Multi-centre parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioural approach to managing fatigue in people with multiple sclerosis

Abstract (provisional) Background Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice. Methods This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change. Discussion This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Trial registration: Current Controlled Trials ISRCTN7651747

The role of social interaction in farmers' climate adaptation choice

Adaptation to climate change might not always occur, with potentially\ud catastrophic results. Success depends on coordinated actions at both\ud governmental and individual levels (public and private adaptation). Even for a “wet” country like the Netherlands, climate change projections show that the frequency and severity of droughts are likely to increase. Freshwater is an important factor for agricultural production. A deficit causes damage to crop production and consequently to a loss of income. Adaptation is the key to decrease farmers’ vulnerability at the micro level and the sector’s vulnerability at the macro level. Individual adaptation decision-making is determined by the behavior of economic agents and social interaction among them. This can be best studied with agentbased modelling. Given the uncertainty about future weather conditions and the costs and effectiveness of adaptation strategies, a farmer in the model uses a cognitive process (or heuristic) to make adaptation decisions. In this process, he can rely on his experiences and on information from interactions within his social network. Interaction leads to the spread of information and knowledge that causes learning. Learning changes the conditions for individual adaptation decisionmaking. All these interactions cause emergent phenomena: the diffusion of adaptation strategies and a change of drought vulnerability of the agricultural sector. In this paper, we present a conceptual model and the first implementation of an agent-based model. The aim is to study the role of interaction in a farmer’s social network on adaptation decisions and on the diffusion of adaptation strategies\ud and vulnerability of the agricultural sector. Micro-level survey data will be used to parameterize agents’ behavioral and interaction rules at a later stage. This knowledge is necessary for the successful design of public adaptation strategies, since governmental adaptation actions need to be fine-tuned to private adaptation behavior

Multiple perspectives on the concept of conditional probability

Conditional probability is a key to the subjectivist theory of probability; however, it plays a subsidiary role in the usual conception of probability where its counterpart, namely independence is of basic importance. The paper investigates these concepts from various perspectives in order to shed light on their multi-faceted character. We will include the mathematical, philosophical, and educational perspectives. Furthermore, we will inspect conditional probability from the corners of competing ideas and solving strategies. For the comprehension of conditional probability, a wider approach is urgently needed to overcome the well-known problems in learning the concepts, which seem nearly unaffected by teaching

Overview on agent-based social modelling and the use of formal languages

Transdisciplinary Models and Applications investigates a variety of programming languages used in validating and verifying models in order to assist in their eventual implementation. This book will explore different methods of evaluating and formalizing simulation models, enabling computer and industrial engineers, mathematicians, and students working with computer simulations to thoroughly understand the progression from simulation to product, improving the overall effectiveness of modeling systems.Postprint (author's final draft

Knowledge transformers : a link between learning and creativity

The purpose of this paper is to investigate whether knowledge transformers which are featured in the learning process, are also present in the creative process. This is achieved by reviewing models and theories of creativity and identifying the existence of the knowledge transformers. The investigation shows that there is some evidence to show that the creative process can be explained through knowledge transformers. Hence, it is suggested that one of links between learning and creativity is through the knowledge transformers

Knowledge transformers : a link between learning and creativity

The purpose of this paper is to investigate whether knowledge transformers that are featured in the learning process are also present in the creative process. First, this was achieved by reviewing accounts of inventions and discoveries with the view of explaining them in terms of knowledge transformers. Second, this was achieved by reviewing models and theories of creativity and identifying the existence of the knowledge transformers. The investigation shows that there is some evidence to show that the creative process can be explained through knowledge transformers. Hence, it is suggested that one of links between learning and creativity is through the knowledge transformers

Relative authenticity : abstraction and the digital domain

This paper intends to offer a preliminary investigation of what will be referred to as the notion of ‘abstraction’ in relation to Sigmund Freud’s ideas of ‘condensation’ and ‘displacement’, together with Ferdinand de Saussure’s theory of signification. Abstraction, then, shall be defined as one process through which a ‘signifier’ is created. The argument shall aim to trace and retrace the cognitive process of abstraction by discussing its role across different facets and layers of contemporary society, with particular attention being paid to the effects of the digital on this role. Abstractions shall be discussed regarding how they occur both in principle and in practice, and in how they might be perceived. This shall lead to a series of hypotheses concerning reflections and reactions which the omnipresence of the digital domain in every-day life might be prompting in contemporary society. The paper shall also focus on the parallel phenomena of ‘relative reality’ and ‘relative authenticity’, which can be understood as the hypothetical middle ground or gradient existing between ‘real’ and ‘fake’, and which shall be argued to be direct implications of abstraction.peer-reviewe