Background: Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods: Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results: Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions: Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation.
MULTIFILE
This paper aims to quantify the evolution of damage in masonry walls under induced seismicity. A damage index equation, which is a function of the evolution of shear slippage and opening of the mortar joints, as well as of the drift ratio of masonry walls, was proposed herein. Initially, a dataset of experimental tests from in-plane quasi-static and cyclic tests on masonry walls was considered. The experimentally obtained crack patterns were investigated and their correlation with damage propagation was studied. Using a software based on the Distinct Element Method, a numerical model was developed and validated against full-scale experimental tests obtained from the literature. Wall panels representing common typologies of house façades of unreinforced masonry buildings in Northern Europe i.e. near the Groningen gas field in the Netherlands, were numerically investigated. The accumulated damage within the seismic response of the masonry walls was investigated by means of representative harmonic load excitations and an incremental dynamic analysis based on induced seismicity records from Groningen region. The ability of this index to capture different damage situations is demonstrated. The proposed methodology could also be applied to quantify damage and accumulation in masonry during strong earthquakes and aftershocks too.
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Behaviour change design has much to gain with the integration of insights from the behavioural sciences in the design process. However, this integration needs to be done without hampering the creative process. In two rich design cases aimed at health and safety behaviour change, we describe our efforts to develop a method for theory driven design based on the Double Diamond. Our method attempts to integrate insights from the Persuasive by Design-model (PbD) for behaviour change into the entire design process. Our case studies demonstrate that our method indeed augments the integration of theory and evidence in our designs, but only if the Double Diamond process model is complemented with an evaluation phase, and insights from the PbD-model are derived using rich, well developed tools.
DOCUMENT
Coastal nourishments, where sand from offshore is placed near or at the beach, are nowadays a key coastal protection method for narrow beaches and hinterlands worldwide. Recent sea level rise projections and the increasing involvement of multiple stakeholders in adaptation strategies have resulted in a desire for nourishment solutions that fit a larger geographical scale (O 10 km) and a longer time horizon (O decades). Dutch frontrunner pilot experiments such as the Sandmotor and Ameland inlet nourishment, as well as the Hondsbossche Dunes coastal reinforcement project have all been implemented from this perspective, with the specific aim to encompass solutions that fit in a renewed climate-resilient coastal protection strategy. By capitalizing on recent large-scale nourishments, the proposed Coastal landSCAPE project C-SCAPE will employ and advance the newly developed Dynamic Adaptive Policy Pathways (DAPP) approach to construct a sustainable long-term nourishment strategy in the face of an uncertain future, linking climate and landscape scales to benefits for nature and society. Novel long-term sandy solutions will be examined using this pathways method, identifying tipping points that may exist if distinct strategies are being continued. Crucial elements for the construction of adaptive pathways are 1) a clear view on the long-term feasibility of different nourishment alternatives, and 2) solid, science-based quantification methods for integral evaluation of the social, economic, morphological and ecological outcomes of various pathways. As currently both elements are lacking, we propose to erect a Living Lab for Climate Adaptation within the C-SCAPE project. In this Living Lab, specific attention is paid to the socio-economic implications of the nourished landscape, as we examine how morphological and ecological development of the large-scale nourishment strategies and their design choices (e.g. concentrated vs alongshore uniform, subaqueous vs subaerial, geomorphological features like artificial lagoons) translate to social acceptance.
