer experience of e-commerce product returns in Indonesia, a clear returns policy (CRP) scored the highest, while the merchandise catalog (Cat) was rated as the lowest priority.

Stable isotopes reveal sex- and context-dependent amino acid routing in green anole lizards (Anolis carolinensis).

Allocation of acquired resources to phenotypic traits is affected by resource availability and current selective context. While differential investment in traits is well documented, the mechanisms driving investment at lower levels of biological organization, which are not directly related to fitness, remain poorly understood. We supplemented adult male and female Anolis carolinensis lizards with an isotopically labelled essential amino acid (13C-leucine) to track routing in four tissues (muscle, liver, gonads, and spleen) under different combinations of resource availability (high and low-calorie diets) and exercise training (sprint training and endurance capacity). We predicted sprint training should drive routing to muscle, and endurance training to liver and spleen, and that investment in gonads should be of lower priority in each of the cases of energetic stress. We found complex interactions between training regime, diet, and tissue type in females, and between tissue type and training and tissue type and diet in males, suggesting that males and females adjust their 13C-leucine routing strategies differently in response to similar environmental challenges. Importantly, our data show evidence of increased 13C-leucine routing in training contexts not to muscle as we expected, but to the spleen, which turns over blood cells, and to the liver, which supports metabolism under differing energetic scenarios. Our results reveal the context-specific nature of long-term tradeoffs associated with increased chronic activity. They also illustrate the importance of considering the costs of locomotion in studies of life history strategies.