Physical Fatigue Research Articles

Online and Face-to-Face Mat Pilates Training for Long COVID-19 Patients: A Randomized Controlled Trial on Health Outcomes

This study investigated the impacts of online and face-to-face Mat Pilates training in adults with persistent symptoms of long COVID on health outcomes. Forty-nine patients (52 ± 5.85 yr.) diagnosed with long COVID related to fatigue symptoms were randomly included in three groups: online Mat Pilates training (n = 16), face-to-face Mat Pilates training (n = 15), and a control group (n = 18) without training. Mat Pilates training was conducted three times a week for 12 weeks. Fatigue, functional capacity, anthropometrics, body composition, and cardiometabolic markers were assessed before and after the interventions. Two-factor Generalized Estimating Equation analyses identified significant differences with Bonferroni post hoc testing (p < 0.05). After the intervention, only the face-to-face Mat Pilates training group had an improved total, physical and mental fatigue, trunk isometric strength, upper limb muscle endurance strength, and aerobic capacity (p < 0.05). No changes were found in fat mass, muscle mass, free fat mass, % of fat, body mass, body mass index, or waist and hip circumferences. No significant changes were observed in blood glucose, glycated hemoglobin, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, or blood pressure (p > 0.05). Our results highlight the potential of face-to-face Mat Pilates training as an effective intervention to mitigate persistent symptoms of long COVID related to fatigue and functional capacities.

Intensive, Real-Time Data Collection of Psychological and Physiological Stress During a 96-Hour Field Training Exercise at a Senior Military College: Feasibility and Acceptability Cohort Study.

Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters. This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX). A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured. A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ≥80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (≥80%) for all metrics and devices. This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery.

Designing Ergonomic Standing Chair for Computer Numerical Control Machine Operators using TRIZ

In this research, the working hours and posture of CNC (Computer Numerical Control) machineoperators were investigated to determine the physical workload that they experienced during theirdaily work. Based on our observations, the operator works 8-hour regular shifts or 12-hour longshifts for 5 – 6 days a week. During these shifts, the operators work in front of the CNC machinewhile standing upright without any tools to rest. Preliminary research was conducted to evaluatethese conditions the results show 13 out of 20 CNC machine operators complained about physicalfatigue while working the CNC machines. It can also be concluded that the operators areexperiencing excessive workload based on a workload assessment using the Quick Exposure Check(QEC) method. To solve this problem, a standing chair is designed with ergonomics in mind. Thedimensions of the standing chair are based on the anthropometry of the CNC machine operators,which was never used before. The design process is conducted using the Theory of InventiveProblem Solving (TRIZ) methodology. Need statements from the CNC machine operators anddesign requirements from the stakeholders are converted into design specifications using TRIZmethodology. Parameters are determined to increase the capability of the existing design based onthe design specifications. The result of this research is a standing chair that is suitable for theoperator’s needs. Based on the analysis of the design result and the stress analysis simulation, it canbe concluded a functional standing chair can be ergonomically designed with the TRIZmethodology.

Self-reported fatigue in people with post COVID-19: impact on functioning in daily life, and associated factors - a cross-sectional study.

To assess (i) the impact of self-reported fatigue on functioning in daily life, and (ii) the association with sociodemographics, physical capacity, and work ability among people with post-COVID-19. A cross-sectional study. Adults reporting post-COVID-19 symptoms for at least 2 months. Participants were recruited through social media and responded to an online survey between October 2021 and February 2022 regarding sociodemographics, COVID-19 symptoms, comorbidities, physical and mental fatigue, aerobic capacity, and work ability. Descriptive statistics and logistic regression analyses were used. A total of 614 participants (88% women, mean age 47 years, on average 13 months of symptoms) were included. A majority (≥ 84%) reported both physical fatigue and mental fatigue, according to the Fatigue Severity Scale and Mental Fatigue Scale. The fatigue impacted motivation, physical functioning, work, family, or social life, and increased sensitivity to stress and concentration difficulties. Among the factors, work ability had the strongest association with both physical fatigue and mental fatigue; odds ratio: 0.650 and 0.473, p < 0.001, respectively. This study found that self-reported fatigue is common among people with post-COVID-19, and negatively impacts functioning in daily life. To achieve a sustainable life and work situation, support and targeted rehabilitation interventions may be important.

Evaluating anchor variables and variation in meaningful score differences for PROMIS® Pediatric measures in children and adolescents living with a rheumatic disease.

Meaningful score differences (MSDs), as defined by recent FDA guidance, can improve the interpretation of outcome measure scores and score changes. Well-accepted methods for estimating MSDs typically rely on external anchor variables, but the applications of these methods are limited in children and adolescents with rheumatic diseases. This project explored multiple candidate anchors for the PROMIS® Pediatric measures of Physical Activity, Fatigue, Pain Interference, and Mobility for children with juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE). Longitudinal data were extracted from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Candidate anchors included patient-reported domain-specific global impressions of change (GIC) along with other parent- and clinician-reported variables. Prior to MSD estimation, the quality of the anchors was assessed using a priori criteria (correlation ≥0.30, n≥10, <10% missing). Anchors meeting criteria were used to calculate MSDs. Among 289 children with JIA and 47 with SLE, the GIC did not meet criteria inhalf of the scenarios. Other candidate anchors performed slightly better. The calculated MSDs varied by external anchor across measures, diagnoses, and direction of change (better vs worse). Many of the candidate external anchoring variables did not meet pre-specified criteria for calculating MSDs. Even for those that did, the choice of anchoring variable had a strong impact on the estimated MSD value and were different from other published values. As in adults, establishing pediatric MSDs requires selection of high-quality anchors, as changes in the variables used as anchors can impact MSD values and any subsequent score interpretations.

Characterizing Fatigue by Multiple Sclerosis Subtype and Determining Validity of a Fatigue Scale Specific to Persons With Progressive Multiple Sclerosis.

Fatigue is a common and debilitating symptom of multiple sclerosis (MS). Prior work suggests that the prevalence of fatigue is higher in progressive MS (PMS) than relapsing MS (RRMS). No patient-reported outcomes of fatigue have been validated specifically for individuals with PMS, despite evidence that they characterize fatigue differently than individuals with RRMS. Therefore, the objective of this study was to characterize fatigue in both the RRMS and PMS subtypes and determine the convergent validity of the Fatigue Symptoms and Impacts Questionnaire (FSIQ) for individuals with PMS. A nationwide survey yielded 806 (637 RRMS, 169 PMS) complete responses. The survey collected demographic information and self-reported disease severity, as well as measures of fatigue, health-related quality of life, and self-reported functioning. People with PMS reported significantly more severe fatigue than those with RRMS (P < .001). The FSIQ subdomains of physical, cognitive/emotional, and coping demonstrated moderate (r = 0.5-0.75) to excellent (r > 0.75) validity (P < .001) with other measures of fatigue. More severe fatigue in people with PMS as compared to those with RRMS underscores the importance of using validated tools to capture fatigue in persons with PMS. The FSIQ is a valid and freely available tool to capture the physical, mental, and emotional fatigue of individuals with PMS.

Analysis of causes of traffic accidents for taxi drivers based on MIMIC and machine learning

Through questionnaire survey, information on individual attributes, physical fatigue perception, work pressure, risky driving behavior and traffic accident experience of 2391 taxi drivers was collected. The multi-indicator multi-cause (MIMIC) model was used for path analysis to explore the inducing effect of physical fatigue perception and risky driving behavior on traffic accidents, and to verify the influence of gender, age and work pressure on physical fatigue perception and distracted driving behavior. Four machine learning algorithms, logistic regression, naive Bayes, support vector machine and random forest, were selected to predict taxi accidents. The results show that the increase of physical fatigue perception, negligent driving behavior, aggressive driving behavior and distracted driving behavior can lead to an increase in accident rate, and gender, age and work pressure will affect the frequency of physical fatigue perception and distracted driving behavior. The accident prediction model based on machine learning has excellent effect, among which the random forest has the best prediction effect. The prediction accuracy of using single feature variables "risky driving behavior", "distracted driving behavior" and "physical fatigue perception" is acceptable. When the personal attribute indicators of "work pressure", "age" and "gender" are introduced, the prediction accuracy is further improved.

The Relationship Between Physical And Mental Workload On Job Fatigue In Maxim Car Drivers In Kupang City In 2024

Transportation is a system consisting of certain facilities along with the flow and control system that allows people or goods to move from one place to another efficiently at any time to support human activities. Indonesia as a developing country certainly has a very rapid development of services in the fields of land, sea and air transportation. Transportation owned by the Indonesian Nation certainly has innovations from past to present in order to advance transportation services, one of which is an online provider company. Online transportation companies offer transportation services such as online motorcycle taxis, online taxis, delivery of goods, food delivery and so on, thus making this service in demand by many people. Likewise in Kupang City where there are several online transportation options, one of which is Maxim car transportation which has the advantage of being quite cheap. The high demand for Maxim online transportation in Kupang City has an impact on the fatigue experienced by online transportation drivers. One of them is also felt by Maxim Mobil drivers. Based on the researcher's initial survey of Maxim drivers in Kupang city, fatigue often occurs in Maxim Car drivers due to the increase in Maxim Car users in Kupang City. This type of research is quantitative using analytic survey method and cros sectional research design. The sample in this study amounted to 81 respondents from a total population of 430 drivers selected using accidental sampling method. The results showed that there was no significant relationship between physical load and work fatigue and there was a significant relationship between mental load and fatigue in maxim car drivers in Kupang City.

Impact of resistance training on fatigue among breast cancer patients undergoing chemotherapy: a systematic review and meta-analysis.

The effects of aerobic exercise interventions for reducing fatigue after cancer treatment are well-established, and the effect of resistance training remains uncertain. Therefore, this systematic review and meta-analysis aim to analyze the effect of resistance training and combined resistance and endurance training on cancer-related fatigue (CRF) in breast cancer patients. A systematic search for randomized controlled trials (RCTs) was conducted on the PubMed, SPORTDiscus, Embase, and Cochrane databases, focusing on the effect of supervised resistance training and combined supervised resistance and endurance training on CRF. Random-effect models were employed for calculating the standardized mean difference (SMD). Risk of bias was assessed with risk of bias 2 (RoB2), and certainty of evidence was judged according to the GRADE approach. A total of 9 RCTs with 1512 participants were included, and data from 866 participants in 8 RCTs were used for the meta-analysis. The risk of bias was deemed low in seven studies, while one study exhibited attrition bias, and one showed possible selection bias. Resistance training probably reduce the total fatigue (SMD= -0.30, 95% CI -0.52, -0.08, p=0.008), with individual studies showing small effects on physical and emotional CRF. A combined resistance and endurance training reduce total fatigue (SMD= -0.34, 95% CI -0.51, -0.17, p= 0.0001), with individual studies indicating moderate effects on physical fatigue, in daily life fatigue, and small effects on emotional and cognitive CRF. Both supervised resistance training and combined resistance and endurance training have a small effect on total CRF. There is a trend towards an influence of intensity, with higher intensity potentially resulting in lower total CRF.

Prevalence, risk factors and clinical impact of burnout in internal medicine units: a call to action.

Health workers, and in particular doctors and nurses working in internal medicine units (IMU), are at high risk of burnout. Overcrowding, complexity and severity of clinical cases, patients' social and family issues, impact of death, and "workload" are all aspects that are specific risk factors that might lead to the development of burnout in this scenario. People suffering from burnout may face several psychological problems (including extreme physical and mental fatigue, emotional exhaustion, loss of enthusiasm concerning work, feelings of cynicism, and a low sense of personal accomplishment) and are also at risk of developing some somatic diseases. Furthermore, the quality of care delivered by a worker in burnout seems to worsen and slip down. In this review, we analyzed the main risk factors and consequences of burnout in IMUs, and we propose individual and organizational measures that may be applied to be able to prevent burnout in this setting.

Prevalence and Outcomes of Gastrointestinal Manifestations in an Australian Scleroderma Cohort.

The gastrointestinal tract (GIT) is the most commonly affected internal organ in systemic sclerosis (SSc). We sought to determine the prevalence and impact of GIT symptoms on survival and patient-reported outcomes. A total of 907 consecutive patients from the Australian Scleroderma Cohort Study who had prospectively completed the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 Questionnaire (UCLA GIT) between 2015 and 2021 were included. The associations between UCLA GIT scores and physical function (Scleroderma Health Assessment Questionnaire), quality of life (QoL; Short Form 36), mood (Patient-Reported Outcomes Measurement Information System [PROMIS] anxiety and depression domains), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue score), and employment were investigated using multivariable population-averaged panel models using generalized estimating equations (GEEs). Kaplan-Meier curves and multivariable Cox proportional hazard regression models were used to evaluate survival according to total UCLA GIT scores. GIT symptoms were reported in 87% of participants, with 46% to 52% reporting moderate to very severe symptoms of reflux, distension, diarrhea, and constipation. Higher total UCLA GIT scores were associated with worse QoL, physical function, fatigue, anxiety, and depression (P < 0.001). In the multivariable GEE analysis, moderate and severe to very severe total scores, reflux scores, and distension scores were associated with worse physical function, QoL, fatigue, anxiety, and depression compared to mild scores (P < 0.05). Patients with severe total scores and diarrhea scores were more likely to be unemployed compared to those with mild scores (P < 0.05). UCLA GIT total scores were not independently associated with death in our cohort. GIT manifestations are common in SSc and negatively impact QoL, physical function, and employment but are not directly associated with increased death.

Wearable network for multilevel physical fatigue prediction in manufacturing workers.

Manufacturing workers face prolonged strenuous physical activities, impacting both financial aspects and their health due to work-related fatigue. Continuously monitoring physical fatigue and providing meaningful feedback is crucial to mitigating human and monetary losses in manufacturing workplaces. This study introduces a novel application of multimodal wearable sensors and machine learning techniques to quantify physical fatigue and tackle the challenges of real-time monitoring on the factory floor. Unlike past studies that view fatigue as a dichotomous variable, our central formulation revolves around the ability to predict multilevel fatigue, providing a more nuanced understanding of the subject's physical state. Our multimodal sensing framework is designed for continuous monitoring of vital signs, including heart rate, heart rate variability, skin temperature, and more, as well as locomotive signs by employing inertial motion units strategically placed at six locations on the upper body. This comprehensive sensor placement allows us to capture detailed data from both the torso and arms, surpassing the capabilities of single-point data collection methods. We developed an innovative asymmetric loss function for our machine learning model, which enhances prediction accuracy for numerical fatigue levels and supports real-time inference. We collected data on 43 subjects following an authentic manufacturing protocol and logged their self-reported fatigue. Based on the analysis, we provide insights into our multilevel fatigue monitoring system and discuss results from an in-the-wild evaluation of actual operators on the factory floor. This study demonstrates our system's practical applicability and contributes a valuable open-access database for future research.

Investigating Factors Responsible for More Boredom in Online Live EFL Classes

Although recent years have seen a growing interest in students’ experiences of boredom in foreign language learning, scant attention has been paid to this negative emotion in online live classes. With a mixed-methods approach, this study investigated what factors were responsible for student boredom in online live classes and what made Chinese students majoring in English more bored in online live classes than in traditional in-person classes. Data were collected through a questionnaire and focus group interviews. Quantitative and qualitative data analyses revealed that the main factors responsible for this negative emotion in online live settings were teacher-centered classes, less engagement and interaction, high task challenges, monotonous and long learning activities, textbook-based activities, students’ lack of self-discipline, peer influences, the absence of emotional support, unreliable internet connection, physical fatigue, a locked-down campus, and a dormitory learning environment. Students’ greater boredom in online live settings than in-person settings arose from student-related factors, technological factors, and environment-related factors. This study sheds light on how to alleviate student boredom in foreign language learning in online live settings.

Associations between wearable device metrics and performance status in adult patients with cancer.

427 Background: Wearable devices present a promising method for monitoring physical performance in cancer patients, potentially bridging the gap between patient experiences at home and clinical evaluations. This study assesses associations between performance status, home-based wearable device metrics, and patient-reported outcomes (PROs) among adults with cancer. (NCT03952767). Methods: This prospective cohort study enrolled 62 adults undergoing treatment for cancer, irrespective of primary site. Participants wore GENEActiv wrist accelerometer sensors (Activinsights Ltd., Kimbolton, UK) on the lumbar region and non-dominant wrist for 2 weeks, tracking gait speed and activity levels. Patients concurrently completed PRO questionnaires on physical function (PF) and fatigue (PROMIS Fatigue 7a &amp; PROMIS Physical Function 10a). Study participants were stratified by baseline self-reported Karnofsky performance status (KPS; 100, 80-90, &amp; ≤70). Linear regression models were used to assess associations between (1) KPS and device metrics and (2) device metrics and PROs. Covariates included age and a binary indicator for COVID period (pre/post 3/1/2020). Results: Average device wear time across the cohort was 22.2 hours/day. Significant differences in gait speed and moderate activity time were observed between the KPS≤70 group and the higher KPS groups ( Table ). Significant associations were also observed between device metrics and PROs. Each 1-hour increment moderate activity was associated with 5.5 point greater PROMIS PF score (95% CI: 3.3, 7.7; p&lt;0.0001) and 4.6 point lower PROMIS Fatigue score (-6.7, -2.5; p&lt;0.0001). Each 0.1 meter/sec increment in gait speed was associated with 4.6 point greater PF score (95% CI: 2.2, 7.1; p=0.0004) and 4.8 point lower Fatigue score (-6.9, -2.7; p&lt;0.0001). Similar associations were observed between in-clinic assessments of gait speed and physical function scores. Conclusions: The associations between wearable device metrics and KPS indicate that wearable technology is both feasible and reliable for remote health monitoring in cancer patients. The associations between device metrics and PROs demonstrate that these metrics reflect patient experiences and outcomes relevant to both patients and regulatory authorities. The associations with physical function, a key PRO in the FDA’s Patient-Focused Drug Development guidance, are particularly noteworthy. Clinical trial information: NCT03952767 . Group 1(KPS 100) Group 2(KPS 80-90) Group 3(KPS ≤70) p (Group 1 vs 3) p (2 vs 3) Gait Speed (m/s) - adjusted mean, 95% CI 0.74 (0.70, 0.78) 0.72 (0.69, 0.74) 0.65 (0.60, 0.70) 0.0058 0.0210 Sedentary time (hours) 11.2 (9.8, 12.6) 10.2 (9.3, 11.0) 10.7 (9.1, 12.2) 0.5912 0.5647 Light activity (hours) 1.4 (1.0, 1.7) 1.3 (1.1, 1.5) 0.9 (0.5, 1.3) 0.0570 0.0474 Moderate activity (hours) 1.4 (1.0, 1.8) 1.2 (0.9, 1.5) 0.5 (0.0, 1.0) 0.0068 0.0159 Vigorous activity (hours) 0.1 (0.0, 0.2) 0.0 (0.0, 0.1) 0.0 (0.0, 0.1) 0.1201 0.2835

Personalised Health Behaviour Support Programme in Adults With Post-COVID Syndrome: A Randomised, Controlled Pilot Feasibility Trial.

We investigated whether a novel 8-week personalised health behaviour support programme, focusing on the stability of symptoms and strategies to improve activities of daily living, was feasible and acceptable in adults with post-COVID syndrome. In this randomised, controlled, pilot feasibility trial, 32 adults with post-COVID syndrome (continued symptoms for ≥ 12 weeks) were randomised 1:1 to receive personalised health behaviour support (self-reported physical activity and symptom diaries, plus seven one-to-one remotely delivered personalised self-management support sessions), once weekly for 8-weeks, or usual care (referral to online 'your COVID-19 recovery' programme). The primary outcome was the feasibility of recruiting and randomising adults with post-COVID syndrome. The secondary outcomes were to assess the acceptability and safety of the intervention and various outcome measures. Of the 48 adults who expressed interest in the study, 32 (67%) were eligible and completed the baseline assessment. All 32 adults were willing to be randomised to either the personalised health behaviour support programme (n = 17) or usual care (n = 15) and 27 (age: 45 ± 12 years) adults completed follow-up at 9 weeks. The intervention was deemed feasible, with high adherence (92% and 94% completion rates for the physical activity and symptom diaries, respectively) and excellent acceptability rates (94% 'liked the intervention a lot'). The intervention was deemed safe, with no symptom exacerbations reported. An 8-week personalised health behaviour support programme was feasible for adults with post-COVID syndrome, with good adherence and acceptability rates. Early pilot data from this small sample also suggests meaningful improvements in physical activity, fatigue and respiratory symptoms. People living with post-COVID syndrome were involved from the outset with the study design, review of study documentation and interpretation of the data following completion. Furthermore, several participants have supported the local dissemination of findings following the completion of the study.

Patient reported fatigue after proton therapy for malignant brain tumours – Is there a relation between radiation dose and brain structures?

BackgroundFatigue may significantly effect everyday- and working life for radiotherapy patients. Some studies indicate a correlation between radiation dose and irradiated volume of the brain and the presence of fatigue. Our hypothesis was that patient reported outcome measures (PROMs) can improve our understanding of the patients’ symptoms following proton beam therapy (PBT) and optimize PBT for future patients. MethodsThis study included 167 adult patients (>18 years) who received PBT for malignant brain tumours. Data on dose metrics to intra-cranial structures was obtained from PBT treatment plans. To explore fatigue and health related quality of life (HRQoL); Multidimensional Fatigue Inventory (MFI-20) and EORTC QLQ-C30 was used at 6-, 12-, 24- and 36 months post PBT. The correlation between fatigue and dosimetry was explored using Spearman’s signed rank test. ResultsNo severe fatigue was recorded during the 36 months follow-up. Correlations between higher radiation dose and worsened fatigue scores were generally weak (rho < 0.3). At 12 months post PBT, higher mean dose to the brain, brainstem, hippocampi and pituitary was correlated to worsened MFI Physical Fatigue. Further, Reduced Motivation according to MFI was correlated to higher radiation dose to the brainstem and the pituitary gland. At 36 months follow-up post-PBT, both Reduced Activity and Reduced motivation according to MFI were correlated to higher radiation dose to the brain, brainstem and hippocampi. ConclusionProton beam therapy are well tolerated, with similar degree of fatigue pre- and post PBT. Achieving further reduction in mean brain dose appears beneficial.

Application of LSTM-based Body Fatigue Detection Algorithm in Tai Chi Training

Tai Chi training sessions are often lengthy, and athletes are prone to experiencing fatigue during the process. Timely detection of body fatigue can help athletes prevent injuries caused by excessive fatigue. This study combines Long Short-Term Memory (LSTM) networks with facial muscle activity detection models to propose a novel fatigue detection algorithm. In this algorithm, the limitations of LSTM networks in capturing future information are addressed by introducing an improved LSTM network model and combining attention mechanisms to highlight the important features of physical fatigue. This study utilizes hyperspectral imaging technology to extract real-time muscle fatigue signals from the faces of subjects in the dataset. Performance validation of the proposed model shows that it effectively extracts facial fatigue features with a detection accuracy of 97.67% and a recall rate of 96.78%, outperforming other existing models in this field. The model constructed through research has excellent performance and has broad application prospects in current and future technological development due to its high flexibility and adaptability, providing support and innovation momentum for different industries.

Prevalence of Thyroid Function Abnormalities and Its Association with Physical Fatigue in First-Year Medical Students

Objective: To estimate prevalence and type of thyroid function abnormalities and explore their associations with physical fatigue in first-year medical students.Methods: This was a cross-sectional observational study comprising of 200 first-year medical students. Demographic details and history of any significant medical illness was asked and noted. Thyroid function tests were conducted on all participants. The prevalence and type of thyroid function abnormalities were documented in all students, and the presence and severity of physical fatigue were assessed on the basis of physical fatigue score. Participants with any kind of thyroid function abnormality were compared with those with normal thyroid function tests for presence and severity of fatigue.Results: Among the 200 students, 144 (72%) were males and 56 (28%) were females, resulting in a male-to-female ratio of 1:0.38. Subclinical hypothyroidism was identified in 9% of students (18 cases), while clinical hypothyroidism was present in 7% (14 cases). Additionally, subclinical hyperthyroidism was detected in 1% of students (2 cases), with no cases of clinical hyperthyroidism reported. Female students were found to be having more thyroid function abnormalities as compared to male students and the difference was found to be statistically significant (p=0.0109). Students with abnormal thyroid function tests (34 cases) had a markedly higher mean FSS score (43.22±4.50) as compared to students with euthyroid (16.85±2.70).Conclusion: Subclinical thyroid abnormalities are prevalent among young individuals, particularly those with physical fatigue. This study revealed a significant link between presence of fatigue and the possibility of thyroid dysfunction.

‘Burnt out by all the exploitation’: Involuted labour in creative fields

This article develops a neo-Bourdieusian analysis of how creative workers respond to the pressures of freelance, contract and project-based cultural production. Using data from 15 in-depth interviews with independent ‘creatives’ we enrol Bourdieu's fields and Clifford Geertz's account of involution – internal over-elaboration – to investigate the tendencies, nuances and outcomes of creative labour's production practices. To answer the field's piecemeal funding and limited market rewards three broad strategic involution strategies are outlined: ‘hard driving’ of resources; reworking and hybridization of existing cultural forms; and uncodified intricacy within the social relations of production. This theorization illustrates how iterative internal complexity aids the economizing of cultural production oriented to gaining recognition while, due to the social intricacy of creative processes, inducing a tendency towards emotional and physical fatigue. Rather than promote a meritocratic productivity imagined by policy discourses, involuted labour produces burnout and thus contributes to the churn of creative talent.

Radiation-Emitting metallic stent for unresectable bismuth type III or IV perihilar cholangiocarcinoma: a multicenter randomized trial

Background &amp; Aims: Self-expandable metallic stents (SEMSs) have been recommended for patients with unresectable malignant biliary obstruction while radiation-emitting metallic stents (REMSs) loaded with 125I seeds have recently been approved to provide longer patency and overall survival in malignant biliary tract obstruction. This trial is to evaluate the efficacy and safety of REMS plus hepatic arterial infusion chemotherapy (REMS-HAIC) versus SEMS plus HAIC (SEMS-HAIC) for unresectable perihilar cholangiocarcinoma (pCCA). Methods: This multicenter randomized controlled trial recruited patients with unresectable Bismuth type III or IV pCCA between March 2021 and January 2023. Patients were randomly assigned (1:1 ratio) to receive either REMS-HAIC or SEMS-HAIC using permuted block randomization, with a block size of six. The primary endpoint was overall survival (OS). The secondary endpoints were time to symptomatic progression (TTSP), stent patency, relief of jaundice, quality of life, and safety. Results: A total of 126 patients were included in the intent-to-treat population, with 63 in each group. The median OS was 10.2 months versus 6.7 months (P=0.002). The median TTSP was 8.6 months versus 5.4 months (P=0.003). The median stent patency was longer in the REMS-HAIC group than in the SEMS-HAIC group (P=0.001). The REMS-HAIC group showed better improvement in physical functioning scale (P&lt;0.05) and fatigue symptoms (P&lt;0.05) when compared to the SEMS-HAIC group. No significant differences were observed in relief of jaundice (85.7% vs. 84.1%; P=0.803) or the incidence of grade 3 or 4 adverse events (9.8% vs. 11.9%; P=0.721). Conclusion: REMS plus HAIC showed better OS, TTSP, and stent patency compared with SEMS plus HAIC in patients with unresectable Bismuth type III or IV pCCA with an acceptable safety profile.