Supply Chain Control and Strategies to Reduce Operational Risk in Russian Extractive Industries Along the Northern Sea Route

Russian resource developers operating in remote parts of the Arctic have demonstrated over the past several years that it is feasible to extract natural resources throughout the year, and ship large quantities of raw materials with regular intervals from the Arctic to international markets; this despite very difficult operational conditions in the Arctic during both winter and spring. Several resource extraction projects are currently being implemented or planned. This study examines how the extractive companies have built up enhanced supply chain resilience and transport reliability to mitigate common Arctic risks. The companies have taken control over supply chains and adopted several precautionary and innovative infrastructure and logistics measures designed to prevent or mitigate disruption to these supply chains. Preferred logistical solutions for all of these extraction projects have developed into large package deals, where long-term production and transport of commodities, icebreaking services, and state support are all included. Western sanctions on Russia as a result of the war in Ukraine, will slow down the pace of future Russian projects in the Arctic, at least in the short to medium-term, but the sanctions are likely to increase the future significance of export terminals on the NSR, as the preferred departure points for Russian Arctic commodities on their way to selective market destinations

On the Vulnerabilities of the Northern Sea Route’s Maritime Transportation System

This study analyses several vulnerabilities in the maritime transportation system of the Northern Sea Route (NSR). The vulnerabilities discussed are already impacting transport and logistics operations on the NSR. These vulnerabilities have greatly increased as a result of Western technological and economic sanctions on Russia and the subsequent departure of Western companies from Russia, where they were previously providers of critical supplies, logistics services, and investments. The cumulative impacts of these vulnerabilities will make the NSR maritime transportation system less efficient and reliable and more prone to failures, reducing operational and environmental standards, impacting safety and increasing the environmental impact of NSR shipping. Russia needs to find suitable replacements for Western technology and services. Chinese companies will likely try to fill the gap left by the departure of Western companies to promote the continuous production of Russian Arctic commodities for export to China

On air ambulance services

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkin

Pesticide use and weed occurrence on farms that use different soil tillage strategies

Reduced tillage has increased in Sweden during several years, primarily to decrease costs and increase efficiency in crop production. Despite this, mouldboard ploughing is still the most common primary tillage method on most farms. The aim with this thesis was to compare the use of pesticides and the occurrence of weeds on ten farms in Skåne and ten farms in Mälardalen that use different soil tillage systems. The object of the study was also to clarify why the farms had chosen their specific soil tillage system and the consequences it has had on weed occurrence and use of pesticides. The result showed a slightly higher use of pesticides on the farms that use reduced tillage. According to the farmers interviewed in Skåne, occurrence of weed was considered higher in reduced tillage, while the result in Mälardalen was the opposite. More weed species were considered hard to control in Skåne as well as in Mälardalen on the farms that used reduced tillage

Management of patients with STEMI transported with air-ambulance to Landspitali University Hospital in Reykjavík

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)INTRODUCTION: A good outcome of patients presenting with STEMI (ST-Segment Elevation Myocardial Infarction) depends on early restoration of coronary blood flow. Pre-hospital fibrinolysis is recommended if primary percutaneous coronary intervention (PPCI) cannot be performed within 90 minutes of first medical contact (FMC). The purpose of this study was to study transport times for patients with STEMI who were transported with air-ambulance from the northern rural areas of Iceland to Landspitali University Hospital in Reykjavík, and to assess if the medical management was in accordance with clinical guidelines. MATERIALS AND METHODS: Retrospective chart review identified 33 patients with STEMI who were transported with air-ambulance to Landspitali University Hospital in Reykjavík during the years 2007 and 2008. RESULTS: The total time from first medical contact to arrival at Landspitali University Hospital emergency room was 3 hours and 7 minutes (median). All patients received aspirin and 26 (78.8%) received clopidogrel and enoxaparin. 16 patients (48.5%) received thrombolytic therapy in median 33 minutes after FMC and 15 patients had PPCI performed in median 4 hours and 15 minutes after FMC. Estimated PCI related delay was 3 hours and 42 minutes (median). One patient died and one was resuscitated within 30 hospital days. Mean hospital stay was 6.0 days. CONCLUSIONS: First medical contact to balloon time of less than 90 minutes is impossible for patients with STEMI transported from the northern rural areas to Landspitali University Hospital in Reykjavík. Medical therapy was in many cases suboptimal and PCI related delay too long.Inngangur:Horfur sjúklinga með brátt ST-hækkunar hjartadrep ráðast af því hversu lengi kransæð er lokuð. Ef kransæðavíkkun verður ekki viðkomið innan 90 mínútna frá komu til læknis er réttast að veita meðferð með segaleysandi lyfi. Tilgangur þessarar rannsóknar var að kanna hversu langan tíma það tók að flytja sjúklinga með STEMI af Norður- og Austurlandi á Landspítala og hvort læknismeðferð var í samræmi við klínískar leiðbeiningar. Efniviður og aðferðir: Rannsóknin er aftursýn og nær til 33 sjúklinga með STEMI frá Norður- og Austurlandi á árunum 2007 og 2008. Niðurstöður:Heildarflutningstími, frá fyrstu samskiptum við lækni í héraði inn á bráðamóttöku Landspítala, var að miðgildi 3 klukkustundir og 7 mínútur. Allir sjúklingar fengu magnýl og 26 sjúklingar (78,8%) fengu clopidogrel og enoxaparin. 16 sjúklingar (48,5%) fengu segaleysandi lyf að miðgildi 33 mínútum eftir fyrstu samskipti við lækni og 15 sjúklingar (45,5%) gengust undir bráða kransæðavíkkun (PPCI) að miðgildi 4 klukkustundum og 15 mínútum eftir fyrstu samskipti við lækni. Áætluð töf í kransæðavíkkun umfram gjöf segaleysandi lyfja var 3 klukkustundir og 42 mínútur. Einn sjúklingur lést og annar var endurlífgaður innan 30 daga eftir hjartadrep. Meðallegutími á Landspítala var 6,0 dagar. Ályktun: Ekki er mögulegt að flytja sjúklinga með ST-hækkunar hjartadrep innan 90 mínútna, frá fyrstu samskiptum við lækni frá Norður- og Austurlandi og þar til æð hefur verið víkkuð á Landspítala í Reykjavík. Lyfjameðferð var í mörgum tilfellum ófullnægjandi og töf í kransæðavíkkun umfram gjöf segaleysandi lyfja of löng

Sjúkraflutningar í dreifbýli

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Ísland er strjálbýlasta land Evrópu, með um þrjá íbúa á ferkílómetra. Oft þarf að flytja sjúklinga um langan veg til að koma þeim á sérhæft sjúkrahús. Til dæmis eru 407 km í beinni loftlínu milli Reykjavíkur og Norðfjarðar. Óblíð náttúra og erfið skilyrði gera flutninga oft erfiða. Sjúkrabílar í landinu eru 77 talsins, þar af 12 í Reykjavík (mynd 1). Um 400 sjúkraflutningamenn eru starfandi, tæplega helmingur þeirra sinnir sjúkraflutningum í hlutastarfi. Þrátt fyrir fjölda sjúkrabíla hefur sjúkraflug verið talsvert hér á landi um langt skeið. Skýringar á því eru margar. Áætlunarflug er til mun færri staða en áður, flutningur með flugvél er oft mun þægilegri en í bíl og flutningstími styttri. Stundum eru sjúklingar fluttir frá stærri sjúkrahúsum á smærri og virðist það verða æ algengara. Sjúkra- og björgunarflug á Íslandi er á tímamótum þar sem Landhelgisgæslan nýtur ekki lengur liðsinnis þyrlusveitar Bandaríkjamanna á Keflavíkurflugvelli. Verið er að sérútbúa sjúkravél á Akureyri sem sinnir sjúkraflugi þar. Miklum fjármunum er varið til utanspítalaþjónustu í dreifbýli og framfarir hafa óneitanlega verið miklar á síðustu árum en ýmislegt mætti betur fara. Til að mynda er samvinna of lítil á milli rekstraraðila og enginn einn aðili virðist hafa heildaryfirsýn yfir málaflokkinn. Brýnt er að heilbrigðisyfirvöld taki stefnumarkandi ákvarðanir. Höfundar birta hér yfirlit frá sínu sjónarhorni og benda á þætti sem þurfa endurskoðunar við

Patient handover between ambulance crew and healthcare professionals in Icelandic emergency departments: A qualitative study

Background: Ambulance services play an important role in the healthcare system when it comes to handling accidents or acute illnesses outside of hospitals. At the time of patient handover from emergency medical technicians (EMTs) to the nurses and physicians in emergency departments (EDs), there is a risk that important information will be lost, the consequences of which may adversely affect patient well-being. The study aimed to describe healthcare professionals’ experience of patient handovers between ambulance and ED staff and to identify factors that can affect patient handover quality. Methods: The Vancouver School’s phenomenological method was used. The participants were selected using purposive sampling from a group of Icelandic EMTs, nurses, and physicians who had experience in patient handovers. Semi-structured individual interviews were conducted and were supported by an interview guide. The participants included 17 EMTs, nurses, and physicians. The process of patient handover was described from the participants’ perspectives, including examples of communication breakdown and best practices. Results: Four main themes and nine subthemes were identified. In the theme of leadership, the participants expressed that it was unclear who was responsible for the patient and when during the process the responsibility was transferred between healthcare professionals. The theme of structured framework described the communication between healthcare professionals before patient’s arrival at the ED, upon ED arrival, and a written patient report. The professional competencies theme covered the participants’ descriptions of professional competences in relation to education and training and attitudes towards other healthcare professions and patients. The collaboration theme included the importance of effective teamwork and positive learning environment. Conclusions: A lack of structured communication procedures and ambiguity about patient responsibility in patient handovers from EMTs to ED healthcare professionals may compromise patient safety. Promoting accountability, mitigating the diffusion of responsibility, and implementing uniform practices may improve patient handover practices and establish a culture of integrated patient-centered care.Peer reviewe

Nordic responses to Brexit:Making the best of a difficult situation

This policy brief examines how the British decision to withdraw from the EU has influenced the political debates in and foreign policies of the five Nordic states – Denmark, Finland, Iceland, Norway and Sweden. With the exception of Iceland, all these countries had a stated preference for Britain to remain in the EU – not least due to historical ties and the tendency of Britain and the Nordic countries to have similar approaches to European integration. Three general findings can be highlighted: First, Brexit has featured prominently in political debates in all the Nordic countries since the British referendum, and the causes and consequences of the Brexit vote continue to be discussed with vigour. In all the Nordic countries, Brexit has also stirred debates about their current relationships with the EU, prompting EU critics to demand new privileges or opt-outs. Overall, however, the Nordic governments, supported by a stable majority among their populations, have signalled that they wish to preserve their EU membership or current forms of association models, with the access and benefits these provide. Second, for all the Nordic countries, securing good relations with Britain post-Brexit is a key priority, but they have generally indicated that maintaining good relations with the EU must come first. Finally, the Nordic governments are well aware that Brexit could create a vacuum in EU policy-making, perhaps tipping the balance among internal clusters. Britain has been a highly visible member of the ‘Northern’ grouping in the EU, and its absence is likely to be noticed. As the Nordic countries are about to lose what has at times been a powerful ally in EU decision-making, they may have to forge new coalitions to safeguard their interests

Understanding exercise addiction, psychiatric characteristics and use of anabolic androgenic steroids among recreational athletes – An online survey study

BackgroundThe purpose of this paper was to explore maladaptive behaviors among physically active individuals, including exercise dependence and use of anabolic steroids. Both exercise addiction (EA) and use of anabolic androgenic steroids (AAS) correlate to high amounts of exercise and EA have been linked to eating disorders and other mental health problems. MethodsAn internet survey was spread through fitness-related social media. Inclusion criteria were age >= 15 years and exercise frequency >= thrice weekly. Exercise addiction inventory identified those at-risk of EA (rEA). Characteristics of rEA were compared to those not at risk. In a separate analysis, AAS users were compared to AAS-naive individuals. ResultsIn total, 3,029 participants completed the questionnaire. Of these, 11% screened positive for being rEA, and 23% for ED. Factors associated with EA included daily exercise, social phobia, eating disorders and OCD. Risk consumption of alcohol was a negative predictor. Thirty seven participants had taken AAS the last year. These were mainly men, bodybuilders/powerlifters and more often used amphetamines and opioids. DiscussionThis exploratory study supports EA being strongly associated with eating disorders. Identified associations between EA and compulsive or anxiety disorders warrant further research to clarify if these associations arise prior to, together with, or secondary to EA

The short-and long term effect of multidisciplinary obesity treatment on body mass index and mental health

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Markmið rannsóknarinnar var að meta skammtíma- og langtímaárangur fjögurra vikna þverfaglegrar hópmeðferðar vegna offitu með eftirfylgd ásamt því að bera saman árangur þeirra sem fóru í hjáveituað- gerð og hinna sem ekki fóru í slíka aðgerð. Efniviður og aðferðir: Þátttakendur voru 100 sjúklingar sem frá árinu 2007 höfðu lokið fjögurra vikna offitumeðferð með allt að tveggja ára eftirfylgd á Fjórðungssjúkrahúsinu í Neskaupstað (FSN). Að meðferð lokinni fóru 28 sjúklingar í hjáveituaðgerð. Þyngd, þunglyndis- og kvíðaeinkenni auk lífsgæða voru mæld hjá þátttakendum fyrir og eftir meðferð, og síðan aftur með póstsendum spurningalistum í þversniðsgagnasöfnun sumarið 2012. Niðurstöður: Þátttakendur léttust marktækt auk þess sem andleg líðan og lífsgæði bötnuðu eftir offitumeðferð (miðgildi 1,85, líkamsþyngdarstuðull, LÞS stig), og hélst árangur til lengri tíma. Þremur árum eftir að meðferð lauk var þyngdartap ennþá marktækt hjá þeim sem ekki fóru í hjáveituaðgerð (miðgildi 2,13 LÞS stig), en breytingar á andlegri líðan og lífsgæðum voru hins vegar ekki lengur til staðar. Þeir sem fóru í hjáveituaðgerð léttust meira (miðgildi 13,12 LÞS stig) og náðu varanlegri árangri í lífsgæðum og þunglyndiseinkennum. Ályktun: Niðurstöður sýna að þverfagleg offitumeðferð er árangursrík leið til að draga úr offitu og bæta andlega líðan og lífsgæði til skamms tíma. Þegar veitt er eftirfylgdarmeðferð viðhelst árangurinn sem náðst hefur við að draga úr offitu allt að þremur árum eftir meðferð hjá öllum þátttakendum. Hjáveituhópurinn náði meiri árangri í að breyta holdafari sínu og sýndi varanlegri bata á þunglyndi og lífsgæðum. Þessar niðurstöður undirstrika mikilvægi þess að veita langtímameðferð til að stuðla að við- varandi árangri í glímunni við offitu.Introduction: The aim of this treatment study was to evaluate both short- and long-term effects of a multidisciplinary obesity treatment. Long-term outcomes of patients receiving gastric bypass surgery in addition to behavioral obesity treatment were compared with those who did not undergo surgery. Material and methods: The participants were 100 patients undergoing a four week inpatient obesity treatment at the Hospital in Neskaupsstaður (Fjórðungsjúkrahúsið í Neskaupstað (FSN). After treatment was completed, 28 of these patients underwent further treatment, receiving gastric bypass surgery. All patients were followed for two years after completing the four week treatment. Body mass index (BMI), quality of life and symptoms of depression and anxiety were measured for all participants before and after treatment, and again using mailed questionnaires in a cross-sectional data collection in the summer of 2012. Results: Participants achieved statistically significant weight loss (median 1,85 BMI points), improved their quality of life and mental health after four week obesity treatment, and long term results remained significant. Three years after the conclusion of treatment, statistically significant weight loss was still present for patients that had not undergone gastric bypass surgery (median 2.13 BMI points), but improvements in mental health and quality of life were no longer present among subjects who did not undergo surgery. Patients who underwent gastric bypass surgery achieved greater weight loss (median 13.12 BMI points) and longer lasting improvements in mental health and quality of life. Conclusion: Results show that the multidisciplinary obesity treatment is effective in reducing obesity and improving mental health and quality of life in the short term. With follow-up treatment, the weight loss is maintained for up to three years after treatment for all participants. The bypass surgery group lost more weight and showed more permanent improvements in mental health and quality of life. These results underline the necessity of providing long-term treatment in maintaining improvements when treating obesit