Laser tracker position optimization

This article presents a laser tracker position optimization code based on the tracker uncertainty model developed by the National Physical Laboratory (NPL). The code is able to find the optimal tracker positions for generic measurements involving one or a network of many trackers, and an arbitrary set of targets. The optimization is performed using pattern search or optionally, genetic algorithm (GA) or particle swarm optimization (PSO). Different objective function weightings for the uncertainties of individual points, distance uncertainties between point pairs, and the angular uncertainties between three points can be defined. Constraints for tracker position limits and minimum measurement distances have also been implemented. Furthermore, position optimization taking into account of lines-of-sight (LOS) within complex CAD geometry have also been demonstrated. The code is simple to use and can be a valuable measurement planning tool.

Laser tracker position optimization

This article presents a laser tracker position optimization code based on the tracker uncertainty model developed by the National Physical Laboratory (NPL). The code is able to find the optimal tracker positions for generic measurements involving one or a network of many trackers, and an arbitrary set of targets. The optimization is performed using pattern search or optionally, genetic algorithm (GA) or particle swarm optimization (PSO). Different objective function weightings for the uncertainties of individual points, distance uncertainties between point pairs, and the angular uncertainties between three points can be defined. Constraints for tracker position limits and minimum measurement distances have also been implemented. Furthermore, position optimization taking into account of lines-of-sight (LOS) within complex CAD geometry have also been demonstrated. The code is simple to use and can be a valuable measurement planning tool.

Desenvolvimento de estruturas integradas de filtros e antenas para aplicações em sistemas de comunicações sem fio

This paper presents a study of the integration of filters and microstrip antennas, yielding devices named as filtennas for applications in wireless communications systems. The design of these structures is given from the observation of filtennas based integration between horn antennas and frequency selective surfaces (FSS), used in the band X. The choice of microstrip line structures for the development of a new configuration filtennas justifies the wide application of these transmission lines, in recent decades, always resulting in the production of circuit structures with planar light-weight, compact size, low cost, easy to construct and particularly easy to integrate with other microwave circuits. In addition, the antenna structure considered for the composition of filtennas consists of a planar monopole microstrip to microstrip filters integrated in the feed line of the antenna. In particular, are considered elliptical monopole microstrip (operating in UWB UWB) microstrip filters and (in structures with associated sections in series and / or coupled). In addition, the monopole microstrip has a proper bandwidth and omnidirectional radiation pattern, such that its integration with microstrip filters results in decreased bandwidth, but with slight changes in the radiation pattern. The methods used in the analysis of monopoles, and filters were filtennas finite elements and moments by using commercial software Ansoft Designer and HFSS Ansoft, respectively. Specifically, we analyze the main characteristics of filtennas, such as radiation pattern, gain and bandwidth. Were designed, constructed and measures, several structures filtennas, for validation of the simulated results. Were also used computational tools (CAD) in the process of building prototypes of planar monopoles, filters and filtennas. The prototypes were constructed on substrates of glass-fiber (FR4). Measurements were performed at the Laboratory for Telecommunications UFRN. Comparisons were made between simulated and measured, and found good agreement in the cases considered

Observação da ação na reabilitação do membro superior de pacientes com acidente vascular cerebral: uma revisão sistemática com metanálise

Background: stroke causes long-term impairments, limitation of activities and restriction in participation in daily life situations, especially for upper limb impairment (UL). Action Observation (AO) has been used for the rehabilitation of UL in these patients. It's a multisensory therapy which consists in observing a healthy subject performing a motor task, followed by physical practice. Objectives: assess whether the AO improves motor function of UL and dependence for activities of daily living (ADLs) of stroke patients or cause any adverse effects. Search methods: a search strategy was words and terms used for the identification of articles, in the following scientific basis Cochrane Central Register of Controlled Trials; MEDLINE; PsycINFO; CINAHL and LILACS. In addition to manual search of the references of articles and search for theses and dissertations in Portal Capes and LILACS. The identification of the studies was conducted from October to December 2015, being the last search on December 3. Selection criteria: randomised controlled trials (RCT) involving adults with stroke who had deficits in upper limb function and used AO as an intervention. Data collection and analysis: the data extracted from the studies were used to analyze the risk of bias, the effect of the treatment and the quality of the body of evidence. Main results: 6 studies were included, totaling 270 patients. The primary outcome analyzed was the motor function of MS. Were combined in meta-analyzes studies comparing AO versus placebo or an active control, considering the immediate and long-term effect (n=241). Regarding the motor function of the arm (5 trials), the estimated effect for the therapy was not significant. However, when considering the hand function estimating the effect was favorable to the group that conducted the AO, in short (mean difference = 6.93, 95% CI 1.48 to 12.39; P = 0.01) and long-term (mean difference = 7.57; 95% CI 1.34 the 13.80; p = 0.02). Unable to perform the analysis for functional dependency. The studies showed a low or uncertain risk of bias, but the quality of evidence the body was considered low and very low quality. Authors’ conclusions: AO was effective in improving hand function of stroke patients. Despite the low quality evidence that the use of OA in clinical practice should not be discouraged. RCT new studies should be conducted with greater methodological rigor and larger samples, covering important outcomes such as functional dependence for ADLs.

The morphology of ordered block copolymer patterns as probed by high resolution imaging

The microphase separation of block copolymer (BCP) thin films can afford a simple and cost-effective means to studying nanopattern surfaces, and especially the fabrication of nanocircuitry. However, because of complex interface effects and other complications, their 3D morphology, which is often critical for application, can be more complex than first thought. Here, we describe how emerging microscopic methods may be used to study complex BCP patterns and reveal their rich detail. These methods include helium ion microscopy (HIM) and high resolution x-section transmission electron microscopy (XTEM), and complement conventional secondary electron and atomic force microscopies (SEM and TEM). These techniques reveal that these structures are quite different to what might be expected. We illustrate the advances in the understanding of BCP thin film morphology in several systems, which result from this characterization. The systems described include symmetric, lamellar forming polystyrene-b-polymethylmethacrylate (PS-b-PMMA), cylinder forming polystyrene-b-polydimethylsiloxane (PS-b-PDMS), as well as lamellar and cylinder forming patterns of polystyrene-b-polyethylene oxide (PS-b-PEO) and polystyrene-b-poly-4-vinylpyridine (PS-b-P4VP). Each of these systems exhibits more complex arrangements than might be first thought. Finding and developing techniques whereby complex morphologies, particularly at very small dimensions, can be determined is critical to the practical use of these materials in many applications. The importance of quantifying these complex morphologies has implications for their use in integrated circuit manufacture, where they are being explored as alternative pattern forming methods to conventional UV lithography.

Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment (Review)

Background

It is estimated that up to 75% of cancer survivors may experience cognitive impairment as a result of cancer treatment and given the increasing size of the cancer survivor population, the number of affected people is set to rise considerably in coming years. There is a need, therefore, to identify effective, non-pharmacological interventions for maintaining cognitive function or ameliorating cognitive impairment among people with a previous cancer diagnosis.
Objectives

To evaluate the cognitive effects, non-cognitive effects, duration and safety of non-pharmacological interventions among cancer patients targeted at maintaining cognitive function or ameliorating cognitive impairment as a result of cancer or receipt of systemic cancer treatment (i.e. chemotherapy or hormonal therapies in isolation or combination with other treatments).
Search methods

We searched the Cochrane Centre Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PUBMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. We also searched registries of ongoing trials and grey literature including theses, dissertations and conference proceedings. Searches were conducted for articles published from 1980 to 29 September 2015.
Selection criteria

Randomised controlled trials (RCTs) of non-pharmacological interventions to improve cognitive impairment or to maintain cognitive functioning among survivors of adult-onset cancers who have completed systemic cancer therapy (in isolation or combination with other treatments) were eligible. Studies among individuals continuing to receive hormonal therapy were included. We excluded interventions targeted at cancer survivors with central nervous system (CNS) tumours or metastases, non-melanoma skin cancer or those who had received cranial radiation or, were from nursing or care home settings. Language restrictions were not applied.
Data collection and analysis

Author pairs independently screened, selected, extracted data and rated the risk of bias of studies. We were unable to conduct planned meta-analyses due to heterogeneity in the type of interventions and outcomes, with the exception of compensatory strategy training interventions for which we pooled data for mental and physical well-being outcomes. We report a narrative synthesis of intervention effectiveness for other outcomes.
Main results

Five RCTs describing six interventions (comprising a total of 235 participants) met the eligibility criteria for the review. Two trials of computer-assisted cognitive training interventions (n = 100), two of compensatory strategy training interventions (n = 95), one of meditation (n = 47) and one of physical activity intervention (n = 19) were identified. Each study focused on breast cancer survivors. All five studies were rated as having a high risk of bias. Data for our primary outcome of interest, cognitive function were not amenable to being pooled statistically. Cognitive training demonstrated beneficial effects on objectively assessed cognitive function (including processing speed, executive functions, cognitive flexibility, language, delayed- and immediate- memory), subjectively reported cognitive function and mental well-being. Compensatory strategy training demonstrated improvements on objectively assessed delayed-, immediate- and verbal-memory, self-reported cognitive function and spiritual quality of life (QoL). The meta-analyses of two RCTs (95 participants) did not show a beneficial effect from compensatory strategy training on physical well-being immediately (standardised mean difference (SMD) 0.12, 95% confidence interval (CI) -0.59 to 0.83; I2= 67%) or two months post-intervention (SMD - 0.21, 95% CI -0.89 to 0.47; I2 = 63%) or on mental well-being two months post-intervention (SMD -0.38, 95% CI -1.10 to 0.34; I2 = 67%). Lower mental well-being immediately post-intervention appeared to be observed in patients who received compensatory strategy training compared to wait-list controls (SMD -0.57, 95% CI -0.98 to -0.16; I2 = 0%). We assessed the assembled studies using GRADE for physical and mental health outcomes and this evidence was rated to be low quality and, therefore findings should be interpreted with caution. Evidence for physical activity and meditation interventions on cognitive outcomes is unclear.
Authors' conclusions

Overall, the, albeit low-quality evidence may be interpreted to suggest that non-pharmacological interventions may have the potential to reduce the risk of, or ameliorate, cognitive impairment following systemic cancer treatment. Larger, multi-site studies including an appropriate, active attentional control group, as well as consideration of functional outcomes (e.g. activities of daily living) are required in order to come to firmer conclusions about the benefits or otherwise of this intervention approach. There is also a need to conduct research into cognitive impairment among cancer patient groups other than women with breast cancer.

Statin withdrawal in people with dementia

Background: There are approximately 24 million people worldwide with dementia; this is likely to increase to 81 million by 2040. Dementia is a progressive condition, and usually leads to death eight to ten years after first symptoms. End-of-life care should emphasise treatments that optimise quality of life and physicians should minimise unnecessary or non-beneficial interventions. Statins are 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors; they have become the cornerstone of pharmacotherapy for the management of hypercholesterolaemia but their ability to provide benefit is unclear in the last weeks or months of life. Withdrawal of statins may improve quality of life in people with advanced dementia, as they will not be subjected to unnecessary polypharmacy or side effects. However, they may help to prevent further vascular events in people of advanced age who are at high risk of such events.

Objectives: To evaluate the effects of withdrawal or continuation of statins in people with dementia on: cognitive outcomes, adverse events, behavioural and functional outcomes, mortality, quality of life, vascular morbidity, and healthcare costs.

Search methods: We searched ALOIS (medicine.ox.ac.uk/alois/), the Cochrane Dementia and Cognitive Improvement Group Specialised Register on 11 February 2016. We also ran additional searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Clinical.Trials.gov and the WHO Portal/ICTRP on 11 February 2016, to ensure that the searches were as comprehensive and as up-to-date as possible.

Selection criteria: We included all randomised, controlled clinical trials with either a placebo or 'no treatment' control group. We applied no language restrictions.

Data collection and analysis: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, using standard methodological procedures expected by Cochrane. We found no studies suitable for inclusion therefore analysed no data.

Main results: The search strategy identified 28 unique references, all of which were excluded.

Authors' conclusions: We found no evidence to enable us to make an informed decision about statin withdrawal in dementia. Randomised controlled studies need to be conducted to assess cognitive and other effects of statins in participants with dementia, especially when the disease is advanced.

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. 

Annotation of Gyrodactylus salaris transcriptome

Relationship between organisms within an ecosystem is one of the main focuses in the study of ecology and evolution. For instance, host-parasite interactions have long been under close interest of ecology, evolutionary biology and conservation science, due to great variety of strategies and interaction outcomes. The monogenean ecto-parasites consist of a significant portion of flatworms. Gyrodactylus salaris is a monogenean freshwater ecto-parasite of Atlantic salmon (Salmo salar) whose damage can make fish to be prone to further bacterial and fungal infections. G. salaris is the only one parasite whose genome has been studied so far. The RNA-seq data analyzed in this thesis has already been annotated by using LAST. The RNA-seq data was obtained from Illumina sequencing i.e. yielded reads were assembled into 15777 transcripts. Last resulted in annotation of 46% transcripts and remaining were left unknown. This thesis work was started with whole data and annotation process was continued by the use of PANNZER, CDD and InterProScan. This annotation resulted in 56% successfully annotated sequences having parasite specific proteins identified. This thesis represents the first of Monogenean transcriptomic information which gives an important source for further research on this specie. Additionally, comparison of annotation methods interestingly revealed that description and domain based methods perform better than simple similarity search methods. Therefore it is more likely to suggest the use of these tools and databases for functional annotation. These results also emphasize the need for use of multiple methods and databases. It also highlights the need of more genomic information related to G. salaris.

Multiple-Retrieval Case-Based Reasoning for Course Timetabling Problems

The structured representation of cases by attribute graphs in a Case-Based Reasoning (CBR) system for course timetabling has been the subject of previous research by the authors. In that system, the case base is organised as a decision tree and the retrieval process chooses those cases which are sub attribute graph isomorphic to the new case. The drawback of that approach is that it is not suitable for solving large problems. This paper presents a multiple-retrieval approach that partitions a large problem into small solvable sub-problems by recursively inputting the unsolved part of the graph into the decision tree for retrieval. The adaptation combines the retrieved partial solutions of all the partitioned sub-problems and employs a graph heuristic method to construct the whole solution for the new case. We present a methodology which is not dependant upon problem specific information and which, as such, represents an approach which underpins the goal of building more general timetabling systems. We also explore the question of whether this multiple-retrieval CBR could be an effective initialisation method for local search methods such as Hill Climbing, Tabu Search and Simulated Annealing. Significant results are obtained from a wide range of experiments. An evaluation of the CBR system is presented and the impact of the approach on timetabling research is discussed. We see that the approach does indeed represent an effective initialisation method for these approaches.

Multiple-retrieval case-based reasoning for course timetabling problems

The structured representation of cases by attribute graphs in a Case-Based Reasoning (CBR) system for course timetabling has been the subject of previous research by the authors. In that system, the case base is organised as a decision tree and the retrieval process chooses those cases which are sub attribute graph isomorphic to the new case. The drawback of that approach is that it is not suitable for solving large problems. This paper presents a multiple-retrieval approach that partitions a large problem into small solvable sub-problems by recursively inputting the unsolved part of the graph into the decision tree for retrieval. The adaptation combines the retrieved partial solutions of all the partitioned sub-problems and employs a graph heuristic method to construct the whole solution for the new case. We present a methodology which is not dependant upon problem specific information and which, as such, represents an approach which underpins the goal of building more general timetabling systems. We also explore the question of whether this multiple-retrieval CBR could be an effective initialisation method for local search methods such as Hill Climbing, Tabu Search and Simulated Annealing. Significant results are obtained from a wide range of experiments. An evaluation of the CBR system is presented and the impact of the approach on timetabling research is discussed. We see that the approach does indeed represent an effective initialisation method for these approaches.

A construção do habitus musical dos músicos amadores

Com esta dissertação pretende-se estudar a construção dos habitatus musicais nos projetos musicais amadores, com base, sobretudo, na teoria da prática de Pierre Bourdieu, procurando-se igualmente compreender o papel da reflexividade e dos quadros de interação ao longo das trajetórias musicais. Entende-se que os músicos amadores assumem uma relação específica com a música, ainda que entre si seja heterogénea e, desta forma, tomou-se como objetivos centrais apreender as matrizes e os modos de socialização, analisar o papel da reflexividade na produção musical e também comparar os habitatus musicais dos músicos amadores. Para tal, utilizou-se uma metodologia qualitativa, dado o cariz analítico do estudo, através da aplicação de entrevistas semidiretivas e, complementarmente, de observação direta não participante; ABSTRACT: With this dissertation it is intended to study the construction of the musical habitatus in amateur musical projects, based, especially, in the Theory of Practice of Pierre Bourdieu, looking for to understand, as well, the role of reflexivity and the interaction settings along the musical trajectories. It is considered that the amateur musicians assume a specific relation with music, even if it’s heterogeneous between them and, therefore, it was taken as the main objectives to learn the pattern and methods of socializing, to analyze the role of reflexivity in the musical production and to compare the musical habitatus between amateur musicians. For such, was used a qualitative methodology, given the analytical nature of the study, through the application of semi directive interviews and, complementarily, of the nonparticipating direct observation.

Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women : a short version Cochrane systematic review with meta-analysis

Background Pelvic floor muscle training (PFMT) is a commonly used physical therapy for women with urinary incontinence (UI). Objectives To determine the effects of PFMT for women with UI in comparison to no treatment, placebo or other inactive control treatments. Search Methods Cochrane Incontinence Group Specialized Register, (searched 15 April 2013). Selection Criteria Randomized or quasi-randomized trials in women with stress, urgency or mixed UI (based on symptoms, signs, or urodynamics). Data Collection and Analysis At least two independent review authors carried out trial screening, selection, risk of bias assessment and data abstraction. Trials were subgrouped by UI diagnosis. The quality of evidence was assessed by adopting the (GRADE) approach. Results Twenty-one trials (1281 women) were included; 18 trials (1051 women) contributed data to the meta-analysis. In women with stress UI, there was high quality evidence that PFMT is associated with cure (RR 8.38; 95% CI 3.68 to 19.07) and moderate quality evidence of cure or improvement (RR 17.33; 95% CI 4.31 to 69.64). In women with any type of UI, there was also moderate quality evidence that PFMT is associated with cure (RR 5.5; 95% CI 2.87–10.52), or cure and improvement (RR 2.39; 95% CI 1.64–3.47). Conclusions The addition of seven new trials did not change the essential findings of the earlier version of this review. In this iteration, using the GRADE quality criteria strengthened the recommendations for PFMT and a wider range of secondary outcomes (also generally in favor of PFMT) were reported.

Adhesives for fixed orthodontic bands

Background: Orthodontic treatment involves using fixed or removable appliances (dental braces) to correct the positions of teeth. It has been shown that the quality of treatment result obtained with fixed appliances is much better than with removable appliances. Fixed appliances are, therefore, favoured by most orthodontists for treatment. The success of a fixed orthodontic appliance depends on the metal attachments (brackets and bands) being attached securely to the teeth so that they do not become loose during treatment. Brackets are usually attached to the front and side teeth, whereas bands (metal rings that go round the teeth) are more commonly used on the back teeth (molars). A number of adhesives are available to attach bands to teeth and it is important to understand which group of adhesives bond most reliably, as well as reducing or preventing dental decay during the treatment period. :Objectives: To evaluate the effectiveness of the adhesives used to attach bands to teeth during fixed appliance treatment, in terms of: (1) how often the bands come off during treatment; and (2) whether they protect the banded teeth against decay during fixed appliance treatment. Search methods: The following electronic databases were searched: Cochrane Oral Health's Trials Register (searched 2 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5) in the Cochrane Library (searched 2 June 2016), MEDLINE Ovid (1946 to 2 June 2016) and EMBASE Ovid (1980 to 2 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: Randomised and controlled clinical trials (RCTs and CCTs) (including split-mouth studies) of adhesives used to attach orthodontic bands to molar teeth were selected. Patients with full arch fixed orthodontic appliance(s) who had bands attached to molars were included. Data collection and analysis: All review authors were involved in study selection, validity assessment and data extraction without blinding to the authors, adhesives used or results obtained. All disagreements were resolved by discussion. Main results: Five RCTs and three CCTs were identified as meeting the review's inclusion criteria. All the included trials were of split-mouth design. Four trials compared chemically cured zinc phosphate and chemically cured glass ionomer; three trials compared chemically cured glass ionomer cement with light cured compomer; one trial compared chemically cured glass ionomer with a chemically cured glass phosphonate. Data analysis was often inappropriate within the studies meeting the inclusion criteria. Authors' conclusions: There is insufficient high quality evidence with regard to the most effective adhesive for attaching orthodontic bands to molar teeth. Further RCTs are required.

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: 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 service. Authors' 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.