Automatic information exchange between interoperable information systems: Potential improvement of access management in a seaport terminal

The purpose of this paper is to explore how and when the most beneficial and cost effective information attributes can be automatically exchanged between interoperable information systems of a seaport terminal operator, a road haulier, and a rail operator to potentially improve their access management. The automatically exchange of the attributes is dependent on interoperability between information systems of the involved actors. The interoperability is achieved through a developed application programming interface in this study. This case study adds to prior research by developing a cost-benefits analysis that categorises the attributes (from low cost / low benefit to high cost / high benefit) involving four strategies: data farming, dedicated information exchange, opportunistic information exchange, and avoiding information exchange. These four strategies are important in identifying when to collect the information attributes automatically to facilitate real-time decision-making and in turn potentially improve the access management for the involved actors. is developed in this case study to enable interoperability between the information systems of involved actors. As a change management tool, the cost-benefit analysis can also be used to identify and support transformation of attributes from one category to another. The empirical study included nine workshops resulting in the identification of the most beneficial and cost effective information attributes: deviation information, direction, driver ID, estimated time of arrival, goods priority information, intermodal transport unit (ITU) ID, ITU status, opening hours, shipment ID, and vehicle ID. The attributes must be automatically exchanged according to three identified time phases: one week before, one day before, and two hours before the ITUs are to be picked up at the terminal. By exchanging these attributes between the interoperable actors\ub4 information systems, there is potential for reducing the actors\ub4 turnaround times, increasing their access reliability, access precision, and access flexibility. Finally, two propositions are formulated from the empirical findings and in relation to prior research results

An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales

[Background] The possibility of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We externally validate 2 previously derived prediction rules for community-onset (CO) and hospital-onset (HO) suspected bloodstream infections.[Methods] In 33 hospitals in 13 countries we prospectively enrolled 200 patients per hospital in whom blood cultures were obtained and intravenous antibiotics with coverage for Enterobacterales were empirically started. Cases were defined as 3GC-R-BSI or 3GC-R gram-negative infection (3GC-R-GNI) (analysis 2); all other outcomes served as a comparator. Model discrimination and calibration were assessed. Impact on carbapenem use was assessed at several cutoff points.[Results] 4650 CO infection episodes were included and the prevalence of 3GC-R-BSI was 2.1% (n = 97). IAT occurred in 69 of 97 (71.1%) 3GC-R-BSI and UCU in 398 of 4553 non–3GC-R-BSI patients (8.7%). Model calibration was good, and the AUC was .79 (95% CI, .75–.83) for 3GC-R-BSI. The prediction rule potentially reduced IAT to 62% (60/97) while keeping UCU comparable at 8.4% or could reduce UCU to 6.3% (287/4553) while keeping IAT equal. IAT and UCU in all 3GC-R-GNIs (analysis 2) improved at similar percentages. 1683 HO infection episodes were included and the prevalence of 3GC-R-BSI was 4.9% (n = 83). Here model calibration was insufficient.[Conclusions] A prediction rule for CO 3GC-R infection was validated in an international cohort and could improve empirical antibiotic use. Validation of the HO rule yielded suboptimal performance.J. R.-B. receives funds for research from Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), co-financed by the European Development Regional Fund “A Way to Achieve Europe,” Operative Program Intelligent Growth 2014-2020.Peer reviewe

Five-year mortality in a cohort of people with schizophrenia in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Schizophrenia is associated with a two to three fold excess mortality. Both natural and unnatural causes were reported. However, there is dearth of evidence from low and middle income (LAMIC) countries, particularly in Africa. To our knowledge this is the first community based report from Africa.</p> <p>Methods</p> <p>We followed a cohort of 307 (82.1% males) patients with schizophrenia for five years in Butajira, rural Ethiopia. Mortality was recorded using broad rating schedule as well as verbal autopsy. Standardized Mortality Ratio (SMR) was calculated using the mortality in the demographic and surveillance site as a reference.</p> <p>Result</p> <p>Thirty eight (12.4%) patients, 34 men (11.1%) and 4 women (1.3%), died during the five-year follow up period. The mean age (SD) of the deceased for both sexes was 35 (7.35). The difference was not statistically significant (p = 0.69). It was 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to7.87). Rural residents had lower mortality with adjusted hazard ratio (HR) of 0.30 (95% CI = 0.12-0.69) but insidious onset and antipsychotic treatment for less than 50% of the follow up period were associated with higher mortality, adjusted HR 2.37 (95% CI = 1.04-5. 41) and 2.66(1.054-6.72) respectively.</p> <p>Conclusion</p> <p>The alarmingly high mortality observed in this patient population is of major concern. Most patients died from potentially treatable conditions. Improving medical and psychiatric care as well as provision of basic needs is recommended.</p

Invasive Staphylococcus aureus infections

Staphylococcus aureus is a leading cause of septicaemia-related death. The aims of this thesis were to describe the epidemiology of invasive Staphylococcus aureus infections (ISA), the clinical course, and serological response in ISA in a prospective, population-based study. The antibody response was compared with the serological findings in healthy individuals. During two years 170 episodes of ISA were registered, with an incidence of 33.9 cases/100,000/year. Haemodialysis (relative risk 291) and peritoneal dialysis (relative risk 204) patients were at the highest risk. Soft tissue infections, bacteraemia without focus, infections of intravenous lines, and joint/bone infections were the most common diagnoses. The spectrum of signs and symptoms was wide, with nearly a quarter of the patients being afebrile. The mortality rate was 19.1% (28-day mortality), with an annual population mortality of 5.9/100,000. Patients with complicated bacteraemia (32% of all episodes) had a mortality rate of 32%, and patients with severe sepsis (30% of all episodes) 54%. Patients with bacteraemia without focus, patients with respiratory infections, and patients with endovascular infections had the highest mortality figures . Only severe sepsis and low systolic blood pressure were independent factors for mortality in a multivariable regression model. We found a relapse rate of 9.3%, and a rate of remaining symptoms after the antibiotic treatment had ended of 34%. Sequelae were seen among 60% of the patients with arthritis. The frequency of different agr, accessory gene regulator, groups was not correlated to the disease entities. The antibody response in ISA showed a great variability. Patients with a fatal outcome produced lower amounts of antibodies to all antigens, and significantly to four antigens (teichoic acid, lipase, enterotoxin A, and scalded skin syndrome toxin). The same trend was noted for patients with a complicated course of infection. Healthy carriers of S. aureus in the nares had higher levels of antibodies to all eleven tested antigens, and significantly to five, than non-carriers. Ages over 65y showed only slightly lower levels

Egensinnig dialektik : En studie i frigörandets paradox i dialog med Hegel och Judith Butler

Hegel’s master-slave dialectic has often been used as a model or starting point for later theories about emancipation and subversive changes in society. But one often overlooks the fact that the chapter in The Phenomenology of Spirit ends in disaster, as Judith Butler remarks. Instead of realising freedom, the consciousness gets entangled in self debasing activities in its attempts to master the unrelenting principles of the abstract freedom. We get “the unhappy consciousness”. This development is further examined in this essay in dialog with Butler and Slavoj Žižek, amongst others. Focus is placed on the concept of stubborn attachment (Eigensinnigkeit) and the paradoxical role this plays in the development towards freedom. What are the possibilities for transcending a detrimental relationship like the one between slave and master according to the Hegelian dialectic? A conclusion drawn here is that the two chapters about the master and the slave and “the unhappy consciousness” together exemplify Hegel’s assertion of the necessity of having both the abstract, universal freedom – which often take extreme expressions in its one-sidedness – and its concrete correspondence. This aspect is easily overlooked with Butler’s Foucault-inspired view on resistance – a suggestion that also will be further developed in the following

Peers, policy, and attitudes as drivers of antibiotic prescribing

In this study we investigated how treatment norms about antibiotic use affect a doctor´s decision to prescribe antibiotics. We also investigated the attitudes and behavior of the same physicians as private persons. We find that compared with ordinary citizens, physicians are more worried and more well-informed about antibiotic resistance and use, yet they consume more antibiotics and are less willing to limit their personal use of antibiotics. There is a strong correlation between a doctor´s decision not to prescribe and the treatment norms, i.e., the perception of the common choice among physicians considering antibiotics prescription and the guidelines of antibiotics use. We also find a strong connection between professional and private attitudes: Although physicians themselves on average use more antibiotics than the general public, those who are willing to abstain from using antibiotics as a private person are also more willing not to prescribe antibiotics to their patients.JEL-code: I11; I1

Measurement of p- and s-wave velocity in material using ultrasonics

The velocities of propagating elastic waves can be used to determine the amount of damage in form of induced microcracks in rock materials and other materials. An increasing number of microcracks yields lower propagation velocities. To assess the damage, e.g. around tunnels caused by the excavation, is of interest since the damage affects the material properties, such as mechanical and thermal properties and permeability. A new ultrasonic testing system ULT-100 from GCTS (Geotechnical Consulting and Testing Systems), aimed for measurement of p- and s-wave velocities, was evaluated. Reference cylindrical specimens in aluminium with different sizes were manufactured and a series of tests were conducted in order to find suitable wave arrival picking methods and to determine equipment specific constants which are needed to be determined. The procedure to do this was according to an ASTM standard. Expanded measurement uncertainties for the wave velocity measurements were calculated according to Guide to the Expression of Uncertainty in Measurement (GUM). Equipment such as sensor holders and fixtures were manufactured in order to be able to conduct repeatable measurement on specimens. One test rig was made to carry out tests on nearly unloaded specimens in one direction and another was made for tests on axially loaded cylinders in a standard load frame with measurements in the axial plus two lateral directions. A Round Robin test was carried out on the three different types of testing equipment, one at SP, one at Swedish Cement and Concrete Research Institute (CBI), and one at Finnish Geological Survey (GTK) in Finland to evaluate the measurement results on p-wave velocity measurements. The results of the measurements were mainly in line with the calculated measurement uncertainties. The report is directed to persons working with wave velocity measurements using ultrasonics with particular interest of quality assurance of the measurements, which includes calibration, validation and uncertainty estimation

Who is willing to stay sick for the collective? – Individual characteristics, experience, and trust

This paper deals with the collective action dilemma of antibiotic resistance. Despite the collective threat posed by antibiotic resistance, there are limited incentives for individuals to consider the contribution of their decisions to use antibiotics to the spread of resistance. Drawing on a novel survey of Swedish citizens (n=1,906), we study factors linked to i) willingness to accept a physician’s decision not to prescribe antibiotics and ii) willingness to limit personal use of antibiotics voluntary. In our study, 53 percent of the respondents stated that they would be willing to accept the physician’s decision despite disagreeing with it, and trust in the healthcare sector is significantly associated with acceptance. When it comes to people’s willingness to voluntarily abstain from using antibiotics, a majority stated that they are willing or very willing not to take antibiotics. The variation in willingness is best explained by concerns about antibiotic resistance and experience of antibiotic therapy, especially if a respondent has been denied antibiotics. Generalized trust seems to be unrelated to willingness to abstain, but the perception that other people limit their personal use of antibiotics is linked to respondents’ own willingness to do so. Few of the individual characteristics can explain the variation in that decision.JEL: D90, I1

Tillfällig avstängning av plaströrsledningar genom sammanklämning - kunskapsläge

Temporary closure of plastic pipes by squeeze-off - state of the art State of the art and present use of squeeze-off methods for temporary closure of polymer pipelines for water and gas was investigated by an enquiry and a literature study. A limited, supplementary series of tests was also performed. The aim was to find, if possible, general limitations for use in terms of temperature at squeezing, pipe dimensions and materials, and to identify important problems that have to be analysed before guidelines can be issued regarding the use of the method. Some producers, suppliers and users in Sweden, were interviewed by the aid of a questionnaire. Although the investigation was limited, the answers are so homogeneous that they are considered representative. The belief is that the technique is harmful. It is used mostly for PE 80 and PE 100 materials and when necessary, e. g. when no valves are available. Decisions and risk assessments are mostly made ad hoc. The performance is according to manuals from producers and suppliers. Design of equipment, geometry, and recommended squeeze rates varies among suppliers. The literature on pipes consists mainly of papers from the 80-ies and 90-ies and from some research groups in the USA. There is a heuristic knowledge about formation and appearance of damage, and to some extent about the influence on service life. Newer research on general damage and fracture in polymers is available that is not related to the specific conditions in squeezed pipes. Such models are lacking, which may be due to the complexity of the area and its hands-on character. The commonly used PE 80 and PE 100 materials are clearly damaged by squeezing, particularly so for high compression levels, but the pipes still fulfil the requirements for use. Stronger and more crystalline materials, and larger pipe sizes, seem to be more severely damaged. It is not known how the damages influence slow crack growth and life. Squeeze-off on PE pipes with external longitudinal scratches should strictly be avoided. Also squeeze-off on PE pipes with PP coating at low temperature should be conducted with precaution until the opposite have been proven as some damage cases were reported. Removing the PP coating is recommended by some in this case. The experiments, on one old PE 80 pipe and two new PE 100 pipes with dimensions from 315 to 355 mm confirm the picture of damage. Commercial equipment was used and according to the supplier’s manual. All the pipes show similar damage, with crack formation and unevenness. Those are less significant for thinner pipe walls than for thicker ones. There is no apparent difference between new and old pipes. A few pressure tests were carried out on the squeezed pipes as well as the untouched pipes. The results show that no significant reduction of the lifetime could be proven regardless when an interrelated comparison between a squeezes and not squeezed pipe was made or when the lifetimes were compared with those obtained in earlier available material classification tests for the actual materials