In this paper, the economic viability and environmental impact of the novel greenhouse dryer with an evacuated solar collector are calculated. For this analysis, tomato is dried inside the dryer as it is a high moisture crop that requires a faster drying rate otherwise it starts giving a bad odor and gets contaminated. The hybrid active greenhouse dryer is developed especially for drying high moisture agro and non-agro-based produce. Evacuated tube solar collector is integrated with the dryer that supplies the hot water to the heat exchanger kept inside the dryer. The hot water flowing inside the copper tubes of the heat exchanger transfers its heat to room air through convection and to crop through conduction. Hence the higher room temperature and faster moisture removal rate are obtained. Tomato slices have been dried from 94.6% (wb) to 10% (wb) moisture content in 10 h. The developed dryer can produce 261 kg of dried tomato annually and its payback time is only 1.73 years which is very less as compared to its life of 30 years. In its entire lifetime, the dryer will mitigate 169.10 tonnes of CO  •A Novel hybrid greenhouse Solar dryer is developed for drying high moisture crops.•Dryer is totally dependent on renewable energy source with an increased drying period per day even after sunset.•The economic analysis shows that the capital cost of hybrid dryer is not too high as compared to other hybrid dryer. There must be an ecological balance to maintain the existence of life on Earth. Any developed product should not harm the environment in any way during its lifetime. Solar dryers are developed as a sustainable solution to reduce the scarcity of food by drying it and storing it for a long duration. As the solar dryers are operated by renewable source of energy hence it does not harm the environment. Solar dryers were basically developed to dry the crops to safe moisture levels by using a renewable energy source i.e. sun. The solar dryers are not limited for agricultural purposes but it is also used in industrial purposes for process heating .2 emissions by 23%  is developed in which the solar collectors are used to supply the additional thermal energy to the dryer. The entire drying system is stand alone and is operated by solar energy only.The novelty in this experimental work is the heat exchanger kept inside the greenhouse dryer. The heat exchanger also works as the drying bed for the crop. The hot water from the evacuated tube solar collector is supplied to the copper tubes of the heat exchanger. The heat in hot water inside the copper tubes is partially conducted to the crop in contact with the tube and partially convected to the inside room air. This raises the room air temperature as well as the crop surface temperature and hence the faster evaporation of moisture from the crop surface takes place. No work is reported till now on the sustainability assessment of such kind of HAGSD with evacuated tube collector (ETC) and a heat exchanger. Hence the environmental and economic analysis of the developed setup is carried out to test its sustainability. Tomato is selected as the crop for the analysis as it is a high moisture crop and the developed dryer is suitable for high moisture crops because of high room air temperature and faster drying rate.2The hybrid greenhouse solar dryer has been designed and constructed at Madhav Institute of Technology and Science, Gwalior . The frame of the dryer is made of hollow square-shaped iron rods which are fixed at the required position through welding. The joints are properly filled through welding and m-seal is used to make it air-tight as much as possible. The UV stabilized polycarbonate sheet of 6 mm thickness is used as a cover material. Four DC fans were provided to circulate the air inside the dryer. The two PV panels are attached to the roof of the dryer for supplying electricity to operate the fans and DC pump. The hot water from ETC is circulated through copper tubes of the heat exchanger placed inside the dryer using a DC pump. The water in tube type ETC was attached with the heat exchanger placed inside the dryer. The hot water from ETC is supplied inside the dryer through the copper tubes of the heat exchanger bed. The pictorial view and schematic diagram of the HAGSD is shown in The opening for air inlet is provided at bottom of the back side of the dryer . Four DC fans of rated power 6 W each and having 12 mm and 5 mm as outer and inner diameter respectively are provided at the front to remove the evaporated moisture of crop along with the air inside the dryer. Based on experiment, four fans are found suitable for maintaining the required air circulation inside the dryer. As the ambient air enters from the bottom of the dryer and after heating it rises upward due to buoyancy effect, hence the fans are provided at the top of the front wall. The heat exchanger kept inside the dryer has a dimension as 2 m × 2 m x 1 m. Total 18 U shaped copper tubes joined together are used in heat exchanger to carry the hot water through it.2 accuracy is used to measure the solar irradiance. Digital weight balance is used to measure the weight of the crop at the 1-h interval. The Datataker DT85 data logger is used to record and display the reading of measured temperature and solar radiation. The possible uncertainty in the measured parameters is shown in For measuring the temperature, K-type thermocouples of accuracy ±0.1 °C are placed at a different location inside the dryer. Pyranometer of Central Electronics Limited with ±1 W/mTomato is one of the most consumed crops in the world that is used for making various dishes. It is also a very high moisture crop so for storage it must be dried to a safe moisture level. For the experiment, the tomato is purchased from the local market and washed properly with fresh water. The tomato is cut into slices of 5 mm thickness and then spread evenly on the drying tray inside the greenhouse. The dryer is operated from 10 a.m. to 8 p.m. as due to the use of heat exchanger inside the dryer, it continues to operate in off sunshine period also till the heat stored in the water of ETC not lost to the surrounding.33.1em)  . The difem)  and quan3.2EPBT is the amount of time taken by the hybrid dryer to recover the energy invested in it during its construction. Mathematically it is expressed as .(1)Energa) is calculated using Eq. The annual energy output DailyThe value of the latent heat of evaporation of water is taken as 2430 kJ/kg.3.32 emission is taken as approximately 0.98 kg/kWh. The annual CO2 emission is given by Eq. Considering that the electricity is generated using coal then the COda) and transmission and distribution losses (Ldt) are considered then Eq. There are various losses related to electricity generation and transmission. If the domestic appliance losses  is given as Can=Cacp is the annual capital cost and Cacf is the annual operational cost of a fan, which are calculated using Eq. cc is the capital cost of the dryer, Nf is the number of an hour the fan run in a year, Pf is the rated power consumed by a fan during its operation and Cue is the electricity charge for one unit.CIn this case, the daily operation hour of the fan is 8 h and taking 290 days of full sunshine days in a year in this location, then the number of an hour the fan operate in a year is 2320 h. The rated power of one DC fan is 6 W so the rated power of 4 DC fans is 24 W. The charge of one unit of Electricity is taken Rs. 5/kWh.mt) and annual salvage value (Sv) is taken as 3% and 10% of the annual capital cost of the dryer  is calculated using Eq. The capital recovery (Fpa) is given by Eq. pd is the mass of product dried in a dryer per batch, D is the number of days for which the dryer is used for drying in a year and Db is the number of days taken for drying the material per batch. The capacity of the developed dryer is 15 kg per batch and the drying time of tomato slices per batch is 1 day (10 h). The photograph of the tomato slices before and after drying is shown in The total mass of dried tomato in the dryer annually (Mu) is given by,Then the drying cost for one kg of material (Cfd) is shown by Eq. f is the mass of fresh product per batch and Cfp is the cost of one kg of fresh product.Cost of fresh product per one kg of dried product (Cud) is given by:The cost of one kg of product dried inside the dryer (Ckg) is given by Eq. Saving obtained from one kg of product dried inside the dryer  is calculated using the relation given by Eq. Finally, the Payback time  and it is dried to 10% (wb) moisture level in 10 h as shown in 5.1The environmental impact of any system depends mostly on its embodied energy. The embodied energy of the materials used in the hybrid dryer is shown in 2 while it will mitigate 169.10 tons. This helps a lot in reducing carbon footprint and from the net mitigated CO2, about Rs.167,182.91  can be earned from the hybrid dryer as a carbon credit.The various environmental parameters calculated to show the impact of the dryer on the environment are shown in From 5.2The economic analysis is one of the important factors justifying the feasibility of the developed system. The various economic parameters calculated to evaluate the economic feasibility of HAGSD are shown in The tomato can be dried and stored for its easier and cheaper availability in all seasons. The developed dryer had a capacity of drying 15 kg per batch and annually it can produce 261 kg of dried tomato. The selling price of dried tomato varies between Rs.1000 to Rs.2000 per kg. In the calculation, it is taken as Rs.1500/kg and this gives the annual saving of Rs. 62,419.58 per day.From The capacity of dryer is 15 kg per batch and drying time is about 2 days, so in a year about 2 Tons of fresh crop can be dried in this developed dryer. The developed dryer is suitable for small-scale industries like the papad industry, cow dung drying in gaushalas, ready-to-make food-making industries, etc. As in conventional open space drying, not only the nutritious value of the dried product is affected but also the drying time is very high which affects the production of any industry. Thus, the developed dryer is not only suitable for large-scale commercial industries but also very helpful for small-scale and rural applications. This shows the economic suitability of dryer from a sustainability point of view.62 in its lifetime which will help in reducing the carbon footprints. This makes the dryer a sustainable solution for the drying purpose as it not only reduces carbon emissions but also it is economically viable due to its low payback period. The CO2 emission from the dryer depends on its embodied energy, so it can be reduced by using aluminium frames instead of iron frames as it is lighter in weight. The capital cost of the dryer can be minimized for small-scale applications by using only a single evacuated tube collector.The developed HAGSD is a sustainable solution for drying high moisture crops as it is both economically and environmentally feasible. The tomato slices are dried from 94.6% (wb) moisture content to 10% moisture content in 10 h only. The capital cost of the developed hybrid dryer is Rs. 99,418, which is high for small-scale purposes or its use in rural areas. But as the life of the dryer is 30 years and its payback time is 1.73 years only so the invested amount will get recovered soon and hence the profit can be earned for the remaining duration. The maximum temperature difference between ambient and inside room air is 13 °C, which is good for thin-layer drying of high moisture crops in the winter season. The dryer mitigates about 169.10 tons of COPushpendra Singh: Writing – original draft, Conceptualization, Methodology, Writing – review & editing. M.K. Gaur: Supervision, Investigation, Visualization.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


N = 789) were offered an educational video prior to completing an online questionnaire that examined genetic knowledge, the perceived severity of MPS III, perceived risk, and attitudes toward ECS. Outcomes were compared to reference data collected previously in which respondents had been offered an educational text (N = 781). We first again studied the attitudes toward ECS in a smaller educational text group (N = 266) in order to assess whether attitudes had changed over time due to increased media coverage on ECS, which did not reveal any significant changes. Respondents who were offered the video had a better genetic knowledge, perceived MPS III as more severe, perceived their risks higher and were more likely to participate in ECS compared to those who were offered text. Online video may well be used as supportive tool to the genetic counseling process, creating more knowledge on ECS and severe genetic disorders included in preconception screening panels.Preconception expanded carrier screening (ECS) aims to identify couples with an increased risk of having a child with an autosomal recessive (AR) disorder before pregnancy, thereby enabling reproductive choices. Genetic knowledge and experiential knowledge both influence the uptake of ECS. As people in the general public often lack such knowledge, it is essential to provide appropriate and understandable information when offering ECS. This study investigated the effect of an educational video, compared to an educational text, on the knowledge and attitudes toward preconception ECS in the general population. Both the text and video consisted of a brief educational summary on AR inheritance and on the type of disorders included in ECS, with the progressive neurodegenerative condition mucopolysaccharidosis type III (MPS III) as an example. Participants in the reproductive age were invited in collaboration with a research agency. Respondents ( Genetic knowledge and experiential knowledge on disorders included in screening panels both influence the uptake of preconception expanded carrier screening.The use of video for educating the general public on preconception expanded carrier screening and on the disorders included in such tests leads to increased genetic knowledge and may well be used as supportive tool to the genetic counseling process.1., Mucopolysaccharidosis type III (MPS III), Zellweger syndrome, and Tay‐Sachs disease), as advised by the European Society of Human Genetics  disorders are generally born into families with no prior family history for that specific disorder. Carrier couples are thus mostly not aware of their carrier status and increased risk of having affected offspring  and experiential knowledge on the potential impact of a severe genetic disease are important factors determining a person's intention whether or not to participate in ECS programs  were recruited online in October 2018 by TNS Kantar, a Dutch research agency, that provide access to a panel of more than 200,000 individuals who are willing to participate in research in exchange of a small reimbursement. The sample was stratified from their database based on the key demographics gender, socio‐economic status, educational level, and regional area to guarantee a representative sample of the Dutch population. Informed consent was obtained from all respondents. The Medical Ethics Committee of the Amsterdam UMC, the Netherlands, stated that Medical Research Involving Human Subject Act (WMO) does not apply to this study as it concerns an anonymous questionnaire study, and therefore, formal ethical approval was not necessary.The recruiting procedure was identical to the procedure used in a previous study on the attitudes toward preconception ECS in the general Dutch population  were offered an educational video (video group) presenting information on ECS and MPS III based on the educational text offered in the study of Nijmeijer et al. . The dat2.2The educational text, video, and questionnaire were all in Dutch. Supplementary materials for this publication were translated into English.2.2.1A full description of the original educational text as used in the study by Nijmeijer et al.  can be f2.2.2https://youtu.be/V9FKDNF_‐tI, including English subtitles).The video was designed and produced in collaboration with an organization specialized in educational videos in the field of medicine . The script of the educational text was used as frame from which the video was designed. We used informative animations with a voice over to visualize the information on AR inheritance and the ECS test. The general concept of ECS, reproductive options, and the nature and course of MPS III as an example of the type of disorders included in ECS were explained by a medical doctor, supported by visual bullets and animations. MPS III was illustrated by video‐recording of two MPS III patients in their home environment . In addition, extra factual information about the general risk of being a carrier couple (1 in 150) and the general risk of having an affected child with one of the AR disorders included in the ECS test (1 in 600) had been added. The video lasted 6:27 minutes  pregnancy, marital status, and religion were collected. Additionally, three multiple choice questions assessed familiarity with carrier screening, with hereditary diseases and previous experience with genetic carrier testing.2.3.2one partner is carrier for one of the diseases, couples have an increased risk to have a child with that disease’) and was answered on a three point scale . The total score ranges from 0 to 7, at which a higher score indicates a better genetic knowledge  (Appendix The perceived severity of MPS III was assessed by two statements (‘I believe MPS III is a severe disease’ and ‘I believe that the life expectancy of MPS III is very bad (severe patients often die before reaching adulthood)’) and answered on a five‐point Likert scale (1 = Appendix .2.3.4very low to 5 = very high)  were assessed and answered on a five‐point Likert scale .Intention to participate in ECS, which was measured multiple choice .Perceived benefits of (A) and barriers against ECS (B), and freedom‐of‐choice statements (C), measured by using a five‐point Likert scale .Perceived personal consequences of ECS: Considerations regarding test results of ECS (A), Perceived consequences as a carrier (B), and Perceived reproductive choices as a carrier couple (C), measured by using a five‐point Likert scale  and computed to a total sum score (range 0–7). All items containing five‐point scales were transformed to binary coded items  disagree/not disagree/not agree or (very) low/not low and not high, 1 = agree/totally agree or (very)high). The word pairs (domain II) were compromised into three answer categories: 1 =  disagree, 2 = do not disagree/do not agree, and 3 =  agree. First, it was assessed whether sociodemographic characteristics, genetic knowledge, perceived severity of MPS III, perceived risk, and attitudes toward preconception ECS remained the same over time by comparing outcomes of respondents who received the text in 2016 and 2018 by using Mann–Whitney U tests and chi‐square tests. Second, answers on the genetic knowledge test, the perceived severity of MPS III, the perceived risk, and attitudes toward ECS were compared between the video group and the text group by using Mann–Whitney U tests and chi‐square tests to assess the impact of the educational video compared to text. Statistical Package for Social Sciences (SPSS) version 25 was carried out for all statistical analyses . p‐values < .05 were considered statistically significant.Descriptive statistics were performed to describe the sociodemographic characteristics of all groups. Sociodemographic characteristics of the groups were compared by using independent sample t tests for continues data and chi‐square tests for categorical data. The items of the genetic knowledge test were transformed to binary coded items .The sociodemographic characteristics of the text group and video group are presented in Table 3.2p = .223). Moreover, no significant differences between both groups were found in 60 of the 62 items relating all other domains. Participants in the current text group only agreed more often on the statement ‘the carrier test can avoid suffering for future parents’  and that MPS III has a very bad life expectancy .There was no significant difference in the number of respondents expressing an intention to participate in ECS between the groups who received the educational text in the current study and 2 years previously in the study by Nijmeijer et al.  (35.1% a3.33.3.1p < .001).Respondents in the video group scored higher on the knowledge test  compared to respondents in the text group  and more often agreed that MPS III has a very bad life expectancy .The majority of all respondents experienced MPS III as a severe disease. However, respondents in the video group more often agreed that MPS III is a severe disease (83.7%) compared to the text group  and a chance of 1:600 of having a child with a severe hereditary disorder as (very) high .Respondents in the video group and the text group equally perceived a chance of 1:6 of being a carrier of a severe hereditary disease as (very) high (70.3%). Compared to the text group, the video group more often perceived a chance of 1:150 that both partners are carrier of the same disease as (very) high .IILevel of agreement on feelings toward ECS in general and personally considering ECS.The minority of respondents stated that they would participate themselves in ECS. However, respondents in the video group reported more often that they would probably or certainly participate in preconception ECS compared to respondents in the text group  and text group (47.2%) was that they want to spare their child a life with a severe hereditary disorder Table . Out of p < .001).There was a significant difference between respondents in the video group and text group regarding their agreement on most items of the domain ‘perceived personal consequences’ Table . For exa4The purpose of the current study was to assess the impact of an educational video compared to an educational text on the knowledge and attitudes toward preconception ECS for severe childhood onset disorders in the general population. MPS III was used as an example of the type of disorders that are included in ECS panels.First, we show that genetic knowledge and the attitudes toward ECS, as assessed by our questionnaire, had not changed over 2 years' time. Therefore, we can assume that the difference in attitudes between the text group and video group is due to the mode of presenting the information and not to accumulating knowledge and awareness over time.Watching the educational video led to an increased intended uptake of ECS testing. Moreover, respondents who watched the video had an overall more positive attitude toward preconception ECS compared to those who read the text. In addition, participants who were offered the video as source of information scored significantly higher on the genetic knowledge test. This is in line with earlier studies demonstrating the positive effect of using video to increase knowledge of (future) parents on Down Syndrome screening . However, intended participation is not always a good reflection of the actual test uptake, since the actual test uptake may be influenced by other factors such as time and costs  screening programs  and the risk of having an affected child when being a carrier couple (1 in 600) was added. However, respondents in the text group were also informed about these risks as this was included in the questionnaire domain ‘perceived risk’. This may have minimized the influence of this difference in content. In addition, the video comprised additional information as the concept of AR inheritance was explained by animations and the example of the disorders included in the ECS panel, MPS III, was illustrated by video‐recordings of two patients. Therefore, the differences between the text group and video group might be caused by the different methods of presenting information, but also by the additional content.4.2As ECS is currently offered to individuals or couples without an a priori risk for, and limited awareness of the disorders included in the screening panels, it is important to educate the general public about the various aspect of ECS and the type of included disorders. This study shows that an educational online video may well be an effective supportive tool to this end and may be used by health care professionals, including genetic counselors and general practitioners.4.3Although our educational video led to improved genetic knowledge compared to text, we show that surprising misconceptions about ECS may still remain. Further research may examine the effectiveness of different types and combinations of educational tools. This might include a combination of video and text, interactive web‐based learning, whether or not in combination with a brief contact with a trained counselor which might be done in person or by phone or video consultation. We believe that such studies are paramount to determine the optimal way to educate the general public on preconception ECS which is essential for responsible and effective introduction of this type of screening.5The results of our study are in line with the current era of online, visual and concise information retrieval as it shows that the use of video for educating the general public on preconception ECS and on the disorders generally included in such tests is superior to text and leads to increased genetic knowledge. Moreover, this study shows that potential uptake rates of ECS may increase with the use of video as educational tool. The success of preconception ECS programs should not be assessed merely on the uptake of screening but rather in terms of a measure of informed choice of (prospective) parents  does not apply to this study as it concerns an anonymous questionnaire study and therefore formal ethical approval was not necessary. Informed consent was obtained from participants prior to completing the online questionnaire.No non‐human animal studies were carried out by the authors for this article.The data that support the findings of this study are available from the corresponding author upon reasonable request.Appendix S1Click here for additional data file.Appendix S2Click here for additional data file.Appendix S3Click here for additional data file.


The aim of this study was to detect the optimal values for Age, Body Mass Index (BMI) and HOMA-IR of obese patients prior to surgery that results in a maximal decrease of visceral fat mass 6 months after bariatric surgery.3 experimental set-ups were designed. This study was approved by Baskent University Medical and Health Sciences Research Board . The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in three categories and at three levels; the response variable was determined as the Change in Epicardial Fat Thickness (ΔEFT).In this study, 3As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, and HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined, when Age = 38.36, BMI = 63.18, and HOMA = 14.95. The optimum ΔEFT was modeled with Contour and Response Surface plots.Based on the two surface response models used in our study, the maximal decrease of visceral fat mass as assessed by measuring echography images of epicardial fat thickness can be obtained by bariatric surgery of persons who are between 31 and 38 year old, have a BMI between 45 and 63 kg/m2 and have a HOMA-IR 34 between 15 and 35. Central Composite Design and a Box-Behnken Design of suitable patient data predicted 35 optimal settings of independent variables for the maximal clinical response of an intervention. Since biological events are under the influence of multiple factors, it is necessary to evaluate the effects of such factors together in any biological event. For this reason, factorial experiments that can examine different levels of multiple factors in tandem and also address the status of a factor at different levels of other factors widely used in the fields of biology and medicine.Considering the factors that are thought to have an effect on the response variable in the factorial experiments, it is necessary to create an appropriate experimental design and use appropriate statistical analysis methods in order to minimize the experimental error. None of the combinations tried in the a priori experimental design created may be the best. In other words, the combination that provides the highest efficiency can be found among or outside of those tried. Therefore, a large number of factor combinations are needed in the factorial experiments. However, performing experiments like this is both expensive and time-consuming. In addition, as the number of factors increases, it becomes difficult to find the homogeneous experimental materials required to test all combinations. Therefore, statistical methods that do not require performing experiments involving all combinations have been developed to find the most appropriate combination of factors. One of these methods is the response surface method. In this method the model is created with the help of regression analysis. The extent to which the main effect or interaction effect of a factor has an important effect on the values of the response variable is decided by the regression coefficients. The first step in the response surface methods is to determine the factors that are thought to have an effect on the response variable and the [effect] levels they have. These two criteria usually determine the experimental designs create the regression model . The maiEpicardial fat [adipose] tissue (EFT) is a part of visceral adiposity. It has endocrine and paracrine effects and is associated with the metabolic syndrome (MetS). EFT is located between the myocardium and the visceral pericardium . There iThe increase in obesity prevalence and the lack of success rates of options other than the surgical treatment have brought this surgical treatment to the fore. Bariatric surgical treatment is very effective in rapid weight loss. There are limited studies in the literature that examine the effect of bariatric surgical treatment on the heart in detail .In this study, small Box-Behnken and Central Composite designs were created to determine the optimum level of the Change in Epicardial Fat Thickness (ΔEFT) of patients who have lost weight through the Bariatric Surgery Method. Both designs were used for the quadratic response surface model. When we determined the group in which we optimized the parameters of Age, Body Mass Index (BMI) and HOMA that were very important in bariatric surgery, we tried to obtain the maximum benefit in the ΔEFT for the patients.There are studies showing that CCD design is superior to BBD design. However, in a clinical experiment, there is no literature in which CCD design was used in this type of study, which has never been thought of before and which we think is a guide in bariatric surgery. Our main motivation is that the findings obtained as a result of two experiments guide the decision-making mechanism of surgeons performing bariatric surgery. For this reason, CCD design cannot be ignored.This study was approved by Baskent University Institutional Review Board and Ethics Committee . In this research article prepared for journal, we: obtained the data, information and documents in the framework of academic and ethical rules; provided all the information, documents, evaluations and results in accordance with scientific ethics and moral codes; referred to all of the articles used in this study with appropriate references; have not made any changes to the data used and the results. The information and findings specified in this study are original. We declare above mentioned issues and accept all rights losses that may arise.The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The CCD and BBD experimental designs were determined before the study. Patients were constantly enrolled in the respective designs in the specified experimental set-ups. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in 3 categories and at 3 levels; the response variable was determined as the ΔEFT.A experimental design with a first-order model will have a linear structure. However, in experiments, the presence of curvilinearity may occur as a result of the curvature test. In this case, the quadratic [second-order] response surfaces analysis should be used. This model is called the quadratic response surface model and has some features ;(i) Each factor must have at least 3 levels.(ii) The model must have at least 1 + 2k + k (k-1) 2 different parameters. As a result, the experimental design should contain the data obtained from 1 + 2k + k (k-1) 2 different points.In these experiments, the point at which the dependent variable takes the maximum or minimum value is called the “stationary point” . This poThe determination of the components in the quadratic response surface method depends on the size of the coefficients given in the regression equation. The steps to be followed for the calculation of stationary points are as follows.(i) A quadratic response surface model is estimated with the help of the data obtained from the experiment [experimental].(ii) Partial derivatives are taken for each of the factors included in a model and equalized to zero. (iii) It is possible to obtain the stationary points with the help of matrices. If the given model is expressed in matrices; b1 is the model constant, b is estimate of the linear model coefficients, and In In addition; k x k dimensions. Stationary points can be obtained from If we substitute the stationary points in the main equation, ry point .λ1, λ2, …, λk show the eigenvalues to be obtained from the vector W1, W2, …, Wk denote the “canonical variables”. It can be possible to understand the properties of the stationary points obtained with the help of When a quadratic equation is found to be adequate, the canonical analysis is applied to decide about the location and structure of stationary points in a quadratic equation. The signs of the eigenvalues obtained with the help of λ1, λ2, …, λk eigenvalues are all negative, the stationary point represents the maximum point.(i) If λ1, λ2, …, λk eigenvalues are all positive, the stationary point shows the minimum point.(ii) If λ1, λ2, …, λk eigenvalues are mixed, the stationary point indicates the “saddle point” ((iii) If the signs of e point” .Initially, CCD and BBD experimental designs used in patient selection were created with the MINITAB package program  and 2. Tk two-level factorial experiments with 2k number of axis points or star points, where “k” is the number of factors. It also contains nc center points. The factors in the model should be at least two levels. The placement of the axis points in the experimental design [set-up] is given in k experiments, the curvilinearity of the system is tested with the help of the center points and the quadratic terms in the model are estimated with the help of the axis points  is one of the most popular methods for generating a quadratic response level model. The CCD consists of a combination of 2s points .These experimental design, introduced by Box and Behnken in 1980, are an effective method for constructing the quadratic response surfaces model. It is a method built on balanced incomplete block experiments. The factors to be included in the model must be at least three levels. If we try to explain the structure of the experiment with the help of a experimental design with three factors; in the Box-Behnken experimental design, while the value of one of the factors is fixed at the central value, the combinations for all levels of other factors are applied . As can x value that gives the levels of the control variables which minimize the expected squared loss error E2y2.The aim is to reach the minimum response variable. When the aim is to minimize the response variable, the target value for the Taguchi response variable is treated as if it is zero. The squared loss function is defined as : the sum of the values in the outer zone of n response variables. The SNR value will be calculated for each inner zone point.y in Equation 8.2  variables allow the researcher to change the mean without changing the variance. This analysis has two stages. First, the adjustment factors that enable the response variable to reach the target value are selected, and then the levels of other control factors that minimize the SNR value are determined. In this case, the expected squared loss error is obtained as follows \doFor cases where the standard error of the response variable is related to the mean values, a different SNR value is proposed. This is a value that can be best applied in cases where the relationship is linear . (15)\doFrom the results of these experiments, firstly, the point belonging to the factor levels providing the highest efficiency is estimated; then it is tried to determine the point in question (the combination that provides the highest efficiency), with the way to reach where the actual optimum point is or by making the steepest increase from the second-order [quadratic] by using the coefficients of the first-order response surface function of the first experimental results (the steepest ascent method).The study data belong to 40 obese patients who lost weight through the Bariatric Surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the Bariatric Surgery were evaluated in three categories and at three levels. Data from a subset of patients from Altin et al., published in 2016, were used in the current study . “VerbalIn the study, after the CCD and BBD designs were determined, patients were selected for 40 subjects who were admitted to the hospital and met the relevant criteria. The age of 40 subjects is 40.45 ± 11.30 minimum age 18 and maximum 66 years. Also, the BMI is 45.95 ± 7.51 minimum 35.06, maximum 64.47. The pre-experimental HOMA values are 8.09 ± 6.52 minimum 2.72 and maximum 38.40. In the study, weights were measured in kg, 2 digits after the comma, before and after the patients were only wearing surgical gowns. Within the scope of the study per protocol, all patients were followed during the 180-day follow-up period and the final measurements were taken. The study was carried out by providing all the assumptions of CCD and BBD experimental designs. The target is best algorithm was used in our study.The division into three categories for age, BMI and HOMA values in Forty obese patients who lost weight by the bariatric surgery between February 2015 and December 2016 were included in the study. The values of BMI, Age, and HOMA were evaluated in three categories and at three levels, and the ΔEFT was chosen as the response variable. The experimental design [set-up] was planned before the study. The study data were collected in accordance with the experimental design. The informed consent was obtained from the study participants.3  experimental designs [set-ups] were determined by CCD [design] and the contours and response plots were drawn according to the steepest ascent/descent condition.First of all, 3While planning the CCD design; the three factors were set up with α = 1.633, six axial points, four central points, and two axial center points.EFT can be identified as the echo-free space between the free [outer] wall of the myocardium and the visceral layer of the pericardium. It is measured by the standard transthoracic 2D echocardiography  in the parasternal long-axis views of three cardiac cycles at the end of the diastole and perpendicular to the right ventricular free wall as previously described . The samp; 0.041, 0.031 and 0.026, respectively). According to these results, the optimum ΔEFT combinations were determined by drawing the contour and response plots, and the model was expressed as specified in R2 value of the model was found to be 87.75%. As can be seen in When While planning the BBD design, it was established as three factors and three central points.p; 0.043, 0.040 and 0.022, respectively). According to these results, the optimum ΔEFT combinations were determined by drawing the contour and response plots, and the model was expressed as specified in R2 value of the model was found to be 91.27%. When When Today, the obesity surgery is frequently applied in developed countries around the world. Among the surgical procedures, the most preferred method is the sleeve gastrectomy. With weight loss after the bariatric surgery, a significant improvement has been observed in the chronic diseases such as hypertension, hyperlipidemia, atherosclerosis, and diabetes mellitus. This improvement is mainly related to breaking the insulin resistance. However, not all patients benefit equally from these surgical operations. Some patients benefit greatly from them, while others get more limited benefit. If it is known which patient group benefits most, these patients can be directed to the surgery in an earlier time. However, this requires advanced statistical analysis. Epicardial adipose tissue is a visceral adipose tissue, and its measurement is a good marker for these chronic diseases. The reduction in epicardial adipose tissue is a reliable parameter that can be used to determine which patient group benefits most .One of the aims of the response surface studies is to identify an appropriate function (or model) that will determine the relationship between the response variable and the input variables in order to accurately predict the future values of the response variable. Another one is to investigate the maximum or the minimum response value depending on the type of the problem and to determine the values of the input variables that can provide this value. Finally, they contribute to understanding the mechanism underlying a response system. As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined when Age = 38.36, BMI = 63.18, HOMA = 14.95. The optimum ΔEFT was modeled with the Contour and Response Surface plots. According to the results of the analysis, it was revealed that BBD analysis generated more positive results for the optimum ΔEFT than CCD, and also the optimum combinations of Age, BMI and HOMA were determined in order to reach the maximum ΔEFT.The body mass index and waist circumference are the widely accepted measurements of generalized adiposity; however, they are poor indicators for the visceral obesity. It is well-known that the visceral adipose tissue accumulation is associated with the subclinical atherosclerosis and increases the cardiovascular risk more strongly than the generalized adiposity . EmerginPatients are generally operated according to the standard bariatric surgical indications in the guidelines . However3). Age and bodyweight are pure variables, but BMI = body weight/ (body lengths) 2 [kg/m2] and HOMA-IR are indexes and in fact are hybrid variables based on the body weight and lengths and fasting blood insulin and glucose concentration, respectively.The response variable was the decrease of epicardial fat thickness as measured by echocardiography. This parameter is a one-dimensional estimate (thickness) of a three-dimensional mass of fat (cmIn our patient population the BBD analysis generated better results for the optimum ΔEFT than CCD for specific values for Age, BMI and HOMA.In conclusion, our study suggests that the weight loss after the bariatric surgery improves the cardiac functions for morbidly obese patients. Our findings showed that there was no negative change in the systolic and diastolic functions of the patients, and the myocardial performance index, which evaluates the systolic and diastolic functions together, improved. At the same time, the positive changes such as decrease in the intracardiac chronic pressure and volume load, significant decrease in the systolic and diastolic blood pressure as well as heart rate and decrease in fasting blood glucose contribute to the current recovery.10.7717/peerj.11831/supp-1Supplemental Information 1Click here for additional data file.


The objective of this study is to highlight the effect of a robotic driver assistance module of powered wheelchair (PWC), using infrared sensors and accessorizing a commercial wheelchair) on the reduction of the number of collisions in standardized circuit in a population with neurological disorders by comparing driving performance with and without assistance.This is a prospective, single-center, controlled, repeated measure design, single-blind pilot study including patients with neurological disabilities who are usual drivers of electric wheelchairs. The main criterion for evaluating the device is the number of collisions with and without the assistance of a prototype anti-collision system on three circuits of increasing complexity. Travel times, cognitive load, driving performance, and user satisfaction are also analyzed.23 Patients, 11 women and 12 men with a mean age of 48 years old completed the study. There was a statistically significant reduction in the number of collisions on the most complex circuit: 61% experienced collisions without assistance versus 39% with assistance (p = 0.038).This study concludes that the PWC driving assistance module is efficient in terms of safety without reducing the speed of movement in a population of people with disabilities who are habitual wheelchair drivers. The prospects are therefore to conduct tests on a target population with driving failure or difficulty who could benefit from this device so as to allow them to travel independently and safely. Most people with disabilities need help getting around and often use technical mobility aids. These aids can have an assistance role, such as canes or walkers or, as in the case of the use of a wheelchair, a role of supplementing the action of the lower limbs when moving. For people with significant motor limitations, an electric wheelchair may be the only solution for long and safe journeys, providing them mobility and independence. Research has documented various benefits of using a wheelchair and has highlighted particularly improved mobility, better social participation, reduced caregiver burden, and reduced likelihood of orientation in the workplace .The prevalence of people using a wheelchair tends to increase in developed countries, with an estimated range of 60 to 200 per 10,000 inhabitants , 25% of The importance of improving the quality of life, user autonomy, and social inclusion through the development of dedicated smart technologies for driving assistance has been underlined by Helal and Edwards , 15. PWCThe problems of assistance to navigation in PWC have for several years been at the heart of the research themes of many research laboratories and have been addressed during several collaborative projects such as the NavChair , Radhar The main drawback of these systems remains the final cost of the solution and the lack of clinical trials leading to technology transfer for use by end-users –24.In all the studies evaluating this type of system, safety is one of the main judgment criteria. Evaluation can be made directly by counting the number of collisions with the environment or indirectly through the measurement of success in different driving tasks, defined specifically for the needs of studies or through standardized driving scores such as WST or PIDA , 25.As part of the European ADAPT project (Assistive Devices for empowering disAbled People through robotic Technologies) , a driveThe objective of this study is to highlight the effects of this robotic driving assistance module for PWC on the reduction of the number of collisions in standardized circuits in a population suffering from neurological disorders and moving in an electric wheelchair by comparing performance with and without assistance in order to validate safety, user satisfaction, and efficiency.For ethical reasons, participants in this first study were regular wheelchair users without any difficulty who are not a priori the targets for a power wheelchair driving assistance system. The objective was to validate the assistance system before proposing it to users in difficulty. We had the assurance for these expert patients that in case of failure of the assistance system they would not lose control of their wheelchair and that the safety would therefore be maximum.Being over 18 years of age,Having benefited from a prescription for an electric wheelchair and traveling with one for more than 3 months,Having the electric wheelchair as one’s main mode of travel,Having compatible physical measurements  with the chosen chair (Quickie SALSA M2) as part of the development of the robotic assistance module,Having freely consented to participate in the study.The inclusion criteria were:Comprehension disorders that make it impossible to consent to the use of clinical results for research purposes were an exclusion criterion, as were motor disorders of the upper limb that require additional technical driving assistance (chin control for example). Likewise, patients who expressed difficulties impacting their indoor and/or outdoor driving safety and vulnerable people were excluded .This is a prospective, single-center, controlled, repeated measure design, single-blind pilot study carried out at Pole MPR St Helier, Rennes, France in June 2019, having received the agreement of the CPP Nord Ouest I on May 27th, 2019.During medical consultations, the investigating doctor presented the objectives and procedures for participating in the protocol in verbal and written forms. For patients who volunteered after a 10-day cooling-off period, the consent form was signed.Circuits (D1 ± 1 – D8 ± 1 – D15 ± 1).Circuit 1 (D1), Fig. Circuit 2 (D8), Figs. Circuit 3 D15), Fig. , Fig. 5.As part of this investigation, the patients were followed for 15 days, at a rate of 3 visits to the Pole Saint-Helier:The ADAPT project teams have defined three circuits intended to evaluate this first robotic assistance module. The circuits have been developed in collaboration with professionals in the training and evaluation of electric wheelchairs, drawing on data from the literature concerning the circuits and recommendations for evaluation ,25,27–29The purpose of these circuits is to assess the benefits of the various assistance modules designed as part of the ADAPT project.These circuits are of increasing difficulty, allowing assistance to be tested through a sequence of tasks Table , in a siThese three circuits have been created to meet specific electric wheelchair driving scenarios, corresponding to low to moderate sedan driving requirements , 28.The circuit is made up of flexible, mobile, and removable plastic walls that promote safe circulation: collision causes the structure to move.The slopes use rails specifically dedicated to PWC traffic, secured by guardrails and lined with wheel guards. The dimensions of width paths are 2 m for C1, 0.9 to 2 m for C2 and 0.75 to 1.10 m for C3.The first circuit Fig.  makes itPWC with activated assistance module,PWC with deactivated assistance module.To be able to assess the benefit of the assistance module on a PWC, the different circuits are carried out under the 2 following distinct conditions in a randomized order, known only to the engineer who programmed the assistance module and who was blinded to the evaluators and the patients.Each patient therefore performed 6 trails per circuit spread over 3 days see Fig. . Before 2 PWC, width of 62 cm from Sunrise Medical  and an on-board calculation unit connected to the sensors and to the wheelchair power module. The module’s sensors are placed in different places on the PWC:Thus, the module is not in direct contact with the user see Fig. .Fig. 6ThConstraints on the speed of the PWC are calculated from the distances measured around the chair. Deduced from the environment, these constraints are subsequently merged with the user’s command (data from the control unit) to recalculate the speed to be applied to the wheelchair to gradually modify its trajectory and to avoid collisions with the environment, while respecting the user’s intention as much as possible Fig. .With the module activated, the PWC will stop on a frontal arrival in front of a positive physical obstacle  at about fifteen centimeters. In the event of an angled arrival, the PWC will autonomously circumvent the obstacle by skirting it. At any time, the user can interrupt the assisted maneuver by releasing the control, as with the traditional PWC.The chair control module is based on the use of a license from chair electronics manufacturer Penny & Giles, obtained by INSA Rennes. The system fully reuses the safeguards provided by Penny & Giles. Thus, when the assistance is activated, the safety installed on conventional PWC consisting of stopping the wheelchair when the joystick is released is maintained. The PWC therefore stops as soon as the joystick is released.The main objective is to highlight the effect of a robotic driving assistance module for PWC on the reduction of the number of collisions in standardized circuits in a population suffering from neurological disorders and moving in an electric wheelchair by comparing performance with and without assistance.To highlight the benefit of a robotic driving assistance module on driving speed,To highlight the value of a robotic driving assistance module on driving performance while carrying out defined tasks,To measure the impact of the module on cognitive load,To assess user satisfaction.The secondary objectives were:The main endpoint is the number of collisions on different standardized circuits with and without activation of the robotic assistance module as evaluated by two independent occupational therapist evaluators. A collision is defined as a contact with real walls of the circuits. The average value over three passages for each circuit and each patient is considered. An agreement between the two evaluators is necessary to validate a collision.the speed measured by the time to complete the course with and without the activation of the assistance system on various circuits in seconds,driving performance measured by the Wheelchair Skill Test items corresponding to the different routes, with and without the activation of the assistance system the cognitive load of the tests under the 2 conditions as measured by the NASA-Task Load Index . Indeedsatisfaction with the use of PWC under the conditions as assessed by the Ease of Use Questionnaire .The secondary endpoints are:Assessments were performed before and at the end of each trials.Statistical data were analyzed using the R studio software version 4.1.0, package rstatix v.0.7.0 (2021) on paired data N = 23. Quantitative descriptive data consisted of mean and standard deviation, median, and quartiles.We used the paired samples Wilcoxon test to compare paired data as the samples were small with a 0.05 significance threshold. Furthermore, due to the small sample size, the size effect was calculated with r of Wilcoxon . There w25 Users were contacted, all accepted to enter the study. Finally, 23 completed the study. The 2 patients left the study for personal reasons . The final sample consisted of 11 women and 12 men, with a mean age of 48 years (SD 11 years). Neurological pathologies were varied: 7 spinal cord injuries with a neurological level between C7 and L1, 5 multiple sclerosis with an EDSS score upper than 6, 5 cerebral palsies with GMF score of 3 and 4, 3 peripheral neuropathies with sensori-motor tetraparesis, 2 strokes, a left hemiplegia with hemineglect and a bilateral motor deficit after multiple brain lesion with restriction of the visual field, and 1 neuromuscular disease with tetraplegia. No patient had cognitive disorders.Circuit 1: 31% of users without assistance experienced collisions vs 26%. Mean number of collision was 0.65 ± 1 without assistance and 0.3 ± 0.6 with assistance (NS).Circuit 2: 4% of users without assistance experienced collisions vs 0%. Mean number of collision was 0.04 ± 0.6 without assistance and 0 ± 0 with assistance (NS).Circuit 3: 61% of users without assistance experienced collisions vs 39%. Mean number of collision was 2 ± 2.4, median 1, without assistance and 0.65 ± 0.9, median 0, with assistance (p = 0.028) with a moerate effect size (r = 0.39) .We can therefore conclude that the assistance had a significant effect on the score by reducing the number of collisions.The mean time on course 1 was higher in the “with assistance” condition than in the “without assistance” condition (87.04 s ± 6.59 versus 85.08 s ± 3.91). This difference was significant (p = 0.024), with a moderate effect size (r = 0.43) No difference was noticed for the circuit 2 (102.04 s ± 6.79 versus 102.09 s ± 6.92).The mean time score on circuit 3 was significantly higher in the “with assistance” condition than in the “without assistance” condition (p = 0.018), with a moderate effect size (r = 0.50) (178.78 ± 16.71 versus 173.52 ± 14.62).We can therefore conclude that the assistance had a significant effect on the time to completion. The course time increased when the assistance was activated.There was no significant difference between the conditions in terms of the overall driving ability scores for either circuit .There was no significant difference between the conditions in terms of the overall cognitive load scores for either circuit .There was no significant difference between the conditions in terms of the U.S.E scores or sub-scores for either circuit .Our study reports statistically significant results on the number of collisions, leading to the conclusion that the electric wheelchair driver assistance module is effective in enhancing user safety, despite a difference in travel time. Besides the efficiency of the system, it is important to emphasize the safety aspect. The assistance system appeared to be reliable. No technical problem was observed during the tests.As this is a pilot study on a prototype power wheelchair add-on, several factors for SWADAPT1 could not be calculated. Nevertheless, the results relate to a population of 23 participants, which is relatively high in view of the data existing in the literature. The sample was heterogenous in terms of diagnosis, but each patient was his own control in the study so the pathology cannot influence the statistical final results. As part of the European ADAPT project, the driver assistance module makes it possible to navigate in safety as shown by the significant reduction in the number of collisions thanks to a system adaptable to any model of electric wheelchair based on inexpensive ultrasound technology.Previous studies have been devoted to the evaluation of anti-collision systems and have underlined the interest of such system ,24,36–39Samples were often small and do not always involved users unlike our study. Thus Sharma et al. evaluated an anti-collision assistance system for PWC in 19 healthy people blinded by a blindfold on a standardized circuit , 24. BouAn increase of mental load due to the assistance system may be a difficulty for patients suffering from cognitive disorders who are one target of the assistance module. Sharma and How assessed the mental load with the NASA-TLX, no increase of the mental load was also found ,40. How One criticism that can be made is related to the evaluation of driving on a standardized course during this first phase and not in a daily life situation. However, the on-road test of a PWC allows a precise assessment of the technical performance and/or driving capabilities of the PWC. Indeed, the use of a course for evaluating the use of a PWC has the advantage of reproducing strictly identical situations and thus of working on the precision of the trajectory, particularly on the avoidance of obstacles, on a persistent difficulty such as going through a door or on learning by repeating a course. This exercise also makes it possible to compare the capacities of users  or, in tAmong the studies regarding a tool for learning and/or evaluating the capacities for using PWCs, the method and the quality of performance of each task is observed. The travel strategy ,42,43, tAmong the studies that evaluate an “intelligent” PWC driving assistance device, priority is given to the evaluation of the system, i.e. of the performance of the wheelchair equipped with the system in the face of an obstacle, particularly on the ability to move around and maneuver , 24 by cDue to a lack of precise information in studies including course evaluations, it is difficult to reproduce the courses and scenarios presented in the literature, which has the consequence of slowing down the possibility of cross-referencing the results of studies using similar routes. Among these studies, several tools have nevertheless proved their validity and reliability: the WST-P , the PMCThis is one of the few studies to validate a driver assistance system on a sample larger than 20 with an adequate methodology.The sample size of our study remains small but it is composed of patients experienced in driving power wheelchairs. The first two circuits seem too simple for expert drivers and therefore not very discriminating. Finally, the third circuit proved to be the most suitable for determining the effectiveness of the assistance system with a fairly high effect size.Moreover this study concerns expert patients who do not need this technological solution. A validation of the clinical interest will be necessary in a second study with subjects in difficulty for power wheelchair driving.This article presents a study to evaluate the use of an electric wheelchair driver assistance system. The objective of the solution developed within the framework of the ADAPT project is to improve safety conditions when driving a PWC, to make it possible to reduce the rate of wheelchair accidents, and to facilitate access to PWC for people who are not currently eligible. The study assessed the efficiency of such a PWC driver assistance system on the driving performance of regular drivers with disabilities to ensure safety. The reduction in the number of collisions confirms the interest of such a module among its target population. This does not modify the cognitive load of driving and meets the objectives of patient satisfaction. The next step is of course the conduct of a similar study to evaluate such an assistance module in prospective users who are currently not eligible, either due to driving difficulties or to not having access to such devices for safety reasons.The authors report no conflicts of interest regarding the methods or the interpretation of the results.


Technical design features for improving the way a passive elastic filament produces propulsive thrust can be understood by analyzing the deformation of sperm‐templated microrobots with segmented magnetization. Magnetic nanoparticles are electrostatically self‐assembled on bovine sperm cells with nonuniform surface charge, producing different categories of sperm‐templated microrobots. Depending on the amount and location of the nanoparticles on each cellular segment, magnetoelastic and viscous forces determine the wave pattern of each category during flagellar motion. Passively propagating waves are induced along the length of these microrobots using external rotating magnetic fields and the resultant wave patterns are measured. The response of the microrobots to the external field reveals distinct flow fields, propulsive thrust, and frequency responses during flagellar propulsion. This work allows predictions for optimizing the design and propulsion of flexible magnetic microrobots with segmented magnetization. Sperm‐templated flexible magnetic microrobots are categorized based on the location and combination of their magnetic segments. The different magnetization profiles lead to distinct wave patterns once exposed to rotating 3D magnetic fields. This results in a variety of frequency responses, flow fields surrounding the microrobots and propulsive thrust force. The article gives indications for the design of flexible magnetic microrobots. In many cases the biological component serves to propel a synthetic structure by the internal active moment of the cell or serves as a structural template actuated by external stimuli. These biohybrid approaches offer the opportunity not only to enhance the structural flexibility of the microrobot but also to achieve higher level of biocompatibility and degradability.Swimming at low Reynolds numbers is one of the main challenges in microrobotics. Nature has provided different ways to generate fluid flow and achieve drag‐based propulsion. Spermatozoa, bacteria and other motile microorganisms owe their ability to propel themselves in a viscosity‐dominated flow regime to the transverse waves generated by their self‐propelling undulatory systems.1 Thes Soft microrobots have been developed by fabricating chains of paramagnetic particles, magnetic rods connected with flexible hinges, hydrogels with programmable motility, polymer sheets with certain magnetization profiles or elastomeric jellyfish‐like robots. Flexible biohybrid microrobots have been proposed in the past few years using DNA strands as flagella, or heart cells cultured along PDMS strips. Another method to construct a self‐propelling undulatory system involves the integration of a motile cell or microorganism to a magnetic constituent. This biohybrid approach relies on the propulsive force of the motile microorganisms and uses the external stimuli for directional control only. Creation of such types of biohybrid systems depends on trapping sperm cells inside magnetic microtubes or achieving bio‐adhesion between bacteria and particles. It is often the case that this approach yields a limited number of functional microrobots, because the underlying process is dependent on coupling of microstructures to motile cells. Further, their operation time is fundamentally limited by the cell's viability and other environmental stimuli such as temperature, pH, and medium components.Microrobots with soft bodies provide distinct advantages as opposed to their rigid counterparts. They can adapt their shape according to the rheological properties of the fluidic environment, and have reconfigurable structures and high capability for grasping and drug delivery.7, 8 Our undulatory system takes a similar biohybrid approach, but makes use of biological entities as templates. This method uses the cell body or biological structure to fabricate a flexible microrobot, and achieves distributed actuation and traveling wave propulsion under the influence of time‐varying external magnetic fields. One desirable property of this type of undulatory system is their naturally optimized design and elasticity as opposed to their artificial counterparts. Moreover, their response is dependent on the robustness of the magnetic torque that is exerted on their magnetic dipole, and their operation time is not limited by physiological environments or the lifetime of the cell. Recently, spermatozoa were self‐assembled with magnetic nanoparticles and the cells were loaded with anticancer drugs. This functionalization enables magnetic actuation and produces detectable ultrasound waves necessary to localize swarms of sperm cells.In this work, we present several undulatory systems with segmented magnetization on the cellular segments. This functionalization led to the development of a sperm‐templated microrobot that is highly compliant and the inside of its organic body enables drug loading.28 OurFigure We investigate the design features of sperm‐templated microrobots with segmented magnetization by analyzing the distributed actuation of all possible configurations that are obtained by self‐assembly of positively charged nanoparticles and negatively charged bovine sperm cells. These biohybrid microrobots are classified into distinct categories based on the magnetized cellular segments , as shown in 2 but it is not likely to improve the magnetization of the segment owing to the low amount of internalized nanoparticles compared to coated nanoparticles.A desirable approach for magnetizing the passive flagellum is to cover its surface with nanoparticles, resulting in an organic body with agglomerated magnetite particles. Even with this surface coating, loading the inside of the cell with nanoparticles through fluid phase endocytosis is possible,31 butThe surface charge of the cell dictates the location of the agglomerates and varies across cells, leading to distinct magnetization profiles along the flagellum Figure . The net allowing us to obtain agglomerates at one segment for example, as shown in Figure Possibilities range from relatively large agglomerates along the length to several small clusters distributed over several locations. The nonuniformity of the surface charge and the distribution of the nanoparticle cluster vary during the electrostatic‐based self‐assembly,28 all This diversity has evolved as a consequence of the highly variable conditions under which spermatozoa compete to fertilize, leading to sexual selection processes that are governed by the conditions in the male and female reproductive organs. The sperm diversity is large within an ejaculate, within a species and across species; this is the case because, due to the selective pressure in reproduction and because sperm cells have adapted to their specific fertilization environment. The underlying selection mechanisms for sperm diversification are addressed by a number of evolutionary biology studies. The natural diversity of sperm cells also displays multimodal propulsion . This diversity has inspired researchers to design and fabricate different types of biohybrid microrobots.The evolution of spermatozoa has led to the male gametes being the most diverse cell type in terms of size, morphology, and function.33 Thi The surface charge of the cell is an important factor in the determination of the magnetization profile of the sperm‐templated microrobots. Magdanz et al. have demonstrated that bovine sperm cells show nonuniform charge distribution and negative overall net charge. Thus, coating the negatively charged areas along the cell with positively charged particles allows various cellular segments to be selectively magnetized. This self‐assembly process between the negatively charged bovine spermatozoa and positively charged iron oxide particles results in various configurations  or not ( mi =  0), we obtain fifteen categories, where mi is the magnetization of the ith segment along the cell. The eight samples in see Figure As previously mentioned, the surface charge of spermatozoa varies throughout the cell and also during the differentiation and maturation of sperm cell.36 The Therefore, separation of sperm by their net surface charge has been proposed as a method for in vitro sperm selection. Typically, a sample contains sperm cells with various surface properties. Figure −10 g per cell, followed by the microrobots with three magnetic segments containing an average of 8.8  × 10−10 g per cell, the category with two magnetic segments with 5  × 10−10 and 3.1  × 10−10 g per cell for microrobots with one magnetic segment.The likelihood of having any of these fifteen categories depends on many factors. The first is the nonuniform charge distribution along the surface of the sperm cells. The sperm head contains the acrosomal area which is important for oocyte fusion, while the midpiece carries many mitochondria. The second is the different types of proteins, glycoproteins, and lipids within the membrane of the cells. Both factors affect the number of each category per sample. However, the surface charge also changes during the lifetime of a cell, and is dependent on its developmental state and quality.37 The3Figure We consider a sperm cell with nanoparticle clusters attached along its length  enclosed between the local tangent (t) and the head axis e1 along the arc length s, and the amplitude y that is measured in the frame of reference , as shown in Figure mi. The distance between these segments is small compared to any change in the actuating magnetic field. Therefore, the magnetization of each segment is dependent on the same field, B, and trails behind when it periodically oscillates under the action of the following magnetic torqueTi is the magnetic torque exerted on the ith segment along the cell, and iv is the volume of its magnetic material. Further, na and nr are demagnetization factors along the axis of symmetry and radial direction of the nanoparticle cluster, respectively, which characterize the magnetic susceptibility and the relative permeability. μ0 is the permeability of free space and θ is the angle between the local tangent along s (at the position of the cluster) and external magnetic field , as shown in Figure To produce flagellar propulsion, we must generate a magnetization which is dependent on the applied magnetic field, d Figure . Figure ex can be used to propel the cell in low‐Re. The bent region trails behind the rotating field and initiates transverse bending waves near the middle of the cell. Because the proximal and distal ends of the cells are free, the amplitude near the free ends becomes progressively smaller. Other types of microrobots use the same rotating field to propel in low‐Re. Figure When the magnetic field is applied, the 0010 cell is magnetized at its principal piece, leading to a bent region along the passive flagellum where particles adhere to the cell. Figure e1). These fields enable the microrobot to have comparable flagellar propulsion with that of live sperm cells through a propagation of waves that is governed by two sets of forces. The first is the elastic forces (Fel) which tend to restore the natural shape of the flagellum and is given byFel is the elastic force on an element dl and κ is the bending stiffness of the flagellum. The distribution of bending moment M along the flagellum describes the active bending generated by the magnetized segment when the external magnetic field is applied and periodically varied. The second is that of the viscous forces (Fvisc) which opposes the motion and is calculated as followsξ⊥ is the normal drag coefficient, and dFvisc is linearly proportional to the velocity of the segment dl due to the low‐Re characteristic of the flagellar propulsion in a fluid with viscosity η. The elastic (2) and viscous (3) forces can only influence a segment along the flagellum owing to the low‐Re characteristics of the medium and absence of other external forces such as magnetic forces (uniform field is used for actuation) and interactions. Therefore, the elastic force on a segment dl must equal the viscous force, and by combining Equations  is the position vector of flagellum centerline with respect to the material frame of reference (e1(t),e2(t)). Further, r(t) is the position of the center of the sperm head and 2a is its major diameter  and U∥ are the normal and tangential velocity components on the segment dl, respectively  and ξ∥ is the tangential drag coefficient. Each segment dl along the length (L) of the flagellum pushes laterally against its surrounding by drag force ξ⊥U⊥ and parallel to its length with drag force ξ∥U∥. Therefore, for a given propagating wave along the flagellum, the average thrust force is determined over the length and one period of oscillation, where 〈 · 〉 denotes averaging over one period of oscillation. This force completes the relation between the magnetic actuation of a particular magnetic segment along the flagellum and the generated propulsive thrust.The steady‐state solution of Equation  characte44(5)3.2N responses due to N spread‐out point forcesU∥ and U⊥ are tangential and normal velocities of the segments at point r0 along the flagellum or any point in fluid, resulting from the superposition of N tangential and normal forces, fn,k∥ and fn,k⊥. The regularized Green's function Sknε depends only on the relative distance between the observation point of the velocity and application point of the force, ε determines the amount of spread‐out for the superposition, and nA is the quardature weight of the nth application point. In this regularized Stokeslets theory, the tangential and normal velocities are known based on the kinematics of the flagellum at any point along the arc length s. The tangential, U∥=·t)t, and normal, U⊥=r˙−U∥, components are determined directly from the balance between the elastic and drag forces given by Equations quations . Under mFigure Lf). The flow field increases toward the distal end of the cell when the bending wave is initiated at the head (1000 cell), as shown in Figure ex), as shown in Figure ex and ey and will likely exhibit low linearity, leading to reduced net propulsion.Like 1000 and 0001 cells, actuation of the principal piece results in relatively higher flow fields at the distal end Figure . Therefoex compared to 0110 cells, as shown in Figure ex. Again, like the case of 1000 and 0010 cells, the flagellar beat patterns of 1100 and 0011 cells are quite different, leading to distinct flow fields. Figure ex. Figure Figure When the number of particle agglomerates is increased to three segments, the behavior of the microrobot becomes increasingly dependent on the location of the nonmagnetic region. Figure In contrast to magnetically actuated microrobots, the adenosine triphosphate (ATP) driven live sperm cells exhibit flagellar propulsion and produce flow fields with gradually increasing velocity toward the free distal end of the flagellum , of bending moment affects the resulting wave pattern, as shown in Figure K0), bending amplitude (A0), and wavelength (λ). These wave parameters are calculated by the Fourier decomposition of the calculated tangent angle, φ. Since the wave variables kinematically prescribe the deformation of the passive flagellum, we also calculate the propulsive thrust for each case using Equation . In this case, the induced magnetic moment at the head trails behind the rotating magnetic field, leading to rotation about Figure λω/(2π) of 0.45 and 0.22 mm s−1 for 1000 and 0001 cells, respectively. The difference in wave propagation rate is attributed to the elastic properties of the distant part from the actuated boundary. Actuation of the head enables the wave to propagate along the principal piece and the distal end, while rotation of the distal end enables the waves to propagate along the principal piece, midpiece and the head. The elastic properties of these parts of the cells are different as the bending stiffness decreases with the length. The flagellum tapers over the length and the stiffness decreases toward the distal end. Therefore, in the case of 1000 cells, the wave propagates along the direction of decreasing stiffness, while for 0001 cells the propagation is along the direction of increasing stiffness.Now consider the case where the cell is covered with particles at the principal piece (0010 cells) and the proximal and distal ends are free from external force and torque. In this case, waves initiate near the middle of the cell and propagates along opposite directions toward the head and the distal end. Figure K0, A0, and λ for the four microrobots with single magnetic cellular segment. The flagellar pattern of the microrobots can be greatly influenced by the location of the magnetized segment along the flagellum, leading to relatively higher average thrust force for 1000 cells compared to 0010 cells. Similar to the fluid response, we use the measured wave pattern to determine the time‐averaged bending moment along the passive flagellum. Figure M/(ηUL2), of type 1000 and 0001 cells for each measured time‐dependent deformation. Figure Figure 4.2Figure The heterogeneity of the surface charge along the cell enables surface‐coating along several segments. Therefore, there is another set of possible microrobot designs with two magnetic segments (see Video S6 in the Supporting Information). 0110 cells consist of magnetic elements along the midpiece and the principal piece. Even without a magnetic element on the head, the rigid connection between the midpiece and the head enables the proximal end of the cell to rotate in sync with the actuating field. Re. Additional two possible categories of microrobots with two magnetic segments include 0011 and 1100 cells 1/4 , and the amplitude of the wave pattern scales with the actuation frequency. A summary of the hydrodynamic parameters can be found in Table S1 in the Supporting Information.In the case of four magnetic cellular segment along 1111 cells, we also observe wave propagation along one direction, as shown in Figure w = κ/ωξ⊥1/4 , between magnetic field and local tangent vector t. The field magnetizes the agglomerate to a magnetization mi, lying between B and the local tangent t and the angle between mi and t was φ∈. A rotating field at frequency of oscillation ω enables mi to trail behind, leading to local bent at the ith segment along the flagellum and wave propagation. The force exerted on the fluid by the flagellum at a point s was proportional to the velocity of the neutral line rU∥ and U⊥ were obtained by separating r˙ into components lying along the directions tangential and normal to the flagellum centerline at a point s, respectively. The drag coefficients used for computing the force are given byThe head of the cell was attached to a midpiece and connected to a flexible flagellum of length mi=1μ0XaiB, where Xai is the susceptibility of the ith cellular segment and is approximated as followsnai and nri are the demagnetization factors along the axial and radial directions of the ith cellular segment, respectively.Note that the relation between the magnetization of cellular segment and the magnetic field is given by, s follows39(10φ0) and first (φ1) Fourier modes as followsφ1∗(s) is the complex conjugate of the first Fourier mode. The zeroth mode characterizes the averaged mean shape of the magnetically actuated flagellum ( φ∼0=K0s), while its bending amplitude (|φ1| = A0 s) and wave propagation speed (arg(φ1)) are characterized by the magnitude of the complex conjugate of the first Fourier mode. The microrobots were to achieve swim and the flagellar beat patterns were measured using a microscopic unit . Videos are acquired using a camera  and a 3 × Mitutoyo phase objective. The time‐dependent deformation, r, is measured by discretizing the flagellum over three consecutive beat cycles at actuation frequency (ω  =  2πf) of 1 Hz. From the Fourier decomposition of r, the mean flagellar curvature K0, amplitude rise A0, and wavelength λ were determined. These parameters characterize the shape of the flagellar beat and RFT obtains the total force of the flagellum.The flagellum is characterized by the tangent angle that is governed by Equations  and 5),,5), and L and 5.6L for microrobots with one and four magnetized cellular segments, respectively. Therefore, the interactions between flows induced by different parts of the flagellum can be neglected and RFT was used to predict the thrust force. The local unit tangent  = dφ/ds ) and normal vectors ) at each discretized segment were calculated along the flagellum. The velocity along the local tangent was calculated as U∥=·t)t and the normal velocity was calculated using U⊥=r˙−U∥. RFT predicts the thrust by integrating the local forces on each segment using Equation . Videos were acquired using a camera  and a 3 × Mitutoyo phase objective. Regardless of the magnetic moment of the samples, rotating magnetic field was applied to determine the frequency response of all groups. The propulsion axis (long axis of the head) of the microrobots aligns with the rotation axis of the magnetic field. To avoid near‐surface effect on the helical propulsion, the axis of rotation of the applied magnetic field was controlled to have a nonzero pitch angle . This angle enables the samples to swim upward away from the surface and from the nanoparticle aggregates. Once located away from the solid boundary of the reservoir, the helical propulsion of the microrobots was measured for frequency range of 1–20 Hz. The steering angle  was used to control the position of microrobots within the same field of view of the microscopic system. In each trial, the samples were controlled using the pitch and steering angles of the field and the velocity was determined at each actuation frequency from a flagellar swim over 5–10 body lengths.U〉, of the flow fields of all groups was normalized by the product of the length of the sperm cell and the actuation frequency, Lf. The distributed bending moment, M(x), of all groups was normalized by the product of the viscosity, velocity, and squared length of the cell, ηUL2. The time‐averaged 〈M/ηUL2〉 was determined for each group from a complete beat cycle based on the total number of captured frames. Each flagellar wave pattern was represented using equally‐spaced measured positions along the centerline. Polynomial regression was used to model the amplitude as a third degree function of x in MATLAB software . The tangent angle along the arc length of the determined polynomials was used in the Fourier analysis of the wave pattern to determine the average K0, A0, and λ.All values are presented as mean ± standard deviation (S.D.). The numbers of samples in the 1000 and 0010 cells were thirteen and eleven, respectively, and those of the samples 1100, 0011, and 0101 cells were three, nine, and three, respectively. The number of samples in the 1101 cells were four, the number of samples in 1110 and 1111 cells were four, and that of all the other groups  was five. The time‐averaged velocity, 〈The authors declare no conflict of interest.Supporting InformationClick here for additional data file.Supplemental Video 1Click here for additional data file.Supplemental Video 2Click here for additional data file.Supplemental Video 3Click here for additional data file.Supplemental Video 4Click here for additional data file.Supplemental Video 5Click here for additional data file.Supplemental Video 6Click here for additional data file.Supplemental Video 7Click here for additional data file.Supplemental Video 8Click here for additional data file.


N-soft set (Decision-making methods play an important role in the real-life of human beings and consist of choosing the best options from a set of possible choices. This paper proposes the notion of complex Fermatean fuzzy  Multi-attribute decision-making (MADM) methods play an important role in the real life of human beings. The process of choosing the best option among a set of possible options is present in all human activities. Decision making in the domain of crisp sets to handle exact and precise data has been a growing field of research for mathematicians.Given the dubious and erroneous nature of human decisions, the limitations of decision making in the area of crisp set have gained importance over time. Zadeh  was the Undoubtedly, FS theory allows to work with unsettling analysis in the field of decision making. Nevertheless, FS theory could not assess the nature of satisfaction and dissatisfaction with human decisions. To salvage these shortcomings, Atanassov  extendedIn 2013, Yager , 2013b and Yager  developeAforementioned models were not applicable in 2-dimensional problems. Thus, Ramot et al.  introducThe idea of soft sets  was proposed by Hwang and Yoon  to solvearaaslan  adapted n et al.  extendedThe comparison of proposed and existing techniques based on TOPSIS method, according to their characteristics, is arranged in Table The idea of The brilliant models of CIFS and CPFS are competitive frameworks for capturing the 2-dimensional vague data simultaneously. But they also have some restrictions due to the inadequacy of ranking based criteria.Moreover, the The decision-making technique based models Further, the novel idea of Classical TOPSIS technique is specifically devised to determine the optimal solution based on the assessed closeness of the preferences choices from the ideal solution. But this hypothetical technique must be altered to tackle the ordered graded obscurity and vagueness of inexact information.Because of all these constraints motivated us to put forward the idea of a ground-breaking hybrid model called The motivation of the proposed hybrid model is given by the following facts:The essence of the first part of this article is to propose the hybrid model of On the other hand, we revamp the TOPSIS approach for the environment of The article sets up a new theory of The algorithms are developed to tackle multi-attribute decision making problems by using numerical examples.The comparative analysis with This research also accomplishes a MAGDM technique, namely The proposed technique is corroborated by a numerical example related to selecting the most suitable city in the USA for farming.The We summarize the main contributions of our research work as follows: From this point on, the paper is organized as follows. Section U be a universe of discourse under consideration and soft set over U if (Molodtsov ) Let U bU be a universe of discourse and S on U if  Let U bU be a universe of discourse. An FFS E on U is defined as an object of the formE.(Senapati and Yager ) Considecomplex Fermatean fuzzy set  U,  is characterized by the membership and non-membership functions A The term U be a universal set and U. A pair S over U, where Let U be a universal set and CFF N-soft set  process for the constructed model. Firstly, we construct the procedures as shown in Algorithms 1–3 for problems that are described by Selection of a car is a difficult task for an auto broker. Productive selection is possible only when there is an essential matching. By choosing the best car, the auto broker will get quality performance. In Example Choice value (CV) of CFF5SWe can calculate the CV of CFF5From Table L-Choice value (L-CV) ofCFF5SL and will calculate the CV by using Algorithm 2, whereNow, we will choose the threshold In Table Comparison table ofCFF5SComparison table is a square table in which rows and columns are represented by the name of objects of universe such as Membership and non-membership values of Table The comparison table of Table The result will be derived by subtracting the row and column sum of Table From Table five four three two one The set of grades 0 stands for 1 stands for 2 stands for 3 stands for 4 stands for 5 stands for Since due to COVID-19, everything has shifted to the online mode. So, the usage of the internet has increased. Due to that, in market, the competition among different network provider companies has been tough day by day. All companies are presenting different internet packages according to the needs of the customers. So, it’s a difficult task for customers to choose the sim card of the best telecommunication company. Suppose that a student, in Pakistan, decides to purchase a new sim card to attend online classes. Before buying the sim, the student has collected some relevant rating based information related to the internet packages and internet speed about five different network companies such as Zong, Ufone, Telenor, Jazz, and Warid. Each network company has different prices of internet packages depending on time as well. Let Based on the overall qualities of the network companies, the student gives evaluation scores to the sim cards which is shown as Table Although it is easy to extract the grade data in actual information, the data possess the fuzzy uncertainty characteristics. In order to address the ambiguity of data, we construct Choice value (CV) ofCFF6SWe can calculate the CV of CFF6From Table L-Choice value (L-CV) of CFF6SL value will be chosen and the results are given by Table Now, by using the second procedure as given by Algorithm 2, In Table Comparison table of CFF6SNow to apply the third procedure as shown in Algorithm 3, membership and non-membership values of Table The comparison table of Table The result will be derived by subtracting the row and column sum of Table From Table Step 1. The membership and non-membership terms of amplitude part are the same as given in Table Step 2. Let Step 3. The entries of aggregated values Step 4. The entries of aggregated values Step 5. The score of each executed value from To certify the rationality of our proposed model, we solve the same example “Selection of the best cellular telecommunication company in Pakistan” using We present a comparative study with existing MADM techniques, namely, According to Table Figure Our proposed approaches provide the most comprehensive and adaptable methodologies because they effectively incorporate the existing proficient MADM methods, namely, In this section, we aim to renovate the TOPSIS approach for the environment of l distinct experts which are appointed for the selection of best alternative from Let Step 1. Firstly, decision-makers will give grades corresponding to the linguistic terms according to the importance of alternatives on the basis of attributes. Then each expert l decision-experts as follows: Each entry of the Step 2. For MAGDM, the individual opinions of the decision-makers are organized to have a generic opinion of all experts about an alternative related to the attributes. This directs to the formation of aggregated Step 3. The attributes nominated by experts may not be equally important and valuable in a MAGDM problem. Therefore, each decision-maker ranks these attributes and assigns a Step 4. Construct the aggregated weighted Step 5. Let Step 6. Now, to find the optimal alternative which is away from Step 7. To find the most suitable alternative, we compare the alternative by some ranking index. The revised closeness index  method, proposed by Senapati and Yager , to authStep 2. The score of all FF numbers (FFNs) are determined to identify the Fermatean fuzzy positive and negative ideal solutions. The score of a FFN can be calculated by the following formula (Senapati and Yager Step 3. Distance of each alternative Step 4. To find out the most suitable alternative, Table Step 5. The increasing order ranking of cities is shown by Table Now, we present a comparison of the proposed technique with the existing FF-TOPSIS method (Senapati and Yager A comparison chart is designed in Figure It is clear from the figure that both techniques elucidate the same outcome and ranking order that indicates the feasibility and sustain-ability of the presented technique.Our proposed Due to the inadequacy of multi-valued grades and periodic terms, FF-TOPSIS cannot deal with In the modern era, the performance appraisal system is commonly used for the rating of restaurant management, schools, candidates for job, online services, online applications, products and websites, etc. The proposed model is designed to handle the rating-based assessment framework along with imprecise and vague two-dimensional information.In this article, the robust technique of The proposed model shows the same accuracy when applied to the existing models inclusive of FF, CIF, CPF, N-soft set. We have advanced a model, Decision-making methods play an important role in the real life of human beings. The process of choosing the best option among a set of possible options is present in all human activities. In this paper, a new theory has been developed that serves as a mathematical tool which deals with the two-dimensional vague information, and which is a generalization of the fuzzy Moreover, we have accomplished three algorithms to resolve multi-attribute decision-making problems. These algorithms have been validated by two real-life examples related to the selection of cars and the selection of the best telecommunication company in Pakistan.Furthermore, in order to analyze the validity, feasibility, and reliability of the proposed model, we have conducted a comparative study of our approach with two operators: the N-soft grading values as well as complex membership and non-membership values. The basic principle of the With respect to the proposed In the presented approach, the primary information has been equipped by ordered grades and their corresponding Along with beneficial characteristics of the proposed technique based on TOPSIS method for MAGDM problems in two-dimensional data, it ensures the same level of authenticity under Fermatean fuzzy environment by eliminating the grades and substituting phase terms equal to zero. On the contrary, the adeptness of the FF-TOPSIS method is restricted to handle one dimensional phenomena, also it is unable to deal with MAGDM problems.Moreover, the proposed