BACKGROUND: Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase.OBJECTIVE: To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR.METHODS: Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped.RESULTS: We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41 days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver.CONCLUSION: This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.
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This paper analyzes the institutional context of maintenance purchasing in higher education. It aims to provide insights into the institutional complexities of smart maintenance purchasing in higher education institutes. In a case study, six external institutional fields and two internal institutional logics are identified. They create two types of institutional complexities that impede innovation if not treated correctly. Three ways are discussed to deal with those institutional complexities, 1) negotiating institutional field boundaries, 2) creating new institutional logics and practices, and 3) implementing institutional changes.
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Renewable energy sources have an intermittent character that does not necessarily match energy demand. Such imbalances tend to increase system cost as they require mitigation measures and this is undesirable when available resources should be focused on increasing renewable energy supply. Matching supply and demand should therefore be inherent to early stages of system design, to avoid mismatch costs to the greatest extent possible and we need guidelines for that. This paper delivers such guidelines by exploring design of hybrid wind and solar energy and unusual large solar installation angles. The hybrid wind and solar energy supply and energy demand is studied with an analytical analysis of average monthly energy yields in The Netherlands, Spain and Britain, capacity factor statistics and a dynamic energy supply simulation. The analytical focus in this paper differs from that found in literature, where analyses entirely rely on simulations. Additionally, the seasonal energy yield profile of solar energy at large installation angles is studied with the web application PVGIS and an hourly simulation of the energy yield, based on the Perez model. In Europe, the energy yield of solar PV peaks during the summer months and the energy yield of wind turbines is highest during the winter months. As a consequence, three basic hybrid supply profiles, based on three different mix ratios of wind to solar PV, can be differentiated: a heating profile with high monthly energy yield during the winter months, a flat or baseload profile and a cooling profile with high monthly energy yield during the summer months. It is shown that the baseload profile in The Netherlands is achieved at a ratio of wind to solar energy yield and power of respectively Ew/Es = 1.7 and Pw/Ps = 0.6. The baseload ratio for Spain and Britain is comparable because of similar seasonal weather patterns, so that this baseload ratio is likely comparable for other European countries too. In addition to the seasonal benefits, the hybrid mix is also ideal for the short-term as wind and solar PV adds up to a total that has fewer energy supply flaws and peaks than with each energy source individually and it is shown that they are seldom (3%) both at rated power. This allows them to share one cable, allowing “cable pooling”, with curtailment to -for example-manage cable capacity. A dynamic simulation with the baseload mix supply and a flat demand reveals that a 100% and 75% yearly energy match cause a curtailment loss of respectively 6% and 1%. Curtailment losses of the baseload mix are thereby shown to be small. Tuning of the energy supply of solar panels separately is also possible. Compared to standard 40◦ slope in The Netherlands, facade panels have smaller yield during the summer months, but almost equal yield during the rest of the year, so that the total yield adds up to 72% of standard 40◦ slope panels. Additionally, an hourly energy yield simulation reveals that: façade (90◦) and 60◦ slope panels with an inverter rated at respectively 50% and 65% Wp, produce 95% of the maximum energy yield at that slope. The flatter seasonal yield profile of “large slope panels” together with decreased peak power fits Dutch demand and grid capacity more effectively.
