Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice.
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This essay explores the notion of resilience by providing a theoretical context and subsequently linking it to the management of safety and security. The distinct worlds of international security, industrial safety and public security have distinct risks as well as distinct ‘core purposes and integrities’ as understood by resilience scholars. In dealing with risks one could argue there are three broad approaches: cost-benefit analysis, precaution and resilience. In order to distinguish the more recent approach of resilience, the idea of adaptation will be contrasted to mitigation. First, a general outline is provided of what resilience implies as a way to survive and thrive in the face of adversity. After that, a translation of resilience for the management of safety and security is described. LinkedIn: https://www.linkedin.com/in/juul-gooren-phd-cpp-a1180622/
The circular economy (CE) is heralded as reducing material use and emissions while providing more jobs and growth. We explored this narrative in a series of expert workshops, basing ourselves on theories, methods and findings from science fields such as global environmental input-output analysis, business modelling, industrial organisation, innovation sciences and transition studies. Our findings indicate that this dominant narrative suffers from at least three inconvenient truths. First, CE can lead to loss of GDP. Each doubling of product lifetimes will halve the related industrial production, while the required design changes may cost little. Second, the same mechanism can create losses of production jobs. This may not be compensated by extra maintenance, repair or refurbishing activities. Finally, ‘Product-as-a-Service’ business models supported by platform technologies are crucial for a CE transition. But by transforming consumers from owners to users, they lose independence and do not share in any value enhancement of assets (e.g., houses). As shown by Uber and AirBNB, platforms tend to concentrate power and value with providers, dramatically affecting the distribution of wealth. The real win-win potential of circularity is that the same societal welfare may be achieved with less production and fewer working hours, resulting in more leisure time. But it is perfectly possible that powerful platform providers capture most added value and channel that to their elite owners, at the expense of the purchasing power of ordinary people working fewer hours. Similar undesirable distributional effects may occur at the global scale: the service economies in the Global North may benefit from the additional repair and refurbishment activities, while economies in the Global South that are more oriented towards primary production will see these activities shrink. It is essential that CE research comes to grips with such effects. Furthermore, governance approaches mitigating unfair distribution of power and value are hence essential for a successful circularity transition.
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