Classification of supplied components

Bakgrund: Elektroniktillverkaren The Company implementerade för 4-5 år sedan en ABC-klassificeringsmodell för klassificering av de komponenter som de köper in. Nu vill företaget utmana den nuvarande modellen och utvärdera om de använder korrekta parametrar för klassificering, för att undersöka om det finns möjlighet till förbättring. Därför efterfrågar The Company en ny modell som baseras på den teoretiska kunskap som finns inom området för att kunna göra en jämförelse med den befintliga modellen. Syftet med ABC klassificering är att hantera osäkerheter från leverantörer vad gäller leveranskvalitet, ledtidsvariationer och saldofel. Syfte: Syfte med examensarbetet är att föreslå en metod för att klassificera de komponenter som The Company köper in, och ge rekommendationer för hur denna kan användas. Modellen skall vara applicerbar inom alla The Company’s marknadssegment och utmana den nuvarande modellen. Problemdefinition: Vilka parametrar är lämpliga att använda för att klassificera de komponenter som köps in? Hur skall parametrarna kombineras för klassificering? Hur många klasser är rimligt att använda och hur skall dessa klasser delas in för att modellen ska vara användbar? Metod: Detta examensarbete har utförts med ett holistiskt perspektiv på klassificeringsmetoder. Ett abduktivt arbetssätt har applicerats på både kvantitativ och kvalitativ dataanalys genom intervjuer, benchmarking och data från företagets ERP-system. Författarna har använt sig av en iterativ process mellan teori och praktik. Resultat: Volymvärde, leverantörers ledtidsdifferens och artikelpris är de tre parametrar som The Company rekommenderas att använda för klassificering tillsammans med Ngmetoden. Vidare är rekommendationen att The Company ska fortsätta arbeta med tio klasser och att utgå ifrån 80-20 regeln vid klassindelning. Slutsats: Följande slutsatser om klassificering har dragits: - Det finns klassificeringsmetoder både med en och flera kriterier. Dessa metoder har utvecklats för att skapa en bättre klassindelning och vara mer användarvänliga. - De använda parametrarna kan både vara kvalitativa och kvantitativa, där de förstnämnda generellt sätt kräver mer arbete av användaren. - Det finns inga tydliga teoretiska riktlinjer för hur många klasser som ska användas. Klassindelningen beror oftast på vad som är möjligt i ett managementperspektiv. - Antalet artiklar i varje klass bestäms oftast efter 80-20-regeln eller efter tidigare erfarenheter.Background: The electronic manufacturing company The Company implemented a new model for ABC classification of supplied components about 4-5 years ago. Today, they want to challenge this model and evaluate if they have been using the correct parameters, or if improvement can be made. They wish for a new model that is based on the theory in field, to make a comparison with the existing model. The purpose with the ABC classification is to manage uncertainties from suppliers, in terms of delivered quality, variation in lead times and inventory errors. Purpose: The purpose of this thesis is to suggest a method for classification of supplied components at The Company that challenges the model currently used, and give recommendations on how to use it. The new model should be applicable to all The Company’s market segments. Problem definition: Which parameters are suitable to use to classify supplied components at The Company? How should the parameters be combined for classification? How many classes are reasonable to use and how should these classes be divided in order for the model to be useful? Methodology: This thesis has been performed with a systems approach, to capture the holistic view of classification models. The abductive research method is used with both qualitative and quantitative data collection through interviews, benchmarking and data from ERP system. The authors have used an iterative process between theory and practice. Results: This thesis has concluded that volume value, supplier lead time deviation and unit cost are suitable parameters to use for classification at The Company, together with the Ng-method. The recommendation is to continue working with ten classes, and use the 80-20 rule as guideline to divide the components. Conclusions: The following conclusions about classification could be drawn from this thesis: - Both single criterion and multiple criteria methods exist and are further developed to give better result and be more user friendly. - Input parameters could be of both qualitative and quantitative nature, where the former in general requires more work from the user. - There is no clear theoretical guidelines of how many classes to use, and it should depend on what is possible from a management perspective. - The difference in number of components in each class is often divided according to the 80-20 rule or according to experience

Practices that Facilitate or Hinder Breastfeeding

The overall aim of this thesis was to address delivery and maternity practices that can impede breastfeeding and to develop methods to facilitate breastfeeding. The specific aims were to study 1) breastfeeding hormones in mothers giving birth vaginally and by cesarean section, 2) to what extent mothers roomed- in with their infants at the maternity and what were their attitudes 3) if anti-secretory factor (AF), known to prevent mastitis in animals, could be induced in human milk 4) if latching-on problems in “older” infants could be remediated by skin-to-skin contact with the mother during breastfeeding. Results and methods: Study I; During a breastfeed on the second day blood samples were taken from 20 mothers with normal vaginal delivery (VD) and from17 mothers with emergency cesarean section (CS) for analyses of oxytocin, prolactin and cortisol. The VD mothers had significantly more oxytocin pulses than the CS mothers. Furthermore, CS mothers did not exhibit a rise in prolactin. Mode of delivery, age of infant at first suckling and maternal somatic anxiety were found to affect the number of oxytocin pulses. Study II; One hundred and eleven mothers answered a questionnaire on the current (1990) maternity practices of keeping the infant in their room during the night (NRI) or not. Mothers who left their babies in the nursery at night were more likely to perceive that staff really believed their babies should be there. However, mothers not rooming-in with their babies scored closeness to their babies as less important than mothers who roomed-in with their babies. Study III; Forty mothers were randomly assigned to eat AF inducing cereals (experimental group) or cereals without AF inducing properties (control group). After 4-5-weeks AF was tested in mothers’ milk. A biological test was used. The median AF level in the experimental group (n=12) and the control group (n= 16) differed significantly: 1.1 (0.7- 1.25) units vs. 0.1(0.0-0.5) units (p=0.0001). The frequency of mastitis was reduced in the experimental group compared to the control group (p-value=0.0086). AF levels differed significantly between mothers with and without mastitis (p=0.017). Study IV: One hundred and three mother-infant pairs with latching-on problems were randomly assigned to skin-to-skin contact (experimental group) or no skin-to-skin contact during breastfeeding (control group). Mothers in the experimental group showed significantly more positive feelings towards breastfeeding than mothers in the control group. About the same percentage of infants in both groups started to latch on. However, infants in the experimental group (n=31) began to latch on in a significantly shorter median time than infants in the control group (n=33) that is 2 weeks vs. 4.7 weeks (p-value =0.02). Most of the infants (94%) in the experimental group who began to suckle within 3 weeks had a history of “strong reaction” when “helped” to the breast by the staff with “hands-on latch intervention;” corresponding figures for the control group was 33% (p=0.0001). Conclusions: It is hypothesized that early suckling, within 2 hours after birth may be the main catalyst for inducing early oxytocin pulsatility. Healthy infants should have the possibility to stay skin-to-skin with the mother the first hours after birth, so that they go through the biological program to develop breastfeeding reflexes and start suckling when ready. Infants with latch-problems are often caused by forceful “handson latch intervention” by staff. However, breastfeeding reflexes may be restored even if the infant is several weeks old, if skin-to-skin contact during breastfeeding with the mother is initiated. Skin-to-skin contact seems to relax the mother as well as the baby. Further, new mothers are often influenced by staff’s more or less explicit attitudes regarding expected maternal behaviors in respect to certain hospital practices such as rooming-in. Women with repeated incidence of mastitis might benefit from consuming cereal with AF inducing properties to prevent the reoccurrence of mastitis

Campolybacter spp. in broilers : risk factors at housing level

Campylobacter spp. är en av de vanligaste orsakerna till gastroenterit hos människor världen över. Hantering och konsumtion av kycklingkött har länge varit en känd orsak till campylobacterios hos människa. Då antalet konfirmerade fall av human campylobacterios samt förekomsten av campylobacter hos slaktkycklingar båda ökar, ökar också behovet av uppfödningsrutiner som ger en så låg förekomst av campylobacter som möjligt. Syftet med denna litteraturstudie var att undersöka hur faktorer i stallmiljön, miljön runt stallet samt uppfödarens arbetsrutiner påverkar förekomsten av Campylobacter spp. hos slaktkyckling i konventionell och ekologisk produktion, samt hur sådana riskfaktorer skulle kunna undvikas i uppfödningsarbetet. Det är endast delvis känt hur campylobacter sprider sig till kycklingflockar och vad som utgör riskfaktorer för smitta. God renlighet överlag har visats kunna minska förekomsten av Campylobacter i kycklingflockar. Mekanisk rengöring och desinficering verkar för det mesta vara tillräckligt för att bli av med bakterien mellan två uppfödningsomgångar. Mänsklig hantering av kycklingarna innebär en hygienrisk eftersom människor har kontakt med utomhusmiljön där campylobacter kan finnas. En tydlig hygiengräns med byte av skodon vid inträde i stallet har visat sig vara mer effektivt än desinfektionsbad. Mänsklig hantering har också visat sig öka risken för campylobacter vid så kallad delad slakt, eftersom bakterien kan spridas i flocken när en del av kycklingarna fångas in för slakt. Att andra djurslag finns i närheten av kycklingstallet har visat sig vara en riskfaktor. Smittspridning verkar kunna ske mellan nötkreatursavföring och kycklingar, exempelvis via kontaminerade skodon och kläder. Att nötkreatur drar till sig flugor som kan sprida campylobacter är också en möjlighet. Skadedjur i form av gnagare verkar vara en riskfaktor, antingen som en indikator för dålig allmän hygien eller som potentiell smittreservoar. Vertikala ventilationstrummor på stallbyggnaden (i motsats till horisontella ventiler) är en riskfaktor, möjligen på grund av att flugor lätt kan komma in den vägen. En annan möjlig förklaring är att ventilationstrummorna är svåra att rengöra. Sommarklimat har också identifierats som en klar riskfaktor, och en säsongsvariation finns där förekomsten av campylobacter är högst på sommaren. Prevalensen av Campylobacter spp. har visats vara förhöjd hos ekologiska och andra utomhusfrigående slaktkycklingar. Troligen beror detta på att de har tillgång till en rastgård utomhus. Rastgården har visat sig kunna vara kontaminerad med campylobacter redan innan kycklingarna får tillgång till den, och kan fungera som en smittkälla då kycklingarna sedan vistas i den.Campylobacter spp. is one of the most common causes of gastroenteritis in humans worldwide. Handling and consuming chicken meat has long been a known cause of human campylobacteriosis. Since the number of confirmed cases of campylobacteriosis as well as the prevalence of campylobacter in broilers are increasing, there is a need for broiler rearing routines that keep the campylobacter levels as low as possible. The aim of this study was to determine which factors related to housing, environment and working routines can affect the prevalence of Campylobacter spp. in broilers, both in organic and conventional production systems, and how such risk factors could be avoided in broiler rearing. It is only partially known how campylobacter spreads to broiler flocks, and what constitutes risk factors for infection. Good cleanliness in general has been shown to lower the prevalence of campylobacter in broilers. Mechanical cleaning combined with desinfection seems to be enough to get rid of the bacteria between two rearing batches. Human presence also poses a hygienic risk since humans are in contact with the outside environment where campylobacter usually is present. A distinct hygiene lock where footwear is changed has been shown to be more effective than a desinfective footwear bath. Human handling has also been shown to increase the risk of campylobacter when so called split slaughter is applied, since campylobacter can be transmitted to the flock when part of the animals are caught for slaughter transport. Keeping other types of animals in close proximity to the broilers has also been identified as a risk factor. Transmission of the bacteria seems to be possible between cattle feces and broilers, presumably spread by contaminated shoes or clothes. Cattle also attracts flies which could possibly spread the campylobacter bacteria. Rodents are another type of pest that has been identified as a risk factor. Rodents could simply be an indicator of generally poor hygiene, or they could act as a reservoir for the bacteria. Vertical ventilation shafts are a risk factor, possibly because they enable flies to access the stable. Another explanation is that the ventilation shafts are difficult to clean. Summer season has also clearly been identified as a risk factor since campylobacter prevalence naturally is higher in the summer. A higher Campylobacter prevalence is usually observed in organic and other outdoor free-range broilers. This is probably due to the access to an outdoor area. Such an area can be contaminated before the broilers get access to it, and when they do it can act as a source of infection

Estimation of Norwegian Asphalt Surfacing Lifetimes Using Survival Analysis Coupled with Road Spatial Data

Combinations of different factors and their relative importance have a mixed effect on the longevity of pavements, which are essential to be understood to enhance long-term maintenance planning. This study used spatial road data from Norway followed by integrating temporal-spatial and statistical analyses to show a potential approach to estimate the lifetimes of asphalt surfacing. For the statistical part, a stratified Cox proportional hazard model was used to understand the relationship between longevity of surface mixtures and different factors, while avoiding having predefined assumptions rooted in deterministic modeling. In addition, rutting was used as the response variable to determine distress-specific asphalt surfacing lifetimes and to handle censored data. Inclusion of rutting as the response variable showed that the median technical lifetime of asphalt surfacing is about 2\ua0years shorter than that of the maintenance activity records. The results showed the significance of each covariate; however, aggregate nominal maximum size and heavy traffic volume were consistently the significant covariates across the studied traffic classes. In addition, the results were fitted to reference categories in each covariate to show a practical approach to interpret absolute values of lifetimes from a survival table

25-Hydroxyvitamin D and Peripheral Immune Mediators:Results from Two Nationwide Danish Pediatric Cohorts

(1) Background: We aimed to examine if 25-hydroxyvitamin D (25(OH)D) was related to the peripheral immunological and inflammatory signature both at birth, and in newly diagnosed patients with childhood type 1 diabetes (T1D) and their healthy controls; (2) Methods: The birth cohort consisted of 470 patients and 500 healthy controls. Dried blood samples were collected from the neonates in the period 1981–1999. The newly diagnosed cohort consisted of 460 patients and 453 siblings. Serum samples were collected in the period 1997–2005. A variety of peripheral immune mediators were measured and compared to total 25(OH)D levels (25(OH)D2 + 25(OH)D3). For each immune mediator, the relative change (RC) in the mean level was modeled by robust log-normal regression and correction for multiple testing was performed; (3) Results: Two associations were identified; there was a negative association between 25(OH)D (10 nmol/L increase) and leptin (RC (95% confidence interval (CI)), 0.98 (0.96; 1.00)), and a positive association between 25(OH)D (10 nmol/L increase) and the chemokine, chemokine (c-x-c motif) ligand (CXCL) 8 (RC (95% CI), 1.07 (1.01; 1.13)); (4) Conclusion: CXCL8 and leptin have significant associations with levels of 25(OH)D in the newly diagnosed cohort. These results do not indicate a strong influence of 25(OH)D on the peripheral immunological or inflammatory signature

Hands-on approach during breastfeeding support in a neonatal intensive care unit: a qualitative study of Swedish mothers' experiences

BACKGROUND: Assisting mothers to breastfeed is not easy when babies experience difficulties. In a neonatal intensive care unit (NICU), nurses often help mothers by using hands-on-breast without their permission. Little is known about how mothers feel about this unusual body touching. To gain more knowledge from mothers who lived through this experience, this hands-on practice was studied in a NICU in Sweden. METHODS: Between January and June 2001, in-depth interviews were conducted with ten mothers of preterm or sick term infants and all of them experienced the hands-on approach. In this research, Radnitzky's seven principles of hermeneutic interpretation were applied in order to interpret the meaning of mothers' responses. This article presents results related to the period of initiation of breastfeeding. This qualitative study was based on a combination of the models of Gustafsson, Orem, and Aarts' Marte Meo. RESULTS: Five main themes were identified: Insult to integrity, Manipulating the baby, Understanding and adjustment, Breasts as objects, Alternatives to this practice. Hands-on help in the breastfeeding situation was experienced as unpleasant and the women experienced their breasts as objectified. The mothers accepted the hands-on help given by nursing staff, even though they considered it unpleasant. Most mothers expressed a need for assistance when starting breastfeeding, but could not suggest any alternative to hands-on help such as demonstrating with an artificial breast and a doll. CONCLUSION: The study provides information about how mothers experience unexpected hands-on help with breastfeeding in a NICU, which has not been described previously. Since most mothers in this study regarded this behavior as unpleasant and not helpful mostly because it was unexpected and unexplained, it would be important to either explain beforehand to mothers what type of physical approach could be attempted on their body or better, to avoid this type of approach completely

Современные подходы в формировании прогнозов у больных артериальной гипертензией

ГИПЕРТЕНЗИЯ /ДИАГНКРОВЕНОСНЫХ СОСУДОВ БОЛЕЗНИПРОГНОЗАЛГОРИТМ

Partial Biliary Diversion May Promote Long-Term Relief of Pruritus and Native Liver Survival in Children with Cholestatic Liver Diseases

Introduction Rare cholestatic liver diseases may cause debilitating pruritus in children. Partial biliary diversion (PBD) may relieve pruritus and postpone liver transplantation which is the only other alternative when conservative treatment fails. The aim was to report long-term outcome after PBD in a population of 26 million people during a 25-year period. Materials and Methods This is an international, multicenter retrospective study reviewing medical journals. Complications were graded according to the Clavien-Dindo classification system. Results Thirty-three patients, 14 males, underwent PBD at a median of 1.5 (0.3-13) years at four Nordic pediatric surgical centers. Progressive familial intrahepatic cholestasis was the most common underlying condition. Initially, all patients got external diversion, either cholecystojejunostomy (25 patients) or button placed in the gallbladder or a jejunal conduit. Early complications occurred in 14 (42%) patients, of which 3 were Clavien-Dindo grade 3. Long-term stoma-related complications were common (55%). Twenty secondary surgeries were performed due to stoma problems such as prolapse, stricture, and bleeding, or conversion to another form of PBD. Thirteen children have undergone liver transplantation, and two are listed for transplantation due to inefficient effect of PBD on pruritus. Serum levels of bile acids in the first week after PBD construction were significantly lower in patients with good relief of pruritus than in those with poor effect (13 [2-192] vs. 148 [5-383] mu mol/L; p =0.02). Conclusion PBD may ensure long-term satisfactory effect on intolerable pruritus and native liver survival in children with cholestatic liver disease. However, stoma-related problems and reoperations are common.Peer reviewe

Kvalitetssäkring av frukt- och bärväxter

Projektet har genomförts som ett partnerskapsprojekt där vi dragit nytta av olika deltagares kompetens och resurser. Partners har varit Elitplantstation-en, E-planta, Fritidsodlingens Riksorganisation, Hushållningssällskapet Rådgivning Nord, HIR Malmöhus samt SLU. Syftet med projektet har varit att tillhandahålla ett modernt växtsortiment som är kvalitetssäkrat och som svarar mot de krav som plantproducenter och olika växtanvändare har. Vik-tiga mål i projektet har varit att ta fram ett hållbart system för att utvärdera nya frukt- och bärväxter, utarbeta ett protokoll för utvärdering av växtegen-skaper, genomföra en analys av befintligt sortiment, insamla och påbörja utvärdering av nytt intressant växtmaterial samt kommunicera verksamhet och resultat med producenter, handel och växtanvändare. Resultaten visar att det finns ett stort behov av att förnya sortimentet och omfattningen av det insamlade växtmaterialet tyder på att det finns goda utsikter att hitta bra och intressant material av frukt- och bär-sorter som passar för svenskt klimat. Modellen för införande av nytt växtmaterial inom frukt- och bär i Sverige omfattar insamling, testodling, dokumentering, utvärdering och information

Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries

Background: While recommendations for the optimal distribution of surgical services in high-income countries (HICs) exist, it is unclear how these translate to resource-limited settings. Given the significant shortage and maldistribution of surgical workforce and infrastructure in many low- and middle-income countries (LMICs), the optimal role of decentralization versus regionalization (centralization) of surgical care is unknown. The aim of this study is to review evidence around interventions aimed at redistributing surgical services in LMICs, to guide recommendations for the ideal organization of surgical services.Methods: A narrative-based literature review was conducted to answer this question. Studies published in English between 1997 and 2017 in PubMed, describing interventions to decentralize or regionalize a surgical procedure in a LMIC, were included. Procedures were selected using the Disease Control Priorities’ (DCP3) Essential Surgery Package list. Intervention themes and outcomes were analyzed using a narrative, thematic synthesis approach. Primary outcomes included mortality, complications, and patient satisfaction. Secondary outcomes included input measures: workforce and infrastructure, and process measures: facility-based care, surgical volume, and referral rates.Results: Thirty-five studies were included. Nine (33%) of the 27 studies describing decentralization showed an improvement in primary outcomes. The procedures associated with improved outcomes after decentralization included most obstetric, gynecological, and family planning services as well as some minor general surgery procedures. Out of 8 studies on regionalization (centralization), improved outcomes were shown for trauma care in one study and cataract extraction in one study.Conclusion: Interventions aimed at decentralizing obstetric care to the district hospital and health center levels have resulted in mortality benefits in several countries. However, more evidence is needed to link service distribution to patient outcomes in order to provide recommendations for the optimal organization of other surgical procedures in LMICs. Considerations for the optimal distribution of surgical procedures should include the acuity of the condition for which the procedure is indicated, anticipated case volume, and required level of technical skills, resources, and infrastructure. These attributes should be considered within the context of each country