Search results for: impacts and adaptation

Authors: Vanja Skoric

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The paper examines whether the impacts of artificial intelligence (AI) can be meaningfully addressed through the rights-based approach to AI design, investigating in particular how the inclusive, participatory process of assessing the AI impact would make this viable. There is a significant gap between envisioning rights-based AI systems and their practical application. Plausibly, internalizing human rights approach within AI design process might be achieved through identifying and assessing implications of AI features human rights, especially considering the case of vulnerable individuals and communities. However, there is no clarity or consensus on how such an instrument should be operationalised to usefully identify the impact, mitigate harms and meaningfully ensure relevant stakeholders’ participation. In practice, ensuring the meaningful inclusion of those individuals, groups, or entire communities who are affected by the use of the AI system is a prerequisite for a process seeking to assess human rights impacts and risks. Engagement in the entire process of the impact assessment should enable those affected and interested to access information and better understand the technology, product, or service and resulting impacts, but also to learn about their rights and the respective obligations and responsibilities of developers and deployers to protect and/or respect these rights. This paper will provide an overview of the study and practice of the participatory design process for AI, including inclusive impact assessment, its main elements, propose a framework, and discuss the lessons learned from the existing theory. In addition, it will explore pathways for enhancing and promoting individual and group rights through such engagement by discussing when, how, and whom to include, at which stage of the process, and what are the pre-requisites for meaningful and engaging. The overall aim is to ensure using the technology that works for the benefit of society, individuals, and particular (historically marginalised) groups.

Keywords: rights-based design, AI impact assessment, inclusion, harm mitigation

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Authors: Connor Dunlop, Bassim Abbassi, Richard G. Zytner

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Life cycle assessment (LCA) is a powerful tool established by the International Organization for Standardization (ISO) that can be used to assess the environmental impacts of a product or process from cradle to grave. Many studies utilize the LCA methodology within the site remediation field to compare various decontamination methods, including bioremediation, soil vapor extraction or excavation, and off-site disposal. However, with the authors' best knowledge, limited information is available in the literature on a sustainability tool that could be used to help with the selection of the optimal remediation technology. This tool, based on the LCA methodology, would consider site conditions like environmental, economic, and social impacts. Accordingly, this project was undertaken to develop a tool to assist with the selection of optimal sustainable technology. Developing a proper tool requires a large amount of data. As such, data was collected from previous LCA studies looking at site remediation technologies. This step identified knowledge gaps or limitations within project data. Next, utilizing the data obtained from the literature review and other organizations, an extensive LCA study is being completed following the ISO 14040 requirements. Initial technologies being compared include bioremediation, excavation with off-site disposal, and a no-remediation option for a generic gasoline-contaminated site. To complete the LCA study, the modelling software SimaPro is being utilized. A sensitivity analysis of the LCA results will also be incorporated to evaluate the impact on the overall results. Finally, the economic and social impacts associated with each option will then be reviewed to understand how they fluctuate at different sites. All the results will then be summarized, and an interactive tool using Excel will be developed to help select the best sustainable site remediation technology. Preliminary LCA results show improved sustainability for the decontamination of a gasoline-contaminated site for each technology compared to the no-remediation option. Sensitivity analyses are now being completed on on-site parameters to determine how the environmental impacts fluctuate at other contaminated gasoline locations as the parameters vary, including soil type and transportation distances. Additionally, the social improvements and overall economic costs associated with each technology are being reviewed. Utilizing these results, the sustainability tool created to assist in the selection of the overall best option will be refined.

Keywords: life cycle assessment, site remediation, sustainability tool, contaminated sites

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Authors: Yu-Yao Wang, Xiao-Meng Hu, Joanne Yeung, Xiao-Yan Li

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The high private cost and unquantified external cost limit the development of reclaimed water. In this study, an integrated framework comprising life cycle assessment (LCA), quantitative microbial risk assessment (QMRA), and life cycle costing (LCC) was developed to evaluate both costs of reclaimed water supply in water systems of various scales. LCA assesses the environmental impacts, and QMRA estimates the associated pathogenic impacts. These impacts are monetized as external costs and analyzed with the private cost by LCC to count the total life cycle cost. The framework evaluated the Hong Kong urban water system in the baseline scenario (BS) and five wastewater reuse scenarios (RS). They are RSI: substituting freshwater for toilet flushing only, RSII: substituting both freshwater and seawater for toilet flushing, RSIII: using reclaimed water for all non-potable uses, RSIV: using reclaimed water for all non-potable uses and indirect potable uses, and RSV: non-potable use and indirect potable use by conveying 100% reclaimed water to recharge the reservoirs. The results show that substituting freshwater and seawater for toilet flushing has the least total life cycle cost, exhibiting that it is the most cost-effective option for Hong Kong. Meanwhile, the evaluation results show that the external cost of each scenario is comparable to the corresponding private cost, indicating the importance of the inclusion of comprehensive external cost evaluation in private cost assessment of water systems with reclaimed water supply.

Keywords: life cycle assessment, life cycle costing, quantitative microbial risk assessment, water reclamation, reclaimed water, alternative water resources

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Authors: S. Grinnell

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A PhD Research Project exploring the Social Health and Well-Being Impacts associated with Hydraulic Fracturing, with an aim to produce a Best Practice Support Guidance for those anticipating dealing with planning applications or submitting Environmental Impact Assessments (EIAs). Amid a possible global energy crisis, founded upon a number of factors, including unstable political situations, increasing world population growth, people living longer, it is perhaps inevitable that Hydraulic Fracturing (commonly referred to as ‘fracking’) will become a major player within the global long-term energy and sustainability agenda. As there is currently no best practice guidance for governing bodies the Best Practice Support Document will be targeted at a number of audiences including, consultants undertaking EIAs, Planning Officers, those commissioning EIAs Industry and interested public stakeholders. It will offer a robust, evidence-based criteria and recommendations which provide a clear narrative and consistent and shared approach to the language used along with containing an understanding of the issues identified. It is proposed that the Best Practice Support Document will also support the mitigation of health impacts identified. The Best Practice Support Document will support the newly amended Environmental Impact Assessment Directive (2011/92/EU), to be transposed into UK law by 2017. A significant amendment introduced focuses on, ‘higher level of protection to the environment and health.’ Methodology: A qualitative research methods approach is being taken with this research. It will have a number of key stages. A literature review has been undertaken and been critically reviewed and analysed. This was followed by a descriptive content analysis of a selection of international and national policies, programmes and strategies along with published Environmental Impact Assessments and associated planning guidance. In terms of data collection, a number of stakeholders were interviewed as well as a number of focus groups of local community groups potentially affected by fracking. These were determined from across the UK. A theme analysis of all the data collected and the literature review will be undertaken, using NVivo. Best Practice Supporting Document will be developed based on the outcomes of the analysis and be tested and piloted in the professional fields, before a live launch. Concluding statement: Whilst fracking is not a new concept, the technology is now driving a new force behind the use of this engineering to supply fuels. A number of countries have pledged moratoria on fracking until further investigation from the impacts on health have been explored, whilst other countries including Poland and the UK are pushing to support the use of fracking. If this should be the case, it will be important that the public’s concerns, perceptions, fears and objections regarding the wider social health and well-being impacts are considered along with the more traditional biomedical health impacts.

Keywords: fracking, hydraulic fracturing, socio-economic health, well-being

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Authors: Omar Romero-Hernandez, Federico Castillo, Armando Sanchez, Sergio Romero, Andrea Romero, Michael Mitchell

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Environmental policies for resource conservation in rural areas include subsidies on services and social programs to cover living expenses. Government's expectation is that rural communities who benefit from social programs, such as payment for ecosystem services, are provided with an incentive to conserve natural resources and preserve natural sinks for greenhouse gases. At the same time, global climate change has affected the lives of people worldwide. The capability to adapt to global warming depends on the available resources and the standard of living, putting rural communities at a disadvantage. This paper explores whether rural entrepreneurship can represent a solution to resource conservation and global warming adaptation in rural communities. The research focuses on a sample of two coffee communities in Oaxaca, Mexico. Researchers used geospatial information contained in aerial photographs of the geographical areas of interest. Households were identified in the photos via the roofs of households and georeferenced via coordinates. From the household population, a random selection of roofs was performed and received a visit. A total of 112 surveys were completed, including questions of socio-demographics, perception to climate change and adaptation activities. The population includes two groups of study: entrepreneurs and non-entrepreneurs. Data was sorted, filtered, and validated. Analysis includes descriptive statistics for exploratory purposes and a multi-regression analysis. Outcomes from the surveys indicate that coffee farmers, who demonstrate entrepreneurship skills and hire employees, are more eager to adapt to climate change despite the extreme adverse socioeconomic conditions of the region. We show that farmers with entrepreneurial tendencies are more creative in using innovative farm practices such as the planting of shade trees, the use of live fencing, instead of wires, and watershed protection techniques, among others. This result counters the notion that small farmers are at the mercy of climate change and have no possibility of being able to adapt to a changing climate. The study also points to roadblocks that farmers face when coping with climate change. Among those roadblocks are a lack of extension services, access to credit, and reliable internet, all of which reduces access to vital information needed in today’s constantly changing world. Results indicate that, under some circumstances, funding and supporting entrepreneurship programs may provide more benefit than traditional social programs.

Keywords: entrepreneurship, global warming, rural communities, climate change adaptation

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Authors: Muhammad Hadi Ibrahim

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The benefits of alternative/renewable fuels in general and a study of the environmental impacts of biofuels in particular have been reviewed in this paper. It is a known fact that, energy generation using fossil fuel produces many important pollutants including; nitrogen oxides, hydrocarbons, soot, dust, smoke and other particulate harmful matter. It’s believed that if carbon dioxide levels continue to increase drastically, the planet will become warmer and will most likely result in a variety of negative impacts including; sea-level rise, extreme and unpredictable weather events and an increased frequency of draughts in inland agricultural zones. Biofuels such as alcohols, biogas, etc. appear to be more viable alternatives, especially for use as fuels in diesel engines. The substitution of fossil fuel through increased utilization of biofuels produced in a sustainable manner, can contribute immensely towards a cleaner environment, reduction in greenhouse gas emissions and mitigation of climate change. Stakeholders in the energy sector can be sensitized by the findings of the research study and to consider the possible adverse effects in developing technologies for the production and combustion of biofuels.

Keywords: emission, energy, renewable/alternative fuel, environment, pollution

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Authors: Alan Lai, Wilson Yik

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With rapid urbanization, there has been a dramatic increase in global urban population in Asia and over half of population in Asia will live in urban regions in the near future. Facing with increasing exposure to climate-related stresses and shocks, most of the Asian cities will very likely to experience more frequent heat waves and flooding with rising sea levels, particularly the coastal cities will grapple for intense typhoons and storm surges. These climate changes have severe impacts in urban areas at the costs of infrastructure and population, for example, human health, wellbeing and high risks of dengue fever, malaria and diarrheal disease. With the increasing prominence of adaptation to climate changes, there have been changes in corresponding policies. Smaller cities have greater potentials for integrating the concept of resilience into their infrastructure as well as keeping pace with their rapid growths in population. It is therefore important to explore the potentials of Asian cities adapting to climate change and the opportunities of building climate resilience in urban planning and building design. Furthermore, previous studies have mainly attempted at exploiting the potential of resilience on a macro-level within urban planning rather than that on micro-level within the context of individual building. The resilience of individual building as a research field has not yet been much explored. Nonetheless, recent studies define that the resilience of an individual building is the one which is able to respond to physical damage and recover from such damage in a quickly and cost-effectively manner, while maintain its primary functions. There is also a need to develop an assessment tool to evaluate the resilience on building scale which is still largely uninvestigated as it should be regarded as a basic function of a building. Due to the lack of literature reporting metric for assessing building resilience with sustainability, the research will be designed as a case study to provide insight into the issue. The aim of this research project is to encourage and assist in developing neighborhood climate resilience design strategies for Hong Kong so as to bridge the gap between difference scales and that between theory and practice.

Keywords: resilience cities, building resilience, resilient buildings and infrastructure, climate resilience, hot and humid southeast area, high-density cities

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Authors: Amr Sultan, Sara Elgazzar, Breksal Elmiligy

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The airline industry nowadays is becoming a more growing industry facing a severe competition. It is an influential issue in this context to utilize revenue management (RM) concept and practice in order to develop the pricing strategy. There is an unfathomable necessity for RM to assist the airlines and their associates to disparage the cost and recuperate their revenue, which in turn will boost the airline industry performance. The complexity of RM imposes enormous challenges on the airline industry. Several studies have been proposed on the RM adaptation in airlines industry while there is a limited availability of implementing RM and its complexity in the developing countries such as Egypt. This research represents a research schema about the implementation of the RM to the Egyptian airline industry. The research aims at investigating and demonstrating the complexities face implementing RM in the airline industry, up on which the research provides a comprehensive understanding of how to overcome these complexities while adapting RM in the Egyptian airline industry. An empirical study was conducted on the Egyptian airline sector based on a sample of four airlines (Egyptair, Britishair, KLM, and Lufthansa). The empirical study was conducted using a mix of qualitative and quantitative approaches. First, in-depth interviews were carried out to analyze the Egyptian airline sector status and the main challenges faced by the airlines. Then, a structured survey on the three different parties of airline industry; airlines, airfreight forwarders, and passengers were conducted in order to investigate the main complexity factors from different parties' points of view. Finally, a focus group was conducted to develop a best practice framework to overcome the complexities faced the RM adaptation in the Egyptian airline industry. The research provides an original contribution to knowledge by creating a framework to overcome the complexities and challenges in adapting RM in the airline industry generally and the Egyptian airline industry particularly. The framework can be used as a RM tool to increase the effectiveness and efficiency of the Egyptian airline industry performance.

Keywords: revenue management, airline industry, revenue management complexity, Egyptian airline industry

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Authors: X. Lu, T. Lu, S. Javadi

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A simple dynamic approach is presented for analyzing thermal and moisture dynamics of buildings, which is of particular relevance to understanding climate change impacts on buildings, including assessment of risks and applications of resilience strategies. With the goal to demonstrate the proposed modeling methodology, to verify the model, and to show that wooden materials provide a mechanism that can facilitate the reduction of moisture risks and be more resilient to global warming, a wooden church equipped with high precision measurement systems was taken as a test building for full-scale time-series measurements. Sensitivity analyses indicate a high degree of accuracy in the model prediction regarding the indoor environment. The model is then applied to a future projection of climate indoors aiming to identify significant environmental factors, the changing temperature and humidity, and effective response to the climate change impacts. The paper suggests that wooden building materials offer an effective and resilient response to anticipated future climate changes.

Keywords: dynamic model, forecast, climate change impact, wooden structure, buildings

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Authors: Penchuk A. Vovkanych

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The adaptive changes in the respiratory system provide the background for the increase of aerobic capacity and sport results on the middle and long distances runners. Effect of such adaptive changes in the sport orienteering remains poorly investigated. Therefore our study was undertaken to reveal the adaptive changes in the respiration indices of high skilled orienteer athletes.

Keywords: adaptation, external, functional state, respiration, running, sport orienteering

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Authors: Erfan Memarian, Seyyed Fazayel Alizadeh

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This study aims to evaluate the impacts of the oil and financial markets of the United States on Iran stock exchange and to develop an ARDL model to predict the short and long-term relationship between these markets. In this regard, all 713 weekly data between 28 July 1999 and 20 March 2013 were analyzed by using Microfit4.0 and Eviews7 econometric softwares. The independent variable of the study is the “Price and Yield Index (TEDPIX)” of Tehran Stock Exchange and the independent variables include S & P 500 Index, the US three-month treasury bill rate and West Texas Intermediate oil spot price index. The results show that the West Texas Intermediate oil spot price and the S&P 500 indices have significant positive relationships with Iran's TEDPIX. Also, there exists a significant negative relationship between Iran's TEDPIX and the US three-month Treasury bill rate.

Keywords: TEDPIX; Tehran Stock Exchange; S&P 500 index; USA three-month Treasury bill rate; West Texas Intermediate oil

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Authors: Ponghyung Lee

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This study seeks to investigate the variations occurring to Korean consonantal variations center around laryngeal features of the concerned sounds, to the exclusion of others. Our fundamental premise is that the weak contrast associated with concerned segments might be held accountable for the oscillation of the status quo of the concerned consonants. What is more, we assume that an array of notions as a measure of communicative efficiency of linguistic units would be significantly influential on triggering those variations. To this end, we have tried to compute the surprisal, entropic contribution, and relative contrastiveness associated with Korean obstruent consonants. What we found therein is that the Information-theoretic perspective is compelling enough to lend support our approach to a considerable extent. That is, the variant realizations, chronologically and stylistically, prove to be profoundly affected by a set of Information-theoretic factors enumerated above. When it comes to the biblical proper names, we use Georgetown University CQP Web-Bible corpora. From the 8 texts (4 from Old Testament and 4 from New Testament) among the total 64 texts, we extracted 199 samples. We address the issue of laryngeal feature variations associated with Korean obstruent consonants under the presumption that the variations stem from the weak contrast among the triad manifestations of laryngeal features. The variants emerge from diverse sources in chronological and stylistic senses: Christianity biblical texts, ordinary casual speech, the shift of loanword adaptation over time, and ideophones. For the purpose of discussing what they are really like from the perspective of Information Theory, it is necessary to closely look at the data. Among them, the massive changes occurring to loanword adaptation of proper nouns during the centennial history of Korean Christianity draw our special attention. We searched 199 types of initially capitalized words among 45,528-word tokens, which account for around 5% of total 901,701-word tokens (12,786-word types) from Georgetown University CQP Web-Bible corpora. We focus on the shift of the laryngeal features incorporated into word-initial consonants, which are available through the two distinct versions of Korean Bible: one came out in the 1960s for the Protestants, and the other was published in the 1990s for the Catholic Church. Of these proper names, we have closely traced the adaptation of plain obstruents, e. g. /b, d, g, s, ʤ/ in the sources. The results show that as much as 41% of the extracted proper names show variations; 37% in terms of aspiration, and 4% in terms of tensing. This study set out in an effort to shed light on the question: to what extent can we attribute the variations occurring to the laryngeal features associated with Korean obstruent consonants to the communicative aspects of linguistic activities? In this vein, the concerted effects of the triad, of surprisal, entropic contribution, and relative contrastiveness can be credited with the ups and downs in the feature specification, despite being contentiousness on the role of surprisal to some extent.

Keywords: entropic contribution, laryngeal feature variation, relative contrastiveness, surprisal

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Authors: Zeleke Ayalew Alemu

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Indian Ocean and the Nile River play significant roles in shaping the hydrological and ecological systems of the regions they traverse. This study explores the interlinkages and impacts of the Indian Ocean on the Nile River, highlighting key factors such as water flow, nutrient distribution, climate patterns, and biodiversity. The Indian Ocean serves as a major source of moisture for the Nile River, contributing to its annual flood cycle and sustaining the river's ecosystem. The Indian Ocean's monsoon winds influence the amount of rainfall received in East Africa, which directly impacts the Nile's water levels. These monsoonal patterns create a vital connection between the Indian Ocean and the Nile, affecting agricultural productivity, freshwater availability, and overall river health. The Indian Ocean also influences the nutrient levels in the Nile River. Coastal upwelling driven by oceanic currents brings nutrient-rich waters from the depths of the ocean to the surface. These nutrients are transported by ocean currents towards the Red Sea and subsequently enter the Nile. This influx of nutrients supports the growth of plankton, which forms the basis of the river's food web and sustains various aquatic species. Additionally, the Indian Ocean's climate patterns, such as El Niño and Indian Ocean Dipole events, exert influence on the Nile River basin. El Niño, for example, can result in drought conditions, reduced precipitation, and altered river flows, impacting agricultural activities and water resource management along the Nile. The Indian Ocean Dipole events can influence the rainfall distribution in East Africa, further impacting the Nile's water levels and ecosystem dynamics. The Indian Ocean's biodiversity is interconnected with the Nile River's ecological system. Many species that inhabit the Indian Ocean, such as migratory birds and marine mammals, migrate along the Nile River basin, utilizing its resources for feeding and breeding purposes. The health of the Indian Ocean's ecosystem thus indirectly affects the biodiversity and ecological balance of the Nile River. Indian Ocean plays a crucial role in shaping the dynamics of the Nile River. Its influence on water flow, nutrient distribution, climate patterns, and biodiversity highlights the complex interdependencies between these two important water bodies. Understanding the interconnectedness and impacts of the Indian Ocean on the Nile is essential for effective water resource management and conservation efforts in the region.

Keywords: water, management, environment, planning

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Authors: Liliana Gomez Cardona, Echo Parent-Racine, Joy Outerbridge, Arlene Laliberté, Outi Linnaranta

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Suicide rates among Inuit in Nunavik are six to eleven times larger than the Canadian average. The colonization, religious missions, residential schools as well as economic and political marginalization are factors that have challenged the well-being and mental health of these populations. In psychiatry, screening for mental illness is often done using questionnaires with which the patient is expected to respond how often he/she has certain symptoms. However, the Indigenous view of mental wellbeing may not fit well with this approach. Moreover, biomedical treatments do not always meet the needs of Indigenous peoples because they do not understand the culture and traditional healing methods that persist in many communities. Assess whether the questionnaires used to measure symptoms, commonly used in psychiatry are appropriate and culturally safe for the Inuit in Quebec. Identify the most appropriate tool to assess and promote wellbeing and follow the process necessary to improve its cultural sensitivity and safety for the Inuit population. Qualitative, collaborative, and participatory action research project which respects First Nations and Inuit protocols and the principles of ownership, control, access, and possession (OCAP). Data collection based on five focus groups with stakeholders working with these populations and members of Indigenous communities. Thematic analysis of the data collected and emerging through an advisory group that led a revision of the content, use, and cultural and conceptual relevance of the instruments. The questionnaires measuring psychiatric symptoms face significant limitations in the local indigenous context. We present the factors that make these tools not relevant among Inuit. Although the scale called Growth and Empowerment Measure (GEM) was originally developed among Indigenous in Australia, the Inuit in Quebec found that this tool comprehends critical aspects of their mental health and wellbeing more respectfully and accurately than questionnaires focused on measuring symptoms. We document the process of cultural adaptation of this tool which was supported by community members to create a culturally safe tool that helps in resilience and empowerment. The cultural adaptation of the GEM provides valuable information about the factors affecting wellbeing and contributes to mental health promotion. This process improves mental health services by giving health care providers useful information about the Inuit population and their clients. We believe that integrating this tool in interventions can help create a bridge to improve communication between the Indigenous cultural perspective of the patient and the biomedical view of health care providers. Further work is needed to confirm the clinical utility of this tool in psychological and psychiatric intervention along with social and community services.

Keywords: cultural adaptation, cultural safety, empowerment, Inuit, mental health, Nunavik, resiliency

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Authors: Atef Mohamed Kamel Ahmed

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House crows (Corvus splendens) have become well-established in Ismailia Governorate, Egypt, where they pose several and serious impacts on native biodiversity, ecosystems and humans health. However, there is a lack of literature on the status and effects of invasive birds in Egypt. Over the past 10 years in Ismailia, House crow have increased at a rate approaching (60000 birds)15% per annum; if this were allowed to continue, the population now 10909 birds and will exceed more by 2013, probably accompanied by an increase in geographical distribution in all Suez canal regions and an exacerbation of the problems caused. Population control is recommended, involving improvements in urban hygiene and the capture of adult crows using stupefying baits. Suitable baits and stupefacient doses were identified and these should be used annually, just before the breeding season. Control should be accompanied by studies of relevant aspects of the biology of house crows in Ismailia Governorate.

Keywords: environmental impact t, non-native invasive species, House crow birds, risk management, Ismailia-Egypt

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Authors: Ndivhudzannyi Rembuluwani, Francis Dacosta, Emmanuel Mhlongo

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The small-scale rock aggregate sector of the mining industry is a major source of employment for a significant number of people, particularly in remote rural areas, where alternative livelihoods are rare. It contributes to local economy by generating income and producing major and essential materials for the building, construction, and other industries. However, the sector is confronted with many challenges that hamper productivity and growth. The problems that confront this sector includes: health and safety, environmental impacts, low production and low adherence to mining legislations. This study investigated the challenges confronting selected small-scale rock aggregate mines in the Vhembe District of Limpopo province of South Africa, assesses the health, safety, low production and environmental impacts associated with aggregate production and to develop an integrated approach of addressing the multi-faceted challenges.

Keywords: health and safety, legislative framework, productivity, rock aggregate, small-scale mining

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Authors: Hafiz Faisal Siddique, Adnan Ahmed Mazari, Antonin Havelka

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Compression socks are highly recommended textile garment for pressure exertion on the lower part of leg. The extent of compression that a patient can easily manage depends on stage (limb size and shape) of venous disease and his activities (mobility, age). Due to dynamic mechanical influence, the socks destroy their extent of pressure exertion around the leg. The main aim of this research is to investigate how the performance of compression socks is deteriorated due to expected induced wearing mechanical impacts. Wearing mechanical impacts influence the durability parameter i.e. tensile energy loss. For tensile energy loss, cut-strip samples were interacted to constant rate of loading and un-loading, cyclic-loading upto 15th cycles for ±5mm extension (considering muscles expansion and relaxation) and were dwelled (stayed) for 3 minutes at 25%, 50% and 75% extension levels, simultaneously. Statistical validation of tensile energy loss was performed by introducing measures of correlation, p-value (≤ 0.05), R-square values using MINITAB 17 software.

Keywords: compression socks, loading and unloading, 15th cyclic loading, Dwell time effect

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Authors: Nina Ponikvar, Katja Zajc Kejžar

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While the positive impacts of heritage on a broad societal spectrum have long been recognized and measured, the economic effects of the heritage sector are often less visible and frequently underestimated. At macro level, economic effects are usually studied based on one of the two mainstream approach, i.e. either the multiplier approach or the value chain approach. Consequently, there is limited comparability of the empirical results due to the use of different methodological approach in the literature. Furthermore, it is also not clear on which criteria the used approach was selected. Our aim is to bring the attention to the difference in the scope of effects that are encompassed by the two most frequent methodological approaches to valuation of economic effects of cultural heritage on macroeconomic level, i.e. the multiplier approach and the value chain approach. We show that while the multiplier approach provides a systematic, theory-based view of economic impacts but requires more data and analysis, the value chain approach has less solid theoretical foundations and depends on the availability of appropriate data to identify the contribution of cultural heritage to other sectors. We conclude that the multiplier approach underestimates the economic impact of cultural heritage, mainly due to the narrow definition of cultural heritage in the statistical classification and the inability to identify part of the contribution of cultural heritage that is hidden in other sectors. Yet it is not possible to clearly determine whether the value chain method overestimates or underestimates the actual economic impact of cultural heritage since there is a risk that the direct effects are overestimated and double counted, but not all indirect and induced effects are considered. Accordingly, these two approaches are not substitutes but rather complementary. Consequently, a direct comparison of the estimated impacts is not possible and should not be done due to the different scope. To illustrate the difference of the impact assessment of the cultural heritage, we apply both approaches to the case of Slovenia in the 2015-2022 period and measure the economic impact of cultural heritage sector in terms of turnover, gross value added and employment. The empirical results clearly show that the estimation of the economic impact of a sector using the multiplier approach is more conservative, while the estimates based on value added capture a much broader range of impacts. According to the multiplier approach, each euro in cultural heritage sector generates an additional 0.14 euros in indirect effects and an additional 0.44 euros in induced effects. Based on the value-added approach, the indirect economic effect of the “narrow” heritage sectors is amplified by the impact of cultural heritage activities on other sectors. Accordingly, every euro of sales and every euro of gross value added in the cultural heritage sector generates approximately 6 euros of sales and 4 to 5 euros of value added in other sectors. In addition, each employee in the cultural heritage sector is linked to 4 to 5 jobs in other sectors.

Keywords: economic value of cultural heritage, multiplier approach, value chain approach, indirect effects, slovenia

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Authors: Yasmine Salehy, Yann Leroy, Francois Cluzel, Hong-Minh Hoang, Laurence Fournaison, Anthony Delahaye, Bernard Yannou

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Taking into consideration all the life cycle of a product is now an important step in the eco-design of a product or a technology. Life cycle assessment (LCA) is a standard tool to evaluate the environmental impacts of a system or a process. Despite the improvement in refrigerant regulation through protocols, the environmental damage of refrigeration systems remains important and needs to be improved. In this paper, the environmental impacts of refrigeration systems in a typical supermarket are compared using the LCA methodology under different conditions. The system is used to provide cold at two levels of temperature: medium and low temperature during a life period of 15 years. The most commonly used architectures of supermarket cold production systems are investigated: centralized direct expansion systems and indirect systems using a secondary loop to transport the cold. The variation of power needed during seasonal changes and during the daily opening/closure periods of the supermarket are considered. R134a as the primary refrigerant fluid and two types of secondary fluids are considered. The composition of each system and the leakage rate of the refrigerant through its life cycle are taken from the literature and industrial data. Twelve scenarios are examined. They are based on the variation of three parameters, 1. location: France (Paris), Spain (Toledo) and Sweden (Stockholm), 2. different sources of electric consumption: photovoltaic panels and low voltage electric network and 3. architecture: direct and indirect refrigeration systems. OpenLCA, SimaPro softwares, and different impact assessment methods were compared; CML method is used to evaluate the midpoint environmental indicators. This study highlights the significant contribution of electric consumption in environmental damages compared to the impacts of refrigerant leakage. The secondary loop allows lowering the refrigerant amount in the primary loop which results in a decrease in the climate change indicators compared to the centralized direct systems. However, an exhaustive cost evaluation (CAPEX and OPEX) of both systems shows more important costs related to the indirect systems. A significant difference between the countries has been noticed, mostly due to the difference in electric production. In Spain, using photovoltaic panels helps to reduce efficiently the environmental impacts and the related costs. This scenario is the best alternative compared to the other scenarios. Sweden is a country with less environmental impacts. For both France and Sweden, the use of photovoltaic panels does not bring a significant difference, due to a less sunlight exposition than in Spain. Alternative solutions exist to reduce the impact of refrigerating systems, and a brief introduction is presented.

Keywords: eco-design, industrial engineering, LCA, refrigeration system

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Authors: Rene Hellmuth

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The requirements for the factory planning and the building concerned have changed in the last years. Factory planning has the task of designing products, plants, processes, organization, areas, and the building of a factory. Regular restructuring gains more importance in order to maintain the competitiveness of a factory. Restrictions regarding new areas, shorter life cycles of product and production technology as well as a VUCA (volatility, uncertainty, complexity and ambiguity) world cause more frequently occurring rebuilding measures within a factory. Restructuring of factories is the most common planning case today. Restructuring is more common than new construction, revitalization and dismantling of factories. The increasing importance of restructuring processes shows that the ability to change was and is a promising concept for the reaction of companies to permanently changing conditions. The factory building is the basis for most changes within a factory. If an adaptation of a construction project (factory) is necessary, the inventory documents must be checked and often time-consuming planning of the adaptation must take place to define the relevant components to be adapted, in order to be able to finally evaluate them. The different requirements of the planning participants from the disciplines of factory planning (production planner, logistics planner, automation planner) and industrial construction planning (architect, civil engineer) come together during reconstruction and must be structured. This raises the research question: Which requirements do the disciplines involved in the reconstruction planning place on a digital factory model? A subordinate research question is: How can model-based decision support be provided for a more efficient design of the conversion within a factory? Because of the high adaptation rate of factories and its building described above, a methodology for rescheduling factories based on the requirements engineering method from software development is conceived and designed for practical application in factory restructuring projects. The explorative research procedure according to Kubicek is applied. Explorative research is suitable if the practical usability of the research results has priority. Furthermore, it will be shown how to best use a digital factory model in practice. The focus will be on mobile applications to meet the needs of factory planners on site. An augmented reality (AR) application will be designed and created to provide decision support for planning variants. The aim is to contribute to a shortening of the planning process and model-based decision support for more efficient change management. This requires the application of a methodology that reduces the deficits of the existing approaches. The time and cost expenditure are represented in the AR tablet solution based on a building information model (BIM). Overall, the requirements of those involved in the planning process for a digital factory model in the case of restructuring within a factory are thus first determined in a structured manner. The results are then applied and transferred to a construction site solution based on augmented reality.

Keywords: augmented reality, digital factory model, factory planning, restructuring

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Authors: Grâce Chidikofan, François Pinta, A. Benoist, G. Volle, J. Valette

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Statement of the Problem: biomass gasification systems may be relevant for decentralized power generation from recoverable agricultural and wood residues available in rural areas. In recent years, many systems have been implemented in all over the world as especially in Cambodgia, India. Although they have many positive effects, these systems can also affect the environment and human health. Indeed, during the process of biomass gasification, black wastewater containing tars are produced and generally discharged in the local environment either into the rivers or on soil. However, in most environmental assessment studies of biomass gasification systems, the impact of these releases are underestimated, due to the difficulty of identification of their chemical substances. This work deal with the analysis of the environmental impacts of tars from wood gasification in terms of human toxicity cancer effect, human toxicity non-cancer effect, and freshwater ecotoxicity. Methodology: A Life Cycle Assessment (LCA) approach was adopted. The inventory of tars chemicals substances was based on experimental data from a downdraft gasification system. The composition of six samples from two batches of raw materials: one batch made of tree wood species (oak+ plane tree +pine) at 25 % moisture content and the second batch made of oak at 11% moisture content. The tests were carried out for different gasifier load rates, respectively in the range 50-75% and 50-100%. To choose the environmental impacts assessment method, we compared the methods available in SIMAPRO tool (8.2.0) which are taking into account most of the chemical substances. The environmental impacts for 1kg of tars discharged were characterized by ILCD 2011+ method (V.1.08). Findings Experimental results revealed 38 important chemical substances in varying proportion from one test to another. Only 30 are characterized by ILCD 2011+ method, which is one of the best performing methods. The results show that wood species or moisture content have no significant impact on human toxicity noncancer effect (HTNCE) and freshwater ecotoxicity (FWE) for water release. For human toxicity cancer effect (HTCE), a small gap is observed between impact factors of the two batches, either 3.08E-7 CTUh/kg against 6.58E-7 CTUh/kg. On the other hand, it was found that the risk of negative effects is higher in case of tar release into water than on soil for all impact categories. Indeed, considering the set of samples, the average impact factor obtained for HTNCE varies respectively from 1.64 E-7 to 1.60E-8 CTUh/kg. For HTCE, the impact factor varies between 4.83E-07 CTUh/kg and 2.43E-08 CTUh/kg. The variability of those impact factors is relatively low for these two impact categories. Concerning FWE, the variability of impact factor is very high. It is 1.3E+03 CTUe/kg for tars release into water against 2.01E+01 CTUe/kg for tars release on soil. Statement concluding: The results of this study show that the environmental impacts of tars emission of biomass gasification systems can be consequent and it is important to investigate the ways to reduce them. For environmental research, these results represent an important step of a global environmental assessment of the studied systems. It could be used to better manage the wastewater containing tars to reduce as possible the impacts of numerous still running systems all over the world.

Keywords: biomass gasification, life cycle analysis, LCA, environmental impact, tars

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Authors: Catia S. A. Sima, K. Bousson

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Congestion in the Terminal Maneuvering Areas (TMAs) of larger airports impacts all aspects of air traffic flow, not only at national level but may also induce arrival delays at international level. Hence, there is a need to monitor appropriately the air traffic flow in TMAs so that efficient decisions may be taken to manage their occupancy rates. It would be desirable to physically increase the existing airspace to accommodate all existing demands, but this question is entirely utopian and, given this possibility, several studies and analyses have been developed over the past decades to meet the challenges that have arisen due to the dizzying expansion of the aeronautical industry. The main objective of the present paper is to propose concepts to manage and reduce the degree of uncertainty in the air traffic operations, maximizing the interest of all involved, ensuring a balance between demand and supply, and developing and/or adapting resources that enable a rapid and effective adaptation of measures to the current context and the consequent changes perceived in the aeronautical industry. A central task is to emphasize the increase in air traffic flow management capacity to the present day, taking into account not only a wide range of methodologies but also equipment and/or tools already available in the aeronautical industry. The efficient use of these resources is crucial as the human capacity for work is limited and the actors involved in all processes related to air traffic flow management are increasingly overloaded and, as a result, operational safety could be compromised. The methodology used to answer and/or develop the issues listed above is based on the advantages promoted by the application of Markov Chain principles that enable the construction of a simplified model of a dynamic network that describes the air traffic flow behavior anticipating their changes and eventual measures that could better address the impact of increased demand. Through this model, the proposed concepts are shown to have potentials to optimize the air traffic flow management combined with the operation of the existing resources at each moment and the circumstances found in each TMA, using historical data from the air traffic operations and specificities found in the aeronautical industry, namely in the Portuguese context.

Keywords: air traffic flow, terminal maneuvering area, TMA, air traffic management, ATM, Markov chains

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Authors: Nirman Kumar Ojha

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Bamboo plantation can be integrated for natural embankment against flood and live fencing against wild animals, at the same time provide economic opportunity for the poor farmers as a sustainable solution and adaptation alternative. 2010 flood in the Rui River completely inundated fields of four VDCs in Madi, Chitwan National Park with extensive bank erosion. The main aim of this action research was to identify an economically sustainable natural embankment against flood and also providing wildlife friendly fencing to reduce human-wildlife conflict. Community people especially poor farmers were trained for soil testing, land identification, plantation, and the harvesting regime, nursery set up and intercropping along with bamboo plantation on the edge of the river bank in order to reduce or minimize soil erosion. Results show that farmers are able to establish cost efficient and economically sustainable river embankment with bamboo plantation also creating a fence for wildlife which has also promoted bamboo cultivation and conservation. This action research has amalgamated flood control and wildlife control with the livelihood of the farmers which otherwise would cost huge resource. Another major impact of the bamboo plantation is its role in climate change and its adaptation process reducing degradation and improving vegetation cover contributing to landscape management. Based on this study, we conclude that bamboo plantation in Madi, Chitwan promoted the livelihood of the poor farmers providing a sustainable economic solution to reduce bank erosion, human-wildlife conflict and contributes to landscape management.

Keywords: climate change and conservation, economic opportunity, flood control, national park

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Authors: Gavin Quibell, Martin Kleynhans, Margot Soler

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The Sendai Framework notes that disaster risk reduction is essential for sustainable development, and Disaster Risk Reduction is included in 3 of the Sustainable Development Goals (SDGs), and 4 of the SDG targets. However, apart from promoting better governance and resourcing of disaster management agencies, little guidance is given how low-income nations can balance investments across the SDGs to achieve sustainable development in an increasingly climate vulnerable world with increasing prevalence of flood and drought disasters. As one of the world’s poorest nations, Malawi must balance investments across all the SDGs. This paper explores how Malawi’s National Guidelines for Community-based Flood Risk Management integrate sustainable development and flood management objectives at different administrative levels. While Malawi periodically suffers from large, widespread flooding, the greatest impacts are felt through the smaller annual floods and flash floods. The Guidelines address this through principles that recognize that while the protection of human life is the most important priority for flood risk management, addressing the impacts of floods on the rural poor and the economy requires different approaches. The National Guidelines are therefore underpinned by the following; 1. In the short-term investments in flood risk management must focus on breaking the poverty – vulnerability cycle; 2. In the long-term investments in the other SDGs will have the greatest flood risk management benefits; 3. If measures are in place to prevent loss of life and protect strategic infrastructure, it is better to protect more people against small and medium size floods than fewer people against larger floods; 4. Flood prevention measures should focus on small (1:5 return period) floods; 5. Flood protection measures should focus on small and medium floods (1:20 return period) while minimizing the risk of failure in larger floods; 6. The impacts of larger floods ( > 1:50) must be addressed through improved preparedness; 7. The impacts of climate change on flood frequencies are best addressed by focusing on growth not overdesign; and 8. Manage floods and droughts conjunctively. The National Guidelines weave these principles into Malawi’s approach to flood risk management through recommendations for planning and implementing flood prevention, protection and preparedness measures at district, traditional authority and village levels.

Keywords: flood risk management in low-income countries, sustainable development, investments in prevention, protection and preparedness, community-based flood risk management, Malawi

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Authors: Sreto Boljevic

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In the absence of considerable investment in electricity generation, transmission and distribution network (DN) capacity, the demand for electrical energy will quickly strain the capacity of the existing electrical power network. With anticipated growth and proliferation of Electric vehicles (EVs) and Heat pump (HPs) identified the likelihood that the additional load from EV changing and the HPs operation will require capital investment in the DN. While an area-wide implementation of EVs and HPs will contribute to the decarbonization of the energy system, they represent new challenges for the existing low-voltage (LV) network. Distributed energy resources (DER), operating both as part of the DN and in the off-network mode, have been offered as a means to meet growing electricity demand while maintaining and ever-improving DN reliability, resiliency and power quality. DN planning has traditionally been done by forecasting future growth in demand and estimating peak load that the network should meet. However, new problems are arising. These problems are associated with a high degree of proliferation of EVs and HPs as load imposes on DN. In addition to that, the promotion of electricity generation from renewable energy sources (RES). High distributed generation (DG) penetration and a large increase in load proliferation at low-voltage DNs may have numerous impacts on DNs that create issues that include energy losses, voltage control, fault levels, reliability, resiliency and power quality. To mitigate negative impacts and at a same time enhance positive impacts regarding the new operational state of DN, CHP system integration can be seen as best action to postpone/reduce capital investment needed to facilitate promotion and maximize benefits of EVs, HPs and RES integration in low-voltage DN. The aim of this paper is to generate an algorithm by using an analytical approach. Algorithm implementation will provide a way for optimal placement of the CHP system in the DN in order to maximize the integration of RES and increase in proliferation of EVs and HPs.

Keywords: combined heat & power (CHP), distribution networks, EVs, HPs, RES

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Authors: Thimma Reddy Pothireddy, Ramesh Srikonda

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India is prone to natural disasters such as Floods, droughts, cyclones, earthquakes and landslides frequently due to its geographical considerations. It has become a persistent phenomenon as observed in last ten decades. The recent survey indicates that about 60% of the landmass is prone to earthquakes of various intensities with reference to Richard scale, over 40 million hectares is prone to floods; about 8% of the total area is prone to cyclones and 68% of the area is vulnerable to drought. Climate change is likely to be perceived through the experience of extreme weather events. There is growing societal concern about climate change, given the potential impacts of associated natural hazards such as cyclones, flooding, earthquakes, landslides etc. The recent natural calamities such as Cyclone Hudhud had crossed the land at Northern cost of AP, Vishakapatanam on 12 Oct’2014 with a wind speed ranging between 175 – 200 kmph and the records show that the tidal waves were reached to the height of 14mts and above; and it alarms us to have critical focus on planning issues so as to find appropriate solutions. The existing condition is effective is in terms of institutional set up along with responsive management mechanism of disaster mitigation but considerations at settlement planning level to allow mitigation operations are not adequate. This paper deals to understand the response to climate change will possibly happen through adaptation to climate hazards and essential to work out an appropriate mechanism and disaster receptive settlement planning for responding to natural (and climate-related) calamities particularly to cyclones and floods. The statistics indicate that 40 million hectares flood prone (5% of area), and 1853 kmts of cyclone prone coastal length in India so it is essential and crucial to have appropriate physical planning considerations to improve preparedness and to operate mitigation measures effectively to minimize the loss and damage. Vijayawada capital region which is susceptible to cyclonic and floods has been studied with respect to trajectory analysis to work out risk vulnerability and to integrated disaster mitigation physical planning considerations.

Keywords: meta analysis, vulnerability index, physical planning, trajectories

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Authors: Mahsa Falahatpour

Abstract:

Introduction: This study aims to explore how inter-observer variability in manual tumor segmentation impacts the reliability of radiomic features in non–small cell lung cancer (NSCLC). Methods: The study included twenty-three NSCLC tumors. Each patient had three tumor segmentations (VOL1, VOL2, VOL3) contoured on PET/CT scans by three radiation oncologists. Dice coefficients (DCS) were used to measure the segmentation variability. Radiomic features were extracted with 3D-slicer software, consisting of 66 features: first-order (n=15), second-order (GLCM, GLDM, GLRLM, and GLSZM) (n=33). The inter-observer variability of radiomic features was assessed using the intraclass correlation coefficient (ICC). An ICC > 0.8 indicates good stability. Results: The mean DSC of VOL1, VOL2, and VOL3 was 0.80 ± 0.04, 0.85 ± 0.03, and 0.76 ± 0.06, respectively. 92% of all extracted radiomic features were found to be stable (ICC > 0.8). The GLCM texture features had the highest stability (96%), followed by GLRLM features (90%) and GLSZM features (87%). The DSC was found to be highly correlated with the stability of radiomic features. Conclusion: The variability in inter-observer segmentation significantly impacts radiomics analysis, leading to a reduction in the number of appropriate radiomic features.

Keywords: PET/CT, radiomics, radiotherapy, segmentation, NSCLC

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Authors: Sami Ayad, Mengshan Lee

Abstract:

The Sustainable Development Goals (SDGs) were designed to be the best possible blueprint to achieve peace, prosperity, and overall, a better and more sustainable future for the Earth and all its people, and such a blueprint is needed more than ever. The SDGs face many hurdles that will prevent them from becoming a reality, one of such hurdles, arguably, is the chemical pollution and unintended chemical impacts generated through the production of various goods and resources that we consume. Chemical Alternatives Assessment has proven to be a viable solution for chemical pollution management in terms of filtering out hazardous chemicals for a greener alternative. However, the current substitution practice lacks crucial quantitative datasets (exposures and life cycle impacts) to ensure no unintended trade-offs occur in the substitution process. A Chemical Life Cycle Alternative Assessment (CLiCAA) framework is proposed as a reliable and replicable alternative to Life Cycle Based Alternative Assessment (LCAA) as it integrates chemical molecular structure analysis and Chemical Life Cycle Collaborative (CLiCC) web-based tool to fill in data gaps that the former frameworks suffer from. The CLiCAA framework consists of a four filtering layers, the first two being mandatory, with the final two being optional assessment and data extrapolation steps. Each layer includes relevant impact categories of each chemical, ranging from human to environmental impacts, that will be assessed and aggregated into unique scores for overall comparable results, with little to no data. A feasibility study will demonstrate the efficiency and accuracy of CLiCAA whilst bridging both cancer potency and exposure limit data, hoping to provide the necessary categorical impact information for every firm possible, especially those disadvantaged in terms of research and resource management.

Keywords: chemical alternative assessment, LCA, LCAA, CLiCC, CLiCAA, chemical substitution framework, cancer potency data, chemical molecular structure analysis

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Authors: Chun Pao Kuo, Chi Tong Lin

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The study explored atomization characteristics of tire pyrolysis fuel and its impacts on using three types of fuel: diesel oil mixed with 10% of tire pyrolysis fuel (called T10), diesel oil mixed with 20% tire pyrolysis (called T20), and consumer-grade diesel oil (D100). The investigators used the fuel for simulation and tests at various fuel injection timing, engine speed, and fuel injection speed to inspect impacts from fuel type on oil droplet atomization speed and output power. Actual vehicle tests were conducted using a 5-ton sedan (Hino) with 3660 cc displacement and a front-end inline four-cylinder diesel engine, and this type of vehicle is easily available from the market. A dynamometer was used to set up three engine speeds for the dynamometer testing at different injection timing and pressure. Next, an exhaust analyzer was used to measure exhaust pollution at different conditions to explore the effect of fuel types and injection speeds on output power in order to establish the best operation conditions for tire pyrolysis fuel.

Keywords: diesel engine, exhaust pollution, fuel injection timing, tire pyrolysis oil

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Authors: Virginia Guillén Cañas, Miren Agurtzane Ortiz-Jauregi, Sonia Ruiz De Azua, Naiara Ozamiz

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We want to focus on relationship of the communicational skills in several key aspects of medicine. The most relevant competencies of a health professional are an adequate communication capacity, which will influence the satisfaction of professionals and patients, therapeutic compliance, conflict prevention, clinical outcomes’ improvement and efficiency of health services. We define empathy as it as Sympathy and connection to others and capability to communicate this understanding. Some outcomes favoring empathy are female gender, younger age, and specialty choice. Third gender or third sex is a concept in which allows a person not to be categorized in a dual way but as a continuous variable, giving the choice of moving along it. This point of view recognizes three or more genders. The subject of Ethics and Clinical Communication is dedicated to sensitizing students about the importance and effectiveness of a good therapeutic relationship. We are also interested in other communicational aspects related to empathy as active listening, assertivity and basic and advanced Social Skills. Objectives: 1. To facilitate the approach of the student in the Medicine Degree to the reality of the medical profession 2. Analyze interesting outcome variables in communication 3. Interactive process to detect the areas of improvement in the learning process of the Physician throughout his professional career needs. Design: A comparative study with a cross-sectional approach was conducted in successive academic year cohorts of health professional students at a public Basque university. Four communicational aspects were evaluated through these questionnaires in Basque, Spanish and English: The active listening questionnaire, the TECA empathy questionnaire, the ACDA questionnaire and the EHS questionnaire Social Skills Scale. Types of interventions for improving skills: Interpersonal skills training intervention, Empathy intervention, Writing about experiential learning, Drama through role plays, Communicational skills training, Problem-based learning, Patient interviews ´videos, Empathy-focused training, Discussion. Results: It identified the need for a cross cultural adaptation and no gender distinction. The students enjoyed all the techniques in comparison to the usual master class. There was medium participation but these participative methodologies are not so usual in the university. According to empathy, men have a greater empathic capacity to fully understand women (p < 0.05) With regard to assertiveness there have been no differences between men and women in self-assertiveness but nevertheless women are more heteroassertive than men. Conclusions: These findings suggest that educational interventions with adequate feedback can be effective in maintaining and enhancing empathy in undergraduate medical students.

Keywords: physician's communicational skills, patient satisfaction, third gender, cross cultural adaptation

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