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Oral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described.
At Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy — General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests.
At baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. −19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue.
Significance of results
One in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.
In the scope of this work, a micromechanical model based on the crystal plasticity finite element method is proposed and applied to describe the nucleation and growth of microstructurally short fatigue cracks in polycrystalline materials under cyclic loads. The microstructure is generated in the form of a representative volume element of a polycrystalline material with equiaxed grains having columnar structure along thickness and random crystallographic texture. With this model, we investigate the influence of loading amplitude on the crack growth behavior. It is shown that for smaller strain amplitudes, a single crack nucleates and propagates, while for larger strain amplitudes several independent crack nucleation sites form, from which microcracks start propagating. It is also observed that the global plastic strain amplitude decreases from the initial to the final cycle, during total strain-controlled loading. However, this can even increase the crack growth rate because the crack advance is governed by the local plastic slip which accumulates at the crack tip over the number of cycles. With this work, it is shown that micromechanical modeling can strongly improve our understanding of the mechanisms of short-crack nucleation and growth under fatigue loading.
Fatigue of superelastic Nitinol in the mixed austenite–martensite state was examined in tension using center-tapered dog-bone specimens. A prestraining procedure, mimicking the load history of a medical device component, was applied prior to cycling: specimens were loaded to a fully martensitic state, unloaded partway into the lower plateau to a mixed-phase state, and then subjected to sinusoidal displacement cycles. Strain maps, obtained using digital image correlation, showed substantial variation in local mean and alternating strains across the gage section. In situ surface imaging using a high-speed camera confirmed crack initiation in a narrow transition zone between austenite and martensite that undergoes cyclic stress-induced martensitic transformation (SIMT). Fatigue life data showed an abrupt transition from high-cycle runouts to low-cycle fatigue failures at a stress amplitude level corresponding to the threshold for activating cyclic SIMT. The fatigue threshold can be estimated from the tensile loading–unloading curve.
To examine associations between IgA responses to Gram-negative gut-commensal bacteria and peri-menstrual symptoms and sex hormone levels during the menstrual cycle in women with and without premenstrual symptoms.
Forty women aged 18-45 years completed the Daily Record of Severity of Problems (DRSP) during all 28 consecutive days of the menstrual cycle. We assayed, in plasma, IgA responses to 6 Gram-negative bacteria, i.e. Hafnei alvei, Pseudomonas aeruginosa, Morganella morganii, Klebsiella pneumoniae, Pseudomonas putida and Citrobacter pylori, progesterone and oestradiol at days 7, 14, 21 and 28 of the menstrual cycle.
Significant changes in Δ (actual minus one week earlier) IgA to LPS of the 6 Gram-negative bacteria during the menstrual cycle were observed with peak IgA levels at T4 (day 28) and lows at T1 or T2 (day 7 or 14). The Δ IgA changes in H. alvei, M. Morganii, P. putida during the menstrual cycle were significantly and positively associated with changes in the total DRSP score, and severity of physio-somatic, anxiety and breast-craving, but not depressive, symptoms. The changes in IgA responses to LPS were largely predicted by changes in progesterone and steady-state levels of progesterone averaged over the luteal phase.
Menstrual cycle-associated changes in IgA directed against LPS and by inference bacterial translocation may be driven by effects of progesterone on transcellular, paracellular and vascular pathways (leaky gut) thereby contributing to the severity of physio-somatic and anxiety symptoms as well as fatigue, breast swelling and food cravings.
Sintered nanoparticle structures are macroscopically brittle but quite robust if deposited on a flexible substrate. The effects of a polymer substrate on the stretchability of both brittle and ductile coatings and traces are well established. Systematic effects of substrate properties on the fatigue resistance of aerosol printed nano-Ag are slightly more complex. The present work is focused on the early stages of fatigue, where the resistance increases significantly but cracks are not yet visible. Overall, the fatigue behavior is seen to vary with the combination of substrate modulus and viscoelastic deformation properties. Comparing two common polyimides, the rate of damage was seen to increase faster with increasing amplitude on the less compliant one. Consistently with this increasing the minimum strain in the cycle led to a significantly stronger reduction in damage rates. However, the damage rate remained lower on the less compliant substrate at all amplitudes and strain ranges of practical concern.
Fatigue properties of Mo/W multilayers with individual layer thickness (λ) of 5, 20, 50 and 100 nm on flexible polyimide substrates were investigated. The experimental results show that the fatigue resistance increases with decreasing λ from 100 nm to 20 nm, and reaches the maximum at λ=20 nm, and then decreases when further decreasing λ. Fatigue cracks of Mo/W multilayers with different λ were found to propagate along columnar grain boundary in the out-of-plane direction and along the boundary of cluster structures. The enhanced fatigue resistance is attributed to the larger cluster inclination angles and the more tortuous in-plane cracking paths.
The field of in situ nanomechanics is greatly benefiting from microelectromechanical systems (MEMS) technology and integrated microscale testing machines that can measure a wide range of mechanical properties at nanometer scales, while characterizing the damage or microstructure evolution in electron microscopes. This article focuses on the latest advances in MEMS-based nanomechanical testing techniques that go beyond stress and strain measurements under typical monotonic loadings. Specifically, recent advances in MEMS testing machines now enable probing key mechanical properties of nanomaterials related to fracture, fatigue, and wear. Tensile properties can be measured without instabilities or at high strain rates, and signature parameters such as activation volume can be obtained. Opportunities for environmental in situ nanomechanics enabled by MEMS technology are also discussed.
We aimed to examine the association between pain, stiffness and fatigue in newly diagnosed polymyalgia rheumatica (PMR) patients using baseline data from a prospective cohort study. Fatigue is a known, but often ignored symptom of PMR. Newly diagnosed PMR patients were recruited from general practice and mailed a baseline questionnaire. This included a numerical rating scale for pain and stiffness severity, manikins identifying locations of pain and stiffness and the FACIT-Fatigue questionnaire. A total of 652 PMR patients responded (88.5%). The mean age of responders was 72.6 years (SD 9.0) and the majority were female (62.0%). Manikin data demonstrated that bilateral shoulder and hip pain and stiffness were common. The mean fatigue score (FACIT) was 33.9 (SD 12.4). Adjusted regression analysis demonstrated that a higher number of pain sites (23–44 sites) and higher pain and stiffness severity were associated with greater levels of fatigue. In newly diagnosed PMR patients, fatigue was associated with PMR symptom severity.
Linear elastic moduli of solids with similar chemical compositions usually vary fairly insignificantly. However, for a broad class of apparently similar materials, their higher-order (nonlinear) moduli may differ by many times or even by orders of magnitude. Besides their large magnitude, nonlinear effects often demonstrate qualitative/functional features inconsistent with predictions of the classical theory of nonlinear elasticity based on consideration of weak lattice (atomic) nonlinearity. The latter is mostly applicable to ideal crystals and flawless amorphous solids, whereas the presence of structural heterogeneities can drastically modify the acoustic nonlinearity of materials without appreciable variation in the linear elastic properties. Despite often rather nontrivial/nonstraightforward relationships between microstructural features of the material and the resultant “nonclassical” acoustic nonlinearity, the extremely high structural sensitivity makes utilization of nonlinear acoustic effects attractive for a broad range of diagnostic applications that have been emerging in recent years in various areas—from seismic sounding and nondestructive testing to materials characterization down to the nanoscale.
Fatigue performance of metallic nanolayered composites (NLCs) has been gaining more and more attention due to the rapid development in the field of both micro-electro-mechanical systems and high-performance engineering structure materials and the increasing demand for long-term fatigue reliability. Metallic NLCs have exhibited different damage behaviors due to the effect of high-density heterogeneous interface compared with bulk materials and thin metal films. In this review paper, the cyclic deformation damage behavior, fatigue cracking feature, and fatigue properties of some metallic NLCs are reviewed. Effects of length scales, including layer thickness and grain size, on fatigue damage behaviors of the NLCs are revealed, and the transition of the fatigue cracking behavior and the corresponding damage mechanism are discussed. Then, the fatigue properties of some typical metallic NLCs are presented and compared with that of bulk materials and metal thin films. The effect of interface type and grain boundary alignment is also discussed to correlate with fatigue cracking resistance of the NLCs. Finally, some prospective research topics on fatigue performance of metallic NLCs are addressed.
Design approaches and achievements for the development of wrought TiAl alloys to be used for LPT and HPC blades are constructed. In case of Ti-Al-M1-M2 quaternary systems, conventional equivalency concept does not work for the alloy design, and a new thermodynamic database for phase diagram calculations in multi-component systems of the alloys is built by introducing the interaction parameters among four phases of β−Ti, α2−Ti3Al, α−Ti and γ−TiAl phases in the systems, in order to reproduce the experimentally determined phase diagrams. Based on the phase diagram calculations, the composition range of a unique phase transformation pathway of β+α→α→β+γ in the multi-component system can be identified, and thus model alloys with excellent hot workability even at higher strain rate and mechanical properties can be successfully proposed. It can be concluded that an introduction of bcc β phase and the morphology control through the phase transformation pathway make it possible to improve the room temperature ductility, creep and fatigue crack propagation resistance.
To evaluate the use of exercise in managing fatigue in breast cancer patients undergoing adjuvant radiotherapy. To explore the effectiveness of different exercise practices and explore how optimum management of fatigue might be achieved.
A CINAHL (Cumulative Index to Nursing and Allied Health Literature) database search of literature was undertaken and publications screened for retrieval with 24 qualifying for inclusion in the review.
There is evidence to support various forms of exercise including aerobic, resistance, alternative and combination exercise in the management of fatigue in early stage breast cancer patients undergoing adjuvant radiotherapy. The benefits of exercise for patients with later stage and metastatic disease is less clear and there is a lack of published research related to this category of patient.
Exercise is considered a safe, non-pharmacological intervention for early stage breast cancer patients receiving adjuvant radiotherapy. Further investigation is required into optimum exercise interventions and the effectiveness and viability of supervised and unsupervised models. Patient centred tailored advice and guidance needs to be developed and effectively promoted by therapeutic radiographers in order for patients to fully realise the benefit.
Fatigue behaviour of titanium reinforced with TiB particles fabricated by ‘plasma transferred arc solid freeform fabrication’ (PTA-SFFF) technique was investigated. Rotation bending fatigue tests were conducted following the MPIF 56 standard using the staircase method approach. Experimental data is used to calculate the fatigue strength and construct S-N curves, where the results were compared to a powder metallurgy FC0205 as a benchmark material. The titanium samples were found to exhibit superior fatigue behaviour in comparison to the reference FC0205 material, performing well above 1/3 of its ultimate tensile strength with a 90% survival fatigue strength of 244 +/- 98.3 MPa versus 141 +/- 17.4 MPa. Fatigue failure mechanisms of samples were identified by examination of the fracture surfaces through scanning electron microscopy (SEM) as well as using transmission-electron microscopy (TEM) and focused ion beam (FIB) analysis techniques. Fatigue crack propagation was either arrested or deflected when propagation occurred within the vicinity of the TiB intermetallics. Fracture surfaces of the titanium matrix displayed evidence of striations while the TiB intermetallic experience cleavage fracture.
The grain boundary network of nanocrystalline Cu foils was modified by the application of cyclic loadings and elevated temperatures. Broadly, the changes to the boundary network were directly correlated with the applied temperature and accumulated strain, including a 300% increase in the twin length fraction. By independently varying each treatment variable, a matrix of grain boundary statistics was built to check the plausibility of hypothesized mechanisms against their expected temperature and stress/strain dependences. These comparisons allow the field of candidate mechanisms to be significantly narrowed. Most importantly, the effects of temperature and strain on twin length fraction were found to be strongly synergistic, with the combined effect being ∼150% that of the summed individual contributions. Looking beyond scalar metrics, an analysis of the grain boundary network showed that twin related domain formation favored larger sizes and repeated twin variant selection over the creation of many small domains with diverse variants.
Nacre-mimetic (PE/TiO2)4 nanolayered composites (NLCs) with the nanocrystalline TiO2 layer thickness less than 30 nm and different thickness ratios of inorganic/organic layers were successfully prepared by using layer-by-layer self-assembly and chemical bath deposition method. Mechanical properties, especially fatigue properties of the NLCs with different thickness ratios were evaluated. The elastic modulus, hardness and fracture toughness, strain amplitude to fatigue limits of the NLCs reached 27.78 ± 5.69 GPa, 1.33 ± 0.31 GPa, and 4.16 ± 0.20 MPa m1/2, respectively. Fatigue performance of the NLCs in the high and low cycle fatigue regimes was optimized by tailoring the thickness ratio of the TiO2/PE layers. The PE/TiO2 NLCs with the larger thickness ratio of ∼3 has the high fatigue limit (the critical strain amplitude of 0.0853%) in the high-cycle fatigue regime, while that with the smaller thickness ratio of ∼1 and ∼0.5 are of the good fatigue strength in the low-cycle fatigue regime. The basic mechanism for the enhanced fatigue performance is elucidated.
A majority of patients with Guillain-Barré syndrome (GBS) have tendency of a good recovery. Our aim was to evaluate the outcome of the disease 1 and 3 years after GBS symptom onset. Methods: During 2014, GBS was diagnosed in 82 patients in seven tertiary healthcare centers. Neurological follow-up was conducted in 57 (70%) patients after 1 year, and in 54 (66%) after 3 years. Functional disability was estimated according to the GBS disability scale (GDS), with a score of 0-3 indicating mild disability and a score of 4-6 indicating severe disability during acute phase, whereas a score >1 indicated poor recovery on follow-ups. Visual analog scale was used to assess sensory symptoms and musculoskelatal pain, and Krupp’s Fatigue Severity Scale was used to asses fatigue. Results: Poor functional outcome was found in 39% of GBS patients at year 1 and 30% at year 3. Paresthesias/dysesthesias were detected in 60% of patients after 1 year and 43% after 3 years. Musculoskeletal pain was present in 40% of patients at year 1 and 33% at year 3. Significant fatigue after 1 year was found in 21% of subjects and after 3 years in 7%. Parameters associated with poor functional outcome after 1 year were age >55 years (p=0.05), severe disability at admission (p<0.05), and on discharge (p<0.01). Poor functional outcome after 3 years was associated with male gender (p<0.05) and severe disability on discharge (p=0.06). Conclusion: One and even three years after GBS onset, a substantial number of patients had neurological sequelae, including functional disability, sensory symptoms, pain, and fatigue.
This article overviews the current status of magnetocaloric materials for room-temperature refrigeration. We discuss the underlying mechanism of the magnetocaloric effect and illustrate differences between first- and second-order type materials starting with gadolinium as a reference system. Beyond the key functional properties of magnetocaloric materials, the adiabatic temperature, and entropy change, we briefly address the criticality of the most promising materials in terms of their supply risk. Looking at practical applications, suitable geometries and processing routes for magnetocaloric heat exchangers for device implementation are introduced.
Pseudoelastic NiTi-based shape-memory alloys (SMAs) have recently received attention as candidate materials for solid-state refrigeration. The elastocaloric effect in SMAs exploits stress-induced martensitic transformation, which is associated with large latent heat. Most importantly, cyclic mechanical loading/unloading provides large adiabatic temperature drops exceeding 25 K at high process efficiencies. This article summarizes the underlying principles, important material parameters and process requirements, and reviews recent progress in the development of pseudoelastic SMAs with large coefficients of performance, as well as very good functional fatigue resistance. The application potential of SMA film and bulk materials is demonstrated for the case of cyclic tensile loading/unloading in prototypes ranging from miniature-scale devices to large-scale cooling units.
Elastocaloric materials exhibit extraordinary cooling potential, but the repetition of cyclic mechanical loadings during long-term operation of cooling systems requires the refrigerant material to have long fatigue life. This article reviews the fundamental cause of fatigue from aspects of initiation and propagation of fatigue cracks in shape-memory alloys (SMAs) that are used as elastocaloric materials, and highlights recent advances in using compression to overcome fatigue by curtailing the generation of surfaces associated with crack propagation. Compression is identified as a key means to extend fatigue lifetime in engineering design of elastocaloric cooling drive mechanisms. We summarize the state-of-the-art performance of different SMAs as elastocaloric materials and discuss the influence of low cyclic strains and high resistance to transformation. We present integration of compression-based material assemblies into a cooling system prototype and optimization of the system efficiency using work recovery and related measures.
Nitrate (NO3−) is an ergogenic nutritional supplement that is widely used to improve physical performance. However, the effectiveness of NO3− supplementation has not been systematically investigated in individuals with different physical fitness levels. The present study analysed whether different fitness levels (non-athletes v. athletes or classification of performance levels), duration of the test used to measure performance (short v. long duration) and the test protocol (time trials v. open-ended tests v. graded-exercise tests) influence the effects of NO3− supplementation on performance. This systematic review and meta-analysis was conducted and reported according to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search of electronic databases, including PubMed, Web of Science, SPORTDiscus and ProQuest, was performed in August 2017. On the basis of the search and inclusion criteria, fifty-four and fifty-three placebo-controlled studies evaluating the effects of NO3− supplementation on performance in humans were included in the systematic review and meta-analysis, respectively. NO3− supplementation was ergogenic in non-athletes (mean effect size (ES) 0·25; 95 % CI 0·11, 0·38), particularly in evaluations of performance using long-duration open-ended tests (ES 0·47; 95 % CI 0·23, 0·71). In contrast, NO3− supplementation did not enhance the performance of athletes (ES 0·04; 95 % CI −0·05, 0·15). After objectively classifying the participants into different performance levels, the frequency of trials showing ergogenic effects in individuals classified at lower levels was higher than that in individuals classified at higher levels. Thus, the present study indicates that dietary NO3− supplementation improves physical performance in non-athletes, particularly during long-duration open-ended tests.