. / This study is about the on-ground implementation of sustainable farm practices supported by policies and directives that form the core of the European Union’s sustainability policy. Its goal is to identify the blockers to effective policy implementation in order to improve the approach to sustainability in the agricultural sector. Exploring ways to engage local stakeholders in farm sustainability has been central to create a holistic understanding about the processes that drive practices in agriculture systems, and the extent to which these processes can be transformed. Sustainability in agriculture is a broad topic, hence this study focuses on one segment of sustainability namely the use and management of water resources in irrigated agriculture. The study’s final recommendations to improve policy design and interventions, however, are general and apply to the implementation of all sustainable farm practices. Practical effectiveness of EU policies and directives for sustainable agriculture is constrained by: a lack of evaluating criteria to measure policy impact and communicate progress; incentives for growers to commit to more than the minimum required, and continuous local renegotiation of proposed measures and programmes which have contributed to a weakening of initial policy proposals. This study demonstrates that policies serve different purposes for different people at different social and political levels. However, sustainability comes into practice on the farm, which is why farmers’ perspective about a sustainable agricultural sector and the proposed voluntary and mandatory policy measures is so important. Farmers’ perspectives are still missing elements in policy design for sustainable agriculture. Co-developing and testing technologies that are meant to deliver sustainability in practice, as well as farm decision support tools, are critical in engaging farmers and other local stakeholders in sustainability and to transform embedded practices and institutions. Collaboration across disciplines is also important to address environmental goals and farmers’ needs in order to extract substantial environmental benefits as well as a long term commitment from land managers in sustainability. This study shows that there are many insights to be gained and learnings to be extracted from scrutinizing policy interventions. It raises awareness about improving policy implementation by providing practical examples from case studies conducted in Spain and in Italy. These insights encourage the use of interdisciplinary approaches, including socio-technical approaches, for an integrated people and technology based perspective on natural resource management to better policy design and interventions and make sustainable agriculture real.

Renny Varghese Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting (Under the direction of Russell Toal, Associate Professor) Electronic medical records (EMRs) have become recognized as an important tool for improving patient safety and quality of care. Decision support tools such as alerting functions for patient medication allergies are a key part of reducing the frequency of serious medication problems. Kaiser Permanente Georgia (KPGA) implemented its EMR system in the primary care departments at Kaiser's twelve facilities in the greater metro Atlanta area over a six month period beginning in June 2005 and ending December 2005. The aim of this study is to analyze the impact of the EMR implementation on the number of drug allergy overrides within this large HMO outpatient setting. Research was conducted by comparing the rate of drug allergy overrides during pre and post EMR implementation. The timeline will be six months pre and post implementation. Observing the impact of the incidence rate of drug allergy alerts after the implementation provided insight into the effectiveness of EMRs in reducing contraindicated drug allergies. Results show that the incidence rate of drug allergy overrides per 1,000 filled prescriptions rose by a statistically significant 5.9% (ñ > 0.0002; 95% CI [-1.531, -0.767]) following the implementation. Although results were unexpected, several factors are discussed as to the reason for the increase. Further research is recommended to explore trends in provider behavior, KPGA specific facilities and departments, and in other KP regions and non-KP healthcare settings. INDEX WORDS: electronic medical records, drug allergy overrides, patient safety, medication errors, decision support tools, outpatient setting, primary care, computerized provider order entry

The diagnostic imaging (DI) literature identifies that unnecessary examinations are occurring. However, there is a gap in the research literature: little is known about how physicians order DI examinations and what efforts need to be undertaken to reduce the number of inappropriate orders made by physicians. Such research is needed in order to promote patient safety and improve utilization of limited health care resources Purpose: The purpose of this study is to explore how physicians order DI services, and what efforts could be made to reduce inappropriate DI ordering. Participants: 12 English speaking, non-radiologist physicians (general practitioners and specialists) participated in this study. Methods: Semi-structured key informant interviews were conducted with participants. Data from these interviews were analyzed using a grounded theory approach. Results: DI ordering practices (both appropriate and inappropriate) emerged as the dominant theme in this research, specifically in the context of prevalence, decision-making, information support, contributing factors, and solutions. Particularly, the majority of participants felt that DI is overused in the medical field and identified contacting physicians (colleagues, specialists, or radiologists) and consulting the literature (using UpToDate® or Google Scholar) as their top methods of information support used in challenging clinical scenarios. Meanwhile, participants suggested factors that contribute to inappropriate ordering: patient demand, legal liability, and duplicate ordering. The majority of participants believed education could reduce inappropriate ordering. Participants also identified increasing communication about requisitions and restricting DI ordering authority as potential solutions to reduce inappropriate ordering. Conclusion: From the interviews, ordering (both appropriate and inappropriate ordering) emerged as the overarching theme. Findings were compared and contrasted to the current literature. Overall, this study revealed how human factors, such as patient demand, influence how a physician orders DI. As well, the majority of participants relied on the patient to recall patient DI history; however, literature suggests this method is unreliable. This study also offers unique insight into the physician’s perspective of what would be effective for reducing inappropriate ordering. These findings contribute to the field of health informatics as any technology developed to reduce inappropriate ordering (such as a clinical decision support system) needs to consider these human factors to support user acceptance. Through findings from this study, further research gaps emerged that can guide future research. / Graduate

Distributed infrastructures (e.g., water networks and electric Grids) are difficult to manage due to their scale, lack of accessibility, complexity, ageing and uncertainties in knowledge of their structure. In addition they are subject to loads that can be highly variable and unpredictable and to accidental events such as component failure, leakage and malicious tampering. To support in-field operations and central management of these infrastructures, the availability of consistent and up-to-date knowledge about the current state of the network and how it would respond to planned interventions is argued to be highly desirable. However, at present, large-scale infrastructures are “data rich but knowledge poor”. Data, algorithms and tools for network analysis are improving but there is a need to integrate them to support more directly engineering operations. Current ICT solutions are mainly based on specialized, monolithic and heavyweight software packages that restrict the dissemination of dynamic information and its appropriate and timely presentation particularly to field engineers who operate in a resource constrained and less reliable environments. This thesis proposes a solution to these problems by recognizing that current monolithic ICT solutions for infrastructure management seek to meet the requirements of different human roles and operating environments (defined in this work as field and central sides). It proposes an architectural approach to providing dynamic, predictive, user-centric, device and platform independent access to consistent and up-to-date knowledge. This architecture integrates the components required to implement the functionalities of data gathering, data storage, simulation modelling, and information visualization and analysis. These components are tightly coupled in current implementations of software for analysing the behaviour of networks. The architectural approach, by contrast, requires they be kept as separate as possible and interact only when required using common and standard protocols. The thesis particularly concentrates on engineering practices in clean water distribution networks but the methods are applicable to other structural networks, for example, the electricity Grid. A prototype implementation is provided that establishes a dynamic hydraulic simulation model and enables the model to be queried via remote access in a device and platform independent manner.This thesis provides an extensive evaluation comparing the architecture driven approach with current approaches, to substantiate the above claims. This evaluation is conducted by the use of benchmarks that are currently published and accepted in the water engineering community. To facilitate this evaluation, a working prototype of the whole architecture has been developed and is made available under an open source licence.

The purpose of this study was to increase the knowledge for both academia and practitioners on how to integrate sustainability aspects in product development by studying current research and comparing these findings to empirical material retrieved from an industrial company. Seco, which functioned as the case company of this study, was used as the source for the empirical data collection. The study used a deductive research approach, which implicates that the literature has steered the collection of the empirical material. In the literature, eight key drivers and seven challenges for sustainable product development were identified to be significantly important. The drivers were categorized as either internal or external for an organization and the challenges were all categorised as internal. Of these eight drivers, one internal and one external driver was identified at Seco to be particularly important. The internal driver was the corporate sustainability strategy from Sandvik Group, which is the corporation Seco is part of, and the external driver was upcoming and existing regulations. Moreover, all six challenges were found to be relevant for Seco. These were handling trade-off situations, short-term economic thinking, lack of information in early phases of product development, measuring sustainability, sustainability strategy remains at the strategic level, and perceived risk of implementing sustainability. This study also examined what attributes that are important in decision support tools to enable the integration of sustainability aspects in product development. To identify important attributes in this study, Seco’s current decision support tools at the strategic, tactical, and operational planning levels were analysed by putting the theoretical framework in relation to the empirical material. From the analysis, the initial seven attributes from the theoretical framework were complemented with the following five attributes identified as important: a top-down approach that focuses on integrating sustainability on all planning levels of the product development process, enabling follow-up on strategic decisions, reduce the room for free interpretations, reduce the complexity and amount of time to use decision support tools, and lastly methodologies to support the collection of the required information to use decision support tools. Thus, it is emphasized that researchers and practitioners continue to develop new and existing decision support tools so that the sustainability of products can be defined and measured. A focus on developing methodologies that guides how the required information can be obtained to use decision support that incorporates all life-cycle phases of a product is also identified as important.

Increasing awareness of anthropogenic impacts on the planet has lead to efforts to reduce negative environmental impacts in product development for several decades. Benefits to companies who focus on sustainability initiatives have been put forth more recently, leading to many efforts to incorporate sustainability considerations in their product innovation processes. The majority of current sustainability considerations in industry constrain design space by emphasizing reduced material and energy flows across the product’s life cycle. However, there is also an opportunity to use awareness of sustainability to bring attention to new facets of design space and to drive innovation. Specifically there is an opportunity for product-service systems (PSS) to be a vehicle through which sustainability-driven innovation occurs. A framework for strategic sustainable development (FSSD) provides the basis for understanding sustainability in this work, and provides clarity with regard to how to think about sustainable products and service innovations. The “backcasting” approach included in this framework also provides insight into how incremental and radical approaches could be aligned within the product innovation working environment. This thesis explores how sustainability considerations can be better integrated into existing product innovation working environments in order to drive innovation processes within firms, with a specific emphasis on opportunities that occur as sustainability knowledge leads to innovation through a product-service system approach. It endeavors to contribute to both theory development within the emerging sustainable PSS design research area, and also to advance the state of practice within industry by connecting dots between the state of theory and the state of practice. Society’s opportunity to become more sustainable and industry’s desire for innovation in order to lead to or increase profitability are often in conflict. However, this thesis argues that knowledge of global social and ecological sustainability can be used to drive innovation processes, and that there are win-win opportunities that can often be achieved through a PSS approach. There is some, but not sufficient, support for the inclusion of sustainability considerations in the product innovation process, and even fewer tools to support the use of sustainability to drive innovation. In response, an approach to providing support that brings together the FSSD and various approaches to systems modeling and simulation is presented. Opportunities to use sustainability-friendly attributes of existing products through a PSS-approach are also presented.

Healthcare systems, driven by increased demand due to growth in chronic diseases and population, suffer from lack of staffing and facility resources. Many major hospitals have long waiting lists and have subsequently pushed their production close to maximum capacity due to the high demand for services. The consequences are lack of overview of the operations and lack of coordination between healthcare staff, which leads to treatment delays. Surgery planning or scheduling is an important part of production planning in hospitals, which is considered highly complex due to high variability and many decisions variables that need to be considered. Those responsible for surgery planning are often considered to lack the right tools to support them in evaluating the many different decision factors.   Simulation is a technology within the field of operations research which has been applied to aid with surgery planning problems and to look for process improvements. Many studies however use a simplified approach to the surgery planning, due to the complexities of the planning problem. Studies have further argued that surgery planning fails to consider downstream resources and the negative effects it has on utilization of those resources. This thesis is based on a case study at one of Sweden’s major hospitals and aims to explore how simulation could become a decision support to help with surgery planning and identifying what process improvements such a tool could be aimed at. The surgery planning decision making process is first analyzed using a hierarchical framework for hospitals’ production planning. The results were that the decision making process regarding patient flows needs to be improved by taking both a top-down and bottom-up strategy for better information flow and coordination. The study further concludes that improved coordination and information sharing are important factors to improve patient flow through the hospital, which could be supported by the usage of Discrete Event Simulation for decision making. The ideal decision support tool is however considered the simulation tool embedded with an online system to support bed management decisions which could increase patient throughput. Such a tool could help to decrease the demand for the hospital’s beds by discharging patients quicker. In addition, it could support the bottom-up strategy for coordination, while implementing a multi-method or hybrid simulation could further support the top-down part of the strategy.

Energy management concerns were raised in France after the oil crisis in the 1970s. From then, the local actors developed policies to better control the energy production and consumption on the territories. Climate considerations and the need to limit greenhouse gases (GHG) emissions were then added to these energy issues in the early 2000s. The Climate Plans first appeared in France in 2004, in the National Climate Plan. This regulatory document outlined the desire to apply national and European energy and climate objectives at the territorial level. This initiative laid the foundations for the principle of territorial climate-air-energy planning, which became statutory in 2015 for Public Establishment of Intercommunal Cooperation with over 50,000 inhabitants. A regulatory framework has defined the ins and outs of this planning exercise, but the first results have shown that not all local authorities have fully taken up these planning issues, due to a lack of internal competence, means and method to answer the formal exercise. Tot heir credit, the regulatory objectives imposed by the National Low Carbon Strategy were quickly judged to be out of touch and disconnected from local reality, particularly for industrial territories. More recently, a growing number of local authorities have chosen to flesh out their territorial strategy by drawing up an Energy Master Plan, a roadmap that outlines a comprehensive and integrated approach to managing energy resources. Based on a case study of the Urban Community of Dunkirk, this thesis investigates how local authorities have taken up these energy and climate planning challenges, the difficulties they face, and how the Plan Climat-Air-Energie Territoriaux (Local Climate Air Energy Plan) could become essential monitoring tools for the low-carbon transition of territories if they were equipped with real decision-support tools. The case of the Urban Community of Dunkirk is emblematic. Responsible for 4% of France's GHG emissions due to its port and industrial activities, the urban area has committed itself to implementing accelerated decarbonisation. An exploratory study is carried out based on a comparative analysis of the 2022 revised climate plan of the Urban Community of Dunkirk and the Energy Master Plan developed by the Greater Lyon Metropolis in 2019, as well as a series of interviews with the departments and researchers specialising in environmental and territorial planning. On the one hand, results identified approximations in the calculations of emissions reduction, and in particular on the formulation of the working and calculation hypotheses for energy and carbon trends by 2050 in the revised climate plan of the Urban Community of Dunkirk. They led to a lack of clarity in the presentation of the territorial strategy defined by the community. On the other hand, results showed that the Energy Master Plan of Grand Lyon allows to build a more robust action plan, whose strength lies in integrating economic, temporal, technical and governance issues. However, a number of limitations have been identified, related to the cumbersome nature of implementing integrated tools for local authorities and the rapid obsolescence of the energy diagnoses carried out on territories resulting from a difficult updating process. Finally, results showed that the decision-support tools that will be developed must meet the technical needs of fine-tuned modelling of territories, the practical needs of coordinating actions over time and measuring their impact, and the cross-sectoral needs of organising governance between all the players involved. / Energifrågorna aktualiserades i Frankrike efter oljekrisen på 1970-talet. Därefter utvecklade de lokala aktörerna strategier för att hantera energiförbrukningen på sina territorier. Klimathänsyn och behovet av att begränsa utsläppen av växthusgaser lades sedan till dessa energifrågor i början av 2000-talet. Klimatplanerna dök först upp i Frankrike 2004, i den nationella klimatplanen. I detta lagstiftningsdokument beskrevs önskan att tillämpa nationella och europeiska energi- och klimatmål på territoriell nivå. Detta initiativ lade grunden till principen om lokal klimat-, luft- och energiplanering, som 2015 blev lagstadgad för offentliga inrättningar för interkommunalt samarbete med över 50 000 invånare. Ett regelverk har definierat hur denna planering ska gå till, men de första resultaten har visat att inte alla lokala myndigheter har tagit sig an dessa planeringsfrågor fullt ut, på grund av brist på intern kompetens, medel och metoder för att svara på den formella uppgiften. De lagstadgade mål som infördes genom den nationella strategin för låga koldioxidutsläpp bedömdes snabbt vara verklighetsfrämmande och inte kopplade till den lokala verkligheten, särskilt för industriområden. På senare tid har ett växande antal lokala myndigheter valt att konkretisera sin territoriella strategi genom att utarbeta en energiplan, en färdplan som beskriver en omfattande och integrerad strategi för att hantera energiresurser. Med utgångspunkt i en fallstudie av stadsregionen Dunkerque undersöker denna avhandling hur lokala myndigheter har tagit sig av dessa utmaningar inom energi- och klimatplanering, vilka svårigheter de möter och hur den lokala klimat- och energiplanen (Plan Climat-Air-Energie Territoriaux) skulle kunna bli viktiga övervakningsverktyg för den koldioxidsnåla omställningen av territorier om de utrustades med verkliga beslutsstödsverktyg. Fallet med den urbana gemenskapen i Dunkerque är emblematiskt. Stadsområdet står för 4% av Frankrikes utsläpp av växthusgaser på grund av sin hamn- och industriverksamhet, och har åtagit sig att genomföra en snabbare utfasning av fossila bränslen. En explorativ studie genomförs baserad på en jämförande analys av den reviderade klimatplanen 2022 för Dunkerque och Energy Master Plan som utvecklades av Greater Lyon Metropolis 2019, samt en serie intervjuer med avdelningar och forskare som är specialiserade på miljö- och territoriell planering. Å ena sidan identifierar resultaten approximationer i beräkningarna av utsläppsminskningar, och i synnerhet i formuleringen av arbets- och beräkningshypoteser för energi- och koldioxidtrender fram till 2050 i den reviderade klimatplanen för Dunkerques stadsgemenskap. De leder till en brist på tydlighet i presentationen av den territoriella strategi som fastställts av kommunen. Å andra sidan visar resultaten att Grand Lyons energimasterplan gör det möjligt att bygga en mer robust handlingsplan, vars styrka ligger i att integrera ekonomiska, tidsmässiga, tekniska och styrningsfrågor. Vi har dock identifierat ett antal begränsningar som rör den besvärliga implementeringen av integrerade verktyg för lokala myndigheter och den snabba föråldringen av de energidiagnoser som utförts på territorier till följd av en svår uppdateringsprocess. Slutligen visade sig att det behövs utveckla beslutsverktyg som måste uppfylla de tekniska behoven av finjusterad modellering av territorier, de praktiska behoven av att samordna åtgärder över tid och mäta deras effekter, samt de sektorsövergripande behoven av att organisera styrning mellan alla aktörer som är involverade.

La transition énergétique est un enjeu majeur actuel et des années à venir. Parmi les défis qu’elle va soulever figure la limitation des impacts environnementaux de la production d’électricité. Pour cela, des outils d’aide à la décision, simples d’utilisation et suffisamment précis, considérant les aspects environnementaux et permettant d’optimiser les choix énergétiques futurs, doivent être mis en place. L’analyse environnementale d’une filière de conversion d’énergie est un sujet complexe. Elle comporte en effet deux niveaux. Le niveau « filière », caractérise le profil global d’impacts environnementaux des systèmes, et le niveau « système » caractérise leurs impacts, permettant ainsi une analyse intra-filière. Pour répondre à ce besoin de caractérisation en deux niveaux, nous proposons une méthodologie générique permettant de développer des modèles d’estimation des profils environnementaux de chacune des filières et d’estimer simplement ceux des systèmes qui la composent sans avoir à réaliser une étude détaillée. Cette méthodologie repose sur la définition d’un modèle d’Analyse de Cycle de Vie paramétré prenant en compte, par Analyse Globale de Sensibilité, un large échantillon de systèmes représentatif des configurations observées en pratique au sein des filières. Dans un second temps, des modèles simplifiés estimant les performances environnementales des systèmes sont définis, en fonction de quelques paramètres clefs identifiés comme expliquant la plus grande part de variance des impacts environnementaux de la filière. Cette méthodologie de réduction de modèle a été appliquée à la filière éolienne terrestre en Europe et à la filière photovoltaïque résidentielle en France. / The energy transition debate is a key issue for today and the coming years. One of the challenges is to limit the environmental impacts of electricity production. Decision support tools, sufficiently accurate, simple to use, accounting for environmental aspects and favoring future energetic choices, must be implemented. However, the environmental assessment of the energy pathways is complex, and it means considering a two levels characterization. The “energy pathway” is the 1st level and corresponds to its environmental distribution, to compare overall pathways. The “system pathway” is the 2nd level and compares environmental impacts of systems within each pathway. We have devised a generic methodology covering both necessary characterization levels by estimating the energy pathways environmental profiles while allowing a simple comparison of its systems environmental impacts. This methodology is based on the definition of a parameterized Life Cycle Assessment model and considers, through a Global Sensitivity Analysis, the environmental impacts of a large sample of systems representative of an energy pathway. As a second step, this methodology defines simplified models based on few key parameters identified as inducing the largest variability in the energy pathway environmental impacts. These models assess in a simple way the systems environmental impacts, avoiding any complex LCAs. This reduction methodology has been applied to the onshore wind power energy pathway in Europe and the photovoltaic energy pathway in France.

<p>Field-edge buffers are a promising way to address nonpoint source pollution from agricultural runoff, but concentrated runoff flow often renders standard fixed-width linear buffers ineffective. AgBufferBuilder (ABB) is a tool within ESRI ArcMap Geographic Information Systems software that designs and evaluates targeted, nonlinear buffers based on hydrologic modeling and other field-specific parameters. We tested ABB on n=45 Areas of Interest (AOIs) stratified based on estimated sediment loading across three sub-watersheds within Michigan’s Saginaw Bay watershed to evaluate the effectiveness of ABB relative to existing practices across a wide range of landscape conditions. We modeled tractor movement around ABB buffer designs to assess more realistic versions of the likely final designs. ABB regularly failed to deliver the desired 75% sediment capture rate using default 9 m x 9 m output raster resolution, with Proposed buffers capturing from 0% to 68.49% of sediment within a given AOI (mean=37.56%). Differences in sediment capture between Proposed and Existing buffers (measured as Proposed – Existing) ranged from -48% to 66.81% of sediment (mean=24.70%). Proposed buffers were estimated to capture more sediment than Existing buffers in 37 of 45 AOIs, representing potential for real improvements over Existing buffers across the wider landscape. In 13 of 45 AOIs, ABB buffers modified for tractor movement captured more sediment than Existing buffers using less total buffer area. We conducted a collaborative design process with three Saginaw Bay watershed farmers to assess their willingness to implement ABB designs. Feedback indicated farmers may prefer in-field erosion control practices like cover cropping and grassed waterways over field-edge ABB designs. More farmer input is needed to better assess farmer perspectives on ABB buffers and to identify preferred data-based design alternatives. Engineered drainage systems with raised ditch berms and upslope catch basins piped underground directly into ditches were encountered several times during site visits. ABB only models surface flow and does not recognize drain output flow entering waterways. Modified ABB functionality that models buffers around drain inlets would greatly improve its functionality on drained sites. This may be accomplishable through modification of user-entered AOI margins but requires further investigation. Unfortunately, the existing tool is built for outdated software and is not widely accessible to non-expert users. We suggest that an update of this tool with additional functionality and user accessibility would be a useful addition in the toolbox of conservation professionals in agricultural landscapes.</p>