Beyond the symptom: the biology of fatigue.

A workshop titled "Beyond the Symptom: The Biology of Fatigue" was held virtually September 27-28, 2021. It was jointly organized by the Sleep Research Society and the Neurobiology of Fatigue Working Group of the NIH Blueprint Neuroscience Research Program. For access to the presentations and video recordings, see: https://neuroscienceblueprint.nih.gov/about/event/beyond-symptom-biology-fatigue. The goals of this workshop were to bring together clinicians and scientists who use a variety of research approaches to understand fatigue in multiple conditions and to identify key gaps in our understanding of the biology of fatigue. This workshop summary distills key issues discussed in this workshop and provides a list of promising directions for future research on this topic. We do not attempt to provide a comprehensive review of the state of our understanding of fatigue, nor to provide a comprehensive reprise of the many excellent presentations. Rather, our goal is to highlight key advances and to focus on questions and future approaches to answering them.

A method to reduce heat strain while clad in encapsulating outerwear.

The use of personal protective equipment (PPE) increases the risk of heat related maladies. A means to enhance heat dissipation capacity of individuals clad in PPE would be of benefit. The glabrous skin regions of the hands, face, and feet are portals for direct heat transfer between the body core and the external environment. The effects of PPE outerwear and palmar glabrous skin cooling on heat storage were assessed. Subjects engaged in fixed load treadmill exercise in a thermoneutral environment (Ta = 20-24°C) or rested in a hot environment (45 ± 0.5°C). The use of PPE outerwear increased the rate of core temperature rise by five-fold during vigorous exercise. Palm cooling using a stationary water circulation system attenuated the rate of core temperature rise by 30-60% during rest and light, moderate, and vigorous exercise while wearing PPE outerwear. However, the subjects were tethered to the system. A wearable cooling system was devised that allowed free range of motion and unrestricted mobility. The wearable system provided thermal benefits equivalent to the use of the tethering cooling system. With optimization, this wearable cooling technique could neutralize the negative thermoregulatory effects of wearing PPE while engaged in light workload activities such as those encountered by healthcare professionals working in infectious disease treatment centers. For individuals working at higher workloads, such as firefighters, a wearable glabrous skin-based cooling system could extend work bout duration as well as enhance heat loss during episodic recovery periods.