Search results for: digital emergency response system

Authors: Hussein Bizimana, Osman Sönmez

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Constructed wetlands are current the most widely recognized waste water treatment option, especially in developing countries where they have the potential for improving water quality and creating valuable wildlife habitat in ecosystem with treatment requirement relatively simple for operation and maintenance cost. Lack of grey waste water treatment facilities in Kigali İnstitute of Science and Technology in Rwanda, causes pollution in the surrounding localities of Rugunga sector, where already a problem of poor sanitation is found. In order to treat grey water produced at Kigali İnstitute of Science and Technology, with high BOD concentration, high nutrients concentration and high alkalinity; a Horizontal Sub-surface Flow pilot-scale constructed wetland was designed and can operate in Kigali İnstitute of Science and Technology. The study was carried out in a sedimentation tank of 5.5 m x 1.42 m x 1.2 m deep and a Horizontal Sub-surface constructed wetland of 4.5 m x 2.5 m x 1.42 m deep. The grey waste water flow rate of 2.5 m3/d flew through vegetated wetland and sandy pilot plant. The filter media consisted of 0.6 to 2 mm of coarse sand, 0.00003472 m/s of hydraulic conductivity and cattails (Typha latifolia spp) were used as plants species. The effluent flow rate of the plant is designed to be 1.5 m3/ day and the retention time will be 24 hrs. 72% to 79% of BOD, COD, and TSS removals are estimated to be achieved, while the nutrients (Nitrogen and Phosphate) removal is estimated to be in the range of 34% to 53%. Every effluent characteristic will meet exactly the Rwanda Utility Regulatory Agency guidelines primarily because the retention time allowed is enough to make the reduction of contaminants within effluent raw waste water. Treated water reuse system was developed where water will be used in the campus irrigation system again.

Keywords: constructed wetlands, hydraulic conductivity, grey waste water, cattails

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Authors: K. K. Bolarinwa, A. F. O. Ayinde, B. B. Abiona, O. Oyekunle

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Conflict and HIV/AIDS infection have had a profound impact on the Sub-Saharan African societies, individually and collectively. Nigeria has been experiencing several violent conflicts in many communities across the geographical spread of the country. These conflicts which often lead to loss of lives, properties and loss of livelihoods are mainly felt by women in terms of increased responsibility towards affected family members with attendant decrease in livelihood options. Despite these, conflict issues have not really received enough focal attention by Nigerian academics. It is against this backdrop that this study was undertaken to describe the respondents, the most prevalent conflict repercussions and most prevalent STDs, in conflict areas. Data were collected using interview schedule to elicit a response from 122 respondents in Southwest Nigeria, through a multi-stage sampling technique involving stratification of respondents into violent conflict areas (VCA) and non-violent conflict areas (NVCA). The data collected were analysed using descriptive statistics and correlation analysis. Results revealed that majority (86.5% and 70.5 %) of the respondents were in the age bracket of 10-39 years in both the VCA and NVCA respectively; 35.5% and 40.2% of the respondents were literate in VCA and NVCA, respectively while 76.5% and 55.8% of the respondents were in the lower income groups in VCA and NVCA, respectively. HIV/AIDS and gonorrhoea were the more predominant (75.2% and 55.6% respectively) STDs in the VCA as against 33.2% and 38.3% respectively in the NVCA. Further, significant (p<0.05) correlation existed between conflict incidence and spread of HIV/AIDS, rape and torture, maltreatment of women as well as sexual harassment; in both VCA and NVCA among others. The study concluded that conflict situations in the study area aggravated incidence of HIV/AIDS and made the women more vulnerable to inhuman treatments such as rape, torture and harassment with attendant reduction in sources of livelihoods. The study recommended among others that sensitisation on control and preventive measures of HIV/AID and other sexually transmitted diseases should be included in programme designed to mitigate against conflicts in the study areas.

Keywords: conflict, gender dimension, HIV/AIDS epidemiology, Nigeria

Procedia PDF Downloads 253

Authors: Paul Rowley, Adam Thirkill, Nick Doylend, Philip Leicester, Becky Gough

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The dynamic performance of all energy generation technologies is impacted to varying degrees by the stochastic properties of the wider system within which the generation technology is located. This stochasticity can include the varying nature of ambient renewable energy resources such as wind or solar radiation, or unpredicted changes in energy demand which impact upon the operational behaviour of thermal generation technologies. An understanding of these stochastic impacts are especially important in contexts such as highly distributed (or embedded) generation, where an understanding of issues affecting the individual or aggregated performance of high numbers of relatively small generators is especially important, such as in ESCO projects. Probabilistic evaluation of monitored or simulated performance data is one technique which can provide an insight into the dynamic performance characteristics of generating systems, both in a prognostic sense (such as the prediction of future performance at the project’s design stage) as well as in a diagnostic sense (such as in the real-time analysis of underperforming systems). In this work, we describe the development, application and outcomes of a new approach to the acquisition of datasets suitable for use in the subsequent performance and impact analysis (including the use of Bayesian approaches) for a number of distributed generation technologies. The application of the approach is illustrated using a number of case studies involving domestic and small commercial scale photovoltaic, solar thermal and natural gas boiler installations, and the results as presented show that the methodology offers significant advantages in terms of plant efficiency prediction or diagnosis, along with allied environmental and social impacts such as greenhouse gas emission reduction or fuel affordability.

Keywords: renewable energy, dynamic performance simulation, Bayesian analysis, distributed generation

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Authors: Alyaa Farouk Ibrahim, Gehan ElSayed, Ola Mamdouh, Nazek AbdelGhany

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Background: Primary health care (PHC) can be considered the first contact between the patient and the health care system. It includes all the basic health care services to be provided to the community. Patient's satisfaction regarding health care has often improved the provision of care, also considered as one of the most important measures for evaluating the health care. Objective: This study aims to identify patient’s satisfaction with services provided at the primary health care settings in Alexandria. Setting: Seven primary health care settings representing the seven zones of Alexandria governorate were selected randomly and included in the study. Subjects: The study comprised 386 patients attended the previously selected settings at least twice before the time of the study. Tools: Two tools were utilized for data collection; sociodemographic characteristics and health status structured interview schedule and patient satisfaction scale. Reliability test for the scale was done using Cronbach's Alpha test, the result of the test ranged between 0.717 and 0.967. The overall satisfaction was computed and divided into high, medium, and low satisfaction. Results: Age of the studied sample ranged between 19 and 62 years, more than half (54.2%) of them aged 40 to less than 60 years. More than half (52.8%) of the patients included in the study were diabetics, 39.1% of them were hypertensive, 19.2% had cardiovascular diseases, the rest of the sample had tumor, liver diseases, and orthopedic/neurological disorders (6.5%, 5.2% & 3.2%, respectively). The vast majority of the study group mentioned high satisfaction with overall service cost, environmental conditions, medical staff attitude and health education given at the PHC settings (87.8%, 90.7%, 86.3% & 90.9%, respectively), however, medium satisfaction was mostly reported concerning medical checkup procedures, follow-up data and referral system (41.2%, 28.5% & 28.9%, respectively). Score level of patient satisfaction with health services provided at the assessed Primary health care settings proved to be significantly associated with patients’ social status (P=0.003, X²=14.2), occupation (P=0.011, X²=11.2), and monthly income (P=0.039, X²=6.50). In addition, a significant association was observed between score level of satisfaction and type of illness (P=0.007, X²=9.366), type of medication (P=0.014, X²=9.033), prior knowledge about the health center (P=0.050, X²=3.346), and highly significant with the administrative zone (P=0.001, X²=55.294). Conclusion: The current study revealed that overall service cost, environmental conditions, staff attitude and health education at the assessed primary health care settings gained high patient satisfaction level, while, medical checkup procedures, follow-up, and referral system caused a medium level of satisfaction among assessed patients. Nevertheless, social status, occupation, monthly income, type of illness, type of medication and administrative zones are all factors influencing patient satisfaction with services provided at the health facilities.

Keywords: patient satisfaction, chronic illness, quality of health service, quality of service indicators

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Authors: Diya Sarkar, Prafulla C. Mishra

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In a parliamentary system, party discipline is the impulse; when it falls short, the government usually falls. Conceivably, the platform of Indian politics suffers with innumerous practical disorders. The politics of defection is one such specie entailing gross miscarriage of fair conduct turning politics into a game of thrones (powers). This practice of political nomaditude can trace its seed in the womb of British House of Commons. Therein, if a legislator was found to cross the floor, the party considered him disloyal. In other words, the legislator lost his allegiance to his former party by joining another party. This very phenomenon, in practice has a two way traffic i.e. ruling party to the opposition party or vice versa. The democracies like USA, Australia and Canada were also aware of this fashion of swapping loyalties. There have been several instances of great politicians changing party allegiance, for example Winston Churchill, Ramsay McDonald, William Gladstone etc. Nevertheless, it is interesting to cite that irrespective of such practice of changing party allegiance, none of the democracies in the west ever desired or felt the need to legislatively ban defections. But, exceptionally India can be traced to have passed anti-defection laws. The politics of defection had been a unique popular phenomenon on the floor of Indian Parliamentary system gradually gulping the democratic essence and synchronization of the Federation. This study is both analytical and doctrinal, which tries to examine whether representative democracy has lost its essence due to political nomadism. The present study also analyzes the classical as well as contemporary pulse of floor crossing amidst dynastic politics in a representative democracy. It will briefly discuss the panorama of defections under the Indian federal structure in the light of the anti-defection law and an attempt has been made to add valuable suggestions to streamline remedy for the still prevalent political defections.

Keywords: constitutional law, defection, democracy, polarization, political anti-trust

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Authors: Pius Borona, Cheikh Mbow, Issa Ouedraogo

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In the Sahel, climate variability has been associated with a complex web of direct and indirect impacts. This natural phenomenon has been an impediment to agro-pastoral communities who experience uncertainty while involving in farming activities which is also their key source of livelihood. In this scenario, the role of climate variability in influencing the performance, quantity and quality of staple cereals yields, vital for food and nutrition security has been a topic of importance. This response of crops and subsequent yield variability is also a subject of immense debate due to the complexity of crop development at different stages. This complexity is further compounded by influence of slowly changing non-climatic factors. With these challenges in mind, the present paper initially explores the occurrence of climate variability at an inter annual and inter decadal level in South Burkina Faso. This is evidenced by variation of the total annual rainfall and the number of rainy days among other climatic descriptors. Further, it is shown how district-scale cereal yields in the study area including maize, sorghum and millet casually associate variably to the inter-annual variation of selected climate variables. Statistical models show that the three cereals widely depict sensitivity to the length of the growing period and total dry days in the growing season. Maize yields on the other hand relate strongly to the rainfall amount variation (R2=51.8%) showing high moisture dependence during critical growth stages. Our conclusions emphasize on adoption of efficient water utilization platforms especially those that have evidently increased yields and strengthening of forecasts dissemination.

Keywords: climate variability, cereal yields, seasonality, rain fed farming, Burkina Faso, rainfall

Procedia PDF Downloads 198

Authors: A. Akbarpour, M. R. Adib Ramezani, M. Zhian, N. Ghorbani Amirabad

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One way to improve the performance of structures against of earthquake is passive control which requires no external power source. In this research, tuned liquid column dampers which are among of systems with the capability to transfer energy between various modes of vibration, are used. For the first time, a liquid column damper for vibration control structure is presented. After modeling this structure in design building software and performing the static and dynamic analysis and obtaining the necessary parameters for the design of tuned liquid column damper, the whole structure will be analyzed in finite elements software. The tuned liquid column dampers are installed on the structure and nonlinear time-history analysis is done in two cases of structures; with and without dampers. Finally the seismic behavior of building in the two cases will be examined. In this study the nonlinear time-history analysis on a twelve-story steel structure equipped with damper subject to records of earthquake including Loma Prieta, Northridge, Imperiall Valley, Pertrolia and Landers was performed. The results of comparing between two cases show that these dampers have reduced lateral displacement and acceleration of levels on average of 10%. Roof displacement and acceleration also reduced respectively 5% and 12%. Due to structural asymmetric in the plan, the maximum displacements of surrounding structures as well as twisting were studied. The results show that the dampers lead to a 10% reduction in the maximum response of structure stories surrounding points. At the same time, placing the dampers, caused to reduce twisting on the floor plan of the structure, Base shear of structure in the different earthquakes also has been reduced on the average of 6%.

Keywords: retrofitting, passive control, tuned liquid column damper, finite element analysis

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Authors: Pawan Kumar Gupta, Sumana Ghosh

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Parkinson's Disease (PD) is a long-term neurodegenerative movement disorder of the central nervous system with vast symptoms related to the motor system. The common symptoms of PD are tremor, rigidity, bradykinesia/akinesia, and postural instability, but the clinical symptom includes other motor and non‐motor issues. The motor symptoms of the disease are consequence of death of the neurons in a region of the midbrain known as substantia nigra pars compacta, leading to decreased level of a neurotransmitter known as dopamine. The cause of this neuron death is not clearly known but involves formation of Lewy bodies, an abnormal aggregation or clumping of the protein alpha-synuclein in the neurons. Unfortunately, there is no cure for PD, and the management of this disease is challenging. Therefore, it is critical for a patient to be diagnosed at early stages. A limited choice of drugs is available to improve the symptoms, but those become less and less effective over time. Apart from that, with rapid growth in the field of science and technology, other methods such as multi-area brain stimulation are used to treat patients. In order to develop advanced techniques and to support drug development for treating PD patients, an accurate mathematical model is needed to explain the underlying relationship of dopamine secretion in the brain with the hand tremors. There has been a lot of effort in the past few decades on modeling PD tremors and treatment effects from a computational point of view. These models can effectively save time as well as the cost of drug development for the pharmaceutical industry and be helpful for selecting appropriate treatment mechanisms among all possible options. In this review paper, an effort is made to investigate studies on PD modeling and analysis and to highlight some of the key advances in the field over the past centuries with discussion on the current challenges.

Keywords: Parkinson's disease, deep brain stimulation, tremor, modeling

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Authors: Lokanath Barik, Abinash Kumar Swain

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This paper presents vibration analysis of FGM sandwich structure with a complex profile governed by refined higher-order shear deformation theory (RHSDT) using isogeometric analysis (IGA). Functionally graded sandwich plates provide a wide range of applications in aerospace, defence, and aircraft industries due to their ability to distribute material functions to influence the thermo-mechanical properties as desired. In practical applications, these structures generally have intrinsic profiles, and their response to loads is significantly affected due to cut-outs. IGA is primarily a NURBS-based technique that is effective in solving higher-order differential equations due to its inherent C1 continuity imposition in solution space for a single patch. Complex structures generally require multiple patches to accurately represent the geometry, and hence, there is a loss of continuity at adjoining patch junctions. Therefore, patch coupling is desired to maintain continuity requirements throughout the domain. In this work, a novel strong coupling approach is provided that generates a well-defined NURBS-based model while achieving continuity. The methodology is validated by free vibration analysis of sandwich plates with present literature. The results are in good agreement with the analytical solution for different plate configurations and power law indexes. Numerical examples of rectangular and annular plates are discussed with variable boundary conditions. Additionally, parametric studies are provided by varying the aspect ratio, porosity ratio and their influence on the natural frequency of the plate.

Keywords: vibration analysis, FGM sandwich structure, multipatch geometry, patch coupling, IGA

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Authors: Y. Melis, E. Apicella, E. Dozio, L. Mendolicchio

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Introduction: Feeding and Eating Disorders (FED) represent the psychiatric pathology with the highest mortality rate and one of the major disorders with the highest psychiatric and clinical comorbidity. The vagus nerve represents one of the main components of the sympathetic and parasympathetic nervous system and is involved in important neurophysiological functions. In FED, there is a spectrum of symptoms which with TaVNS (Transcutaneous Auricular Vagus Nerve Stimulation) therapy, is possible to have a therapeutic efficacy. Materials and Methods: Sample subjects are composed of 15 female subjects aged > 18 ± 51. Admitted to a psychiatry community having been diagnosed according to DSM-5: anorexia nervosa (AN) (N= 9), bulimia nervosa (BN) (N= 5), binge eating disorder (BED) (N= 1). The protocol included 9 weeks of Ta-VNS stimulation at a frequency of 1.5-3.5 mA for 4 hours per day. The variables detected are the following: Heart Rate Variability (HRV), Hamilton Depression Rating Scale (HAMD-HDRS-17), Body Mass Index (BMI), Beck Anxiety Index (BAI). Results: Data analysis showed statistically significant differences between recording times (p > 0.05) in HAM-D (t0 = 18.28 ± 5.31; t4 = 9.14 ± 7.15), in BAI (t0 = 24.7 ± 10.99; t4 = 13.8 ± 7.0). The reported values show how during (T0-T4) the treatment there is a decay of the degree in the depressive state, in the state of anxiety, and an improvement in the value of BMI. In particular, the BMI in the AN-BN sub-sample had a minimum gain of 5% and a maximum of 11%. The analysis of HRV did not show a clear change among subjects, thus confirming the discordance of the activity of the sympathetic and parasympathetic nervous system in FED. Conclusions: Although the sample does not possess a relevant value to determine long-term efficacy of Ta-VNS or on a larger population, this study reports how the application of neuro-stimulation in FED may become a further approach therapeutic. Indeed, substantial improvements are highlighted in the results and confirmed hypotheses proposed by the study.

Keywords: feeding and eating disorders, neurostimulation, anxiety disorders, depression

Procedia PDF Downloads 141

Authors: Pham Minh Duc, Tran Thi Thanh Hien, David A. Bengtson

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Laboratory feeding trial: the study was conducted to find out the optimal dietary vitamin C, or ascorbic acid (AA) levels in terms of the growth performance of snakehead. The growth trial included six treatments with five replications. Each treatment contained 0, 125, 250, 500, 1000 and 2000 mg AA equivalent kg⁻¹ diet which included six iso-nitrogenous (45% protein), iso-lipid (9% lipid) and isocaloric (4.2 Kcal.g¹). Eighty snakehead fingerlings (6.24 ± 0.17 g.fish¹) were assigned randomly in 0.5 m³ composite tanks. Fish were fed twice daily on demand for 8 weeks. The result showed that growth rates increased, protein efficiency ratio increased and the feed conversion ratio decreased in treatments with AA supplementation compared with control treatment. The survival rate of fish tends to increase with increase AA level. The number of RBCs, lysozyme in treatments with AA supplementation tended to rise significantly proportional to the concentration of AA. The number of WBCs of snakehead in treatments with AA supplementation was higher 2.1-3.6 times. In general, supplementation of AA in the diets for snakehead improved growth rate, feed efficiency and immune response. Hapa on-farm trial: based on the results of the laboratory feeding trial, the effects of AA on snakehead in hapas to simulate farm conditions, was tested using the following treatments: commercial feed; commercial feed plus hand mixed AA at 500; 750 and 1000 mg AA.kg⁻¹; SBM diet without AA; SBM diet plus 500; 750 and 1000 mg AA.kg⁻¹. The experiment was conducted in two experimental ponds (only SBM diet without AA placed in one pond and the rest in the other pond) with four replicate hapa each. Stocking density was 150 fish.m² and culture period was 5 months until market size was attained. The growth performance of snakehead and economic aspects were examined in this research.

Keywords: fish health, growth rate, snakehead, Vitamin C

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Authors: Ahmad Ammar, Umar Khan Khattak, Muhammad Majid

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Empirically based lumped hydrologic models have an extensive track record of use for various watershed managements and flood related studies. This study focuses on the impacts of LULC change for 10 year period on the discharge in watershed using lumped model HEC-HMS. The Indus above Tarbela region acts as a source of the main flood events in the middle and lower portions of Indus because of the amount of rainfall and topographic setting of the region. The discharge pattern of the region is influenced by the LULC associated with it. In this study the Landsat TM images were used to do LULC analysis of the watershed. Satellite daily precipitation TRMM data was used as input rainfall. The input variables for model building in HEC-HMS were then calculated based on the GIS data collected and pre-processed in HEC-GeoHMS. SCS-CN was used as transform model, SCS unit hydrograph method was used as loss model and Muskingum was used as routing model. For discharge simulation years 2000 and 2010 were taken. HEC-HMS was calibrated for the year 2000 and then validated for 2010.The performance of the model was assessed through calibration and validation process and resulted R2=0.92 during calibration and validation. Relative Bias for the years 2000 was -9% and for2010 was -14%. The result shows that in 10 years the impact of LULC change on discharge has been negligible in the study area overall. One reason is that, the proportion of built-up area in the watershed, which is the main causative factor of change in discharge, is less than 1% of the total area. However, locally, the impact of development was found significant in built up area of Mansehra city. The analysis was done on Mansehra city sub-watershed with an area of about 16 km2 and has more than 13% built up area in 2010. The results showed that with an increase of 40% built-up area in the city from 2000 to 2010 the discharge values increased about 33 percent, indicating the impact of LULC change on discharge value.

Keywords: LULC change, HEC-HMS, Indus Above Tarbela, SCS-CN

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Authors: Luiz F. J. Maia

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This paper presents an approach to fuzzy control, with the use of new pertinence functions, applied in the case of an inverted pendulum. Appropriate definitions of pertinence functions to fuzzy sets make possible the implementation of the controller with only one control rule, resulting in a smooth control surface. The fuzzy control system can be implemented with analog devices, affording a true real-time performance.

Keywords: control surface, fuzzy control, Inverted pendulum, pertinence functions

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Authors: Mehdi Khaki, Ehsan Forootan, Joseph Awange, Michael Kuhn

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Terrestrial water storage, as a source of freshwater, plays an important role in human lives. Hydrological models offer important tools for simulating and predicting water storages at global and regional scales. However, their comparisons with 'reality' are imperfect mainly due to a high level of uncertainty in input data and limitations in accounting for all complex water cycle processes, uncertainties of (unknown) empirical model parameters, as well as the absence of high resolution (both spatially and temporally) data. Data assimilation can mitigate this drawback by incorporating new sets of observations into models. In this effort, we use multi-mission satellite-derived remotely sensed observations to improve the performance of World-Wide Water Resources Assessment system (W3RA) hydrological model for estimating terrestrial water storages. For this purpose, we assimilate total water storage (TWS) data from the Gravity Recovery And Climate Experiment (GRACE) and surface soil moisture data from the Advanced Microwave Scanning Radiometer for the Earth Observing System (AMSR-E) into W3RA. This is done to (i) improve model estimations of water stored in ground and soil moisture, and (ii) assess the impacts of each satellite of data (from GRACE and AMSR-E) and their combination on the final terrestrial water storage estimations. These data are assimilated into W3RA using the Ensemble Square-Root Filter (EnSRF) filtering technique over Mississippi Basin (the United States) and Murray-Darling Basin (Australia) between 2002 and 2013. In order to evaluate the results, independent ground-based groundwater and soil moisture measurements within each basin are used.

Keywords: data assimilation, GRACE, AMSR-E, hydrological model, EnSRF

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Authors: Kareem Abdelwahed, Ahmed Salama, Ahmed Rabie, Ahmed Hamdy, Waleed Abdelfattah, Ahmed Abd El-Rahman

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Conventional vapor-compression refrigeration systems rely on typical refrigerants, such as CFC, HCFC and ammonia. Despite of their suitable thermodynamic properties and their stability in the atmosphere, their corresponding global warming potential and ozone depletion potential raise concerns about their usage. Thus, the need for new refrigeration systems, which are environment-friendly, inexpensive and simple in construction, has strongly motivated the development of thermoacoustic energy conversion systems. A thermoacoustic refrigerator (TAR) is a device that is mainly consisting of a resonator, a stack and two heat exchangers. Typically, the resonator is a long circular tube, made of copper or steel and filled with Helium as a the working gas, while the stack has short and relatively low thermal conductivity ceramic parallel plates aligned with the direction of the prevailing resonant wave. Typically, the resonator of a standing-wave refrigerator has one end closed and is bounded by the acoustic driver at the other end enabling the propagation of half-wavelength acoustic excitation. The hot and cold heat exchangers are made of copper to allow for efficient heat transfer between the working gas and the external heat source and sink respectively. TARs are interesting because they have no moving parts, unlike conventional refrigerators, and almost no environmental impact exists as they rely on the conversion of acoustic and heat energies. Their fabrication process is rather simpler and sizes span wide variety of length scales. The viscous and thermal interactions between the stack plates, heat exchangers' plates and the working gas significantly affect the flow field within the plates' channels, and the energy flux density at the plates' surfaces, respectively. Here, the design, the manufacture and the testing of a compact refrigeration system that is based on the thermoacoustic energy-conversion technology is reported. A 1-D linear acoustic model is carefully and specifically developed, which is followed by building the hardware and testing procedures. The system consists of two harmonically-oscillating pistons driven by a simple 1-HP rotary drive mechanism operating at a frequency of 42Hz -hereby, replacing typical expensive linear motors and loudspeakers-, and a thermoacoustic stack within which the energy conversion of sound into heat is taken place. Air at ambient conditions is used as the working gas while the amplitude of the driver's displacement reaches 19 mm. The 30-cm-long stack is a simple porous ceramic material having 100 square channels per square inch. During operation, both oscillating-gas pressure and solid-stack temperature are recorded for further analysis. Measurements show a maximum temperature difference of about 27 degrees between the stack hot and cold ends with a Carnot coefficient of performance of 11 and estimated cooling capacity of five Watts, when operating at ambient conditions. A dynamic pressure of 7-kPa-amplitude is recorded, yielding a drive ratio of 7% approximately, and found in a good agreement with theoretical prediction. The system behavior is clearly non-linear and significant non-linear loss mechanisms are evident. This work helps understanding the operation principles of thermoacoustic refrigerators and presents a keystone towards developing commercial thermoacoustic refrigerator units.

Keywords: refrigeration system, rotary drive mechanism, standing-wave, thermoacoustic refrigerator

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Authors: L. Gyansah, Yanfang Shen, Jiqiang Wang, Tianying Xiong

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SiCₚ/ pure Al composites with different SiC fractions (20 wt %, 30 wt %, and 40 wt %) were precisely cold sprayed, followed by hot axial-compression tests at deformation temperatures of 473 K to 673 K, leading to failure of specimens through routine crack propagation in their multiphase. The plastic deformation behaviour with respect to the SiCₚ contents and the deformation temperatures were studied at strain rate 1s-1.As-sprayed and post-failure specimens were analyzed by X-ray computed tomography (XCT), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Quasi-static thermomechanical testing results revealed that compressive strength (UTS = 228 MPa and 30.4 %) was the highest in the composites that was thermomechanically compressed at 473 K compared to those of the as-sprayed, while the as-sprayed exhibited a compressive strength of 182.8 MPa related to the increment in SiC fraction. Strength—plasticity synergy was promoted by dynamic recrystallization (DRX) through strengthening and refinement of the grains. The DRX degree depends relevantly on retainment of the uniformly ultrafine SiCₚ particulates, the pinning effects of the interfaces promoted by the ultrafine grain structures (UFG), and the higher deformation temperature. Reconstructed X-ray computed tomography data revealed different crack propagation mechanisms. A single-plane shear crack with multi-laminates fracture morphology yields relatively through the as-sprayed and as-deformed at 473 K deposits, while a multiphase plane shear cracks preeminently existed in high temperature deformed deposits resulting in multiphase-interface delaminations. Three pertinent strengthening mechanisms, videlicet, SiCp dispersed strengthening, refined grain strengthening, and dislocation strengthening, existed in the gradient microstructure, and their detailed contributions to the thermomechanical properties were discussed.

Keywords: cold spraying, hot deformation, deformation temperature, thermomechancal properties, SiC/Al composite

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Authors: Udomporn Pangnakorn, Settawut Prasatporn, Sombat Chuenchooklin

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The effect of biopesticide on growth, yield and pest infestation of maize (Zea mays Linn.) (variety DK 6818) was evaluated during the drought season. The experimental plots were located at research station of Faculty of Agriculture, Natural Resources and Environment, Naresuan University, Phitsanulok, Thailand. The extracted substance from plants was evaluated in the plots in 4 treatments: 1) water as control; 2) bitter bush (Chromolaena odorata L.); 3) neem (Azadirachta indica A. Juss), 4) golden shower (Cassia fistula Linn.). The experiment was followed a Randomized Complete Block Design (RCBD) with 4 treatments and 4 replications per treatment. The results showed that golden shower gave the highest growth of maize in term of height (203.29 cm), followed by neem and bitter bush with average height of 202.66 cm and 191.66 cm respectively with significance different. But neem treatment given significantly higher average of yield component in term of length, width, and weight of pod corn with 18.89 cm 13.91 cm and 166.46 g respectively. Also, treatment of neem showed the highest harvested yield at 284.06 kg/ha followed by the golden shower and bitter bush with harvested yield at 245.86 kg/ha and 235.52 kg/ha respectively. Additionally, treatment of neem and golden shower were the highest effectiveness for reducing insects pest infestation of maize: corn leaf aphid Rhopalosiphum maidis Fitch, corn borer Ostrinia fumacalis Guenee and corn armyworm Mythimna separata Walker. The treatment of neem, golden shower, and bitter bush given reduction insect infestation on maize with leaves area were infested at 5,412 mm², 6,827 mm² and 8,910 mm² respectively with significance different when compared to control.

Keywords: maize, Zea mays Linn., biopesticide, bitter bush, Chromolaena odorata L.), neem, Azadirachta indica A. Juss, golden shower, Cassia fistula Linn.

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Authors: Fariha Akhter Chowdhury, Sabrina Mahboob, Anamika Saha, Afrin Jahan, Mohammad Nurul Islam

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Urinary tract infection (UTI) is frequently experienced by the female population where the prevalence increases with aging. Escherichia coli, one of the most common UTI causing organisms, retains glutathione defense mechanism that aids the organism to withstand the harsh physiological environment of urinary tract, host oxidative immune response and even to affect antibiotic-mediated cell death and the emergence of resistance. In this study, we aimed to investigate the glutathione reductase activity of uropathogenic E. coli (UPEC) by observing the reduced glutathione (GSH) level alteration under stressful condition. Urine samples of 58 patients with UTI were collected. Upon isolation and identification, 88% of the samples presented E. coli as UTI causing organism among which randomly selected isolates (n=9), obtained from urine samples of female patients, were considered for this study. E. coli isolates were grown under normal and stressful conditions where H₂O₂ was used as the stress-inducing agent. GSH level estimation of the isolates in both conditions was carried out based on the colorimetric measurement of 5,5'-dithio-bis (2-nitrobenzoic acid) (DTNB) and GSH reaction product using microplate reader assay. The GSH level of isolated E. coli sampled from adult patients decreased under stress compared to normal condition (p = 0.011). On the other hand, GSH production increased markedly in samples that were collected from elderly subjects (p = 0.024). A significant partial correlation between age and change of GSH level was found as well (p = 0.007). This study may help to reveal ways for better understanding of E. coli pathogenesis of UTI prevalence in elderly patients.

Keywords: Escherichia coli, glutathione reductase activity, oxidative stress, reduced glutathione (GSH), urinary tract infection (UTI)

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Authors: Zahrasadat Hosseini, Jie Yuan

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Point-of-care (POC) diagnostic devices based on lab-on-a-chip (LOC) technology have the potential to revolutionize medical diagnostics. However, the development of an ideal microfluidic system based on LOC technology for diagnostics purposes requires overcoming several obstacles, such as improving sensitivity, selectivity, portability, cost-effectiveness, and prototyping methods. While numerous studies have introduced technologies and systems that advance these criteria, existing systems still have limitations. Electrochemical enzyme-linked immunosorbent assay (e-ELISA) in a LOC device offers numerous advantages, including enhanced sensitivity, decreased turnaround time, minimized sample and analyte consumption, reduced cost, disposability, and suitability for miniaturization, integration, and multiplexing. In this study, we present a novel design and fabrication method for a microfluidic diagnostic platform that integrates screen-printed electrochemical carbon/silver chloride electrodes on flexible printed circuit boards with flexible, multilayer, polydimethylsiloxane (PDMS) microfluidic networks to accurately manipulate and pre-immobilize analytes for performing electrochemical enzyme-linked immunosorbent assay (e-ELISA) for multiplexed quantification of blood serum biomarkers. We further demonstrate fast, cost-effective prototyping, as well as accurate and reliable detection performance of this device for quantification of interleukin-6-spiked samples through electrochemical analytics methods. We anticipate that our invention represents a significant step towards the development of user-friendly, portable, medical-grade, POC diagnostic devices.

Keywords: lab-on-a-chip, point-of-care diagnostics, electrochemical ELISA, biomarker quantification, fast prototyping

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Authors: Said Ghalem

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Honey is primarily composed of sugars: glucose and fructose. Depending honey, it's either fructose or glucose predominates. More the fructose concentration and the less the glycemic index (GI) is high. Thus, changes in the insulin response shows a decrease of the amount of insulin secreted at an increased fructose honey. Honey is also a compound that can reduce the lipid in the blood. Several studies on animals, but which remain to be checked in humans, have shown that the honey can have interesting effects when combined with other molecules: associated with Metformin (a medicine taken by diabetics), it shows the benefits and effects of diabetes preserves the tissue; associated ginger, it increases the antioxidant activity and thus avoids neurologic complications, neuropathic. Molecular modeling techniques are widely used in chemistry, biology, and the pharmaceutical industry. Most of the currently existing drugs target enzymes. Inhibition of DPP-4 is an important approach in the treatment of type 2 diabetes. We have chosen for the inhibition of DPP-4 the following molecules: Linagliptin (BI1356), Sitagliptin (Januvia), Vildagliptin, Saxagliptin, Alogliptin, and Metformin (Glucophage), that are involved in the disease management of type 2 diabetes and added to honey. For this, we used software Molecular Operating Environment. A Wistar rat study was initiated in our laboratory with a well-studied protocol; after sacrifice, according to international standards and respect for the animal This theoretical approach predicts the mode of interaction of a ligand with its target. The honey can have interesting effects when combined with other molecules, it shows the benefits and effects of honey preserves the tissue, it increases the antioxidant activity, and thus avoids neurologic complications, neuropathic or macrovascular. The organs, especially the kidneys of Wistar, shows that the parameters to renal function let us conclude that damages caused by diabetes are slightly perceptible than those observed without the addition of a high concentration of fructose honey.

Keywords: honey, molecular modeling, DPP4 enzyme, metformin

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Authors: Elisabeth Mamani-Mategula

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Background: Anaemia has significant consequences on both the mother and child's health as it results in maternal haemorrhage, low childbirth weight, premature delivery, poor organ development, and infections at birth and hence the need for treatment. In low-middle income countries, anaemic pregnant women are recommended to take 30 mg to 60 mg of elemental iron daily throughout pregnancy which are often poorly tolerated and adhered to. A potential alternative to oral iron is intravenous (IV) iron which allows the saturation of the body’s iron stores quickly. Currently, a randomised controlled trial on the Effect of intravenous iron on Anaemia in Malawian Pregnant women (REVAMP) is underway. Since this is new in Africa and Malawi is the second country to implement it, its acceptability to both the providers and end-users is not known. Suppose the use of IV iron during pregnancy would be acceptable in Malawi, it could change how we treat and manage pregnant women with anaemia and be scaled up throughout Malawi to improve maternal and child health. Objectives: To identify the barriers and facilitators of implementing IV iron in the Malawian healthcare system and identify ‘touchpoints’ and co-develop strategies to support and inform the implementation of the trial Methodology: A qualitative study was conducted with policymakers, government partners, and health managers through in-depth interviews to identify barriers and facilitators relating to the implementation of IV iron in the health system of Malawi. From the interviews, touchpoints were identified that formed the basis of the discussion in further discussing the barriers and suggested solutions in the co-design workshops with the community members and the health workers, respectively. We purposively recruited 20 health workers (10 male, 10 Female). 20 community members (10 male, 10 female) were recruited randomly. Data was collected through group discussions and interactive sessions and was recorded through audios, flip charts, and sticky notes. We familiarized ourselves with the data and identified themes. Results: Two co-design workshops were conducted with different community members and different health worker carders. Identified individual factors included lack of knowledge about anaemia, lack of male involvement, the attitude of health workers and patient non-compliance with appointments. Community factors included myths and misconceptions about IV iron, including associating the use of IV iron with vampirism and covid 19 vaccination. Health system factors identified were a shortage of staff and equipment, unfamiliarity with IV iron and its cost. Discussion: The use of IV iron, as suggested by the community members and health workers, demands civic education through bringing awareness to end-users and training to providers. Through these co-design workshops, community sensitization and awareness, briefing and training of health workers and creation of educational materials were done.

Keywords: acceptability, IV iron, barriers, facilitators, co-design

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Authors: Ayman M. A. Rashwan, Mohamed F. Mohamed, Mohamed M. A. Abdalla

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A field experiment was conducted in the Agricultural Research Station, at El-Ghoraieb, Assiut to study dry seed yield performance of two locally adapted cultivars (‘Azmerly’ and ‘Cream 7’) and two line introductions (IT81D-1032 and IT82D-812) of common cowpea (Vigna unguiculata (L.) Walp) grown at three different within-row spaces (20, 30 and 40 cm) and two planting dates in the summer (April 15th and 30th) and in the fall season (Aug. 12th and 27th) of two successive seasons. The data showed that total dry-seed yield produced by plants grown at 20 cm was greater than at 30 cm in all cvs/lines in both years. Increases in 1000-seed weight were detected in cv ‘Azmerly’ and line IT82D-812 when they were grown at 30 cm as compared with 20 cm in the summer season. However, in the fall season such increases were found in all cvs/lines. Planting at 40 cm produced seeds of greater weight than planting at 30 cm for all cvs/lines in the fall season and also in cv. Cream 7 and line IT82D-812 in the summer season. Planting on April 15th in the summer and also planting on Aug. 12th in the fall had plants which showed increases in 1000-seed weight and total dry-seed yield. The greatest 1000-seed weight was found in the line IT81D-1032 in the summer season and in the line IT82D-812 in the fall season. The sum up results revealed that ‘Azmerly’ produced greater dry-seed yield than ‘Cream 7’ and both of them were superior to the line IT82D-812 and IT81D-1032 in the summer season. In the fall, however, the line IT82D-812 produced greater dry-seed yield than the other cultivars/lines.

Keywords: Cowpea, Assiut, fall, planting dates, El-Ghoraieb, dry-seed yield

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Authors: Gabrielle Brand, Christopher Etherton-Beer

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The learning landscape of higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practice in today’s complex Australian health care systems, including responding to changing demographics of population ageing. To counteract a widespread perception of health professions students’ disinterest in caring for older persons, the authors will report on an exploratory, mixed method research study that used photographs, narrative and small group work to enhance medical and nursing students’ reflective learning experience. An innovative photo-elicitation technique and reflective questioning prompts were used to increase engagement, and challenge students to consider new perspectives (around ageing) by constructing shared storylines in small groups. The qualitative themes revealed how photographs, narratives and small group work created learning spaces for reflection whereby students could safely explore their own personal and professional values, beliefs and perspectives around ageing. By providing the space for reflection, the students reported how they found connection and meaning in their own learning through a process of self-exploration that often challenged their assumptions of both older people and themselves as future health professionals. By integrating cognitive and affective elements into the learning process, this research demonstrates the importance of embedding visual methodologies that enhance reflection and transformative learning. The findings highlight the importance of integrating the arts into predominantly empirically driven health professional curricula and can be used as a catalyst for individual and/or collective reflection which can potentially enhance empathy, insight and understanding of the lived experiences of older patients. Based on these findings, the authors have developed ‘Depth of Field: Exploring Ageing’ an innovative, interprofessional, digital reflective learning resource that uses Prezi Inc. software (storytelling tool that presents ideas on a virtual canvas) to enhance students’ reflective capacity in the higher education environment.

Keywords: narrative, photo-elicitation, reflective learning, qualitative research

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Authors: Seyhan Sahan-Firat, Meryem Temiz-Resitoglu, Demet Sinem Guden, Sefika Pinar Kucukkavruk, Bahar Tunctan, Ayse Nihal Sari, Zumrut Kocak

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We hypothesized that mTOR inhibition may prevent the multiple organ failures following severe multiple tissue injury associated with increased NADPH oxidase system activity occur in zymosan-induced systemic inflammation. Therefore, we investigated the role of mTOR in oxidative/nitrosative stress associated with increase in NADPH oxidase activity in zymosan-induced systemic inflammation model in rats. Male Wistar rats received saline (4 ml/kg, i.p.) and zymosan (500 mg/kg, i.p.) at time 0. Saline, or zymosan-treated rats were given rapamycin (1 mg/kg, i.p.) 1 h after saline or zymosan injections. Rats were sacrified 4 h after zymosan challenge and kidney, heart, thoracic aorta, and superior mesenteric artery were collected. NADPH oxidase activity, p22phox, gp91phox, and p47phox protein expression and nitrotyrosine levels were measured in tissue samples. Zymosan administration caused an increase in NADPH oxidase activity, p22phox, gp91phox, and p47phox protein expression and nitrotyrosine levels in kidney, heart, thoracic aorta, and superior mesenteric artery. These changes caused by zymosan reversed by rapamycin, a selective mTOR inhibitor. Rapamycin alone had no effect on the parameters measured. Our results demonstrated that zymosan-induced oxidative/nitrosative stress presumably due to enhanced activity of NADPH oxidase, expression of p22phox, gp91phox, and p47phox and production of peroxynitrite were mediated by mTOR. [This work was financially supported by Research Foundation of Mersin University (2016-2-AP3-1900)].

Keywords: oxidative stress, mTOR, nitrosative stress, zymosan

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Authors: Jiun Jeon, Byung-Ju Yi

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This paper investigates modeling and shape prediction of elastic kinematic chains such as colonoscopy. 2D and 3D models of elastic kinematic chains are suggested and their behaviors are demonstrated through simulation. To corroborate the effectiveness of those models, experimental work is performed using a magnetic sensor system.

Keywords: elastic kinematic chain, shape prediction, colonoscopy, modeling

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Authors: Fernando Nobre Cavalcante

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In Brazil, and more recently in the city of Fortaleza, there is a new form of entrepreneurship that is focused on the information and communication technology service sector and that draws the attention of young people, investors, governments, authors and media companies: it is known as the start-up movement. Today, it is considered to be a driving force behind the creative economy. Rooted on progressive discourse, the words enterprise and innovation seduce new economic agents motivated by success stories from Silicon Valley in America along with increasing commercial activity for digital goods and services. This article assesses, from a sociological point of view, the new productive wave problematized by the light of Manuel Castells’ informational capitalism. Considering the skeptical as well as the optimistic opinions about the impact of this new entrepreneurial rearrangement, the following question is asked: How Brazilian entrepreneurs evaluate public policy incentives for startups Brazilian Federal Government? The raised hypotheses are based on employability factors as well as cultural, economical, and political matters related to innovation and technology. This study has produced a nationwide quantitative assessment with a special focus on the reality of these Ceará firms; as well as comparative qualitative interviews on Brazilian experiences lived by identified agents. This article outlines the public incentive policy of the federal government, the Start-up Brasil Program, from the perspective of these companies and provides details as to the discipline methods of the new enterprising way born in the United States. The startups are very young companies that are headed towards the economic sustainment of the productive sector services. These companies are dropping the seeds that will produce the re-enchantment of young people and bring them back to participation in political debate; they provide relief and reheats the job market; and they produce a democratization of the entrepreneurial ‘Do-It-Yourself’ culture. They capitalize the pivot of the wall street wolves and of agents being charged for new masks. There are developmental logic’s prophylaxis in the face of dreadful innovation stagnation. The lack of continuity in Brazilian governmental politics and cultural nuances related to entrepreneurship are barring the desired regional success of this ecosystem.

Keywords: creative economy, entrepreneurship, informationalism, innovation, startups, start-up brasil program

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Authors: Zahra Fotovatnia, Jeffery A. Jones, Alexandra Gottardo

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Speech communication often occurs in environments where noise conceals part of a message. Listeners should compensate for the lack of auditory information by picking up distinct acoustic cues and using semantic and sentential context to recreate the speaker’s intended message. This situation seems to be more challenging in a nonnative than native language. On the other hand, early bilinguals are expected to show an advantage over the late bilingual and monolingual speakers of a language due to their better executive functioning components. In this study, English monolingual speakers were compared with early and late nonnative speakers of English to understand speech in noise processing (SIN) and the underlying neurobiological features of this phenomenon. Auditory mismatch negativities (MMNs) were recorded using a double-oddball paradigm in response to a minimal pair that differed in their middle vowel (beat/bit) at Wilfrid Laurier University in Ontario, Canada. The results did not show any significant structural and electroneural differences across groups. However, vocabulary knowledge correlated positively with performance on tests that measured SIN processing in participants who learned English after age 6. Moreover, their performance on the test negatively correlated with the integral area amplitudes in the left superior temporal gyrus (STG). In addition, the STG was engaged before the inferior frontal gyrus (IFG) in noise-free and low-noise test conditions in all groups. We infer that the pre-attentive processing of words engages temporal lobes earlier than the fronto-central areas and that vocabulary knowledge helps the nonnative perception of degraded speech.

Keywords: degraded speech perception, event-related brain potentials, mismatch negativities, brain regions

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Authors: Harish Aryal

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The safe and reliable operation of nuclear reactors has always been one of the topmost priorities in the nuclear industry. Transient testing allows us to understand the time-dependent behavior of the neutron population in response to either a planned change in the reactor conditions or unplanned circumstances. These unforeseen conditions might occur due to sudden reactivity insertions, feedback, power excursions, instabilities, and accidents. To study such behavior, we need transient testing, which is like car crash testing, to estimate the durability and strength of a car design. In nuclear designs, such transient testing can simulate a wide range of accidents due to sudden reactivity insertions and helps to study the feasibility and integrity of the fuel to be used in certain reactor types. This testing involves a high neutron flux environment and real-time imaging technology with advanced instrumentation with appropriate accuracy and resolution to study the fuel slumping behavior. With the aid of transient testing and adequate imaging tools, it is possible to test the safety basis for reactor and fuel designs that serves as a gateway in licensing advanced reactors in the future. To that end, it is crucial to fully understand advanced imaging techniques both analytically and via simulations. This paper presents an innovative method of supporting real-time imaging of fuel pins and other structures during transient testing. The major fuel-motion detection device that is studied in this dissertation is the Hodoscope which requires collimators. This paper provides 1) an MCNP model and simulation of a Transient Reactor Test (TREAT) core with a central fuel element replaced by a slotted fuel element that provides an open path between test samples and a hodoscope detector and 2) a choice of good filter to improve image resolution.

Keywords: hodoscope, transient testing, collimators, MCNP, TREAT, hodogram, filters

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Authors: Yuliya Markava

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The laser in situ keratomileusis (LASIK) is widely common surgical procedure, which has become an alternative for patients who are not satisfied with the performance of other correction methods. A high level of patient satisfaction functional outcomes after refractive surgery confirms the high reliability and safety of LASIK and provides a significant improvement in the quality of life and social adaptation. Purpose: To perform clinical analysis of the results of correction made to the excimer laser system SCHWIND AMARIS 500E in patients with different types of refractive anomalies. Materials and Methods: This was a retrospective analysis of 1581 operations (812 patients): 413 males (50.86%) and 399 females (49.14%) at the age from 18 to 47 years with different types of ametropia. All operations were performed on excimer laser SCHWIND AMARIS 500E in the LASIK procedure. Formation of the corneal flap was made by mechanical microkeratome SCHWIND. Results: Analyzing the structure of refractive anomalies: The largest number of interventions accounted for myopia: 1505 eyes (95.2%), of which about a low myopia: 706 eyes (44.7%), moderate myopia: 562 eyes (35.5 %), high myopia: eyes 217 (13.7%) and supermyopia: 20 eyes (1.3%). Hyperopia was 0.7% (11 eyes), mixed astigmatism: 4.1% (65 eyes). The efficiency was 80% (in patients with supermyopia) to 91.6% and 95.4% (in groups with myopia low and moderate, respectively). Uncorrected visual acuity average values before and after laser operation was in groups: a low myopia 0.18 (up 0.05 to 0.31) and 0.80 (up 0.60 to 1.0); moderate myopia 0.08 (up 0.03 to 0.13) and 0.87 ( up 0.74 to 1.0); high myopia 0.05 (up 0.02 to 0.08) and 0.83 (up 0.66 to 1.0); supermyopia 0.03 (up 0.02 to 0.04) and 0.59 ( up 0.34 to 0.84); hyperopia 0.27 (up 0.16 to 0.38) and 0.57 (up 0.27 to 0.87); mixed astigmatism of 0.35 (up 0.19 to 0.51) and 0.69 (up 0.44 to 0.94). In all cases, after LASIK indicators uncorrected visual acuity significantly increased. Reoperation was 4.43%. Significance: Clinical results of refractive surgery at the excimer laser system SCHWIND AMARIS 500E in different ametropia correction is characterized by high efficiency.

Keywords: effectiveness of laser correction, LASIK, refractive anomalies, surgical treatment

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Authors: Yih-Jer Wu, Ling-Lang Huang

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Shared decision-making (SDM) is a critical aspect of determining optimal medical strategies. However, current patient decision aids (PDAs) often prioritize evidence-based discussions over value-based considerations. Despite its significance, there is limited research addressing the 'value gap' between patients and healthcare providers. To address this gap, we developed the 'Patient-Doctor Relationship Questionnaire,' consisting of 12 questions. To explore potential variations in the patient-doctor value gap across different medical specialties, we conducted interviews with physicians, surgeons, and their respective patients, utilizing the questionnaire. Between 2020 and 2022, we interviewed a total of 144 patients and 19 doctors. Among the 12 questions, physicians demonstrated significant patient-doctor value gaps in 5 questions, while surgeons in 3 questions. Only one question turned out significant gaps in both physicians and surgeons. When asking both doctors and their patients to choose one from the following 6 answers (1. No issue significant; 2. Not knowing how to make a medical decision; 3. Not confident in the doctor’s clinical judgment; 4. Not knowing how to articulate one’s own condition; 5. Unable to afford medical expenses; 6. Not understanding what doctors explain) in response to the question “what the most significant issue is in the medical consultation”, over 50% of doctors chose “Not knowing how to make a medical decision” (physicians vs. patients, 50% vs. 11%, p=0.046; surgeon vs. patients, 83% vs. 29%, p=0.001), while significantly more patients chose “No issue significant” (10% vs. 52%, p=0.002; 0% vs. 33%, p<0.001, respectively). Our findings indicate that value gaps do exist between patients and doctors and that most patients in Taiwan "fully trust" their doctors' recommendations for medical decisions. However, when treatment outcomes are far from ideal, this overinflated "trust" may turn into frustration, which could become the catalyst for medical disputes. Doctors should spend more time having more effective communication with their patients, particularly regarding potentially dissatisfactory treatment outcomes. This study underscores the substantial variability in the patient-doctor value gap, often overlooked in SDM. Patients from different clinical backgrounds may hold values distinct from those of their healthcare providers. Bridging this value gap is imperative for achieving genuine and effective SDM.

Keywords: share-decision making, value gaps, communication, doctor-patient relationship

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