Search results for: on-board environmental factors
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 16160

Search results for: on-board environmental factors

12410 Optimizing Recycling and Reuse Strategies for Circular Construction Materials with Life Cycle Assessment

Authors: Zhongnan Ye, Xiaoyi Liu, Shu-Chien Hsu

Abstract:

Rapid urbanization has led to a significant increase in construction and demolition waste (C&D waste), underscoring the need for sustainable waste management strategies in the construction industry. Aiming to enhance the sustainability of urban construction practices, this study develops an optimization model to effectively suggest the optimal recycling and reuse strategies for C&D waste, including concrete and steel. By employing Life Cycle Assessment (LCA), the model evaluates the environmental impacts of adopted construction materials throughout their lifecycle. The model optimizes the quantity of materials to recycle or reuse, the selection of specific recycling and reuse processes, and logistics decisions related to the transportation and storage of recycled materials with the objective of minimizing the overall environmental impact, quantified in terms of carbon emissions, energy consumption, and associated costs, while adhering to a range of constraints. These constraints include capacity limitations, quality standards for recycled materials, compliance with environmental regulations, budgetary limits, and temporal considerations such as project deadlines and material availability. The strategies are expected to be both cost-effective and environmentally beneficial, promoting a circular economy within the construction sector, aligning with global sustainability goals, and providing a scalable framework for managing construction waste in densely populated urban environments. The model is helpful in reducing the carbon footprint of construction projects, conserving valuable resources, and supporting the industry’s transition towards a more sustainable future.

Keywords: circular construction, construction and demolition waste, life cycle assessment, material recycling

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12409 Spatial Occupation of the Wild Boar 'Sus Scrofa Algirus' in the Oasis of Southern Tunisia: The Continental Oasis of Kebili and the Coastal Oasis of Gabes

Authors: Ghandri Aida

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The wild boar ‘Sus scrofa algirus’ is an invasive species that has a significant invasive potential allowing it to colonize the agroecosystems of southern Tunisia. In fact, these agroecosystems contain sites with high tranquility-refuge value (refuge zones) which are very attractive for this Suidae thanks to the very dense vegetation (reed beds on the outskirts of the oases and the border areas of the wadis and chotts) and the almost impenetrability for man. When this species is present in abundance, it could cause severe ecological and socio-economic damage. The present work aims to analyze the spatial distribution of this species in the oases of southern Tunisia, namely the coastal oases of Gabès and the continental oases of Kébili, using GLMMs (generalized linear mixed models). In particular, it aims to evaluate the influence of certain landscape factors and vegetation on the occurrence of this harmful species. Our results suggest that the spatial occupancy of wild boar in Tunisian oases essentially depends on proximity to the nearest roads as a repelling factor as well as irrigation, the proportion of cereal cultivation and proximity to areas of refuge as attractive factors.

Keywords: sus scrofa algirus, occurence, GLMM, oasis of southern tunisia

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12408 Posterior Circulation Ischemic Strokes in Olympic and Division 1 Wrestlers

Authors: Christen Kutz

Abstract:

Objective: The aim of this study is to review a case series of 4 high-level Olympic and Division 1 wrestlers who experienced debilitating posterior circulation ischemic strokes during or after a competitive wrestling event and to identify risk factors, etiology and outcomes of stroke in young, healthy elite wrestlers. Background: Stroke occurs in one in 10,000 people under age 64. In young adults, the most common causes of stroke are cardiac embolism, hypercoagulable state, and vasculopathy. One-third of these strokes occur in young, fit individuals. There is little published literature about ischemic strokes that occur in wrestlers. Based on the nature of wrestling, the risk of injury or dissection to neurovascular structures may be a possible theory, but very few case reports exist. Methodology: 4 wrestlers under the age of 44 with a known history of ischemic stroke participated in individual interviews either in person or virtually. Each of the wrestlers provided their demographic information, wrestling background, clinical presentation at the time of stroke, imaging results, identification of potential risk factors, acute treatment and recovery. Results: 3 white male Division 1 wrestlers (2 Lehigh University, 1 Lock Haven University) and 1 black male 2008 Olympian experienced posterior circulation strokes. Case #1 felt a “pop” while wrestling (lateral medullary infarct, possible vertebral artery dissection); Case #2 awoke with severe vertigo, sweating, and vomiting after wrestling the previous day (left cerebellar infarct, (+) protein S deficiency); Case #3 severe vertigo, ataxia, and sensation of impending doom after wrestling earlier that week (left cerebellar infarct, hypoplastic left vertebral artery (+) anti-cardiolipin antibodies). Case #4 severe dizziness, confusion (left cerebellar stroke, vertebral artery dissection, small PFO). Conclusion: 3 wrestlers were started on anti-platelet therapy, risk factors were modified, and returned to their sport. 1 wrestler was placed on anti-coagulation and retired from competition.

Keywords: stroke, wrestling, Olympic, posterior circulation

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12407 Environmental Impact of a New-Build Educational Building in England: Life-Cycle Assessment as a Method to Calculate Whole Life Carbon Emissions

Authors: Monkiz Khasreen

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In the context of the global trend towards reducing new buildings carbon footprint, the design team is required to make early decisions that have a major influence on embodied and operational carbon. Sustainability strategies should be clear during early stages of building design process, as changes made later can be extremely costly. Life-Cycle Assessment (LCA) could be used as the vehicle to carry other tools and processes towards achieving the requested improvement. Although LCA is the ‘golden standard’ to evaluate buildings from 'cradle to grave', lack of details available on the concept design makes LCA very difficult, if not impossible, to be used as an estimation tool at early stages. Issues related to transparency and accessibility of information in the building industry are affecting the credibility of LCA studies. A verified database derived from LCA case studies is required to be accessible to researchers, design professionals, and decision makers in order to offer guidance on specific areas of significant impact. This database could be the build-up of data from multiple sources within a pool of research held in this context. One of the most important factors that affects the reliability of such data is the temporal factor as building materials, components, and systems are rapidly changing with the advancement of technology making production more efficient and less environmentally harmful. Recent LCA studies on different building functions, types, and structures are always needed to update databases derived from research and to form case bases for comparison studies. There is also a need to make these studies transparent and accessible to designers. The work in this paper sets out to address this need. This paper also presents life-cycle case study of a new-build educational building in England. The building utilised very current construction methods and technologies and is rated as BREEAM excellent. Carbon emissions of different life-cycle stages and different building materials and components were modelled. Scenario and sensitivity analyses were used to estimate the future of new educational buildings in England. The study attempts to form an indicator during the early design stages of similar buildings. Carbon dioxide emissions of this case study building, when normalised according to floor area, lie towards the lower end of the range of worldwide data reported in the literature. Sensitivity analysis shows that life cycle assessment results are highly sensitive to future assumptions made at the design stage, such as future changes in electricity generation structure over time, refurbishment processes and recycling. The analyses also prove that large savings in carbon dioxide emissions can result from very small changes at the design stage.

Keywords: architecture, building, carbon dioxide, construction, educational buildings, England, environmental impact, life-cycle assessment

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12406 Innovative Waste Management Practices in Remote Areas

Authors: Dolores Hidalgo, Jesús M. Martín-Marroquín, Francisco Corona

Abstract:

Municipal waste consist of a variety of items that are everyday discarded by the population. They are usually collected by municipalities and include waste generated by households, commercial activities (local shops) and public buildings. The composition of municipal waste varies greatly from place to place, being mostly related to levels and patterns of consumption, rates of urbanization, lifestyles, and local or national waste management practices. Each year, a huge amount of resources is consumed in the EU, and according to that, also a huge amount of waste is produced. The environmental problems derived from the management and processing of these waste streams are well known, and include impacts on land, water and air. The situation in remote areas is even worst. Difficult access when climatic conditions are adverse, remoteness of centralized municipal treatment systems or dispersion of the population, are all factors that make remote areas a real municipal waste treatment challenge. Furthermore, the scope of the problem increases significantly because the total lack of awareness of the existing risks in this area together with the poor implementation of advanced culture on waste minimization and recycling responsibly. The aim of this work is to analyze the existing situation in remote areas in reference to the production of municipal waste and evaluate the efficiency of different management alternatives. Ideas for improving waste management in remote areas include, for example: the implementation of self-management systems for the organic fraction; establish door-to-door collection models; promote small-scale treatment facilities or adjust the rates of waste generation thereof.

Keywords: door to door collection, islands, isolated areas, municipal waste, remote areas, rural communities

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12405 Effectiveness of Qanun Number 14 of 2013 on Khalwat, Nasty in the Enforcement of Islamic Shari'a in Banda Aceh, Aceh Province

Authors: Muhadam Labolo, Mughny Ibtisyam Mukhlis, Zulkarnaen, Safira Maulida Rahman Soulisa

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This research is motivated by one of the functions of government is a regulatory function. Aceh Province, especially in Banda Aceh City has special autonomy, one of them is in the application of Islamic law, but when the law implemented to the citizen, there are many problems happens. One of the problems faced by the Government and people of Banda Aceh was Seclusion. Seclusion/nasty silent act between two people mukallafor more of the opposite sex who is not mahram or without marriage. This study aims to determine and analyze how the effectiveness of the policy as well as enabling and inhibiting factors of Qanun Number 14 of 2003 On Khalwat (nasty) in sharia Islam Islamic law in the city of Banda Aceh. This type of research is qualitative research method is a descriptive and inductive approach. The source of data used is People, Problem, Phenomenon, and programs, while the data collection through field studies and literature such as interviews, observation, and documentation. The results of this study were analyzed by using data reduction, display data, conclusions, and verification. The results showed that the Qanun Number 14 of 2003 on Khalwat (nasty) in the establishment of Islamic law in Banda Aceh is still not effective. It is seen from the high number of violations seclusion committed by Banda Aceh citizen, especially among teenagers, lack of socialization, as well as a lack of budgetary support for the implementation of Islamic Law in Banda Aceh. The supporting factors are 1) Coordination and communication among agencies had been walking steadily. 2) Facilities and infrastructure Syar'iah Court of Banda Aceh and the Office of Sharia Islam Banda Aceh that very good. 3) The Cultural majority of the people of Banda Aceh that support. Inhibiting factors: 1) There are no written duties of each institution for the prosecution case Seclusion. 2) The lack of socialization programs. 3) Lack of facilities and infrastructure Municipal Police Unit and the WH less. 4) Lack of control by the family. 5) The absence of training for officials Municipal Police Units and the Wilayatul Hisbah Banda Aceh.

Keywords: effectiveness, Islamic Sharia, Khalwat, Qanun

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12404 Attitude towards Biology among Academic Talented Students in Term of Gender: Case Study of ASASIpintar Pre–University Programme

Authors: Sy Ing Ong, N. Norazman, H. W. You, A. Zahidi, R. Ahmad Faisal

Abstract:

The decline in students’ involvement in the fields of Science, Technology, Engineering and Mathematics (STEM) worldwide is alarming. In Malaysia, this scenario also draws the attention of Ministry of Education due to the high demand for professionals in STEM industries and for the sake of country development. Intensive researches have been done worldwide to identify the best solution to improve the enrolment of students in science studies. Attitude is being identified as one of the key factors that will influence students’ interest and achievement in academic. Male students are always associated with negative attitudes compared to female students towards the study of Biological science. Hence, this study investigates the attitudes of students towards Biology in the setting of an academic talented institution in Malaysia namely ASASIpintar Pre-University Programme. A total of 84 students were randomly selected from 127 students as the samples of this study. The instrument of Biology Attitude Scale (BAS) from Russell and Hollander (1975) was used to identify the attitudes of samples. Based on the analysis, there was no significant difference in the students’ mean attitude towards Biology subject in this institution between genders with a significant level of p = 0.05. This indicated that gender is not a key factor that influences students’ attitude towards Biology in this study. Future research can be done on other factors that will contribute to the attitude of students towards biology in Malaysia, especially for academically talented students.

Keywords: academic talented, attitude, biology, gender

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12403 The Use of Polar Substituent Groups for Promoting Azo Disperse Dye Solubility and Reactivity for More Economic and Environmental Benign Applications: A Computational Study

Authors: Olaide O. Wahab, Lukman O. Olasunkanmi, Krishna K. Govender, Penny P. Govender

Abstract:

The economic and environmental challenges associated with azo disperse dyes applications are due to poor aqueous solubility and low degradation tendency which stems from low chemical reactivity. Poor aqueous solubility property of this group of dyes necessitates the use of dispersing agents which increase operational costs and also release toxic chemical components into the environment, while their low degradation tendency is due to the high stability of the azo functional group (-N=N-) in their chemical structures. To address these problems, this study investigated theoretically the effects of some polar substituents on the aqueous solubility and reactivity properties of disperse yellow (DY) 119 dye with a view to theoretically develop new azo disperse dyes with improved solubility in water and higher degradation tendency in the environment using DMol³ computational code. All calculations were carried out using the Becke and Perdew version of Volsko-Wilk-Nusair (VWN-BP) level of density functional theory in conjunction with double numerical basis set containing polarization function (DNP). The aqueous solubility determination was achieved with conductor-like screening model for realistic solvation (COSMO-RS) in conjunction with known empirical solubility model, while the reactivity was predicted using frontier molecular orbital calculations. Most of the new derivatives studied showed evidence of higher aqueous solubility and degradation tendency compared to the parent dye. We conclude that these derivatives are promising alternative dyes for more economic and environmental benign dyeing practice and therefore recommend them for synthesis.

Keywords: aqueous solubility, azo disperse dye, degradation, disperse yellow 119, DMol³, reactivity

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12402 Behavioral Patterns of Adopting Digitalized Services (E-Sport versus Sports Spectating) Using Agent-Based Modeling

Authors: Justyna P. Majewska, Szymon M. Truskolaski

Abstract:

The growing importance of digitalized services in the so-called new economy, including the e-sports industry, can be observed recently. Various demographic or technological changes lead consumers to modify their needs, not regarding the services themselves but the method of their application (attracting customers, forms of payment, new content, etc.). In the case of leisure-related to competitive spectating activities, there is a growing need to participate in events whose content is not sports competitions but computer games challenge – e-sport. The literature in this area so far focuses on determining the number of e-sport fans with elements of a simple statistical description (mainly concerning demographic characteristics such as age, gender, place of residence). Meanwhile, the development of the industry is influenced by a combination of many different, intertwined demographic, personality and psychosocial characteristics of customers, as well as the characteristics of their environment. Therefore, there is a need for a deeper recognition of the determinants of the behavioral patterns upon selecting digitalized services by customers, which, in the absence of available large data sets, can be achieved by using econometric simulations – multi-agent modeling. The cognitive aim of the study is to reveal internal and external determinants of behavioral patterns of customers taking into account various variants of economic development (the pace of digitization and technological development, socio-demographic changes, etc.). In the paper, an agent-based model with heterogeneous agents (characteristics of customers themselves and their environment) was developed, which allowed identifying a three-stage development scenario: i) initial interest, ii) standardization, and iii) full professionalization. The probabilities regarding the transition process were estimated using the Method of Simulated Moments. The estimation of the agent-based model parameters and sensitivity analysis reveals crucial factors that have driven a rising trend in e-sport spectating and, in a wider perspective, the development of digitalized services. Among the psychosocial characteristics of customers, they are the level of familiarization with the rules of games as well as sports disciplines, active and passive participation history and individual perception of challenging activities. Environmental factors include general reception of games, number and level of recognition of community builders and the level of technological development of streaming as well as community building platforms. However, the crucial factor underlying the good predictive power of the model is the level of professionalization. While in the initial interest phase, the entry barriers for new customers are high. They decrease during the phase of standardization and increase again in the phase of full professionalization when new customers perceive participation history inaccessible. In this case, they are prone to switch to new methods of service application – in the case of e-sport vs. sports to new content and more modern methods of its delivery. In a wider context, the findings in the paper support the idea of a life cycle of services regarding methods of their application from “traditional” to digitalized.

Keywords: agent-based modeling, digitalized services, e-sport, spectators motives

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12401 Prevalence and Risk Factors of Cardiovascular Diseases among Bangladeshi Adults: Findings from a Cross Sectional Study

Authors: Fouzia Khanam, Belal Hossain, Kaosar Afsana, Mahfuzar Rahman

Abstract:

Aim: Although cardiovascular diseases (CVD) has already been recognized as a major cause of death in developed countries, its prevalence is rising in developing countries as well, and engendering a challenge for the health sector. Bangladesh has experienced an epidemiological transition from communicable to non-communicable diseases over the last few decades. So, the rising prevalence of CVD and its risk factors are imposing a major problem for the country. We aimed to examine the prevalence of CVDs and socioeconomic and lifestyle factors related to it from a population-based survey. Methods: The data used for this study were collected as a part of a large-scale cross-sectional study conducted to explore the overall health status of children, mothers and senior citizens of Bangladesh. Multistage cluster random sampling procedure was applied by considering unions as clusters and households as the primary sampling unit to select a total of 11,428 households for the base survey. Present analysis encompassed 12338 respondents of ≥ 35 years, selected from both rural areas and urban slums of the country. Socio-economic, demographic and lifestyle information were obtained through individual by a face-to-face interview which was noted in ODK platform. And height, weight, blood pressure and glycosuria were measured using standardized methods. Chi-square test, Univariate modified Poisson regression model, and multivariate modified Poisson regression model were done using STATA software (version 13.0) for analysis. Results: Overall, the prevalence of CVD was 4.51%, of which 1.78% had stroke and 3.17% suffered from heart diseases. Male had higher prevalence of stroke (2.20%) than their counterparts (1.37%). Notably, thirty percent of respondents had high blood pressure and 5% population had diabetes and more than half of the population was pre-hypertensive. Additionally, 20% were overweight, 77% were smoker or consumed smokeless tobacco and 28% of respondents were physically inactive. Eighty-two percent of respondents took extra salt while eating and 29% of respondents had deprived sleep. Furthermore, the prevalence of risk factor of CVD varied according to gender. Women had a higher prevalence of overweight, obesity and diabetes. Women were also less physically active compared to men and took more extra salt. Smoking was lower in women compared to men. Moreover, women slept less compared to their counterpart. After adjusting confounders in modified Poisson regression model, age, gender, occupation, wealth quintile, BMI, extra salt intake, daily sleep, tiredness, diabetes, and hypertension remained as risk factors for CVD. Conclusion: The prevalence of CVD is significant in Bangladesh, and there is an evidence of rising trend for its risk factors such as hypertension, diabetes especially in older population, women and high-income groups. Therefore, in this current epidemiological transition, immediate public health intervention is warranted to address the overwhelming CVD risk.

Keywords: cardiovascular diseases, diabetes, hypertension, stroke

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12400 Predicting and Optimizing the Mechanical Behavior of a Flax Reinforced Composite

Authors: Georgios Koronis, Arlindo Silva

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This study seeks to understand the mechanical behavior of a natural fiber reinforced composite (epoxy/flax) in more depth, utilizing both experimental and numerical methods. It is attempted to identify relationships between the design parameters and the product performance, understand the effect of noise factors and reduce process variations. Optimization of the mechanical performance of manufactured goods has recently been implemented by numerous studies for green composites. However, these studies are limited and have explored in principal mass production processes. It is expected here to discover knowledge about composite’s manufacturing that can be used to design artifacts that are of low batch and tailored to niche markets. The goal is to reach greater consistency in the performance and further understand which factors play significant roles in obtaining the best mechanical performance. A prediction of response function (in various operating conditions) of the process is modeled by the DoE. Normally, a full factorial designed experiment is required and consists of all possible combinations of levels for all factors. An analytical assessment is possible though with just a fraction of the full factorial experiment. The outline of the research approach will comprise of evaluating the influence that these variables have and how they affect the composite mechanical behavior. The coupons will be fabricated by the vacuum infusion process defined by three process parameters: flow rate, injection point position and fiber treatment. Each process parameter is studied at 2-levels along with their interactions. Moreover, the tensile and flexural properties will be obtained through mechanical testing to discover the key process parameters. In this setting, an experimental phase will be followed in which a number of fabricated coupons will be tested to allow for a validation of the design of the experiment’s setup. Finally, the results are validated by performing the optimum set of in a final set of experiments as indicated by the DoE. It is expected that after a good agreement between the predicted and the verification experimental values, the optimal processing parameter of the biocomposite lamina will be effectively determined.

Keywords: design of experiments, flax fabrics, mechanical performance, natural fiber reinforced composites

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12399 Standardization of Propagation Techniques in Selected Native Plants of Kuwait

Authors: Laila Almulla, Narayana Bhat, Majda Suleiman, Sheena Jacob

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Biodiversity conservation has become one of the challenging priorities to combat species extinction for many countries, including the state of Kuwait. Since native plants are better adapted to the local environment, can endure long spells of drought, withstand high soil salinity levels and provide a more natural effect to landscape projects, their use will both conserve natural resources and produce sustainable greenery. When native plants are properly blended with naturalized exotic ornamental plants in a landscape, they can improve social and cultural benefits. Screening of exotic and native plants in Kuwait during the past two decades has led to the selection of some very promising plants. Continuation of evaluation of additional native and exotic plants is essential to increase diversity of plant resources for greenery projects. Therefore, an effort was made to evaluate further native plants for their suitability for greenery applications. In the present study, various treatments were used to mass multiply selected plants using seeds to secure maximum germination. Seeds were subjected to nine treatments, and each treatment was replicated five times with ten seeds per treatment unit. After the treatment, the seeds of Zygophyllum qatarense were incubated at 30 °C, three lights for 12 h, at 40% humidity; where as the seeds of Haloxylon salicornicum were incubated at 22 °C with continuous light, at 40% humidity. Soaking in 250-ppm GA3 resulted in highest germination percentage of 20% in Zygophyllum qatarense and, Soaking in 500-ppm GA3 resulted in 6% germination in Haloxylon salicornicum. Germination of the viable seeds is influenced by various external and internal factors, seed must not be in a state of dormancy and the environmental requirements for germination of that seed must be met, before germination can occur.

Keywords: landscape, native plants, revegetation, seed germination

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12398 Evaluation of Medication Administration Process in a Paediatric Ward

Authors: Zayed Alsulami, Asma Aldosseri, Ahmed Ezziden, Abdulrahman Alonazi

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Children are more susceptible to medication errors than adults. Medication administration process is the last stage in the medication treatment process and most of the errors detected in this stage. Little research has been undertaken about medication errors in children in the Middle East countries. This study was aimed to evaluate how the paediatric nurses adhere to the medication administration policy and also to identify any medication preparation and administration errors or any risk factors. An observational, prospective study of medication administration process from when the nurses preparing patient medication until administration stage (May to August 2014) was conducted in Saudi Arabia. Twelve paediatric nurses serving 90 paediatric patients were observed. 456 drug administered doses were evaluated. Adherence rate was variable in 7 steps out of 16 steps. Patient allergy information, dose calculation, drug expiry date were the steps in medication administration with lowest adherence rates. 63 medication preparation and administration errors were identified with error rate 13.8% of medication administrations. No potentially life-threating errors were witnessed. Few logistic and administrative factors were reported. The results showed that the medication administration policy and procedure need an urgent revision to be more sensible for nurses in practice. Nurses’ knowledge and skills regarding the medication administration process should be improved.

Keywords: medication sasfety, paediatric, medication errors, paediatric ward

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12397 Exploration of Abuse of Position for Sexual Gain by UK Police

Authors: Terri Cole, Fay Sweeting

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Abuse of position for sexual gain by police is defined as behavior involving individuals taking advantage of their role to pursue a sexual or improper relationship. Previous research has considered whether it involves ‘bad apples’ - individuals with poor moral ethos or ‘bad barrels’ – broader organizational flaws which may unconsciously allow, minimize, or do not effectively deal with such behavior. Low level sexual misconduct (e.g., consensual sex on duty) is more common than more serious offences (e.g., rape), yet the impact of such behavior can have severe implications not only for those involved but can also negatively undermine public confidence in the police. This ongoing, collaborative research project has identified variables from 514 historic case files from 35 UK police forces in order to identify potential risk indicators which may lead to such behavior. Quantitative analysis using logistic regression and the Cox proportion hazard model has resulted in the identification of specific risk factors of significance in prediction. Factors relating to both perpetrator background such as a history of intimate partner violence, debt, and substance misuse coupled with in work behavior such as misusing police systems increase the risk. Findings are able to provide pragmatic recommendations for those tasked with identifying potential or investigating suspected perpetrators of misconduct.

Keywords: abuse of position, forensic psychology, misconduct, sexual abuse

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12396 Planning for Sustainability in the Built Environment

Authors: Adedayo Jeremiah Adeyekun, Samuel Oluwagbemiga Ishola

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This paper aimed to identify the significance of sustainability in the built environment, the economic and environmental importance to building and construction projects. Sustainability in the built environment has been a key objective of research over the past several decades. Sustainability in the built environment requires reconciliation between economic, environmental and social impacts of design and planning decisions made during the life cycle of a project from inception to termination. Planning for sustainability in the built environment needs us to go beyond our individual disciplines to consider the variety of economic, social and environmental impacts of our decisions in the long term. A decision to build a green residential development in an isolated location may pass some of the test of sustainability through its reduction in stormwater runoff, energy efficiency, and ecological sustainability in the building, but it may fail to be sustainable from a transportation perspective. Sustainability is important to the planning, design, construction, and preservation of the built environment; because it helps these activities reflect multiple values and considerations. In fact, the arts and sciences of the built environment have traditionally integrated values and fostered creative expression, capabilities that can and should lead the sustainability movement as society seeks ways to live in dynamic balance with its own diverse needs and the natural world. This research aimed to capture the state-of-the-art in the development of innovative sustainable design and planning strategies for building and construction projects. Therefore, there is a need for a holistic selection and implication approach for identifying potential sustainable strategies applicable to a particular project and evaluating the overall life cycle impact of each alternative by accounting for different applicable impacts and making the final selection among various viable alternatives.

Keywords: sustainability, built environment, planning, design, construction

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12395 How Social Support, Interaction with Clients and Work-Family Conflict Contribute to Mental Well-Being for Employees in the Human Service System

Authors: Uwe C. Fischer

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Mental health and well-being for employees working in the human service system are getting more and more important given the increasing rate of absenteeism at work. Besides individual capacities, social and community factors seem to be important in the working setting. Starting from a demand resource framework including the classical demand control aspects, social support systems, specific demands and resources of the client work, and work-family conflict were considered in the present study. We state hypothetically, that these factors have a meaningful association with the mental quality of life of employees working in the field of social, educational and health sectors. 1140 employees, working in human service organizations (education, youth care, nursing etc.) were asked for strains and resources at work (selected scales from Salutogenetic Subjective Work Assessment SALSA and own new scales for client work), work-family conflict, and mental quality of life from the German Short Form Health Survey. Considering the complex influences of the variables, we conducted a multiple hierarchical regression analysis. One third of the whole variance of the mental quality of life can be declared by the different variables of the model. When the variables concerning social influences were included in the hierarchical regression, the influence of work related control resource decreased. Excessive workload, work-family conflict, social support by supervisors, co-workers and other persons outside work, as well as strains and resources associated with client work had significant regression coefficients. Conclusions: Social support systems are crucial in the social, educational and health related service sector, regarding the influence on mental well-being. Especially the work-family conflict focuses on the importance of the work-life balance. Also the specific strains and resources of the client work, measured with new constructed scales, showed great impact on mental health. Therefore occupational health promotion should focus more on the social factors within and outside the working place.

Keywords: client interaction, human service system, mental health, social support, work-family conflict

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12394 Evaluation Practices in Colombia: Between Beliefs and National Exams

Authors: Danilsa Lorduy, Liliana Valle

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Assessment and evaluation are inextricable parts of the teaching learning process. Evaluation practices concerns are gaining popularity among curriculum developers an educational researchers, particularly in Colombian regions where English language is taught as a foreign language EFL. This study addressed one of those issues, which are the unbalanced in –services’ evaluation practices perceived in school classes. They present predominance on the written test among the procedures they use to evaluate; therefore, the purpose of this case study was to explore in-service teachers’ evaluation practices, their beliefs about evaluation and to establish an eventual connection between practices and beliefs. To this end, classroom observations, questionnaires, and a semi structured interview were applied to three in-service English teachers from different schools in a city in Colombia. The findings suggested that teachers’ beliefs indicate a formative inclination and they actually are using a variety of procedures different from test but they seem to have some issues regarding their appropriateness for application Moreover, it was found that teachers’ practices are being influenced by external factors such as school requirements and national policies. It could be concluded that the predominance in using tests is not only elicited by teachers’ beliefs but also by national test results 'Pruebas Saber' and law 115 demanding. It was also suggested that further quantitative research is needed to demonstrate connections between overuse of testing procedures and 'Pruebas Saber' national test.

Keywords: beliefs, evaluation, external factors, national test

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12393 Identification of Fluorinated Methylsiloxanes in Environmental Matrices Near a Manufacturing Plant in Eastern China

Authors: Liqin Zhi, Lin Xu, Wenxia Wei, Yaqi Cai

Abstract:

Recently, replacing some of the methyl groups in polydimethylsiloxanes with other functional groups has been extensively explored to obtain modified polymethylsiloxanes with special properties that enable new industrial applications. Fluorinated polysiloxanes, one type of these modified polysiloxanes, are based on a siloxane backbone with fluorinated groups attached to the side chains of polysiloxanes. As a commercially significant material, poly[methyl(trifluoropropyl)siloxane] (PMTFPS) has sufficient fluorine content to be useful as a fuel-and oil-resistant elastomer, which combines both the chemical and solvent resistance of fluorocarbons and the wide temperature range applicability of organosilicones. PMTFPS products can be used in many applications in which resistance to fuel, oils and hydrocarbon solvents is required, including use as lubricants in bearings, sealants, and elastomers for aerospace and automotive fuel systems. Fluorinated methylsiloxanes, a type of modified methylsiloxane, include tris(trifluoropropyl)trimethylcyclotrisiloxane (D3F) and tetrakis(trifluoropropyl)tetramethylcyclotetrasiloxane (D4F), both of which contain trifluoropropyl groups in the side chains of cyclic methylsiloxanes. D3F, as an important monomer in the manufacture of PMTFPS, is often present as an impurity in PMTFPS. In addition, the synthesis of PMTFPS from D3F could form other fluorinated methylsiloxanes with low molecular weights (such as D4F). The yearly demand and production volumes of D3F increased rapidly all over world. Fluorinated methylsiloxanes might be released into the environment via different pathways during the production and application of PMTFPS. However, there is a lack of data concerning the emission, environmental occurrence and potential environmental impacts of fluorinated methylsiloxanes. Here, we report fluorinated methylsiloxanes (D3F and D4F) in surface water and sediment samples collected near a fluorinated methylsiloxane manufacturing plant in Weihai, China. The concentrations of D3F and D4F in surface water ranged from 3.29 to 291 ng/L and from 7.02 to 168 ng/L, respectively. The concentrations of D3F and D4F in sediment ranged from 11.8 to 5478 ng/g and from 17.2 to 6277 ng/g, respectively. In simulation experiment, the half-lives of D3F and D4F at different pH values (5.2, 6.4, 7.2, 8.3 and 9.2) varied from 80.6 to 154 h and from 267 to 533 h respectively. CF₃(CH₂)₂MeSi(OH)₂ was identified as one of the main hydrolysis products of fluorinated methylsiloxanes. It was also detected in the river samples at concentrations of 72.1-182.9 ng/L. In addition, the slow rearrangement of D3F (spiked concentration = 500 ng/L) to D4F (concentration = 11.0-22.7 ng/L) was also found during 336h hydrolysis experiment.

Keywords: fluorinated methylsiloxanes, environmental matrices, hydrolysis, sediment

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12392 Usage of “Flowchart of Diagnosis and Treatment” Software in Medical Education

Authors: Boy Subirosa Sabarguna, Aria Kekalih, Irzan Nurman

Abstract:

Introduction: Software in the form of Clinical Decision Support System could help students in understanding the mind set of decision-making in diagnosis and treatment at the stage of general practitioners. This could accelerate and ease the learning process which previously took place by using books and experience. Method: Gather 1000 members of the National Medical Multimedia Digital Community (NM2DC) who use the “flowchart of diagnosis and treatment” software, and analyse factors related to: display, speed in learning, convenience in learning, helpfulness and usefulness in the learning process, by using the Likert Scale through online questionnaire which will further be processed using percentage. Results and Discussions: Out of the 1000 members of NM2DC, apparently: 97.0% of the members use the software and 87.5% of them are students. In terms of the analysed factors related to: display, speed in learning, convenience in learning, helpfulness and usefulness of the software’s usage, the results indicate a 90.7% of fairly good performance. Therefore, the “Flowchart of Diagnosis and Treatment” software has helped students in understanding the decision-making of diagnosis and treatment. Conclusion: the use of “Flowchart of Diagnosis and Treatment” software indicates a positive role in helping students understand decision-making of diagnosis and treatment.

Keywords: usage, software, diagnosis and treatment, medical education

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12391 Factors Affecting Online Tourism Services in Israel

Authors: Shlomit Hon-Snir, Shosh Shahrabai, Sharon Teitler Regev, Anabel Friedlander-Lifszyc

Abstract:

Today, online travel sites account for a large share of the orders for tourism services, leading to the expectation that many traditional travel agencies will become redundant in the future. Technological changes are offering customers a wider variety and better prices, and the improved competition in the industry has increased customer well-being significantly. Therefore, the question is whether all customers can enjoy this change, specifically whether different groups in the Israeli population enjoy the changes similarly. The purpose of this study is to identify the factors that affect the collection of data and the purchase of tourism products online and in particular to identify the barriers and limitations of technology usage among the population. The results of the current research are of great importance both economically and socially. The theory of Reasoned Action assumes that actual behavior is based on intention. Volitional behavior is predicted by individuals' attitudes to that behavior and by the way they think other people will look at them. Two cognitive variables regarding the use of technology are: perceived usefulness and perceived ease-of-use. Moreover, early adopters of innovations have different characteristics than people that adopt an innovation at a later stage. In the study, we analyze four groups of factors: Customer characteristics, internet usage, technology acceptance and product characteristics. Some of the parameters are gender, age, income level, frequency and type of internet use, proficiency in English, traveler type, number of trips abroad, perceived ease of use, perceived usefulness, perceived risk, perceived trust and product type. We investigate online purchasing and online information search separately. Data will be collected using an online questionnaire distributed among a representative sample of 600 citizens in Israel. Some of the research questions will be based on previous research studies (that underwent reliability and validity testing). Those questions will be translated into Hebrew and adjusted for the tested population.

Keywords: customer characteristics, online travel sites, technology acceptance, tourism

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12390 Machine Learning Model Applied for SCM Processes to Efficiently Determine Its Impacts on the Environment

Authors: Elena Puica

Abstract:

This paper aims to investigate the impact of Supply Chain Management (SCM) on the environment by applying a Machine Learning model while pointing out the efficiency of the technology used. The Machine Learning model was used to derive the efficiency and optimization of technology used in SCM and the environmental impact of SCM processes. The model applied is a predictive classification model and was trained firstly to determine which stage of the SCM has more outputs and secondly to demonstrate the efficiency of using advanced technology in SCM instead of recuring to traditional SCM. The outputs are the emissions generated in the environment, the consumption from different steps in the life cycle, the resulting pollutants/wastes emitted, and all the releases to air, land, and water. This manuscript presents an innovative approach to applying advanced technology in SCM and simultaneously studies the efficiency of technology and the SCM's impact on the environment. Identifying the conceptual relationships between SCM practices and their impact on the environment is a new contribution to the research. The authors can take a forward step in developing recent studies in SCM and its effects on the environment by applying technology.

Keywords: machine-learning model in SCM, SCM processes, SCM and the environmental impact, technology in SCM

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12389 Rebalancing Your Workforce Post-COVID - A Leadership Framework for Unlocking Performance and Strengthen Resilience

Authors: Thomas Seemann, Melanie Seemann

Abstract:

The work environment has changed considerably due to the COVID pandemic. A growing body of empirical research shows that employees feel increasingly stressed and anxious. They consider themselves more detached from the organization they work for than previously. Organizations need to readjust their leadership practices to cope with this situation and rebuild work motivation and resilience. We propose a leadership tool that focuses on two key dimensions, which we call the "task channel" and the "energy channel." Managing the task channel comprises balancing the challenge [C] of a task and the corresponding skill set [S] of the individual performing the task. Recent research findings shed light on how to balance these two factors and create optimal work conditions in the workplace. Managing the energy channel comprise balancing the workload [WL] of an employee and his/her capacity to work [CW]. This ensures that the mid-term and long-term effectiveness of employees is maintained and energy depletion, fatigue, and burn-out are prevented. Organizations can actively apply strategies to leverage wellsprings and effectively reenergize their workforce. Thinking through and acting upon these factors will provide leaders with the insights they need to maximize their people's performance and, at the same time, establish a more mindful workplace.

Keywords: resilience, motivation, employee engagement, leadership

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12388 A Critical Geography of Reforestation Program in Ghana

Authors: John Narh

Abstract:

There is high rate of deforestation in Ghana due to agricultural expansion, illegal mining and illegal logging. While it is attempting to address the illegalities, Ghana has also initiated a reforestation program known as the Modified Taungya System (MTS). Within the MTS framework, farmers are allocated degraded forestland and provided with tree seedlings to practice agroforestry until the trees form canopy. Yet, the political, ecological and economic models that inform the selection of tree species, the motivations of participating farmers as well as the factors that accounts for differential access to the land and performance of farmers engaged in the program lie underexplored. Using a sequential explanatory mixed methods approach in five forest-fringe communities in the Eastern Region of Ghana, the study reveals that economic factors and Ghana’s commitment to international conventions on the environment underpin the selection of tree species for the MTS program. Social network and access to remittances play critical roles in having access to, and enhances poor farmers’ chances in the program respectively. Farmers are more motivated by the access to degraded forestland to cultivate food crops than having a share in the trees that they plant. As such, in communities where participating farmers are not informed about their benefit in the tree that they plant, the program is largely unsuccessful.

Keywords: translocality, deforestation, forest management, social network

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12387 Design Intervention to Achieve Space Efficiency for Commercial Interiors

Authors: Hari Krishna Ayyappa, Reenu Singh

Abstract:

Rising population and restricted land for development has led towards the growth of vertical buildings and small complexes. It provides many possibilities to change the shape and size of internal space in addition to the social impacts on the commercial spaces. With the increased volatility of necessities of people, the need for mental and physical comfort has continuously increased. . Living in a small space musts minimalist and space- saving cabinetwork results to sustain mortal good. This paper attempts to explore the Influence of Using Minimalist Furniture on the Efficiency of the commercial Space interiors by means of the variable resulting from preceding studies based on literature. A literature review was conducted on research articles to understand the contributing variables in a well designed small commercial spaces. A questionnaire survey was conducted to understand the layout of small commercial spaces with respect to Environmental impact, material, Design elements, Modern approach, Layered lightings, and colours. The problem of small spaces can be resolved by some ways; it's still needed for cabinetwork to develop to be more innovative to accommodate small living spaces. Since cabinetwork is a necessity and not luxury, everybody is in need of it. The spatial factors affecting overall satisfaction at a detailed position were bandied. The variable helped in proposing design ideation and mock ups to explore improved interiors. This paper concludes that most of the principles of the minimalist approach have been overlooked at, which had an impact on the space efficiency in commercial spaces like storage rooms, office area, retail stores, restaurants, and other spaces where business is conducted.

Keywords: materials, modern approach, space efficiency, tall commercial buildings

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12386 Analysis of Environmental Sustainability in Post- Earthquake Reconstruction : A Case of Barpak, Nepal

Authors: Sudikshya Bhandari, Jonathan K. London

Abstract:

Barpak in northern Nepal represents a unique identity expressed through the local rituals, values, lifeways and the styles of vernacular architecture. The traditional residential buildings and construction practices adopted by the dominant ethnic groups: Ghales and Gurungs, reflect environmental, social, cultural and economic concerns. However, most of these buildings did not survive the Gorkha earthquake in 2015 that made many residents skeptical about their strength to resist future disasters. This led Barpak residents to prefer modern housing designs primarily for the strength but additionally for convenience and access to earthquake relief funds. Post-earthquake reconstruction has transformed the cohesive community, developed over hundreds of years into a haphazard settlement with the imposition of externally-driven building models. Housing guidelines provided for the community reconstruction and earthquake resilience have been used as a singular template, similar to other communities on different geographical locations. The design and construction of these buildings do not take into account the local, historical, environmental, social, cultural and economic context of Barpak. In addition to the physical transformation of houses and the settlement, the consequences continue to develop challenges to sustainability. This paper identifies the major challenges for environmental sustainability with the construction of new houses in post-earthquake Barpak. Mixed methods such as interviews, focus groups, site observation, and documentation, and analysis of housing and neighborhood design have been used for data collection. The discernible changing situation of this settlement due to the new housing has included reduced climatic adaptation and thermal comfort, increased consumption of agricultural land and water, minimized use of local building materials, and an increase in energy demand. The research has identified that reconstruction housing practices happening in Barpak, while responding to crucial needs for disaster recovery and resilience, are also leading this community towards an unsustainable future. This study has also integrated environmental, social, cultural and economic parameters into an assessment framework that could be used to develop place-based design guidelines in the context of other post-earthquake reconstruction efforts. This framework seeks to minimize the unintended repercussions of unsustainable reconstruction interventions, support the vitality of vernacular architecture and traditional lifeways and respond to context-based needs in coordination with residents.

Keywords: earthquake, environment, reconstruction, sustainability

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12385 Importance of E-Participation by U-Society in the Development of the U-City

Authors: Jalaluddin Abdul Malek, Mohd Asruladlyi Ibrahim, Zurinah Tahir

Abstract:

This paper is to reveal developments in the areas of urban technology in Malaysia. Developments occur intend to add value intelligent city development to the ubiquitous city (U-city) or smart city. The phenomenon of change is called the development of post intelligent cities. U-City development discourse is seen from the perspective of the philosophy of the virtuous city organized by al-Farabi. The prosperity and perfection of a city is mainly caused by human personality factors, as well as its relationship with material and technological aspects of the city. The question is, to what extent to which human factors are taken into account in the concept of U-City as an added value to the intelligent city concept to realize the prosperity and perfection of the city? Previously, the intelligent city concept was developed based on global change and ICT movement, while the U-city added value to the development of intelligent cities and focused more on the development of information and communications technology (ICT). Value added is defined as the use of fiber optic technology that is wired to the use of wireless technology, such as wireless broadband. In this discourse, the debate on the concept of U-City is to the symbiosis between the U-City and the importance of local human e-participation (U-Society) for prosperity. In the context of virtuous city philosophy, it supports the thought of symbiosis so the concept of U-City can achieve sustainability, prosperity and perfection of the city.

Keywords: smart city, ubiquitous city, u-society, e-participation, prosperity

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12384 The Influencing Factors of Export Performance Amongst Halal Small and Medium-Sized Enterprises (SMEs) in Malaysia

Authors: Shanorfizah Mohd Safar, Shaizatulaqma Kamalul Ariffin

Abstract:

Internationalization of halal small and medium-sized enterprises (SMEs) is necessary for SMEs to become more involved in regional trade and business cooperation. By internationalization, SMEs' profit can increase, and market expansion of SMEs is basic for rising economies of countries to contend all around in the halal industry globally. There are several modes of internationalization; exporting is one of the first steps for internationalization with less capital needed. The study examines the influential factors of export performance amongst halal SMEs in Malaysia. Specifically, this study examines the positive and significant relationships amongst human capital, managerial capability, Halal Assurance Management System (HAMS), digital transformation, government support, and networking capability on halal SMEs' export performance toward SMEs' competitive advantage. In addition, this study will examine innovation capabilities as a moderator in the relationship between independence variables and competitive advantage. Competitive advantage is the most compelling perspective that drives the export performance of halal SMEs in Malaysia. A quantitative method will be used: an online questionnaire survey distributed through emails and face-to-face toward selected halal-certificated SMEs registered in JAKIM, MATRADE website and SME Corp Malaysia website. Nevertheless, whether the halal SMEs practice global business, they will still be the potential respondents. The data were examined and obtained using the statistical software Smart PLS. The analysis used is reliability, correlation, and regression analysis to meet the research objectives. This study contributes significantly to the theory by integrating Resource Based View (RBV) theory, Technology–Organization–Environment (TOE) framework and Networking theory. In addition, this research extends the RBV by extending a variable, the Halal Assurance Management System. This study also examines a moderating role of innovation capabilities in the framework and competitive advantage as a mediator. This research aims to analyze the factors that will impact the internationalization of halal SMEs.

Keywords: internationalization, halal SMEs, competitive advantage, export performance

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12383 Building Carbon Footprint Comparison between Building Permit, as Built, as Built with Circular Material Usage

Authors: Kadri-Ann Kertsmik, Martin Talvik, Kimmo Lylykangas, Simo Ilomets, Targo Kalamees

Abstract:

This study compares the building carbon footprint (CF) values for a case study of a private house located in a cold climate, using the Level(s) methodology. It provides a framework for measuring the environmental performance of buildings throughout their life cycle, taking into account various factors. The study presents the results of the three scenarios, comparing their carbon emissions and highlighting the benefits of circular material usage. The construction process was thoroughly documented, and all materials and components (including minuscule mechanical fasteners, each meter of cable, a kilogram of mortar, and the component of HVAC systems, among other things) delivered to the construction site were noted. Transportation distances of each delivery, the fuel consumption of construction machines, and electricity consumption for temporary heating and electrical tools were also monitored. Using the detailed data on material and energy resources, the CF was calculated for two scenarios: one where circular material usage was applied and another where virgin materials were used instead of reused ones. The results were compared with the CF calculated based on the building permit design model using the Level(s) methodology. To study the range of possible results in the early stage of CF assessment, the same building permit design was given to several experts. Results showed that embodied carbon values for a built scenario were significantly lower than the values predicted by the building permit stage as a result of more precise material quantities, as the calculation methodology is designed to overestimate the CF. Moreover, designers made an effort to reduce the building's CF by reusing certain materials such as ceramic tiles, lightweight concrete blocks, and timber during the construction process. However, in a cold climate context where operational energy (B6) continues to dominate, the total building CF value changes between the three scenarios were less significant. The calculation for the building permit project was performed by several experts, and CF results were in the same range. It alludes that, for the first estimation of preliminary building CF, using average values proves to be an appropriate method for the Estonian national carbon footprint estimation phase during building permit application. The study also identified several opportunities for reducing the carbon footprint of the building, such as reusing materials from other construction sites, preferring local material producers, and reducing wastage on site. The findings suggest that using circular materials can significantly reduce the carbon footprint of buildings. Overall, the study highlights the importance of using a comprehensive approach to measure the environmental performance of buildings, taking into account both the project and the actually built house. It also emphasises the need for ongoing monitoring for designing the building and construction site waste. The study also gives some examples of how to enable future circularity of building components and materials, e.g., building in layers, using wood as untreated, etc.

Keywords: carbon footprint, circular economy, sustainable construction, level(s) methodology

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12382 Angiogenic, Cytoprotective, and Immunosuppressive Properties of Human Amnion and Chorion-Derived Mesenchymal Stem Cells

Authors: Kenichi Yamahara, Makiko Ohshima, Shunsuke Ohnishi, Hidetoshi Tsuda, Akihiko Taguchi, Toshihiro Soma, Hiroyasu Ogawa, Jun Yoshimatsu, Tomoaki Ikeda

Abstract:

We have previously reported the therapeutic potential of rat fetal membrane(FM)-derived mesenchymal stem cells (MSCs) using various rat models including hindlimb ischemia, autoimmune myocarditis, glomerulonephritis, renal ischemia-reperfusion injury, and myocardial infarction. In this study, 1) we isolated and characterized MSCs from human amnion and chorion; 2) we examined their differences in the expression profile of growth factors and cytokines; and 3) we investigated the therapeutic potential and difference of these MSCs using murine hindlimb ischemia and acute graft-versus-host disease (GVHD) models. Isolated MSCs from both amnion and chorion layers of FM showed similar morphological appearance, multipotency, and cell-surface antigen expression. Conditioned media obtained from amnion- and chorion-derived MSCs inhibited cell death caused by serum starvation or hypoxia in endothelial cells and cardiomyocytes. Amnion and chorion MSCs secreted significant amounts of angiogenic factors including HGF, IGF-1, VEGF, and bFGF, although differences in the cellular expression profile of these soluble factors were observed. Transplantation of human amnion or chorion MSCs significantly increased blood flow and capillary density in a murine hindlimb ischemia model. In addition, compared to human chorion MSCs, human amnion MSCs markedly reduced T-lymphocyte proliferation with the enhanced secretion of PGE2, and improved the pathological situation of a mouse model of GVHD disease. Our results highlight that human amnionand chorion-derived MSCs, which showed differences in their soluble factor secretion and angiogenic/immuno-suppressive function, could be ideal cell sources for regenerative medicine.

Keywords: amnion, chorion, fetal membrane, mesenchymal stem cells

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12381 Influencing Factors and Mechanism of Patient Engagement in Healthcare: A Survey in China

Authors: Qing Wu, Xuchun Ye, Kirsten Corazzini

Abstract:

Objective: It is increasingly recognized that patients’ rational and meaningful engagement in healthcare could make important contributions to their health care and safety management. However, recent evidence indicated that patients' actual roles in healthcare didn’t match their desired roles, and many patients reported a less active role than desired, which suggested that patient engagement in healthcare may be influenced by various factors. This study aimed to analyze influencing factors on patient engagement and explore the influence mechanism, which will be expected to contribute to the strategy development of patient engagement in healthcare. Methods: On the basis of analyzing the literature and theory study, the research framework was developed. According to the research framework, a cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale, Facilitation of Patient Involvement Scale and Wake Forest Physician Trust Scale, and other influencing factor related scales. A convenience sample of 580 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province, and Zhejiang Province. Results: The results of the cross-sectional survey indicated that the mean score for the patient engagement behavior was (4.146 ± 0.496), and the mean score for the willingness was (4.387 ± 0.459). The level of patient engagement behavior was inferior to their willingness to be involved in healthcare (t = 14.928, P < 0.01). The influencing mechanism model of patient engagement in healthcare was constructed by the path analysis. The path analysis revealed that patient attitude toward engagement, patients’ perception of facilitation of patient engagement and health literacy played direct prediction on the patients’ willingness of engagement, and standard estimated values of path coefficient were 0.341, 0.199, 0.291, respectively. Patients’ trust in physician and the willingness of engagement played direct prediction on the patient engagement, and standard estimated values of path coefficient were 0.211, 0.641, respectively. Patient attitude toward engagement, patients’ perception of facilitation and health literacy played indirect prediction on patient engagement, and standard estimated values of path coefficient were 0.219, 0.128, 0.187, respectively. Conclusions: Patients engagement behavior did not match their willingness to be involved in healthcare. The influencing mechanism model of patient engagement in healthcare was constructed. Patient attitude toward engagement, patients’ perception of facilitation of engagement and health literacy posed indirect positive influence on patient engagement through the patients’ willingness of engagement. Patients’ trust in physician and the willingness of engagement had direct positive influence on the patient engagement. Patient attitude toward engagement, patients’ perception of physician facilitation of engagement and health literacy were the factors influencing the patients’ willingness of engagement. The results of this study provided valuable evidence on guiding the development of strategies for promoting patient rational and meaningful engagement in healthcare.

Keywords: healthcare, patient engagement, influencing factor, the mechanism

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