There has been an increased awareness of the current problems regarding the environmental changes in the world. Companies are acknowledging these problems more and more to try and prevent the heavy pollution humans contribute. The metal industry is one of the highest emitters in the world because its manufacturing, production, and processing require substantial amounts of energy. While the pressure of addressing environmental issues has been on the bigger companies in history, the smaller ones are being caught up in the same pressure from customers and partners. Because of the raised awareness of the environmental impact, even the smaller companies, which are low on environmental impact alone but substantial when defined as a whole market, are more often required to implement an environmental management system. However, the limitations of resources are different for smaller companies. There is no structured way to work towards a certification in ISO 14001 with the barriers that might limit them. This study has its focus on gathering information in a qualitative mean to interpret and generalize the reality of smaller companies in the metal industry. By doing so, the main goal is to investigate the barriers that appear for the management when implementing an EMS according to ISO 14001 and identify the potential procedures taken to reach the end goal of certification. The results of this study are that companies don’t face the barrier of economic resources and the true barrier is the interpretation of costs. The implementation of a certified EMS is a long-term investment and generates money through continuous improvements and creates a business opportunity by opening a new market to customers with ISO 14001 requirements. Knowledge was a barrier and the change in ISO 14001 being more compatible with previous quality certification ISO 9001 helped the implementation.

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The selection of hospital once an ambulance has picked up its patient is today decided by the ambulance staff. This report describes a supervised machinelearning approach for predicting hospital selection. This is a multi-classclassification problem. The performance of random forest, logistic regression and neural network were compared to each other and to a baseline, namely the one rule-algorithm. The algorithms were applied to real world data from SOS-alarm, the company that operate Sweden’s emergency call services. Performance was measured with accuracy and f1-score. Random Forest got the best result followed by neural network. Logistic regression exhibited slightly inferior results but still performed far better than the baseline. The results point toward machine learning being a suitable method for learning the problem of hospital selection. / Beslutet om till vilket sjukhus en ambulans ska köra patienten till bestäms idag av ambulanspersonalen. Den här rapporten beskriver användandet av övervakad maskininlärning för att förutsåga detta beslut. Resultaten från algoritmerna slumpmässig skog, logistisk regression och neurala nätvärk jämförs med varanda och mot ett basvärde. Basvärdet erhölls med algorithmen en-regel. Algoritmerna applicerades på verklig data från SOS-alarm, Sveriges operatör för larmsamtal. Resultaten mättes med noggrannhet och f1-poäng. Slumpmässigskog visade bäst resultat följt av neurala nätverk. Logistisk regression uppvisade något sämre resultat men var fortfarande betydligt bättre än basvärdet. Resultaten pekar mot att det är lämpligt att använda maskininlärning för att lära sig att ta beslut om val av sjukhus.

Researchers at the University of Central Florida (UCF) have been working during the past few years on different strategies to improve freeway safety in real-time. An ongoing research at UCF has investigated crash patterns that occurred on a stretch of Interstate-4 located in Orlando, FL and created statistical models to predict in real-time the likelihood of a crash in terms of time and space. The models were then tested using PARAMICS micro-simulation and different strategies that would reduce the risk of crashes were suggested. One of the main recommended strategies was the use of Variable Speed Limits (VSL) which intervenes by reducing the speed upstream the segment of high risk and increasing the speed downstream. The purpose of this study is to examine the recommendations reached by the micro-simulation using the UCF driving simulator. Drivers' speed behavior in response to changes in speed limits and different information messages are observed. Different scenarios that represent the recommendations from the earlier micro-simulation study and three different messages displayed using Variable Message Signs (VMS) as an added measure to advice drivers about changes in the speed limit were created. In addition, abrupt and gradual changes in speed were tested against the scenarios that maintained the speed limit constant or did include a VSL or VMS in the scenarios' design (base case). Dynamic congestion was also added to the scenarios' design to observe drivers' reactions and speed reductions once drivers approached congestion. A total of 85 subjects were recruited. Gender and age were the controlling variables for the subjects' recruitment. Each of the subjects drove 3 out of a total of 24 scenarios. In addition, a survey was conducted and involved hypothetical questions, including knowledge about VMS and VSL, and questions about their driving behavior. The survey data were useful in identifying the subjects' compliance with the speed limit and VSL/VMS acceptance. Two statistical analytical techniques were performed on the data that were collected from the simulator: ANOVA and PROC MIXED. The ANOVA test was used to investigate if the differences in speed and reaction distances between subjects were statistically significant for each sign compared to the base case. The PROC MIXED analysis was used to investigate the differences of all scenarios (24x24) based on the spot speed data collected for each driver. It was found from the analyses that drivers follow better the message displayed on VMS that informs them that the speed is changing, whether it is or not, strictly enforced as opposed to providing the reason for change or no information. Moreover, an abrupt change in speed produced immediate results; however both abrupt and gradual changes in speed produced the same reduction in speed at the target zone. It was also noticed that most drivers usually drive 5 mph above the speed limit, even though in the survey analysis the majority of them stated that they drive in compliance with the speed limit or with the flow of traffic. This means that if a modest speed reduction of 5 mph is requested they will ignore it, but if a 10 mph reduction is recommended they will reduce the speed by at least 5 mph. Consequently, it was noticed that drivers arrived at the congestion zone with a slower speed than the base speed limit due to the combination of VMS and VSL signage. By having drivers approaching congestion with a slower speed, potential rear-end crashes could be avoided. Comparing the two genders indicated that females are more likely to follow the VMS's recommendations to reduce the speed. Also females in general drive above the speed limit between 2 mph and 3 mph, while males drive above the speed limit between 5 mph and 8 mph. From the analysis of the age factor, it was concluded that drivers from the 16-19 age group drive faster and drivers from the 45 and above age group drive slower, than the drivers from the other groups. In general, all drivers reduced and/or increased their speed accordingly when a VMS and/or VSL was present in the scenario advising for this change in the speed limit. The investigations conducted for this thesis proved that the recommendations suggested previously based on the crash risk model and micro-simulation (Abdel-Aty et al., 2006) aid drivers in reducing their speed before they approach a segment of high risk and by doing so reduce the likelihood of a crash. Finally, the real-time safety benefits of VMS and VSL should be continuously evaluated in future studies.

<p>Smart and connected technology solutions have emerged as a promising way to enhance EMS services, particularly in areas where access to professional services is limited. However, a significant challenge for improving their implementation is determining which technologies to use and how they will change current logistic operations to enhance service efficiencies and expand access to care. In this context, this thesis explores opportunities for the smart and connected technology solutions.</p> <p>The first study explores the use of medically trained volunteers in the community, known as Citizen Responders (CRs). These individuals can be quickly notified of an EMS request upon its arrival via a mobile alert receiver, which allows them to provide timely and potentially life-saving assistance before an ambulance arrives. However, traditional EMS logistic decision platforms are not equipped to effectively leverage the sharing of the real-time CR information enabled by connected technologies, such as their location and availability. To improve coordination between CRs and ambulances, this study proposes two decision tools that incorporate real-time CR information: one for redeploying ambulances after they complete service and another for dispatching ambulances in response to calls. The redeployment procedure uses mixed-integer linear programming (MILP) to maximize patient survival, while the dispatch procedure enhances a locally optimal dispatch procedure by integrating real-time CR information for priority-differentiated emergencies.</p> <p>In the second study, a third decision tool was developed to take advantage of the increasing availability of feature information provided by connected technologies: an AI-enabled dispatch rule recommendation model that is more usable for dispatchers than black-box decision models. This is a model based on supervised learning that outputs a “promising” metric-based dispatch rule for the human decision-maker. The model maintains the usability of rules while enhancing the system’s performance and alleviating the cognitive burden of dispatchers. A set of experiments were performed on a self-developed simulator to assess the performance of all the decision tools. The findings suggest they have the potential to significantly enhance the EMS system performance. </p>

Immediate treatment is of extreme importance for stroke patients. However, providing fast enough treatment for stroke patients is far from trivial, mainly due to logistical challenges and difficulties in diagnosing the correct stroke type. One way to reduce the time to treatment is to use so-called Mobile Stroke Units (MSUs), which allows to diagnose and provide treatment for stroke patients already at the patient scene. A well-designed stroke transport policy is vital to improve the access to treatment for stroke patients. Simulation and mathematical optimization are useful approaches for assessing and optimizing stroke transport policies, without endangering the health of the patients. The main purpose of this thesis is to contribute to improving the situation for stroke patients and to reducing the social impacts of stroke. The aim is to study how to use simulation and optimization to achieve improved analysis and planning of prehospital stroke care. In particular, we focus on assessing the potential use of MSUs in a geographic area. In this thesis, optimization is used to identify the optimal locations of MSUs, and simulation is used to assess different stroke transport policies, including MSU locations. The results of this thesis aim to support public health authorities when making decisions in the prehospital stroke care domain. In order to fulfill the aim of this thesis, we develop and analyze a number of different simulation and optimization models. First, we propose a macro-level simulation model, an average time to treatment estimation model, used to estimate the expected time to treatment for different parts of a geographic region. Using the proposed model, we generate two different MSU scenarios to explore the potential benefits of employing MSUs in Sweden’s southern healthcare region (SHR).   Second, we present an optimization model to identify the best placement of MSUs while making a trade-off between the efficiency and equity perspectives, providing maximum population coverage and equal service for all patients, respectively. The trade-off function used in the model makes use of the concepts of weighted average time to treatment to model efficiency and the time difference between the expected time to treatment for different geographical areas to model equity. In a scenario study applied in the SHR, we evaluate our optimization model by comparing the current situation with three MSU scenarios, including 1, 2, and 3 MSUs. Third, we present a micro-level discrete event simulation model to assess stroke transport policies, including MSUs, allowing us to model the behaviors of individual entities, such as patients and emergency vehicles, over time. We generate a synthetic set of stroke patients using a Poisson distribution, used as input in a scenario study. Finally, we present a modeling framework with reusable components, which aims to facilitate the construction of discrete event simulation models in the emergency medical services domain. The framework consists of a number of generic activities, which can be used to represent healthcare chains modeled in the form of flowcharts. As the framework includes activities and policies modeled on the general level, the framework can be used to create models only by providing input data and a care chain specification. We evaluate the framework by using it to build a model for simulating EMS activities related to the complex case of acute stroke. / <p>Note: The papers are not included in the fulltext online.</p>

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The modern concept of Emergency Medical Services (EMS) has grown from its humble volunteerism origins to a multidisciplinary enterprise, outstretched into the realms of both healthcare and public service. As the American EMS community continues to assume greater responsibilities and further develop its professional standards, the moral foundations of this field open themselves to more thorough scrutiny. Upon examination, the major deficit in the ethical structuring of EMS becomes glaringly obvious: it exists as a piecemeal collection of its medical and militaristic counterparts unified by theoretical generalizations that avoid its inherently unique structure. If EMS wishes to matriculate into complete professionalism, or even continue its assumption of critical responsibilities surrounding the health and safety of others, then it must also develop and maintain its own individual ethical framework from which it operates. In doing so, an urban bioethical approach rooted in context-driven analysis and pragmatic solutions may provide the best guidance and protections for all those who interact with the EMS system while respecting the values of this distinctively prideful service. / Urban Bioethics

Early Mortality Syndrome (EMS) is a widespread bacterial infection of shrimp, attributed to pathogenic Vibrio parahaemolyticus strains (VP-EMS). This disease threatens aquaculture production and global food security. A valuable and alternative approach to using antibiotics for pathogen control, is the practice of incorporating direct-fed microbes (DFM) or probiotics. In order to evaluate the hypothesis that probiotics (specific strains of Bacillus subtilis spores) are able to provide shrimp, Litopenaeus vannamei, protection to the EMS disease, a pathogen growth model, disease challenge model, and probiotic feed coating methodologies were developed and refined, allowing independent shrimp probiotic trials to be piloted. A single probiotic strain of Bacillus subtilis: O14VRQ and a blend of Bacillus subtilis strains: Plus10, were evaluated as feed additives or as water additions, for their efficacy. Accordingly, two independent trials were conducted in which shrimp were fed daily with a probiotic-coated feed for seven days, before a challenge with VP-EMS. Each trial consisted of a negative control (no VP-EMS exposure, no probiotic) and positive control (VP-EMS exposure, no probiotic), with five additional probiotic treatment groups, which were fed and exposed to VP-EMS in the same manner as the positive control. Shrimp were observed for clinical signs of disease after the initial exposure and were continuously exposed every 24 hours until 50% of the population remained in the positive control treatment. Both probiotics studied were shown to significantly (p < 0.05) improve shrimp survival. Overall the data presented in this work demonstrates that probiotic prophylaxis is reliant upon probiotic dose, regardless of application. / Master of Science in Life Sciences / Aquaculture is one of the fastest growing agricultural sectors in the world allowing it to greatly contribute to global food security. Seafood products are known for their excellent health benefits, providing good sources of protein, fatty acids, and vitamins. However, the animals raised in this industry, like in many facets of animal agriculture, are susceptible to disease. Diseases can be costly to treat and if no treatment exists, can be detrimental to farms, especially to highly valued species such as shrimp. Traditionally, many diseases have been treated with antibiotics, however this can promote the growth of antibiotic resistant bacteria, which is a public health concern especially when involving animals fit for human consumption. An alternative to this approach is administering probiotics or beneficial bacteria to these animals. When incorporated with feed or applied to water, these beneficial bacteria can prevent diseases and help promote the growth of healthy animals. Two novel probiotics were fed to shrimp, before exposing them to the bacteria, Vibrio parahaemolyticus, which causes Early Mortality Syndrome, and is responsible for annual shrimp losses of more than $1 billion USD. Signs of this disease and survival were observed to assess if this probiotic could provide protection against this bacterium. Results from these studies show that these probiotics were capable of offering protection to shrimp when they were fed or introduced into tank water in high concentrations. Such probiotic applications could have beneficial effects on intensive shrimp aquaculture and help prevent this disease.

Europe’s and the world’s security has worsened in the last couple years, and with that the possibility of war became a reality. Because of that Sweden’s civil defence system is going through a revival for the first time since the end of the Cold War. The civil defence system is tasked with making sure that societally important functions keep operating even in disasters and war. One of these is the healthcare system, which includes care in hospitals, at primary care facilities, and ambulances. The Swedish Emergency Medical Services are included in the civil defence system and thus their organisations need to work on contingency planning and preparedness efforts. In order to get an understanding of where this process is at the moment, a case study is conducted by interviewing personnel working within the EMS in Sweden. Themes are identified to showcase the level of preparedness and competency the Swedish EMS has now. The study is grounded in previous research and has identified significant topics like the low level of disaster preparedness among nurses, the long- and short-term consequences of working in dangerous conditions, and that training is possibly the most important when it comes to preparations. The interview materials are analysed by abductive thematic analysis and the results show that the Swedish EMS is not prepared to deal with war, and more resources and training is needed in order to achieve a desired level of preparedness.