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PLoS Biology Dec 2020Neurons extend long axons that require maintenance and are susceptible to degeneration. Long-term integrity of axons depends on intrinsic mechanisms including axonal...
Neurons extend long axons that require maintenance and are susceptible to degeneration. Long-term integrity of axons depends on intrinsic mechanisms including axonal transport and extrinsic support from adjacent glial cells. The mechanisms of support provided by myelinating oligodendrocytes to underlying axons are only partly understood. Oligodendrocytes release extracellular vesicles (EVs) with properties of exosomes, which upon delivery to neurons improve neuronal viability in vitro. Here, we show that oligodendroglial exosome secretion is impaired in 2 mouse mutants exhibiting secondary axonal degeneration due to oligodendrocyte-specific gene defects. Wild-type oligodendroglial exosomes support neurons by improving the metabolic state and promoting axonal transport in nutrient-deprived neurons. Mutant oligodendrocytes release fewer exosomes, which share a common signature of underrepresented proteins. Notably, mutant exosomes lack the ability to support nutrient-deprived neurons and to promote axonal transport. Together, these findings indicate that glia-to-neuron exosome transfer promotes neuronal long-term maintenance by facilitating axonal transport, providing a novel mechanistic link between myelin diseases and secondary loss of axonal integrity.
Topics: Animals; Axonal Transport; Axons; Exosomes; Extracellular Vesicles; Female; HEK293 Cells; Humans; Maintenance; Male; Mice; Mice, Inbred C57BL; Myelin Sheath; Neuroglia; Neurons; Oligodendroglia; Signal Transduction
PubMed: 33351792
DOI: 10.1371/journal.pbio.3000621 -
American Journal of Industrial Medicine May 2020Transportation road maintenance and repair workers, or "maintainers," are exposed to hazardous and variable noise levels and often rely on hearing protection devices...
BACKGROUND
Transportation road maintenance and repair workers, or "maintainers," are exposed to hazardous and variable noise levels and often rely on hearing protection devices (HPD) to reduce noise-exposure levels. We aimed to improve upon HPD use as part of the HearWell program that used a Total Worker Health, participatory approach to hearing conservation.
METHODS
Full-shift, personal noise sampling was performed during the routine task of brush cutting. Work activities and equipment were recorded and combined with 1-min noise measures to summarize personal noise-exposure levels by equipment. Using noise-monitoring results, HPD noise reduction ratings, and input from worker-based design teams, a noise-hazard scheme was developed and applied to the task and equipment used during brush cutting.
RESULTS
Average (standard deviation) and maximum L 1-minute, personal noise-exposure levels recorded during brush cutting included chainsaws at 92.1 (7.6) and max of 111 dBA, leaf blowers at 91.2 (7.5) and max 107 dBA, and wood chipper at 90.3 (7.3) and max of 104 dBA. The worker-designed noise-hazard scheme breaks down noise exposures into one of three color bands and exposure ranges: red (over 105 dBA), orange (90-105 dBA), or yellow (85-90 dBA). The scheme simplifies the identification of noise levels, assessment of noise-hazard, and choice of appropriate hearing protection for workers.
CONCLUSION
Combining noise-exposure assessment with intervention development using participatory methods, we characterized noise exposure and developed an intervention to educate and assist in protecting workers as they perform noisy tasks.
Topics: Adult; Ear Protective Devices; Environmental Monitoring; Hearing Loss, Noise-Induced; Humans; Maintenance; Noise, Occupational; Occupational Diseases; Occupational Exposure; Occupational Health Services; Patient Acceptance of Health Care; Program Evaluation; Transportation
PubMed: 31953973
DOI: 10.1002/ajim.23091 -
Journal of Oral Science Sep 2020Discontinuation of implant maintenance is the main risk factor for implant failure. The purpose of this study was to identify factors associated with previous...
Discontinuation of implant maintenance is the main risk factor for implant failure. The purpose of this study was to identify factors associated with previous discontinuation and resumption of maintenance among implant patients. A questionnaire survey was sent to 171 patients receiving implant maintenance at a university hospital; 169 patients responded. To assess the effect of job status, 26 patients (15.4%) with a history of maintenance discontinuation were classified as employed and nonemployed. The main reasons for previously discontinuing maintenance were work issues (in employed respondents) and dissatisfaction with treatment skill or chairside manner (in nonemployed respondents). The main reasons for resuming maintenance were those related to dental treatment (in employed respondents) and awareness of the importance of maintenance (in nonemployed respondents). There were significant differences in relation to job status in the reasons reported for discontinuing and resuming maintenance (both P < 0.05). The present findings suggest that oral health professionals should consider these factors when assisting patients in reducing the risk of implant failure.
Topics: Dental Implants; Humans; Peri-Implantitis; Risk Factors; Surveys and Questionnaires
PubMed: 32741849
DOI: 10.2334/josnusd.19-0318 -
British Medical Journal (Clinical... Oct 1981
Topics: Female; Humans; Male; Middle Aged; Sleep Initiation and Maintenance Disorders
PubMed: 6793154
DOI: 10.1136/bmj.283.6296.874 -
International Journal of Environmental... Dec 2020Mega infrastructure projects provide a basic guarantee for social development, economic construction, and livelihood improvement. Their operation and maintenance (O&M)...
Mega infrastructure projects provide a basic guarantee for social development, economic construction, and livelihood improvement. Their operation and maintenance (O&M) management are of great significance for the smooth operation and the realization of the value created by the projects. In order to provide an approach for effectively evaluating O&M management, this study develops a holistic indicator system using a mixed-review method from the national macro perspective in China. In this study, literature analysis, policy texts, expert interviews, and grounded theory were used to collect relevant data at home and abroad, and establish an initial evaluation indicator system with 23 indicators covering two dimensions and five aspects. Then the questionnaire survey and factor analysis were used to score and categorize the indicators, and finally an evaluation indicator system for O&M management of mega infrastructure projects was formed. The results show that social relations, environmental benefits, macro policy, and operational capacities play an important role in the evaluation of the O&M of mega infrastructure projects. This study helps the management team to avoid negative impacts in the O&M management of mega infrastructure projects and lays a theoretical foundation for future research. The indicator system in this study is based on the Chinese context, and it remains to be verified whether the indicator system is applicable to other countries due to the differences in political and cultural backgrounds in different regions.
Topics: China; City Planning; Construction Industry; Maintenance
PubMed: 33371434
DOI: 10.3390/ijerph17249589 -
BMC Public Health May 2019We review the current state of quality assurance in laboratories of the five Central Asia Republics (CARs), focusing on laboratory equipment, and compare quality... (Review)
Review
We review the current state of quality assurance in laboratories of the five Central Asia Republics (CARs), focusing on laboratory equipment, and compare quality assurance approaches with CLSI standards. The laboratories of the CARs faced exceptional challenges including highly-structured laboratory systems that retain centralized and outmoded Soviet-era approaches to quality assurance, considerably jeopardizing the validity of laboratory tests. The relative isolation of the CARs, based on geography and almost exclusive use of the Russian language, further hamper change. CARs must make high-level government decisions to widely implement quality assurance programs within their laboratory systems, within which approaches to the management of laboratory equipment will be a prominent part.
Topics: Asia, Central; Developing Countries; Equipment and Supplies; Humans; Laboratories; Maintenance; Program Evaluation; Quality Assurance, Health Care
PubMed: 32326932
DOI: 10.1186/s12889-019-6782-5 -
International Journal of Health Care... 2015The purpose of this paper is to improve overall healthcare maintenance (HM) service performance in NHS infection control (IC). Hence, the authors identify critical...
PURPOSE
The purpose of this paper is to improve overall healthcare maintenance (HM) service performance in NHS infection control (IC). Hence, the authors identify critical success factors (CSFs) and key performance measures in maintenance-associated infections. These infections occur because of the poor performance of HM service in IC.
DESIGN/METHODOLOGY/APPROACH
In the first Delphi exercise, complete CSFs and performance measures were presented to the Delphi participants for refinement and modification. Delphi round 1 data were analysed manually and used to refine the rounds 2 and 3 Delphi instruments. In subsequent Delphi rounds, the results were analysed through descriptive statistics.
FINDINGS
In total, eight CSFs and 53 key performance measures were identified for reducing maintenance-associated infections in hospitals. For example, establishing clear communication between the infection control team (ICT) and HM unit is important for preventing maintenance-associated HAIs. Dust prevention is also identified by the healthcare experts as an important measure to prevent maintenance-associated HAIs in high-risk patient areas.
ORIGINALITY/VALUE
The findings provide CSFs and key performance measures for measuring performance in HM in IC. Reducing the rate of maintenance-associated infections will have important socio-economic and health ramifications for hospitals. It will reduce cost and free up additional resources for alternative projects. It will also raise confidence among healthcare users about the quality of services provided by hospitals.
Topics: Cross Infection; Delphi Technique; England; Hospitals; Housekeeping, Hospital; Humans; Infection Control; Maintenance and Engineering, Hospital; State Medicine
PubMed: 26241091
DOI: 10.1108/IJHCQA-12-2014-0117 -
World Journal of Clinical Oncology May 2014The purpose of this article is to review the role of maintenance therapy in the treatment of advanced non-small cell lung cancer (NSCLC). A brief overview about... (Review)
Review
The purpose of this article is to review the role of maintenance therapy in the treatment of advanced non-small cell lung cancer (NSCLC). A brief overview about induction chemotherapy and its primary function in NSCLC is provided to address the basis of maintenance therapies foundation. The development of how maintenance therapy is utilized in this population is discussed and current guidelines for maintenance therapy are reviewed. Benefits and potential pitfalls of maintenance therapy are addressed, allowing a comprehensive review of the achieved clinical benefit that maintenance therapy may or may not have on NSCLC patient population. A review of current literature was conducted and a table is provided comparing the results of various maintenance therapy clinical trials. The table includes geographical location of each study, the number of patients enrolled, progression free survival and overall survival statistics, post-treatment regimens and if molecular testing was conducted. The role of molecular testing in relation to therapeutic treatment options for advanced NSCLC patients is discussed. A treatment algorithm clearly depicts first line and second line treatment for management of NSCLC and includes molecular testing, maintenance therapy and the role clinical trials have in treatment of NSCLC. This treatment algorithm has been specifically tailored and developed to assist clinicians in the management of advanced NSCLC.
PubMed: 24829857
DOI: 10.5306/wjco.v5.i2.103 -
BMC Health Services Research Aug 2022About half of all medical devices in low- and lower-middle-income countries are currently non-operational because equipment maintenance is lacking. Thus, choosing a...
BACKGROUND
About half of all medical devices in low- and lower-middle-income countries are currently non-operational because equipment maintenance is lacking. Thus, choosing a cost-efficient equipment maintenance approach has the potential to increase both the quantity and quality of important health services. Between 2010 and 2014 Nepal's Ministry of Health chose two of its development regions to pilot the contracting-out of maintenance services to the private sector. We develop a cost model and employ different data to calculate the cost of this contracted-out scheme. The latter we compare with two additional common approaches to maintenance: in-house maintenance and no maintenance.
METHODS
We use invoiced pilot program costs, device depreciation estimates from the literature, and hospital case numbers from Nepal's Health Management Information System. We estimate net-present values for a three-year horizon, incorporating both fixed and operational cost. Operational costs include downtime cost measured as lost revenues due to non-working equipment.
RESULTS
The contracted-out maintenance scheme shows a strong relative cost performance. Its cost after 3 years amount to 4,501,574 International Dollars Purchasing Power Parity (I$ PPP), only 90% of the cost with no maintenance. The contracted-out scheme incurs 670,288 I$ PPP and 3,765,360 I$ PPP in fixed cost and operational cost, respectively. The cost for replacing broken devices is 1,920,467 I$ PPP lower with maintenance. In addition, after 3 years total cost of contracted-out maintenance is 489,333 I$ PPP (11%) below total cost of decentralized in-house maintenance. After 10 years, contracted-out maintenance saves 2.5 million I$ PPP (18%) compared to no maintenance.
CONCLUSIONS
We find that contracted-out maintenance provides cost-efficient medical equipment maintenance in a lower-middle income context. Our findings contrast with studies from high- and upper-middle-income countries, which reflect contexts with more in-house engineering expertise than in our study area. Since the per hospital fixed cost decrease with scheme size, our results lend support to an expansion of contracted-out maintenance to the remaining three development regions in Nepal.
Topics: Costs and Cost Analysis; Female; Hospitals, District; Humans; Income; Nepal; Pregnancy
PubMed: 35953804
DOI: 10.1186/s12913-022-08392-6 -
Frontiers in Microbiology 2017Microbes maintain themselves through a variety of processes. Several of these processes can be reduced or shut down entirely when resource availability declines. In pure...
Microbes maintain themselves through a variety of processes. Several of these processes can be reduced or shut down entirely when resource availability declines. In pure culture conditions with ample substrate supply, a relationship between the maximum growth rate and the energy invested in maintenance has been reported widely. However, at the other end of the resources spectrum, bacteria are so extremely limited by energy that no growth occurs and metabolism is constrained to the most essential functions only. These minimum energy requirements have been called the basal power requirement. While seemingly different from each other, both aspects are likely components of a continuum of regulated maintenance processes. Here, we analyze cross-species tradeoffs in cellular physiology over the range of bacterial size and energy expenditure and determine the contributions to maintenance metabolism at each point along the size-energy spectrum. Furthermore, by exploring the simplest bacteria within this framework- which are most affected by maintenance constraints- we uncover which processes become most limiting. For the smallest species, maintenance metabolism converges on total metabolism, where we predict that maintenance is dominated by the repair of proteins. For larger species the relative costs of protein repair decrease and maintenance metabolism is predicted to be dominated by the repair of RNA components. These results provide new insights into which processes are likely to be regulated in environments that are extremely limited by energy.
PubMed: 28197128
DOI: 10.3389/fmicb.2017.00031