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Background: While some long-term effects of COVID-19 are respiratory in nature, a non-respiratory effect gaining attention has been a decline in hemoglobin, potentially mediated by inflammatory processes. In this study, we examined the correlations between hemoglobin levels and inflammatory biomarkers and evaluated the association between hemoglobin and fatigue in a cohort of Long-COVID patients. Methods: This prospective cohort study in the Netherlands evaluated 95 (mostly hospitalized) patients, aged 40-65 years, 3-6 months post SARS-CoV-2 infection, examining their venous hemoglobin concentration, anemia (hemoglobin < 7.5 mmol/L in women and <8.5 mmol/L in men), inflammatory blood biomarkers, average FSS (Fatigue Severity Score), demographics, and clinical features. Follow-up hemoglobin was compared against hemoglobin during acute infection. Spearman correlation was used for assessing the relationship between hemoglobin concentrations and inflammatory biomarkers, and the association between hemoglobin and fatigue was examined using logistic regression. Results: In total, 11 (16.4%) participants were suffering from anemia 3-6 months after SARS-CoV-2 infection. The mean hemoglobin value increased by 0.3 mmol/L 3-6 months after infection compared to the hemoglobin during the acute phase ( p-value = 0.003). Whilst logistic regression showed that a 1 mmol/L greater increase in hemoglobin is related to a decrease in experiencing fatigue in Long-COVID patients (adjusted OR 0.38 [95%CI 0.13-1.09]), we observed no correlations between hemoglobin and any of the inflammatory biomarkers examined. Conclusion: Our results indicate that hemoglobin impairment might play a role in developing Long-COVID fatigue. Further investigation is necessary to identify the precise mechanism causing hemoglobin alteration in these patients.

A burn can be a traumatic experience for both the survivor and the partner. This thesis aims to enhance our understanding of the traumatic impact of burn injuries on the quality of life of burn survivors and the psychological symptoms experienced by their partners. The research is divided into two main parts. In the first part, the focus is on the development and trajectory of PTSD symptoms in partners of burn survivors, examining how the interpersonal behavior of both partners influences these symptoms over time. The second part investigates the impact of the survivor’s PTSD symptoms on their health-related quality of life (HRQL) and fatigue. Additionally, the study explores different recovery patterns to pre-burn HRQL levels and compares the perspectives of survivors and their partners on the survivor’s pre-burn HRQL. The findings reveal significant insights into the mental well-being of burn survivors and their partners during the 18 months following the injury. Both survivors and their partners may experience post-traumatic stress symptoms. The study highlights the importance of couple dynamics, showing that partners who are more involved in the mental well-being of burn survivors can help reduce the survivors' traumatic stress. Conversely, it is crucial for the partners' own well-being that they do not suppress their feelings out of a desire to protect the survivor. Furthermore, early signs of post-traumatic stress in burn survivors are strong predictors of persistent symptoms and a long-term decline in quality of life, and increased fatigue. These results underscore the importance of early detection and continuous monitoring of psychological symptoms, both in the hospital and throughout the aftercare phase. The significant impact of post-traumatic stress symptoms supports the implementation of trauma-informed care, emphasizing early symptom recognition and the need for care practices that are aligned with the psychological needs of both patients and their fami

Background: In the Netherlands, the prevalence of post COVID-19 condition is estimated at 12.7% at 90–150 days after SARS-CoV-2 infection. This study aimed to determine the occurrence of fatigue and other symptoms, to assess how many patients meet the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) criteria, to identify symptom-based clusters within the P4O2 COVID-19 cohort and to compare these clusters with clusters in a ME/CFS cohort. Methods: In this multicentre, prospective, observational cohort in the Netherlands, 95 post COVID-19 patients aged 40–65 years were included. Data collection at 3–6 months after infection included demographics, medical history, questionnaires, and a medical examination. Follow-up assessments occurred 9–12 months later, where the same data were collected. Fatigue was determined with the Fatigue Severity Scale (FSS), a score of ≥ 4 means moderate to high fatigue. The frequency and severity of other symptoms and the percentage of patients that meet the ME/CFS criteria were assessed using the DePaul Symptom Questionnaire-2 (DSQ-2). A self-organizing map was used to visualize the clustering of patients based on severity and frequency of 79 symptoms. In a previous study, 337 Dutch ME/CFS patients were clustered based on their symptom scores. The symptom scores of post COVID-19 patients were applied to these clusters to examine whether the same or different clusters were found. Results: According to the FSS, fatigue was reported by 75.9% of the patients at 3–6 months after infection and by 57.1% of the patients 9–12 months later. Post-exertional malaise, sleep disturbances, pain, and neurocognitive symptoms were also frequently reported, according to the DSQ-2. Over half of the patients (52.7%) met the Fukuda criteria for ME/CFS, while fewer patients met other ME/CFS definitions. Clustering revealed specific symptom patterns and showed that post COVID-19 patients occurred in 11 of the clusters that have been observed in the M

The corticospinal tract serves as the primary pathway for motor function in the human brain, transmitting signals from upper motoneurons to lower motoneurons to ultimately produce muscle contractions. Motoneurons generate firing patterns in response to synaptic input, with the voltage-sensitive conductance determining the cell's output based on thresholds and firing. However, neuromodulators in the central nervous system (CNS), including those in the brainstem, intricately regulate activity in corticospinal motor pathways by regulating the gain of motoneuron output. The purpose of this PhD Thesis is to examine the neuromodulatory role that muscarinic acetylcholine receptors (mAChRs) have on human corticospinal corticospinal motor pathways. To achieve this, three studies were performed using a human, double-blinded, placebo-controlled and crossover design. Each study assessed the effects of a muscarinic blockade (Phenergan 25 mg) on the motor system using TMS, peripheral nerve stimulation and somatosensory recordings. [...], Thesis (PhD Doctorate), Doctor of Philosophy, School of Health Sci & Soc Wrk, Griffith Health

OBJECTIVE: To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints. DESIGN: Prospective, multicentre cohort study. SETTING: Six Dutch hospitals. PARTICIPANTS: 205 initially hospitalized (March-June 2020), confirmed SARS-CoV-2 patients, aged =18 years, physically able to visit the hospital, without prior cognitive deficit, MRI contraindication, or severe neurological damage post-hospital discharge. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences following Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: 1. Demographic and premorbid factors (sex, age, education, comorbidities), 2. Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), 3. Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), and 4. Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), 5. Fatigue or cognitive complaints. RESULTS: The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (p=.01), lower PROMIS-PF (p<.001), higher HADS-Depression (p=.03), and CLC-high (p=.04). Greater odds of CLC-high were

Introduction: There is increasing evidence showing the adverse effects of academic stress on higher education students in health fields. Objective: The aim of this research was to identify the presence of academic stress in morphology students of four programs of a Health Sciences Faculty. Method: A descriptive longitudinal study was carried out with a population of 78 morphology students, where the main stressors were evaluated through the application of the Academic Stress Questionnaire. Results: It was identified that morphology students perceive stress in an increased way as the academic semester goes by, this is mainly related to stressors such as academic overload, exams and methodological deficiencies of the teaching staff. In response to stress, the students reported that the most experienced feeling was physical exhaustion, followed by anger and sleep disturbances. Finally, it was determined that the students, as strategies to cope with stress, resorted mainly to the search for social support, positive reappraisal, planning and management of personal resources. Conclusions: Academic stress is a growing problem that considerably affects young people due to various stressors. This article highlights the stress conditions that health sciences students face, and calls on university institutions to identify the stress conditions to which their students are subjected and to generate strategies that can mitigate them, Introducción: existe un aumento en la evidencia que demuestra los efectos adversos del estrés académico en los estudiantes de educación superior de áreas de la salud. Objetivo: identificar la presencia de estrés académico en estudiantes de morfología de cuatro programas de una facultad de ciencias de la salud. Método: se realizó un estudio descriptivo de corte longitudinal con una población de 78 estudiantes de morfología donde se evaluaron los principales estresores a través de la aplicación del Cuestionario de Estrés Académico. Resultados: se identificó que los estudiantes de morfología perciben el estrés de manera aumentada a medida que transcurre el semestre académico, esto se relaciona principalmente con estresores como sobrecarga académica, exámenes y deficiencias metodológicas del profesorado. En respuesta al estrés, los estudiantes relataron que el sentimiento más experimentado era agotamiento físico, seguido por irascibilidad y alteraciones de sueño. Por último, se determinó que los estudiantes recurrían principalmente a la búsqueda de apoyo social, la reevaluación positiva, planificación y gestión de recursos personales como estrategias para afrontar el estrés. Conclusiones: el estrés académico es una problemática en ascenso que afecta considerablemente a los jóvenes debido a diversos factores estresores. Este artículo resalta las condiciones de estrés a las que se enfrentan los estudiantes de ciencias de la salud y hace un llamado a las instituciones universitarias a identificar las condiciones de estrés a las que se ven sometidos sus estudiantes y a generar estrategias que puedan mitigarlas.

Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.

The incidence and mortality rates for gynecologic cancers continue to increase globally. Albeit limited research suggests that these patients experience a very high symptom burden. In fact, patients with gynecologic cancers reported an average of 14 co-occurring symptoms. These unrelieved symptoms have a negative impact on patients’ functional status and quality of life (QOL). Given the deleterious effects of these symptoms, detailed information on their occurrence, severity, and distress is needed to guide the development of effective symptom management interventions for these patients.Therefore, the first two aims of this dissertation were to: 1) conduct a systematic review to assess the symptom burden and determine the prevalence rates for multiple co-occurring symptoms in patients with gynecologic cancers and 2) develop a comprehensive conceptual model of energy in patients with cancer. In addition, using data from a sample of patients with gynecologic cancers (n = 233), the third and fourth aims of this dissertation were to: 3) evaluate for differences in demographic, clinical, and symptom characteristics and QOL outcomes among patients with distinct morning and evening fatigue profiles and 4) evaluate for differences in demographic, clinical, and symptom characteristics and QOL outcomes among patients with distinct morning and evening energy profiles. In terms of Aim 1, a systematic review was done that synthesized the extant literature on multiple co-occurring symptoms in patients receiving treatment for gynecologic cancers. A total of 118 studies were included in this review. Ninety-six symptoms were assessed across these studies. Grand mean prevalence rates for the top six symptoms were: lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across these studies. This review concluded with directions for future research. In

Current US building codes require the Lateral-Force Resisting System (LFRS) of reinforced concrete structures resisting wind loads to be designed for elastic response. Imposing the requirement of elastic behavior may produce an overly conservative design if the lateral system has some inherent ductility and may also have unintended adverse effects on structural performance under seismic loading. Performance-Based Wind Design (PBWD), which would allow limited nonlinear behavior in key components, has been introduced by the American Society of Civil Engineers (ASCE) Structural Engineering Institute (SEI) and the American Concrete Institute (ACI) to address these issues. A critical aspect of PBWD involves an assessment of the strength and detailing requirements needed to allow limited nonlinear demands in critical components. Of particular interest is the behavior at critical sections subjected to high-cycle fatigue loading, which is common for wind loading. If detailing commonly used for special seismic systems is used, then it is reasonable to assume that behavior under high-cycle fatigue loading will be acceptable, although the importance of stiffness degradation under wind loading requires investigation. The need for improved detailing for nonlinear responses under wind loading, in addition to that required of ordinary or intermediate structural systems, requires additional study.This thesis focuses on the behavior of lap splices at critical sections in ordinary structural walls under wind loading. A detailed literature review was conducted and it was revealed that the existing information in the literature is insufficient to develop recommendations; therefore, an experimental program was developed. Lap splice behavior was initially investigated by testing T-beams subjected to 4-point loading, which are cheaper to construct and easier to test than walls, followed by testing of C-shaped walls. The T-beam tests were conducted in two phases: Phase I involved three sma

PURPOSE: The OlympiA randomized phase III trial compared 1 year of olaparib (OL) or placebo (PL) as adjuvant therapy in patients with germline BRCA1/2, high-risk human epidermal growth factor receptor 2-negative early breast cancer after completing (neo)adjuvant chemotherapy ([N]ACT), surgery, and radiotherapy. The patient-reported outcome primary hypothesis was that OL-treated patients may experience greater fatigue during treatment. METHODS: Data were collected before random assignment, and at 6, 12, 18, and 24 months. The primary end point was fatigue, measured with the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary end points, assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30 item, included nausea and vomiting (NV), diarrhea, and multiple functional domains. Scores were compared between treatment groups using mixed model for repeated measures. Two-sided P values <.05 were statistically significant for the primary end point. All secondary end points were descriptive. RESULTS: One thousand five hundred and thirty-eight patients (NACT: 746, ACT: 792) contributed to the analysis. Fatigue severity was statistically significantly greater for OL versus PL, but not clinically meaningfully different by prespecified criteria (≥3 points) at 6 months (diff OL v PL: NACT: -1.3 [95% CI, -2.4 to -0.2]; P = .022; ACT: -1.3 [95% CI, -2.3 to -0.2]; P = .017) and 12 months (NACT: -1.6 [95% CI, -2.8 to -0.3]; P = .017; ACT: -1.3 [95% CI, -2.4 to -0.2]; P = .025). There were no significant differences in fatigue severity between treatment groups at 18 and 24 months. NV severity was worse in patients treated with OL compared with PL at 6 months (NACT: 6.0 [95% CI, 4.1 to 8.0]; ACT: 5.3 [95% CI, 3.4 to 7.2]) and 12 months (NACT: 6.4 [95% CI, 4.4 to 8.3]; ACT: 4.5 [95% CI, 2.8 to 6.1]). During treatment, there were some clinically meaningful differences between groups for other symptoms but

OBJECTIVES: The objective of this research was to generate psychometric evidence supporting the myasthenia gravis (MG) symptoms patient-reported outcome (PRO) scales as a fit-for-purpose measure of severity of core symptoms of MG and provide information allowing their meaningful interpretation using data from a phase 3 study in MG. METHODS: Data from the MycarinG study, a phase 3 study of rozanolixizumab in patients with generalized MG who experience moderate to severe symptoms (ClinicalTrials.gov Identifier: NCT03971422) were analyzed with both classical test theory (CTT) and Rasch measurement theory (RMT). Meaningful within-individual change and group-level meaningful change were estimated for three MG Symptoms PRO scales using anchor- and distribution-based methods. Anchor-based methods used patient global impression of severity (PGIS) and change (PGIC) in MG symptoms as anchors. RESULTS: Good measurement properties of the MG Symptoms PRO scales were shown in the sample of 200 participants: good to excellent reliability (test-retest and internal consistency reliability) and validity (associations between items and scores within the MG Symptoms PRO scales and between the MG Symptoms PRO scores and other clinical outcomes-MG ADL, QMG score, MGC score, and MGFA classes-were as expected); and the items showed good coverage of the continuum and fit to the Rasch model. Triangulation of the anchor- and distribution-based method results led to the definition of clinically meaningful within-patient improvement in scores for Muscle Weakness Fatigability (-16.67), Physical Fatigue (-20.00), and Bulbar Muscle Weakness (-20.00), with associated ranges. Benchmarks are also proposed for the interpretation of group-level results. CONCLUSION: The strong psychometric performance of the MG Symptoms PRO scales and the information generated to guide its interpretation supports its use in clinical trials for demonstrating the clinical benefits of new treatments targeting core symptoms

In the present study, polylactic acid (PLA) scaffolds with a 60 % porosity and gyroid pore structure were 3D printed using the extrusion-based method and employing various printing parameters. The specimens were loaded under quasit-static and cyclic conditions and their mechanical behaviour were evaluated. The Taguchi method was utilized to design experiments and investigate the impact of printing parameters on the compressive properties of the scaffolds. Moreover, thermography analysis was used to examine the influence of cyclic heating during fatigue experiments. The results indicated that extrusion width was the sole variable significantly affecting the quasi-static properties of scaffolds. The largest extrusion width (0.65 mm) resulted in the highest compressive properties (6–7 MPa), plateau stress (8–9 MPa), and compressive modulus (200–215 MPa). However, fatigue experiments revealed that nozzle temperature was the sole influencing factor on the fatigue performance of scaffolds, with specimens printed at low nozzle temperature (190 °C) demonstrating the highest fatigue resistance. Thermography analysis exhibited a negative correlation between scaffold temperature and stiffness. However, the impact of temperature on the structural integrity of the scaffolds was insignificant, given that the highest temperature recorded during fatigue cycles (i.e., 39 °C) was below the glass transition temperature of the scaffolds’ material.

Post-COVID condition (PCC) and multiple sclerosis (MS) share some clinical and demographic features, including cognitive symptoms and fatigue. Some pathophysiological mechanisms well-known in MS, such as autoimmunity, neuroinflammation and myelin damage, have also been implicated in PCC. In this study, we aimed to compare the cognitive phenotypes of two large cohorts of patients with PCC and MS, and to evaluate the relationship between fatigue and cognitive performance. Cross-sectional study including 218 patients with PCC and 218 with MS matched by age, sex, and years of education. Patients were evaluated with a comprehensive neuropsychological protocol and were categorized according to the International Classification of Cognitive Disorders system. Fatigue and depression were also assessed. Cognitive profiles of PCC and MS largely overlapped, with a greater impairment in episodic memory in MS, but with small effect sizes. The most salient deficits in both disorders were in attention and processing speed. The severity of fatigue was greater in patients with PCC. Still, the correlations between fatigue severity and neuropsychological tests were more prominent in the case of MS. There were no differences in the severity of depression among groups. Our study found similar cognitive profiles in PCC and MS. Fatigue was more severe in PCC, but was more associated with cognitive performance in MS. Further comparative studies addressing the mechanisms related to cognitive dysfunction and fatigue may be of interest to advance the knowledge of these disorders and develop new therapies., Comunidad de Madrid, Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Satisfaction with life is considered an essential indicator of quality of life and has implications not only for parents but also for the general health of society. It is relevant to know the factors that could explain differences in parents’ satisfaction with life. The objectives of this study were to analyse the degree of satisfaction with life of a cohort of fathers 13–24 months after the birth of their child and to analyse the predictive capacity of sociodemographic, physical, psychological, and social factors on their long-term life satisfaction. This was a longitudinal study with follow-up at 6–12 months and at 13–24 months (n = 152 fathers). The Fatigue Assessment Scale, Athens Insomnia Scale, Parental Stress Scale and short version of the Dyadic Adjustment Scale were completed online at 6–12 months. Finally, Satisfaction with Life Scale was assessed between 13 and 24 months after birth. The mean score of life satisfaction of the participants 13–24 months after the birth of their child was 18.72 (SD = 3.71) and was negatively correlated with fatigue, insomnia, and stress (p < 0.01), and positively correlated with dyadic adjustment (p < 0.01). The final hierarchical regression model showed that educational levels and insomnia were the main predictive variables for life satisfaction during the second-year postpartum. This work has important implications for clinical practice because it allows health professionals to understand the factors influencing satisfaction with life and health among fathers and to plan more effective antenatal and postnatal care.

Latar Belakang: Prevalensi dan insiden gagal ginjal kronis meningkat tiap tahunnya, hal ini telah menjadi masalah kesehatan global. Gagal Ginjal kronik bersifat progresif dan irreversible, pada tahap lanjut tidak dapat pulih kembali. Pasein memerlukan terapi pengganti ginjal untuk mempertahankan kehidupannya. Salah satu dampak hemodialisis adalah fatigue atau kelelahan. Fatigue yang tidak ditangani dapat mengakibatkan gejala seperti hipotensi, lemas, kram pada otot, pusing dan mual muntah, dan, selain itu hal ini juga akan berdampak pada konsentrasi, proses berpikir, gangguan hubungan sosial dan kualitas hidup dari pasien. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui gambaran tingkat fatigue pada pasien yang menjalani hemodialisis. Metode: Desain penelitian adalah deskriptif kuantitatif. Sampel adalah pasien yang menjalani hemodialisis di RS Dharmayadnya dipilih menggunakan teknik total sampling dengan jumlah sampel sebanyak 44 pasien. Data tingkat fatigue dikumpulkan dengan kuisioner Fatigue Assessment Scale (FAS). Analisa data menggunakan Analisa univariat dengan mencari distribusi frekuensi variabel. Hasil: Hasil penelitian menunjukkan 59% mengalami fatigue, 27% mengalami ekstreme fatigue, 14% tidak ada keluhan fatigue. Kesimpulan: Fatigue pada pasien dengan hemodialisis berhubungan dengan gangguan pada kondisi fisik, termasuk malnutrisi, anemia, uremia.

Latar Belakang: Prevalensi dan insiden gagal ginjal kronis meningkat tiap tahunnya, hal ini telah menjadi masalah kesehatan global. Gagal Ginjal kronik bersifat progresif dan irreversible, pada tahap lanjut tidak dapat pulih kembali. Pasein memerlukan terapi pengganti ginjal untuk mempertahankan kehidupannya. Salah satu dampak hemodialisis adalah fatigue atau kelelahan. Fatigue yang tidak ditangani dapat mengakibatkan gejala seperti hipotensi, lemas, kram pada otot, pusing dan mual muntah, dan, selain itu hal ini juga akan berdampak pada konsentrasi, proses berpikir, gangguan hubungan sosial dan kualitas hidup dari pasien. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui gambaran tingkat fatigue pada pasien yang menjalani hemodialisis. Metode: Desain penelitian adalah deskriptif kuantitatif. Sampel adalah pasien yang menjalani hemodialisis di RS Dharmayadnya dipilih menggunakan teknik total sampling dengan jumlah sampel sebanyak 44 pasien. Data tingkat fatigue dikumpulkan dengan kuisioner Fatigue Assessment Scale (FAS). Analisa data menggunakan Analisa univariat dengan mencari distribusi frekuensi variabel. Hasil: Hasil penelitian menunjukkan 59% mengalami fatigue, 27% mengalami ekstreme fatigue, 14% tidak ada keluhan fatigue. Kesimpulan: Fatigue pada pasien dengan hemodialisis berhubungan dengan gangguan pada kondisi fisik, termasuk malnutrisi, anemia, uremia.

While colonoscopy certainly poses a minimal, but existing threat to a patient undergoing colonoscopy, it also poses a threat to the physician performing colonoscopy as they are at risk of developing endoscopy-related injuries (ERIs) which are a form of Repetitive Stress Injuries (RSIs). Our group created a device called the “EndoGrip” in order to reduce the risk of ERIs by reducing hand and risk fatigue through reducing the force required to grip and torque the colonoscope. The goal was to design an inexpensive device that uses the mechanical advantage from a wedge to increase gripping strength and to provide a more ergonomic gripping surface for the hand, similar to handles found in tools like a screwdriver.

Background Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacologicaltreatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is stillunclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-toheadtrial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadinevs. placebo in patients with advanced cancer. Methods The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will usea parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidatevs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0–10 scale. The study periodincludes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcomeis the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illnesstherapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, whichwill be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for AdverseEvents in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learningalgorithm will be employed for the clinical prediction of different agents in homogeneous subgroups. Discussion The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatmentapproach, design of future trials, as well as the development of CRF management guidelines. Trial registration IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.

Gliomas are a malignant and infiltrative brain cancer, and to date, these tumors are non‐curable. Essentially, glioma patients live with a double diagnosis: cancer and a neurological disorder. Consequently, they suffer from many symptoms, with fatigue being one of the most prevalent and burdensome. Hence, health‐related quality of life (HRQoL) and symptom management are essential to treatment. However, as the etiology of fatigue is largely unknown, no effective treatments are available. Therefore, this thesis aimed to uncover which factors are associated with fatigue in glioma, to understand the complex relation between fatigue, symptoms, and HRQoL using network analysis and to explore which interventions can effectively alleviate fatigue in glioma.

The phase field method has gathered significant attention in the past decade due to its versatile applications in engineering contexts, including fatigue crack propagation modeling. Particularly, the phase field cohesive zone method (PF-CZM) has emerged as a promising approach for modeling fracture behavior in quasi-brittle materials, such as concrete. The present contribution expands the applicability of the PF-CZM to include the modeling of fatigue-induced crack propagation. This study critically examines the validity of the extended PF-CZM approach by evaluating its performance across various fatigue behaviors, encompassing hysteretic behavior, S-N curves, fatigue creep curves, and the Paris law. The experimental investigations and validation span a diverse spectrum of loading scenarios, encompassing pre- and post-peak cyclic loading, as well as low- and high-cyclic fatigue loading. The validation process incorporates 2D and 3D boundary value problems, considering mode I and mixed-modes fatigue crack propagation. The results obtained from this study show a wide range of validity, underscoring the remarkable potential of the proposed PF-CZM approach to accurately capture the propagation of fatigue cracks in concrete-like materials. Furthermore, the paper outlines recommendations to improve the predictive capabilities of the model concerning key fatigue characteristics.

Sociala medier (SM) har blivit en central del i många människors vardagliga liv där applikationer som Instagram, TikTok och Snapchat, lockar många användare genom bland annat kommunikation, underhållning, och rekommendationer. Den stora användningen av SM bidrar till att det kan finnas ett konstant behov av att vilja vara uppkopplad, vilket resulterat i ett vanebeteende många användare har svårt att styra över. Överanvändning av SM kan leda till allvarliga hälsoproblem som trötthet, frustration, ångest, stress och depression. För att främja digitalt välbefinnande bland användare har flera Digital Self-Control Tools (DSCT) designats, med målet att stödja användare att kontrollera deras SM användning. Trots att det finns flera hundra nedladdningsbara applikationer är det en utmaning att engagera användarna till att inte överge verktygen. Studien ämnar utforska vad designers kan ta i beaktande vid utformande av verktyg för att upprätthålla ett digitalt välbefinnande. Detta besvaras genom att studien utforskar hur användare upplever restriktiva och icke-begränsande DSCTs i relation till deras användande av SM. Respektive verktyg implementerades i deltagarnas telefoner och deras upplevelser inhämtades genom semistrukturerade intervjuer och dagboksundersökning. Studien identifierade tre teman designers kan ta i beaktande när DSCTs designas. Dessa tre teman är “Anpassa DSCTs utifrån typ av användning”, “Uppmuntra användandet av DSCTs” och “Synliggör användarvanor med hjälp av DSCTs”., Social media (SM) has become a central part of many people's daily lives, where applications such as Instagram, TikTok, and Snapchat attract users through communication, entertainment, and recommendations. The extensive use of SM can contribute to a constant need among users to stay connected, resulting in habitual behavior, that users struggle to control. Overuse of SM can lead to serious health problems such as fatigue, frustration, anxiety, stress, and depression. To promote digital well-being among users, several Digital Self-Control Tools (DSCTs) have been designed with the goal of supporting users in controlling their SM usage. Despite the availability of hundreds of downloadable applications, engaging users to not abandon these tools is a challenge. This study aims to explore what designers can consider when designing tools to maintain digital wellbeing. This is addressed by investigating how users experience restrictive and non-restrictive DSCTs in relation to their use of SM. Each tool was implemented on participants' phones, and their experiences were collected through semi-structured interviews and diary studies. The study identified three themes that designers can consider when designing DSCTs. These three themes are "Customizing DSCTs determined by type of use," "Encouraging the use of DSCTs," and "Visualizing user habits using DSCTs."

Introduction: Currently, there is no cure for spinal cord injury (SCI). People living with SCI face numerous life-threatening risks due to motor, sensory, autonomic, cardiovascular, and respiratory dysfunctions. Exercise is fundamental for these individuals to manage these diverse risks, where arm crank ergometry (ACErg) exercise is one of the most commonly used methods. However, the efficiency of the traditionally recommended crank axis height at shoulder level (ASL) during the ACErg has not been systematically investigated. Furthermore, their exercise capacity is significantly low, particularly those with cervical injury, making it challenging to maximize exercise benefits. So, exercise optimization is fundamental to improving exercise performance and physiological responses and promoting health benefits. Thus, this study aims to determine the effects of lowering the arm crank height during ACErg on exercise duration, physiological responses, and perceived function during maximal and submaximal exercise of persons with SCI. Methods: This randomized cross-over trial was conducted from July 2023 to April 2024 at the Spinal Cord Research Centre Human Laboratory in Winnipeg, Canada. Eight participants (C5-T12 injury level) underwent two peak oxygen uptake (V ̇O2peak) tests and two constant workload tests (CWT) until fatigue with the axis of the arm crank height ASL and below shoulder level (BSL). The Wilcoxon sign-rank test (two-tailed) was used to compare exercise durations and physiological responses between the two crank heights. Results: Exercise duration during the CWT was significantly longer with the crank axis BSL compared to ASL (Mdn=512 vs 410, W = 35, p = 0.016, r = 0.944). However, there was no effect on V ̇O2peak, peak carbon dioxide output (V ̇CO2peak), peak respiratory quotient (RQpeak), peak heart rate (HRpeak), time to all these variables, and test duration during the V ̇O2peak test. For perceived function, 87.5% of our participants favoured BSL over

Fatigue life calculation is crucial for those structures that are applied into a severe dynamic environment, also characterized by high level of randomness.Some commercial software, as Ansys and Comsol, have already built-in tools for random vibration fatigue calculation but Abaqus CAE does not. Hence, this thesis fills this gap, developing a plug-in tool integrated into Abaqus CAE to perform multi-axial fatigue analysis of metal components subjected to random vibration loading.Since this loading is characteristic of high cycle fatigue, first a random stress analysis is perform in Abaqus CAE and then the tool is applied as a post-processor. The literary review suggests some frequency domain methods extremely more efficient compared to time-domain approaches. Thus, they are implemented by Python scripting and incorporated into an Abaqus’s Graphic User Interface.The tool, which can be applied to study random vibration with Gaussian distribution and zero mean, was first validated studying a simple L-plate. The hotspot identification and the maximum damage accumulated were compared against the results obtained with the commercial software Simulia Fe-Safe. Then, a real application case was analyzed and the fatigue effect of the background random vibrations were studied for a cable connectors bracket mounted on a helicopter. Satisfying results were obtained for both cases and they allowed to explore the accuracy and limitations of the tool developed. Moreover, the study permitted to give some suggestion of future works on this field which include non-isotropic materials, critical plane methods, transient random vibration loading and non-Gaussian processes. The tool showed promising results on the hot-spot identification and damage calculation especially for in-phase loading. Hence, it can be an useful tool for the analysis of random vibration fatigue in Abaqus CAE but further improvements are required in case of out-of-phase loading., Beräkning av utmattningslivslängd är avgörande för de strukturer som appliceras i en svår dynamisk miljö, även kännetecknad av hög grad av slumpmässighet.Vissa kommersiella program, som Ansys och Comsol, har redan inbyggda verktyg för slumpmässig beräkning av vibrationsutmattning, men det har inte Abaqus CAE. Därför fyller denna avhandling denna lucka och utvecklar ett plug-in-verktyg integrerat i Abaqus CAE för att utföra multiaxiell utmattningsanalys av metallkomponenter som utsätts för slumpmässig vibrationsbelastning.Eftersom denna belastning är karakteristisk för hög cykelutmattning, utförs först en slumpmässig spänningsanalys i Abaqus CAE och sedan appliceras verktyget som en postprocessor. Litteraturöversikten föreslår vissa frekvensdomänmetoder som är extremt effektivare jämfört med tidsdomänmetoder. Således implementeras de av Python-skript och införlivas i ett Abaqus grafiska användargränssnitt.Verktyget, som kan användas för att studera slumpmässiga vibrationer med Gauss-fördelning och nollmedelvärde, validerades först genom att studera en enkel L-platta. Hotspot-identifieringen och den maximala ackumulerade skadan jämfördes med resultaten som erhölls med den kommersiella programvaran Simulia Fe-Safe. Därefter analyserades ett verkligt applikationsfall och utmattningseffekten av de slumpmässiga bakgrundsvibrationerna studerades för en kabelanslutningskonsol monterad på en helikopter. Tillfredsställande resultat erhölls för båda fallen och de gjorde det möjligt att utforska noggrannheten och begränsningarna hos det utvecklade verktyget. Dessutom tillät studien att ge några förslag på framtida arbeten på detta område som inkluderar icke-isotropa material, kritiska planmetoder, transient slumpmässig vibrationsbelastning och icke-Gaussiska processer. Verktyget visade lovande resultat för identifiering av hotspots och skadeberäkning, speciellt för fasbelastning. Därför kan det vara ett användbart verktyg för analys av slumpmässig vibrationsutmattning i Abaqus

Bolts in trucks are subjected to cycled loading and are therefore prone to fatigue failure, mostlikely under the bolt head or at the start of the thread. When evaluating a bolt for fatigue,evaluation surfaces must be created manually at the critical positions in a finite element solverwhich is time consuming. The purpose of this project is to reduce the amount of manual inputby developing a method for calculating the stress at the thread start, without an evaluationsurface. Furthermore, bolts with reduced shank have longer fatigue life but the amount ofexperimental test data available is limited. Therefore, in this project, a fatigue test in bendingon bolts with reduced shank will be conducted. By creating an evaluation surface of a bolt in a finite element model, the bending moments fora cross section can be found. These are then used in a polynomial that calculates the axialequivalent stress for the cross section. In a reference method, evaluation surfaces are made bothunderneath the bolt head and at the start of the thread while in the new method developedin this thesis there is no evaluation surface at the start of the thread. Instead, the bendingmoments are extrapolated from the head evaluation surface. By doing a free body diagram ofa bolt, an expression for calculating the bending moment at the start of the thread is derived.The expression states that the bending moment at the thread can be found if the shear forcesand bending moments at the head evaluation as well as the distance between the bolt head andthread start is known. The new evaluation method is implemented in a script. First the distance between the bolthead and start of thread is found by using the head evaluation surface and a node set thatis created automatically when the thread is modeled. Thereafter, the bending moments areextrapolated and the axial equivalent stress is calculated. A finite element model of a boltedjoint is created in Abaqus, and the two different stress evaluation methods ar

Taping is increasingly used to manage proprioceptive deficits, but existing reviews on its impact have shortcomings. To accurately assess the effects of taping, a separate meta-analyses for different population groups and tape types is needed. Therefore, both between- and within-group meta-analyses are needed to evaluate the influence of taping on proprioception. According to PRISMA guidelines, a literature search was conducted across seven databases (Web of Science, PEDro, Pubmed, EBSCO, Scopus, ERIC, SportDiscus, Psychinfo) and one register (CENTRAL) using the keywords “tape” and “proprioception”. Out of 1372 records, 91 studies, involving 2718 individuals, met the inclusion criteria outlined in the systematic review. The meta-analyses revealed a significant between and within-group reduction in repositioning errors with taping compared to no tape (Hedge’s g: -0.39, p < 0.001) and placebo taping (Hedge’s g: -1.20, p < 0.001). Subgroup and sensitivity analyses further confirmed the reliability of the overall between and within-group analyses. The between-group results further demonstrated that both elastic tape and rigid tape had similar efficacy to improve repositioning errors in both healthy and fatigued populations. Additional analyses on the threshold to detection of passive motion and active movement extent discrimination apparatus revealed no significant influence of taping. In conclusion, the findings highlight the potential of taping to enhance joint repositioning accuracy compared to no tape or placebo taping. Further research needs to uncover underlying mechanisms and refine the application of taping for diverse populations with proprioceptive deficits.

Syfte: Syftet med denna studie var att göra en översikt av vilka arbetsterapeutiska interventioner som finns vid fatigue hos barn och ungdomar. Metod: För att svara på syftet valde författarna att basera litteraturöversikten på kvalitativ och kvantitativ forskning. Sökningar gjordes i databaserna PubMed, Scopus, MEDLINE, CINAHL och PsycINFO under perioden januari-februari 2024. Författarna analyserade totalt elva artiklar och tre interventionskategorier skapades utifrån studiens syfte. Resultat: Resultatet innefattar arbetsterapeutiska interventioner för målgruppen utifrån tre kategorier; förbättra färdigheter genom lek och ADL (uppgiftsorienterad kognitiv träning genom lek, lekbaserad arbetsterapi och uppgiftsorienterad träning genom ADL), anpassning av aktivitetsnivå (aktivitetshantering, activity pacing och strukturering av aktiviteter) och psykoedukation (utbildningsinsatser för barn och deras familjer). I flera av interventionerna inkluderades familjen, där föräldrarna utbildades gällande fatigues påverkan på barnet. Interventioner som genomfördes digitalt återfanns i två av artiklarna. Detta gjorde arbetsterapin mer tillgänglig för personer med bristande energi samt där geografiska avstånd och långa väntetider begränsade tillgången till specialiserad vård. Slutsats: Litteraturöversikten visar på att det finns arbetsterapeutiska interventioner kopplat till målgruppen men att forskningen inom detta område är begränsad. Författarna ser behov av fler omfattande RCT-studier för att undersöka effekten av interventionerna samt kvalitativa studier som lyfter arbetsterapeuters erfarenheter av området. Utöver detta ser vi att det finns potential att kunna anpassa befintliga interventionsprogram för vuxna utifrån målgruppen barn och unga med fatigue., Aim: The aim of this literature review was to make an overview of which occupational therapy interventions are available for children and adolescents with fatigue. Method: To reach the aim, the authors chose qualitative and quantitative research as a basis for this literature review. Several searches were made in databases PubMed, Scopus, MEDLINE, CINAHL and PsycINFO during the time period January to February 2024. The authors analysed eleven articles and three intervention categories were created based on the aim of this study. Results: The result contains occupational therapy interventions within three categories; improving skills through play and ADL (task-oriented cognitive rehabilitation through play, play-based occupational therapy and task-oriented training through ADL), adaptation of activity (activity management, activity pacing and structuring of activities) and psychoeducation of children and the families. Several of the rehabilitation interventions included both the child and the family, with focus on how fatigue affects the child and the daily living. Two of the studies were based on digitally delivered interventions making the interventions more available for children and adolescents with limited energy, geographic distance and long waiting lists. Conclusion: This literature review results in several occupational therapy interventions for the target group, but the research in this area is limited. The view of the authors is that several comprehensive RCT-studies are needed to investigate the effectiveness of the interventions, as well as qualitative studies raising the experiences of the occupational therapists working with children and adolescents with fatigue. In addition, there is a potential to adapt current intervention programs made for adults to suit children and adolescents with fatigue.

Bakgrund: Stroke orsakas av en hjärnblödning eller en hjärninfarkt. År 2022 drabbades 25,100 personer i Sverige. Fatigue är ett vanligt förekommande tillstånd efter stroke. Fatigue definieras som en ihållande, extrem trötthet. Syfte: Litteraturstudiens syfte var att beskriva personers upplevelse av att leva med fatigue efter stroke. Metod: Litteratursökning genomfördes i databaserna PubMed och Cinahl. Efter kvalitetsgranskning inkluderades 14 artiklar som analyserades med en kvalitativ analysmetod med manifest ansats. Resultat: Analysen resulterade i fyra huvudkategorier: Att fatigue upplevs visa sig på olika sätt, Att livsstilen förändras och begränsas, Individuella strategier och anpassningar för att hantera fatigue och För acceptans och fungerande strategier krävs kunskap och professionellt stöd. Slutsats:Upplevelsen av fatigue var individuell, vilket medför att det inte finns en behandling som passar allas behov. Det är därför viktigt att få ett personcentrerat bemötande av sjuksköterskor för att hjälpa strokeöverlevaren att identifiera sina behov och mål och tillsammans med vårdens kliniska kunskap hitta sätt som stärker strokeöverlevarens livskvalité och välmående. Mer forskning inom detta område är viktigt för att få djupare förståelse.

SAMMANFATTNING Bakgrund: I Sverige lever knappt 10 000 barn med cancer och 85% av de barn som drabbas botas. Både cancersjukdomen och den onkologiska behandlingen påverkar dessa barn fysiskt, psykiskt och socialt. Hela organsystem kan påverkas negativt och många drabbas av fatigue. Syfte: Syftet var att undersöka resultaten av den senaste forskningen gällande biopsykosociala effekter av fysisk träning för barn som är under pågående onkologisk behandling, eller som nyligen genomgått behandling. Metod: Genom litteratursökningar i databaserna PEDro och PubMed valdes fyra randomiserade kontrollerade studier ut. Väsentliga data från studierna extraherades och sedan bedömdes studierna avseende relevans och kvalitet. Slutligen bedömdes sammantagen preliminär evidens. Resultat: Interventionerna innehöll fysisk träning med inslag av konditionsträning, styrketräning, stretching samt träning av psykologiska funktioner. Interventionstiden varierade mellan åtta veckor och sex månader. Antalet deltagare varierade mellan 68–222. För utfallen fatigue och muskelstyrka i nedre extremitet påvisades en signifikant förbättring. Den preliminära evidensen bedömdes vara låg. Slutsats: Resultatet av denna översikt stärker betydelsen av fysisk träning för populationen. Sättet som träningen administreras på, påverka givna utfall där interaktion med andra deltagare samt träningsledare har en stor inverkan. Således kan man konstatera att fysisk träning är fördelaktigt för populationen och det finns ett värde i att utgå från ett biopsykosocialt perspektiv vid utformning av träning., Background: The prevalence of children with cancer is barely 10 000 in Sweden and 85% are cured. The disease itself, as well as the treatment affects children physically, mentally, and even socially. Organ systems are negatively affected, and fatigue is a common side effect. Objective: The aim was to investigate results of the latest research on the biopsychosocial effects of physical training for children undergoing oncological treatment, or children who recently have received treatment. Method: For this systematic review, four randomized controlled trials were selected through literature searches in the databases PEDro and PubMed. Essential data from the studies were extracted and relevance and quality of each trial were assessed. Finally, the overall preliminary evidence was evaluated. Results: The interventions included physical exercise with elements of aerobic exercises, strength training, stretching and psychological tasks. The intervention duration varied between eight weeks and six months, and the number of participants ranged from 68 to 222. A significant improvement was demonstrated regarding fatigue and muscle strength in the lower extremity. The preliminary evidence was considered low. Conclusions: The effects of physical exercise in this review reinforce the importance of exercise for the population. The administration of physical exercise should be considered, as interactions with other children as well as trainers seemingly have a considerable beneficial impact. Thus, this indicates that physical activity is beneficial for this population and that implementation of a biopsychosocial perspective is favorable in this setting.

Bakgrund: Fler och fler drabbas av cancer och med det drabbas än fler av de biverkningar som följer på cancerbehandlingar. Översikten avser att lyfta fram patientens upplevelser av hur deras fatigue påverkas av att delta i vårdinterventioner som sjuksköterskan leder. Syfte: Syftet var att beskriva patienters erfarenheter av att delta i sjuksköterskeledda interventioner vid cancerrelaterad fatigue. Frågeställningar: 1. Hur upplevdes fatigue hos patienterna efter utförd sjuksköterskeledd intervention? 2. Hur uppfattade patienterna den sjuksköterskeledda interventionen? Metod: En litteraturöversikt utfördes av åtta vetenskapliga originalartiklar. Sökningarna gjordes i databaserna Cinahl Complete och PubMed med dataanalys utförd enligt Friberg. Resultat: Resultatet av översikten visade att patienterna upplevde en minskning av fatigue genom att delta i sjuksköterskeledda interventioner. Interventionerna främjade deras förmåga till egenvård och gav dem insikten att de själva kunde påverka symtom av fatigue i en positiv riktning. Patienterna upplevde också att det stöd och den hjälp de fick från sjuksköterskor i samband med interventionerna ökade viljan och förmågan att klara av att genomföra interventionen. Slutsats: Patienter och sjuksköterskor bör kunna få välja på fler vårdinterventioner som har till uppgift att minska upplevd fatigue. Sjuksköterskornas deltagande vid vårdinterventionen är av stor betydelse för att den ska bli genomförd på ett bra sätt., Background: More and more people are affected by cancer and with that, even more are affected by the side effects that follow cancer treatments. The overview wants to emphasize the patient's experiences of how their fatigue is affected by participating in care interventions led by the nurse. Aim: The aim was to describe patients' experiences of participating in nurse-led interventions for cancer-related fatigue. Questions: 1. How did the patients experience fatigue after undergoing nurse-led intervention? 2. How did patients perceive the nurse-led intervention? Method: A literature review was performed of eight original scientific articles. The searches were made in the databases Cinahl Complete and PubMed with data analysis performed according to Friberg. Results The outcome of the review indicated that patients experienced a reduction in fatigue by participating in nurse-led interventions. These interventions promoted their ability for self-care and gave them the insight that they themselves could positively influence symptoms of fatigue. Patients also felt that the support and assistance they received from nurses during the interventions increased their willingness and ability to carry out the intervention. Conclusions Patients and nurses should be able to choose more care interventions that have the task of reducing perceived fatigue. Nurses' participation is very important for successful implementation of the care interventions.

Taping is increasingly used to manage proprioceptive deficits, but existing reviews on its impact have shortcomings. To accurately assess the effects of taping, a separate meta-analyses for different population groups and tape types is needed. Therefore, both between- and within-group meta-analyses are needed to evaluate the influence of taping on proprioception. According to PRISMA guidelines, a literature search was conducted across seven databases (Web of Science, PEDro, Pubmed, EBSCO, Scopus, ERIC, SportDiscus, Psychinfo) and one register (CENTRAL) using the keywords “tape” and “proprioception”. Out of 1372 records, 91 studies, involving 2718 individuals, met the inclusion criteria outlined in the systematic review. The meta-analyses revealed a significant between and within-group reduction in repositioning errors with taping compared to no tape (Hedge’s g: -0.39, p < 0.001) and placebo taping (Hedge’s g: -1.20, p < 0.001). Subgroup and sensitivity analyses further confirmed the reliability of the overall between and within-group analyses. The between-group results further demonstrated that both elastic tape and rigid tape had similar efficacy to improve repositioning errors in both healthy and fatigued populations. Additional analyses on the threshold to detection of passive motion and active movement extent discrimination apparatus revealed no significant influence of taping. In conclusion, the findings highlight the potential of taping to enhance joint repositioning accuracy compared to no tape or placebo taping. Further research needs to uncover underlying mechanisms and refine the application of taping for diverse populations with proprioceptive deficits.

Background Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacologicaltreatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is stillunclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-toheadtrial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadinevs. placebo in patients with advanced cancer. Methods The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will usea parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidatevs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0–10 scale. The study periodincludes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcomeis the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illnesstherapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, whichwill be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for AdverseEvents in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learningalgorithm will be employed for the clinical prediction of different agents in homogeneous subgroups. Discussion The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatmentapproach, design of future trials, as well as the development of CRF management guidelines. Trial registration IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.

Purpose: This narrative umbrella review evaluates the efficacy of recovery strategies for elite winter sports athletes by comparing their scientific and clinical validity. It aims to provide evidence-based recommendations for coaches and athletes, preparing them for the Milano-Cortina 2026 Olympic Games through a critical evaluation of various post-training and competition recovery methods. Methods: This narrative umbrella review involved a systematic literature search on PubMed, focusing on recent meta-analyses and review articles related to recovery strategies. Special emphasis was placed on their practical applications to ensure the findings are relevant to real-world settings. Results: The study examined multiple recovery strategies, including sleep, nutrition, and physical methods, revealing a general scarcity of high-quality studies and insufficient control over placebo effects. A key finding emphasizes the crucial roles of nutrition and sleep in the recovery process, highlighting the need for personalized recovery plans tailored to the athlete's and sport's specific demands. The effectiveness of physical recovery methods varied, with some demonstrating significant benefits in specific contexts (e.g., massage and cold-water immersion to alleviate muscle pain and fatigue), whereas others (e.g., stretching and sauna) lacked robust evidence of their efficacy as recovery methods. Conclusion: This paper presents recommendations for optimizing recovery strategies in elite winter sports, focusing on the specific demands of the Milano-Cortina 2026 Olympic Games. It provides a framework for athletes and coaches aiming to enhance performance recovery and achieve optimal athletic condition.

BACKGROUND: The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions. OBJECTIVES: The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being. DESIGN: A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences. METHODS: Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study. RESULTS: The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes. CONCLUSION: The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.

Background Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacologicaltreatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is stillunclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-toheadtrial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadinevs. placebo in patients with advanced cancer. Methods The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will usea parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidatevs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0–10 scale. The study periodincludes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcomeis the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illnesstherapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, whichwill be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for AdverseEvents in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learningalgorithm will be employed for the clinical prediction of different agents in homogeneous subgroups. Discussion The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatmentapproach, design of future trials, as well as the development of CRF management guidelines. Trial registration IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.

Bus driver sleepiness is commonplace but often goes unreported within the industry. Whilst past research has begun to shed a light on the prevalence, potential causes, and consequences of bus driver sleepiness, this is often done using self-report methods. This is the first study to investigate sleepiness amongst city bus drivers on-road using a live bus route with drivers’ regular schedules. A total of 16 participants completed two drives of their regular bus route once during an early morning shift and once during a daytime shift whilst physiological and self-report measures of sleep and stress were taken. Prior to these drives, drivers recorded their sleep in a diary and wore an actigraph to obtain objective sleep measures. Results showed that most drivers did not obtain sufficient sleep prior to early morning shifts, and often did not obtain as much sleep as they would need in order to feel rested before work. Sleepiness and stress were observed in both shifts. During early morning shifts sleepiness was likely a result of working during circadian lows and not obtaining enough sleep prior to the shift. In contrast, sleepiness during the daytime shift was likely a result of completing a highly demanding task in complex traffic which not only contributed to fatigue, but also led to increased levels of stress. As well as demonstrating the prevalence of sleepiness amongst bus drivers, these findings show that the causes of sleepiness can be multifaceted and often come about due to a combination of work and personal factors. In addition, the experience of sleepiness is not the same for all drivers, with individual differences in the experience of sleepiness playing a large role. These differences highlight the need for individualised interventions which should be considered by policymakers alongside the combination of causal factors within a larger systems approach., Research funding provided by Transport for London [grant number 94050]. Please note that the affiliation for Anna Anund has been mistakenly listed in the article. The correct affiliation should be Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden.

It is not a simple task to assess the fatigue capacity of steel bridges in order to prolong their lifespan. The traffic load history for existing structures is rarely known in detail, constraints within the static system can often be difficult to estimate as well as the choice of the fatigue detail category. Too conservative assumptions may result in replacement of existing bridges, since minor overestimations of stresses have significant effects on the lifespan of the structure, due to the log-log relationship of the well-established S-N curves. One way of reducing uncertainties, related to loads and load-effects as well as to the dynamic effects, is to perform measurements on existing structures exposed to live loads. This paper presents the fatigue evaluation of derived fatigue stress-cycles based on rainflow counting (RFC) on measured data from two different, but identically built, steel bridges in Sweden. The Rautasjokk Bridge located along the Iron Ore line (Malmbanan) were found to be exposed to more and higher stress cycles compared to the Åby Bridge, located along the Main line (Stambanan). For the Rautasjokk Bridge, the trains loaded with iron ore were responsible for about 80% of the fatigue damage on the stringer beams. Presented in this paper is also a comparison of theoretical methods for fatigue assessment, prescribed in the Swedish bridge assessment code. Furthermore, suggestions for improvement of theoretical assessment methods are also presented., Full text license: CC BY

Presented test results on transverse cracking in cross-ply laminates upon tension–tension cyclic loading show that the increase of crack density depends not only on the maximum transverse stress in the cycle but also on the local cyclic stress ratio RTloc in the analyzed layer. To include the effect of the RTloc in the model with statistical failure stress distribution for crack initiation (based on Weibull distribution) adapted for fatigue, an equivalent stress is introduced in a similar manner as the equivalent strain energy release rate has been used for delamination crack propagation. The equivalent stress in the layer is defined as a power function of the maximum stress and the stress ratio in the layer. It was found, testing laminates with two different fiber contents that higher the local stress ratio in 90-layer, higher the transverse cracking resistance. Transverse crack density simulation using the developed equivalent stress model has been validated against test results., Validerad;2024;Nivå 2;2024-07-31 (signyg);Funder: Swedish Aeronautical Research Program NFFP 7 (2019-02777); Swedish Aeronautical Research Program NFFP 8 (2023-01199); GKN Aerospace, Sweden;Full text license: CC BY

Taping is increasingly used to manage proprioceptive deficits, but existing reviews on its impact have shortcomings. To accurately assess the effects of taping, a separate meta-analyses for different population groups and tape types is needed. Therefore, both between- and within-group meta-analyses are needed to evaluate the influence of taping on proprioception. According to PRISMA guidelines, a literature search was conducted across seven databases (Web of Science, PEDro, Pubmed, EBSCO, Scopus, ERIC, SportDiscus, Psychinfo) and one register (CENTRAL) using the keywords “tape” and “proprioception”. Out of 1372 records, 91 studies, involving 2718 individuals, met the inclusion criteria outlined in the systematic review. The meta-analyses revealed a significant between and within-group reduction in repositioning errors with taping compared to no tape (Hedge’s g: -0.39, p < 0.001) and placebo taping (Hedge’s g: -1.20, p < 0.001). Subgroup and sensitivity analyses further confirmed the reliability of the overall between and within-group analyses. The between-group results further demonstrated that both elastic tape and rigid tape had similar efficacy to improve repositioning errors in both healthy and fatigued populations. Additional analyses on the threshold to detection of passive motion and active movement extent discrimination apparatus revealed no significant influence of taping. In conclusion, the findings highlight the potential of taping to enhance joint repositioning accuracy compared to no tape or placebo taping. Further research needs to uncover underlying mechanisms and refine the application of taping for diverse populations with proprioceptive deficits.

This manuscript introduces a perturbation-free extremum-seeking control strategy specifically designed to enhance the operational performance of wind turbines under optimal conditions. The strategy employed utilizes a perturbation-free extremum-seeking approach to ensure the wind turbine farm operates at maximum power efficiency while also reducing power output fluctuations. By employing this control system, the wind turbine generators are maintained at their optimal power output level, effectively navigating through disturbances such as tower shadow, wind shear, and the erratic nature of wind speeds without introducing external perturbations. The algorithm is adept at managing the blade pitch angles and the turbines’ rotational speed, ensuring a controlled and efficient operation. Furthermore, this paper outlines a perturbation-free method to optimize energy production and decrease fatigue loads, thereby extending the operational lifespan of a wind turbine. The superior operational efficiency of the wind turbine array generators achieved through this approach underscores its effectiveness. The robustness and effectiveness of this perturbation-free control system are validated through comprehensive simulation tests on an array comprising four wind turbine generators. The outcomes of these simulations solidly back the extremum-seeking control system's proficiency in reaching maximum power output without relying on perturbative methods, highlighting its innovative contribution to wind turbine efficiency optimization., Validerad;2024;Nivå 1;2024-06-28 (joosat);Full text license: CC BY-NC-ND

Background: Previous phase 3 studies showed that the AS01E-adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine for older adults (RSVPreF3 OA) is well tolerated and efficacious in preventing RSV-associated lower respiratory tract disease in adults ≥ 60 years of age. This study evaluated lot-to-lot immunogenicity consistency, reactogenicity, and safety of three RSVPreF3 OA lots. Methods: This phase 3, multicenter, double-blind study randomized (1:1:1) participants ≥ 60 years of age to receive one of three RSVPreF3 OA lots. Serum RSVPreF3-binding immunoglobulin G (IgG) concentration was assessed at baseline and 30 days post-vaccination. Lot-to-lot consistency was demonstrated if the two-sided 95 % confidence intervals (CIs) of the RSVPreF3-binding IgG geometric mean concentration (GMC) ratios between each lot pair at 30 days post-vaccination were within 0.67 and 1.50. Solicited adverse events (AEs) within four days, unsolicited AEs within 30 days, and serious AEs (SAEs) and potential immune-mediated diseases within six months post-vaccination were recorded. Results: A total of 757 participants received RSVPreF3 OA, of whom 708 were included in the per-protocol set (234, 237, and 237 participants for each lot). Lot-to-lot consistency was demonstrated: GMC ratios were 1.06 (95 % CI: 0.94–1.21), 0.92 (0.81–1.04), and 0.87 (0.77–0.99) between the lot pairs (lot 1/2; 1/3; 2/3). For the three lots, the RSVPreF3-binding IgG concentration increased 11.84-, 11.29-, and 12.46-fold post-vaccination compared to baseline. The reporting rates of solicited and unsolicited AEs, SAEs, and potential immune-mediated diseases were balanced between lots. Twenty-one participants reported SAEs; one of these–a case of atrial fibrillation–was considered by the investigator as vaccine-related. SAEs with a fatal outcome were reported for four participants, none of which were considered by the investigator as vaccine-related. Conclusion: This study demonstrated lot-to-l

In this study, we investigate the relation between microstructure and fatigue crack propagation mechanisms in three commercial hot-rolled thick-plate advanced high-strength steels (AHSSs), namely 800CP, 700MC, and 700MCPlus, and compare them with a conventional high-strength low-alloy (HSLA) steel, 500MC, commonly used in heavy-duty vehicle chassis production. Tensile testing, and fatigue crack growth rate (FCGR) assessments have been conducted, and mechanisms controlling the performance of these steels are comprehensively examined through microstructure characterization before and after fatigue testing. Notably, FCGR results reveal that, despite having the highest yield strength among the investigated steels, 700MCPlus exhibits the slowest FCGR in both near-threshold and stable crack growth regimes. This improved fatigue crack propagation resistance of 700MCPlus in terms of its threshold stress intensity factor range (Delta Kth) is attributed to its unique texture, which restricts slip activity, and the presence of martensite at grain boundaries, contributing to fatigue crack deflection. This martensite-induced crack deflection becomes more significant in the stable crack growth regime, where fatigue crack primarily propagates intergranularly as the stress intensity factor range (Delta K) increases. These mechanistic findings offer new design possibilities for AHSSs, combining excellent strength and fatigue performance., QC 20240903

Plate thickness influences the fatigue performance of welded components. In fatigue design standards and recommendations, the thickness effect and fatigue strength reduction have been considered by modifying the S–N curve for plates thicker than a reference thickness. However, increasing fatigue strength due to the thinness effect is often disregarded. The current study focuses on the size effect in fatigue of butt welded and non-load carrying cruciform welded joints under constant amplitude tension load. Literature data is evaluated using the effective notch stress method with a reference radius of 1 mm, which is used for all finite element models to ensure that FAT-value corresponding to a 1 mm notch radius remains constant across all models. A probabilistic assessment of the results using the weakest-link theory is applied to improve the prediction accuracy of thinner members outside the recommended thickness range of the used radius. The method reduces the S–N data scatter in comparison to the variation of test data and shows applicability also for thinner members. A comparison of the size effect for the current method with extrapolated values from standards and recommendations shows a difference in the size effect for thinner members., QC 20240823

China initiative Accelerator Driven System (CiADS) is a 10 MW lead–bismuth eutectic (LBE) cooled subcritical reactor, which is designed to demonstrate the engineering feasibility of the ADS concept. An elaborated methodology was developed to deal with the nonlinear mechanical behaviors of fuels under transients. Based on this methodology, the fuel mechanical module was accomplished and coupled with the neutron dynamics module and thermo-hydraulics module in the extended BELLA code. The cladding mechanical simulation under frequent beam trips for CiADS was carried out using BELLA, and fatigue analysis based on the experimental data was discussed. Combined with the CiADS beam-trip transients, it is concluded that the tolerance of the CiADS cladding to beam trips is between 1000 and 11,000 cycles., QC 20240624

A probabilistic framework is developed utilizing a two-scale modeling approach to efficiently consider the material variability that is typical for composite materials. The modeling integrates a macro-scale model with effective elastic properties extracted from micro-mechanical simulations. Using a weakest link modeling approach for fatigue assessment the combined effects of defects on fatigue strength in a Carbon Fiber Reinforced Polymer (CFRP) material can be investigated. A full fatigue test program is presented and is used to calibrate the probabilistic fatigue model. By including material variability in the numerical model, the calibrated probabilistic model improves the fatigue life prediction., QC 20240626

It is not a simple task to assess the fatigue capacity of steel bridges in order to prolong their lifespan. The traffic load history for existing structures is rarely known in detail, constraints within the static system can often be difficult to estimate as well as the choice of the fatigue detail category. Too conservative assumptions may result in replacement of existing bridges, since minor overestimations of stresses have significant effects on the lifespan of the structure, due to the log-log relationship of the well-established S-N curves. One way of reducing uncertainties, related to loads and load-effects as well as to the dynamic effects, is to perform measurements on existing structures exposed to live loads. This paper presents the fatigue evaluation of derived fatigue stress-cycles based on rainflow counting (RFC) on measured data from two different, but identically built, steel bridges in Sweden. The Rautasjokk Bridge located along the Iron Ore line (Malmbanan) were found to be exposed to more and higher stress cycles compared to the Åby Bridge, located along the Main line (Stambanan). For the Rautasjokk Bridge, the trains loaded with iron ore were responsible for about 80% of the fatigue damage on the stringer beams. Presented in this paper is also a comparison of theoretical methods for fatigue assessment, prescribed in the Swedish bridge assessment code. Furthermore, suggestions for improvement of theoretical assessment methods are also presented., Full text license: CC BY

Purpose: The aim was to investigate the associations between cognitive impairment and biopsychosocial factors among older stroke survivors and predictors of poststroke return to daily life. Materials and methods: This cross-sectional study involved 117 stroke survivors (61% men) with an average age of 77 years (range 65–91). The participants completed two questionnaires (Riksstroke and Short Form 36 questionnaires). The Montreal Cognitive Assessment (MoCA) was used to assess cognitive abilities. The International Classification of Functioning, Disability, and Health (ICF) framework guided the selection of biopsychosocial variables. We used Spearman’s correlation coefficient and multiple logistic regression in the analyses. Results: The average MoCA score was 21.7 points (range: 4–30, SD 5.6). The need for assistance from relatives and professionals, need for help with dressing and household chores, reliance on others for mobility, and reading and balance problems were correlated with more severe cognitive impairment (r = 0.20–0.33). Cognitive impairment, fatigue, and balance issues predicted an unfavorable return to daily life (odds ratio: 6.2–6.8). Conclusion: The study indicated that cognitive impairment is associated with difficulties in all ICF domains. Cognitive impairment, fatigue, and balance issues are associated with an unsuccessful return to daily life. Prioritizing these factors and screening for cognitive impairment with objective assessment tools may improve rehabilitation outcomes and enhance overall quality of life poststroke.