Search results for: compassion fatigue
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 694

Search results for: compassion fatigue

424 Determination of Influence Lines for Train Crossings on a Tied Arch Bridge to Optimize the Construction of the Hangers

Authors: Martin Mensinger, Marjolaine Pfaffinger, Matthias Haslbeck

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The maintenance and expansion of the railway network represents a central task for transport planning in the future. In addition to the ultimate limit states, the aspects of resource conservation and sustainability are increasingly more necessary to include in the basic engineering. Therefore, as part of the AiF research project, ‘Integrated assessment of steel and composite railway bridges in accordance with sustainability criteria’, the entire lifecycle of engineering structures is involved in planning and evaluation, offering a way to optimize the design of steel bridges. In order to reduce the life cycle costs and increase the profitability of steel structures, it is particularly necessary to consider the demands on hanger connections resulting from fatigue. In order for accurate analysis, a number simulations were conducted as part of the research project on a finite element model of a reference bridge, which gives an indication of the internal forces of the individual structural components of a tied arch bridge, depending on the stress incurred by various types of trains. The calculations were carried out on a detailed FE-model, which allows an extraordinarily accurate modeling of the stiffness of all parts of the constructions as it is made up surface elements. The results point to a large impact of the formation of details on fatigue-related changes in stress, on the one hand, and on the other, they could depict construction-specific specifics over the course of adding stress. Comparative calculations with varied axle-stress distribution also provide information about the sensitivity of the results compared to the imposition of stress and axel distribution on the stress-resultant development. The calculated diagrams help to achieve an optimized hanger connection design through improved durability, which helps to reduce the maintenance costs of rail networks and to give practical application notes for the formation of details.

Keywords: fatigue, influence line, life cycle, tied arch bridge

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423 A Study of Social Media Users’ Switching Behavior

Authors: Chiao-Chen Chang, Yang-Chieh Chin

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Social media has created a change in the way the network community is clustered, especially from the location of the community, from the original virtual space to the intertwined network, and thus the communication between people will change from face to face communication to social media-based communication model. However, social media users who have had a fixed engagement may have an intention to switch to another service provider because of the emergence of new forms of social media. For example, some of Facebook or Twitter users switched to Instagram in 2014 because of social media messages or image overloads, and users may seek simpler and instant social media to become their main social networking tool. This study explores the impact of system features overload, information overload, social monitoring concerns, problematic use and privacy concerns as the antecedents on social media fatigue, dissatisfaction, and alternative attractiveness; further influence social media switching. This study also uses the online questionnaire survey method to recover the sample data, and then confirm the factor analysis, path analysis, model fit analysis and mediating analysis with the structural equation model (SEM). Research findings demonstrated that there were significant effects on multiple paths. Based on the research findings, this study puts forward the implications of theory and practice.

Keywords: social media, switching, social media fatigue, alternative attractiveness

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422 Affects Associations Analysis in Emergency Situations

Authors: Joanna Grzybowska, Magdalena Igras, Mariusz Ziółko

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Association rule learning is an approach for discovering interesting relationships in large databases. The analysis of relations, invisible at first glance, is a source of new knowledge which can be subsequently used for prediction. We used this data mining technique (which is an automatic and objective method) to learn about interesting affects associations in a corpus of emergency phone calls. We also made an attempt to match revealed rules with their possible situational context. The corpus was collected and subjectively annotated by two researchers. Each of 3306 recordings contains information on emotion: (1) type (sadness, weariness, anxiety, surprise, stress, anger, frustration, calm, relief, compassion, contentment, amusement, joy) (2) valence (negative, neutral, or positive) (3) intensity (low, typical, alternating, high). Also, additional information, that is a clue to speaker’s emotional state, was annotated: speech rate (slow, normal, fast), characteristic vocabulary (filled pauses, repeated words) and conversation style (normal, chaotic). Exponentially many rules can be extracted from a set of items (an item is a previously annotated single information). To generate the rules in the form of an implication X → Y (where X and Y are frequent k-itemsets) the Apriori algorithm was used - it avoids performing needless computations. Then, two basic measures (Support and Confidence) and several additional symmetric and asymmetric objective measures (e.g. Laplace, Conviction, Interest Factor, Cosine, correlation coefficient) were calculated for each rule. Each applied interestingness measure revealed different rules - we selected some top rules for each measure. Owing to the specificity of the corpus (emergency situations), most of the strong rules contain only negative emotions. There are though strong rules including neutral or even positive emotions. Three examples of the strongest rules are: {sadness} → {anxiety}; {sadness, weariness, stress, frustration} → {anger}; {compassion} → {sadness}. Association rule learning revealed the strongest configurations of affects (as well as configurations of affects with affect-related information) in our emergency phone calls corpus. The acquired knowledge can be used for prediction to fulfill the emotional profile of a new caller. Furthermore, a rule-related possible context analysis may be a clue to the situation a caller is in.

Keywords: data mining, emergency phone calls, emotional profiles, rules

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421 Physiological and Psychological Influence on Office Workers during Demand Response

Authors: Megumi Nishida, Naoya Motegi, Takurou Kikuchi, Tomoko Tokumura

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In recent years, power system has been changed and flexible power pricing system such as demand response has been sought in Japan. The demand response system is simple in the household sector and the owner, decision-maker, can gain the benefits of power saving. On the other hand, the execution of the demand response in the office building is more complex than household because various people such as owners, building administrators and occupants are involved in making decisions. While the owners benefit from the demand saving, the occupants are forced to be exposed to demand-saved environment certain benefits. One of the reasons is that building systems are usually centralized control and each occupant cannot choose either participate demand response event or not, and contribution of each occupant to demand response is unclear to provide incentives. However, the recent development of IT and building systems enables the personalized control of office environment where each occupant can control the lighting level or temperature around him or herself. Therefore, it can be possible to have a system which each occupant can make a decision of demand response participation in office building. This study investigates the personal behavior upon demand response requests, under the condition where each occupant can adjust their brightness individually in their workspace. Once workers participate in the demand response, their task lights are automatically turned off. The participation rates in the demand response events are compared between four groups which are divided by different motivation, the presence or absence of incentives and the way of participation. The result shows that there are the significant differences of participation rates in demand response event between four groups. The way of participation has a large effect on the participation rate. ‘Opt-out’ group, where the occupants are automatically enrolled in a demand response event if they don't express non-participation, will have the highest participation rate in the four groups. The incentive has also an effect on the participation rate. This study also reports that the impact of low illumination office environment on the occupants, such as stress or fatigue. The electrocardiogram and the questionnaire are used to investigate the autonomic nervous activity and subjective symptoms about the fatigue of the occupants. There is no big difference between dim workspace during demand response event and bright workspace in autonomic nervous activity and fatigue.

Keywords: demand response, illumination, questionnaire, electrocardiogram

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420 Simple Finite-Element Procedure for Modeling Crack Propagation in Reinforced Concrete Bridge Deck under Repetitive Moving Truck Wheel Loads

Authors: Rajwanlop Kumpoopong, Sukit Yindeesuk, Pornchai Silarom

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Modeling cracks in concrete is complicated by its strain-softening behavior which requires the use of sophisticated energy criteria of fracture mechanics to assure stable and convergent solutions in the finite-element (FE) analysis particularly for relatively large structures. However, for small-scale structures such as beams and slabs, a simpler approach relies on retaining some shear stiffness in the cracking plane has been adopted in literature to model the strain-softening behavior of concrete under monotonically increased loading. According to the shear retaining approach, each element is assumed to be an isotropic material prior to cracking of concrete. Once an element is cracked, the isotropic element is replaced with an orthotropic element in which the new orthotropic stiffness matrix is formulated with respect to the crack orientation. The shear transfer factor of 0.5 is used in parallel to the crack plane. The shear retaining approach is adopted in this research to model cracks in RC bridge deck with some modifications to take into account the effect of repetitive moving truck wheel loads as they cause fatigue cracking of concrete. First modification is the introduction of fatigue tests of concrete and reinforcing steel and the Palmgren-Miner linear criterion of cumulative damage in the conventional FE analysis. For a certain loading, the number of cycles to failure of each concrete or RC element can be calculated from the fatigue or S-N curves of concrete and reinforcing steel. The elements with the minimum number of cycles to failure are the failed elements. For the elements that do not fail, the damage is accumulated according to Palmgren-Miner linear criterion of cumulative damage. The stiffness of the failed element is modified and the procedure is repeated until the deck slab fails. The total number of load cycles to failure of the deck slab can then be obtained from which the S-N curve of the deck slab can be simulated. Second modification is the modification in shear transfer factor. Moving loading causes continuous rubbing of crack interfaces which greatly reduces shear transfer mechanism. It is therefore conservatively assumed in this study that the analysis is conducted with shear transfer factor of zero for the case of moving loading. A customized FE program has been developed using the MATLAB software to accomodate such modifications. The developed procedure has been validated with the fatigue test of the 1/6.6-scale AASHTO bridge deck under the applications of both fixed-point repetitive loading and moving loading presented in the literature. Results are in good agreement both experimental vs. simulated S-N curves and observed vs. simulated crack patterns. Significant contribution of the developed procedure is a series of S-N relations which can now be simulated at any desired levels of cracking in addition to the experimentally derived S-N relation at the failure of the deck slab. This permits the systematic investigation of crack propagation or deterioration of RC bridge deck which is appeared to be useful information for highway agencies to prolong the life of their bridge decks.

Keywords: bridge deck, cracking, deterioration, fatigue, finite-element, moving truck, reinforced concrete

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419 Railway Crane Accident: A Comparative Metallographic Test on Pins Fractured during Operation

Authors: Thiago Viana

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Eventually train accidents occur on railways and for some specific cases it is necessary to use a train rescue with a crane positioned under a platform wagon. These tumbled machines are collected and sent to the machine shop or scrap yard. In one of these cranes that were being used to rescue a wagon, occurred a fall of hoist due to fracture of two large pins. The two pins were collected and sent for failure analysis. This work investigates the main cause and the secondary causes for the initiation of the fatigue crack. All standard failure analysis procedures were applied, with careful evaluation of the characteristics of the material, fractured surfaces and, mainly, metallographic tests using an optical microscope to compare the geometry of the peaks and valleys of the thread of the pins and their respective seats. By metallographic analysis, it was concluded that the fatigue cracks were started from a notch (stress concentration) in the valley of the threads of the pin applied to the right side of the crane (pin 1). In this, it was verified that the peaks of the threads of the pin seat did not have proper geometry, with sharp edges being present that caused such notches. The visual analysis showed that fracture of the pin on the left side of the crane (pin 2) was brittle type, being a consequence of the fracture of the first one. Recommendations for this and other railway cranes have been made, such as nondestructive testing, stress calculation, design review, quality control and suitability of the mechanical forming process of the seat threads and pin threads.

Keywords: crane, fracture, pin, railway

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418 Implementation of Active Recovery at Immediate, 12 and 24 Hours Post-Training in Young Soccer Players

Authors: C. Villamizar, M. Serrato

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In the pursuit of athletic performance, the role of physical training which is determined by a number of charges or taxes on physiological stress and musculoskeletal systems of the human body generated by the intensity and duration is fundamental. Given the physical demands of these activities both training and competitive must take into account the optimal relationship with a straining process recovery post favoring the process of overcompensation which aims to facilitate the return and rising energy potential and protein synthesis also of different tissues. Allowing muscle function returns to baseline or pre-exercise states. If this recovery process is not performed or is not allowed in a proper way, will result in an increased state of fatigue. Active recovery, is one of the strategies implemented in the sport for a return to pre-exercise physiological states. However, there are some adverse assumptions regarding the negative effects, as is the possibility of increasing the degradation of muscle glycogen and thus delaying the synthesis thereof. For them, it is necessary to investigate what would be the effects generated application made at different times after the effort. The aim of this study was to determine the effects of active recovery post effort made at three different times: immediately, at 12 and 24 hours on biochemical markers creatine kinase in youth soccer player’s categories. A randomized controlled trial with allocation to three groups was performed: A. active recovery immediately after the effort; B. active recovery performed at 12 hours after the effort; C. active recovery made at 24 hours after the effort. This study included 27 subjects belonging to a Colombian soccer team of the second division. Vital signs, weight, height, BMI, the percentage of muscle mass, fat mass percentage, personal medical history, and family were valued. The velocity, explosive force and Creatin Kinase (CK) in blood were tested before and after interventions. SAFT 90 protocol (Soccer Field specific Aerobic Test) was applied to participants for generating fatigue. CK samples were taken one hour before the application of the fatigue test, one hour after the fatigue protocol and 48 of the initial CK sample. Mean age was 18.5 ± 1.1 years old. Improvements in jumping and speed recovery the 3 groups (p < 0.05), but no statistically significant differences between groups was observed after recuperation. In all participants, there was a significant increment of CK when applied SAFT 90 in all the groups (median 103.1-111.1). The CK measurement after 48 hours reflects a recovery in all groups, however the group C, a decline below baseline levels of -55.5 (-96.3 /-20.4) which is a significant find. Other research has shown that CK does not return quickly to their baseline, but our study shows that active recovery favors the clearance of CK and also to perform recovery 24 hours after the effort generates higher clearance of this biomarker.

Keywords: active recuperation, creatine phosphokinase, post training, young soccer players

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417 Conceptual Design of Panel Based Reinforced Concrete Floating Substructure for 10 MW Offshore Wind Turbine

Authors: M. Sohail Hasan, Wichuda Munbua, Chikako Fujiyama, Koichi Maekawa

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During the past few years, offshore wind energy has become the key parameter to reduce carbon emissions. In most of the previous studies, floaters in floating offshore wind turbines (FOWT) are made up of steel. However, fatigue and corrosion are always major concerns of steel marine structures. Recently, researchers are working on concrete floating substructures. In this paper, the conceptual design of pre-cast panel-based economical and durable reinforced concrete floating substructure for a 10 MW offshore wind turbine is proposed. The new geometrical shape, i.e., hexagon with inside hollow boxes, is proposed under static conditions. To design the outer panel/side walls to resist hydrostatic forces, special consideration for durability is given to limit the crack width within permissible range under service limit state. A comprehensive system is proposed for transferring the ultimate moment and shear due to strong wind at the connection between steel tower and concrete floating substructure. Moreover, a stable connection is also designed considering the fatigue of concrete and steel due to the fluctuation of stress from the mooring line. This conceptual design will be verified by subsequent dynamic analysis soon.

Keywords: cracks width control, mooring line, reinforced concrete floater, steel tower

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416 Adaptation to Repeated Eccentric Exercise Assessed by Double to Single Twitch Ratio

Authors: Damian Janecki, Anna Jaskólska, Jarosław Marusiak, Artur Jaskólski

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The aim of this study was to assess double to single twitch ratio after two bouts of eccentric exercise of the elbow flexors. Maximal isometric torque, single and double twitch responses and low-frequency fatigue were assessed on the elbow flexors in 19 untrained male volunteers before, immediately after, 24 and 48 hours following two bouts of eccentric exercise consisted of 30 repetitions of lowering a dumbbell adjusted to ~75% of each individual's maximal isometric torque. Maximal isometric torque and electrically evoked responses decreased significantly in all measurements after the first bout of eccentric exercise (P<0.05). In measurements performed at 24 and 48 hours after the second bout both maximal voluntary isometric torque and electrically evoked contractions were significantly higher than in measurements performed after the fist bout (P<0.05). Although low-frequency fatigue significantly increased up to 48 hours after each bout of eccentric exercise, its values at 24 and 48 hours after the second bout were significantly lower than at respective time points after the first bout (P<0.05). Smaller changes in double to single twitch ratio at 24 and 48 hours after the second bout of eccentric exercise reflects repeated bout effect that confers protection against subsequent exercise-induced muscle damage.

Keywords: biceps brachii, electrical stimulation, lenghtening contractions, repeated bout effect

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415 A Call for Justice and a New Economic Paradigm: Analyzing Counterhegemonic Discourses for Indigenous Peoples' Rights and Environmental Protection in Philippine Alternative Media

Authors: B. F. Espiritu

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This paper examines the resistance of the Lumad people, the indigenous peoples in Mindanao, Southern Philippines, and of environmental and human rights activists to the Philippine government's neoliberal policies and their call for justice and a new economic paradigm that will uphold peoples' rights and environmental protection in two alternative media online sites. The study contributes to the body of knowledge on indigenous resistance to neoliberal globalization and the quest for a new economic paradigm that upholds social justice for the marginalized in society, empathy and compassion for those who depend on the land for their survival, and environmental sustainability. The study analyzes the discourses in selected news articles from Davao Today and Kalikasan (translated to English as 'Nature') People's Network for the Environment’s statements and advocacy articles for the Lumad and the environment from 2018 to February 2020. The study reveals that the alternative media news articles and the advocacy articles contain statements that expose the oppression and violation of human rights of the Lumad people, farmers, government environmental workers, and environmental activists as shown in their killings, illegal arrest and detention, displacement of the indigenous peoples, destruction of their schools by the military and paramilitary groups, and environmental plunder and destruction with the government's permit for the entry and operation of extractive and agribusiness industries in the Lumad ancestral lands. Anchored on Christian Fuch's theory of alternative media as critical media and Bert Cammaerts' theorization of alternative media as counterhegemonic media that are part of civil society and form a third voice between state media and commercial media, the study reveals the counterhegemonic discourses of the news and advocacy articles that oppose the dominant economic system of neoliberalism which oppresses the people who depend on the land for their survival. Furthermore, the news and advocacy articles seek to advance social struggles that transform society towards the realization of cooperative potentials or a new economic paradigm that upholds economic democracy, where the local people, including the indigenous people, are economically empowered their environment and protected towards the realization of self-sustaining communities. The study highlights the call for justice, empathy, and compassion for both the people and the environment and the need for a new economic paradigm wherein indigenous peoples and local communities are empowered towards becoming self-sustaining communities in a sustainable environment.

Keywords: alternative media, environmental sustainability, human rights, indigenous resistance

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414 Experimental Evaluation of Contact Interface Stiffness and Damping to Sustain Transients and Resonances

Authors: Krystof Kryniski, Asa Kassman Rudolphi, Su Zhao, Per Lindholm

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ABB offers range of turbochargers from 500 kW to 80+ MW diesel and gas engines. Those operate on ships, power stations, generator-sets, diesel locomotives and large, off-highway vehicles. The units need to sustain harsh operating conditions, exposure to high speeds, temperatures and varying loads. They are expected to work at over-critical speeds damping effectively any transients and encountered resonances. Components are often connected via friction joints. Designs of those interfaces need to account for surface roughness, texture, pre-stress, etc. to sustain against fretting fatigue. The experience from field contributed with valuable input on components performance in hash sea environment and their exposure to high temperature, speed and load conditions. Study of tribological interactions of oxide formations provided an insight into dynamic activities occurring between the surfaces. Oxidation was recognized as the dominant factor of a wear. Microscopic inspections of fatigue cracks on turbine indicated insufficient damping and unrestrained structural stress leading to catastrophic failure, if not prevented in time. The contact interface exhibits strongly non-linear mechanism and to describe it the piecewise approach was used. Set of samples representing the combinations of materials, texture, surface and heat treatment were tested on a friction rig under range of loads, frequencies and excitation amplitudes. Developed numerical technique extracted the friction coefficient, tangential contact stiffness and damping. Vast amount of experimental data was processed with the multi-harmonics balance (MHB) method to categorize the components subjected to the periodic excitations. At the pre-defined excitation level both force and displacement formed semi-elliptical hysteresis curves having the same area and secant as the actual ones. By cross-correlating the terms remaining in the phase and out of the phase, respectively it was possible to separate an elastic energy from dissipation and derive the stiffness and damping characteristics.

Keywords: contact interface, fatigue, rotor-dynamics, torsional resonances

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413 Attitude and Perception of Multiple Sclerosis Patients toward Exercise

Authors: Ali Fuad Ashour

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Introduction: Contrary to the common belief that physical training for multiple sclerosis (MS) patients might exacerbate fatigue and provoke other symptoms of the illness, it is now widely accepted that exercise can be actually beneficial in terms of activities of daily living, reduced fatigue, and improved quality of life. The aim of this study was to assess the attitude of MS patients toward exercise. Methodology: 112 MS patients who were recruited from the local community participated in this study. We utilised a self-developed questionnaire targeting attitudes and perceptions of MS patients towards physical exercise. The questionnaire was piloted and tested for validity and reliability. Results: Before being diagnosed with MS, 49.9% of our MS patients’ respondents used to engage in different types of physical activities and sports, namely aerobics/walking (35.3%), stretching exercise (18.7%), and strengthening exercise (11.4%). After being diagnosed with MS, 40.8% of our sample showed determination to remain physically active. The interest in sports activities was consistent after the diagnoses with MS and included aerobics/walking (33.8%), stretching exercise (22.6%), and strengthening exercise (19.7%). Discussion: The Kuwaiti respondents thought that lack of encouragement was the main reason for them not exercise. Aptly put, if they try to exercise, they will be discouraged by the loved ones lest the worse happens. On the other side, British patients are generally aware of the benefits of physical and mental health-promoting activities; they can seek help from a wide range of professionals and are more actively involved in the management of their condition. It is therefore important that the benefits of physical activity are promoted among MS patients, and that attitude towards MS and MS patients is changed through education.

Keywords: perception, multiple sclerosis, exercise, physical training

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412 The Beneficial Effects of Hydrotherapy for Recovery from Team Sport – A Meta-Analysis

Authors: Trevor R. Higgins

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To speed/enhance recovery from sport, cold water immersion (CWI) and contrast water therapy (CWT) have become common practice within the high-level team sport. Initially, research into CWI and CWT protocols and recovery was sparse; athletes relied solely upon an anecdotal support. However, an increase into recovery research has occurred. A number of reviews have subsequently been conducted to clarify scientific evidence. However, as the nature of physiological stress and training status of participants will impact on results, an opportunity existed to narrow the focus to a more exacting review evaluating hydrotherapy for recovery in a team sport. A Boolean logic [AND] keyword search of databases was conducted: SPORTDiscus; AMED; CINAHL; MEDLINE. Data was extracted and the standardized mean differences were calculated with 95% CI. The analysis of pooled data was conducted using a random-effect model, with Heterogeneity assessed using I2. 23 peer reviewed papers (n=606) met the criteria. Meta-analyses results indicated CWI was likely beneficial for recovery at 24h (Countermovement Jump (CMJ): p= 0.05, CI -0.004 to 0.578; All-out sprint: p=0.02, -0.056 to 0.801; DOMS: p=0.08, CI -0.092 to 1.936) and at 72h (accumulated sprinting: p=0.07, CI -0.062 to 1.209; DOMS: p=0.09, CI -0.121 to 1.555) following team sport. Whereas CWT was likely beneficial for recovery at 1h (CMJ: p= 0.07, CI -0.004 to 0.863) and at 48h (fatigue: p=0.04, CI 0.013 to 0.942) following team sport. Athlete’s perceptions of muscle soreness and fatigue are enhanced with CWI and/or CWT, however even though CWI and CWT were beneficial in attenuating decrements in neuromuscular performance 24 hours following team sport, indications are those benefits were no longer Sydney evident 48 hours following team sport.

Keywords: cold water immersion, contrast water therapy, recovery, team sport

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411 Uncommon Presentation of Iscahemic Heart Disease with Sheehan’s Syndrome at Mid-Level Private Hospital of Bangladesh and Its Management- A Case Report

Authors: Nazmul Haque, Syeda Tasnuva Maria

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Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

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410 Burnout Recognition for Call Center Agents by Using Skin Color Detection with Hand Poses

Authors: El Sayed A. Sharara, A. Tsuji, K. Terada

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Call centers have been expanding and they have influence on activation in various markets increasingly. A call center’s work is known as one of the most demanding and stressful jobs. In this paper, we propose the fatigue detection system in order to detect burnout of call center agents in the case of a neck pain and upper back pain. Our proposed system is based on the computer vision technique combined skin color detection with the Viola-Jones object detector. To recognize the gesture of hand poses caused by stress sign, the YCbCr color space is used to detect the skin color region including face and hand poses around the area related to neck ache and upper back pain. A cascade of clarifiers by Viola-Jones is used for face recognition to extract from the skin color region. The detection of hand poses is given by the evaluation of neck pain and upper back pain by using skin color detection and face recognition method. The system performance is evaluated using two groups of dataset created in the laboratory to simulate call center environment. Our call center agent burnout detection system has been implemented by using a web camera and has been processed by MATLAB. From the experimental results, our system achieved 96.3% for upper back pain detection and 94.2% for neck pain detection.

Keywords: call center agents, fatigue, skin color detection, face recognition

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409 Analysis of the Effects of Vibrations on Tractor Drivers by Measurements With Wearable Sensors

Authors: Gubiani Rino, Nicola Zucchiatti, Da Broi Ugo, Bietresato Marco

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The problem of vibrations in agriculture is very important due to the different types of machinery used for the different types of soil in which work is carried out. One of the most commonly used machines is the tractor, where the phenomenon has been studied for a long time by measuring the whole body and placing the sensor on the seat. However, this measurement system does not take into account the characteristics of the drivers, such as their body index (BMI), their gender (male, female) or the muscle fatigue they are subjected to, which is highly dependent on their age for example. The aim of the research was therefore to place sensors not only on the seat but along the spinal column to check the transmission of vibration on drivers with different BMI on different tractors and at different travel speeds and of different genders. The test was also done using wearable sensors such as a dynamometer applied to the muscles, the data of which was correlated with the vibrations produced by the tractor. Initial data show that even on new tractors with pneumatic seats, the vibrations attenuate little and are still correlated with the roughness of the track travelled and the forward speed. Another important piece of data are the root-mean square values referred to 8 hours (A(8)x,y,z) and the maximum transient vibration values (MTVVx,y,z) and, the latter, the MTVVz values were problematic (limiting factor in most cases) and always aggravated by the speed. The MTVVx values can be lowered by having a tyre-pressure adjustment system, able to properly adjust the tire pressure according to the specific situation (ground, speed) in which a tractor is operating.

Keywords: fatigue, effect vibration on health, tractor driver vibrations, vibration, muscle skeleton disorders

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408 Chronic Fatigue Syndrome/Myalgic Encephalomyelitis in Younger Children: A Qualitative Analysis of Families’ Experiences of the Condition and Perspective on Treatment

Authors: Amberly Brigden, Ali Heawood, Emma C. Anderson, Richard Morris, Esther Crawley

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Background: Paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) is characterised by persistent, disabling fatigue. Health services see patients below the age of 12. This age group experience high levels of disability, with low levels of school attendance, high levels of fatigue, anxiety, functional disability and pain. CFS/ME interventions have been developed for adolescents, but the developmental needs of younger children suggest treatment should be tailored to this age group. Little is known about how intervention should be delivered to this age group, and further work is needed to explore this. Qualitative research aids patient-centered design of health intervention. Methods: Five to 11-year-olds and their parents were recruited from a specialist CFS/ME service. Semi-structured interviews explored the families’ experience of the condition and perspectives on treatment. Interactive and arts-based methods were used. Interviews were audio-recorded, transcribed and analysed thematically. Qualitative Results: 14 parents and 7 children were interviewed. Early analysis of the interviews revealed the importance of the social-ecological setting of the child, which led to themes being developed in the context of Systems Theory. Theme one relates to the level of the child, theme two the family system, theme three the organisational and societal systems, and theme four cuts-across all levels. Theme1: The child’s capacity to describe, understand and manage their condition. Younger children struggled to describe their internal experiences, such as physical symptoms. Parents felt younger children did not understand some concepts of CFS/ME and did not have the capabilities to monitor and self-regulate their behaviour, as required by treatment. A spectrum of abilities was described; older children (10-11-year-olds) were more involved in clinical sessions and had more responsibility for self-management. Theme2: Parents’ responsibility for managing their child’s condition. Parents took responsibility for regulating their child’s behaviour in accordance with the treatment programme. They structured their child’s environment, gave direct instructions to their child, and communicated the needs of their child to others involved in care. Parents wanted their child to experience a 'normal' childhood and took steps to shield their child from medicalization, including diagnostic labels and clinical discussions. Theme3: Parental isolation and the role of organisational and societal systems. Parents felt unsupported in their role of managing the condition and felt negative responses from primary care health services and schools were underpinned by a lack of awareness and knowledge about CFS/ME in younger children. This sometimes led to a protracted time to diagnosis. Parents felt that schools have the potential important role in managing the child’s condition. Theme4: Complexity and uncertainty. Many parents valued specialist treatment (which included activity management, physiotherapy, sleep management, dietary advice, medical management and psychological support), but felt it needed to account for the complexity of the condition in younger children. Some parents expressed uncertainty about the diagnosis and the treatment programme. Conclusions: Interventions for younger children need to consider the 'systems' (family, organisational and societal) involved in the child’s care. Future research will include interviews with clinicians and schools supporting younger children with CFS/ME.

Keywords: chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME), pediatric, qualitative, treatment

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407 Non-Linear Dynamic Analyses of Grouted Pile-Sleeve Connection

Authors: Mogens Saberi

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The focus of this article is to present the experience gained from the design of a grouted pile-sleeve connection and to present simple design expressions which can be used in the preliminary design phase of such connections. The grout pile-sleeve connection serves as a connection between an offshore jacket foundation and pre-installed piles located in the seabed. The jacket foundation supports a wind turbine generator resulting in significant dynamic loads on the connection. The connection is designed with shear keys in order to optimize the overall design but little experience is currently available in the use of shear keys in such connections. It is found that the consequence of introducing shear keys in the design is a very complex stress distribution which requires special attention due to significant fatigue loads. An optimal geometrical shape of the shear keys is introduced in order to avoid large stress concentration factors and a relatively easy fabrication. The connection is analysed in ANSYS Mechanical where the grout is modelled by a non-linear material model which allows for cracking of the grout material and captures the elastic-plastic behaviour of the grout material. Special types of finite elements are used in the interface between the pile sleeve and the grout material to model the slip surface between the grout material and the steel. Based on the performed finite element modelling simple design expressions are introduced.

Keywords: fatigue design, non-linear finite element modelling, structural dynamics, simple design expressions

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406 Component Test of Martensitic/Ferritic Steels and Nickel-Based Alloys and Their Welded Joints under Creep and Thermo-Mechanical Fatigue Loading

Authors: Daniel Osorio, Andreas Klenk, Stefan Weihe, Andreas Kopp, Frank Rödiger

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Future power plants currently face high design requirements due to worsening climate change and environmental restrictions, which demand high operational flexibility, superior thermal performance, minimal emissions, and higher cyclic capability. The aim of the paper is, therefore, to investigate the creep and thermo-mechanical material behavior of improved materials experimentally and welded joints at component scale under near-to-service operating conditions, which are promising for application in highly efficient and flexible future power plants. These materials promise an increase in flexibility and a reduction in manufacturing costs by providing enhanced creep strength and, therefore, the possibility for wall thickness reduction. At the temperature range between 550°C and 625°C, the investigation focuses on the in-phase thermo-mechanical fatigue behavior of dissimilar welded joints of conventional materials (ferritic and martensitic material T24 and T92) to nickel-based alloys (A617B and HR6W) by means of membrane test panels. The temperature and external load are varied in phase during the test, while the internal pressure remains constant. At the temperature range between 650°C and 750°C, it focuses on the creep behavior under multiaxial stress loading of similar and dissimilar welded joints of high temperature resistant nickel-based alloys (A740H, A617B, and HR6W) by means of a thick-walled-component test. In this case, the temperature, the external axial load, and the internal pressure remain constant during testing. Numerical simulations are used for the estimation of the axial component load in order to induce a meaningful damage evolution without causing a total component failure. Metallographic investigations after testing will provide support for understanding the damage mechanism and the influence of the thermo-mechanical load and multiaxiality on the microstructure change and on the creep and TMF- strength.

Keywords: creep, creep-fatigue, component behaviour, weld joints, high temperature material behaviour, nickel-alloys, high temperature resistant steels

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405 Effects of Overtraining in Female Collegiate Athletes

Authors: Morgan Dombroski, Alexis Hartman

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Purpose: The present study aimed to explore factors related to overtraining within a female collegiate sample by analyzing the aftereffects of overtraining on athletes' physical and emotional well-being. Methods: 51 female collegiate athletes participated in a de-identified survey to assess factors related to overtraining. All survey questions were derived from the Recovery-Stress Questionnaire. Descriptive and bivariate correlations were conducted to test for significant factors related to the athletes' physical and emotional well-being relating to sports engagement. Results: Descriptive statistics indicated: 80.4% of athletes reported feeling tired from sport-related work, 72.5% reported parts of their body were aching, 47.1% reported feeling emotionally drained, and 37.3% reported feeling burnt out by sport. These findings were consistent with bivariate correlations, which yielded statistically significant findings between physical fatigue and emotional distress. Discussion: In a general sense, athletes increase their training to maximize their performance. The current study aimed to analyze how this training process can result in overtraining of female collegiate athletes, which in turn may negatively impact their physical and emotional functioning. Overtraining syndrome can occur as a maladaptive response to excessive exercise and inappropriate rest caused by systemic inflammation, which negatively affects the central nervous system. The physical manifestations of overtraining can then lead to depressed mood, fatigue, and neurohormonal changes in athletes. To remain competitive and high performing in sports, athletes partaking in excessive training can result in overtraining syndrome, athlete burnout, and compulsive exercise. Additionally, overtrained athletes were defined by displaying high levels of perfectionism, maladaptive coping, and training distress. The current study supported these findings, which yielded a strong correlation between physical and emotional functioning in the context of overtraining in sports. All in all, the environment revolving around sports and the intensity of training can be extremely stressful for athletes. There is a need to monitor athletes’ subjective responses to training, which will allow for early identification of at-risk athletes giving clinicians various opportunities to reduce the negative consequences of overtraining. By better understanding symptoms of emotional and physical fatigue, collegiate sports can become more aware of overtraining symptoms to prevent further detriment to female athletes' overall well-being.

Keywords: burnout, emotionally drained, overtraining, performance, well-being

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404 Biaxial Fatigue Specimen Design and Testing Rig Development

Authors: Ahmed H. Elkholy

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An elastic analysis is developed to obtain the distribution of stresses, strains, bending moment and deformation for a thin hollow, variable thickness cylindrical specimen when subjected to different biaxial loadings. The specimen was subjected to a combination of internal pressure, axial tensile loading and external pressure. Several axial to circumferential stress ratios were investigated in detail. The analytical model was then validated using experimental results obtained from a test rig using several biaxial loadings. Based on the preliminary results obtained, the specimen was then modified geometrically to ensure uniform strain distribution through its wall thickness and along its gauge length. The new design of the specimen has a higher buckling strength and a maximum value of equivalent stress according to the maximum distortion energy theory. A cyclic function generator of the standard servo-controlled, electro-hydraulic testing machine is used to generate a specific signal shape (sine, square,…) at a certain frequency. The two independent controllers of the electronic circuit cause an independent movement to each servo-valve piston. The movement of each piston pressurizes the upper and lower sides of the actuators alternately. So, the specimen will be subjected to axial and diametral loads independent of each other. The hydraulic system has two different pressures: one pressure will be responsible for axial stress produced in the specimen and the other will be responsible for the tangential stress. Changing the two pressure ratios will change the stress ratios accordingly. The only restriction on the maximum stress obtained is the capacity of the testing system and specimen instability due to buckling.

Keywords: biaxial, fatigue, stress, testing

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403 Development of Probability Distribution Models for Degree of Bending (DoB) in Chord Member of Tubular X-Joints under Bending Loads

Authors: Hamid Ahmadi, Amirreza Ghaffari

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Fatigue life of tubular joints in offshore structures is not only dependent on the value of hot-spot stress, but is also significantly influenced by the through-the-thickness stress distribution characterized by the degree of bending (DoB). The DoB exhibits considerable scatter calling for greater emphasis in accurate determination of its governing probability distribution which is a key input for the fatigue reliability analysis of a tubular joint. Although the tubular X-joints are commonly found in offshore jacket structures, as far as the authors are aware, no comprehensive research has been carried out on the probability distribution of the DoB in tubular X-joints. What has been used so far as the probability distribution of the DoB in reliability analyses is mainly based on assumptions and limited observations, especially in terms of distribution parameters. In the present paper, results of parametric equations available for the calculation of the DoB have been used to develop probability distribution models for the DoB in the chord member of tubular X-joints subjected to four types of bending loads. Based on a parametric study, a set of samples was prepared and density histograms were generated for these samples using Freedman-Diaconis method. Twelve different probability density functions (PDFs) were fitted to these histograms. The maximum likelihood method was utilized to determine the parameters of fitted distributions. In each case, Kolmogorov-Smirnov test was used to evaluate the goodness of fit. Finally, after substituting the values of estimated parameters for each distribution, a set of fully defined PDFs have been proposed for the DoB in tubular X-joints subjected to bending loads.

Keywords: tubular X-joint, degree of bending (DoB), probability density function (PDF), Kolmogorov-Smirnov goodness-of-fit test

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402 Psychosocial Predictors of Non-Suicidal Self-Injury in Adolescents: Literature Review

Authors: K. Grigoryan, T. Jurcik

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Interpersonal and school-related factors, along with individual characteristics, can predict non-suicidal self-injures (NSSI). The objective of this review is to describe psychosocial variables associated with NSSI among adolescents. A better understanding of this phenomenon may facilitate the identification of potentially effective interventions for adolescents. Relevant empirical studies and reviews from clinical, cross-cultural, and social psychology, as well as cognitive psychology literature, were synthesized into two broad topics: social/interpersonal and individual factors. Variables related to the occurrence of NSSI are discussed, including social support, peer modeling, abuse, personality traits, sense of belongingness, self-compassion, and others. Based on these findings, specific clinical recommendations were identified that need to be further evaluated empirically. The systemic interventions recommended in this review may further promote research in circumventing this social and clinical problem.

Keywords: non-suicidal self-injury, psychosocial factors, mental health, adolescence

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401 Effect of Citrulline on the Physical Performance of a Soccer-Specific Exercises in Adult Professional Soccer Players

Authors: Bezuglov Eduard, Ryland Morgans, Talibov Oleg, Kalinin Evgeny, Butovsky Mikhail, Savin Evgeny, Tzgoev Eduard, Artemii Lazarev, Bekzhan Pirmakhanov, Anthony C. Hackney

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Currently, there is conflicting evidence regarding the efficacy of citrulline for physical performance and post-exercise recovery. Moreover, the vast majority of studies conducted used physically active volunteers from the general population and heterogeneous exercise protocols that are not specific to most sports. A single use of citrulline, regardless of the dose, will not have a significant effect on physical performance and post-exercise recovery in highly trained soccer players performing sport-specific exercises at maximum intensity. To evaluate the effectiveness of a single administration of citrulline at various doses in adult male professional soccer players performing sport-specific exercise at maximum intensity. A randomized, double-blind, placebo-controlled study analyzing eighteen soccer players from the top divisions of several European countries. The participants were randomized into three groups of six and performed a field-based soccer-specific test at 115% VO2max for 18-minutes. Comparative analysis of the cardiovascular system, physical activity, subjective perceived fatigue and post-exercise recovery was conducted. There were no statistically significant differences in more than one analyzed parameter. A single application of 3 to 6 grams of citrulline does not affect physical performance, subjective feeling of fatigue and post-exercise recovery in adult professional soccer players who have performed a sport-specific test. Currently, citrulline cannot be recommended for use as a supplement in adult professional soccer players

Keywords: citrulline, performance, recovery, soccer players

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400 Electromechanical Reliability of ITO/Ag/ITO Multilayer Coated Pet Substrate for Optoelectronic Application

Authors: D. W. Mohammed, J. Bowen, S. N. Kukureka

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Successful design and fabrication of flexible devices for electrode components requires a low sheet resistance, high optical transmittance, high mechanical reliability. Indium tin oxide (ITO) film is currently the predominant transparent conductive oxide (TCO) film in potential applications such as flexible organic light- emitting diodes, flat-panel displays, solar cells, and thin film transistors (TFTs). However ITO films are too brittle and their resistivity is rather high in some cases compared with ITO/Ag/ ITO, and they cannot completely meet flexible optoelectronic device requirements. Therefore, in this work the mechanical properties of ITO /Ag/ITO multilayer film that deposited on Polyethylene terephthalate (PET) compared with the single layered ITO sample were investigated using bending fatigue, twisting fatigue and thermal cycling experiments. The electrical resistance was monitored during the application of mechanical and thermal loads to see the pattern of relationship between the load and the electrical continuity as a consequent of failure. Scanning electron microscopy and atomic force microscopy were used to provide surface characterization of the mechanically-tested samples. The effective embedment of the Ag layer between upper and lower ITO films led to metallic conductivity and superior flexibility to the single ITO electrode, due to the high failure strain of the ductile Ag layer. These results indicate that flexible ITO/Ag/ITO multilayer electrodes are a promising candidate for use as transparent conductor in flexible displays. They provided significantly reduced sheet resistance compared to ITO, and improved bending and twisting properties both as a function of radius, angle and thermal cycling.

Keywords: ITO/Ag/ITO multilayer, failure strain, mechanical properties, PET

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399 Creating Inclusive Educational Environments for Women Faculty of Color Harnessing Ubuntu Perspectives

Authors: Gonzaga Mukasa, Faith Maina, Amani Zaier

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This study investigated whether harnessing Ubuntu perspectives can aid in healing wounds Hierarchical Microaggressive intersectionalities inflict on African immigrant women faculty in predominantly white institutions. The study interviewed 8 African immigrant faculty from different higher education institutions in the United States selected using the snowball sampling technique. The Ubuntu Theory anchored the study. Findings indicated that women faculty of color experience Hierarchical Microaggressive intersectionalities leading them to lose job satisfaction and feel deprofessionalized and isolated. The recommendations were that institutions make their recruitment more inclusive of women of color to avoid isolation. And should embrace Ubuntu perspectives such as survival, solidarity, compassion, dignity, and mutual respect to architect educational environments that foster diversity and inclusion.

Keywords: ubuntu, women faculty, African immigrants, hierarchical microaggressive intersectionalities

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398 A Study of Fatigue Life Estimation of a Modular Unmanned Aerial Vehicle by Developing a Structural Health Monitoring System

Authors: Zain Ul Hassan, Muhammad Zain Ul Abadin, Muhammad Zubair Khan

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Unmanned aerial vehicles (UAVs) have now become of predominant importance for various operations, and an immense amount of work is going on in this specific category. The structural stability and life of these UAVs is key factor that should be considered while deploying them to different intelligent operations as their failure leads to loss of sensitive real-time data and cost. This paper presents an applied research on the development of a structural health monitoring system for a UAV designed and fabricated by deploying modular approach. Firstly, a modular UAV has been designed which allows to dismantle and to reassemble the components of the UAV without effecting the whole assembly of UAV. This novel approach makes the vehicle very sustainable and decreases its maintenance cost to a significant value by making possible to replace only the part leading to failure. Then the SHM for the designed architecture of the UAV had been specified as a combination of wings integrated with strain gauges, on-board data logger, bridge circuitry and the ground station. For the research purpose sensors have only been attached to the wings being the most load bearing part and as per analysis was done on ANSYS. On the basis of analysis of the load time spectrum obtained by the data logger during flight, fatigue life of the respective component has been predicted using fracture mechanics techniques of Rain Flow Method and Miner’s Rule. Thus allowing us to monitor the health of a specified component time to time aiding to avoid any failure.

Keywords: fracture mechanics, rain flow method, structural health monitoring system, unmanned aerial vehicle

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397 Explore the Effect of Telecare for the Elderly in Preventing and Delaying the Quality of Disability Care with Bluetooth Brainwave Equipment

Authors: Jui-Chen Huang

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The purpose of this study is to explore the effects of telecare on preventing and delaying the quality of disability care in elderly people with portable comfort Bluetooth brainwave devices with remote healthcare functions. Through the teaching videos and remotely teaching the elderly, which had ever learned the care courses of the prevent and delay disability, these elderly did muscle strength training. Then this paper explores the effect of training with the data by SPSS 18.0 statistical software. The data is collected with pre-test, post-test and analyze data from the measure of the Bluetooth brain wave equipment including the pressure index, relaxation index, attention and fatigue index of the elderly. In this study, 30 elderly people who had taken preventive and delayed disability care courses were studied to explore the effect of their care quality improvement. The results showed that the pressure index, relaxation index, attention, and fatigue index of the elderly had statistically significant differences in two months. It can be seen that elderly people who have been treated to prevent and delay disability care courses can significantly improve their care quality if they continue to receive intensive training to prevent and delay disability through remote mode. This telecare is applied to the elderly program that has been used to prevent and delay disability care courses. It is worth continuing to promote, and it is recommended that follow-up studies be conducted in a longer-term manner to explore long-term benefits. It can solve the current insufficiency of long-term care resources, but the demand is urgent.

Keywords: telecare, bluetooth brainwave equipment, prevention and delay of disability, the elderly, care quality

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396 Meditation, Mental States, Quantum Mechanics and Enlightenment

Authors: Ven. Bhikkhu Ananda

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Mind emerged from the quantum field. The practice of mediation can take one to the state of enlightenment. During meditation, the change in the very behaviour of electrons, protons, and photons and their fields, known to be quantum fields, create mental states. This could well be expressed in the mathematical language of quantum mechanics. This paper qualifies and quantifies mental states created during meditation and is explained by quantum mechanics. In meditation, phenomenology can be seen as the process of enlightenment. In this process, the emptiness shown in Buddhist philosophy and the emptiness of quantum fields is compared. The methodologies used here are mindfulness meditation and metta mediation (compassion meditation ). The research findings suggest not only quantumness and change are consciousness, but well-founded behaviour of an individual in the society, which can amplify the positive behaviour caused by mental states, and that emptiness and impermanence of phenomenon are based on dependent arisings. The presence of quantum coherence indicates that quantum mechanics has a role in the evolution of the pure mind and the phenomenology created thereof in mediation.

Keywords: meditation, mental states, quantum mechanics, enlightenment

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395 Promoting Compassionate Communication in a Multidisciplinary Fellowship: Results from a Pilot Evaluation

Authors: Evonne Kaplan-Liss, Val Lantz-Gefroh

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Arts and humanities are often incorporated into medical education to help deepen understanding of the human condition and the ability to communicate from a place of compassion. However, a gap remains in our knowledge of compassionate communication training for postgraduate medical professionals (as opposed to students and residents); how training opportunities include and impact the artists themselves, and how train-the-trainer models can support learners to become teachers. In this report, the authors present results from a pilot evaluation of the UC San Diego Health: Sanford Compassionate Communication Fellowship, a 60-hour experiential program that uses theater, narrative reflection, poetry, literature, and journalism techniques to train a multidisciplinary cohort of medical professionals and artists in compassionate communication. In the culminating project, fellows design and implement their own projects as teachers of compassionate communication in their respective workplaces. Qualitative methods, including field notes and 30-minute Zoom interviews with each fellow, were used to evaluate the impact of the fellowship. The cohort included both artists (n=2) and physicians representing a range of specialties (n=7), such as occupational medicine, palliative care, and pediatrics. The authors coded the data using thematic analysis for evidence of how the multidisciplinary nature of the fellowship impacted the fellows’ experiences. The findings show that the multidisciplinary cohort contributed to a greater appreciation of compassionate communication in general. Fellows expressed that the ability to witness how those in different fields approached compassionate communication enhanced their learning and helped them see how compassion can be expressed in various contexts, which was both “exhilarating” and “humbling.” One physician expressed that the fellowship has been “really helpful to broaden my perspective on the value of good communication.” Fellows shared how what they learned in the fellowship translated to increased compassionate communication, not only in their professional roles but in their personal lives as well. A second finding was the development of a supportive community. Because each fellow brought their own experiences and expertise, there was a sense of genuine ability to contribute as well as a desire to learn from others. A “brave space” was created by the fellowship facilitators and the inclusion of arts-based activities: a space that invited vulnerability and welcomed fellows to make their own meaning without prescribing any one answer or right way to approach compassionate communication. This brave space contributed to a strong connection among the fellows and reports of increased well-being, as well as multiple collaborations post-fellowship to carry forward compassionate communication training at their places of work. Results show initial evidence of the value of a multidisciplinary fellowship for promoting compassionate communication for both artists and physicians. The next steps include maintaining the supportive fellowship community and collaborations with a post-fellowship affiliate faculty program; scaling up the fellowship with non-physicians (e.g., nurses and physician assistants); and collecting data from family members, colleagues, and patients to understand how the fellowship may be creating a ripple effect outside of the fellowship through fellows’ compassionate communication.

Keywords: compassionate communication, communication in healthcare, multidisciplinary learning, arts in medicine

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