Search results for: negative media influence
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 14185

Search results for: negative media influence

565 A Framework for Teaching the Intracranial Pressure Measurement through an Experimental Model

Authors: Christina Klippel, Lucia Pezzi, Silvio Neto, Rafael Bertani, Priscila Mendes, Flavio Machado, Aline Szeliga, Maria Cosendey, Adilson Mariz, Raquel Santos, Lys Bendett, Pedro Velasco, Thalita Rolleigh, Bruna Bellote, Daria Coelho, Bruna Martins, Julia Almeida, Juliana Cerqueira

Abstract:

This project presents a framework for teaching intracranial pressure monitoring (ICP) concepts using a low-cost experimental model in a neurointensive care education program. Data concerning ICP monitoring contribute to the patient's clinical assessment and may dictate the course of action of a health team (nursing, medical staff) and influence decisions to determine the appropriate intervention. This study aims to present a safe method for teaching ICP monitoring to medical students in a Simulation Center. Methodology: Medical school teachers, along with students from the 4th year, built an experimental model for teaching ICP measurement. The model consists of a mannequin's head with a plastic bag inside simulating the cerebral ventricle and an inserted ventricular catheter connected to the ICP monitoring system. The bag simulating the ventricle can also be changed for others containing bloody or infected simulated cerebrospinal fluid. On the mannequin's ear, there is a blue point indicating the right place to set the "zero point" for accurate pressure reading. The educational program includes four steps: 1st - Students receive a script on ICP measurement for reading before training; 2nd - Students watch a video about the subject created in the Simulation Center demonstrating each step of the ICP monitoring and the proper care, such as: correct positioning of the patient, anatomical structures to establish the zero point for ICP measurement and a secure range of ICP; 3rd - Students train the procedure in the model. Teachers help students during training; 4th - Student assessment based on a checklist form. Feedback and correction of wrong actions. Results: Students expressed interest in learning ICP monitoring. Tests concerning the hit rate are still being performed. ICP's final results and video will be shown at the event. Conclusion: The study of intracranial pressure measurement based on an experimental model consists of an effective and controlled method of learning and research, more appropriate for teaching neurointensive care practices. Assessment based on a checklist form helps teachers keep track of student learning progress. This project offers medical students a safe method to develop intensive neurological monitoring skills for clinical assessment of patients with neurological disorders.

Keywords: neurology, intracranial pressure, medical education, simulation

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564 Carbon-Supported Pd Nano-Particles as Green Catalysts for the Production of Fuels from Biomass

Authors: Andrea Dragu, Solen Kinayyigit, Valerie Colliere, Karin Karin Philippot, Camelia Bala, Vasile I. Parvulescu

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The production of transportation fuels from biomass has gained a growing attention due to diminishing fossil fuel reserves, rising petroleum prices and increasing concern about global warming. In recent years, renewable hydrocarbons that are completely fungible with fossil fuels have been suggested to be efficiently produced by catalytic deoxygenation of fatty acids and their derivatives viadecarboxylation / decarbonylation. Several triglycerides (tall oil fatty acids) and saturated/unsaturated fatty acids and their corresponding esters were used as feedstocks. Their impact together with the influence of the reaction conditions and the catalyst composition on the nature of the reaction pathways of the deoxygenation of vegetable oils and their derivatives were recently reviewed. Following this state of the art the aim of the present study was the investigation of Pd NPs deposited onto mesoporous carbon supports as active and stable catalysts for the deoxygenation of oleic acid. The catalysts were prepared by the deposition of Pd NPs synthesised following an organometallic route on mesoporous carbons with different characteristics. Experiments were carried out under both batch and flow conditions. They demonstrated that under batch conditions (200 atm; 573K), the extent of the reaction depended, firstly, on the Pd loading and then on the metal dispersion and the oxidation state of palladium, both influenced by the way the support has been treated before the NPs deposition and by the preparation/stabilization methodology of Pd NPs. No aromatic compounds were detected in the reaction products but octadecanol and octadecane were observed in large extents. Under flow conditions (4 atm; 573 K), the conversion of stearic acid was superior to that observed in batch conditions. The product mixture contained over 20% heptadecane. No octadecanol, octadecane, and aromatic compounds were detected. The maxima in performances are obtained after only 0.5 h. After that, the yields in heptadecane suffer from a severe decrease until 3h reaction time. However, at that time, stopping feeding the reactor with oleic acid and flushing the catalyst only with mesitylene recovered the activity and the selectivity of the catalysts. With the complete removal of H2, the analysis revealed the presence of heptadecene in high excess compared to heptadecane (almost 7 to 1), thus suggesting decarbonylation as the main route. ICP-OES measurements indicated no leaching of palladium and simple washing of catalysts with mesitylene allowed recycling without any change in conversion or product distribution. Noteworthy, mesitylene as solvent exhibited no effect in this reaction. In conclusion, this study demonstrates the feasibility of such catalysts for the green production of fuels from biomass.

Keywords: fuels from biomass, green catalyst, Pd nano-particles , recycble catalyst

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563 The Impact of Emotional Intelligence on Organizational Performance

Authors: El Ghazi Safae, Cherkaoui Mounia

Abstract:

Within companies, emotions have been forgotten as key elements of successful management systems. Seen as factors which disturb judgment, make reckless acts or affect negatively decision-making. Since management systems were influenced by the Taylorist worker image, that made the work regular and plain, and considered employees as executing machines. However, recently, in globalized economy characterized by a variety of uncertainties, emotions are proved as useful elements, even necessary, to attend high-level management. The work of Elton Mayo and Kurt Lewin reveals the importance of emotions. Since then emotions start to attract considerable attention. These studies have shown that emotions influence, directly or indirectly, many organization processes. For example, the quality of interpersonal relationships, job satisfaction, absenteeism, stress, leadership, performance and team commitment. Emotions became fundamental and indispensable to individual yield and so on to management efficiency. The idea that a person potential is associated to Intellectual Intelligence, measured by the IQ as the main factor of social, professional and even sentimental success, was the main problematic that need to be questioned. The literature on emotional intelligence has made clear that success at work does not only depend on intellectual intelligence but also other factors. Several researches investigating emotional intelligence impact on performance showed that emotionally intelligent managers perform more, attain remarkable results, able to achieve organizational objectives, impact the mood of their subordinates and create a friendly work environment. An improvement in the emotional intelligence of managers is therefore linked to the professional development of the organization and not only to the personal development of the manager. In this context, it would be interesting to question the importance of emotional intelligence. Does it impact organizational performance? What is the importance of emotional intelligence and how it impacts organizational performance? The literature highlighted that measurement and conceptualization of emotional intelligence are difficult to define. Efforts to measure emotional intelligence have identified three models that are more prominent: the mixed model, the ability model, and the trait model. The first is considered as cognitive skill, the second relates to the mixing of emotional skills with personality-related aspects and the latter is intertwined with personality traits. But, despite strong claims about the importance of emotional intelligence in the workplace, few studies have empirically examined the impact of emotional intelligence on organizational performance, because even though the concept of performance is at the heart of all evaluation processes of companies and organizations, we observe that performance remains a multidimensional concept and many authors insist about the vagueness that surrounds the concept. Given the above, this article provides an overview of the researches related to emotional intelligence, particularly focusing on studies that investigated the impact of emotional intelligence on organizational performance to contribute to the emotional intelligence literature and highlight its importance and show how it impacts companies’ performance.

Keywords: emotions, performance, intelligence, firms

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562 Efficiency of Different Types of Addition onto the Hydration Kinetics of Portland Cement

Authors: Marine Regnier, Pascal Bost, Matthieu Horgnies

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Some of the problems to be solved for the concrete industry are linked to the use of low-reactivity cement, the hardening of concrete under cold-weather and the manufacture of pre-casted concrete without costly heating step. The development of these applications needs to accelerate the hydration kinetics, in order to decrease the setting time and to obtain significant compressive strengths as soon as possible. The mechanisms enhancing the hydration kinetics of alite or Portland cement (e.g. the creation of nucleation sites) were already studied in literature (e.g. by using distinct additions such as titanium dioxide nanoparticles, calcium carbonate fillers, water-soluble polymers, C-S-H, etc.). However, the goal of this study was to establish a clear ranking of the efficiency of several types of additions by using a robust and reproducible methodology based on isothermal calorimetry (performed at 20°C). The cement was a CEM I 52.5N PM-ES (Blaine fineness of 455 m²/kg). To ensure the reproducibility of the experiments and avoid any decrease of the reactivity before use, the cement was stored in waterproof and sealed bags to avoid any contact with moisture and carbon dioxide. The experiments were performed on Portland cement pastes by using a water-to-cement ratio of 0.45, and incorporating different compounds (industrially available or laboratory-synthesized) that were selected according to their main composition and their specific surface area (SSA, calculated using the Brunauer-Emmett-Teller (BET) model and nitrogen adsorption isotherms performed at 77K). The intrinsic effects of (i) dry powders (e.g. fumed silica, activated charcoal, nano-precipitates of calcium carbonate, afwillite germs, nanoparticles of iron and iron oxides , etc.), and (ii) aqueous solutions (e.g. containing calcium chloride, hydrated Portland cement or Master X-SEED 100, etc.) were investigated. The influence of the amount of addition, calculated relatively to the dry extract of each addition compared to cement (and by conserving the same water-to-cement ratio) was also studied. The results demonstrated that the X-SEED®, the hydrated calcium nitrate, the calcium chloride (and, at a minor level, a solution of hydrated Portland cement) were able to accelerate the hydration kinetics of Portland cement, even at low concentration (e.g. 1%wt. of dry extract compared to cement). By using higher rates of additions, the fumed silica, the precipitated calcium carbonate and the titanium dioxide can also accelerate the hydration. In the case of the nano-precipitates of calcium carbonate, a correlation was established between the SSA and the accelerating effect. On the contrary, the nanoparticles of iron or iron oxides, the activated charcoal and the dried crystallised hydrates did not show any accelerating effect. Future experiments will be scheduled to establish the ranking of these additions, in terms of accelerating effect, by using low-reactivity cements and other water to cement ratios.

Keywords: acceleration, hydration kinetics, isothermal calorimetry, Portland cement

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561 Characterization of the Lytic Bacteriophage VbɸAB-1 against Drug Resistant Acinetobacter baumannii Isolated from Hospitalized Pressure Ulcers Patients

Authors: M. Doudi, M. H. Pazandeh, L. Rahimzadeh Torabi

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Bedsores are pressure ulcers that occur on the skin or tissue due to being immobile and lying in bed for extended periods. Bedsores have the potential to progress into open ulcers, increasing the possibility of variety of bacterial infection. Acinetobacter baumannii, a pathogen of considerable clinical importance, exhibited a significant correlation with Bedsores (pressure ulcers) infections, thereby manifesting a wide spectrum of antibiotic resistance. The emergence of drug resistance has led researchers to focus on alternative methods, particularly phage therapy, for tackling bacterial infections. Phage therapy has emerged as a novel therapeutic approach to regulate the activity of these agents. The management of bacterial infections greatly benefits from the clinical utilization of bacteriophages as a valuable antimicrobial intervention. The primary objective of this investigation consisted of isolating and discerning potent bacteriophage capable of targeting multi drug-resistant (MDR) and extensively drug-resistant (XDR) bacteria obtained from pressure ulcers. In present study, analyzed and isolated A. baumannii strains obtained from a cohort of patients suffering from pressure ulcers at Taleghani Hospital in Ahvaz, Iran. An approach that included biochemical and molecular identification techniques was used to determine the taxonomic classification of bacterial isolates at the genus and species levels. The molecular identification process was facilitated by using the 16S rRNA gene in combination with universal primers 27 F, and 1492 R. Bacteriophage was obtained through the isolation process conducted on treatment plant sewage located in Isfahan, Iran. The main goal of this study was to evaluate different characteristics of phage, such as their appearance, range of hosts they can infect, how quickly they can enter a host, their stability at varying temperatures and pH levels, their effectiveness in killing bacteria, the growth pattern of a single phage stage, mapping of enzymatic digestion, and identification of proteomics patterns. The findings demonstrated that an examination was conducted on a sample of 50 specimens, wherein 15 instances of A. baumannii were identified. These microorganisms are the predominant Gram-negative agents known to cause wound infections in individuals suffering from bedsores. The study's findings indicated a high prevalence of antibiotic resistance in the strains isolated from pressure ulcers, excluding the clinical strains that exhibited responsiveness to colistin.According to the findings obtained from assessments of host range and morphological characteristics of bacteriophage VbɸAB-1, it can be concluded that this phage possesses specificity towards A. Baumannii BAH_Glau1001 was classified as a member of the Plasmaviridae family. The bacteriophage mentioned earlier showed the strongest antibacterial effect at a temperature of 18 °C and a pH of 6.5. Through the utilization of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis on protein fragments, it was established that the bacteriophage VbɸAB-1 exhibited a size range between 50 and 75 kilodaltons (KDa). The numerous research findings on the effectiveness of phages and the safety studies conducted suggest that the phages studied in this research can be considered as a practical solution and recommended approach for controlling and treating stubborn pathogens in burn wounds among hospitalized patients.

Keywords: acinetobacter baumannii, extremely drug- resistant, phage therapy, surgery wound

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560 From Clients to Colleagues: Supporting the Professional Development of Survivor Social Work Students

Authors: Stephanie Jo Marchese

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This oral presentation is a reflective piece regarding current social work teaching methods that value and devalue the lived experiences of survivor students. This presentation grounds the term ‘survivor’ in feminist frameworks. A survivor-defined approach to feminist advocacy assumes an individual’s agency, considers each case and needs independent of generalizations, and provides resources and support to empower victims. Feminist ideologies are ripe arenas to update and influence the rapport-building schools of social work have with these students. Survivor-based frameworks are rooted in nuanced understandings of intersectional realities, staunchly combat both conscious and unconscious deficit lenses wielded against victims, elevate lived experiences to the realm of experiential expertise, and offer alternatives to traditional power structures and knowledge exchanges. Actively importing a survivor framework into the methodology of social work teaching breaks open barriers many survivor students have faced in institutional settings, this author included. The profession of social work is at an important crux of change, both in the United States and globally. The United States is currently undergoing a radical change in its citizenry and outlier communities have taken to the streets again in opposition to their othered-ness. New waves of students are entering this field, emboldened by their survival of personal and systemic oppressions- heavily influenced by third-wave feminism, critical race theory, queer theory, among other post-structuralist ideologies. Traditional models of sociological and psychological studies are actively being challenged. The profession of social work was not founded on the diagnosis of disorders but rather a grassroots-level activism that heralded and demanded resources for oppressed communities. Institutional and classroom acceptance and celebration of survivor narratives can catapult the resurgence of these values needed in the profession’s service-delivery models and put social workers back in the driver's seat of social change (a combined advocacy and policy perspective), moving away from outsider-based intervention models. Survivor students should be viewed as agents of change, not solely former victims and clients. The ideas of this presentation proposal are supported through various qualitative interviews, as well as reviews of ‘best practices’ in the field of education that incorporate feminist methods of inclusion and empowerment. Curriculum and policy recommendations are also offered.

Keywords: deficit lens bias, empowerment theory, feminist praxis, inclusive teaching models, strengths-based approaches, social work teaching methods

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559 Influence of Laser Treatment on the Growth of Sprouts of Different Wheat Varieties

Authors: N. Bakradze, T. Dumbadze, N. Gagelidze, L. Amiranashvili, A. D. L. Batako

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Cereals are considered as a strategic product in human life and it demand is increasing with the growth of world population. There is always shortage of cereals in various areas of the globe. For example, Georgia own production meets only 15-20% of the demand for grain, despite the fact that the country is considered one of the main centers of wheat origin. In Georgia, there are 14 types of wheat and more than 150 subspecies, and 40 subspecies of common wheat. Increasing wheat production is important for the country. One of the ways to solve the problem is to develop and implement new, environmentally and economically acceptable technologies. Such technologies include pre-sowing treatment of seed with a laser and associative nitrogen-fixing of the Azospirillum brasilensse bacteria. In the region there are Dika and Lomtagora which are among the most common in Georgia. Dika is a frost-resistant wheat, with a high ability to adapt to the environment, resistant to falling and it is sown in highlands. Dicka excellent properties are due to its strong immunity to fungal diseases; Dicka grains are rich in protein and lysine. Lomtagora 126 differs with its winter and drought resistance, and, it has a great ability to germinate. Lomtagora is characterized by a strong root system and a high budding capacity. It is an early variety, fall-resistant, easy to thresh and suitable for mechanized harvesting with large and red grains. The plant is moderately resistant to fungal diseases. This paper presents some preliminary experimental results where, a continuous CO2 laser at a power of 25-40 W/cm2 was used to radiate grains at a flow rate of 10-15 cm/sec. The treatment was carried out on grains of the Triticum aestivum L. var. of Lutescens (local variety name - Lomtagora 126), and Triticum carthlicum Nevski (local variety name - Dika). Here the grains were treated with Azospirillum brasilensse isolate (108-109 CFU / ml), which was isolated from the rhizosphere of wheat. It was observed that the germination of the wheat was not significantly influenced by either laser or bacteria treatment. In the case of the variety Lomtagora 126, when irradiated at an angle of 90°, it slightly improved the growth within 38 days of sawing, and in the case of irradiation at an angle of 90°+1, by 23%. The treatment of seeds with Azospirillum brazilense in both irradiated and non-irradiated variants led to an improvement in the growth of ssprouts. However, in the case of treatment with azospiril alone - by 22%, and with joint treatment of seeds with azospiril and irradiation - by 29%. In the case of the Dika wheat, the irradiation only led to an increase in growth by 8-9%, and the combine treatment of seeds with azospiril and irradiation - by 10-15%, in comparison with the control. Thus, the combine treatment of wheat of different varieties provided the best effect on the growth. Acknowledgment: This work was supported by Shota Rustaveli National Science Foundation of Georgia (SRNSFG) (Grant number CARYS 19-573)

Keywords: laser treatment, Azospirillum brasilensse, seeds, wheat varieties, Lomtagora, Dika

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558 Teachers’ Instructional Decisions When Teaching Geometric Transformations

Authors: Lisa Kasmer

Abstract:

Teachers’ instructional decisions shape the structure and content of mathematics lessons and influence the mathematics that students are given the opportunity to learn. Therefore, it is important to better understand how teachers make instructional decisions and thus find new ways to help practicing and future teachers give their students a more effective and robust learning experience. Understanding the relationship between teachers’ instructional decisions and their goals, resources, and orientations (beliefs) is important given the heightened focus on geometric transformations in the middle school mathematics curriculum. This work is significant as the development and support of current and future teachers need more effective ways to teach geometry to their students. The following research questions frame this study: (1) As middle school mathematics teachers plan and enact instruction related to teaching transformations, what thinking processes do they engage in to make decisions about teaching transformations with or without a coordinate system and (2) How do the goals, resources and orientations of these teachers impact their instructional decisions and reveal about their understanding of teaching transformations? Teachers and students alike struggle with understanding transformations; many teachers skip or hurriedly teach transformations at the end of the school year. However, transformations are an important mathematical topic as this topic supports students’ understanding of geometric and spatial reasoning. Geometric transformations are a foundational concept in mathematics, not only for understanding congruence and similarity but for proofs, algebraic functions, and calculus etc. Geometric transformations also underpin the secondary mathematics curriculum, as features of transformations transfer to other areas of mathematics. Teachers’ instructional decisions in terms of goals, orientations, and resources that support these instructional decisions were analyzed using open-coding. Open-coding is recognized as an initial first step in qualitative analysis, where comparisons are made, and preliminary categories are considered. Initial codes and categories from current research on teachers’ thinking processes that are related to the decisions they make while planning and reflecting on the lessons were also noted. Surfacing ideas and additional themes common across teachers while seeking patterns, were compared and analyzed. Finally, attributes of teachers’ goals, orientations and resources were identified in order to begin to build a picture of the reasoning behind their instructional decisions. These categories became the basis for the organization and conceptualization of the data. Preliminary results suggest that teachers often rely on their own orientations about teaching geometric transformations. These beliefs are underpinned by the teachers’ own mathematical knowledge related to teaching transformations. When a teacher does not have a robust understanding of transformations, they are limited by this lack of knowledge. These shortcomings impact students’ opportunities to learn, and thus disadvantage their own understanding of transformations. Teachers’ goals are also limited by their paucity of knowledge regarding transformations, as these goals do not fully represent the range of comprehension a teacher needs to teach this topic well.

Keywords: coordinate plane, geometric transformations, instructional decisions, middle school mathematics

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557 The Direct Deconvolution Model for the Large Eddy Simulation of Turbulence

Authors: Ning Chang, Zelong Yuan, Yunpeng Wang, Jianchun Wang

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Large eddy simulation (LES) has been extensively used in the investigation of turbulence. LES calculates the grid-resolved large-scale motions and leaves small scales modeled by sub lfilterscale (SFS) models. Among the existing SFS models, the deconvolution model has been used successfully in the LES of the engineering flows and geophysical flows. Despite the wide application of deconvolution models, the effects of subfilter scale dynamics and filter anisotropy on the accuracy of SFS modeling have not been investigated in depth. The results of LES are highly sensitive to the selection of fi lters and the anisotropy of the grid, which has been overlooked in previous research. In the current study, two critical aspects of LES are investigated. Firstly, we analyze the influence of sub-fi lter scale (SFS) dynamics on the accuracy of direct deconvolution models (DDM) at varying fi lter-to-grid ratios (FGR) in isotropic turbulence. An array of invertible filters are employed, encompassing Gaussian, Helmholtz I and II, Butterworth, Chebyshev I and II, Cauchy, Pao, and rapidly decaying filters. The signi ficance of FGR becomes evident, as it acts as a pivotal factor in error control for precise SFS stress prediction. When FGR is set to 1, the DDM models cannot accurately reconstruct the SFS stress due to the insufficient resolution of SFS dynamics. Notably, prediction capabilities are enhanced at an FGR of 2, resulting in accurate SFS stress reconstruction, except for cases involving Helmholtz I and II fi lters. A remarkable precision close to 100% is achieved at an FGR of 4 for all DDM models. Additionally, the further exploration extends to the fi lter anisotropy to address its impact on the SFS dynamics and LES accuracy. By employing dynamic Smagorinsky model (DSM), dynamic mixed model (DMM), and direct deconvolution model (DDM) with the anisotropic fi lter, aspect ratios (AR) ranging from 1 to 16 in LES fi lters are evaluated. The findings highlight the DDM's pro ficiency in accurately predicting SFS stresses under highly anisotropic filtering conditions. High correlation coefficients exceeding 90% are observed in the a priori study for the DDM's reconstructed SFS stresses, surpassing those of the DSM and DMM models. However, these correlations tend to decrease as lter anisotropy increases. In the a posteriori studies, the DDM model consistently outperforms the DSM and DMM models across various turbulence statistics, encompassing velocity spectra, probability density functions related to vorticity, SFS energy flux, velocity increments, strain-rate tensors, and SFS stress. It is observed that as fi lter anisotropy intensify , the results of DSM and DMM become worse, while the DDM continues to deliver satisfactory results across all fi lter-anisotropy scenarios. The fi ndings emphasize the DDM framework's potential as a valuable tool for advancing the development of sophisticated SFS models for LES of turbulence.

Keywords: deconvolution model, large eddy simulation, subfilter scale modeling, turbulence

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556 Beyond Sexual Objectification: Moderation Analysis of Trauma and Overexcitability Dynamics in Women

Authors: Ritika Chaturvedi

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Introduction: Sexual objectification, characterized by the reduction of an individual to a mere object of sexual desire, remains a pervasive societal issue with profound repercussions on individual well-being. Such experiences, often rooted in systemic and cultural norms, have long-lasting implications for mental and emotional health. This study aims to explore the intricate relationship between experiences of sexual objectification and insidious trauma, further investigating the potential moderating effects of overexcitability as proposed by Dabrowski's theory of positive disintegration. Methodology: The research involved a comprehensive cohort of 204 women, spanning ages from 18 to 65 years. Participants were tasked with completing self-administered questionnaires designed to capture their experiences with sexual objectification. Additionally, the questionnaire assessed symptoms indicative of insidious trauma and explored overexcitability across five distinct domains: emotional, intellectual, psychomotor, sensory, and imaginational. Employing advanced statistical techniques, including multiple regression and moderation analysis, the study sought to decipher the intricate interplay among these variables. Findings: The study's results revealed a compelling positive correlation between experiences of sexual objectification and the onset of symptoms indicative of insidious trauma. This correlation underscores the profound and detrimental effects of sexual objectification on an individual's psychological well-being. Interestingly, the moderation analyses introduced a nuanced understanding, highlighting the differential roles of various overexcitability. Specifically, emotional, intellectual, and sensual overexcitability were found to exacerbate trauma symptomatology. In contrast, psychomotor overexcitability emerged as a protective factor, demonstrating a mitigating influence on the relationship between sexual objectification and trauma. Implications: The study's findings hold significant implications for a diverse array of stakeholders, encompassing mental health practitioners, educators, policymakers, and advocacy groups. The identified moderating effects of overexcitability emphasize the need for tailored interventions that consider individual differences in coping and resilience mechanisms. By recognizing the pivotal role of overexcitability in modulating the traumatic consequences of sexual objectification, this research advocates for the development of more nuanced and targeted support frameworks. Moreover, the study underscores the importance of continued research endeavors to unravel the intricate mechanisms and dynamics underpinning these relationships. Such endeavors are crucial for fostering the evolution of informed, evidence-based interventions and strategies aimed at mitigating the adverse effects of sexual objectification and promoting holistic well-being.

Keywords: sexual objectification, insidious trauma, emotional overexcitability, intellectual overexcitability, sensual overexcitability, psychomotor overexcitability, imaginational overexcitability

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555 Health and Disease, Sickness and Well Being: Depictions in the Vinaya Pitaka and Jataka Narratives

Authors: Abhimanyu Kumar

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The relationship between religion and medicine is much evident in the context of Buddhism. This paper is an attempt to look at the processes of social and cultural evolution of scientific creativity in the field of medicine and institutionalization of medical practices. The objective of the paper is to understand the Buddhist responses towards health as understood from the Vinaya Piṭaka and the Jātaka. This work is a result of the analysis of two important Buddhist texts: the Vinaya Piṭaka and the Jātaka. Broadly the Vinaya Piṭaka is concerned with the growth of Buddhist monasticism. The Vinaya Piṭaka is considered one of the most important sacred texts of the Buddhists, and contains rules for monastic life. These rules deal with such aspects as formal meetings of the saṃgha (monastery), expiation, confession, training, and legal questions. The Jātaka stories, on the other hand, are in the form of folk narratives, and provide a major source of medical consultation for all classes. These texts help us to ascertain the ‘proficiency and perceptions’ of the prevailing medical traditions. The Jātakas are a collection of 547 stories about the past lives of the Buddha, who is represented in anthropomorphic and animal form. The Jātaka connects itself between existing cognitive environments related to ethics and Buddhist didacticism. These stories are a reflection of the connection between the past and contemporary times (in the sense of time of creation of the story) as well. This is visible through the narrative strategy of the text, where every story is sub-divided into the story of the past and story of the present, and there is a significant identification element or connection that established at the end of each story. The minimal presence of philosophical content and the adoption of a narrative strategy make it possible for more of everyday life. This study gives me an opportunity to raise questions about how far were the body and mind closely interrelated in the Buddhist perceptions, and also did the society act like a laboratory for the Buddhists to practice healing activities? How far did religious responses to afflictions, be they leprosy or plague or anger, influence medical care; what impact did medical practitioners, religious authorities and the regulation of medical activity and practice have on healing the body and the mind; and, how has the healing environment been viewed. This paper is working with the idea that medical science in early India was not only for the curative purpose of diseases, but it fulfilled a greater cause of promoting, maintaining and restoring human health. In this regard, studying these texts gives an insight regarding religious responses to epidemics, from leprosy to plague, as well as to behavioral disorder such as anger. In other words, it deals with the idea about healing the body and healing the soul from a religious perspective.

Keywords: food for health, folk narratives, human body, materia medica, social sickness

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554 Tourism Policy Challenges in Post-Soviet Georgia

Authors: Merab Khokhobaia

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The research of Georgian tourism policy challenges is important, as the tourism can play an increasing role for the economic growth and improvement of standard of living of the country even with scanty resources, at the expense of improved creative approaches. It is also important to make correct decisions at macroeconomic level, which will be accordingly reflected in the successful functioning of the travel companies and finally, in the improvement of economic indicators of the country. In order to correctly orient sectoral policy, it is important to precisely determine its role in the economy. Development of travel industry has been considered as one of the priorities in Georgia; the country has unique cultural heritage and traditions, as well as plenty of natural resources, which are a significant precondition for the development of tourism. Despite the factors mentioned above, the existing resources are not completely utilized and exploited. This work represents a study of subjective, as well as objective reasons of ineffective functioning of the sector. During the years of transformation experienced by Georgia, the role of travel industry in economic development of the country represented the subject of continual discussions. Such assessments were often biased and they did not rest on specific calculations. This topic became especially popular on the ground of market economy, because reliable statistical data have a particular significance in the designing of tourism policy. In order to deeply study the aforementioned issue, this paper analyzes monetary, as well as non-monetary indicators. The research widely included the tourism indicators system; we analyzed the flaws in reporting of the results of tourism sector in Georgia. Existing defects are identified and recommendations for their improvement are offered. For stable development tourism, similarly to other economic sectors, needs a well-designed policy from the perspective of national, as well as local, regional development. The tourism policy must be drawn up in order to efficiently achieve our goals, which were established in short-term and long-term dynamics on the national or regional scale of specific country. The article focuses on the role and responsibility of the state institutes in planning and implementation of the tourism policy. The government has various tools and levers, which may positively influence the processes. These levers are especially important in terms of international, as well as internal tourism development. Within the framework of this research, the regulatory documents, which are in force in relation to this industry, were also analyzed. The main attention is turned to their modernization and necessity of their compliance with European standards. It is a current issue to direct the efforts of state policy on support of business by implementing infrastructural projects, as well as by development of human resources, which may be possible by supporting the relevant higher and vocational studying-educational programs.

Keywords: regional development, tourism industry, tourism policy, transition

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553 The Use of Platelet-rich Plasma in the Treatment of Diabetic Foot Ulcers: A Scoping Review

Authors: Kiran Sharma, Viktor Kunder, Zerha Rizvi, Ricardo Soubelet

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Platelet rich plasma (PRP) has been recognized as a method of treatment in medicine since the 1980s. It primarily functions by releasing cytokines and growth factors that promote wound healing; these growth promoting factors released by PRP enact new processes such as angiogenesis, collagen deposition, and tissue formation that can change wound healing outcomes. Many studies recognize that PRP aids in chronic wound healing, which is advantageous for patients who suffer from chronic diabetic foot ulcers (DFUs). This scoping review aims to examine literature to identify the efficacy of PRP use in the healing of DFUs. Following PRISMA guidelines, we searched randomized-controlled trials involving PRP use in diabetic patients with foot ulcers using PubMed, Medline, CINAHL Complete, and Cochrane Database of Systematic Reviews. We restricted the search to articles published during 2005-2022, full texts in the English language, articles involving patients aged 19 years or older, articles that used PRP on specifically DFUs, articles that included a control group, articles on human subjects. The initial search yielded 119 articles after removing duplicates. Final analysis for relevance yielded 8 articles. In all cases except one, the PRP group showed either faster healing, more complete healing, or a larger percentage of healed participants. There were no situations in the included studies where the control group had a higher rate of healing or decreased wound size as compared to a group with isolated PRP-only use. Only one study did not show conclusive evidence that PRP caused accelerated healing in DFUs, and this study did not have an isolated PRP variable group. Application styles of PRP for treatment were shown to influence the level of healing in patients, with injected PRP appearing to achieve the best results as compared to topical PRP application. However, this was not conclusive due to the involvement of several other variables. Two studies additionally found PRP to be useful in healing refractory DFUs, and one study found that PRP use in patients with additional comorbidities was still more effective in healing DFUs than the standard control groups. The findings of this review suggest that PRP is a useful tool in reducing healing times and improving rates of complete wound healing in DFUs. There is room for further research in the application styles of PRP before conclusive statements can be made on the efficacy of injected versus topical PRP healing based on the findings in this study. The results of this review provide a baseline for further research in PRP use in diabetic patients and can be used by both physicians and public health experts to guide future treatment options for DFUs.

Keywords: diabetic foot ulcer, DFU, platelet rich plasma, PRP

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552 Religious Capital and Entrepreneurial Behavior in Small Businesses: The Importance of Entrepreneurial Creativity

Authors: Waleed Omri

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With the growth of the small business sector in emerging markets, developing a better understanding of what drives 'day-to-day' entrepreneurial activities has become an important issue for academicians and practitioners. Innovation, as an entrepreneurial behavior, revolves around individuals who creatively engage in new organizational efforts. In a similar vein, the innovation behaviors and processes at the organizational member level are central to any corporate entrepreneurship strategy. Despite the broadly acknowledged importance of entrepreneurship and innovation at the individual level in the establishment of successful ventures, the literature lacks evidence on how entrepreneurs can effectively harness their skills and knowledge in the workplace. The existing literature illustrates that religion can impact the day-to-day work behavior of entrepreneurs, managers, and employees. Religious beliefs and practices could affect daily entrepreneurial activities by fostering mental abilities and traits such as creativity, intelligence, and self-efficacy. In the present study, we define religious capital as a set of personal and intangible resources, skills, and competencies that emanate from an individual’s religious values, beliefs, practices, and experiences and may be used to increase the quality of economic activities. Religious beliefs and practices give individuals a religious satisfaction, which can lead them to perform better in the workplace. In addition, religious ethics and practices have been linked to various positive employee outcomes in terms of organizational change, job satisfaction, and entrepreneurial intensity. As investigations of their consequences beyond direct task performance are still scarce, we explore if religious capital plays a role in entrepreneurs’ innovative behavior. In sum, this study explores the determinants of individual entrepreneurial behavior by investigating the relationship between religious capital and entrepreneurs’ innovative behavior in the context of small businesses. To further explain and clarify the religious capital-innovative behavior link, the present study proposes a model to examine the mediating role of entrepreneurial creativity. We use both Islamic work ethics (IWE) and Islamic religious practices (IRP) to measure Islamic religious capital. We use structural equation modeling with a robust maximum likelihood estimation to analyze data gathered from 289 Tunisian small businesses and to explore the relationships among the above-described variables. In line with the theory of planned behavior, only religious work ethics are found to increase the innovative behavior of small businesses’ owner-managers. Our findings also clearly demonstrate that the connection between religious capital-related variables and innovative behavior is better understood if the influence of entrepreneurial creativity, as a mediating variable of the aforementioned relationship, is taken into account. By incorporating both religious capital and entrepreneurial creativity into the innovative behavior analysis, this study provides several important practical implications for promoting innovation process in small businesses.

Keywords: entrepreneurial behavior, small business, religion, creativity

Procedia PDF Downloads 245
551 Benjaminian Translatability and Elias Canetti's Life Component: The Other German Speaking Modernity

Authors: Noury Bakrim

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Translatability is one of Walter Benjamin’s most influential notions, it is somehow representing the philosophy of language and history of what we might call and what we indeed coined as ‘the other German Speaking Modernity’ which could be shaped as a parallel thought form to the Marxian-Hegelian philosophy of history, the one represented by the school of Frankfurt. On the other hand, we should consider the influence of the plural German speaking identity and the Nietzschian and Goethean heritage, this last being focused on a positive will of power: the humanised human being. Having in perspective the benjaminian notion of translatability (Übersetzbarkeit), to be defined as an internal permanent hermeneutical possibility as well as a phenomenological potential of a translation relation, we are in fact touching this very double limit of both historical and linguistic reason. By life component, we mean the changing conditions of genetic and neurolinguistic post-partum functions, to be grasped as an individuation beyond the historical determinism and teleology of an event. It is, so to speak, the retrospective/introspective canettian auto-fiction, the benjaminian crystallization of the language experience in the now-time of writing/transmission. Furthermore, it raises various questioning points when it comes to translatability, they are basically related to psycholinguistic separate poles, the fatherly ladino Spanish and the motherly Vienna German, but relating more in particular to the permanent ontological quest of a world loss/belonging. Another level of this quest would be the status of Veza Canetti-Taubner Calderón, german speaking Author, Canetti’s ‘literary wife’, writer’s love, his inverted logos, protective and yet controversial ‘official private life partner’, the permanence of the jewish experience in the exiled german language. It sheds light on a traumatic relation of an inadequate/possible language facing the reconstruction of an oral life, the unconscious split of the signifier and above all on the frustrating status of writing in Canetti’s work : Using a suffering/suffered written German to save his remembered acquisition of his tongue/mother tongue by saving the vanishing spoken multilingual experience. While Canetti’s only novel ‘Die Blendung’ designates that fictional referential dynamics focusing on the nazi worldless horizon: the figure of Kien is an onomastic signifier, the anti-Canetti figure, the misunderstood legacy of Kant, the system without thought. Our postulate would be the double translatability of his auto-fiction inventing the bios oral signifier basing on the new praxemes created by Canetti’s german as observed in the English, French translations of his memory corpus. We aim at conceptualizing life component and translatability as two major features of a german speaking modernity.

Keywords: translatability, language biography, presentification, bioeme, life Order

Procedia PDF Downloads 427
550 Optimal Pressure Control and Burst Detection for Sustainable Water Management

Authors: G. K. Viswanadh, B. Rajasekhar, G. Venkata Ramana

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Water distribution networks play a vital role in ensuring a reliable supply of clean water to urban areas. However, they face several challenges, including pressure control, pump speed optimization, and burst event detection. This paper combines insights from two studies to address these critical issues in Water distribution networks, focusing on the specific context of Kapra Municipality, India. The first part of this research concentrates on optimizing pressure control and pump speed in complex Water distribution networks. It utilizes the EPANET- MATLAB Toolkit to integrate EPANET functionalities into the MATLAB environment, offering a comprehensive approach to network analysis. By optimizing Pressure Reduce Valves (PRVs) and variable speed pumps (VSPs), this study achieves remarkable results. In the Benchmark Water Distribution System (WDS), the proposed PRV optimization algorithm reduces average leakage by 20.64%, surpassing the previous achievement of 16.07%. When applied to the South-Central and East zone WDS of Kapra Municipality, it identifies PRV locations that were previously missed by existing algorithms, resulting in average leakage reductions of 22.04% and 10.47%. These reductions translate to significant daily Water savings, enhancing Water supply reliability and reducing energy consumption. The second part of this research addresses the pressing issue of burst event detection and localization within the Water Distribution System. Burst events are a major contributor to Water losses and repair expenses. The study employs wireless sensor technology to monitor pressure and flow rate in real time, enabling the detection of pipeline abnormalities, particularly burst events. The methodology relies on transient analysis of pressure signals, utilizing Cumulative Sum and Wavelet analysis techniques to robustly identify burst occurrences. To enhance precision, burst event localization is achieved through meticulous analysis of time differentials in the arrival of negative pressure waveforms across distinct pressure sensing points, aided by nodal matrix analysis. To evaluate the effectiveness of this methodology, a PVC Water pipeline test bed is employed, demonstrating the algorithm's success in detecting pipeline burst events at flow rates of 2-3 l/s. Remarkably, the algorithm achieves a localization error of merely 3 meters, outperforming previously established algorithms. This research presents a significant advancement in efficient burst event detection and localization within Water pipelines, holding the potential to markedly curtail Water losses and the concomitant financial implications. In conclusion, this combined research addresses critical challenges in Water distribution networks, offering solutions for optimizing pressure control, pump speed, burst event detection, and localization. These findings contribute to the enhancement of Water Distribution System, resulting in improved Water supply reliability, reduced Water losses, and substantial cost savings. The integrated approach presented in this paper holds promise for municipalities and utilities seeking to improve the efficiency and sustainability of their Water distribution networks.

Keywords: pressure reduce valve, complex networks, variable speed pump, wavelet transform, burst detection, CUSUM (Cumulative Sum), water pipeline monitoring

Procedia PDF Downloads 88
549 Prosecution as Persecution: Exploring the Enduring Legacy of Judicial Harassment of Human Rights Defenders and Political Opponents in Zimbabwe, Cases from 2013-2016

Authors: Bellinda R. Chinowawa

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As part of a wider strategy to stifle civil society, Governments routinely resort to judicial harassment through the use of civil and criminal to impugn the integrity of human rights defenders and that of perceived political opponents. This phenomenon is rife in militarised or autocratic regimes where there is no tolerance for dissenting voices. Zimbabwe, ostensibly a presidential republic founded on the values of transparency, equality, freedom, is characterised by brutal suppression of perceived political opponents and those who assert their basic human rights. This is done through a wide range of tactics including unlawful arrests and detention, torture and other cruel, inhuman degrading treatment and enforced disappearances. Professionals including, journalists and doctors are similarly not spared from state attack. For human rights defenders, the most widely used tool of repression is that of judicial harassment where the judicial system is used to persecute them. This can include the levying of criminal charges, civil lawsuits and unnecessary administrative proceedings. Charges preferred against range from petty offences such as criminal nuisance to more serious charges of terrorism and subverting a constitutional government. Additionally, government sponsored individuals and organisations file strategic lawsuits with pecuniary implications order to intimidate and silence critics and engender self-censorship. Some HRDs are convicted and sentenced to prison terms, despite not being criminals in a true sense. While others are acquitted judicial harassment diverts energy and resources away from their human rights work. Through a consideration of statistical data reported by human rights organisations and face to face interviews with a cross section of human rights defenders, the article will map the incidence of judicial harassment in Zimbabwe. The article will consider the multi-level sociological and contextual factors which influence the Government of Zimbabwe to have easy recourse to criminal law and the debilitating effect of these actions on HRDs. These factors include the breakdown of the rule of law resulting in state capture of the judiciary, the proven efficacy of judicial harassment from colonial times to date, and the lack of an adequate redress mechanism at international level. By mapping the use of the judiciary as a tool of repression, from the inception of modern day Zimbabwe to date, it is hoped that HRDs will realise that they are part of a greater community of activists throughout the ages and should emboldened in the realisation that it is an age old tactic used by fallen regimes which should not deter them from calling for accountability.

Keywords: autocratic regime, colonial legacy, judicial harassment, human rights defenders

Procedia PDF Downloads 233
548 Activating Psychological Resources of DUI (Drivers under the Influence of Alcohol) Using the Traffic Psychology Intervention (IFT Course), Germany

Authors: Parichehr Sharifi, Konrad Reschke, Hans-Liudger Dienel

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Psychological intervention generally targets changes in attitudes and behavior. Working with DUIs is part of traffic psychologists’ work. The primary goal of this field is to reduce the probability of re-conspicuous of the delinquent driver. One of these measurements in Germany is IFT courses for DUI s. The IFT course was designed by the Institute for Therapy Research. Participants are drivers who have fallen several times or once with a blood alcohol concentration of 1.6 per mill and who have completed a medical-psychological assessment (MPU) with the result of the course recommendation. The course covers four sessions of 3.5 hours each (1 hour / 60 m) and in a period of 3 to 4 weeks in the group discussion. This work analyzes interventions for the rehabilitation of DUI (Drunk Drivers offenders) offenders in groups under the aspect of activating psychological resources. From the aspect of sustainability, they should also have long-term consequences for the maintenance of unproblematic driving behavior in terms of the activation of resources. It is also addressing a selected consistency-theory-based intervention effect, activating psychological resources. So far, this has only been considered in the psychotherapeutic field but never in the field of traffic psychology. The methodology of this survey is one qualitative and three quantitative. In four sub-studies, it will be examined which measurements can determine the resources and how traffic psychological interventions can strengthen resources. The results of the studies have the following implications for traffic psychology research and practice: (1) In the field of traffic psychology intervention for the restoration of driving fitness, it can be stated that aspects of resource activation in this work have been investigated for the first time by qualitative and quantitative methods. (2) The resource activation could be confirmed based on the determined results as an effective factor of traffic psychological intervention. (3) Two sub-studies show a range of resources and resource activation options that must be given greater emphasis in traffic psychology interventions: - Social resource activation - improvement of the life skills of participants - Reactivation of existing social support options - Re-experiencing self-esteem, self-assurance, and acceptance of traffic-related behaviors. (4) In revising the IFT-§70 course, as well as other courses on recreating aptitude for DUI, new traffic-specific resource-enabling interventions against alcohol abuse should be developed to further enhance the courses through motivational, cognitive, and behavioral effects of resource activation, Resource-activating interventions can not only be integrated into behavioral group interventions but can also be applied in psychodynamic, psychodynamic (individual psychological) and other contexts of individual traffic psychology. The results are indicative but clearly show that personal resources can be strengthened through traffic psychology interventions. In the research, practice, training, and further education of traffic psychology, the aspect of primary resource activation (Grawe, 1999), therefore, always deserves the greatest attention for the rehabilitation of DUIs and Traffic safety.

Keywords: traffic safety, psychological resources, activating of resources, intervention programs for alcohol offenders, empowerment

Procedia PDF Downloads 80
547 Examining the Relationship Between Green Procurement Practices and Firm’s Performance in Ghana

Authors: Clement Yeboah

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Prior research concludes that environmental commitment positively drives organisational performance. Nonetheless, the nexus and conditions under which environmental commitment capabilities contribute to a firm’s performance are less understood. The purpose of this quantitative relational study was to examine the relationship between environmental commitment and 500 firms’ performances in Ghana. The researchers further seek to draw insights from the resource-based view to conceptualize environmental commitment and green procurement practices as resource capabilities to enhance firm performance. The researchers used insights from the contingent resource-based view to examine green leadership orientation conditions under which environmental commitment capability contributes to firm performance through green procurement practices. The study’s conceptual framework was tested on primary data from some firms in the Ghanaian market. PROCESS Macro was used to test the study’s hypotheses. Beyond that, green procurement practices mediated the association between environmental commitment capabilities and the firm’s performance. The study further seeks to find out whether green leadership orientation positively moderates the indirect relationship between environmental commitment capabilities and firm performance through green procurement practices. While conventional wisdom suggests that improved environmental commitment capabilities help improve a firm’s performance, this study tested this presumed relationship between environmental commitment capabilities and firm performance and provides theoretical arguments and empirical evidence to justify how green procurement practices uniquely and in synergy with green leadership orientation transform this relationship. The study results indicated a positive correlation between environmental commitment and firm performance. This result suggests that firms that prioritize environmental sustainability and demonstrate a strong commitment to environmentally responsible practices tend to experience better overall performance. This includes financial gains, operational efficiency, enhanced reputation, and improved relationships with stakeholders. The study's findings inform policy formulation in Ghana related to environmental regulations, incentives, and support mechanisms. Policymakers can use the insights to design policies that encourage and reward firms for their environmental commitments, thereby fostering a more sustainable and environmentally responsible business environment. The findings from such research can influence the design and development of educational programs in Ghana, specifically in fields related to sustainability, environmental management, and corporate social responsibility (CSR). Institutions may consider integrating environmental and sustainability topics into their business and management courses to create awareness and promote responsible practices among future business professionals. Also the study results can also promote the adoption of environmental accounting practices in Ghana. By recognizing and measuring the environmental impacts and costs associated with business activities, firms can better understand the financial implications of their environmental commitments and develop strategies for improved performance.

Keywords: firm’s performance, green procurement practice, environmental commitment, environmental management, sustainability

Procedia PDF Downloads 88
546 The Usefulness of Medical Scribes in the Emengecy Department

Authors: Victor Kang, Sirene Bellahnid, Amy Al-Simaani

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Efficient documentation and completion of clerical tasks are pillars of efficient patient-centered care in acute settings such as the emergency department (ED). Medical scribes aid physicians with documentation, navigation of electronic health records, results gathering, and communication coordination with other healthcare teams. However, the use of medical scribes is not widespread, with some hospitals even continuing to discontinue their programs. One reason for this could be the lack of studies that have outlined concrete improvements in efficiency and patient and provider satisfaction in emergency departments before and after incorporating scribes. Methods: We conducted a review of the literature concerning the implementation of a medical scribe program and emergency department performance. For this review, a narrative synthesis accompanied by textual commentaries was chosen to present the selected papers. PubMed was searched exclusively. Initially, no date limits were set, but seeing as the electronic medical record was officially implemented in Canada in 2013, studies published after this date were preferred as they provided insight into the interplay between its implementation and scribes on quality improvement. Results: Throughput, efficiency, and cost-effectiveness were the most commonly used parameters in evaluating scribes in the Emergency Department. Important throughput metrics, specifically door-to-doctor and disposition time, were significantly decreased in emergency departments that utilized scribes. Of note, this was shown to be the case in community hospitals, where the burden of documentation and clerical tasks would fall directly upon the attending physician. Academic centers differ in that they rely heavily on residents and students; so the implementation of scribes has been shown to have limited effect on these metrics. However, unique to academic centers was the provider’s perception of incrased time for teaching was unique to academic centers. Consequently, providers express increased work satisfaction in relation to time spent with patients and in teaching. Patients, on the other hand, did not demonstrate a decrease in satisfaction in regards to the care that was provided, but there was no significant increase observed either. Of the studies we reviewed, one of the biggest limitations was the lack of significance in the data. While many individual studies reported that medical scribes in emergency rooms improved relative value units, patient satisfaction, provider satisfaction, and increased number of patients seen, there was no statistically significant improvement in the above criteria when compiled in a systematic review. There is also a clear publication bias; very few studies with negative results were published. To prove significance, data from more emergency rooms with scribe programs would need to be compiled which also includes emergency rooms who did not report noticeable benefits. Furthermore, most data sets focused only on scribes in academic centers. Conclusion: Ultimately, the literature suggests that while emergency room physicians who have access to medical scribes report higher satisfaction due to lower clerical burdens and can see more patients per shift, there is still variability in terms of patient and provider satisfaction. Whether or not this variability exists due to differences in training (in-house trainees versus contractors), population profile (adult versus pediatric), setting (academic versus community), or which shifts scribe work cannot be determined based on the studies that exist. Ultimately, more scribe programs need to be evaluated to determine whether these variables affect outcomes and prove whether scribes significantly improve emergency room efficiency.

Keywords: emergency medicine, medical scribe, scribe, documentation

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545 Towards the Rapid Synthesis of High-Quality Monolayer Continuous Film of Graphene on High Surface Free Energy Existing Plasma Modified Cu Foil

Authors: Maddumage Don Sandeepa Lakshad Wimalananda, Jae-Kwan Kim, Ji-Myon Lee

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Graphene is an extraordinary 2D material that shows superior electrical, optical, and mechanical properties for the applications such as transparent contacts. Further, chemical vapor deposition (CVD) technique facilitates to synthesizing of large-area graphene, including transferability. The abstract is describing the use of high surface free energy (SFE) and nano-scale high-density surface kinks (rough) existing Cu foil for CVD graphene growth, which is an opposite approach to modern use of catalytic surfaces for high-quality graphene growth, but the controllable rough morphological nature opens new era to fast synthesis (less than the 50s with a short annealing process) of graphene as a continuous film over conventional longer process (30 min growth). The experiments were shown that high SFE condition and surface kinks on Cu(100) crystal plane existing Cu catalytic surface facilitated to synthesize graphene with high monolayer and continuous nature because it can influence the adsorption of C species with high concentration and which can be facilitated by faster nucleation and growth of graphene. The fast nucleation and growth are lowering the diffusion of C atoms to Cu-graphene interface, which is resulting in no or negligible formation of bilayer patches. High energy (500W) Ar plasma treatment (inductively Coupled plasma) was facilitated to form rough and high SFE existing (54.92 mJm-2) Cu foil. This surface was used to grow the graphene by using CVD technique at 1000C for 50s. The introduced kink-like high SFE existing point on Cu(100) crystal plane facilitated to faster nucleation of graphene with a high monolayer ratio (I2D/IG is 2.42) compared to another different kind of smooth morphological and low SFE existing Cu surfaces such as Smoother surface, which is prepared by the redeposit of Cu evaporating atoms during the annealing (RRMS is 13.3nm). Even high SFE condition was favorable to synthesize graphene with monolayer and continuous nature; It fails to maintain clean (surface contains amorphous C clusters) and defect-free condition (ID/IG is 0.46) because of high SFE of Cu foil at the graphene growth stage. A post annealing process was used to heal and overcome previously mentioned problems. Different CVD atmospheres such as CH4 and H2 were used, and it was observed that there is a negligible change in graphene nature (number of layers and continuous condition) but it was observed that there is a significant difference in graphene quality because the ID/IG ratio of the graphene was reduced to 0.21 after the post-annealing with H2 gas. Addition to the change of graphene defectiveness the FE-SEM images show there was a reduction of C cluster contamination of the surface. High SFE conditions are favorable to form graphene as a monolayer and continuous film, but it fails to provide defect-free graphene. Further, plasma modified high SFE existing surface can be used to synthesize graphene within 50s, and a post annealing process can be used to reduce the defectiveness.

Keywords: chemical vapor deposition, graphene, morphology, plasma, surface free energy

Procedia PDF Downloads 244
544 Breast Cancer Awareness among Female Nurses: Time to Scrub off Assumptions

Authors: Rahy Farooq, Maria Ahmad Khan, Ayesha Isani Majeed

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Objective: The main aim of this research is to assess the knowledge, attitude and practices of female nursing staff and nursing students regarding breast cancer, to provide a baseline for monitoring trends of breast cancer awareness in them. Background: Healthcare professionals are a direct source of information for the patients and the general public as a whole. It is, therefore, essential that the information they convey be accurate and helps in building additional awareness. However, clinical experience does not influence the knowledge, attitude and practices regarding breast cancer. Nurses, being the prime part of the healthcare professionals, play a significant role and hence, their awareness regarding this pressing issue is pertinent. Lack of awareness regarding common presenting symptoms or breast cancer risk factors translates to poor breast cancer screening practices and late diagnosis. Methodology: A cross-sectional study of 280 female nurses was conducted at a tertiary care hospital in Islamabad, Pakistan. A pre-tested structured questionnaire with additional variables like cultural barriers to seeking medical help was used. The scores for outcome variables including knowledge, attitude and practices were pre-defined. Data was analyzed using SPSSv23. Results: Of the 280 participants with a mean age of 28.99±9.98 years, 142 (50.7%) were married, and 138 (49.3%) were unmarried. Mean scores were computed to be 6.14±2.93 (out of 12), 0.30±0.7 (out of 3) and 9.53±1.92 (out of 16) for knowledge, attitude and practice respectively. Using independent sample T-test, a statistically significant correlation was found when means for the score of Attitude was compared with age. With a p-value of 0.018, 117 nurses of age more than 30 years, faced more practical, financial, emotional and service barriers as compared to 163 women younger than 30 years of age. Knowledge of age-related lifetime risks was also significantly poor more in single women; with a p-value of 0.006 for identification of correct age as a risk factor and a p-value of 0.005 for correct identification of risk for development of breast cancer in the lifetime of women. By application of Chi-square test, there was a significant correlation between marital status and cultural barriers to seeking medical help, showing that single women (58.7%) shy away from talking about breast cancer considering it a taboo (p-value 0.028) whereas, more married nurses (59.2%) were apprehensive that they might be considered at fault by the society, as compared to 40.8% of single nurses. (p-value 0.038). Conclusion: Owing to the scarcity of awareness among nurses, this study recognizes the need for delivering effective information to the female nurses regarding breast cancer. Educating patients is likely to be effective if the female nurses play their part and have correct attitudes towards breast cancer practices. A better understanding of the knowledge and practices regarding breast cancer among the nursing population will enable high-risk patients to be recognized early. Therefore, we recommend arrangement of special courses and seminars for all healthcare professionals including the nursing staff.

Keywords: breast cancer, cultural barriers, kap, nurses

Procedia PDF Downloads 239
543 Investigation of Residual Stress Relief by in-situ Rolling Deposited Bead in Directed Laser Deposition

Authors: Ravi Raj, Louis Chiu, Deepak Marla, Aijun Huang

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Hybridization of the directed laser deposition (DLD) process using an in-situ micro-roller to impart a vertical compressive load on the deposited bead at elevated temperatures can relieve tensile residual stresses incurred in the process. To investigate this stress relief mechanism and its relationship with the in-situ rolling parameters, a fully coupled dynamic thermo-mechanical model is presented in this study. A single bead deposition of Ti-6Al-4V alloy with an in-situ roller made of mild steel moving at a constant speed with a fixed nominal bead reduction is simulated using the explicit solver of the finite element software, Abaqus. The thermal model includes laser heating during the deposition process and the heat transfer between the roller and the deposited bead. The laser heating is modeled using a moving heat source with a Gaussian distribution, applied along the pre-formed bead’s surface using the VDFLUX Fortran subroutine. The bead’s cross-section is assumed to be semi-elliptical. The interfacial heat transfer between the roller and the bead is considered in the model. Besides, the roller is cooled internally using axial water flow, considered in the model using convective heat transfer. The mechanical model for the bead and substrate includes the effects of rolling along with the deposition process, and their elastoplastic material behavior is captured using the J2 plasticity theory. The model accounts for strain, strain rate, and temperature effects on the yield stress based on Johnson-Cook’s theory. Various aspects of this material behavior are captured in the FE software using the subroutines -VUMAT for elastoplastic behavior, VUHARD for yield stress, and VUEXPAN for thermal strain. The roller is assumed to be elastic and does not undergo any plastic deformation. Also, contact friction at the roller-bead interface is considered in the model. Based on the thermal results of the bead, the distance between the roller and the deposition nozzle (roller o set) can be determined to ensure rolling occurs around the beta-transus temperature for the Ti-6Al-4V alloy. It is identified that roller offset and the nominal bead height reduction are crucial parameters that influence the residual stresses in the hybrid process. The results obtained from a simulation at roller offset of 20 mm and nominal bead height reduction of 7% reveal that the tensile residual stresses decrease to about 52% due to in-situ rolling throughout the deposited bead. This model can be used to optimize the rolling parameters to minimize the residual stresses in the hybrid DLD process with in-situ micro-rolling.

Keywords: directed laser deposition, finite element analysis, hybrid in-situ rolling, thermo-mechanical model

Procedia PDF Downloads 111
542 Processes Controlling Release of Phosphorus (P) from Catchment Soils and the Relationship between Total Phosphorus (TP) and Humic Substances (HS) in Scottish Loch Waters

Authors: Xiaoyun Hui, Fiona Gentle, Clemens Engelke, Margaret C. Graham

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Although past work has shown that phosphorus (P), an important nutrient, may form complexes with aqueous humic substances (HS), the principal component of natural organic matter, the nature of such interactions is poorly understood. Humic complexation may not only enhance P concentrations but it may change its bioavailability within such waters and, in addition, influence its transport within catchment settings. This project is examining the relationships and associations of P, HS, and iron (Fe) in Loch Meadie, Sutherland, North Scotland, a mesohumic freshwater loch which has been assessed as reference condition with respect to P. The aim is to identify characteristic spectroscopic parameters which can enhance the performance of the model currently used to predict reference condition TP levels for highly-coloured Scottish lochs under the Water Framework Directive. In addition to Loch Meadie, samples from other reference condition lochs in north Scotland and Shetland were analysed. By including different types of reference condition lochs (clear water, mesohumic and polyhumic water) this allowed the relationship between total phosphorus (TP) and HS to be more fully explored. The pH, [TP], [Fe], UV/Vis absorbance/spectra, [TOC] and [DOC] for loch water samples have been obtained using accredited methods. Loch waters were neutral to slightly acidic/alkaline (pH 6-8). [TP] in loch waters were lower than 50 µg L-1, and in Loch Meadie waters were typically <10 µg L-1. [Fe] in loch waters were mainly <0.6 mg L-1, but for some loch water samples, [Fe] were in the range 1.0-1.8 mg L-1and there was a positive correlation with [TOC] (r2=0.61). Lochs were classified as clear water, mesohumic or polyhumic based on water colour. The range of colour values of sampled lochs in each category were 0.2–0.3, 0.2–0.5 and 0.5–0.8 a.u. (10 mm pathlength), respectively. There was also a strong positive correlation between [DOC] and water colour (R2=0.84). The UV/Vis spectra (200-700 nm) for water samples were featureless with only a slight “shoulder” observed in the 270–290 nm region. Ultrafiltration was then used to separate colloidal and truly dissolved components from the loch waters and, since it contained the majority of aqueous P and Fe, the colloidal component was fractionated by gel filtration chromatography method. Gel filtration chromatographic fractionation of the colloids revealed two brown-coloured bands which had distinctive UV/Vis spectral features. The first eluting band had larger and more aromatic HS molecules than the second band, and in addition both P and Fe were primarily associated with the larger, more aromatic HS. This result demonstrated that P was able to form complexes with Fe-rich components of HS, and thus provided a scientific basis for the significant correlation between [Fe] and [TP] that the previous monitoring data of reference condition lochs from Scottish Environment Protection Agency (SEPA) showed. The distinctive features of the HS will be used as the basis for an improved spectroscopic tool.

Keywords: total phosphorus, humic substances, Scottish loch water, WFD model

Procedia PDF Downloads 546
541 Assessing Acute Toxicity and Endocrine Disruption Potential of Selected Packages Internal Layers Extracts

Authors: N. Szczepanska, B. Kudlak, G. Yotova, S. Tsakovski, J. Namiesnik

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In the scientific literature related to the widely understood issue of packaging materials designed to have contact with food (food contact materials), there is much information on raw materials used for their production, as well as their physiochemical properties, types, and parameters. However, not much attention is given to the issues concerning migration of toxic substances from packaging and its actual influence on the health of the final consumer, even though health protection and food safety are the priority tasks. The goal of this study was to estimate the impact of particular foodstuff packaging type, food production, and storage conditions on the degree of leaching of potentially toxic compounds and endocrine disruptors to foodstuffs using the acute toxicity test Microtox and XenoScreen YES YAS assay. The selected foodstuff packaging materials were metal cans used for fish storage and tetrapak. Five stimulants respectful to specific kinds of food were chosen in order to assess global migration: distilled water for aqueous foods with a pH above 4.5; acetic acid at 3% in distilled water for acidic aqueous food with pH below 4.5; ethanol at 5% for any food that may contain alcohol; dimethyl sulfoxide (DMSO) and artificial saliva were used in regard to the possibility of using it as an simulation medium. For each packaging three independent variables (temperature and contact time) factorial design simulant was performed. Xenobiotics migration from epoxy resins was studied at three different temperatures (25°C, 65°C, and 121°C) and extraction time of 12h, 48h and 2 weeks. Such experimental design leads to 9 experiments for each food simulant as conditions for each experiment are obtained by combination of temperature and contact time levels. Each experiment was run in triplicate for acute toxicity and in duplicate for estrogen disruption potential determination. Multi-factor analysis of variation (MANOVA) was used to evaluate the effects of the three main factors solvent, temperature (temperature regime for cup), contact time and their interactions on the respected dependent variable (acute toxicity or estrogen disruption potential). From all stimulants studied the most toxic were can and tetrapak lining acetic acid extracts that are indication for significant migration of toxic compounds. This migration increased with increase of contact time and temperature and justified the hypothesis that food products with low pH values cause significant damage internal resin filling. Can lining extracts of all simulation medias excluding distilled water and artificial saliva proved to contain androgen agonists even at 25°C and extraction time of 12h. For tetrapak extracts significant endocrine potential for acetic acid, DMSO and saliva were detected.

Keywords: food packaging, extraction, migration, toxicity, biotest

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540 Investigating Learners’ Online Learning Experiences in a Blended-Learning School Environment

Authors: Abraham Ampong

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BACKGROUND AND SIGNIFICANCE OF THE STUDY: The development of information technology and its influence today is inevitable in the world of education. The development of information technology and communication (ICT) has an impact on the use of teaching aids such as computers and the Internet, for example, E-learning. E-learning is a learning process attained through electronic means. But learning is not merely technology because learning is essentially more about the process of interaction between teacher, student, and source study. The main purpose of the study is to investigate learners’ online learning experiences in a blended learning approach, evaluate how learners’ experience of an online learning environment affects the blended learning approach and examine the future of online learning in a blended learning environment. Blended learning pedagogies have been recognized as a path to improve teacher’s instructional strategies for teaching using technology. Blended learning is perceived to have many advantages for teachers and students, including any-time learning, anywhere access, self-paced learning, inquiry-led learning and collaborative learning; this helps institutions to create desired instructional skills such as critical thinking in the process of learning. Blended learning as an approach to learning has gained momentum because of its widespread integration into educational organizations. METHODOLOGY: Based on the research objectives and questions of the study, the study will make use of the qualitative research approach. The rationale behind the selection of this research approach is that participants are able to make sense of their situations and appreciate their construction of knowledge and understanding because the methods focus on how people understand and interpret their experiences. A case study research design is adopted to explore the situation under investigation. The target population for the study will consist of selected students from selected universities. A simple random sampling technique will be used to select the targeted population. The data collection instrument that will be adopted for this study will be questions that will serve as an interview guide. An interview guide is a set of questions that an interviewer asks when interviewing respondents. Responses from the in-depth interview will be transcribed into word and analyzed under themes. Ethical issues to be catered for in this study include the right to privacy, voluntary participation, and no harm to participants, and confidentiality. INDICATORS OF THE MAJOR FINDINGS: It is suitable for the study to find out that online learning encourages timely feedback from teachers or that online learning tools are okay to use without issues. Most of the communication with the teacher can be done through emails and text messages. It is again suitable for sampled respondents to prefer online learning because there are few or no distractions. Learners can have access to technology to do other activities to support their learning”. There are, again, enough and enhanced learning materials available online. CONCLUSION: Unlike the previous research works focusing on the strengths and weaknesses of blended learning, the present study aims at the respective roles of its two modalities, as well as their interdependencies.

Keywords: online learning, blended learning, technologies, teaching methods

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539 Mechanical Properties and Antibiotic Release Characteristics of Poly(methyl methacrylate)-based Bone Cement Formulated with Mesoporous Silica Nanoparticles

Authors: Kumaran Letchmanan, Shou-Cang Shen, Wai Kiong Ng

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Postoperative implant-associated infections in soft tissues and bones remain a serious complication in orthopaedic surgery, which leads to impaired healing, re-implantation, prolong hospital stay and increase cost. Drug-loaded implants with sustained release of antibiotics at the local site are current research interest to reduce the risk of post-operative infections and osteomyelitis, thus, minimize the need for follow-up care and increase patient comfort. However, the improved drug release of the drug-loaded bone cements is usually accompanied by a loss in mechanical strength, which is critical for weight-bearing bone cement. Recently, more attempts have been undertaken to develop techniques to enhance the antibiotic elution as well as preserve the mechanical properties of the bone cements. The present study investigates the potential influence of addition of mesoporous silica nanoparticles (MSN) on the in vitro drug release kinetics of gentamicin (GTMC), along with the mechanical properties of bone cements. Simplex P was formulated with MSN and loaded with GTMC by direct impregnation. Meanwhile, Simplex P with water soluble poragen (xylitol) and high loading of GTMC as well as commercial bone cement CMW Smartset GHV were used as controls. MSN-formulated bone cements are able to increase the drug release of GTMC by 3-fold with a cumulative release of more than 46% as compared with other control groups. Furthermore, a sustained release could be achieved for two months. The loaded nano-sized MSN with uniform pore channels significantly build up an effective nano-network path in the bone cement facilitates the diffusion and extended release of GTMC. Compared with formulations using xylitol and high GTMC loading, incorporation of MSN shows no detrimental effect on biomechanical properties of the bone cements as no significant changes in the mechanical properties as compared with original bone cement. After drug release for two months, the bending modulus of MSN-formulated bone cements is 4.49 ± 0.75 GPa and the compression strength is 92.7 ± 2.1 MPa (similar to the compression strength of Simplex-P: 93.0 ± 1.2 MPa). The unaffected mechanical properties of MSN-formulated bone cements was due to the unchanged microstructures of bone cement, whereby more than 98% of MSN remains in the matrix and supports the bone cement structures. In contrast, the large portions of extra voids can be observed for the formulations using xylitol and high drug loading after the drug release study, thus caused compressive strength below the ASTM F541 and ISO 5833 minimum of 70 MPa. These results demonstrate the potential applicability of MSN-functionalized poly(methyl methacrylate)-based bone cement as a highly efficient, sustained and local drug delivery system with good mechanical properties.

Keywords: antibiotics, biomechanical properties, bone cement, sustained release

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538 Multiple Primary Pulmonary Meningiomas: A Case Report

Authors: Wellemans Isabelle, Remmelink Myriam, Foucart Annick, Rusu Stefan, Compère Christophe

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Primary pulmonary meningioma (PPM) is a very rare tumor, and its occurrence has been reported only sporadically. Multiple PPMs are even more exceptional, and herein, we report, to the best of our knowledge, the fourth case, focusing on the clinicopathological features of the tumor. Moreover, the possible relationship between the use of progesterone–only contraceptives and the development of these neoplasms will be discussed. Case Report: We report a case of a 51-year-old female presenting three solid pulmonary nodules, with the following localizations: right upper lobe, middle lobe, and left lower lobe, described as incidental findings on computed tomography (CT) during a pre-bariatric surgery check-up. The patient revealed no drinking or smoking history. The physical exam was unremarkable except for the obesity. The lesions ranged in size between 6 and 24 mm and presented as solid nodules with lobulated contours. The largest lesion situated in the middle lobe had mild fluorodeoxyglucose (FDG) uptake on F-18 FDG positron emission tomography (PET)/CT, highly suggestive of primary lung neoplasm. For pathological assessment, video-assisted thoracoscopic middle lobectomy and wedge resection of the right upper nodule was performed. Histological examination revealed relatively well-circumscribed solid proliferation of bland meningothelial cells growing in whorls and lobular nests, presenting intranuclear pseudo-inclusions and psammoma bodies. No signs of anaplasia were observed. The meningothelial cells expressed diffusely Vimentin, focally Progesterone receptors and were negative for epithelial (cytokeratin (CK) AE1/AE3, CK7, CK20, Epithelial Membrane Antigen (EMA)), neuroendocrine markers (Synaptophysin, Chromogranin, CD56) and Estrogenic receptors. The proliferation labelling index Ki-67 was low (<5%). Metastatic meningioma was ruled out by brain and spine magnetic resonance imaging (MRI) scans. The third lesion localized in the left lower lobe was followed-up and resected three years later because of its slow but significant growth (14 mm to 16 mm), alongside two new infra centimetric lesions. Those three lesions showed a morphological and immunohistochemical profile similar to previously resected lesions. The patient was disease-free one year post-last surgery. Discussion: Although PPMs are mostly benign and slow-growing tumors with an excellent prognosis, they do not present specific radiological characteristics, and it is difficult to differentiate it from other lung tumors, histopathologic examination being essential. Aggressive behavior is associated with atypical or anaplastic features (WHO grades II–III) The etiology is still uncertain and different mechanisms have been proposed. A causal connection between sexual hormones and meningothelial proliferation has long been suspected and few studies examining progesterone only contraception and meningioma risk have all suggested an association. In line with this, our patient was treated with Levonorgestrel, a progesterone agonist, intra-uterine device (IUD). Conclusions: PPM, defined by the typical histological and immunohistochemical features of meningioma in the lungs and the absence of central nervous system lesions, is an extremely rare neoplasm, mainly solitary and associating, and indolent growth. Because of the unspecific radiologic findings, it should always be considered in the differential diagnosis of lung neoplasms. Regarding multiple PPM, only three cases are reported in the literature, and this is the first described in a woman treated by a progesterone-only IUD to the best of our knowledge.

Keywords: pulmonary meningioma, multiple meningioma, meningioma, pulmonary nodules

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537 A Study of the Challenges in Adoption of Renewable Energy in Nigeria

Authors: Farouq Sule Garo, Yahaya Yusuf

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The purpose of this study is to investigate why there is a general lack of successful adoption of sustainable energy in Nigeria. This is particularly important given the current global campaign for net-zero emissions. The 26th United Nations Conference of the Parties (COP26), held in 2021, was hosted by the UK, in Glasgow, where, amongst other things, countries including Nigeria agreed to a zero emissions pact. There is, therefore, an obligation on the part of Nigeria for transition from fossil fuel-based economy to a sustainable net-zero emissions economy. The adoption of renewable energy is fundamental to achieving this ambitious target if decarbonisation of economic activities were to become a reality. Nigeria has an abundance of sources of renewable energy and yet there has been poor uptake and where attempts have been made to develop and harness renewable energy resources, there has been limited success. It is not entirely clear why this is the case. When analysts allude to corruption as the reason for failure for successful adoption of renewable energy or project implementation, it is arguable that corruption alone cannot explain the situation. Therefore, there is the need for a thorough investigation into the underlying issues surrounding poor uptake of renewable energy in Nigeria. This pilot study, drawing upon stakeholders’ theory, adopts a multi-stakeholder’ perspectives to investigate the influence and impacts of economic, political, technological, social factors in adoption of renewable energy in Nigeria. The research will also investigate how these factors shape (or fail to shape) strategies for achieving successful adoption of renewable energy in the country. A qualitative research methodology has been adopted given the nature of the research requiring in-depth studies in specific settings rather than a general population survey. There will be a number of interviews and each interview will allow thorough probing of sources. This, in addition to the six interviews that have already been conducted, primarily focused on economic dimensions of the challenges in adoption of renewable energy. The six participants in these initial interviews were all connected to the Katsina Wind Farm Project that was conceived and built with the view to diversifying Nigeria's energy mix and capitalise on the vast wind energy resources in the northern region. The findings from the six interviews provide insights into how the economic factors impacts on the wind farm project. Some key drivers have been identified, including strong governmental support and the recognition of the need for energy diversification. These drivers have played crucial roles in initiating and advancing the Katsina Wind Farm Project. In addition, the initial analysis has highlighted various challenges encountered during the project's implementation, including financial, regulatory, and environmental aspects. These challenges provide valuable lessons that can inform strategies to mitigate risks and improve future wind energy projects.

Keywords: challenges in adoption of renewable energy, economic factors, net-zero emission, political factors

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536 Recurrent Torsades de Pointes Post Direct Current Cardioversion for Atrial Fibrillation with Rapid Ventricular Response

Authors: Taikchan Lildar, Ayesha Samad, Suraj Sookhu

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Atrial fibrillation with rapid ventricular response results in the loss of atrial kick and shortened ventricular filling time, which often leads to decompensated heart failure. Pharmacologic rhythm control is the treatment of choice, and patients frequently benefit from the restoration of sinus rhythm. When pharmacologic treatment is unsuccessful or a patient declines hemodynamically, direct cardioversion is the treatment of choice. Torsades de pointes or “twisting of the points'' in French, is a rare but under-appreciated risk of cardioversion therapy and accounts for a significant number of sudden cardiac death each year. A 61-year-old female with no significant past medical history presented to the Emergency Department with worsening dyspnea. An electrocardiogram showed atrial fibrillation with rapid ventricular response, and a chest X-ray was significant for bilateral pulmonary vascular congestion. Full-dose anticoagulation and diuresis were initiated with moderate improvement in symptoms. A transthoracic echocardiogram revealed biventricular systolic dysfunction with a left ventricular ejection fraction of 30%. After consultation with an electrophysiologist, the consensus was to proceed with the restoration of sinus rhythm, which would likely improve the patient’s heart failure symptoms and possibly the ejection fraction. A transesophageal echocardiogram was negative for left atrial appendage thrombus; the patient was treated with a loading dose of amiodarone and underwent successful direct current cardioversion with 200 Joules. The patient was placed on telemetry monitoring for 24 hours and was noted to have frequent premature ventricular contractions with subsequent degeneration to torsades de pointes. The patient was found unresponsive and pulseless; cardiopulmonary resuscitation was initiated with cardioversion, and return of spontaneous circulation was achieved after four minutes to normal sinus rhythm. Post-cardiac arrest electrocardiogram showed sinus bradycardia with heart-rate corrected QT interval of 592 milliseconds. The patient continued to have frequent premature ventricular contractions and required two additional cardioversions to achieve a return of spontaneous circulation with intravenous magnesium and lidocaine. An automatic implantable cardioverter-defibrillator was subsequently implanted for secondary prevention of sudden cardiac death. The backup pacing rate of the automatic implantable cardioverter-defibrillator was set higher than usual in an attempt to prevent premature ventricular contractions-induced torsades de pointes. The patient did not have any further ventricular arrhythmias after implantation of the automatic implantable cardioverter-defibrillator. Overdrive pacing is a method utilized to treat premature ventricular contractions-induced torsades de pointes by preventing a patient’s susceptibility to R on T-wave-induced ventricular arrhythmias. Pacing at a rate of 90 beats per minute succeeded in controlling the arrhythmia without the need for traumatic cardiac defibrillation. In our patient, conversion of atrial fibrillation with rapid ventricular response to normal sinus rhythm resulted in a slower heart rate and an increased probability of premature ventricular contraction occurring on the T-wave and ensuing ventricular arrhythmia. This case highlights direct current cardioversion for atrial fibrillation with rapid ventricular response resulting in persistent ventricular arrhythmia requiring an automatic implantable cardioverter-defibrillator placement with overdrive pacing to prevent a recurrence.

Keywords: refractory atrial fibrillation, atrial fibrillation, overdrive pacing, torsades de pointes

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