human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Complaints of fatigue are frequent in patients with obstructive sleep apnea ( OSA ) ; however , the impact of continuous positive airway pressure ( CPAP ) on fatigue remains unclear . METHODS Fifty-nine men and women with OSA were r and omly assigned to therapeutic or placebo CPAP in a double-blind fashion for a 3-week intervention period . Four outcome measures were assessed : ( 1 ) fatigue/vigor measured with the Multidimensional Fatigue Symptom Inventory -- Short Form ( MFSI-sf ) , the ( 2 ) fatigue and ( 3 ) vigor subscales of the Profile of Mood States -- Short Form ( POMS ) , and ( 4 ) the Epworth Sleepiness Scale ( ESS ) . Data were analyzed using repeated- measures analysis of variance . RESULTS Compared with patients receiving placebo CPAP , those patients treated with therapeutic CPAP showed significant reductions in the apnea-hypopnea index , as well as decreases in both measures of fatigue and increases in vigor ( P values < 0.05 ) . The beneficial effect of therapeutic treatment was most pronounced in patients with high levels of fatigue at study onset . Significant treatment effects in sleepiness scores were not observed in the entire sample ( P > 0.05 ) ; however , in a subset of patients with excessive sleepiness at the onset of treatment , ESS scores were significantly reduced with use of therapeutic CPAP ( P < 0.05 ) . CONCLUSIONS Results suggest that 3 weeks of therapeutic CPAP significantly reduced fatigue and increased energy in patients with OSA . Therapeutic CPAP significantly reduced daytime sleepiness in patients who reported excessive sleepiness at the onset of treatment BACKGROUND Cognitive complaints are reported frequently after breast cancer treatments . Their association with neuropsychological ( NP ) test performance is not well-established . METHODS Early-stage , posttreatment breast cancer patients were enrolled in a prospect i ve , longitudinal , cohort study prior to starting endocrine therapy . Evaluation included an NP test battery and self-report question naires assessing symptoms , including cognitive complaints . Multivariable regression models assessed associations among cognitive complaints , mood , treatment exposures , and NP test performance . RESULTS One hundred eighty-nine breast cancer patients , aged 21 - 65 years , completed the evaluation ; 23.3 % endorsed higher memory complaints and 19.0 % reported higher executive function complaints ( > 1 SD above the mean for healthy control sample ) . Regression modeling demonstrated a statistically significant association of higher memory complaints with combined chemotherapy and radiation treatments ( P = .01 ) , poorer NP verbal memory performance ( P = .02 ) , and higher depressive symptoms ( P < .001 ) , controlling for age and IQ . For executive functioning complaints , multivariable modeling controlling for age , IQ , and other confounds demonstrated statistically significant associations with better NP visual memory performance ( P = .03 ) and higher depressive symptoms ( P < .001 ) , whereas combined chemotherapy and radiation treatment ( P = .05 ) approached statistical significance . CONCLUSIONS About one in five post-adjuvant treatment breast cancer patients had elevated memory and /or executive function complaints that were statistically significantly associated with domain-specific NP test performances and depressive symptoms ; combined chemotherapy and radiation treatment was also statistically significantly associated with memory complaints . These results and other emerging studies suggest that subjective cognitive complaints in part reflect objective NP performance , although their etiology and biology appear to be multifactorial , motivating further transdisciplinary research This investigation evaluates two common measures of cancer-related fatigue , one multidimensional/retrospective and one unidimensional/same day . Fifty-two African American survivors of diverse cancers completed  fatigue visual analogue scales once daily , and the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) once weekly , for four weeks . Zero-order correlations showed retrospective fatigue was significantly related to average , peak , and most recent same-day fatigue . Multilevel r and om coefficient modeling showed unidimensional fatigue shared the most variance with the MFSI-SF 's General subscale for three weeks , and with the Vigor subscale for one week . Research ers and clinicians may wish to prioritize multidimensional measures when assessing cancer-related fatigue , if appropriate OBJECTIVE Insomnia is frequently comorbid with other medical and psychological disorders . This secondary data analysis investigated whether an Internet-delivered cognitive behavioral therapy for insomnia ( CBT-I ) intervention could also reduce comorbid psychological and fatigue symptoms . METHOD Data from a pilot r and omized controlled trial ( RCT ) testing the efficacy of Internet-delivered CBT-I relative to a waitlist control was used to examine changes in symptoms of depression , anxiety , mental health quality of life ( QOL ) , and fatigue . RESULTS Group by time interactions from repeated measures analyses revealed significant post intervention improvements in Internet participants ( n = 22 ) relative to  control participants ( n = 22 ) on all psychological symptoms , mental health QOL , and fatigue . A small post hoc sub sample of Internet participants with mild or moderate depression also showed large effect size changes in these constructs ( depression , anxiety , mental health QOL , and fatigue ) . CONCLUSION Internet-delivered CBT-I appears to not only improve sleep but also reduce comorbid psychological and fatigue symptoms Women with breast cancer are one of the largest groups of cancer survivors . This research examined whether breast cancer has a long-term impact on quality of life ( QOL ) by comparing 5-year disease-free survivors to age-matched controls and by comparing women who sustained a recurrence to disease-free survivors . Controls  were recruited using the neighborhood control methodology .  QOL ( physical , emotional , social , and spiritual ) was assessed during in-person interviews . There were no differences between disease-free survivors ( n = 267 ) and controls ( n = 187 ) on many indicators of QOL . However , survivors reported more difficulties with physical functioning , more physical symptoms , and more faith than did controls ( all ps < 0.05 ) . Compared to disease-free survivors , survivors with a recurrence ( n = 37 ) had a worse QOL on most indices , less positive affect , more general fatigue , and more intrusive and avoidant thoughts ( all ps < 0.05 ) . There were no differences between the two groups of survivors on indices of marriage , work experiences , or spirituality . These findings suggest that the QOL of long-term survivors who remain disease-free is comparable to that of women their age with the exception of physical functioning . Women who sustain a recurrence suffer an impaired QOL in some , but not all , domains Purpose Fatigue is one of the most disturbing complaints of cancer patients and is often the reason for discontinuing treatment . This r and omized controlled study tested the hypothesis that increased morning bright light , compared to dim light , would result in less fatigue in women with breast cancer undergoing chemotherapy . Methods Thirty-nine women newly diagnosed with stage I – III breast cancer were r and omized to either  bright white light ( BWL ) or dim red light ( DRL ) treatment and were instructed to use the light box for 30 min every morning throughout the first four cycles of chemotherapy . The Multidimensional Fatigue Symptom Inventory was administered prior to the start of chemotherapy ( baseline ) , during the chemotherapy treatment week of cycle 1 ( C1TW ) , the last week ( recovery week ) of cycle 1 ( C1RW ) , the chemotherapy treatment week of cycle 4 ( C4TW ) , and the last week ( recovery week ) of cycle 4 ( C4RW ) . Results The DRL group reported increased fatigue at C1TW ( p = 0.003 ) and C4TW ( p < 0.001 ) compared to baseline , while there was no significant change from baseline in the BWL group . A secondary analysis showed that the increases in fatigue levels in the DRL group were not mediated through nor associated with changes in sleep or in circadian rhythms as measured with wrist actigraphy . Conclusions The results of this study suggest that morning bright light treatment may prevent overall fatigue from worsening during chemotherapy . Although our hypothesis that overall fatigue would improve with bright light treatment was not supported , the lack of deterioration in total fatigue scores suggests that bright morning light may be a useful intervention during chemotherapy for breast cancer OBJECTIVE In April 2005 a phase III r and omized study was started to establish which was the most effective and safest treatment of cancer-related anorexia/cachexia syndrome and oxidative stress in improving identified primary endpoints : increase of lean body mass , decrease of resting energy expenditure ( REE ) , increase of total daily physical activity , decrease of interleukin-6 and tumor necrosis factor-alpha , and improvement of fatigue assessed by the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . METHODS All patients were given as basic treatment polyphenols plus antioxidant agents alpha-lipoic acid , carbocysteine , and vitamins A , C , and E , all orally . Patients were then r and omized to one of the following five arms : 1 ) medroxyprogesterone acetate/megestrol acetate ; 2 ) pharmacologic nutritional support containing eicosapentaenoic acid ; 3 ) L-carnitine ; 4 ) thalidomide ; or 5 ) medroxyprogesterone acetate/megestrol acetate plus pharmacologic nutritional support plus L-carnitine plus thalidomide . Treatment duration was 4 mo . The sample comprised 475 patients . RESULTS By January 2007 , 125 patients , well balanced for all clinical characteristics , were included . No severe side effects were observed . As for efficacy , an interim analysis on 125 patients showed an improvement of at least one primary endpoint in arms 3 , 4 , and 5 , whereas arm 2 showed a significant worsening of lean body mass , REE , and MFSI-SF . Analysis of variance comparing the change of primary endpoints between arms showed a significant improvement of REE in favor of arm 5 versus arm 2 and a significant improvement of MFSI-SF in favor of arms 1 , 3 , and 5 versus arm 2 . A significant inferiority of arm 2 versus arms 3 , 4 , and 5 for the primary endpoints lean body mass , REE , and MFSI-SF was observed on the basis of t test for changes . CONCLUSION The interim results obtained thus far seem to suggest that the most effective treatment for cancer-related anorexia/cachexia syndrome and oxidative stress should be a combination regimen . The study is still in progress and the final results should confirm these data Background While exercise acts to combat inflammation and aging , the ability to exercise may itself be compromised by inflammation and inflammation 's impact on muscle recovery and joint inflammation . A number of nutritional supplements have been shown to reduce inflammation and improve recovery . The purpose of the current investigation was to examine the effect of a multi-nutrient supplement containing branched chain amino acids , taurine , anti-inflammatory plant extracts , and B vitamins on inflammatory status , endothelial function , physical function , and mood in middle-aged individuals . Methods Thirty-one healthy and active men ( N = 16 , mean age 56 ± 6.0 yrs ) and women ( N = 15 , mean age = 52 ± 7.5 yrs ) participated in this investigation . Subjects completed one 28 day cycle of placebo supplementation and one 28 day cycle of multi-nutrient supplementation ( separated by a one week washout period ) in a balanced , r and omized , double-blind , cross-over design . Subjects completed weekly perceptual logs ( PROMIS-57 , KOOS ) and pre- and post- testing around the supplementation period . Testing consisted of brachial artery flow mediated dilation ( FMD ) , blood measures , and physical performance on vertical jump , h and grip strength , and balance ( dispersion from center of pressure ) . Significance for the investigation was p ≤ 0.05 . Results IL-6 significantly decreased in both men ( from 1.2 ± 0.2 to 0.7 ± 0.4 pg·mL-1 ) and women ( from 1.16 ± 0.04 to 0.7 ± 0.4 pg·mL-1 ) . Perceived energy also improved for both men ( placebo : 1.8 ± 0.7 ; supplement : 3.7 ± 0.8 AUC ) and women ( placebo : 1.2 ± 0.7 ; supplement : 2.8 ± 0.8 AUC ) . Alpha-1-antichymotrypsin ( from 108.9 ± 38.6 to 55.5 ± 22.2 ug·mL-1 ) , Creatine Kinase ( from 96 ± 34 to 67 ± 23 IU·L-1 ) , general pain , and joint pain decreased in men only , while anxiety and balance ( from 0.52 ± 0.13 to 0.45 ± 0.12 cm ) improved in women only . Men showed increased performance in vertical jump power ( from 2642 ± 244 to 3134 ± 282 W ) and grip strength ( from 42.1 ± 5.9 to 48.5 ± 4.9 kg ) . Conclusions A multi-nutrient supplement is effective in improving inflammatory status in both men and women , markers of pain , joint pain , strength , and power in men only , and both anxiety and balance ( a risk factor for hip fracture ) in women . Therefore , a multi-nutrient supplement may help middle-aged individuals to prolong physical function and maintain a healthy , active lifestyle Objective : To examine the hypothesis that young adults with major depress 
    Output:
    
agent
The MFSI-SF demonstrated moderate test-retest reliability in a small number of studies .
The MFSI-SF fatigue subscales were positively correlated with measures of distress , depressive , and anxious symptoms .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Complaints of fatigue are frequent in patients with obstructive sleep apnea ( OSA ) ; however , the impact of continuous positive airway pressure ( CPAP ) on fatigue remains unclear . METHODS Fifty-nine men and women with OSA were r and omly assigned to therapeutic or placebo CPAP in a double-blind fashion for a 3-week intervention period . Four outcome measures were assessed : ( 1 ) fatigue/vigor measured with the Multidimensional Fatigue Symptom Inventory -- Short Form ( MFSI-sf ) , the ( 2 ) fatigue and ( 3 ) vigor subscales of the Profile of Mood States -- Short Form ( POMS ) , and ( 4 ) the Epworth Sleepiness Scale ( ESS ) . Data were analyzed using repeated- measures analysis of variance . RESULTS Compared with patients receiving placebo CPAP , those patients treated with therapeutic CPAP showed significant reductions in the apnea-hypopnea index , as well as decreases in both measures of fatigue and increases in vigor ( P values < 0.05 ) . The beneficial effect of therapeutic treatment was most pronounced in patients with high levels of fatigue at study onset . Significant treatment effects in sleepiness scores were not observed in the entire sample ( P > 0.05 ) ; however , in a subset of patients with excessive sleepiness at the onset of treatment , ESS scores were significantly reduced with use of therapeutic CPAP ( P < 0.05 ) . CONCLUSIONS Results suggest that 3 weeks of therapeutic CPAP significantly reduced fatigue and increased energy in patients with OSA . Therapeutic CPAP significantly reduced daytime sleepiness in patients who reported excessive sleepiness at the onset of treatment BACKGROUND Cognitive complaints are reported frequently after breast cancer treatments . Their association with neuropsychological ( NP ) test performance is not well-established . METHODS Early-stage , posttreatment breast cancer patients were enrolled in a prospect i ve , longitudinal , cohort study prior to starting endocrine therapy . Evaluation included an NP test battery and self-report question naires assessing symptoms , including cognitive complaints . Multivariable regression models assessed associations among cognitive complaints , mood , treatment exposures , and NP test performance . RESULTS One hundred eighty-nine breast cancer patients , aged 21 - 65 years , completed the evaluation ; 23.3 % endorsed higher memory complaints and 19.0 % reported higher executive function complaints ( > 1 SD above the mean for healthy control sample ) . Regression modeling demonstrated a statistically significant association of higher memory complaints with combined chemotherapy and radiation treatments ( P = .01 ) , poorer NP verbal memory performance ( P = .02 ) , and higher depressive symptoms ( P < .001 ) , controlling for age and IQ . For executive functioning complaints , multivariable modeling controlling for age , IQ , and other confounds demonstrated statistically significant associations with better NP visual memory performance ( P = .03 ) and higher depressive symptoms ( P < .001 ) , whereas combined chemotherapy and radiation treatment ( P = .05 ) approached statistical significance . CONCLUSIONS About one in five post-adjuvant treatment breast cancer patients had elevated memory and /or executive function complaints that were statistically significantly associated with domain-specific NP test performances and depressive symptoms ; combined chemotherapy and radiation treatment was also statistically significantly associated with memory complaints . These results and other emerging studies suggest that subjective cognitive complaints in part reflect objective NP performance , although their etiology and biology appear to be multifactorial , motivating further transdisciplinary research This investigation evaluates two common measures of cancer-related fatigue , one multidimensional/retrospective and one unidimensional/same day . Fifty-two African American survivors of diverse cancers completed  fatigue visual analogue scales once daily , and the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) once weekly , for four weeks . Zero-order correlations showed retrospective fatigue was significantly related to average , peak , and most recent same-day fatigue . Multilevel r and om coefficient modeling showed unidimensional fatigue shared the most variance with the MFSI-SF 's General subscale for three weeks , and with the Vigor subscale for one week . Research ers and clinicians may wish to prioritize multidimensional measures when assessing cancer-related fatigue , if appropriate OBJECTIVE Insomnia is frequently comorbid with other medical and psychological disorders . This secondary data analysis investigated whether an Internet-delivered cognitive behavioral therapy for insomnia ( CBT-I ) intervention could also reduce comorbid psychological and fatigue symptoms . METHOD Data from a pilot r and omized controlled trial ( RCT ) testing the efficacy of Internet-delivered CBT-I relative to a waitlist control was used to examine changes in symptoms of depression , anxiety , mental health quality of life ( QOL ) , and fatigue . RESULTS Group by time interactions from repeated measures analyses revealed significant post intervention improvements in Internet participants ( n = 22 ) relative to  control participants ( n = 22 ) on all psychological symptoms , mental health QOL , and fatigue . A small post hoc sub sample of Internet participants with mild or moderate depression also showed large effect size changes in these constructs ( depression , anxiety , mental health QOL , and fatigue ) . CONCLUSION Internet-delivered CBT-I appears to not only improve sleep but also reduce comorbid psychological and fatigue symptoms Women with breast cancer are one of the largest groups of cancer survivors . This research examined whether breast cancer has a long-term impact on quality of life ( QOL ) by comparing 5-year disease-free survivors to age-matched controls and by comparing women who sustained a recurrence to disease-free survivors . Controls  were recruited using the neighborhood control methodology .  QOL ( physical , emotional , social , and spiritual ) was assessed during in-person interviews . There were no differences between disease-free survivors ( n = 267 ) and controls ( n = 187 ) on many indicators of QOL . However , survivors reported more difficulties with physical functioning , more physical symptoms , and more faith than did controls ( all ps < 0.05 ) . Compared to disease-free survivors , survivors with a recurrence ( n = 37 ) had a worse QOL on most indices , less positive affect , more general fatigue , and more intrusive and avoidant thoughts ( all ps < 0.05 ) . There were no differences between the two groups of survivors on indices of marriage , work experiences , or spirituality . These findings suggest that the QOL of long-term survivors who remain disease-free is comparable to that of women their age with the exception of physical functioning . Women who sustain a recurrence suffer an impaired QOL in some , but not all , domains Purpose Fatigue is one of the most disturbing complaints of cancer patients and is often the reason for discontinuing treatment . This r and omized controlled study tested the hypothesis that increased morning bright light , compared to dim light , would result in less fatigue in women with breast cancer undergoing chemotherapy . Methods Thirty-nine women newly diagnosed with stage I – III breast cancer were r and omized to either  bright white light ( BWL ) or dim red light ( DRL ) treatment and were instructed to use the light box for 30 min every morning throughout the first four cycles of chemotherapy . The Multidimensional Fatigue Symptom Inventory was administered prior to the start of chemotherapy ( baseline ) , during the chemotherapy treatment week of cycle 1 ( C1TW ) , the last week ( recovery week ) of cycle 1 ( C1RW ) , the chemotherapy treatment week of cycle 4 ( C4TW ) , and the last week ( recovery week ) of cycle 4 ( C4RW ) . Results The DRL group reported increased fatigue at C1TW ( p = 0.003 ) and C4TW ( p < 0.001 ) compared to baseline , while there was no significant change from baseline in the BWL group . A secondary analysis showed that the increases in fatigue levels in the DRL group were not mediated through nor associated with changes in sleep or in circadian rhythms as measured with wrist actigraphy . Conclusions The results of this study suggest that morning bright light treatment may prevent overall fatigue from worsening during chemotherapy . Although our hypothesis that overall fatigue would improve with bright light treatment was not supported , the lack of deterioration in total fatigue scores suggests that bright morning light may be a useful intervention during chemotherapy for breast cancer OBJECTIVE In April 2005 a phase III r and omized study was started to establish which was the most effective and safest treatment of cancer-related anorexia/cachexia syndrome and oxidative stress in improving identified primary endpoints : increase of lean body mass , decrease of resting energy expenditure ( REE ) , increase of total daily physical activity , decrease of interleukin-6 and tumor necrosis factor-alpha , and improvement of fatigue assessed by the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . METHODS All patients were given as basic treatment polyphenols plus antioxidant agents alpha-lipoic acid , carbocysteine , and vitamins A , C , and E , all orally . Patients were then r and omized to one of the following five arms : 1 ) medroxyprogesterone acetate/megestrol acetate ; 2 ) pharmacologic nutritional support containing eicosapentaenoic acid ; 3 ) L-carnitine ; 4 ) thalidomide ; or 5 ) medroxyprogesterone acetate/megestrol acetate plus pharmacologic nutritional support plus L-carnitine plus thalidomide . Treatment duration was 4 mo . The sample comprised 475 patients . RESULTS By January 2007 , 125 patients , well balanced for all clinical characteristics , were included . No severe side effects were observed . As for efficacy , an interim analysis on 125 patients showed an improvement of at least one primary endpoint in arms 3 , 4 , and 5 , whereas arm 2 showed a significant worsening of lean body mass , REE , and MFSI-SF . Analysis of variance comparing the change of primary endpoints between arms showed a significant improvement of REE in favor of arm 5 versus arm 2 and a significant improvement of MFSI-SF in favor of arms 1 , 3 , and 5 versus arm 2 . A significant inferiority of arm 2 versus arms 3 , 4 , and 5 for the primary endpoints lean body mass , REE , and MFSI-SF was observed on the basis of t test for changes . CONCLUSION The interim results obtained thus far seem to suggest that the most effective treatment for cancer-related anorexia/cachexia syndrome and oxidative stress should be a combination regimen . The study is still in progress and the final results should confirm these data Background While exercise acts to combat inflammation and aging , the ability to exercise may itself be compromised by inflammation and inflammation 's impact on muscle recovery and joint inflammation . A number of nutritional supplements have been shown to reduce inflammation and improve recovery . The purpose of the current investigation was to examine the effect of a multi-nutrient supplement containing branched chain amino acids , taurine , anti-inflammatory plant extracts , and B vitamins on inflammatory status , endothelial function , physical function , and mood in middle-aged individuals . Methods Thirty-one healthy and active men ( N = 16 , mean age 56 ± 6.0 yrs ) and women ( N = 15 , mean age = 52 ± 7.5 yrs ) participated in this investigation . Subjects completed one 28 day cycle of placebo supplementation and one 28 day cycle of multi-nutrient supplementation ( separated by a one week washout period ) in a balanced , r and omized , double-blind , cross-over design . Subjects completed weekly perceptual logs ( PROMIS-57 , KOOS ) and pre- and post- testing around the supplementation period . Testing consisted of brachial artery flow mediated dilation ( FMD ) , blood measures , and physical performance on vertical jump , h and grip strength , and balance ( dispersion from center of pressure ) . Significance for the investigation was p ≤ 0.05 . Results IL-6 significantly decreased in both men ( from 1.2 ± 0.2 to 0.7 ± 0.4 pg·mL-1 ) and women ( from 1.16 ± 0.04 to 0.7 ± 0.4 pg·mL-1 ) . Perceived energy also improved for both men ( placebo : 1.8 ± 0.7 ; supplement : 3.7 ± 0.8 AUC ) and women ( placebo : 1.2 ± 0.7 ; supplement : 2.8 ± 0.8 AUC ) . Alpha-1-antichymotrypsin ( from 108.9 ± 38.6 to 55.5 ± 22.2 ug·mL-1 ) , Creatine Kinase ( from 96 ± 34 to 67 ± 23 IU·L-1 ) , general pain , and joint pain decreased in men only , while anxiety and balance ( from 0.52 ± 0.13 to 0.45 ± 0.12 cm ) improved in women only . Men showed increased performance in vertical jump power ( from 2642 ± 244 to 3134 ± 282 W ) and grip strength ( from 42.1 ± 5.9 to 48.5 ± 4.9 kg ) . Conclusions A multi-nutrient supplement is effective in improving inflammatory status in both men and women , markers of pain , joint pain , strength , and power in men only , and both anxiety and balance ( a risk factor for hip fracture ) in women . Therefore , a multi-nutrient supplement may help middle-aged individuals to prolong physical function and maintain a healthy , active lifestyle Objective : To examine the hypothesis that young adults with major depress 
    Output:
    