Chronic fatigue syndrome; an approach combining self-management with graded exercise to avoid exacerbations.

Controversy regarding the aetiology and treatment of patients with chronic fatigue syndrome (CFS) continues to affect the medical professions. The Cochrane collaboration advises practitioners to implement graded exercise therapy for CFS sufferers using cognitive behavioural principles. In contrast there is evidence that exercise can induce symptom exacerbations in CFS where too vigorous exercise/activity promotes immune dysfunction, which in turn increases symptoms in patients with CFS. When designing and implementing an exercise programme it is important to be aware of both these seemingly opposing view points in order to deliver a programme without any detrimental effects on CFS pathophysiology. Using evidence from both the biological and clinical sciences, the present manuscript explains that graded exercise therapy for people with CFS can be safely undertaken without detrimental effects to the immune system. Exercise programs should be designed to cater for individual physical capabilities and should also account for the fluctuating nature of symptoms commonly reported by people with CFS. In line with cognitive behaviourally and graded exercise-based strategies, self-management for people with CFS involves encouraging the patients to pace their activities and respect their physical and mental limitations with the ultimate aim of improving their everyday function

Towards a Butlerian methodology: undoing organizational performativity through anti-narrative research

This article explores the methodological possibilities that Butler’s theory of performativity opens up, attempting to ‘translate’ her theoretical ideas into research practice. Specifically, it considers how research on organizational subjectivity premised upon a performative ontology might be undertaken. It asks: What form might a Butler-inspired methodology take? What methodological opportunities might it afford for developing self-reflexive research? What political and ethical problems might it pose for organizational researchers, particularly in relation to the challenges associated with power asymmetries, and the risks attached to ‘fixing’ subjects within the research process? The article outlines and evaluates a method described as ‘anti-narrative’ interviewing, arguing that it constitutes a potentially valuable methodological resource for researchers interested in understanding how and why idealized organizational subjectivities are formed and sustained. It further advances the in-roads that Butler’s writing has made into organization studies, thinking through the methodological and ethical implications of her work for understanding the performative constitution of organizational subjectivities. The aim of the paper is to advocate a research practice premised upon a reflexive undoing of organizational subjectivities and the normative conditions upon which they depend. It concludes by emphasizing the potential benefits and wider implications of a methodologically reflexive undoing of organizational performativity

Revisiting consistency conditions for quantum states of systems on closed timelike curves: an epistemic perspective

There has been considerable recent interest in the consequences of closed timelike curves (CTCs) for the dynamics of quantum mechanical systems. A vast majority of research into this area makes use of the dynamical equations developed by Deutsch, which were developed from a consistency condition that assumes that mixed quantum states uniquely describe the physical state of a system. We criticise this choice of consistency condition from an epistemic perspective, i.e., a perspective in which the quantum state represents a state of knowledge about a system. We demonstrate that directly applying Deutsch's condition when mixed states are treated as representing an observer's knowledge of a system can conceal time travel paradoxes from the observer, rather than resolving them. To shed further light on the appropriate dynamics for quantum systems traversing CTCs, we make use of a toy epistemic theory with a strictly classical ontology due to Spekkens and show that, in contrast to the results of Deutsch, many of the traditional paradoxical effects of time travel are present.Comment: 10 pages, 6 figures, comments welcome; v2 added references and clarified some points; v3 published versio

Fatigue Intervention by Nurses Evaluation - The FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: study protocol. [ISRCTN74156610]

Background: Chronic fatigue syndrome, also known as ME (CFS/ME), is a condition characterised primarily by severe, disabling fatigue, of unknown origin, which has a poor prognosis and serious personal and economic consequences. Evidence for the effectiveness of any treatment for CFS/ME in primary care, where most patients are seen, is sparse. Recently, a brief, pragmatic treatment for CFS/ME, based on a physiological dysregulation model of the condition, was shown to be successful in improving fatigue and physical functioning in patients in secondary care. The treatment involves providing patients with a readily understandable explanation of their symptoms, from which flows the rationale for a graded rehabilitative plan, developed collaboratively with the therapist. The present trial will test the effectiveness and cost-effectiveness of pragmatic rehabilitation when delivered by specially trained general nurses in primary care. We selected a client-centred counselling intervention, called supportive listening, as a comparison treatment. Counselling has been shown to be as effective as cognitive behaviour therapy for treating fatigue in primary care, is more readily available, and controls for supportive therapist contact time. Our control condition is treatment as usual by the general practitioner (GP). Methods and design: This study protocol describes the design of an ongoing, single-blind, pragmatic randomized controlled trial of a brief (18 week) self-help treatment, pragmatic rehabilitation, delivered by specially trained nurse-therapists in patients' homes, compared with nurse-therapist delivered supportive listening and treatment as usual by the GP. An economic evaluation, taking a societal viewpoint, is being carried out alongside the clinical trial. Three adult general nurses were trained over a six month period to deliver the two interventions. Patients aged over 18 and fulfilling the Oxford criteria for CFS are assessed at baseline, after the intervention, and again one year later. Primary outcomes are self-reported physical functioning and fatigue at one year, and will be analysed on an intention-to-treat basis. A qualitative study will examine the interventions' mechanisms of change, and also GPs' drivers and barriers towards referral

Randomized compiling for scalable quantum computing on a noisy superconducting quantum processor

The successful implementation of algorithms on quantum processors relies on the accurate control of quantum bits (qubits) to perform logic gate operations. In this era of noisy intermediate-scale quantum (NISQ) computing, systematic miscalibrations, drift, and crosstalk in the control of qubits can lead to a coherent form of error which has no classical analog. Coherent errors severely limit the performance of quantum algorithms in an unpredictable manner, and mitigating their impact is necessary for realizing reliable quantum computations. Moreover, the average error rates measured by randomized benchmarking and related protocols are not sensitive to the full impact of coherent errors, and therefore do not reliably predict the global performance of quantum algorithms, leaving us unprepared to validate the accuracy of future large-scale quantum computations. Randomized compiling is a protocol designed to overcome these performance limitations by converting coherent errors into stochastic noise, dramatically reducing unpredictable errors in quantum algorithms and enabling accurate predictions of algorithmic performance from error rates measured via cycle benchmarking. In this work, we demonstrate significant performance gains under randomized compiling for the four-qubit quantum Fourier transform algorithm and for random circuits of variable depth on a superconducting quantum processor. Additionally, we accurately predict algorithm performance using experimentally-measured error rates. Our results demonstrate that randomized compiling can be utilized to maximally-leverage and predict the capabilities of modern-day noisy quantum processors, paving the way forward for scalable quantum computing

Miscellaneous Problems

Contains reports on eight research projects

Miscellaneous Problems

Contains reports on eleven research projects

Differences and similarities between the EULAR/ASAS-EULAR and national recommendations for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe

This is the first report comparing EULAR and national treatment recommendations for PsA patients across Europe, and the first this decade to compare ASAS-EULAR and national treatment recommendations in axSpA patients. An electronic survey was completed from October 2021–April 2022 by rheumatologists in 15 European countries. One and four countries followed all EULAR and ASAS-EULAR recommendations, respectively. Five countries had no national treatment recommendations for PsA and/or axSpA, but followed other regulations. In several countries, national treatment recommendations predated the most recent EULAR/ASAS-EULAR recommendations. Entry criteria for starting biologic/targeted synthetic disease-modifying anti-rheumatic drugs varied considerably. In several countries, for PsA patients with significant skin involvement, interleukin-17 inhibitors were not given preference. The positioning of Janus Kinase inhibitors differed and Phosphodiesterase-4 inhibitors were not in use/reimbursed in most countries. This study may motivate European countries to update their national treatment recommendations, to align them better with the latest international recommendations

Activity pacing: moving beyond taking breaks and slowing down

This brief communication responds to the paper by Jeong and Cho (Qual Life Res 26(4):903–911, 2017) that has described activity pacing in limited terms of adjusting activities through going at a slower rate and taking breaks. Activity pacing was reported as not involving goal setting, in comparison to other strategies for long-term conditions such as Acceptance and Commitment Therapy. This brief communication aims to challenge this limited perception of activity pacing in light of numerous studies that recognise pacing to be a more complex strategy. Pacing is considered to be a multifaceted coping strategy, including broad themes of not only adjusting activities, but also planning activities, having consistent activity levels, acceptance of current abilities and gradually increasing activities, and one that includes goal setting as a key facet. It is essential that pacing is both defined and measured as a multifaceted strategy in order to assess the outcomes of pacing, and for meaningful comparisons with other strategies regarding efficacy for the management of long-term conditions

The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden

BACKGROUND: People of low socioeconomic status have worse health and a higher probability of being granted a disability pension than people of high socioeconomic status. It is also known that public and private general physicians and public and private specialists have varying practices for issuing sick leave certificates (which, if longstanding, may become the basis of disability pensions). However, few studies have investigated the influence of a patient's country of birth in this context. METHODS: We used multilevel logistic regression analysis with individuals (first level) nested within countries of birth (second level). We analysed the entire population between the ages of 40 and 64 years (n = 80 212) in the city of Malmo, Sweden, in 2003, and identified 73% of that population who had visited a physician at least once during that year. We studied the associations between individuals and country of birth socioeconomic characteristics, as well as individual utilisation of different kinds of physicians in relation to having been granted a disability pension. RESULTS: Living alone (OR(women )= 1.72, 95% CI: 1.62–1.82; OR(men )= 2.64, 95% CI: 2.46–2.83) and having limited educational achievement (OR(women )= 2.14, 95% CI: 2.00–2.29; OR(men )= 2.12, 95% CI: 1.98–2.28) were positively associated with having a disability pension. Utilisation of public specialists was associated with a higher probability (OR(women )= 2.11, 95% CI: 1.98–2.25; OR(men )= 2.16, 95% CI: 2.01–2.32) and utilisation of private GPs with a lower probability (OR(men )= 0.76, 95% CI: 0.69–0.83) of having a disability pension. However, these associations differed by countries of birth. Over and above individual socioeconomic status, men from middle income countries had a higher probability of having a disability pension (OR(men )= 1.61, 95% CI: 1.06–2.44). CONCLUSION: The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation