Fatigue Rate Research Articles

Sleep-disordered breathing in a multi-ethnic cohort of preterm adolescents and adults: assessment of neonatal and subsequent risk factors.

Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry. This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI. Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001). Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.

Effects of age and gender on immunogenicity and reactogenicity of SpikoGen recombinant spike protein vaccine: a post-hoc analysis

SpikoGen® COVID-19 vaccine is based on the spike protein extracellular domain of the ancestral Wuhan-Hu-1 strain modified by removal of the furin cleavage site and addition of stabilising mutations expressed as a recombinant protein in insect cells. It is formulated with Advax-CpG55.2™ adjuvant to ensure optimal immunogenicity. In this study, data from several SpikoGen® clinical trials was retrospectively analysed to assess for any effect of gender or age on seroconversion, neutralizing antibody levels or the incidence of adverse events. Following the 1st dose, older age was associated with a reduced rate of fatigue (RR 0.97, p < 0.001), headache (RR 0.98, p = 0.034) and myalgia (RR 0.97, p=0.016), following the 2nd dose, the rate of fatigue (RR 0.98, p = 0.017) but following the 3rd dose no effect of age on adverse events was evident. Similarly, following the 1st dose, men reported a 19% lower incidence of fatigue, 36% lower incidence of headache and 28% lower incidence of myalgia when compared to women. Interestingly, there was no relationship between age or gender and serum neutralizing antibody levels, although after each vaccine dose there was a consistent trend to women having a higher seroconversion rate. There was no correlation between neutralizing antibody levels and adverse events. Unlike what is seen with mRNA vaccines, reactogenicity trended lower after each subsequent SpikoGen® dose. Overall, SpikoGen® exhibited positive immunogenicity and low reactogenicity, indicating that a low incidence of adverse events does not equate to poor immunogenicity. SpikoGen® remains a promising protein-based vaccine platform for COVID-19 protection.

Fatigue and depression at 8 weeks and 1 year after bacterial brain abscess and their relationship with cognitive status

ABSTRACT A bacterial brain abscess (BA) is a focal brain infection with largely unknown long-term implications. This prospective study assessed the frequency of fatigue and symptoms of depression at 8 weeks and 1 year after BA and examined the relationship between fatigue, depressive symptoms, and cognitive status. Twenty BA-patients (age 17–73; 45% female) were assessed for fatigue, depression, memory, and executive functions. Fatigue rates were 40-65% at 8 weeks and 25-33% at 1 year on various fatigue questionnaires. Patient Health Questionnaire indicated symptoms of depression in 10% at the 8-week follow-up only. Relevant comorbidities and vocational outcomes were not associated with fatigue or symptoms of depression. Mean fatigue scores improved significantly between the two-time points. Greater fatigue was related to subjective problems with working memory, inhibition, self-monitoring, and emotional control and worse objective verbal memory performance. Symptoms of depression were associated with one out of two fatigue measures. We conclude that fatigue is common in the first year after BA, and higher levels of fatigue are related to more cognitive problems. Symptoms of clinical depression were rare. These findings underscore fatigue as an important consequence of BA and emphasize the necessity for targeted rehabilitation interventions.

Enhancing Customer Satisfaction Analysis Using Advanced Machine Learning Techniques in Fintech Industry

Customer satisfaction (CSAT) is vital in service and marketing, indicating how well products or services meet customer expectations. Traditional CSAT methods like the American Customer Satisfaction Index (ACSI) and Net Promoter Score (NPS) face challenges such as survey fatigue and low response rates. This study introduces a novel framework using advanced machine learning (ML) and deep learning (DL) techniques, specifically Bidirectional Encoder Representations from Transformers (BERT), to classify customer feedback into distinct CSAT drivers. Integrating term frequency-inverse document frequency (TF-IDF) methods with BERT-based embeddings, the framework significantly improves prediction accuracy. Using a proprietary dataset of 5,943 customer feedback responses from 39 companies across 13 industries, the fine-tuned BERT model achieved an F1 score of 0.84, surpassing traditional methods like TF-IDF and support vector machine (SVM) with an F1 score of 0.47, and TF-IDF with multi-layer perceptron (MLP) networks at 0.50. A hybrid approach combining BERT and TF-IDF embeddings with MLP networks yielded an F1 score of 0.71. The results show the transformative potential of DL techniques, particularly fine-tuned BERT models, in enhancing CSAT prediction accuracy. This research bridges the gap between traditional and advanced text mining methods, setting a new standard for CSAT modeling and offering a robust framework for extracting actionable insights from customer feedback. It highlights the importance of adopting advanced ML and DL models for strategic decision-making and improving customer satisfaction measurement.

Evaluating the protective effectiveness and risk factors of ursodeoxycholic acid on COVID-19 among outpatients.

Objective: This study aimed to assess the chemopreventive effect of ursodeoxycholic acid (UDCA) against COVID-19 and to analyze infection risk factors, symptoms, and recovery in outpatients with UDCA exposure. Methods: The study enrolled outpatients prescribed UDCA from the Second Affiliated Hospital of Chongqing Medical University, China, between 01 July 2022, and 31 December 2022. Data on demographics, comorbidities, and drug combinations were collected using electronic medical records. COVID-19 infection, symptoms, severity, prognosis, vaccinations, and UDCA administration were surveyed by telephone interviews. UDCA non-users served as controls and were matched in a 1:2 ratio with UDCA users using propensity score matching with the nearest neighbor algorithm. Infection rates, symptomatology, severity, and prognosis were compared between matched and control cohorts, and risk factors and infection and recovery symptoms were analyzed in UDCA-exposed outpatients. Results: UDCA-exposed outpatients (n = 778, 74.8%) and matched UDCA users (n = 95, 74.2%) showed significantly lower SARS-CoV-2 infection rates than control patients (n = 59, 92.2%) (p < 0.05). The matched UDCA group exhibited substantially lower fever, cough, sore throat, and fatigue rates than controls (p < 0.05). Participants with UDCA exposure generally experienced mild symptoms, while those without UDCA had moderate symptoms. The matched UDCA group also had significantly shorter durations of fever and cough (p < 0.05). Risk factors such as age over 60, less than 1month of UDCA administration, diabetes mellitus, and coronary artery disease significantly increased SARS-CoV-2 infection rates (p < 0.05), while smoking led to a decrease (p < 0.05). Hypertension was associated with a prolonged COVID-19 recovery (p < 0.05), while smoking, vaccination, and fatty liver disease were associated with shorter recovery periods (p < 0.05). The main symptoms in the full UDCA cohort were fever, cough, and sore throat, with fatigue, cough, and hyposthenia being the most persistent. Conclusion: UDCA demonstrated chemopreventive effect against SARS-CoV-2 in outpatients by significantly reducing infection incidence and mitigating COVID-19 symptoms, severity, and recovery duration. Old age, short UDCA course, and comorbidities such as diabetes mellitus and CAD increased infection rates, while hypertension prolonged recovery. Smoking, vaccination, and fatty liver disease reduced infection rates and shortened recovery. UDCA had minimal impact on symptom types. Larger and longer-term clinical studies are needed further to assess UDCA's effectiveness in COVID-19 prevention or treatment.

Identifying relevant factors influencing cancer-related fatigue in patients with diffuse large B-cell lymphoma during chemotherapy.

Diffuse large B-cell lymphoma (DLBCL) is a rapidly growing malignant tumor, and chemotherapy is one of the treatments used to combat it. Although advancements of science and technology have resulted in more and more patients being able to receive effective treatment, they still face side effects such as fatigue and weakness. It is important to thoroughly investigate the factors that contribute to cancer-related fatigue (CRF) during chemotherapy. To explore the factors related to CRF, anxiety, depression, and mindfulness levels in patients with DLBCL during chemotherapy. General information was collected from the electronic medical records of eligible patients. Sleep quality and mindfulness level scores in patients with DLBCL during chemotherapy were evaluated by the Pittsburgh Sleep Quality Index and Five Facet Mindfulness Questionnaire-Short Form. The Piper Fatigue Scale was used to evaluate the CRF status. The Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to evaluate anxiety and depression status. Univariate analysis and multivariate regression analysis were used to investigate the factors related to CRF. The overall average CRF level in 62 patients with DLBCL during chemotherapy was 5.74 ± 2.51. In 25 patients, the highest rate of mild fatigue was in the cognitive dimension (40.32%), and in 35 patients the highest moderate fatigue rate in the behavioral dimension (56.45%). In the emotional dimension, severe fatigue had the highest rate of occurrence, 34 cases or 29.03%. The CRF score was positively correlated with cancer experience (all P < 0.01) and negatively correlated with cancer treatment efficacy (all P < 0.01). Tumor staging, chemotherapy cycle, self-efficacy level, and anxiety and depression level were related to CRF in patients with DLBCL during chemotherapy. There was a significant correlation between CRF and perceptual control level in patients. Tumor staging, chemotherapy cycle, self-efficacy level, and anxiety and depression level influenced CRF in patients with DLBCL during chemotherapy.

The impact of population ageing on the burden of chronic kidney disease.

The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3-G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.

Gastrointestinal and Neuropsychological Symptoms Are Associated With Distinct Vomiting Profiles in Patients Receiving Chemotherapy.

To identify subgroups of patients with distinct chemotherapy-induced vomiting (CIV) profiles; determine how these subgroups differ on several demographic, clinical, and symptom characteristics; and evaluate factors associated with chemotherapy-induced nausea and CIV profiles. Adult patients (N = 1,338) receiving cancer chemotherapy. Data were collected on demographic, clinical, and symptom characteristics. Differences among subgroups of patients with distinct CIV profiles were evaluated using parametric and nonparametric tests. Three CIV profiles (None, Decreasing, and Increasing) were identified. Compared with the None class, Decreasing and Increasing classes were more likely to have lower household income and a higher comorbidity burden, as well as to report higher rates of dry mouth, nausea, diarrhea, depression, anxiety, sleep disturbance, morning fatigue, and pain interference. Clinicians need to assess common and distinct risk factors for CIV and chemotherapy-induced nausea.

A systematic review and meta-analysis of compassion fatigue among healthcare professionals before and during COVID-19 in Sub-Saharan Africa.

Compassion fatigue is a significant concern globally, particularly in Sub-Saharan Africa, where the COVID-19 pandemic exacerbated existing challenges, placing unprecedented strain on healthcare professionals. This study systematically estimated the prevalence of compassion fatigue among healthcare professionals before and during COVID-19 in Sub-Saharan Africa. A systematic review was conducted using keywords in PubMed, ScienceDirect, Google Scholar, and grey literature, covering all literature published between 2012 and December 30, 2023. The search team independently conducted study selection, quality assessments, data extractions, and analysis of all included studies. The systematic review, reported following PRISMA guidelines, included 11 studies. The results show that the pooled overall prevalence of compassion fatigue in Sub-Saharan Africa was 70% (95% CI: 57-82, I2 = 88.37%). The highest prevalence was found in Eastern Africa at 74% (95% CI: 55-93, I2 = 94.40%), compared to 64% in Southern Africa (95% CI: 49-79, I2 = 59.01%). Nurses reported the highest rates of compassion fatigue at 80% (95% CI: 57-100, I2 = 34.77%), followed by general healthcare professionals at 59% (95% CI: 22-97, I2 = 94.11%) and nursing students at 50% (95% CI: 35-64, I2 = 0.00%). Before COVID-19, the overall prevalence of compassion fatigue was 66% (95% CI: 41-91, I2 = 27%). During COVID-19, this increased to 74% (95% CI: 63-85, I2 = 88.73%). Our results indicate that nearly 3 in 4 healthcare professionals in Sub-Saharan Africa experience compassion fatigue, and this prevalence increased due to the pandemic. The high prevalence underscores the importance of addressing and mitigating compassion fatigue to support the mental health and emotional well-being of healthcare professionals dedicated to helping others in challenging circumstances. Systematic registration: PROSPERO. REG No: CRD42023449462.

Frequency of dose reductions of abemaciclib in metastatic and early-stage hormone positive, HER2 negative breast cancer.

e13099 Background: Abemaciclib is a CDK4/6 inhibitor which in combination with endocrine therapy (ET) improves progression-free survival in hormone receptor (HR)-positive, HER2 negative advanced breast cancer, as well as invasive disease free-survival in high-risk early-stage breast cancer. However, abemaciclib is associated with adverse events which may limit treatment adherence. In this single-center study, we describe real-world safety outcomes of early-stage and advanced HR-positive, HER2 negative breast cancer patients prescribed abemaciclib in conjunction with ET. Specifically, we analyze the frequency of adverse events and dose reductions (DR). Methods: We conducted a retrospective study of patients treated at Scripps Clinic between 1/1/2019-1/1/2023 with HR-positive, HER2 negative breast cancer prescribed abemaciclib with ET. Primary analyses were performed to discern clinical characteristic differences between groups. Categorical variables were summarized as frequencies and compared between arms by Chi-Square tests or Fisher’s Exact Tests. All continuous variables were summarized as means and standard deviations and compared between arms by T-Tests if normally distributed or summarized as medians and compared between arms by Mann-Whitney Tests otherwise. Statistical significance was set to 0.05 and all analyses were conducted in R. Results: A total of 77 patients were analyzed including 62% in the adjuvant setting and 38% in the metastatic setting. 51% of patients required DR. Patients requiring DR were older relative to those not requiring DR (59 vs 52 years of age, p=0.019). Those requiring DR remained on abemaciclib longer relative to those without DR (509 vs 350 days, p=0.057). Among those requiring DR, there were higher rates of grades II-IV diarrhea (p&lt;0.001) and Loperamide use (p=0.083). Those requiring DR also had higher rates of neutropenia (54% vs 29%, p=0.027), abdominal cramping (39% vs 8%, p=0.002), nausea (39% vs 13%, p=0.011), and fatigue (51% vs 32%, p=0.079). Among 9 patients who expired on abemaciclib, 7 were in the metastatic setting and 1 was linked to an adverse effect from abemaciclib; none required DR (24% vs 0%, p&lt;0.001). Finally, patients in the adjuvant setting remained on abemaciclib longer relative to those in the metastatic setting (526 vs 281 days, p=0.01). 95% of patients experienced symptom improvement with DR (p&lt;0.001). Conclusions: Our study describes real-world safety outcomes of patients with HR-positive, HER2 negative breast cancer treated with abemaciclib and ET. More than half of patients required DR. Those who reduced their abemaciclib dose had improvement of clinical symptoms and remained on therapy longer. Based on our findings and given the importance of adherence in treatment efficacy, a lower starting dose of abemaciclib may be a more tolerable strategy, especially among older patients who required more DR in our study.

Comparative analysis of Keynote522 treatment outcomes in Hispanic versus non-Hispanic patients with breast cancer: A single tertiary center experience.

e12661 Background: The addition of pembrolizumab to neoadjuvant chemotherapy on the Keynote522 (KN522) clinical trial, changed the standard of care for early stage triple negative breast cancer (TNBC). This regimen demonstrated longer event free survival and higher percentage of patients with pathologic complete responses (pCR). However, limited data exist on the comparative outcomes between Hispanic and non-Hispanic patients in real-world settings as this patient population was likely underrepresented on the original trial. Methods: We conducted a retrospective analysis of patients with early stage TNBC treated on KN522 regimen and undergoing surgery at a single tertiary center from July 2021 to present. Patients were stratified into Hispanic and non-Hispanic ethnicity cohorts. The primary endpoint was pCR rate, and secondary endpoints was incidence of adverse effects (AEs). Results: Among a cohort of 41 patients identified, 26 (63%) were of Hispanic and 15 (37%) were non-Hispanic. The pCR rate was 50% among Hispanic and 53% among non-Hispanic patients (p=0.83). Hispanic patients experienced higher rates of anemia (88% vs. 67%, p=0.06), fatigue (85% vs. 60%, p=0.07), skin rash (46% vs. 27%, p=0.21), and endocrine toxicities (23% vs. 13%, p=0.21). However, Hispanic patient also had fewer hospitalizations (35% vs. 47%, p=0.44), dose-modifications (12% vs. 40%, p=0.53), dose omissions (19% vs. 33%, p=0.31), and showed higher KN522 completion rates (81% vs. 53%, p=0.06). Conclusions: Our findings indicate a comparable pCR rate between Hispanic and non-Hispanic patients with early-stage TNBC receiving KN522 therapy. While Hispanic patients exhibited higher incidences of certain adverse effects, they demonstrated lower rates of hospitalizations, dose modifications, and omissions, alongside a notably higher completion rate of the KN522 regimen. These trends may be attributed to various factors such as genetic predispositions, and potentially differential physiological responses to therapy within this ethnic group. These findings underscore the importance of including minorities, such as Hispanic patients, in clinical trial populations to ensure that treatment outcomes are representative of diverse patient demographics. [Table: see text]

Clinical outcomes of patients receiving venetoclax and hypomethylating agents for AML in academic and academic-community partnerships.

e23235 Background: Prior studies have reported improved outcomes for acute myeloid leukemia (AML) in academic over nonacademic settings potentially due to the availability of multidisciplinary teams, clinical trials and increased resources (1,2). Our institution has partnered with community practices to further evaluate this disparity. In this study, we analyzed treatment outcomes when nonacademic centers partnered with academic centers to treat AML using a regimen of venetoclax and a hypomethylating agent. Methods: We reviewed 92 patients with newly diagnosed AML treated with venetoclax and either decitabine or azacitidine at an academic center (n = 57) or community practice with academic center support (n = 35). When partnering with the community, patients received the first cycle of therapy at an academic center. Before discharge, our team completed financial screening, scheduled follow up appointments and provided prescriptions. The primary objective was to evaluate the overall response rate (ORR) with a secondary evaluation of differences in chemotherapy management and complications. Results: Patients in the academic setting tended to have more adverse risk disease (80.7% vs. 74.3%, p = 0.36) according to the European LeukemiaNet (ELN) (table). The overall survival (OS) of all patients was 10.7 months (95% CI 9.4-15.7) with no significant difference between the groups. The ORR was similar between the community and academic settings (40.0% vs. 36.8%, p = 0.46). The complete remission (CR) rate was 11.4% in the community versus 19.3% in the academic setting (p = 0.67), and the CR rates were improved in the academic group versus the community after cycle 2 (12.9% vs. 0%, p = 0.72) and cycle 3 (25.0% vs. 0%, p = 0.46). Adverse events were comparable, except for increased rates of fatigue (80.7 vs. 54.3%, p = 0.01) and diarrhea (33.3 vs. 11.4%, p = 0.04) in the academic setting. Conclusions: Contrary to prior studies, our evaluation and ongoing partnerships support the transition of AML treatment to a community setting with academic consultation. Although there were some differences in adverse events, the OS and ORR were similar. Furthermore, this study did not identify any significant safety concerns that could prevent patients from receiving this regimen in either setting. Our goal is to continue evaluating this partnership, as we design prospective studies to improve the care of this patient population. 1. Giri S et al. OS of AML Treated at Academic Center Vs Nonacademic Center. Blood 2015. 2. Halpern AB et al. Practice patterns &amp; outcomes for adults with AML. Hematol Am Soc 2020.[Table: see text]

Abdominal Fatigue Impairs Anaerobic, but not Aerobic,Cycling Performance in Untrained Adults

Relevance. Coaches and athletes across a variety of sports commonly perform abdominal exercises to promote core strength and endurance. However, the precise influence of abdominal strength and endurance on cycling performance remains elusive. Purpose. Determine whether abdominal fatigue affects anaerobic sprint and aerobic time- trial (TT) cycling performance. Methods. Twenty-three untrained young adults (age: 19,2 ± 1,0 years, height: 170,4 ± 7,5 cm, and weight: 74,5 ± 14,1 kg) participated in this study. Twelve of the participants completed two Wingate anaerobic power tests on a Monark 834 E ergometer set at 7,5 % of body mass and the remaining 11 participants completed two 3,2 km cycling TTs on an Expresso S3U virtual reality bike; tests were separated by 96 hours. All participants performed abdominal crunches to fatigue prior to the second test. Dependent t-tests were used to assess differences between the cycling trials for the two groups. Results. Abdominal muscle fatigue decreased mean anaerobic power (Pre: 486,75 vs. Post: 408,83 Watts (W, p &lt; 0,001), increased the rate of fatigue (Pre: 42,01 vs. Post: 50,32 %, p = 0,004), and tended to decrease peak anaerobic power (Pre: 643,17 vs. Post: 607,27 W, p = 0,088). However, abdominal muscle fatigue did not affect TT mean power (Pre: 228,18 vs. Post: 220,09 W, p = 0,127) or TT performance (Pre: 382,7 vs. Post: 388,0 seconds, p = 0,222). Conclusion. Abdominal fatigue negatively affects anaerobic cycling performance in untrained young adults. Future studies should evaluate the impact of abdominal fatigue on cycling performance in trained cyclists.

Oxygen therapy for exercise capacity in fibrotic interstitial lung disease: A systematic review and meta-analysis of randomised controlled trials

BackgroundFibrotic interstitial lung disease (fILD) is characterised primarily by impaired lung function and quality of life. The present study investigated whether oxygen therapy could improve exercise capacity among patients with fILD. MethodsPreviously published randomised controlled trials (RCTs) were surveyed. A systematic review and meta-analysis was conducted to evaluate the effectiveness of oxygen therapy in improving the exertional capacity of patients with fILD. The primary outcome was peripheral oxygen saturation (SpO2) during exercise. The effects of oxygen therapy on fatigue, dyspnoea, heart rate, and exercise duration or distance were also analysed. ResultsFourteen RCTs involving 370 patients were included. Oxygen therapy improved SpO2 during exercise (mean difference, MD = 6.26 %), exercise duration (MD = 122.15 s), fatigue (standard mean difference, SMD = −0.30), and dyspnoea (MD = −0.75 Borg score units). High-flow oxygen systems tended to be more effective than low-flow systems in improving exercising SpO2, duration, fatigue, dyspnoea, and heart rate. High-flow nasal cannulas (HFNCs) yielded better outcomes regarding SpO2 and fatigue than did high-flow Venturi masks (MD = 1.60 % and MD = −1.19 Borg score units, respectively). No major adverse events were reported. ConclusionThe evidence from RCTs supports the short-term use of oxygen supplementation to improve SpO2, exercise capacity, fatigue, and dyspnoea among patients with fILD. Further analyses demonstrates that HFNCs yield more favourable outcomes, yet not reaching statistical significance except for improving SpO2 and fatigue. However, the long-term effects of oxygen therapy on quality of life and mortality remain unclear.

FUNCTIONAL ELECTRICAL STIMULATION COMBINED WITH VOLUNTARY CYCLING ACCENTUATES VO2 RESPONSE IN PEOPLE WITH ADVANCED MULTIPLE SCLEROSIS: A PILOT STUDY

INTRODUCTION &amp; AIMS Lower limb muscle weakness and reduced balance due to disease progression in multiple sclerosis (MS) may make robust aerobic exercise difficult. Functional electrical stimulation (FES) cycling combined with voluntary cycling may allow people with advanced MS to enhance the intensity of aerobic exercise. The aim of this study was to investigate the cardiorespiratory, power, and participant perceptions during acute bouts of FES cycling, voluntary cycling, and FES cycling combined with voluntary cycling (FES assist cycling). METHODS Participants with advanced MS (Expanded Disability Status Scale [EDSS] ≥ 6.0) undertook three exercise trials on a leg cycle ergometer. Trial 1: 30 minutes of FES cycling; Trial 2: two 10-minute bouts of voluntary cycling separated by 10 minutes rest; and Trial 3: a combination of trials 1 and 2 (FES assist cycling). Outcome measures included VO2, cycle power output, heart rate, exertion, and post-exercise perceptions of fatigue. RESULTS Ten people with advanced MS participated (9 female; age 52.4±9.98 y; EDSS 7.1±0.6). Average VO2 during the 30-minute trials was significantly higher for FES assist cycling compared to voluntary cycling (429.7 ± 111.0 vs 388.5 ± 101.0 mL/min, 95% CI 23.4 to 113.0 mL/min, p=0.01), with a large effect size (Hedges’ g=1.04). Participants reported similar perceptions of exertion at the end of each trial (p=0.14). There was no difference in self-reported fatigue at the end of each trial (p=0.21). CONCLUSION This study found FES assist cycling produced significantly higher VO2 values than voluntary cycling, although the clinical significance of these differences is unknown. Participants performed FES assist cycling at a self-reported levels of exertion consistent with moderate to vigorous intensity, however it was considered light-intensity exercise when expressed by METS. FES assist cycling was no more fatiguing post-exercise than the other modes.

Fracturing behavior and damage model of spatial-rotation fissured sandstone: An experimental study on freeze–thaw and fatigue loads coupling

Earthquake exposure can greatly weaken the mechanical properties and affect the failure process of fractured rocks in cold regions. Creep tests of the spatial-rotation (SR) fissured rock with sandstone as the bedrock under different fatigue combinations and angles were carried out. The effects of freeze–thaw and fatigue loads (FT-FLs) on the deformation behaviour of samples, for example, creep, fatigue deformation, frost heave pressure, and creep rate, were explored. The mechanical responses and failure modes of the specimens were analysed in detail. Based on the experimental results, a new coupled damage model was explored. The results show that in addition to the typical creep stage, the rheological curve also included the phase of disturbance deformation under fatigue loading. The attenuation rates of the rock samples had downward trends with increasing load level under the fatigue combinations and angles, and these decreasing trends had linear characteristics. Moreover, the fatigue rate values increased gradually as the fatigue amplitude, fissure angle and rotation angle increased. In addition, with the change in the fissure and rotation angles, the curves of the tensile crack number had inverted U-shaped trends. The 3D fracture patterns under fatigue were dominated by vertical and vertical-lateral penetration, in which secondary fissure expansion also occurred at different angles. A combined damage model based on the damage variable of freeze–thaw cycles, fatigue loading, and spatial rotation of fissures was established. Compared with test data and other models, the coupled model has good accuracy in describing the entire failure process of specimens under FT-FLs and provides a new framework for the stability of fractured rock masses.

The COVID-19 pandemic, psychologists' professional quality of life and mental health.

Psychologists are at known risk of work-related stress, secondary trauma, and burnout. The COVID-19 pandemic increased stress and anxiety for communities worldwide and corresponded with an increased demand for mental health services. Our study investigated the impact of COVID-19 on psychologists' professional quality of life, psychological symptoms, and work-related stress in Aotearoa, New Zealand (NZ). Ninety-nine registered psychologists were recruited via NZ professional psychology organizations, representing 3% of the total workforce. Survey data collected included symptoms of compassion fatigue and satisfaction, psychological symptoms, COVID-19-related stress and resilience, and professional and personal circumstances during the third year of the pandemic, 2022. Seventy percent reported that their work stress had increased, and 60% reported that their caseload intensity had increased during the COVID-19 pandemic. Psychologists reported receiving little to no additional personal or professional support, while 55% reported increased personal responsibilities during the pandemic (for example, closed childcare and schools during lockdowns). High rates of compassion fatigue (burnout and secondary traumatic stress) and low resilience were reported. We observed that psychological distress was higher than the community averages before the pandemic and comparable with frontline healthcare professionals. Compassion fatigue was associated with COVID-related stress, psychological distress, years in practice, and more frequent supervision, but not with working with at-risk clients, levels of personal support, or having children at home. Despite these difficulties, high Compassion Satisfaction scores were also reported, with over 90% indicating they had no intention of leaving the profession in the foreseeable future. Psychologists' compassion fatigue appears to have worsened during the COVID-19 pandemic, as have their symptoms of psychological distress. Increased workplace and clinical demands, telehealth difficulties, stress relating to the pandemic, inadequate support, and increased personal responsibilities were reported by psychologists. Mental health workforces are not immune to the personal and professional impacts of crises and are at risk of burnout and secondary traumatic stress. We hope that increased awareness and understanding of psychologists' own difficulties during COVID-19 can be used to better tackle future crises and support mental health professionals.

Fatigue and Performance Rates as Decision-Making Criteria in Pacing Control During CrossFit®.

We investigated fatigue and performance rates as decision-making criteria in pacing control during CrossFit®. Thirteen male regional-level competitors completed conditions of all-out (maximum physical work from beginning to end) and controlled-split (controlled physical work in the first two rounds but maximum work in the third round) pacing throughout the Fight Gone Bad workout separated by one week. We assessed benchmarks, countermovement jumps and ratings of fatigue after each round. Benchmarks were lower in round 1 (99 vs. 114, p < .001) but higher in rounds 2 (98 vs. 80, p < .001) and 3 (97 vs. 80, p < .001) for controlled-split compared with all-out pacing. Reductions in countermovement jumps were higher after rounds 1 (-12.6% vs. 1.6%, p < .001) and 2 (-12.7% vs. -4.0%, p = .014) but similar after round 3 (-13.2% vs. -11.3%, p = .571) for all-out compared with controlled-split pacing. Ratings of fatigue were higher after rounds 1 (7 vs. 5 a.u., p < .001) and 2 (8 vs. 7 a.u, p = .023) but similar after round 3 (9 vs. 9 a.u., p = .737) for all-out compared with controlled-split pacing. During all-out pacing, countermovement jump reductions after round 2 correlated with benchmark drops across rounds 1 and 2 (r = .78, p = .002) and rounds 1 and 3 (r = -.77, p = .002) and with benchmark workout changes between pacing strategies (r = -.58, p = .036), suggesting that the larger the countermovement jump reductions the higher the benchmark drops across rounds and workouts. Therefore, benchmarks, countermovement jumps and ratings of fatigue may assess exercise-induced fatigue as decision-making criteria to improve pacing strategy during workouts performed for as many repetitions as possible.

The effects of virtual reality interventions on occupational participation and distress from symptoms in palliative care patients: A pilot study.

Virtual reality (VR) offers the prospect of a safe and effective adjunct therapeutic modality to promote mental health and reduce distress from symptoms in palliative care patients. Common physiological and psychological symptoms experienced at the end of life may impact the person's participation in day-to-day activities that bring them meaning. The purpose of this study was to examine the effect of VR interventions on occupational participation and distress from symptoms. To describe the stimulus, results, and learnings from a single-site pilot study of virtual reality therapy in a specialist palliative care setting. Participants engaged in a VR session lasting from 9 to 30 minutes related to coping with pain, inner peace and mindfulness, adventure, and bucket list. The pilot prospective quantitative observational cohort study was conducted from November 2021 through March 2022 using a pre-post VR intervention research design. Quantitative data was collected using patient-rated assessments and a wireless pulse oximeter. Occupational performance, satisfaction, and distress symptoms were measured using the Canadian Occupational Performance Measure and the Palliative Care Outcomes Collaboration Symptom Assessment Scale (PCOC SAS). The intervention and study design adhered to international guidelines. Ten participants engaged in the VR interventions. Data showed significantly improved occupational performance and satisfaction scores (p < .001), decreases in PCOC SAS distress from pain (p = .01), fatigue (p < .001), and heart rate (p = .018). No adverse side effects were observed. Outcomes included an analysis of virtual reality's effectiveness to alleviate symptom burden and increase occupational participation for palliative care patients. Of specific interest to the research team was the application of virtual reality in a community-based and inpatient palliative care context to supplement allied health services and its feasibility of integration into standard palliative care. VR therapy showed positive improvements in the participants' occupational performance, satisfaction, and distress from pain and fatigue.

London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

Background/AimLondon Protocol (LP) and Classification allied to high-resolution manometry (HRM) technological evolution has updated and enhanced the diagnostic armamentarium in anorectal disorders. This study aims to evaluate LP reproducibility under water-perfused HRM, provide normal data and new parameters based on 3D and healthy comparison studies under perfusional HRM.MethodsFifty healthy (25 F) underwent water-perfused 36 channel HRM based on LP at resting, squeeze, cough, push, and rectal sensory. Additional 3D manometric parameters were: pressure-volume (PV) 104mmHg2.cm (resting, short and long squeeze, cough); highest and lowest pressure asymmetry (resting, short squeeze, and cough). Complementary parameters (CP) were: resting (mean pressure, functional anal canal length); short squeeze (mean and maximum absolute squeeze pressure), endurance (fatigue rate, fatigue rate index, capacity to sustain); cough (anorectal gradient pressure); push (rectum-anal gradient pressure, anal canal relaxation percent); recto-anal inhibitory reflex (anal canal relaxation percent).ResultsNo difference to genders: resting (LP, CP, and 3D); short squeeze (highest pressure asymmetry); endurance (CP); cough (CP, highest and lowest pressure asymmetry); push (gradient pressure); rectal sensory. Higher pressure in men: short squeeze (maximum incremental, absolute, and mean pressure, PV, lowest pressure asymmetry); long squeeze (PV); cough (anal canal and rectum maximum pressure, anal canal PV); push (anal canal and rectum maximum pressure). Anal canal relaxation was higher in women (push).ConclusionsLP reproducibility is feasible under water-perfused HRM, and comparative studies could bring similarity to dataset expansion. Novel 3D parameters need further studies with healthy and larger data to be validated and for disease comparisons.Key points• London Protocol and Classification allied with the technological evolution of HRM (software and probes) has refined the diagnostic armamentarium in anorectal disorders.• Novel 3D and deepening the analysis of manometric parameters before the London Classification as a contributory diagnostic tool.• Comparison of healthy volunteers according to the London Protocol under a perfusional high-resolution system could establish equivalence points.