The potential role of fatigue in difficult-to-treat rheumatoid arthritis.

OBJECTIVES: A subset of patients with rheumatoid arthritis (RA) who remains symptomatic after failing to multiple drugs are deemed to have "difficult-to-treat RA" (D2T RA). Fatigue is a burdensome symptom for RA patients, hindering their improvement. Our purpose was to evaluate the role of fatigue in D2T RA. METHODS: This cross-sectional study included rheumatoid arthritis (RA) patients between 2018 and 2022, treated with biological agents or targeted synthetic disease-modifying antirheumatic drugs. D2T RA was defined attending EULAR criteria. Independent variable was fatigue (dimensions and impact) assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire and Numerical Rating Scales. Covariables: sociodemographic, clinical and treatment. To identify factors independently associated to D2T RA, multivariable logistic regression was run. RESULTS: The study included 145 patients and 38 (26.21%) developed D2T RA. D2T RA group were older, with more comorbidity and disability. D2T RA patients scored higher for global fatigue (p = 0.003), and almost for all their dimensions except for cognitive fatigue (p = 0.06) and fatigue coping (p = 0.07). Females with D2T RA showed more fatigue than those with non-D2T RA. In the adjusted models, all fatigue dimensions were associated with D2T RA: global fatigue RA (OR: 1.03; p = 0.007), physical (OR: 1.09; p = 0.008), living (OR: 1.09; p = 0.016), cognitive (OR: 1.1; p = 0.046) and emotional (OR: 1.18; p = 0.012). CONCLUSIONS: Despite the absence of an explicit mention of fatigue in the definition of D2T RA, it appears to be associated to this outcome. Fatigue should be evaluated in a multidimensional perspective, and gender-specific differences should be considered.

The persistence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis.

OBJECTIVES: Long COVID-19 (LC) patients experience a number of chronic idiopathic symptoms that are highly similar to those of post-viral Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). We have therefore performed a systematic review and meta-analysis to determine the proportion of LC patients that satisfy ME/CFS diagnostic criteria. METHODS: Clinical studies published between January 2020 to May 2023 were identified using the PubMed, Web of Science, Embase and CINAHL databases. Publication inclusion/exclusion criteria were formulated using the global CoCoPop framework. Data were pooled using a random-effects model with a restricted maximum-likelihood estimator. Study quality was assessed using the Joanna Briggs Institute critical assessment tool. RESULTS: We identified 13 eligible studies that reported a total of 1,973 LC patients. Our meta-analysis indicated that 51% (95% CI, 42%-60%) of LC patients satisfied ME/CFS diagnostic criteria with fatigue, sleep disruption, and muscle/joint pain being the most common symptoms. Importantly, LC patients also experienced the ME/CFS hallmark symptom, post-exertional malaise. CONCLUSIONS: Our study not only demonstrates that LC patients exhibit similar symptom clusters to ME/CFS, but that approximately half of LC patients satisfy a diagnosis of ME/CFS. Our findings suggest that current ME/CFS criteria could be adapted to the identification of a subset of LC patients that may facilitate the standardized diagnosis, management and the recruitment for clinical studies in the future. DATA AVAILABILITY: Data available upon request.

Countermovement Jump and Isometric Strength Test-Retest Reliability in English Premier League Academy Football Players.

PURPOSE: To examine the test-retest reliability of countermovement jump (CMJ) and isometric strength testing measures in elite-level under-18 and under-23 academy football players. METHODS: A total of 36 players performed 3 maximal CMJs and isometric abductor (IABS), adductor (IADS), and posterior chain (IPCS) strength tests on 2 separate test days using dual force plates (CMJ and IPCS) and a portable strength testing device (IABS and IADS). Relative (intraclass correlation coefficient) and absolute (coefficient of variation, standard error of the measurement, and minimal detectable change [MDC%]) reliabilities for 34 CMJ, 10 IABS, 10 IADS, and 11 IPCS measures were analyzed using between-sessions best, mean, and within-session methods. RESULTS: For all methods, relative reliability was good to excellent for all CMJ and all IADS measures and poor to good for all IABS and IPCS measures. Absolute reliability was good (ie, coefficient of variation < 10%) for 27 (best) and 28 (mean) CMJ variables and for 6 (IABS and IADS) and 2 (IPCS) isometric measures. Commonly used CMJ measures (jump height, eccentric duration, and flight-time:contraction-time ratio) had good to excellent relative reliability and an MDC% range of 14.6% to 23.7%. Likewise, commonly used isometric peak force measures for IABS, IADS, and IPCS had good to excellent relative reliability and an MDC% range of 22.2% to 26.4%. CONCLUSIONS: Commonly used CMJ and isometric strength measures had good test-retest reliability but might be limited by their MDC%. Rate-of-force-development measures (for all isometric tests) and impulse measures (IPCS) are limited by poor relative and absolute reliability and high MDC%. MDC% statistics should be considered in the context of typical responsiveness.

Correlation between postural stability and fall risk in trans-femoral amputees due to muscle fatigue.

[Purpose] This study aimed to establish a connection between postural stability and falling in individuals with transfemoral amputation (TFA), particularly with muscle fatigue. [Participants and Methods] Fourteen participants were recruited. Muscle fatigue was induced using a sit-to-stand (STS) fatigue protocol. Pre-fatigue and post-fatigue assessments were conducted using the Biodex Balance System (BBS). [Result] The findings of the study revealed significant increases in the postural stability index between the pre-fatigue and post-fatigue conditions for the TFA group, particularly in the overall stability index (OSI) and anterior-posterior stability index (APSI) components. The mean postural stability index scores for the TFA group exhibited a percentage increase of 65.2% for OSI, 52.7% for APSI, and 50% for medial-lateral stability index (MLSI). Furthermore, the TFA fall risk index surged by 61.4%. Regarding the relationships observed, a significant correlation emerged between fall risk and both OSI and APSI. [Conclusion] These findings underscore the impact of muscle fatigue on postural stability and an increase in fall risk among TFA. By mitigating the effects of muscle fatigue, therapists can play an important role in reducing the risk of falls and promoting better postural stability in this population.

Thiamine deficiency as a differential diagnosis for severe fatigue in terminally ill cancer patients.

OBJECTIVES: Patients with advanced cancer present various symptoms as their disease progresses. Among these, fatigue is a frequent symptom in patients with advanced cancer and is associated with decreased quality of life (QOL). However, there are few reports regarding its association with thiamine deficiency (TD). METHODS: We report a case in which we found TD in a patient with advanced lung cancer who presented with weight loss, significant fatigue, and appeared to have a worsening general condition, for whom symptoms were dramatically improved within a short period of time by intravenous administration of thiamine. RESULTS: The patient was a 76-year-old woman who had been diagnosed with lung cancer and liver metastases 6 months earlier. Due to interstitial pneumonia, she was not a candidate for chemotherapy and so palliative care was started. At 8 months after initial diagnosis, the patient complained of fatigue during a medical examination, so a blood sample was taken. A week later, she visited the hospital with a cane. She felt extremely fatigued and was unable to stand, but results from the previous blood test revealed that a TD. The fatigue disappeared 15 minutes after intravenous administration of thiamine and she was able to return home without the cane. SIGNIFICANCE OF RESULTS: Fatigue is a frequent symptom in advanced cancer patients, and TD may be the underlying cause. Inclusion of TD in the differential diagnosis may contribute to improving patient QOL.

Performance fatigability in adults with spinal muscular atrophy treated long-term with nusinersen.

INTRODUCTION/AIMS: Persons with spinal muscular atrophy (pwSMA) report progressive muscle weakness but also reduced endurance when performing repetitive tasks in daily life, referred to as "performance fatigability" (PF). Data regarding the effects of the new disease-modifying drugs on PF are scarce. Thus, our main objective was to examine PF in adult ambulatory pwSMA treated long-term with nusinersen. METHODS: Six-minute walk test (6MWT) data from 14 adult pwSMA treated with nusinersen for up to 70 months were retrospectively analyzed to determine PF. Performance fatigability was defined as the percentage change in the distance covered between the last and first minute of the 6MWT. In addition, relationships between PF and other clinical features were assessed. RESULTS: Performance fatigability was found in 12/14 pwSMA (85.7%) prior to treatment. The mean distance walked in the sixth minute (71.1 m) was shorter than the distance covered in the first minute (81.8 m), corresponding to a mean PF of 13.1% (95% confidence interval (CI): 6.5-19.6, p = .0007). During treatment with nusinersen, there was a mean reduction in PF of 5.6% (95% CI: -10.0 to -1.3, p = .0148). We found no relationship between PF and fatigue as measured by the Fatigue Severity Scale. DISCUSSION: This study demonstrates the presence of PF as an independent component of motor impairment and as a potential therapeutic target in our cohort of adult ambulatory pwSMA. Furthermore, the observations in our cohort suggest that nusinersen may have a beneficial effect on PF.

Compaction of Pressure-Driven Water Treatment Membranes: Real-Time Quantification and Analysis.

Water treatment membranes play crucial roles in applications such as desalination, wastewater treatment, and potable water reuse. In a prior study, we introduced a novel method, combining electrical impedance spectroscopy with dynamic mechanical analysis, to quantify single-layer homogeneous membrane compaction up to 12.5 psi. Now we extend the method's capabilities to quantify real-time compaction of multilayer heterogeneous nanofiltration and reverse osmosis (RO) membranes up to 330 psi. Our findings demonstrate that membrane compaction does not solely occur in the support/backing layer. The air pockets between the polysulfone support and the polyester backing layers, which were not discussed previously, account for up to 18% and 14% of total membrane compaction for the nanofiltration and RO membranes. For the nanofiltration membrane, the majority of compaction (up to 45%) occurs in the void spaces of the backing layer, while for the RO membrane, the majority of compaction (up to 40%) occurs in the solid material of the backing layer. We also confirm, with experimental results, the importance of using compressive testing instead of tensile testing to accurately characterize compaction. Membrane fatigue is characterized by experimental trends including: increasing irrevocable compaction, increasing creep/instantaneous compaction ratios, and increasing strains in hysteresis experiments.

A pilot cross-sectional investigation of symptom clusters and associations with patient-reported outcomes in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post COVID-19 Condition.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is associated with long-term disability and poor quality of life (QoL). Cardinal ME/CFS symptoms (including post-exertional malaise, cognitive dysfunction and sleep disturbances) have been observed in Post COVID-19 Condition (PCC). To gain further insight into the potential role of ME/CFS as a post-COVID-19 sequela, this study investigates associations between symptoms and patient-reported outcomes, as well as symptom clusters. METHODS: Participants included Australian residents aged between 18 and 65 years formally diagnosed with ME/CFS fulfilling the Canadian or International Consensus Criteria or PCC meeting the World Health Organization case definition. Validated, self-administered questionnaires collected participants' sociodemographic and illness characteristics, symptoms, QoL and functional capacity. Associations between symptoms and patient-reported outcomes were investigated with multivariate linear regression models. Hierarchical cluster analysis was performed to identify symptom clusters. RESULTS: Most people with ME/CFS (pwME/CFS) and people with PCC (pwPCC) were female (n = 48/60, 80.0% and n = 19/30, 63.3%, respectively; p = 0.12). PwME/CFS were significantly younger (x̄=41.75, s = 12.91 years) than pwPCC (x̄=48.13, s =10.05 years; p =0.017). Autonomic symptoms (notably dyspnoea) were associated with poorer scores in most patient-reported outcome domains for both cohorts. None of the four symptom clusters identified were unique to ME/CFS or PCC. Clusters were largely delineated by the presence of gastrointestinal and neurosensory symptoms, illness duration, ME/CFS criteria met and total symptoms. CONCLUSIONS: Illness duration may explain differences in symptom burden between pwME/CFS and pwPCC. PCC diagnostic criteria must be refined to distinguish pwPCC at risk of long-term ME/CFS-like illness and subsequently deliver necessary care and support.

Post COVID-19 Condition (PCC), or Long COVID, refers to the ongoing symptoms experienced after acute COVID-19 illness. The symptoms reported by people with PCC (pwPCC) resemble Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). However, existing diagnostic criteria for PCC are broad and cannot discern PCC subtypes (such as pwPCC experiencing ME/CFS-like illness), which may require different approaches to care. This study contributes to improving PCC case criteria and approaches to care for both ME/CFS and PCC by investigating the relationships between symptoms and patient-reported outcomes among pwPCC and people with ME/CFS (pwME/CFS).For both cohorts, symptoms had a negative relationship with all aspects of health. Autonomic symptoms, notably breathing issues, returned the most negative associations. Pain, flu-like symptoms and lack of temperature control appeared more burdensome among pwPCC. These symptoms may signify the early stages of ME/CFS. Symptom clusters were also identified for the first time among a combined cohort of pwME/CFS and pwPCC in this study. Importantly, none of the symptom clusters were specific to ME/CFS or PCC. Instead, symptom clusters were defined by the prevalence of gastrointestinal and neurosensory symptoms, illness duration, ME/CFS criteria met and the total number of symptoms.This study suggests that the few differences between ME/CFS and PCC may be explained by illness duration. These findings further implicate ME/CFS as a potential post-COVID-19 outcome. As ME/CFS is associated with profound reductions in quality of life and functioning, identifying pwPCC experiencing ME/CFS-like illness through refined diagnostic criteria must be prioritised to ensure the delivery of necessary care.

Autoimmunity's enigmatic role: exploring the connection with myalgic encephalomyelitis/chronic fatigue syndrome.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complicated, heterogeneous condition distinguished by post-exertional neuroimmune exhaustion and multisystem symptoms. Its complexity poses challenges for physicians, researchers and those inflicted by its presence. Due to conflicting evidence and limiting consensus, the association and contribution autoimmunity serves in the pathophysiology or aetiology of ME/CFS is yet to be confirmed. This systematic review synthesises the currently available data to clarify the role autoimmunity has in the pathogenesis of ME/CFS and explore the therapeutic limitations. METHODS: This systematic review was conducted in accordance with the PRISMA and Cochrane guidelines. Full-text articles containing the primary key terms "Autoimmunity/Autoimmune" and "ME/CFS" were included provided their suitability to the inclusion and exclusion criteria. RESULTS: Ten publications investigating the role of autoimmunity in ME/CFS were examined. One investigated the role of cytokine signalling; Three investigated the genetic nature of autoimmunity in ME/CFS patients; One examined the immune lineage of ME/CFS patients; Six investigated the presence and role of autoantibodies in ME/CFS patients. CONCLUSION: The findings generated from this systematic review highlight inconsistent and insufficient evidence to classify ME/CFS as an autoimmune disease. Additionally, it further emphasises the complexity of ME/CFS and highlights the challenges in distinguishing autoreactivity from deregulatory processes. Future research is urgently needed to advance the development of diagnostic and treatment strategies. PROSPERO REGISTRATION CODE: CRD42024533447.

Tensile, Fatigue Properties and Their Anisotropies of Al-Mg Alloy Fabricated by Wire-Arc Additive Manufacturing.

The microstructure, mechanical properties (tensile, fatigue, etc.) and the anisotropies of the Al-Mg alloy fabricated by wire arc additive manufacturing are studied in this work. The results show that the microstructure of the deposited alloy is composed of coarse columnar grains in the inner-layer region and fine equiaxed grains in the interlayer region. The tensile and fatigue properties exhibit strong anisotropies. The ultimate tensile strength (258 MPa), yield strength (140 MPa), elongation (21.3%), and fatigue life (2.56 × 105) of the sample along travel direction (0° direction) are the best, whereas those of the sample along the deposited direction (90° direction) are the lowest and those of the sample along 45° direction are the medium. It is found that the lowest strength and elongation of the sample in the deposited direction can be attributed to the large weak bonding areas between the deposition layers, whereas the lowest fatigue property is associated with the fatigue crack propagation along the grain boundaries of the columnar grains.

Fatigue and Corrosion Evaluation of L-PBF 316L Stainless Steel Having Undergone a Self-Terminating Etching Process for Surface Finish Improvement.

The poor surface finish of as-printed (AP) laser powder bed fusion (L-PBF) 316L stainless steels has detrimental impacts on the resulting fatigue and corrosion performance. One postprocessing method, a self-terminating etching process (STEP), can improve the surface finish of parts up to 76%, but the resulting effects on fatigue life and corrosion reliability remain unknown. This work evaluates the effect of the STEP on the fatigue and corrosion performance of L-PBF 316L. In addition, to determine the influence of changing the microstructures from the as-built condition, specimens having undergone a pre-STEP stress relief (SR + STEP) heat treatment and a pre-STEP solution anneal (SA + STEP) were evaluated. The results showed that a pre-STEP SR resulted in the best Sa roughness, while a pre-STEP SA had the biggest improvement in Sv roughness. Despite Sv roughness being a major indicator of fatigue performance, the coarse grains and internal porosity in the SA specimens resulted in the poorest fatigue performance. The SR + STEP specimens' fatigue lives were 10 × higher than the AP samples under a load of 275 MPa and 2-3 × higher under a 350 MPa load. The SR + STEP specimen also had the best corrosion performance in a sodium chloride electrolyte due to the smoother surface and least remnant surface carbides.

No reduced serum serotonin levels in patients with post-acute sequelae of COVID-19.

PURPOSE: Approximately 10-20% of patients previously infected with SARS-CoV-2 experience post-acute sequelae of COVID-19 (PASC), presenting with fatigue and neurocognitive dysfunction along various other symptoms. Recent studies suggested a possible role of a virally induced decrease in peripheral serotonin concentration in the pathogenesis of PASC. We set out to verify this finding in an independent and well-defined cohort of PASC patients from our post-COVID-19 outpatient clinic. METHODS: We performed a retrospective case-control study including 34 confirmed PASC patients and 14 healthy controls. Clinical assessment encompassed physician examination as well as questionnaire based evaluation. Eligibility required ongoing symptoms for at least 6 months post-PCR-confirmed infection, relevant fatigue (CFS ≥ 4), and no other medical conditions. Serum serotonin was determined by LC-MS/MS technique. RESULTS: Serum serotonin levels in PASC patients did not significantly differ from healthy controls. Most subjects had normal serotonin levels, with no subnormal readings. Subgroup analyses showed no significant differences in serotonin levels based according to predominant fatigue type, high overall fatigue score or depression severity. CONCLUSION: We postulate that peripheral serotonin is no reliable biomarker for PASC and that it should not be used in routine diagnostic. Therapy of PASC with serotonin-reuptake inhibitors or tryptophane supplementation should not be based solely on the assumption of lowered serotonin levels.

Incidence and risk factors for limb fracture in greyhound racing in Western Australia.

Identification of risk factors for race day injury can improve greyhound welfare. Race day fractures are the most significant injury event and have the greatest negative impact on dog welfare and the industry's social license to operate. This study aimed to describe the incidence and risk factors for race-related fractures in greyhounds racing in Western Australia. Electronic extracts describing race level data and race day injuries were provided by Racing and Wagering Western Australia (RWWA). The incidence rate (IR) of fractures for all greyhound race starts in Western Australia from 1 January 2017-31/12/2023 was calculated per 1000 starts. Univariable and multivariable models using Poisson regression were used to calculate the IR ratio of fracture type based on race and greyhound-level factors. There were 198,008 racing starts and 662 (n = 643, 97.1% involving the limbs) fractures resulting in an IR of 3.3 fractures per 1000 starts (95%CI 3.1-3.6). Greyhounds that had an injury in their previous race were 2.3 times (95%CI1.4-4.3) more likely to have a forelimb fracture than greyhounds that did not have an injury (P = 0.013). The risk of tarsal bone fracture was greater in greyhounds older than 30 months and greyhounds that had not raced in the previous 15 days. Risk factors for fractures in the forelimb were associated with trauma after interference or dog collisions, whereas tarsal fractures were associated with strain and cyclic loading from race training/racing. Changes to racing structure, rules and policies based on these risk factors may help to reduce fracture incidence in racing greyhounds.

[Post-COVID-19 condition-Clinical phenotyping in practice]. / Post-COVID-19-Zustand ­ klinische Phänotypisierung in der Praxis.

BACKGROUND: The high number and clinical heterogeneity of neurological impairments in patients with a post-COVID-19 condition (PCC) poses a challenge for outpatient care. OBJECTIVE: Our aim was to evaluate the applicability of the proposed subtypes according to the guidelines "Long/Post-COVID" (30 May 2024) and their phenotyping using clinical and neuropsychological findings from our post-COVID outpatient clinic. METHODS: The evaluation was based on cross-sectional neurological and psychological test examinations of the patients, which were carried out using standardized questionnaires and test batteries. In addition, a detailed anamnesis of the current symptoms and a retrospective survey of the acute symptoms up to 4 weeks after the confirmed infection was conducted. The subtypes were classified according to the abovementioned guidelines based on the medical history and selected patient questionnaires, to which we added a 5th subtype with reference to the previous guidelines "Long/Post-COVID" (as of 5 March 2023). RESULTS: A total of 157 patients were included between August 2020 and March 2022. The presentation was at a median of 9.4 months (interquartile range, IQR = 5.3) after infection, with a mean age of 49.9 years (IQR = 17.2) and more women (68%) presenting, with a total hospitalization rate of 26%. Subtype 1 (postintensive care syndrome) showed the highest proportion of men, highest body mass index (BMI) scores and the highest rates of subjective complaints of word-finding difficulties (70%). Subtype 2 (secondary diseases) was dominated by cognitive impairment and had the highest depression scores. Subtype 3 (fatigue and exercise-induced insufficiency) was the most common, had the most symptoms and most severe subjective fatigue and the largest proportion of women. Subtype 4 (exacerbation) mainly showed affective symptoms. Subtype 5 (complaints without relevance to everyday life) had the lowest scores for depression, fatigue and BMI. Neurological and psychological conditions were frequently pre-existing in all groups. DISCUSSION: The management of PCC can be improved at various levels. A standardized subtype classification enables early individually tailored treatment concepts. Patients at risk should be identified at the primary care level and informed about risk factors and prevention strategies. Regular monitoring of cardiovascular risk factors and physical activity are essential for PCC treatment. In the case of cognitive deficits and concurrent affective symptoms, psychotherapeutic support and drug treatment with selective serotonin reuptake inhibitors (SSRI) should be provided at an early stage.

Brain endurance training improves sedentary older adults' cognitive and physical performance when fresh and fatigued.

OBJECTIVES: Cognitive and physical performance is impaired by aging and fatigue. Cognitive and exercise training may mitigate such impairments. Accordingly, we investigated the effect of Brain Endurance Training (BET) - combined cognitive and exercise training - on cognitive and physical performance when fresh and fatigued in older adults. DESIGN: Twenty-four healthy sedentary women (65-78 years) were randomly allocated to one of three training groups: BET, exercise training, and control (no training). The BET and exercise training groups completed the same physical training protocol comprising three 45-min exercise sessions (20-min resistance exercise plus 25-min endurance exercise) per week for eight weeks. The BET group completed a 20-min cognitive task prior to exercise tasks. Cognitive (tasks: psychomotor vigilance, Stroop) and physical (tests: walk, chair-stand, arm curl) performance was tested when fresh and fatigued (before and after a 30-min cognitive task) at weeks 0 (pre-test), 4 (mid-test), 8 (post-test), and 12 (follow-up test). RESULTS: Cognitive and physical and performance was generally superior when fresh and fatigued at mid-test and post-test for both BET and exercise training groups compared to the control group. The BET group outperformed the exercise group when fatigued at mid-test and post-test both cognitively (always) and physically (sometimes). The pre-to-post changes in cognitive performance when fresh and fatigued averaged 3.7 % and 7.8 % for BET, 3.6 % and 4.5 % for exercise, and -0.4 % and 0.3 % for control groups. The corresponding changes in physical performance averaged 16.5 % and 29.9 % for BET, 13.8 % and 22.4 % for exercise, and 10.8 % and 7.1 % for control groups. CONCLUSION: These findings show that BET can improve cognitive and physical performance in older adults.

Coping strategies of intensive care units nurses in alarm management: a qualitative research study.

BACKGROUND: Intensive care units are critical environments where various alarm systems play a pivotal role in patient monitoring and safety. Alarm fatigue can lead to slower response times and missed alarms, compromising patient safety and increasing stress and burnout among intensive care unit nurses. Understanding how intensive care unit nurses respond to and manage these alarms is crucial in evaluating their impact on patient care and nursing well-being. METHODS: This descriptive qualitative study explored the experiences of intensive care unit nurses in alarm management. Conducted in the medical and surgical intensive care units of a Northern Taiwan medical center, the study involved 15 nurses. Semi-structured interviews were utilized to investigate the working experiences of ICU nurses in alarm management and to identify their coping strategies for dealing with the constant inundation of medical device alarms. The interviews were transcribed, and content analysis was applied to identify key themes in the responses. RESULTS: The study revealed five main themes in intensive care unit nurses' strategies for managing alarms: (1) Mastering alarm signals and acting; (2) Team monitoring for life preservation; (3) Enhancing senses and distinguishing carefully; (4) Learning from the lessons of incidents for vigilant reflection; and (5) Detach alarms' influence on daily life. These coping strategies are effective in alarm management, safeguarding patients' lives, enhancing the serenity of the clinical environment, and mitigating the physical and mental exhaustion caused by alarm fatigue. CONCLUSIONS: Intensive Care Unit nurses develop various coping strategies to manage medical device alarms, based on their experience. These strategies are crucial in maintaining patient safety and reducing nurse alarm fatigue. They can also be used for nursing education and clinical training.

Decoding burst swimming performance: a scaling perspective on time-to-fatigue.

Fatigue curves quantify fish swimming performance, providing information about the time ([Formula: see text]) fish can swim against a steady flow velocity (Uf) before fatiguing. Such curves represent a key tool for many applications in ecological engineering, especially for fish pass design and management. Despite years of research, though, our current ability to model fatigue curves still lacks theoretical foundations and relies primarily on fitting empirical data, as obtained from time-consuming and costly experiments. In the present article, we address this shortcoming by proposing a theoretical analysis that builds upon concepts of fish hydrodynamics to derive scaling laws linking statistical properties of [Formula: see text] to velocities Uf, pertaining to the so-called burst range. Theoretical arguments, in the present study, suggest that the proposed scaling laws may hold true for all fish species and sizes. A new experimental database obtained from over 800 trials and five small-sized Cypriniformes support theoretical predictions satisfactorily and calls for further experiments on more fish species and sizes to confirm their general validity.

Self-care practices among professional nurses employed in primary health care clinics.

BACKGROUND:  Professional nurses typically promote and advocate self-care practices to their patients to achieve better health outcomes, but rarely engage in these practices themselves. METHODS:  A qualitative, descriptive phenomenological approach was used in this study. Ten professional nurses employed in different primary health care facilities were purposively sampled. Semi-structured interviews were conducted to collect data, which were analysed using Colaizzi's data analysis strategy, and data saturation was reached. RESULTS:  Two themes were identified. Theme 1: the participants expressed that internal and external factors compromised self-care practices, such as subconscious self-neglect, insufficient resources, and a depressed economy, which encouraged them to work extended hours. Theme 2: participants' holistic well-being was compromised, as they neglected their mental well-being. CONCLUSION:  Self-care practices among professional nurses seem unachievable. The extent of this population's self-care neglect was evident during the coronavirus disease 2019 (COVID-19) pandemic when professional nurses globally gave of themselves relentlessly.Contribution: This is the first study conducted on the topic in the City of Ekurhuleni, and the findings will provide relevant stakeholders with a directive on what strategies, policies, and guidelines to develop and implement to make self-care practices attainable for professional nurses.

Determinants of brain drain among physicians in Turkey: Findings from a national exploratory study.

BACKGROUND: The shortage of physicians in Turkey is a highly critical emergency. In fact, physicians' migration to developing or high-income countries, defined as brain drain, threatens the sustainability of the national healthcare system. AIMS: This study explored the driving factors associated with Turkish Physicians' brain drain, including high-economic inflation, social-politics, poor-living, equity, violence, and the desire to practice medical activity abroad. METHODS: A cross-sectional survey of 1,861 Turkish physicians aged 25 to 65 years old was conducted employing the Brain Drain questionnaire, the Depression Anxiety Stress Scale (DASS-21), the Patient Health Questionnaire 9 (PHQ-9), and the Fatigue Assessment Scale (FAS). RESULTS: Significant differences were observed among physicians staying in Turkey versus considering migration to Western countries, regarding their age, gender, marital status, educational level, occupational status, work years, hospital night shifts, income, and cigarette/nargileh smoking habits (all p ⩽ .018). The main reasons for brain drain included transport problems, harassment, low salary, malpractice, bad environment, job insecurity, workload, burnout, treating difficult patients, inadequate postgraduate systems, peer-pressure, health safety concerns, and favoritism in the workplace, as well as stress and depression caused by work overload. In fact, depression, anxiety, stress, fatigue, and burnout varied significantly among the different groups of physicians (all p ⩽ .013). Additionally, key predictors of brain drain were better job opportunities, poor hospital management (in Turkey), job-related stress, dealing with difficult patients, research deficiencies, workload, burnout, transportation issues, short consultation time, low salary, and fatigue. Among the general factors contributing to the brain drain in the Turkish Health System, we identified significant issues related to research deficiencies, compulsory working duties, poor quality of postgraduate, inadequate medical-schools, poor hospital management, and shortage of consultants. CONCLUSION: Physicians' migration is a major global public health concern, leading to substantial risks for healthcare services, especially in Turkey. Many physicians decide to migrate to work in Western countries.

Comparative study for fatigue prevalence in subjects with diseases: a systematic review and meta-analysis.

Fatigue is one of the common symptoms in individuals with diseases or disorders, significantly affecting quality of life (QoL) and the prognosis of diseases. This study aimed to comprehensively compare the features of fatigue across a wide range of diseases. We systematically searched the PubMed and Cochrane Library databases from inception to March 31st, 2021, and conducted a meta-analysis to generate precise estimates. The analyses were stratified by classification of diseases, gender, and severity of fatigue (moderate and severe), and study quality was assessed using the Newcastle-Ottawa Scale (NOS). In total, 214 articles (233 prevalence data) met our eligibility criteria, covering 102,024 participants (mean 438 ± 1,421) across 88 diseases. Among these, seventy-eight data sets (52,082 participants) and thirty-nine data sets (10,389 participants) reported gender- and severity-related fatigue prevalence. The overall prevalence among subjects with 88 diseases was 49.4% [95% CI 46.9-52.1]. According to the International Classification of Diseases-10 (ICD-10) classification, the highest prevalence of fatigue (65.9% [95% CI 54.9-79.6]) was observed in patients with mental/behavioral diseases, whereas the lowest prevalence (34.7% [95% CI 24.5-49.2]) was found among those with circulatory system diseases. A slight female dominance (43.5% vs. 49.8%) was observed in the total data, with the most notable female predominance (1.8-fold) seen in patients with low back pain. The top disease groups with a moderate to severe level of fatigue included gastroparesis (92.3%), pulmonary hypertension (90.0%), chronic obstructive pulmonary disease (COPD, 83.2%), and multiple sclerosis (80.0%). These results are the first to comprehensively show the comparative features of fatigue prevalence among subjects across 88 diseases. Our findings provide valuable reference data for future research on fatigue and for the management of patients with fatigue.Prospero registration number: CRD42021270494.