Measuring service outcomes for adaptive preventive maintenance

Services account for an increasing share of economic activity in the western world. As part of this, preventive maintenance (PM) service volumes are constantly growing as a result of a growing (and aging) asset population and maintenance outsourcing. While the pursuit of improved service productivity is in the interest of both firms and nations, the challenges of measuring service performance, and more specifically service outcomes, persist. This paper presents an outcome-based measure for fleet PM, which has far-reaching implications considering service productivity and performance measurement. We develop a statistical process control based measure that utilizes data typically available in PM. The measure is grounded in reliability theory, which enables generalization of the measure within PM services but also outlines the limitations of its application. Finally we apply the measure in a PM field service process of a servitized equipment manufacturer. Based on actual maintenance records we show that the service provider could reduce their service output by at least 5–10% without significantly affecting the aggregate service outcome. The developed measure and control process form the basis for adaptive preventive maintenance, which is expected to facilitate the transition towards outcome-based contracts through complementing condition-based maintenance. One of the key benefits of the approach is that it provides a cost-effective way of revealing the scarcely studied phenomenon of service overproduction. Based on our case, we conclude that there are significant productivity gains in making sure that you meet required standards for service output but do not exceed them

Turning Water into Power: Debates over the Development of Tanzania’s Rufiji River Basin, 1945–1985

This historical analysis examines the forces that shaped the collection and use of geographical data in Tanzania’s Rufiji Basin. Hoping to develop irrigated agriculture, colonial engineers surveyed the basin’s social and environmental landscapes and weighed the costs of damming. Following World War II, international experts interested in hydropower development conducted more geographical studies. While their studies offered limited information on stream flow, political and economic pressures led to their acceptance over those of colonial engineers. By illustrating how international institutions select what is accepted as knowledge and how such knowledge is used, the case highlights the politics of hydropower development in Africa. Based on archival work and fieldwork conducted in Tanzania and Sweden, this article argues that the shifting of the setting of knowledge construction from the basin to distant planning offices did not lead to projects based on better scientific knowledge, but set the stage for Tanzania’s current electricity problems

Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure

Aims There is little evidence-based therapy existing for acute heart failure (AHF), hospitalizations are lengthy and expensive, and optimal monitoring of AHF patients during in-hospital treatment is poorly defined. We evaluated a rapid cardiothoracic ultrasound (CaTUS) protocol, combining focused echocardiographic evaluation of cardiac filling pressures, that is, medial E/e' and inferior vena cava index, with lung ultrasound (LUS) for guiding treatment in hospitalized AHF patients. Methods and results We enrolled 20 consecutive patients hospitalized for AHF, whose in-hospital treatment was guided using the CaTUS protocol according to a pre-specified treatment protocol targeting resolution of pulmonary congestion on LUS and lowering cardiac filling pressures. Treatment results of these 20 patients were compared with those of a standard care sample of 100 patients, enrolled previously for follow-up purposes. The standard care sample had CaTUS performed daily for follow-up and received standard in-hospital treatment without ultrasound guidance. All CaTUS exams were performed by a single experienced sonographer. The CaTUS-guided therapy resulted in significantly larger decongestion as defined by reduction in symptoms, cardiac filling pressures, natriuretic peptides, cumulative fluid loss, and resolution of pulmonary congestion (P <0.05 for all) despite a shorter mean length of hospitalization. Congestion parameters were significantly lower also at discharge (P <0.05 for all), without any significant difference in these parameters on admission. The treatment arm displayed better survival regarding the combined endpoint of 6 month all-cause death or AHF re-hospitalization (log rank P = 0.017). No significant difference in adverse events occurred between the groups. Conclusions The CaTUS-guided therapy for AHF resulted in greater decongestion during shorter hospitalization without increased adverse events in this small pilot study and might be associated with a better post-discharge prognosis.Peer reviewe

Current advances in digital cognitive assessment for preclinical Alzheimer's disease

There is a pressing need to capture and track subtle cognitive change at the preclinical stage of Alzheimer's disease (AD) rapidly, cost-effectively, and with high sensitivity. Concurrently, the landscape of digital cognitive assessment is rapidly evolving as technology advances, older adult tech-adoption increases, and external events (i.e., COVID-19) necessitate remote digital assessment. Here, we provide a snapshot review of the current state of digital cognitive assessment for preclinical AD including different device platforms/assessment approaches, levels of validation, and implementation challenges. We focus on articles, grants, and recent conference proceedings specifically querying the relationship between digital cognitive assessments and established biomarkers for preclinical AD (e.g., amyloid beta and tau) in clinically normal (CN) individuals. Several digital assessments were identified across platforms (e.g., digital pens, smartphones). Digital assessments varied by intended setting (e.g., remote vs. in-clinic), level of supervision (e.g., self vs. supervised), and device origin (personal vs. study-provided). At least 11 publications characterize digital cognitive assessment against AD biomarkers among CN. First available data demonstrate promising validity of this approach against both conventional assessment methods (moderate to large effect sizes) and relevant biomarkers (predominantly weak to moderate effect sizes). We discuss levels of validation and issues relating to usability, data quality, data protection, and attrition. While still in its infancy, digital cognitive assessment, especially when administered remotely, will undoubtedly play a major future role in screening for and tracking preclinical AD

Short-term serotonergic but not noradrenergic antidepressant administration reduces attentional vigilance to threat in healthy volunteers

Anxiety is associated with threat-related biases in information processing such as heightened attentional vigilance to potential threat. Such biases are an important focus of psychological treatments for anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) are effective in the treatment of a range of anxiety disorders. The aim of this study was to assess the effect of an SSRI on the processing of threat in healthy volunteers. A selective noradrenergic reuptake inhibitor (SNRI), which is not generally used in the treatment of anxiety, was used as a contrast to assess the specificity of SSRI effects on threat processing. Forty-two healthy volunteers were randomly assigned to 7 d double-blind intervention with the SSRI citalopram (20 mg/d), the SNRI reboxetine (8 mg/d), or placebo. On the final day, attentional and interpretative bias to threat was assessed using the attentional probe and the homograph primed lexical decision tasks. Citalopram reduced attentional vigilance towards fearful faces but did not affect the interpretation of ambiguous homographs as threatening. Reboxetine had no significant effect on either of these measures. Citalopram reduces attentional orienting to threatening stimuli, which is potentially relevant to its clinical use in the treatment of anxiety disorders. This finding supports a growing literature suggesting that an important mechanism through which pharmacological agents may exert their effects on mood is by reversing the cognitive biases that characterize the disorders that they treat. Future studies are needed to clarify the neural mechanisms through which these effects on threat processing are mediated

Genetics of diabetic microvascular disease

Publisher Copyright: © 2020 John Wiley & Sons, Inc.Diabetic microvascular complications, affecting the kidneys, retina, and the nervous system, are a heavy burden for both the diabetic individual and society. The complications seem to cluster in families suggesting a genetic component in their pathogenesis. However, the actual genetic factors have long remained unknown. During the past few years, major advances have been made with large-scale genetic studies that have identified common genetic risk factors, e.g. in the AFF3 and CNKSR3 gene loci affecting the risk of diabetic kidney disease (DKD) end-stage renal disease. There is increasing evidence that genetic factors affecting kidney disease in non-diabetic individuals also affect the risk in individuals with type 2 diabetes (T2D), while less evidence is found for individuals with type 1 diabetes (T1D). While genetic explorations for diabetic retinopathy remain limited in sample size, a recent genome-wide association study (GWAS) identified variants associated with retinopathy on the GRB2 gene. Nevertheless, the field is still lacking strong validated genetic markers. In the future, better phenotyping, larger studies, and exploration of the rare variation are essential to identify the genetic causes behind diabetic microvascular complications, and to understand the interplay between genes and environment.Peer reviewe

The influence of color on snake detection in visual search in human children

It is well known that adult humans detect snakes as targets more quickly than flowers as the targets and that how rapidly they detect a snake picture does not differ whether the images are in color or gray-scale, whereas they find a flower picture more rapidly when the images are in color than when the images are gray-scale. In the present study, a total of 111 children were presented with 3-by-3 matrices of images of snakes and flowers in either color or gray-scale displays. Unlike the adults reported on previously, the present participants responded to the target faster when it was in color than when it was gray-scale, whether the target was a snake or a flower, regardless of their age. When detecting snakes, human children appear to selectively attend to their color, which would contribute to the detection being more rapidly at the expense of its precision

Human Young Children as well as Adults Demonstrate ‘Superior’ Rapid Snake Detection When Typical Striking Posture Is Displayed by the Snake

Humans as well as some nonhuman primates have an evolved predisposition to associate snakes with fear by detecting their presence as fear-relevant stimuli more rapidly than fear-irrelevant ones. In the present experiment, a total of 74 of 3- to 4-year-old children and adults were asked to find a single target black-and-white photo of a snake among an array of eight black-and-white photos of flowers as distracters. As target stimuli, we prepared two groups of snake photos, one in which a typical striking posture was displayed by a snake and the other in which a resting snake was shown. When reaction time to find the snake photo was compared between these two types of the stimuli, its mean value was found to be significantly smaller for the photos of snakes displaying striking posture than for the photos of resting snakes in both the adults and children. These findings suggest the possibility that the human perceptual bias for snakes per se could be differentiated according to the difference of the degree to which their presence acts as a fear-relevant stimulus