Planering av ett integrerat verksamhetssystem för ett småföretag inom servicesektorn

I dagens läge börjar kunderna intressera sig allt mera för företagens säkerhets- och miljöpolitik. Detta resulterar i att större företag i allt större utsträckning börjar kräva att deras underleverantörer har certifiering och ledningssystem i skick. Detta examensarbete har utförts till en följd av detta. Examensarbetet har utförts som en del av Ab Engman Services Oy’s process i att bli ett mera systematiserat företag. En annan del av syftet har varit att man vill stärka företagets brand. Arbetet har tagit form med hjälp av intervjuer, litteraturstudier och analys av tidigare utförda arbeten och studier. Med detta examensarbete kunde konstateras att man erlagt goda grunder och förståelser inför implementeringsfasen av det integrerade verksamhetssystemet, vilket är nästa fas i projektet mot certifiering enligt standarderna ISO 9001 & 14001 och OHSAS 18001 sommaren 2016 hos Engman Services.Nowadays, customers are showing more and more interest in different corporations’ safety and environmental policies. As a result, larger corporations are widely beginning to require that their subcontractors have certification and management systems in order. This bachelor’s thesis has been executed as a result hereof. This bachelor’s thesis has been executed as a part of Ab Engman Services Oy’s process to become a more systematic corporation. Another purpose of this work has been to improve the company’s brand. The work has been shaped via interviews, literature studies and analyses of earlier performed works and studies. A good basis and comprehension prior to the implementation phase of the integrated management system were created by this thesis. Implementation is the next phase of the project and certification according to ISO 9001 & 14001 and OHSAS 18001 will be carried out during the summer of 2016 at Engman Services.Nykyään asiakkaat ovat yhä kiinnostuneempia eri yrityksien turvallisuus- ja ympäristöpolitiikasta. Tämä aiheuttaa sen, että suuremmat yritykset yhä suuremmassa määrin alkavat vaatia, että heidän alihankkijoilla on sertifioinnit ja johtajajärjestelmät kunnossa. Tämä opinnäytetyö vastaa näihin tarpeisiin. Opinnäytetyö on suoritettu osana Ab Engman Services Oy:n prosessia tulla systematisoituneemmaksi yritykseksi. Toinen syy tähän opinnäytetyöhön on se, että halutaan vahvistaa yrityksen brändiä. Työ pohjautuu haastatteluihin, kirjallisuustutkintoihin ja aiemmin suoritettujen töiden ja tutkimuksien analyyseihin. Tämän opinnäytetyön perusteella voitiin huomata, että on luotu hyviä perusteita ja tulkintoja integroidun toimintajärjestelmän implementointivaiheeseen, joka on seuraava vaihe projektissa: sertifiointi ISO 9001- ja 14001- sekä OHSAS 18001-standardien mukaan, kesällä 2016 Engman Servicellä

Investigating practice variation in a changing primary care. A multilevel perspective on The Skaraborg Primary Care Database

Background and Aims: Differences in the clinical care of patients have been explained through the concept of practice variation, that is, the occurrence of established local medical procedures that varies between geographic areas. The primary measures introduced to eliminate undesirable differences in medical care are the introduction of medical guidelines and economical incentives that rewards the desired behaviour. Practice variation in primary care can be seen on different hierarchically organised levels (e.g. patient, physician, health care center (HCC)) and Multilevel Regression analysis techniques (MLRA) offer a suitable tool to analyse these kinds of data. Data extracted from computerised medical records are ideal for studying practice variation as they often comprise information from several levels. In the region of Skaraborg in Sweden a new database, the Skaraborg Primary care database (SPCD), comprising information extracted form the computerised medical records of all public health care centres has recently been established. The overall aims of this thesis were to examine the usefulness and quality of the SPCD database for research and to study practice variation in some important areas such as diagnosis registration, laboratory analysis ordering and prescriptions. Furthermore, the influence of changes in the economic incentives on physician’s clinical behaviour was investigated. Material and Methods: In all studies data from the SPCD comprising data on individual patients from all public health care centres was used. The registration of diagnoses in the SPCD was validated by comparing the occurrence of recorded diagnosis in the diagnosis register of the database with the free text part of the patient medical records for a randomly selected sample of patients. Multilevel logistic regression analysis was used to investigate practice variation in prescribing and laboratory test ordering, focusing on measures of both frequency and variance. The effects of changes in economic incentives for diagnosis coding and prescribing were examined by comparing multilevel analysis results before and after implementation of the economic incentives. Results and Conclusions: The frequency of registration of ICD codes varied between diagnoses but also between physicians and HCCs. Different diagnoses need to be validated separately. The occurrence of practice variation was demonstrated both in laboratory test ordering where the physician level was the most important level and in prescribing where physician and HCC levels were equally important in explaining the observed variation. A positive effect in adherence to prescribing guidelines was demonstrated after the introduction of a decentralised drug budget. The introduction of a strong economic incentive for ICD coding showed the expected rise in coding rates and decline in variation, directly affecting the diagnoses register of the research database. Changes in the healthcare process will have a direct impact on the research database. Knowledge about the local health care processes is essential when interpreting database data. The SPCD seems as a good complement to previously established databases and quality registers, offering new possibilities when studying primary care

Bacterial interactions across a porous membrane

Deepening our knowledge about bacterial infections is of high priority in the work against antimicrobial resistance. Many infections are as well polymicrobial, and the different bacterial species are able to affect each other by cell-cell communication. This is a phenomenon that in several cases is known to enhance the virulence and the severity of the infection. Therefore, new approaches to study bacterial interactions are needed. In this project we have designed a bacterial growth chamber with a porous membrane as a separating wall between two bacterial species. This gave us the ability to discriminate what molecules that can be exchanged between the bacterial cultures by choosing the membrane properties. The setup allows the two bacterial cultures to be spatially separated, yet chemically connected via diffusion through the growth medium and the porous membrane. Two different kinds of hydrophilic membranes were chosen for investigation of their performance as filters in this membrane setup for bacterial growth: a block copolymer based membrane with a pore size of 10 nm and commercially available Millipore membranes with two pore sizes of 220 and 450 nm respectively. The studied bacterial interaction is between Pseudomonasaeruginosa and Staphylococcus aureus, two commonly found bacterial species in the lungs of patients with Cystic Fibrosis and in chronic wounds. We could conclude that bacterial interspecies cell-cell communication through a membrane was possible in our setup. Further, a double membrane setup with a water phase in between the membranes, showed the same bacterial interaction. This last setup enabled molecular analysis of the water phase and thereby the signal molecules.Kan man tjuvlyssna på bakteriers kommunikation? - I infektioner finns ofta flera olika sorters bakterier och de kommunicerar med varandra. Detta kan förvärra infektionen och leda till antibiotikaresistens. Nya metoder behövs därför för att ta reda på mer om de signalmolekyler som bakterier använder för att kommunicera

Side reactions do not completely disrupt linear self-replicating chemical reaction systems

A crucial question within the fields of origins of life and metabolic networks is whether or not a self-replicating chemical reaction system is able to persist in the presence of side reactions. Due to the strong nonlinear effects involved in such systems, they are often difficult to study analytically. There are however certain conditions that allow for a wide range of these reaction systems to be well described by a set of linear ordinary differential equations. In this article, we elucidate these conditions and present a method to construct and solve such equations. For those linear self-replicating systems, we quantitatively find that the growth rate of the system is simply proportional to the sum of all the rate constants of the reactions that constitute the system (but is nontrivially determined by the relative values). We also give quantitative descriptions of how strongly side reactions need to be coupled with the system in order to completely disrupt the system

Analysis of Body Kinematics and Force Modulation

To analyse the connection between kinematics and stabilizing forces related to human postural dynamics, fourteen normal subjects were investigated with posturography. Stimulation signals according to Pseudo-Random- Binary-Sequence patterns were applied to each subject. The stimulation consisted both of calf vibration and of combined calf vibration and galvanic stimulation to the inner ear. The tests were made with eyes open and with eyes closed. The stabilizing forces and torques against the floor were recorded by a force platform, while the body motions were recorded by an ultrasound system Zebris for measuring 3D-motion. System identification routines were employed to derive connections between the stimuli, the movements, the forces and the torques. Two subspace model identification algorithms were evaluated on the measurement data and the stimulated movement patterns were investigated using variance and correlation analysis. The results from the evaluation showed that the Multivariable Output-Error State Space Algorithm (MOESP) of Verhaegen et al is superior to the Numerical algorithms for Subspace State Space System IDentification (N4SID) in modeling performance. The investigation of movement patterns proved that standing humans exposed to calf vibration and vestibular galvanic stimulation under the test conditions in this study sway as single-segment pendulums

Molecular steps towards improving prognosis in ovarian cancer

Epithelial ovarian cancer (EOC) is the most lethal of gynecological cancers, and cure rates have improved very little in the last 30 years. The most common histological subtypes are serous, endometrioid, clear cell and mucinous EOC. To date, all EOC have been treated as one entity. However, based on epidemiological and molecular studies it is now clear that the different subtypes should be considered as different diseases. Also, low-grade serous and high-grade serous EOC (HGSOC) has distinctive molecular characteristics. The majority of EOCs are HGSOCs characterized by genetic instability, advanced stage at presentation and acquired chemoresistance. There is an urgent need to identify new targets in order to improve prognosis for these tumors. A deregulated energy metabolism is a hallmark of malignant disease that offers possible future targets for treatment. Its major features are an increased aerobic glycolysis and alterations in mitochondrial bioenergetics. This thesis aims at identifying prognostic and treatment predictive markers in advanced HGSOC. We specifically explore the expression of metabolic enzymes and heat shock protein 60 (HSP60) and test the chemo-potentiating effect of glycolysis inhibitor 2-deoxy-D-glucose (2-DG) in vitro. We found a platinum-potentiating effect of 2-DG in two EOC cell lines and 17 freshly isolated ascites EOC samples. We also found the ability of the mitochondrial β-F1- ATPase:HSP60 ratio to predict sensitivity to such combination treatment. We prospectively collected fresh tumor samples from 123 patients undergoing primary surgery for advanced EOC. Of these, 56 met the eligibility criteria with adequate sample RNA yield. Ninety-three percent were high-grade tumors. We performed real- time PCR and immunohistochemistry to study the expression of HSP60, glyceraldehyde-3P-dehydrogenase (GAPDH), pyruvate kinase M2 (PKM2), mitochondrial β-F1-ATPase (ATP5B) and the bioenergetic cellular (BEC)-index. We used Cox proportional hazards models to estimate overall survival (OS) and platinum- free interval (PFI). A high HSP60 mRNA was associated with shorter OS (HR, 3.4 95% CI 1.3-8.5) and PFI (HR, 3.3; 95% CI 1.5-7.2). At the protein level, HSP60 was also of independent prognostic value, with a median survival difference of 24 months between high- and low expressing groups. All patients with low tumor HSP60 protein expression responded to primary chemotherapy. High GAPDH mRNA levels (HR 2.1, 95% CI 1.0-4.5) and low BEC-index mRNA (HR 0.47, 95% CI 0.23-0.95) were both independently associated with shorter PFI. We also compared the mRNA expression of metabolic markers and HSP60 in a series of 25 matched serous solid tumors and corresponding detached tumor cells in ascites. GAPDH, PKM2, ATP5B and HSP60 did not significantly differ in these respective cell states, indicating that further reprogramming of glycolysis or oxidative phosphorylation is not a prerequisite for serous cancer cell survival after detachment. This thesis validates targeting glucose metabolism for increasing treatment efficacy in EOC. Our findings also indicate that HSP60, GAPDH and BEC-index may, within the seemingly homogenous group of advanced HGSOCs, identify patients with different prognosis

Återvinning av asfalt - en fallstudie i Malmberget

This thesis investigates how manufacturing of asphalt containing recycled materials can be conducted when the purpose is to use the recycled material in another road construction. The study show that manufacturing of asphalt containing recycled materials then can be conducted in three ways, through hot, less hot and cold manufacturing processes. The possible use of the final products is dependent on the manufacturing processes since they result in different properties of the products. The choice between different products is not only affected by the possible use and the properties but also the environmental and economical value of the products. Previous studies have shown that environmental and economical value assessments between different recycling methods, associated products and products with no recycled materials is difficult to go through with and that it’s not being realized by asphalt manufactures, recyclers and buyers (public authorities and companies). One area of interest is the law of public procurement in Sweden, which makes it difficult for public authorities to make environmental demands when they procure services and products. This difficulty affects the asphalt manufacturers incentive and possibility to recycle. This thesis also investigates the possibility to recycle asphalt from Malmberget in Sweden and the results show that there are many practical possibilities as well as driving forces for recycling. One of the most important driving forces being the transport distance to landfill areas. The implementation is on the other hand affected by different guidelines for contaminated asphalt, the possibility to use mobile asphalt plants and collaboration possibilities with the local county, the public authority ”Trafikverket” and when the asphalt can be recycled.Hur och varför ska man återvinna asfalt i Malmberget? Tätorterna Malmberget och Kiruna i nordligaste Sverige byggs upp och avvecklas samtidigt i samband med att mineralkoncernen LKAB fortsätter sin gruvverksamhet på båda orterna. Många asfalterade ytor kommer därför att tas bort samtidigt som nya behöver läggas eftersom nya områden med bostäder och verksamheter behöver byggas upp. Frågan om asfalt kan återvinnas från områden som ska avvecklas är därför högaktuell på båda orterna. Asfalt består av stenmaterial och någon form av bindemedel, ofta framställd ur olja. Möjligheterna till att återvinna asfalt är många men det finns i huvudsak ett sätt att göra det på när asfalt ska tas bort från en plats och användas på en annan. Asfalten kan då tas bort med hjälp av någon typ av grävmaskin eller fräsmaskin och därefter blandas i ett asfaltverk med nytt stenmaterial och bindemedel. När asfalten tillverkas sker det i olika temperaturer, 135 – 180 °C om den tillverkas varmt, 50 – 120 °C om den tillverkas halvvarm och upp till 50 °C om den tillverkas kallt. De olika tillverkningsteknikerna (varmt, halvvarmt och kallt) kan i sin tur sägas vara de olika återvinningsmetoderna som man kan återvinna asfalten på. När asfalten sedan har tillverkats läggs den ut på den nya platsen och blir till en ny asfalterad yta. I min studie som handlar om vilka möjligheter det finns att återvinna asfalt från områden som ska avvecklas i Malmberget har jag kommit fram till att det finns goda möjligheter att återvinna asfalten därifrån. Mina intervjuer med flera asfalttillverkare (NCC, Lemminkäinen och Peab Asfalt) har visat att alla kan återvinna asfalt genom alla tillverkningstekniker (varm, halvvarm och kall). Det som i huvudsak kan utgöra ett hinder är istället om asfalten i de områden som ska avvecklas innehåller polycykliska aromatiska kolväten (PAH). PAH och återvinning av asfalt PAH är en stor ämnesgrupp med cancerframkallande ämnen som påverkar möjligheten till att återvinna asfalten. Om det är för höga halter av PAH kan det exempelvis leda till att asfalten måste deponeras och om halterna inte är för höga bör man ändå inte återvinna asfalten genom alla tillverkningstekniker. Vid varm tillverkning kan PAH-innehållet i asfalten resultera i höga luftutsläpp av cancerogena ämnen som i sin tur kan påverka personalen som arbetar med tillverkningen. Halvvarm och kall tillverkning bör därför användas istället då PAH asfalt ska återvinnas. En av slutsatserna i studien är att det är bättre att försöka återvinna asfalt som innehåller PAH i de områden som ska avvecklas i Malmberget istället för att deponera asfalten. Det beror på att transportsträckorna till närmaste deponeringsplats ligger ca 45 mil bort från Malmberget vilket kan ge höga transportkostnader men också utsläpp av växthusgaser om asfalten transporteras med lastbil. Ett annat argument är att avfallsmängderna till deponi och uttaget av ändliga resurser som olja och sten minskar när man återvinner vilket är viktigt att sträva efter för att uppnå en hållbar utveckling

Vilka behov av mertjänster har Areals fastighetsköpare?

Areal is one of the major players in the Swedish market for real estate brokerage of agricultural properties and related additional services. The purpose of this report is to give a better picture of the needs for additional services of property purchasers of Areal. Add-on services are the type of counseling you may need to achieve good economy on an agricultural property. Through a survey of property buyers of Areal information has been collected and compiled. A very good response rate was obtained and the material seemed reliable as it reflected the population in general. The results showed that first-time buyers of properties often have no contact with companies when it comes to counseling. Instead they rely on their own knowledge or on relatives, friends and acquaintances. This is a potential group to turn to in order to offer additional services. It has also been shown that the need for help in the area of taxation, accounting and financial statements are great in general and specifically for those who doesn´t live near their property. Reasons why people choose a particular company are trust, commitment, complete expertise, local presence and personal chemistry. It has also emerged tendencies that Areal does not reach out with their marketing on additional services to all their property buyers. This has shown by several comments in the survey