Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background: Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability. Objective: While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested. Methods: This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened. Results: The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon. Conclusions: This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice.

Internalising the external costs of light goods vehicle transport in Britain

Report produced as part of the Green Logistics project (EPSRC and Department for Transport funded). To what extent do the taxes paid by the light goods vehicles (LGVs) users in Britain cover their allocated infrastructural, environmental and congestion costs? This report is a continuation of a study on the internalisation of the external costs of heavy goods vehicle activity. Research undertaken jointly by the Transport Studies Group at University of Westminster and Logistics Research Centre at Heriot-Watt University has attempted to answer this question using official government transport statistics and monetary valuations for the external costs.

Internalising the external costs of light and heavy goods vehicle transport in London

Report produced as part of the Green Logistics project (EPSRC and Department for Transport funded). This report provides estimates of the total external costs of LGV and HGV operations in London. In 2006, total LGV and HGV activity imposed external costs of approximately £1.75-£1.8 billion using low, medium and high emission cost values. About 27 per cent of these costs were internalised by duties and taxes paid by LGV operators, compared with 26% in the case of HGVs. If congestion costs are excluded, taxes and duties paid by LGV operators are estimated to be 155% of LGVs' allocated infrastructural and environmental costs, compared with 85% in the case of HGVs. When using the medium emission cost values, LGVs accounted for 56% of these external costs in London and HGVs for 44%.

Logistics management and costs of biomass fuel supply

Discusses part of a project conducted by the authors into the logistics planning and management and costs of supplying biomass fuels to biomass-fired power stations in the UK. Defines biomass fuels and the reasons for the growth in interest in their use for electricity generation. The activities and parties involved in the biomass fuel supply chain are discussed together with the management of the chain in order to achieve smooth and consistent flow of biomass fuel to power stations. Explains the approach used to modelling the delivered costs of biomass fuels for four types of biomass fuel included in the project: forest fuel, short rotation coppice, straw and miscanthus. Comments are given on the environmental impacts of the fuel supply chains. The results indicate that straw supply systems are capable of producing the lowest delivered costs of the four fuels studied. Short rotation coppice and miscanthus, two new energy crops, are likely to have the highest delivered costs at present. This is due to the cost of growing these fuels and the financial incentives required by farmers to persuade them to grow these crops. Logistics costs (i.e. transport, storage and handling) are shown to represent a significant proportion of total delivered cost in biomass supply. Careful supply chain planning and logistics management will be of central importance to the success of the biomass industry.

Internalising the external costs of light and heavy goods vehicles in London

This report provides estimates of the total external costs of LGV and HGV operations in London. In 2006, total LGV and HGV activity imposed external costs of approximately £1.75-£1.8 billion using low, medium and high emission cost values. About 27 per cent of these costs were internalised by duties and taxes paid by LGV operators, compared with 26% in the case of HGVs. If congestion costs are excluded, taxes and duties paid by LGV operators are estimated to be 155% of LGVs' allocated infrastructural and environmental costs, compared with 85% in the case of HGVs. When using the medium emission cost values, LGVs accounted for 56% of these external costs in London and HGVs for 44%.

Product innovation and the costs of energy-using product policies

Energy-using Products (EuPs) contribute significantly to the United Kingdom’s CO2 emissions, both in the domestic and non-domestic sectors. Policies that encourage the use of more energy efficient products (such as minimum performance standards, energy labelling, enhanced capital allowances, etc.) can therefore generate significant reductions in overall energy consumption and hence, CO2 emissions. While these policies can impose costs on the producers and consumers of these products in the short run, the process of product innovation may reduce the magnitude of these costs over time. If this is the case, then it is important that the impacts of innovation are taken into account in policy impact assessments. Previous studies have found considerable evidence of experience curve effects for EuP categories (e.g. refrigerators, televisions, etc.), with learning rates of around 20% for both average unit costs and average prices; similar to those found for energy supply technologies. Moreover, the decline in production costs has been accompanied by a significant improvement in the energy efficiency of EuPs. Building on these findings and the results of an empirical analysis of UK sales data for a range of product categories, this paper sets out an analytic framework for assessing the impact of EuP policy interventions on consumers and producers which takes explicit account of the product innovation process. The impact of the product innovation process can be seen in the continuous evolution of the energy class profiles of EuP categories over time; with higher energy classes (e.g. A, A+, etc.) entering the market and increasing their market share, while lower classes (e.g. E, F, etc.) lose share and then leave the market. Furthermore, the average prices of individual energy classes have declined over their respective lives, while new classes have typically entered the market at successively lower “launch prices”. Based on two underlying assumptions regarding the shapes of the “lifecycle profiles” for the relative sales and the relative average mark-ups of individual energy classes, a simple simulation model is developed that can replicate the observed market dynamics in terms of the evolution of market shares and average prices. The model is used to assess the effect of two alternative EuP policy interventions – a minimum energy performance standard and an energy-labelling scheme – on the average unit cost trajectory and the average price trajectory of a typical EuP category, and hence the financial impacts on producers and consumers.

Internalising the external costs of light goods vehicle transport in Britain

To what extent do the taxes paid by the light goods vehicles (LGVs) users in Britain cover their allocated infrastructural, environmental and congestion costs? This report is a continuation of a study on the internalisation of the external costs of heavy goods vehicle activity. Research undertaken jointly by the Transport Studies Group at University of Westminster and Logistics Research Centre at Heriot-Watt University has attempted to answer this question using official government transport statistics and monetary valuations for the external costs.

The challenge of managing airline delay costs

Estimates of airline delay costs as a function of delay magnitude are combined with fuel and (future) emissions charges to make cost-benefit trade-offs in the pre-departure and airborne phases. Hypothetical scenarios for the distribution of flow management slots are explored in terms of their cost and target-setting implications. The general superiority of passenger-centric metrics is of significance for delay measurement, although flight delays are still the only commonly-reported type of metric in both the US and Europe. There is a particular need for further research into reactionary (network) effects, especially with regard to passenger metrics and flow management delay.

Modelling the airline costs of delay propagation

Reactionary delays constitute nearly half of all delay minutes in Europe. A capped, multi-component model is presented for estimating reactionary delay costs, as a non-linear function of primary delay duration. Maximum Take-Off Weights, historically established as a charging mechanism, may be used to model delay costs. Current industry reporting on delay is flight-centric. Passenger-centric metrics are needed to better understand delay propagation. In ATM, it is important to take account of contrasting flight- and passenger-centric effects, caused by cancellations, for example. Costs to airlines and passenger disutility will both continue to be driven by delay relative to the original schedule.

A review of dynamic Bayesian network techniques with applications in healthcare risk modelling

Coping with an ageing population is a major concern for healthcare organisations around the world. The average cost of hospital care is higher than social care for older and terminally ill patients. Moreover, the average cost of social care increases with the age of the patient. Therefore, it is important to make efficient and fair capacity planning which also incorporates patient centred outcomes. Predictive models can provide predictions which their accuracy can be understood and quantified. Predictive modelling can help patients and carers to get the appropriate support services, and allow clinical decision-makers to improve care quality and reduce the cost of inappropriate hospital and Accident and Emergency admissions. The aim of this study is to provide a review of modelling techniques and frameworks for predictive risk modelling of patients in hospital, based on routinely collected data such as the Hospital Episode Statistics database. A number of sub-problems can be considered such as Length-of-Stay and End-of-Life predictive modelling. The methodologies in the literature are mainly focused on addressing the problems using regression methods and Markov models, and the majority lack generalisability. In some cases, the robustness, accuracy and re-usability of predictive risk models have been shown to be improved using Machine Learning methods. Dynamic Bayesian Network techniques can represent complex correlations models and include small probabilities into the solution. The main focus of this study is to provide a review of major time-varying Dynamic Bayesian Network techniques with applications in healthcare predictive risk modelling.