Meta-analysis of natural killer cell cytotoxicity in myalgic encephalomyelitis/chronic fatigue syndrome.

Reduced natural killer (NK) cell cytotoxicity is the most consistent immune finding in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Meta-analysis of the published literature determined the effect size of the decrement in ME/CFS. Databases were screened for papers comparing NK cell cytotoxicity in ME/CFS and healthy controls. A total of 28 papers and 55 effector:target cell ratio (E:T) data points were collected. Cytotoxicity in ME/CFS was significantly reduced to about half of healthy control levels, with an overall Hedges' g of 0.96 (0.75-1.18). Heterogeneity was high but was explained by the range of E:T ratios, different methods, and potential outliers. The outcomes confirm reproducible NK cell dysfunction in ME/CFS and will guide studies using the NK cell model system for pathomechanistic investigations. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024542140.

Chronic Fatigue Syndrome: Diagnosis, Treatment, and Future Direction.

Myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), is a complex, chronic condition marked by persistent, debilitating fatigue that is not alleviated by rest and often worsens with physical or mental exertion. Along with fatigue, patients experience various symptoms, including cognitive impairments, post-exertional malaise, muscle and joint pain, sleep disturbances, and immune system dysfunction. Diagnosing CFS/ME is challenging due to the absence of definitive biomarkers, the overlap of symptoms with other conditions, and the lack of standardized diagnostic criteria. This comprehensive literature review aims to contribute to the understanding of CFS/ME, including its diagnosis, pathophysiology, differential diagnosis, treatment, and future directions.

The impact of the filling technique with two sealers in bulk or associated with gutta-percha on the fatigue behavior and failure patterns of endodontically treated teeth.

Background: The present in vitro study aimed to evaluate the fatigue behavior of teeth filled with a calcium silicate-based sealer (Bio-C Sealer, BC) or an epoxy resin-based sealer (AH Plus, AH), in bulk or associated with gutta-percha as main core material. Methods: Seventy-two sound human maxillary anterior teeth were initially selected. Sixty of them, were randomly chosen, and had their root canals prepared using nickel-titanium reciprocating instruments, being again randomly assigned to five experimental groups (n = 12): C+ (control + prepared but not filled); BC-B (BC in bulk); BC-GP (BC+ gutta-percha); AP-B (AH in bulk); AP-GP (AH+ gutta-percha). An additional negative control group (C-) was considered (n = 12), consisting only on sound teeth, without preparation and filling. The specimens were submitted to a survival analysis after the cyclic fatigue test. Results: Sound teeth (C-) presented the best fatigue performance (P < 0.05), being similar only to the AP-GP group (P > 0.05). Despite that, all experimental groups showed similar fatigue behavior (P > 0.05) to C+ (BC-B = BC-GP = AP-B = AP-GP = C+). Based on that, it can be seen that the use of gutta-percha, as a main core material, associated with the AH Plus sealer, reestablished the mechanical fatigue performance of endodontically treated teeth comparable to sound teeth, still consisting on the most promising approach to rehabilitate such scenario. Teeth filled in bulk, had discreetly higher risk of premature failures and inferior fatigue performance.

Assessing the relationship between mental workload and work fatigue among oil and gas workers in PT X, Jambi Province, Indonesia: PLS-SEM analysis.

Occupational fatigue among oil and gas workers can have perilous consequences related to safety, health, economy, and wellbeing. This makes it necessary to discover major factors related to fatigue and implement appropriate prevention programs and education. Therefore, this study aimed to investigate the relationship between mental workload, sleep quality, and occupational fatigue in oil and gas office workers in Jambi Province, Indonesia. Mental workload, sleep quality, and occupational fatigue were measured using the NASA-TLX, PSQI, and the Indonesian Questionnaire Measuring Feelings of Work Fatigue (KAUPK2), respectively. A PLS-SEM approach was used to determine the association between mental workload, sleep quality, and occupational fatigue. Out of the 116 oil and gas workers in Jambi Province who participated in this study, 58.6% were male, 54.3% had Senior High School or less, 85.3% were not smoking, and 88.8% were married, working experience from 0.17 to 34 years. The mean of body height, weight, and mass index were 165.35 cm, 64.65 kg, and 23.64 respectively. The PLS-SEM model illustrated that the direct effect of mental workload on occupational fatigue was not significant. Meanwhile, the mental workload had a significant effect on sleep quality, which significantly affected fatigue. This indicated that the effect of workload on fatigue was fully mediated by sleep quality. The impact of good sleep on an employee's ability to recover from increased mental workload was substantial. According to this study, introducing mental workload coping methods, routine measurement, and sleep hygiene programs among oil and gas workers can reduce occupational fatigue.

Mechanical fatigue in microtubules.

Mechanical failure of biological nanostructures due to sustained force application has been studied in great detail. In contrast, fatigue failure arising from repeated application of subcritical stresses has received little attention despite its prominent role in engineering and potentially biology. Here, paclitaxel-stabilized microtubules are up to 256 times bent into sinusoidal shapes of varying wavelength and the frequency of breaking events are observed. These experiments allow the calculation of fatigue life parameters for microtubules. Repeated buckling due to 12.5% compression-equal to the compression level experienced by microtubules in contracting cardiomyocytes - results in failure after in average 5 million cycles, whereas at 20.0% compression failure occurs after in average one thousand cycles. The fatigue strength (Basquin) exponent B is estimated as - 0.054±0.009.

Long-term course and factors influencing work ability and return to work in post-COVID patients 12 months after inpatient rehabilitation.

BACKGROUND: Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation. METHODS: This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability. RESULTS: At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability. CONCLUSIONS: The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health. TRIAL REGISTRATION: This study is registered in the German Clinical Trials Register under DRKS00022928.

Simulation and experimentation of nonlinear Rayleigh wave inspection of fatigue surface microcracks.

The nonlinear ultrasonic inspection is a method that the higher harmonics generated by the interaction of ultrasound and fatigue damage, which is used to evaluate material properties. In this paper, the difference between experimental measurement and simulation analysis was discussed, based on the simulation and experimentation. The results of simulation and experimentation both show that the nonlinear coefficient increases, reaches the maximum near the wavelength of 0.3λ, and then decreases to a certain extent and stabilizes. The difference between the simulation and the experimentation is that the crack depth corresponding to the maxima of the nonlinear coefficient and the relative variation between the nonlinear coefficient and the peak are different. And the causes of the difference were analyzed according to the simulation results and experimental measurements, which provides a reliable basis for the further study of the evaluation mechanism of the nonlinear Rayleigh wave.

Relationship Between Alarm Fatigue and Stress Among Acute Care Nurses: A Cross-Sectional Study.

Introduction: Given the vital nature of their profession, ICU nurses endure significant psychological and physical stress. Burnout, low job satisfaction, and deteriorated patient care might result from the high-stress atmosphere. Objectives: This study aims to assess the level of alarm fatigue and stress among nurses who work in acute care units. Methods: A descriptive design was used to recruit nurses in acute care units. A self-administered questionnaire was used to collect the required data composed of three parts, namely demographical data; the alarm fatigue part, which was created by Torabizadeh et al. and composed of 13 items, and the perceived stress scale (PSS) which is a psychological diagnostic instrument created to assess how much people find their daily lives to be stressful. It was created by Cohen et al. and composed of 10 items. Results: An average age of (35.3 ± 6.24) years, and an average number of years of experience of (7.63 ± 5.56), were found among the 128 nurses that were recruited. Acute care nurses had a significant degree of alarm fatigue, as indicated by the overall alarm fatigue score of (M = 30.1 ± SD = 7.47). A moderate degree of stress was also indicated by the overall perceived stress score, which was (M = 21.5 ± 5.02). Among nurses, alarm fatigue and felt stress are not correlated with any demographic feature, including sex, educational attainment, marital status, and working location. Conclusion: Stress and alarm fatigue are serious problems for acute care units that can jeopardize nurse and patient safety. The implementation of methods that mitigate alarm fatigue and stress, such as alarm customization, adequate staffing, and support systems, can enhance the work environment in acute care units. Healthcare companies can raise the grade of care provided to patients and enhance the general well-being and job satisfaction of their nursing staff by addressing these challenges.

Web-based telemedicine approach for treatment of post-COVID-19 in Thuringia (WATCH).

Objective: After infection with SARS-CoV-2, a substantial proportion of patients develop long-lasting sequelae. These sequelae include fatigue (potentially as severe as that seen in ME/CFS cases), cognitive dysfunction, and psychiatric symptoms. Because the pathophysiology of these sequelae remains unclear, existing therapeutic concepts address the symptoms through pacing strategies, cognitive training, and psychological therapy. Methods: Here, we present a protocol for a digital multimodal structured intervention addressing common symptoms through three intervention modules: BRAIN, BODY, and SOUL. This intervention includes an assessment conducted via a mobile "post-COVID-19 bus" near the patient's home, as well as the use of wearable devices and mobile applications to support pacing strategies and collection of data, including ecological momentary assessment. Results: We will focus on physical component subscore of the SF36 as Quality of Life parameter as the primary outcome parameter for WATCH to take into account the holistic approach that is necessary for care of post-COVID patients. Conclusion: In the current project, we present a protocol for a holistic and multimodal structured therapeutic concept which is easily accessible, and scalable for post-COVID patients.

Presence of COVID-19 self-reported symptoms at 12 months in patients discharged from hospital in 2020-2021: a Spanish cross-sectional study.

The long-term effects of SARS-CoV-2 infection, and their determinants, are still unknown. This study aimed to assess symptoms one year after admission for COVID-19, according to the organ/system involved, and to identify factors. Cross-sectional study with retrospective data collection from March 2020 to February 2021. Inclusion criteria: aged ≥ 18 years and admitted for COVID-19. Exclusion criteria: death, not localized, refusal to participate, cognitive impairment or language barrier. A telephone survey was conducted on long COVID-related symptoms one year after hospital discharge. n = 486. The most frequent symptom groups were neurological (n = 225; 46.3%) and respiratory (n = 201; 41.4%). Multivariable analysis showed that a history of anxiety was significantly associated with psychiatric symptoms (ORa = 2.04, 95%CI = 1.02-4.06), fibromyalgia/chronic fatigue with general symptoms (ORa = 11.59, 95%CI = 1.47-9.34) and obesity with respiratory (ORa 1.90, 95%CI = 1.27-2.83) and musculoskeletal symptoms (ORa 1.96, 95%CI = 1.30-2.96). Male sex was associated with a significantly lower risk of neurological (ORa 0.64, 95%CI = 0.44-0.93), respiratory (ORa 0.45, 95%CI = 0.31-0.67), general (ORa 0.43, 95%CI = 0.29-0.63), psychiatric (ORa 0.34, 95%CI = 0.22-0.51), musculoskeletal (ORa 0.47, 95%CI = 0.32-0.70), dermatological (ORa 0.24, 95%CI = 0.14-0.42) and digestive (ORa 0.38, 95%CI = 0.20-0.73) symptoms. Advanced age (≥ 71 years) also had a protective effect against general (ORa 0.60, 95%CI = 0.39-0.95), psychiatric (ORa 0.39, 95%CI = 0.23-0.64), and dermatological (ORa 0.47, 95%CI = 0.24-0.92) symptoms. Patients admitted for SARS-CoV-2 infection frequently experience symptoms at one year, especially neurological and respiratory symptoms. Female sex, obesity, a history of anxiety and fibromyalgia/chronic fatigue were independent risk factors for presenting symptoms. Advanced age acted as a protective factor.

Detecting muscle fatigue among community-dwelling senior adults with shape features of the probability density function of sEMG.

BACKGROUND: Physical exercise is an important method for both the physical and mental health of the senior population. However, excessive exertion can lead to increased risks of falls, severe injuries, and diminished quality of life. Therefore, simple and effective methods for fatigue monitoring during exercise are highly desirable, particularly in community settings. The purpose of this study was to explore the possibility of real-time detection of exercise-induced fatigue using surface Electromyogram (sEMG) features, including the kurtosis and skewness of the Probability Density Function (PDF) in the community settings to solve the issues of low sensitivity and high computational complexity of commonly used sEMG features. METHODS: sEMG signals from six forearm muscles were recorded during hand grip tasks at 20% maximal voluntary contraction (MVC) task-to-failure contractions from 30 healthy community-dwelling elders at their respective community centers. PDF shape features of the sEMG, namely kurtosis and skewness, were computed from 25 s of non-fatigue stable phase and 25 s of fatigue data for comparison. Statistical tests were conducted to compare and test for the significance of these features. We further proposed a novel fatigue indicator, Temporal-Mean-Kurtosis (TMK) of channel-averaged kurtosis, to detect fatigue with relatively low computational complexity and adequate sensitivity in community settings. ANOVA and post-hoc analyses were performed to examine the performance of TMK. RESULTS: Statistically significant differences were found between the non-fatigue period and the fatigue period for both kurtosis and skewness, with increasing values when approaching fatigue. TMK was shown to be sensitive in detecting fatigue with respect to time with lower computational complexity than the Sample Entropy. CONCLUSION: This study investigated PDF shape features of sEMG signals during a handgrip exercise to identify muscle fatigue in older adults in community experiments. Results revealed significant changes in kurtosis upon fatigue, indicating that PDF shape features were suitable convenient detectors of muscle fatigue in community experiments. The proposed indicator, TMK, showed potential sensitivity in tracking muscle fatigue over time in community-based settings with limited computational complexity, highlighting the promise of sEMG's PDF features in detecting muscle fatigue among the elderly.

Two-Day Cardiopulmonary Exercise Testing in Long COVID Post-Exertional Malaise Diagnosis.

BACKGROUND: Long COVID patients present with a myriad of symptoms that can include fatigue, exercise intolerance and post exertional malaise (PEM). Long COVID has been compared to other post viral syndromes, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), where a reduction in day 2 cardiopulmonary exercise test (CPET) performance of a two-day CPET protocol is suggested to be a result of PEM. We investigated cardiopulmonary and perceptual responses to a two-day CPET protocol in Long COVID patients. METHODS: 15 Long COVID patients [n=7 females; mean (SD) age: 53(11) yr; BMI = 32.2(8.5) kg/m2] performed a pulmonary function test and two ramp-incremental CPETs separated by 24hr. CPET variables included gas exchange threshold (GET), V̇O2peak and WRpeak. Ratings of perceived dyspnoea and leg effort were recorded at peak exercise using the modified 0-10 Borg Scale. PEM (past six months) was assessed using the modified DePaul Symptom Questionnaire (mDSQ). One-sample t-tests were used to test significance of mean difference between days (p<0.05). RESULTS: mDSQ revealed PEM in 80% of patients. Lung function was normal. Responses to day 1 CPET were consistent with the presence of aerobic deconditioning in 40% of patients (V̇O2peak <80% predicted, in the absence of evidence of cardiovascular and pulmonary limitations). There were no differences between day-1 and day-2 CPET responses (all p>0.05). CONCLUSION: Post exertional malaise symptoms in Long COVID patients, in the absence of differences in two-day CPET responses separated by 24hours, suggests that post-exertional malaise is not due to impaired recovery of exercise capacity between days.

Premenstrual symptoms risk factors among newly graduated nurses in shift work: A prospective longitudinal study.

PURPOSE: The premenstrual symptoms (PMS) is a common health issue affecting women of reproductive age and is associated with various physiological, psychological, and situational factors. Newly graduated nurses, when suddenly exposed to excessive workloads and shift work, may experience disturbances such as sleep disorders, fatigue, depression, and stress. These factors are related to PMS, and their occurrence varies. Therefore, this study aimed to understand the changes in PMS and its risk factors among newly graduated nurses across shift work periods, and investigate the longitudinal relationships between PMS and its risk factors based on the Theory of Unpleasant Symptoms. METHODS: This study constituted a secondary data analysis and employed a prospective longitudinal design. Newly graduated nurses were assessed three times: before starting shift work, six months after initiating shift work, and 18 months thereafter. Physiological (age, body mass index, alcohol consumption, dietary behavior), psychological (sleep quality, fatigue, depression, stress, life satisfaction), and situational (social support) factors were included as PMS-related factors. RESULTS: PMS worsened six months after the initiation of shift work compared to those before, and this aggravation persisted even after 18 months of shift work (p < .001). Age (p = .043), sleep quality (p = .004), and fatigue (p < .001) were associated with PMS. An interaction between time and depression that affected PMS was observed (p = .021). CONCLUSIONS: Newly graduated nurses need to pay attention to the exacerbation of PMS after initiating shift work. Interventions to improve sleep quality and reduce fatigue are crucial for novice nurses, irrespective of shiftwork duration. Additionally, it is important to assess depressive symptoms before starting shift work and implement early interventions. Furthermore, the need for interventions addressing depression escalates with the increase in shiftwork duration.

Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT.

Design: Parallel-group randomised controlled trial. Methods: Adolescents aged 11-17 years, diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome and with no local specialist treatment centre, were referred to a specialist service in South West England. Interventions: Fatigue In Teenagers on the interNET in the National Health Service is a web-based myalgic encephalomyelitis/chronic fatigue syndrome-focused cognitive-behavioural therapy programme for adolescents, supported by individualised written, asynchronous electronic consultations with a clinical psychologist/cognitive-behavioural therapy practitioner. The comparator was videocall-delivered activity management with a myalgic encephalomyelitis/chronic fatigue syndrome clinician. Both treatments were intended to last 6 months. Objectives: Estimate the effectiveness of Fatigue In Teenagers on the interNET in the National Health Service compared to Activity Management for paediatric myalgic encephalomyelitis/chronic fatigue syndrome. Estimate the effectiveness of Fatigue In Teenagers on the interNET in the National Health Service compared to Activity Management for those with mild/moderate comorbid mood disorders. From a National Health Service perspective, estimate the cost-effectiveness of Fatigue In Teenagers on the interNET in the National Health Service compared to Activity Management over a 12-month horizon. Primary Outcome: 36-item Short Form Health Survey Physical Function subscale at 6 months post randomisation. Randomisation: Web-based, using minimisation with a random component to balance allocated groups by age and gender. Blinding: While the investigators were blinded to group assignment, this was not possible for participants, parents/carers and therapists. Results: The treatment of 314 adolescents was randomly allocated, 155 to Fatigue In Teenagers on the interNET in the National Health Service. Mean age was 14 years old and 63% were female. Primary outcome: At 6 months, participants allocated to Fatigue In Teenagers on the interNET in the National Health Service were more likely to have improved physical function (mean 60.5, standard deviation 29.5, n = 127) compared to Activity Management (mean 50.3, standard deviation 26.5, n = 138). The mean difference was 8.2 (95% confidence interval 2.7 to 13.6, p = 0.003). The result was similar for participants meeting the National Institute for Health and Care Excellence 2021 diagnostic criteria. Secondary outcomes: Fatigue In Teenagers on the interNET in the National Health Service participants attended, on average, half a day more school per week at 6 months than those allocated Activity Management, and this difference was maintained at 12 months. There was no strong evidence that comorbid mood disorder impacted upon the relative effectiveness of the two interventions. Similar improvement was seen in the two groups for pain and the Clinical Global Impression scale, with a mixed picture for fatigue. Both groups continued to improve, and no clear difference in physical function remained at 12 months [difference in means 4.4 (95% confidence interval -1.7 to 10.5)]. One or more of the pre-defined measures of a worsening condition in participants during treatment, combining therapist and patient reports, were met by 39 (25%) participants in the Fatigue In Teenagers on the interNET in the National Health Service group and 42 (26%) participants in the Activity Management group. A small gain was observed for the Fatigue In Teenagers on the interNET in the National Health Service group compared to Activity Management in quality-adjusted life-years (0.002, 95% confidence interval -0.041 to 0.045). From an National Health Service perspective, the costs were £1047.51 greater in the Fatigue In Teenagers on the interNET in the National Health Service group (95% confidence interval £624.61 to £1470.41). At a base cost-effectiveness threshold of £20,000 per quality-adjusted life-year, the incremental cost-effectiveness ratio was £457,721 with incremental net benefit of -£1001 (95% confidence interval -£2041 to £38). Conclusion: At 6 months post randomisation, compared with Activity Management, Fatigue In Teenagers on the interNET in the National Health Service improved physical function and school attendance. The additional cost of Fatigue In Teenagers on the interNET in the National Health Service and limited sustained impact mean it is unlikely to be cost-effective. Trial registration: This trial is registered as ISRCTN18020851. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/109) and is published in full in Health Technology Assessment; Vol. 28, No. 70. See the NIHR Funding and Awards website for further award information.

Why did we do the study? The best evidence for the treatment of adolescents with myalgic encephalomyelitis/chronic fatigue syndrome is cognitive­behavioural therapy for fatigue delivered in person. In the United Kingdom, most adolescents with myalgic encephalomyelitis/chronic fatigue syndrome cannot get this specialist treatment where they live. Fatigue In Teenagers on the interNET in the National Health Service is an online treatment using cognitive­behavioural therapy designed for myalgic encephalomyelitis/chronic fatigue syndrome, which has been shown to work in the Netherlands. To find out if Fatigue In Teenagers on the interNET in the National Health Service would be beneficial in the United Kingdom, we compared Fatigue In Teenagers on the interNET in the National Health Service to Activity Management. Activity Management is the treatment most often offered to children and young people with myalgic encephalomyelitis/chronic fatigue syndrome in the United Kingdom, and aims to avoid peaks in activity (sometimes called 'pacing'). What was the question? Does Fatigue In Teenagers on the interNET in the National Health Service lead to greater improvements in children and young people with myalgic encephalomyelitis/chronic fatigue syndrome when compared to Activity Management, when both interventions are delivered remotely? What did we do? We compared Fatigue In Teenagers on the interNET in the National Health Service and Activity Management in two comparable groups of children, and measured physical function at 6 months as the main indication of improvement. We measured how much the treatments cost and we asked children and young people, their parents and treatment providers what they thought about the two interventions. What did we find? At 6 months, adolescents saw greater improvements in physical function, and attended half a day more school per week, with Fatigue In Teenagers on the interNET in the National Health Service compared to Activity Management. Both interventions were associated with improvements over 12 months, with there being no clear difference between them after that time. However, the Fatigue In Teenagers on the interNET in the National Health Service treatment was more expensive. What does this mean? We have shown that cognitive­behavioural therapy for fatigue can be provided online to children as Fatigue In Teenagers on the interNET in the National Health Service, leading to faster improvement in physical function and greater school attendance compared to Activity Management. However, Fatigue In Teenagers on the interNET in the National Health Service is expensive and is unlikely to be good value for money.

Biomimetic Structural Hydrogels Reinforced by Gradient Twisted Plywood Architectures.

Naturally structural hydrogels such as crustacean exoskeletons possess a remarkable combination of seemingly contradictory properties: high strength, modulus, and toughness coupled with exceptional fatigue resistance, owing to their hierarchical structures across multiple length scales. However, replicating these unique mechanical properties in synthetic hydrogels remains a significant challenge. This work presents a synergistic approach for constructing hierarchical structural hydrogels by employing cholesteric liquid crystal self-assembly followed by nanocrystalline engineering. The resulting hydrogels exhibit a long-range ordered gradient twisted plywood structure with high crystallinity to mimic the design of crustacean exoskeletons. Consequently, the structural hydrogels achieve an unprecedented combination of ultrahigh strength (46 ± 3 MPa), modulus (496 ± 25 MPa), and toughness (170 ± 14 MJ m-3), together with recorded high fatigue threshold (32.5 kJ m-2) and superior impact resistance (48 ± 2 kJ m-1). Additionally, through controlling geometry and compositional gradients of the hierarchical structures, a programmable shape morphing process allows for the fabrication of complex 3D hydrogels. This study not only offers valuable insights into advanced design strategies applicable to a broad range of promising hierarchical materials, but also pave the ways for load-bearing applications in tissue engineering, wearable devices, and soft robotics.

Post-stroke fatigue - a multidimensional problem or a cluster of disorders? A case for phenotyping post-stroke fatigue.

Post-stroke fatigue is a chronic problem with significant impact on morbidity and mortality, which urgently needs effective treatments. The last decade has seen a considerable increase in interest in understanding the pathophysiology of fatigue and developing treatments. In this review, following a summary of theoretical frameworks to understand chronic fatigue, I make a case for why phenotyping fatigue is a necessary step to fully understand pathophysiology, which in turn is essential for the development of robust treatments. I then appraise current post-stroke fatigue literature with the view of identifying post-stroke fatigue phenotypes.

Impact of combined plant extracts on long COVID: An exploratory randomized controlled trial.

BACKGROUND: Long COVID have posed a global health burden since the COVID-19 pandemic. This study aimed to evaluate the efficacy and safety of a combined plant extract (CPE) formulation, containing Citrus aurantifolia, Tiliacora triandra, Cannabis sativa, Alpinia galanga, and Piper nigrum, in participants with long COVID. A newly developed long COVID symptom questionnaire was used to evaluate outcomes. METHODS: This randomized, double-blinded, placebo-controlled trial was conducted at the College of Pharmacy, Rangsit University, Thailand. Participants were randomly assigned to receive either a CPE supplement (4,500mg/day) or a placebo for 7 days. Primary outcomes were changes in C-reactive protein (CRP) levels and the total symptom score (ranging from 0 to 57 points). Secondary outcomes included full recovery/improvement of long COVID symptoms, health-related quality of life (HRQOL), and adverse events. RESULTS: A total of 66 participants were enrolled, with 33 in each group. The CPE supplement did not significantly reduce CRP levels, with a median difference (MD) (95% CI) of -0.05 (-0.49, 0.39) mg/L compared to placebo. However, the CPE group showed a reduction in the total symptom score [MD (95% CI) of -4.00 (-7.58, -0.42)], and a reduction in overall moderate to severe symptoms [RR (95% CI) of 0.57 (0.35, 0.91)], moderate to severe fatigue [RR (95% CI) of 0.25 (0.08, 0.81)], and moderate to severe post-exertional malaise (PEM) [RR (95% CI) of 0.35 (0.16, 0.78)]. Changes in HRQOL scores did not differ significantly between groups. Adverse events were mostly mild and resolved by the end of the follow-up period. CONCLUSIONS: Our study suggests potential benefits of the CPE in alleviating moderate to severe long COVID symptoms, particularly fatigue and PEM, with an acceptable safety profile. However, larger-scale trials are necessary to validate these findings, and assessing the reliability of the long COVID symptom questionnaire is essential before its application in future studies.

ACR Appropriateness Criteria® Stress (Fatigue-Insufficiency) Fracture Including Sacrum Excluding Other Vertebrae: 2024 Update.

Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in a variety of patients (athletes, older patients, and patients with predisposing conditions). Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Nuclear medicine scintigraphy and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go on to healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential to progress to completion, necessitating surgery. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated differently (ie, metastatic disease). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Evaluation of occupational therapy in persons with COVID-19: a pre-post observational cohort study.

BACKGROUND: Persons with COVID-19 may experience limitations in daily functioning and can be referred to occupational therapy. OBJECTIVES: To evaluate changes in daily functioning, cognitive complaints, fatigue and self-management of persons with COVID-19 who received occupational therapy in primary care.To get insights in the volume and duration of occupational therapy. DESIGN: A pre-post observational cohort study from October 2020 until April 2021. SETTING: Fifty-eight occupational therapy practices in primary care throughout the Netherlands participated with 68 occupational therapists. PARTICIPANTS: 228 adults (≥18 years) with COVID-19, referred to occupational therapy, gave informed consent and participated in the pre-post evaluation. The mean age was 49 years (SD 13) and 79% of the patients was female. The most frequently reported complaints included fatigue and cognitive complaints. INTERVENTIONS: Occupational therapy using Dutch guidelines for occupational therapy in clients with COVID-19. OUTCOME MEASURES: Performance and satisfaction with performance using the Canadian Occupational Performance Measure (COPM); the impact of Cognitive Complaints on Participation (CoCo-P); and daily activities, self-management and perceived contribution of occupational therapy using the Patient Reported Outcome Measure for Occupational Therapy (PROM-OT). RESULTS: COPM-performance score improved with a mean difference of 2.9 points (95% CI 2.7 to 3.2), and COPM-satisfaction score improved with 3.2 points (95% CI 2.9 to 3.5). CoCo-P score improved with a mean difference of 20.9 points (95% CI from 14.4 to 27.4), and PROM-OT improved with 42.8 points (95% CI from 40.2 to 45.4). Participants received a median of seven sessions of occupational therapy (IQR 5-10) with a median duration of 18 weeks (IQR 12-25). They valued the contribution of occupational therapy to their improved functioning with a mean score of 8 (SD 1.4) and recommended this to others with a mean score of 9 (SD 1.2). CONCLUSIONS: Persons with COVID-19 who received occupational therapy in primary care improved significantly in daily functioning and highly valued occupational therapy.

Post-stroke fatigue and its correlation with family functioning in patients who have experienced a first episode of stroke.

Objective: This study aimed to analyse the relevant factors that may affect post-stroke fatigue (PSF) in patients with stroke and further explore the correlation between family functioning and PSF. Methods: Patients who had experienced a first episode of stroke and were admitted to the Department of Neurology of the First Affiliated Hospital of Wenzhou Medical University were rigorously screened. The general data and family functioning of the patients on admission were collected, and their family adaptation, partnership, growth, affection and resolve scores and their PSF on the 5th day of admission were collected using the fatigue severity scale (FSS). Multiple linear regression analysis was then utilized to explore the factors affecting PSF in patients with stroke. Results: A total of 220 questionnaires were distributed, and 220 were returned, with 212 valid questionnaires and a valid return rate of 96.4%. These 212 patients had a family functioning score of 6.58 ± 2.00 and an FSS score of 36.62 ± 10.96. Spearman's correlation analysis showed negative correlations between the FSS scores and the adaptation, partnership, growth, affection, resolve and family functioning scores (r = -0.380, -0.505, -0.470, -0.303, -0.281 and -0.712, respectively; p < 0.001). Furthermore, multiple linear regression analysis showed that family functioning (ß' = -0.516), marital status (ß' = -0.244), household income (ß' = -0.185), literacy (ß' = -0.181) and activities of daily living (ß' = -0.084) were influential factors for PSF in patients with stroke (p < 0.05). Conclusion: There is a significant negative correlation between family functioning and PSF, suggesting that better family functioning may help mitigate the severity of post-stroke fatigue. Healthcare providers should identify interventions to help patients and families address fatigue, boost disease recovery, promote patients' physical and mental health and improve their quality of life.