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

Seed conformal blocks in 4D CFT

We compute in closed analytical form the minimal set of \u201cseed\u201d conformal blocks associated to the exchange of generic mixed symmetry spinor/tensor operators in an arbitrary representation (\u2113, \u2113) of the Lorentz group in four dimensional conformal field theories. These blocks arise from 4-point functions involving two scalars, one (0, |\u2113 12 \u2113|) and one (|\u2113 12 \u2113|, 0) spinors or tensors. We directly solve the set of Casimir equations, that can elegantly be written in a compact form for any (\u2113, \u2113), by using an educated ansatz and reducing the problem to an algebraic linear system. Various details on the form of the ansatz have been deduced by using the so called shadow formalism. The complexity of the conformal blocks depends on the value of p = |\u2113 12 \u2113| and grows with p, in analogy to what happens to scalar conformal blocks in d even space-time dimensions as d increases. These results open the way to bootstrap 4-point functions involving arbitrary spinor/tensor operators in four dimensional conformal field theories

Bounds on OPE coefficients in 4D Conformal Field Theories

We numerically study the crossing symmetry constraints in 4D CFTs, using previously introduced algorithms based on semidefinite programming. We study bounds on OPE coefficients of tensor operators as a function of their scaling dimension and extend previous studies of bounds on OPE coefficients of conserved vector currents to the product groups SO(N) 7SO(M). We also analyze the bounds on the OPE coefficients of the conserved vector currents associated with the groups SO(N), SU(N) and SO(N) 7SO(M) under the assumption that in the singlet channel no scalar operator has dimension less than four, namely that the CFT has no relevant deformations. This is motivated by applications in the context of composite Higgs models, where the strongly coupled sector is assumed to be a spontaneously broken CFT with a global symmetry. \ua9 The Authors

Deconstructing Conformal Blocks in 4D CFT

We show how conformal partial waves (or conformal blocks) of spinor/tensor correlators can be related to each other by means of differential operators in four dimensional conformal field theories. We explicitly construct such differential operators for all possible conformal partial waves associated to four-point functions of arbitrary traceless symmetric operators. Our method allows any conformal partial wave to be extracted from a few \u201cseed\u201d correlators, simplifying dramatically the computation needed to bootstrap tensor correlators. \ua9 2015, The Author(s)

Genetics of focal segmental glomerulosclerosis

The recent advances in understanding the pathophysiology of focal segmental glomerulosclerosis (FSGS) and molecular function of glomerular filtration barrier come directly from genetic linkage and positional cloning studies. The exact role and function of the newly discovered genes and proteins are being investigated by in vitro and in vivo mechanistic studies. Those genes and proteins interactions seem to change susceptibility to kidney disease progression. Better understanding of their exact role in the development of FSGS may influence future therapies and outcomes in this complex disease