A systematic review evaluating the impact of paid home carer training, supervision, and other interventions on the health and well-being of older home care clients

BACKGROUND: Interventions to support and skill paid home carers and managers could potentially improve health and well-being of older home care clients. This is the first systematic review of interventions to improve how home carers and home care agencies deliver care to older people, with regard to clients’ health and wellbeing and paid carers’ well-being, job satisfaction, and retention. METHODS: We reviewed 10/731 papers found in the electronic search (to January 2016) fitting predetermined criteria, assessed quality using a checklist, and synthesized data using quantitative and qualitative techniques. RESULTS: Ten papers described eight interventions. The six quantitative evaluations used diverse outcomes that precluded meta-analysis. In the only quantitative study (a cluster Randomized Controlled Trial), rated higher quality, setting meaningful goals, carer training, and supervision improved client health-related quality of life. The interventions that improved client outcomes comprised training with additional implementation, such as regular supervision and promoted care focused around clients’ needs and goals. In our qualitative synthesis of four studies, intervention elements carers valued were greater flexibility to work to a needs-based rather than a task-based model, learning more about clients, and improved communication with management and other workers. CONCLUSION: There is a dearth of evidence regarding effective strategies to improve how home care is delivered to older clients, particularly those with dementia. More research in this sector including feasibility testing of the first home care intervention trials to include health and life quality outcomes for clients with more severe dementia is now needed

Upper bounds on subglacial channel development for interior regions of the Greenland Ice Sheet

AbstractWe use a simple numerical model to test whether surface water influx to the bed of the interior Greenland ice sheet has the potential to cause significant subglacial channel growth similar to that observed near the ice-sheet margin and at alpine glaciers. We examine the effects on channel growth from (1) rapid supraglacial lake drainage events and (2) sustained water input into moulins. By assuming that all drainage occurs through subglacial channels and by prescribing favorable pressure conditions at the domain inlet, the model can provide upper bounds on channel growth. Our results indicate that R-channels do not grow significantly within the limited period of high pressure associated with lake drainage events. Subsequent channel growth only occurs with sustained pressures above overburden. Rapid closure of channels at low pressures suggests channels in the interior are unlikely to draw significant quantities of water from nearby distributed networks. These results indicate that other drainage mechanisms such as turbulent sheets or linked-cavity networks are likely to be of greater importance for interior subglacial drainage than the growth of channels.</jats:p

Mapping of serotype-specific, immunodominant epitopes in the NS-4 region of hepatitis C virus (HCV):use of type-specific peptides to serologically differentiate infections with HCV types 1, 2, and 3

The effect of sequence variability between different types of hepatitis C virus (HCV) on the antigenicity of the NS-4 protein was investigated by epitope mapping and by enzyme-linked immunosorbent assay with branched oligopeptides. Epitope mapping of the region between amino acid residues 1679 and 1768 in the HCV polyprotein revealed two major antigenic regions (1961 to 1708 and 1710 to 1728) that were recognized by antibody elicited upon natural infection of HCV. The antigenic regions were highly variable between variants of HCV, with only 50 to 60% amino acid sequence similarity between types 1, 2, and 3. Although limited serological cross-reactivity between HCV types was detected between peptides, particularly in the first antigenic region of NS-4, type-specific reactivity formed the principal component of the natural humoral immune response to NS-4. Type-specific antibody to particular HCV types was detected in 89% of the samples from anti-HCV-positive blood donors and correlated almost exactly with genotypic analysis of HCV sequences amplified from the samples by polymerase chain reaction. Whereas almost all blood donors appeared to be infected with a single virus type (97%), a higher proportion of samples (40%) from hemophiliacs infected from transfusion of non-heat-inactivated clotting factor contained antibody to two or even all three HCV types, providing evidence that long-term exposure may lead to multiple infection with different variants of HCV

The Coulomb Sum and Proton-Proton Correlations in Few-Body Nuclei

In simple models of the nuclear charge operator, measurements of the Coulomb sum and the charge form factor of a nucleus directly determine the proton-proton correlations. We examine experimental results obtained for few-body nuclei at Bates and Saclay using models of the charge operator that include both one- and two-body terms. Previous analyses using one-body terms only have failed to reproduce experimental results. However, we find that the same operators which have been used to successfully describe the charge form factors also produce substantial agreement with measurements of the Coulomb sum.Comment: 11 pages, Revtex version 3.0 with 3 Postscript figures appended, ANL preprint PHY-7473-TH-9

Using Field Data to Assess Model Predictions of Surface and Ground Fuel Consumption by Wildfire in Coniferous Forests of California

Inventories of greenhouse gas (GHG) emissions from wildfire provide essential information to the state of California, USA, and other governments that have enacted emission reductions. Wildfires can release a substantial amount of GHGs and other compounds to the atmosphere, so recent increases in fire activity may be increasing GHG emissions. Quantifying wildfire emissions however can be difficult due to inherent variability in fuel loads and consumption and a lack of field data of fuel consumption by wildfire. We compare a unique set of fuel data collected immediately before and after six wildfires in coniferous forests of California to fuel consumption predictions of the first-order fire effects model (FOFEM), based on two different available fuel characterizations. We found strong regional differences in the performance of different fuel characterizations, with FOFEM overestimating the fuel consumption to a greater extent in the Klamath Mountains than in the Sierra Nevada. Inaccurate fuel load inputs caused the largest differences between predicted and observed fuel consumption. Fuel classifications tended to overestimate duff load and underestimate litter load, leading to differences in predicted emissions for some pollutants. When considering total ground and surface fuels, modeled consumption was fairly accurate on average, although the range of error in estimates of plot level consumption was very large. These results highlight the importance of fuel load input to the accuracy of modeled fuel consumption and GHG emissions from wildfires in coniferous forests

Global wave loads on a damaged ship

A computational tool was applied based on a two dimensional linear method to predict the hydrodynamic loads for damaged ships. Experimental tests on a ship model have also been carried out to predict the hydrodynamic loads in various design conditions. The results of the theoretical method and experimental tests are compared to validate the theoretical method. The extreme wave induced loads have been calculated by short term prediction. For the loads in intact condition, the prediction with duration of 20 years at sea state 5 is used, while for loads in damaged conditions the prediction in 96 hours exposure time at sea 3 is used. The maximum values of the most probable extreme amplitudes of dynamic wave induced loads in damaged conditions are much less than those in intact condition because of the reduced time. An opening could change the distribution of not only stillwater bending moment but also wave-induced bending moment. It is observed that although some cross sections are not structurally damaged, the total loads acting on these cross sections after damage may be increased dramatically compared to the original design load in intact condition

Correlations, spectral gap, and entanglement in harmonic quantum systems on generic lattices

We investigate the relationship between the gap between the energy of the ground state and the first excited state and the decay of correlation functions in harmonic lattice systems. We prove that in gapped systems, the exponential decay of correlations follows for both the ground state and thermal states. Considering the converse direction, we show that an energy gap can follow from algebraic decay and always does for exponential decay. The underlying lattices are described as general graphs of not necessarily integer dimension, including translationally invariant instances of cubic lattices as special cases. Any local quadratic couplings in position and momentum coordinates are allowed for, leading to quasi-free (Gaussian) ground states. We make use of methods of deriving bounds to matrix functions of banded matrices corresponding to local interactions on general graphs. Finally, we give an explicit entanglement-area relationship in terms of the energy gap for arbitrary, not necessarily contiguous regions on lattices characterized by general graphs.Comment: 26 pages, LaTeX, published version (figure added

A unified approach for the solution of the Fokker-Planck equation

This paper explores the use of a discrete singular convolution algorithm as a unified approach for numerical integration of the Fokker-Planck equation. The unified features of the discrete singular convolution algorithm are discussed. It is demonstrated that different implementations of the present algorithm, such as global, local, Galerkin, collocation, and finite difference, can be deduced from a single starting point. Three benchmark stochastic systems, the repulsive Wong process, the Black-Scholes equation and a genuine nonlinear model, are employed to illustrate the robustness and to test accuracy of the present approach for the solution of the Fokker-Planck equation via a time-dependent method. An additional example, the incompressible Euler equation, is used to further validate the present approach for more difficult problems. Numerical results indicate that the present unified approach is robust and accurate for solving the Fokker-Planck equation.Comment: 19 page

Tankyrase inhibition sensitizes cells to CDK4 blockade

Tankyrase (TNKS) 1/2 are positive regulators of WNT signaling by controlling the activity of the ss-catenin destruction complex. TNKS inhibitors provide an opportunity to suppress hyperactive WNT signaling in tumors, however, they have shown limited anti-proliferative activity as a monotherapy in human cancer cell lines. Here we perform a kinome-focused CRISPR screen to identify potential effective drug combinations with TNKS inhibition. We show that the loss of CDK4, but not CDK6, synergizes with TNKS1/2 blockade to drive G1 cell cycle arrest and senescence. Through precise modelling of cancer-associated mutations using cytidine base editors, we show that this therapeutic approach is absolutely dependent on suppression of canonical WNT signaling by TNKS inhibitors and is effective in cells from multiple epithelial cancer types. Together, our results suggest that combined WNT and CDK4 inhibition might provide a potential therapeutic strategy for difficult-to-treat epithelial tumors

Modeling of subglacial hydrological development following rapid supraglacial lake drainage

The rapid drainage of supraglacial lakes injects substantial volumes of water to the bed of the Greenland ice sheet over short timescales. The effect of these water pulses on the development of basal hydrological systems is largely unknown. To address this, we develop a lake drainage model incorporating both (1) a subglacial radial flux element driven by elastic hydraulic jacking and (2) downstream drainage through a linked channelized and distributed system. Here we present the model and examine whether substantial, efficient subglacial channels can form during or following lake drainage events and their effect on the water pressure in the surrounding distributed system. We force the model with field data from a lake drainage site, 70 km from the terminus of Russell Glacier in West Greenland. The model outputs suggest that efficient subglacial channels do not readily form in the vicinity of the lake during rapid drainage and instead water is evacuated primarily by a transient turbulent sheet and the distributed system. Following lake drainage, channels grow but are not large enough to reduce the water pressure in the surrounding distributed system, unless preexisting channels are present throughout the domain. Our results have implications for the analysis of subglacial hydrological systems in regions where rapid lake drainage provides the primary mechanism for surface-to-bed connections