This thesis, in the field of healthcare logistics, has been carried out at Hjärt- och Medicincentrum (HMC) at the University Hospital in Linköping during the fall and spring of 2012/2013. The thesis is done by two students at Linköping University at master’s level within the framework of Industrial Engineering and Management. As Sweden's county councils should not make a profit or loss, it is important that the councils are aware of how much care processes cost. Kardiologiska kliniken at HMC in Östergötland’s county council is one of the clinics that are profitable. One reason for this is believed to be that the care processes related to patients outside the county, are billed at a higher rate than the actual cost. The aim of this project is to create a spreadsheet template for how the total cost of care shall be calculated for cardiovascular sicknesses, and to calculate the total cost of care for three types of cardiovascular sicknesses. First a rough flow chart of the three cardiovascular sicknesses PTMV, Mitraclips and TAVI, were done in a pilot study. This was done so that the authors better would understand the sicknesses, and to create a first, rough overview of what could be included in the spreadsheet template. This, together with literature about flow charts and Activity Based Costing, decided how detailed the data collection phase would be. Through further interviews and observations a more detailed flow chart of activities could be created for each of the three sicknesses before a merged flow chart was constructed. Interviews were conducted with all categories of personnel involved, to create an accurate map as possible. By using the income statements for Seldingerenheten and Kardiologiska kliniken, and the economy cube and KPP cube of the county council, costs have been identified to either be allocated directly to the sicknesses, spreadsheet objects, or indirectly through the identified activities. The Activity Based Costing generated an expense of 110 376 SEK for PTMV, 356 669 SEK for Mitraclips and 432 159 SEK for TAVI. When comparing these costs with the previous calculated sickness type costs in the KPP cube, it showed that the developed spreadsheet template expects high with 7 000 to 13 000 SEK for the sickness types. This means less than 7% of the current cost. The estimated total cost is considered to be reliable enough to use for a rough calculation of the cost for the three types of sicknesses. Based on the Activity Based Costing a spreadsheet template was created involving how the total cost of care can be calculated. The template includes six overall steps to, in a general way, calculate the cost of care for a sickness type. The first step involves making a flow chart of the type to identify activities. The next step involves that costs must be identified in existing accounting systems, so these, in the third step, can be divided into the six cost items "Staff", "Local", "External Examinations", "Material & Medicine", "Computing & IT" or "Other", depending on where they best fit. In step four, the costs identified as directly linked to the sickness shall be distributed by using KPP or other bases. Then, the remaining costs will be distributed to the identified activities in step five, and in the last step, these costs of the activities will be allocate to the sickness type. The developed spreadsheet template can, according to the authors, be generalized to be useful in other areas in order to easily calculate the total cost of care for a sickness type in the Swedish health care. Its weakness, however, is how many clinics’ costs that are analysed. In this study only the costs of Kardiologiska kliniken finance system was analysed. A more accurate cost would be calculated if costs of other clinics also were examined, instead of being picked directly from the KPP cube. Despite this, the authors consider that the template is useful for a rough estimation of the total costs for different types of sicknesses.

The integrated Membrane Yeast Two-Hybrid technology (iMYTH) was employed to screen the ABCD family of ABC Transporters in S. cerevisiae. The two ABCD members, Pxa1p and Pxa2p were screened against yeast libraries which detected many interactors involved in expected biological processes in accordance with Pxa1p and Pxa2p’s annotated function (i.e. fatty acid metabolism), and unexpected new interactors that may elucidate a new role for the transporters (e.g. oxidative protection). Members of the glutaredoxins and thioredoxins, and associated proteins were found to interact with Pxa1p and Pxa2p. This may indicate that Pxa1p and Pxa2p also play a role in managing the redox environment, protecting against reactive oxygen species. The iMYTH technology was also used to show that Pxa2p is able to form homodimers, and that Pxa1p localization is directly or indirectly dependent on Pxa2p.

ATP Binding Cassette (ABC) transporters are trans-membrane proteins that exist in all phyla. Mutations in this family of proteins can cause inherited diseases like Cystic Fibrosis. ABC transporters consist of dimers of nucleotide binding domains (NBDs) and transmembrane domains (TMDs). NBDs regulate ABC transporters by binding to and hydrolyzing ATP. Although NBD-ATP interactions, NBD-TMD interactions and NBD-water interactions are known to be crucial to the function of these proteins, it is still not clear what structural and energetic factors are involved in the NBD-NTP interactions, how NBD and TMD interact with each other, how water is involved in the functions of ABC transporters and what are the structures and energetics of protein bound water. Molecular modeling and molecular dynamics (MD) simulations were conducted to interpret and predict the structural and energetic factors in control and action of two ABC transporters, CvaB and SUR2B. Water is essential for ABC transporters to carry out their functions, to increase the accuracy of simulations. Therefore, water potentials in molecular modeling and dynamics simulations were improved based on the calculation of water structures from protein surface. Previous study showed the NBDs of ABC transporter CvaB bind tighter to GTP than to ATP at lower temperature but not at high temperature. The MD simulations in this study suggested the velocity of water molecules initiates the temperature dependent functional change of proteins. Previous study found that Ser1387 in the NBD of SUR2B, an ABC transporter in vascular smooth muscles, is critical to Kir6.1/SUR2B channel. The molecular modeling and dynamics simulation conducted on SUR2B showed that Ser1387 is located at a region that contacts a TMD. Upon the phosphorylation, the interaction between the NBD and TMD was enhanced which led to an inter domain movement. Water is essential for ABC transporters to carry out their functions, to increase the accuracy of simulations, and, therefore, the structures and energetics of protein bound water were studied. The water radial distribution function for protein bound water was calculated from 105 atomic resolution protein crystal structures and was found to be sharper than that observed for bulk water.

The integrated Membrane Yeast Two-Hybrid technology (iMYTH) was employed to screen the ABCD family of ABC Transporters in S. cerevisiae. The two ABCD members, Pxa1p and Pxa2p were screened against yeast libraries which detected many interactors involved in expected biological processes in accordance with Pxa1p and Pxa2p’s annotated function (i.e. fatty acid metabolism), and unexpected new interactors that may elucidate a new role for the transporters (e.g. oxidative protection). Members of the glutaredoxins and thioredoxins, and associated proteins were found to interact with Pxa1p and Pxa2p. This may indicate that Pxa1p and Pxa2p also play a role in managing the redox environment, protecting against reactive oxygen species. The iMYTH technology was also used to show that Pxa2p is able to form homodimers, and that Pxa1p localization is directly or indirectly dependent on Pxa2p.

Syftet med denna uppsats är att undersöka hur arbetet med att utveckla och modernisera samhället Oxelösund gick till under expansionsåren 1956 till 1973. Frågeställningarna som studien ska formas kring utgår från följande frågor: Hur såg det konkreta arbetet ut? Vilka åtgärder ansåg man sig tvungen att vidtaga? Hur återspeglas folkhemsideologin i arbetet med att förnya Oxelösund? Det primära materialet till uppsatsen är generalplanen för Oxelösund som låg färdig 1959 och de protokoll som finns bevarade från generalplanekommittéerna, vilka arbetade med att utveckla och förverkliga generalplanen. Undersökningen sker utifrån ett antal nedslagspunkter i planeringsarbetet. Poängen med de olika nedslagspunkterna är att de speglar många olika aspekter på förändringsarbetet, samt kanske framförallt, att de tillsammans ger en övergripande bild av hur man tänkte sig det nya Oxelösund. Resultatet visar att utvecklingen och moderniseringen av Oxelösund i många fall utgick från folkhemsideologins aspekter. Planeringen för det nya samhället genomfördes inte bara som ett lokalt projekt utan även regionala instanser samt instanser på riksnivån var inblandade i arbetet. Stor tilltro fästes också vid experter. Även när det gällde genomförandet av själva arbetet slår folkhemstanken igenom på många sätt. ABC-tanken, där man skilde mellan arbetsplatser, bostäder och centrumfunktioner är genomgående. Analysen av bostadsaspekterna visar att utformningen av dessa var starkt klassrelaterade. Stor ansträngning lades från planerarnas sida på att utforma sociala mötesplatser exempelvis idrottsplatser, lekparker och andra fritidsrelaterade funktioner

The cost management and control are the important topic that most of enterprise operators have to confront with. Facing the increasing competition in enterprise environment, it is, in active respect, necessary to control the cost effectively in order to gain niche in keen market competition; in positive respect, it is to avoid any error policy decision because of inaccurate cost data. In traditional cost accounting, the allocation method of overhead is incomplete so that it is easier to result a distortion phenomenon in production cost structure. For the past years, the management academic world has proved through detailed study and real application that using the Activity-Based Costing (ABC) System can improve the defect of traditional cost accounting. The reasonable operation analysis and the exact cost driver allocation of ABC System will enhance the accuracy of the cost data. This case study company is a sole integrated steel producer in Taiwan. Due to the diversity of products, the company¡¦s production processes are extremely complicated and varied. The existing cost management system is unable to provide an actual cost under the different processes. Therefore, there is a room for improvement in analyzing the cost sharing of product expenses. This report takes the case study company¡¦s BOF plant as an example to research, by means of the process analysis, how to allocate the cost exactly, and to make a new cost system which can match the spirit of ABC. Meanwhile, this report makes a comparative analysis between the original cost system and ABC one. The result of the research revealed that the ABC cost system may truly improve the phenomenon of distortion of the product cost structure in the case study company. Using ABC cost system may not only promote the accuracy of the cost information, but also enhance the working performance under the activities analysis and control and reduce the waste of resources.

Thèse de doctorat : Epidémiologie et Santé Publique : Nancy 1 : 2008. / Titre provenant de l'écran-titre.

Detta examensarbete har utförts på Almroths Åkeri AB i Norrköping. Almroths är ett tredjepartslogistikföretag som inriktar sig på service inom lager och transport såväl som helhetslösningar skräddarsydda för att erhålla en god servicenivå mot slutkund. Stora krav ställs därför på effektiva flöden och hantering av artiklar på lagret. Fokus i detta arbete har koncentrerats på Almroths kund Garden Girl, som säljer trädgårdsartiklar av varierat sortiment med en säsongsbetonad försäljning. Almroths lagerhåller Garden Girls artiklar innan vidare leverans sker mot slutkund. Syftet med detta examensarbete är att effektivisera Almroths verksamhet med hänsyn till plockning av artiklar genom en förbättrad artikelplacering för kunden Garden Girl. Utifrån Almroths affärssystem innehållande artikeldata över Garden Girls efterfråga har en ABC-klassificering genomförts. Denna klassificering ska generera en placering för Garden Girls artiklar som minskar plocktiden. Observationer av Almroths lager har utförts för att kartlägga hur plockningen genomförs i nuläget. En mätning av plockmetoder har genomförts för att jämföra nulägets plockmetod med orderplockning, artikelplockning och zonplockning. Resultatet av ABC-klassificeringen utformas av ett Excelark innehållande en klassificering för samtliga artiklar som förekommer i Garden Girls sortiment. Dessa artiklar delas in i A, B och C klass (A är den grupp med högst antal artiklar placerade i en order) beroende på hur många gånger en artikel plockas. Klass A i ABC-klassificeringen består av artiklar som lagts i en order mellan 36-24 gånger, klass B artiklar mellan 24-7 gånger och klass C artiklar mellan 7-1 gång. Med detta menas att artiklarna i klass A kommer placeras närmst plockcentralen, klass B artiklar därefter och längst ifrån plockcentralen placeras klass C artiklar. Resultatet för mätningen av plockmetoder visade på att orderplockning med två order är den metod som anses effektivast tidsmässigt för Garden Girls artiklar. Vid mätningen framkom att plockning med totalt 100 artiklar kunde generera en tidsbesparing på upp till sju minuter alternativt 30 % med plockmetoden orderplockning om två order plockas parallellt jämfört med en order åt gången. Rekommendationerna gruppen ger till Almroths är att utifrån ABC-klassificeringen, arrangera om Garden Girls artiklarna efter det resultat som tagits fram. Även trots att omplaceringen kräver mycket tid och kapacitet anser gruppen det kommer bli en besparing i framtiden. Avslutningsvis föreslår gruppen att Almroths ska bibehålla sin nuvarande plockmetod orderplockning, med två eller tre order.

Purpose – The study aims to examine why material waste is generated in a production process in the corrugated cardboard industry and identify the products that cause the most waste, and how the classification can be used as a basis for addressing these wastes. Metholodgy – To meet the purpose of the report, a case study has been conducted in collaboration with Stora Enso Packaging AB in Jönköping. The authors first created a theoretical framework that was continously compared and analyzed with the empirical data gathered through observations, interviews and document studies. The empirical data has generated an analysis and discussion of the study's main area. Background – Material waste is a form of waste in the corrugated board industry which creates unnecessary costs in the material flow. These costs are part of what is called quality costs, costs that are estimated at 10-30% of the company's revenue in the Swedish industries. Findings – Based on empirical data collected and studied literature the authors have identified three main reasons why material waste occurs in a production process of the corrugated board industry. The three reasons are; lack of standardized work, lack of internal communication and the lack of quality controls of raw materials. The findings also present how product classification can be used identify the products which causes the most material waste. Conclusions – The authors believe that the main reason behind a lot of the material waste that occurs in the studied process is its varying input. Various grades of raw materials and various settings of the machine makes it difficult to achieve a stable process, which leads to the occurance of material waste. Implications – The identified material waste and its cause is only designed for a corrugated board industry and the shortcomings that the properties of a typical process industry contributes to. The report is based on a case study in the corrugated board industry and could be generalized to most businesses within the same segment. The work, however, may have to be adapted for other activities depending on varying conditions. Keywords – Corrugated cardboard industry, process industry, material waste, ABC analysis,,fishbone,diagram.

Multidrug resistance protein (MRP)1, a member of the ABCC branch of the ATP-binding cassette (ABC) superfamily of transporters, can confer resistance to a broad spectrum of chemotherapeutic agents. In addition to the core functional unit of ABC transporters that consists of two membrane spanning domains (MSD) and two nucleotide binding domains (NBD), MRP1 contains a third MSD (MSD0) resulting in the following arrangement: NH2-MSD-(MSD-NBD)2. In lieu of high-resolution structural information for MRP1, cysteine scanning mutagenesis (CSM) was applied to MRP1 and involves the development of a functional template devoid of cysteines into which paired cysteines can be introduced. Previous attempts to create a functional, cys-less template of MRP1 demonstrated that cysteines in MSD0 were structurally and functional important (1;2). However, given that MRP1 lacking MSD0 remains functional, a partially functional, cys-less MRP1 lacking this domain has been expressed in yeast (3-5). Given these results, with the ultimate goal of applying CSM to MRP1 in its entirety, we investigated the endogenous cysteines within MSD0 and co-expressed MRP1 half-molecules and validated these potential CSM templates by transport and ATP binding/hydrolysis assays. Mutation of cysteines within the core of MRP1 had detrimental effects on MRP1 transport activity and further mutation of cysteines by domain revealed that wild-type activity was retained in an MSD0-less MRP1 dual lacking cysteines in both NBDs. This construct was used for introduction of cysteines on juxtaposed faces of the NBD1:NBD2 heterodimer at positions 775 and 1329; comparable residues in the related Cystic Fibrosis Transmembrane Regulator (CFTR/ABCC7) have been suggested to be evolutionarily coupled and joined by a hydrogen bond, maintained in structures of related proteins (6). Unfortunately, functional assays revealed that introduction of cysteines at these positions greatly reduced transport activity of MRP1 and diminished trapping of nucleotide at both NBDs. Finally, alanine substitution of the seven cysteines in MSD0 was not without effect and cellular trafficking assays, co-expression studies and SDS-PAGE analysis suggested an altered conformation of this domain. In addition, a disulfide pair of Cys7 and Cys32 was suggested by these experiments in MSD0 and further supported by examination of these mutants in full-length MRP1. / Thesis (Master, Pathology & Molecular Medicine) -- Queen's University, 2009-02-17 12:51:38.13