Expression of Leptospira Biflexa Serovar Patoc Antigens in Escherichia Coli JA221

The genus Leptospira belongs to the order Spirochaetales and the family Leptospiraceae. Currently, there are two Leptospira species: L. interrogans, which includes the pathogenic or parasitic organisms; and L. biflexa, all of which are saphrophytic, free-living leptospires. Approximately 240 different serovars, the final taxonomic subdivision of these organisms, have been reported based on antigenic analysis via microscopic agglutination and cross-agglutination absorption tests. These serovars are categorized into serogroups (approximately 60) due to antigenic cross-reactivity. In addition to antigenic analysis, a number of biological and biochemical tests are used to distinguish the two species including: growth at low temperatures, sensitivity to 8-azaguanine and/or the purine derivative 2,6-diaminopurine, the presence or absence of lipase activity, the ability to grow in trypticase soy broth, and the requirement of 1-2% NaCl for growth. These biological and biochemical tests unfortunately do not distinguish between serovars, therefore serology remains the primary means of identification of the specific serovar. The organisms are flexible, right-handed helical rods that are 0.1 um in diameter and 6-12 um in length. The hooks seen at both ends of this negatively stained Leptospira are typical of the organism. Leptospiras are entirely enclosed in the outer cell envelope or sheath (OS). Inside this OS is the protoplasmic cylinder which contains both cytoplasmic and nuclear regions enclosed by the cytoplasmic membrane-cell wall complex. Around the helical protoplasmic cylinder are wound 2 periplasmic flagella (PF), also commonly called axial filaments or endoflagella. Each PF is subterminally attached to the protoplasmic cylinder. Stuart developed an early culture medium in which the nutritional requirements of leptospiras were provided in the form of a rabbit serum supplement. One major drawback of this medium is that variability in rabbit serum leads to inconsistency in maximal growth of the leptospiras. In 1965, Ellinghausen and McCullough developed an albumin medium for leptospiras, which Johnson and Harris improved upon in 1967. Modified Ellinghausen, McCullough, Johnson and Harris (EMJH) medium or the modified albumin medium of Bey and Johnson are the most commonly used media in the United States. The above described albumin media require preparation of separate albumin supplements and chemically defined basal media which makes media preparation both difficult and time consuming. Medium that supports the growth of leptospiras is now commercially available, but its expense often precludes its routine use

Klímaváltozás - társadalom - gazdaság: Hosszú távú területi folyamatok és trendek Magyarországon

Mattias Mogard Gustav von Heijne Sammanfattning För framgångsrika företag är det essentiellt att ha kontroll över sina resurser. Studien tar upp ett ämne som handlar om att skapa en överblick och en medvetenhet om resurseffektivitet inom ett företags produktion. Performance measurement är ett tillvägagångssätt för att kvantifiera aktiviteterna inom en produktion. Data struktureras genom nyckeltal, Key performance indicators (KPI:er), till övergriplig och användbar information. ISO 22400 är en uppsättning standardiserade nyckeltal med ändamålet att appliceras på automatiserad produktion. Studiens syfte är hitta vilka av nyckeltalen från ISO 22400 som är lämpliga att använda vid mätningen av en helt automatiserad produktionskedja som tillverkar motorblock. Kedjan är en del av produktionen hos den globala lastbilstillverkaren Scania. Resultatet av studien är en uppsättning nyckeltal som tillhandahåller information om maskinerna och en hel order för produktionskedjan. Detta är värdefull information vid arbetet att effektivisera användningen av företagets resurser. Det utvalda systemet av nyckeltal kan optimeras om det testas i praktiken och modifieras utefter behov. Det nuvarande systemet som Scania använder för att mäta och förbättra sin produktion är mer övergripande än det av standardiserade nyckeltal, som är mer detaljerat. De båda system är därmed bra komplement till varandra. Nyckelord: Performance measurement, Key performance indicator, KPI, diskret tillverkning, lean manufacturingMattias Mogard Gustav von Heijne Abstract For successful companies it is essential to have control over its resources. This study covers a topic of getting control and awareness of the resource efficiency within the manufacturing of a company. Performance measurement is a way of quantifying activities of the production and structuring the data into KPIs, Key performance indicators, that makes the information foreseeable and useful. ISO 22400 is a set of standardized KPIs, developed for automated manufacturing. The purpose of the study is to find which of the KPIs from ISO 22400 that is suitable to measure a fully automated discrete production chain that produces engine blocks. The applied chain is a part of the production of the global truck manufacturer Scania. The result of the study is a set of metrics that provides information about the machines and entire orders, which is valuable in the work of streamlining the processes. The system of KPIs could be more optimized if it were tested in practice, and modified after needs. The current system that Scania uses for measuring and improving its production is more overviewing that the one consisting of standardized KPIs, which is more detailed. The both systems are though good complement to each other. Keyword: Performance measurement, Key performance indicator, KPI, discrete manufacturing, lean manufacturin

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Pain and physical function in patients with spondyloarthritis

AbstractAnkylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) are two subgroups of the rheumatic disease spondyloarthritis (SpA). The diseases typically debut in early adulthood with periods of fluctuating and persistent pain and stiffness, and can result in consequences such as impaired functioning and reduced quality of life. SpA is a heterogenous group but AS and USpA share many common features. Most evidence is based on studies of men with AS. The aim was to study chronic pain and physical function, including differences betweenAS and USpA, and between men and women, regarding (I) spinal mobility in relation to disease duration, (II) prevalence of chronic widespread pain (CWP), (III) possible risk factors for development of CWP and having persistent CWP, and (IV) different aspects of pain, including pain sensitivity (pain threshold, pain tolerance, and temporal summation of pain).Adult patients with ICD-10 diagnoses corresponding to AS or USpA identified through registers in the Region Skåne, were included in the studies. In Papers I (n=183) and IV (n=226) two clinical cohorts with an axial disease at Skåne University Hospital were studied. In Papers II (n=940) and III (n=712), cross-sectional and longitudinal data from a population-based survey, including patients with AS or USpA were analysed.Patients with SpA showed decreased spinal mobility over time, most evident in AS, and spinal mobility was more severely impaired in the lumbar and thoracic spine in AS compared to USpA. Few differences, between men and women were found, besides anthropometric measures (Paper I). The one-year period prevalence of CWP was 49% in USpA vs. 45% in AS, and more common in females. CWP was associated with female sex, higher BMI and smoking. Men and women with chronic pain reported similar pain intensity, a novel finding (Paper II). Theprevalence of CWP remained high over time, and risk factors for development of, and having persistent CWP included more pain regions, and worse outcomes in health status, disease activity, mental and physical function, and self-efficacy at baseline. Higher age and being female also predicted persistent CWP (Paper III). Patients within the SpA-subgroups reported similar pain sensitivity and pain intensity, but women reported lower pain tolerance, and higher pain intensity compared to men. Lower pain tolerance was associated with worse outcomes in disease activity, fatigue and spinal mobility. In conclusion, concomitant CWP is common in AS and USpA and often persists over time. Together with the finding of impaired spinal mobility in all SpA, these consequences emphasise regular follow-ups, with attention to risk factors for CWP and an early and combinedmanagement with pharmacological and non-pharmacological treatment

Does a prospective payment system like the DRG induce a moral hazard behavior?

This bachelor essay examines whether a prospective payment system such as the Diagnose Related Group (DRG) reimbursement system create moral hazard behavior like supplier induced demand in the Swedish healthcare market using data from 2012. Supply induced demand in the Swedish healthcare sector is suggested by some descriptive evidence, but is not supported by a controlled regression analysis of an almost universal sample of healthcare consumption in Swedish hospitals

Business model implications of HCT introduction in Sweden

Syfte – Studiens syfte är att öka kunskapen om hur fordonstillverkares affärsmodeller påverkas vid förändring av statliga regelverk genom att studera ett framtida införande av HCT i Sverige. HCT, High Capacity Transports, är ett samlingsnamn för lastbilar som är tyngre och/eller längre än vad gällande lagstiftning tillåter. Regelförändringen övervägs för att sänka kostnader och miljöpåverkan.  Metod – Arbetet har genomförts i form av en case-studie. För att studera påverkan på både fordonstillverkares och åkeriers affärsmodeller har intervjuer genomförts med varuägare, åkerier och förare inom fjärrtransporter av styckegods. Detta har kompletterats med löpande kontakt med uppdragsgivande fordonstillverkare samt deltagande i konferenser inom ramen för det nationella HCT-arbetet.  Resultat – Inget större modalskifte mellan järnvägs- och landsvägstransporter förväntas eftersom järnvägens infrastruktur styr transportvalet och inte påverkas av ett HCT-tillåtande. Vidare riskerar fordonstillverkare att sälja färre lastbilar vid ett tillåtande av HCT men genom anpassning av affärsmodellen kan de öka värdet per fordon. Detta värde kan ökas genom att sänka kundernas driftkostnad, maximera fordonens drifttid och föra kundens talan mot myndigheter.  Praktiskt bidrag – Studien har resulterat i ett nytt affärsmodellsramverk för fordonstillverkare vid införande av HCT. Ramverket visar att samtliga nuvarande värdeområden bör inkluderas i kommande affärsmodell och att flertalet får ökad betydelse. På grund av nya förutsättningar blir vissa av dessa områden dessutom svårare att uppnå samtidigt som nya områden kan läggas till.  Vetenskapligt bidrag – Genom att öka kunskapen om affärsmodellspåverkan vid förändring av statliga regelverk utvidgar studien befintlig teori om förändringar av affärsmodeller. Studien belyser även vikten av att studera hela leverantörskedjan vid sådana förändringar. Detta eftersom statliga regelverk styr förutsättningarna för flera aktörer med starka inbördes relationer. Därmed sprider sig effekterna av en regelverksförändring till övriga aktörer i kedjan.Purpose – The purpose of this study is to increase the knowledge about how legislative changes affect the business model of vehicle manufactures by studying a future allowance of HCT in Sweden. HCT, High Capacity Transports, is a generic term for trucks exceeding today’s weight and/or length regulations. Reasons for implementing HCT include reducing costs and environmental consequences. Method – Effects of legislative changes have been studied through a case-study of how HCT would affect the Swedish transport system. In order to study business model implications for both vehicle manufactures and hauliers, interviews have been held with transport buyers, hauliers and drivers within long distance haulage of break bulk cargo. This has been complemented by continuous contact with the commissioning vehicle manufacturer and participation in HCT conferences. Findings – Findings indicate that there will be no major modal shift between railway and road since the railway infrastructure determines the modal choice and is unaffected by HCT. Furthermore findings show that vehicle manufactures risk to sell fewer vehicles in case of HCT allowance but a business model adaption can increase the value per vehicle. This can be achieved by reducing customer operating costs, increasing vehicle uptime and being the voice of the customer against authorities. Practical implications – The study has resulted in a HCT business model framework for vehicle manufactures. The framework shows that all present value areas should be included in a future business model and that several areas will increase in importance. In the effect of new conditions several areas will become more difficult to fulfill. Furthermore new areas will be added. Theoretical implications – This study expands current theories within business model changes by increasing knowledge about how legislative changes affect business models. Furthermore this study highlights the importance of studying the whole supply chain in the event of these changes. The reason for this is that legislations affect the conditions for several players with strong peer relationships. Thereby effects due to changed legislations will spread to other players in the chain

Modeller för effektiv produktutveckling : En undersökning av produktutvecklingsmodeller i stålindustrin

Utvecklingen i dagens samhälle är snabbt ökande och likaså utvecklingen av produkter i alla branscher. För att idag följa med i snabba förändringar och behålla sina marknadsandelar krävs struktur för framtagningen av nya produkter. Som en följd av detta har vi i detta arbete utgått från stålindustriföretaget Outokumpu som under 2011 och 2012 har tagit fram en ny arbetsmodell för att jobba med produktframtagning. Denna modell är under vårt arbete inte färdigställd och implementerad vilket har lett oss till de frågeställningar och syfte som besvaras i rapporten. Syftet med denna rapport är således att undersöka vilka rutiner som bör finnas vid produktframtagning i stålindustrin och göra utvecklingsprocessen så effektiv som möjligt utan att kvaliteten på den framtagna produkten blir lidande. Resultaten från denna undersökning kan appliceras även på andra områden. De områden som kan tänkas vara intressanta ur ett utvecklingsperspektiv undersöks i det andra kapitlet och ger en bra bakgrund till kapitel fyra där vi har jämfört tre företag i stålindustrin och ett i pappersindustrin. De teoretiska områden som berörs är bland annat riskhantering och projektledning. Med anledning av att den modell vi har som utgångspunkt inte är införd i företaget i sin helhet, undersöks även hur förändringsprocesser går till och vilka aspekter som finns värda att beakta ur den synvinkeln. Detta område kallas för Change Management och samma metoder går ofta att applicera på flera branscher. Det kan även tillämpas när nya produkter kräver justeringar av arbetssätt. Teorin är en sak men verkligheten en annan. Därför undersöks som nämndes några företag i stålindustrin för att jämföra deras arbetsmodeller och sätt att arbeta i utvecklingsprocessen. Detta för att i resultatet inte bara dra paralleller till teorin utan även till lika stor del mellan de olika företagen. Under arbetets gång framkom en del förslag till rutiner vilka en del av företagen redan arbetade med medan en del av dem var helt nya. Bland annat bör det arbetas med parallella aktiviteter på ett uttalat sätt för att öka transparensen för processen inom företaget. Vi kunde dessutom konstatera att Time to market är av betydelse i dagens samhälle på grund av föränderliga marknadsförutsättningar. Vi fann det även viktigt att det finns en eller några personer som idag har full förståelse för hela kedjan från idé till den produkt som marknaden behöver. Som en sista sak kunde vi gällande implementeringen konstatera att är det alltid bra att ha en Change Agent som katalysator i förändringsprocessen.The development around us is rapidly increasing, and the same applies for the development of products in all industries. In order to be able to follow the rapid changes and keep the market share, structure is required for development of new products. As a result we have in this work started from the steel company Outokumpu, which during 2011 and 2012 has developed a new framework for product development. This framework is during our work not completed and implemented which has led us to the questions and the purpose that are answered in the report. The purpose for this report is therefore to determine which routines that should be included in a product development process in the steel industry and make the process as efficient as possible, without a poor quality. The results of this study are also applicable to other areas. The areas interesting from a development perspective are examined in the second chapter and give a good background to chapter four where we have compared three companies in the steel industry and one in the pulp and paper industry. Theoretical areas in chapter two are among others risk management and project management. As a result of the fact that the framework we have as a starting point is not implemented in the company entirely, we are also investigating change processes and important aspects of that area. This area is called change management. Even if the theory says one thing the reality is often something different. Therefore as mentioned earlier some companies in the steel industry are examined in order to compare their development processes and how each company is working with their model. This is because we in the Result chapter shall be able not only to draw conclusions from the theory but also between the companies. During the working process we came up with some suggestions for routines. Some of them the companies already use in their daily work and some are completely new. One of the routines is that the company should work with parallel activities in a distinct way, in order to increase the transparency. We also found that Time to Market is of great importance in the society of today due to changeable market conditions. Additionally, we found it important that there are one or more employees that have a full understanding of the whole process chain, from idea to the product that the market needs. As a last thing, we could regarding the implementation conclude that it is always good to have a change agent as catalysis in the change process

Ett koncept för dynamik på marknaden för handelsövervakningssystem : En studie av förändringar på den svenska marknaden för handelsövervakning i samband med MiFID2/MiFIR och MAD2/MAR

Financial markets have been subjected to numerous regulations during the last two decades. MiFID2/MiFIR and MAD2/MAR are two extensive regulations that will apply on European level during 2016 - 2018. Both these regulations stress areas that are of relevance to trade surveillance. Trade surveillance systems are IT systems applied to the market for financial instruments to identify market abuse or other harmful patterns in participants’ trading activity. The purpose of this report is to map the market of trade surveillance technology in Stockholm, Sweden, and examine the impact on these actors in conjunction with the regulations. Since MiFID2/MiFIR and MAD2/MAR are extensive regulations, these were condensed to key points that were considered as relevant for surveillance.   This research is a qualitative study and data was gathered by interviews with market actors. A pre-study and a literature study were made. These were used as basis to construct an analytical framework for market dynamics, which was used as a descriptive concept to design interview questions, structure data and analyze results. The framework was named Market Dynamics Framework and considered the macro-environmental factors: Technology, Actors’ preferences, Market structure and Regulations.   The market was segmented in order to more accurately examine regulatory impact. Market actors were divided into four groups. The results were analyzed according to the framework and for each of the segmented market actor groups. Preference of surveillance solution was shown to be one distinct difference between every segment. A purchased surveillance system from a vendor was most common, and actors of smaller scale preferred to outsource.   The market is concluded to be prepared in terms of having systems and arrangement for monitoring trades in place. Expected impact is mostly related to new market structures and more detailed data of larger amounts. Increased capacity need for surveillance departments is expected in combination with a need for more advanced technologies; e.g. automatic screening of social media, efficient minimization of false positives, functionality coverage for a broader range of financial instruments.   This research introduces two concepts as descriptive frames, Market Dynamics Framework and a segmentation. These are proposed as methods when conducting a market analysis. A validation study for these methods is suggested as a possible topic for future studies

Användning av nyckeltal, Key performance indicators, som underlag till resurseffektivisering av produktion

Mattias Mogard Gustav von Heijne Sammanfattning För framgångsrika företag är det essentiellt att ha kontroll över sina resurser. Studien tar upp ett ämne som handlar om att skapa en överblick och en medvetenhet om resurseffektivitet inom ett företags produktion. Performance measurement är ett tillvägagångssätt för att kvantifiera aktiviteterna inom en produktion. Data struktureras genom nyckeltal, Key performance indicators (KPI:er), till övergriplig och användbar information. ISO 22400 är en uppsättning standardiserade nyckeltal med ändamålet att appliceras på automatiserad produktion. Studiens syfte är hitta vilka av nyckeltalen från ISO 22400 som är lämpliga att använda vid mätningen av en helt automatiserad produktionskedja som tillverkar motorblock. Kedjan är en del av produktionen hos den globala lastbilstillverkaren Scania. Resultatet av studien är en uppsättning nyckeltal som tillhandahåller information om maskinerna och en hel order för produktionskedjan. Detta är värdefull information vid arbetet att effektivisera användningen av företagets resurser. Det utvalda systemet av nyckeltal kan optimeras om det testas i praktiken och modifieras utefter behov. Det nuvarande systemet som Scania använder för att mäta och förbättra sin produktion är mer övergripande än det av standardiserade nyckeltal, som är mer detaljerat. De båda system är därmed bra komplement till varandra. Nyckelord: Performance measurement, Key performance indicator, KPI, diskret tillverkning, lean manufacturingMattias Mogard Gustav von Heijne Abstract For successful companies it is essential to have control over its resources. This study covers a topic of getting control and awareness of the resource efficiency within the manufacturing of a company. Performance measurement is a way of quantifying activities of the production and structuring the data into KPIs, Key performance indicators, that makes the information foreseeable and useful. ISO 22400 is a set of standardized KPIs, developed for automated manufacturing. The purpose of the study is to find which of the KPIs from ISO 22400 that is suitable to measure a fully automated discrete production chain that produces engine blocks. The applied chain is a part of the production of the global truck manufacturer Scania. The result of the study is a set of metrics that provides information about the machines and entire orders, which is valuable in the work of streamlining the processes. The system of KPIs could be more optimized if it were tested in practice, and modified after needs. The current system that Scania uses for measuring and improving its production is more overviewing that the one consisting of standardized KPIs, which is more detailed. The both systems are though good complement to each other. Keyword: Performance measurement, Key performance indicator, KPI, discrete manufacturing, lean manufacturin