Environmental and Economic Benefits of using Multi-Echelon Inventory Control

Summary This master thesis evaluates the benefits of using multi-echelon control instead of single-echelon control of a multi-echelon inventory system. The multi-echelon inventory system studied in this thesis is a one-warehousemultiple- retailer inventory system. Multi-echelon inventory control is defined as a method to optimize the inventory system by taking the interdependencies between different stock locations in the system into consideration. Single-echelon control on the other hand is defined as optimizing each stock point in isolation and disregarding the interdependencies that exists. There has been extensive research in this area, and the fact that large potential cost reductions exist is well documented. However, little research has been performed to evaluate the environmental benefits that can be rendered by implementing multiechelon inventory control. The purpose of this master thesis is to evaluate the environmental and economic benefits of using a more advanced multi-echelon control method in a real case instead of the commercial single-echelon control method currently used. The hypothesis is that by fulfilling the fill-rates better, the amount of emergency orders can be reduced significantly, and by this also the total CO2-emissions can be reduced. The company studied is Lantmännen Maskin AB (LM) who provides their retailers in Sweden, Norway and Denmark with spare parts for agricultural machinery. The methodology used have been that of an operations research study where both mathematical models and simulations have been used. As a base model a commercial single-echelon model currently used at Lantmännen Maskin has been used, called SCP in this thesis. This model was compared to a more sophisticated multi-echelon model developed at Production Management, Lund University, Faculty of Engineering by Berling and Marklund (2012;2013), called MEM in this thesis. The approach of the project can be divided into five steps; first the data from the case company was gathered. Secondly, an existing simulation model was extended to fit the needs of this study. Thirdly, a stratified sampling was performed on the gathered data to find a representative sample of the case company’s items. Fourthly, the inventory system was optimized with SCP and MEM respectively. Finally, the results from the SCP-model and the MEM-model was simulated and compared. The results show that the average fill-rate was increased with 8.3% from 92.0% to 99.6%, the holding costs went down with 18.1% and the CO2- emissions were reduced with 57.0%. Further, the MEM model shows to be more consistent on achieving target fill-rate, whereas the SCP model varies a lot and delivers some fill-rates which are well below target and some that are above. Sensitivity analysis of the results concerning the CO2-emissions shows that for this case study the emergency orders sent by air do not affect the system very much. The reason is that the emergency transports by air are very few compared to the ones sent by truck. To really examine the benefits that could be achieved with the MEM model compared to the SCP model, a modified case set up was investigated where all emergency orders were assumed to be sent by air. In this case the reduction of CO2-emissions can be as high as 90%. Another important aspect found during this thesis concerning the CO2-emissions is that certain item attributes can make some items affect the CO2-emissions of the whole system in a non-proportional way. Two important factors were found, weight and mean demand. All CO2-emissions are linearly dependent on the weight, and consequently, this is a very important factor. But the second factor has even more influence. The reason for this is that if the mean demand for an item is high compared to other items then this item can have relatively many emergency orders even if the fill-rate is high. This was found during the study where one item, which had a high fill-rate, emitted CO2-emissions equivalent to 68% of the CO2-emissions of all of the studied items. Consequently, the conclusion from the results is that implementing the MEM model instead of the SCP model will reduce the environmental impact. Further, there are other aspects which are important to consider; firstly the MEM model will be more consistent on achieving target fillrates than the SCP model, secondly the reduction of CO2-will be greater in a system using air transport for emergency orders instead of land transport, and finally, the weight and mean demand are important aspects to consider if the environmental impact is to be reduced

En fika på vägen till ett (mer) självständigt liv? - empowermentprocesser på ett aktivitetshus

Studien är en kvalitativ fallstudie kring brukarinflytande och empowerment på aktivitetshuset Gunnareds gård. Syftet har varit att undersöka hur empowermentliknande metoder tillämpas och hur empowermentarbetet upplevs av deltagare och personal. För att få undersöka detta har vi haft följande frågeställningar • Vilka metoder används vid tillämpningen av empowerment? -Hur tillämpas dessa metoder i verksamheten? • Kan deltagarna påverka verksamheten? -Hur/Varför inte? • Hur beskriver personalen de begrepp de arbetar med? • Hur upplevs arbetet med inflytande och empowerment? Resultat Arbetet med brukarinflytande på Gunnareds gård sker främst genom verksamhetens möten och arbetsgrupper. Ett av de resultat som kom fram i vår studie är hur deltagare och personals uppfattning av möten delvis skiljer sig åt. Då personalen ser dessa som demokratiska forum för inflytande uppfattar istället deltagarna dessa som framförallt en källa för information, främst om dagens ’schema’. Det som deltagarna lyfte fram som viktigast och mest stärkande i verksamheten var gemenskap och stöttning från de andra deltagarna, vilket vi uppfattar som en typ av självhjälp. Vi har upptäckt att makt och maktlöshet berörs på olika vis i intervjuerna och observationerna. Det har bland annat varit personalens upplevelse av maktlöshet gentemot överordnade chefer, lagar och riktlinjer. Vi har även identifierat ett förhållningssätt vi valt att kalla ’jämlika förhållanden’ efter Grant Larsons (2008) principer för ett anti-förtryckande arbete. Detta förhållningssätt innebär en strävan från personalens sida för att uppnå goda och jämlika relationer med deltagarna, där bland annat en medvetenhet om språkets betydelse för en jämlik relation ingår

Förberedd inför att handha trycksår? En komparativ tvärsnittsstudie om sjuksköterskestudenters skattning av sin kompetens

Bakgrund. Trycksår är ett ofta förekommande sår och den näst dyraste vårdskadan inom svensk slutenvård. Den årliga kostnaden för trycksår i Sverige är mellan 2-8 miljarder svenska kronor. Tidigare studier uppmärksammar att sjuksköterskor ofta har bristfälliga kunskaper om trycksår och att detta till viss mån skulle kunna bero på brister i sjuksköterskeutbildningen. Syfte. Studiens syfte var att undersöka hur sjuksköterskestudenter i termin sex skattade den erhållna utbildning och om de ansåg sig vara förberedda på att utföra bedömning och behandling av trycksår. Metod. En komparativ enkätstudie riktad mot sjuksköterskestudenter i termin sex utförd på två lärosäten i södra Sverige. Resultatet. Totalt medverkade 106 studenter i studien. Sammantaget uppgav ca 60 % av studenterna att de kände sig mycket/ganska förberedda inför att bedöma och behandla trycksår. Störst osäkerhet kunde ses gällande val av omläggningsmaterial och upprensning av trycksår. En övervägande andel av sjuksköterskestudenter, på båda lärosätena, ansåg att den erhållna utbildningen i mycket/ganska liten utsträckning givit kunskaper och färdigheter om bedömning och behandling av trycksår. Den vanligaste metoden som sjuksköterskestudenterna hade för avsikt att använda, som legitimerade sjuksköterskor, för att uppdatera sina kunskaper var att söka i Vårdhandboken och den minst vanliga var att läsa vetenskapliga artiklar. Konklusion. Fler övningstillfällen i klinisk läromiljö och under verksamhetsförlagd utbildning skulle kunna gynna inlärningen av praktiska färdigheter. Evidensbaserad omvårdnad behöver ta större plats när sjuksköterskestudenter uppdaterar sina kunskaper om trycksår.Background. Pressure ulcer is a common wound and the second most expensive injury during care within Swedish inpatient care. The annual cost of pressure ulcer in Sweden is between 2-8 billion Swedish Kronor. Previous studies note that nurses often have inadequate knowledge about pressure ulcers and that this to some extent could be due to inefficiency in the education of nurses’. Aim. The aim of the study was to explore how student nurses’ valued the obtained education and whether they considered themselves to be prepared to assess and treat pressure ulcers. Method. A comparative survey directed towards term six student nurses’, conducted in two universities in southern Sweden. Result. A total of 106 students participated in the study. Overall about 60 % of the students reported that they felt very/fairly prepared to assess and treat pressure ulcers. The biggest uncertainty could be seen regarding the choice of dressing materials and debridement of pressure ulcers. A majority of student nurses’, at both universities, held that the obtained education had provided knowledge and skills in very/fairly small extent when it came to the assessment and treatment of pressure ulcers. The most common method that student nurses’ intended to use, as registered nurses’, to update their knowledge and skills was to search Vårdhandboken and the least common method was to read scientific articles. Conclusion. More exercises in clinical learning environment and during clinical training could benefit student nurses’ learning of practical skills. Evidence-based treatment aught to take a bigger role when nursing students update their knowledge on pressure ulcers

Development of sliding door concepts for home interior

This report was written as a result of a Bachelor Degree Project at the School of Technology and Society at University of Skövde, first semester 2007. The assigner was Tibrokök in Tibro, Sweden. The commission was originally to design a sliding door concept for kitchen. Later it was expanded to also include bathrooms. During the feasibility study of the project Internet was used as an information source. Kitchen brochures and magazines were ordered from different companies to give inspiration and ideas. A wide range of products from both Tibrokök and their competitors were examined through phone calls, visits and interviews. Because the final products would have to be manufactured by Tibrokök it was also important to know about the company’s resources. The factory was therefore also visited during the feasibility study. A design specification was written together with Tibrokök. This was to work as a control document during the project. To simplify the making of the design specification, a design brief and an objectives tree were first made. The design brief summarizes the commission and goals. The objectives tree helps to clarify all the requirements. With the design specification as a foundation, the period of idea generating was started. During that period a number of creative methods were used to enhance creativity. Methods used were: 6-3-5, brainstorming and collective notebook. Some simple mock-ups were also made to help with three-dimensional thinking. The next step, after the period of idea generation, was to develop the ideas further into concepts. Firstly a selection of ideas had to be made. The remaining ideas were then developed into concepts. The best concepts were then, during meetings with Tibrokök, selected for further development. This procedure was repeated several times. All changes made were recorded into the design specification. The final result was four products: two bathroom cabinets, one room divider and one show case. Prototypes were made of the bathroom cabinets and room divider. All products were also displayed with rendered computerized images. At the conclusion of this report a discussion is given, where the design group members give their opinion of the project, the cooperation with Tibrokök, the final products and what will happen after the project.Denna rapport skrevs i samband med ett examensarbete i integrerad produktutveckling vid Högskolan i Skövde våren 2007. Uppdragsgivaren var Tibrokök och uppdraget bestod i att utveckla nya skjutdörrskoncept för köksmiljö. Uppdraget utvidgades senare till att innefatta även badrum. Till en början, och igenom hela förstudien, användes Internet som en stor informationskälla. Kökskataloger, vilka gav idéer och inspiration, beställdes från olika köksföretag. Med hjälp av telefonsamtal, studiebesök och intervjuer undersöktes konkurrenternas och Tibroköks sortiment. En annan viktig del av förstudien var att undersöka företagets resurser eftersom tillverkningen måste kunna ske i Tibroköks befintliga maskinpark. Efter förstudien upprättades en designspecifikation tillsammans med företaget, vilken skulle komma fungera som ett styrdokument igenom hela arbetet. För att förenkla skapandet av designspecifikationen gjordes först en designbrief, där uppdraget och målsättningen kortfattat beskrevs, och sedan ett kravträd, där i stort sett alla krav fanns representerade. Med designspecifikationen som underlag inleddes idégenereringsfasen. Under fasen användes flertalet kreativitetsmetoder för att underlätta och öka kreativiteten. Metoderna som användes var 6-3-5, brainstorming och kollektiv anteckningsbok. Det byggdes även flera enklare mock-ups som underlättade det tredimensionella tänkandet. Steget efter idégenereringen var att vidareutveckla idéerna till koncept. Denna process inleddes med ett konceptval av de idéer som framkommit under idégenereringen. Därefter utvecklades de valda koncepten vidare för att återigen genomgå ett konceptval och så vidare. Under tiden hölls en nära kontakt med företaget. Alla ändringar som gjordes resulterade i nya krav som fördes in i designspecifikationen. Resultatet blev fyra stycken olika skåp: två varianter av badrumsskåp, en rumsavdelare och ett dekor-/väggskåp. Till badrumsskåpen och rumsavdelaren byggdes prototyper och dessutom gjordes slutgiltiga renderingar till alla skåpen. I avslutningen av rapporten återfinns en diskussion där produktutvecklingsgruppen resonerar kring projektets upplägg, samarbetet med företaget, de slutgiltiga koncepten och även tiden efter projektets slut

Outcome after red trauma alarm at an urban Swedish hospital: Implications for prevention.

We applied the new injury severity scoring system and studied mechanisms of injury and risk factors for mortality, in order to find potential preventive measures, in the present Scandinavian trauma cohort triaged through red trauma alarm according to the Medical Emergency Triage and Treatment System

Analysis of pre-hospital rescue times on mortality in trauma patients in a Scandinavian urban setting

Objective: To analyze if pre-hospital rescue times were associated with mortality in a trauma cohort arriving by ambulance to hospital in a Scandinavian urban setting. Methods: Between 2011 and 2013, individuals and pre-hospital rescue times were identified in Emergency Medical Dispatcher Centre, hospital, and forensic records in red alarm trauma. Major trauma was defined as a New Injury Severity Score (NISS)>15. Results: Overall, 89% of 378 trauma patients received hospital care within 60 min; 51% had a response time of 8 min, and 95% had response time within 20 min. The on-scene time (p15 were found to have the same pre-hospital rescue times as those with NISS15. There was a trend that the occurrence of gunshots was associated with increased mortality (p¼0.074). When entering age, NISS, penetrating versus blunt injury, response time, and on-scene time in a multivariate regression analysis, age (p<0.001), NISS (p<0.001), and penetrating injury (p=0.009) remained as independent factors associated with mortality and a trend for shorter on-scene time (p=0.093). Conclusions: Pre-hospital rescue times had less impact on mortality than injury severity, age, and penetrating trauma. Even though penetrating traumas were associated with shorter on-scene time and shorter transport distance to hospital, mortality was increased in this Scandinavian urban setting

Digestibility index and factors affecting rate of starch digestion in vitro in conventional food preparation

The rate of starch hydrolysis in ten cereal-based food preparations was studied using an in vitro dialysis system. The foods were incubated with human saliva and porcine pancreatin, The sugars released after 3 h digestion were expressed as digestibility index (DI), the percentage starch digested was determined and correlated with the degree of gelatinization (DG). Granule morphology was also investigated and related with starch availability for hydrolysis. Significant differences were observed in the in vitro starch digestibility of the 10 foods (P < 0.05). The DI ranged from 53 for chapathi to 78 for rice flakes. DI was inversely related to the protein (r = -0.79, P < 0.01) fat (r = -0.63, P < 0.05) and energy (r = -0.61, P < 0.01), Percent starch digested was inversely related to the insoluble (r = -0.49, P < 0.05) and total dietary fiber (r = -0.63, P < 0.01) content of the foods. The SEM results provided a better understanding of granular morphology on cooking and the effect of protein on limiting DG. The results suggest that carbohydrate: foods of potential use in the therapeutic diets may be identified by their in vitro digestion characteristics

Antibodies against High Mobility Group Box protein-1 (HMGB1) versus other anti-nuclear antibody fine-specificities and disease activity in systemic lupus erythematosus

Introduction: The non-histone nuclear protein high mobility group box protein-1 (HMGB1) is typically associated with nucleosomes, but may shuttle between the nucleus and the cytoplasm, and under some conditions also be released extracellularly and participate in systemic inflammation. Monoclonal HMGB1-targeting antibodies can ameliorate murine polyarthritis and lupus-like disease. Interestingly, autoantibodies against HMGB1 have also been described in patients with systemic lupus erythematosus (SLE), but their clinical implications remain elusive. The main aims of this study were to detect serum anti-HMGB1 antibodies in patients with SLE and relate them to other types of antinuclear antibodies (ANA), and to disease activity. Methods: 188 Swedish SLE patients meeting the 1982 American College of Rheumatology classification criteria and/or the 2012 Systemic Lupus International Collaborating Clinics classification criteria participated in the study. Anti-HMGB1 antibody levels were analysed in patient and control (n = 112) sera by an in-house ELISA using recombinant histidine-tagged HMGB1. SLE sera were also analysed for ANA by immunofluorescence (IF) microscopy (IF-ANA) using fixed HEp-2 cells, and by a line-blot assay for antigen fine-specificities. To quantify antibodies to double-stranded DNA, a fluoroenzyme-immunoassay was employed. Results: At inclusion, 23 % of the SLE patients were anti-HMGB1 antibody positive compared to 5 % of the controls. Anti-HMGB1 antibodies occurred in 49 % of the IF-ANA positive SLE patients, and in 34 % of IF-ANA negative cases (p = 0.004). Levels of anti-HMGB1 antibodies correlated with anti-dsDNA antibody levels (r = 0.49; p less than 0.001). Significant, but less pronounced correlations were found regarding anti-HMGB1 and SLE disease activity index (SLEDAI-2K: r = 0.15; p = 0.04), classical complement function (r = -0.24; p = 0.002) and complement protein C4 (r = -0.23; p = 0.002). Average anti-HMGB1 antibody levels were significantly higher among patients with homogenous +/- other IF-ANA staining patterns (median 180 AU) compared to IF-ANA negative cases (median 83 AU) (p = 0.004). Rabbit anti-HMGB1 antibodies gave rise to cytoplasmic, but not nuclear, staining of HEp-2 cells. Conclusions: We confirm that anti-HMGB1 antibodies are common in SLE and correlate with disease activity variables. Although anti-HMGB1 antibodies measured by ELISA often coincide with nuclear IF-ANA staining, our results indicate that anti-HMGB1 antibodies do not give rise to nuclear staining of the predominantly used commercial HEp-2 cell slides.Funding Agencies|Swedish Society for Medical Research, Region Ostergotland; Swedish Research Council; Swedish Rheumatism Association; Swedish Society of Medicine; Professor Nanna Svartz foundation; King Gustaf Vs 80-year foundation</p

The inverse association between a fish consumption biomarker with gingival inflammation and periodontitis : a population-based study

AIM: The metabolite 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) is a fatty fish-intake biomarker. We investigated the association between plasma levels of CMPF in relation to gingival inflammation and periodontitis case definition, as well as extent and severity variables. METHODS: The Malmö Offspring Study (MOS) is a population-based study, and the Malmö Offspring Dental Study (MODS) is its dental arm, including periodontal charting. Plasma CMPF was measured using liquid chromatography-mass spectrometry and studied in relation to periodontal diagnosis and parameters using multivariable linear or logistic regression modelling adjusting for age, sex, education, BMI, fasting glucose and smoking. RESULTS: Metabolite data were available for 922 MODS participants. Higher CMPF levels were associated with less gingival inflammation (beta -2.12, p=0.002), and lower odds of severe periodontitis (OR 0.74, 95% CI=0.56-0.98). Higher CMPF levels were also associated with more teeth (beta 0.19, p=0.001), lower number of periodontal pockets (&gt;4 mm) (beta -1.07, p=0.007) and lower odds of having two or more &gt;6 mm periodontal pockets (OR 0.80, 95% CI=0.65-0.98) in fully adjusted models. CONCLUSION: CMPF, a validated biomarker of fatty fish consumption, is associated with less periodontal inflammation and periodontitis. Residual confounding cannot be ruled out and future studies are warranted. This article is protected by copyright. All rights reserved