Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives:Objectives To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods:We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.Selection criteria:We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis:Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.Main results:Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months’ follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months’ follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the serviceAuthors’ conclusions:There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries. 

Work Fluctuations in Bosonic Josephson Junctions

We calculate the first two moments and full probability distribution of the work performed on a system of bosonic particles in a two-mode Bose-Hubbard Hamiltonian when the self-interaction term is varied instantaneously or with a finite-time ramp. In the instantaneous case, we show how the irreversible work scales differently depending on whether the system is driven to the Josephson or Fock regime of the bosonic Josephson junction. In the finite-time case, we use optimal control techniques to substantially decrease the irreversible work to negligible values. Our analysis can be implemented in present-day experiments with ultracold atoms and we show how to relate the work statistics to that of the population imbalance of the two modes.

Constructive Synthesis of Memory-Intensive Accelerators for FPGA From Nested Loop Kernels

Field-programmable gate arrays are ideal hosts to custom accelerators for signal, image, and data processing but de- mand manual register transfer level design if high performance and low cost are desired. High-level synthesis reduces this design burden but requires manual design of complex on-chip and off-chip memory architectures, a major limitation in applications such as video processing. This paper presents an approach to resolve this shortcoming. A constructive process is described that can derive such accelerators, including on- and off-chip memory storage from a C description such that a user-defined throughput constraint is met. By employing a novel statement-oriented approach, dataflow intermediate models are derived and used to support simple ap- proaches for on-/off-chip buffer partitioning, derivation of custom on-chip memory hierarchies and architecture transformation to ensure user-defined throughput constraints are met with minimum cost. When applied to accelerators for full search motion estima- tion, matrix multiplication, Sobel edge detection, and fast Fourier transform, it is shown how real-time performance up to an order of magnitude in advance of existing commercial HLS tools is enabled whilst including all requisite memory infrastructure. Further, op- timizations are presented that reduce the on-chip buffer capacity and physical resource cost by up to 96% and 75%, respectively, whilst maintaining real-time performance.

Finite Element Simulations of stretch-blow moulding with experimental validation over a broad process window

Injection stretch blow moulding is a well-established method of forming thin-walled containers and has been extensively researched for numerous years. This paper is concerned with validating the finite element analysis of the free-stretch-blow process in an effort to progress the development of injection stretch blow moulding of poly(ethylene terephthalate). Extensive data was obtained experimentally over a wide process window accounting for material temperature and air flow rate, while capturing cavity pressure, stretch-rod reaction force and preform surface strain. This data was then used to assess the accuracy of the correlating FE simulation constructed using ABAQUS/Explicit solver and an appropriate viscoelastic material subroutine. Results reveal that the simulation is able to give good quantitative correlation for conditions where the deformation was predominantly equal biaxial whilst qualitative correlation was achievable when the mode of deformation was predominantly sequential biaxial. Overall the simulation was able to pick up the general trends of how the pressure, reaction force, strain rate and strain vary with the variation in preform temperature and air flow rate. The knowledge gained from these analyses provides insight into the mechanisms of bottle formation, subsequently improving the blow moulding simulation and allowing for reduction in future development costs.

Searching for swept-up hydrogen and helium in the late-time spectra of 11 nearby Type Ia supernovae

The direct detection of a stellar system that explodes as a Type Ia supernova (SN Ia) has not yet been successful. Various indirect methods have been used to investigate SN Ia progenitor systems but none have produced conclusive results. A prediction of single-degenerate models is that H- (or He-) rich material from the envelope of the companion star should be swept up by the SN ejecta in the explosion. Seven SNe Ia have been analysed to date looking for signs of H-rich material in their late-time spectra and none were detected. We present results from new late-time spectra of 11 SNe Ia obtained at the Very Large Telescope using XShooter and FORS2. We present the tentative detection of Hα emission for SN 2013ct, corresponding to ∼0.007 M_⊙ of stripped/ablated companion star material (under the assumptions of the spectral modelling). This mass is significantly lower than expected for single-degenerate scenarios, suggesting that >0.1 M_⊙ of H-rich is present but not observed. We do not detect Hα emission in the other 10 SNe Ia. This brings the total sample of normal SNe Ia with non-detections (<0.001–0.058 M_⊙) of H-rich material to 17 events. The simplest explanation for these non-detections is that these objects did not result from the explosion of a CO white dwarf accreting matter from a H-rich companion star via Roche lobe overflow or symbiotic channels. However, further spectral modelling is needed to confirm this. We also find no evidence of He-emission features, but models with He-rich companion stars are not available to place mass limits.