Accounting for some the highest arrival rates and widest varieties of medical conditions in a hospital, the emergency department is highly dependent on efficient operations strategies in order to function effectively and provide qualitative health care. This is especially true for the emergency department of Karolinska University Hospital in Huddinge from which real patient data has been obtained. In attempting to improve service levels, current operational structures are evaluated and several different scenarios are simulated mathematically in this study. After validating the adequacy of modeling the emergency department as a Jackson Network, the network is simulated for various combinations of patient flow parameters enabling the study of the effects of resource allocation strategies. The results indicate that the current organization of, and resources available to, the emergency department leaves room for improvement in terms of service levels. Resource levels needed for specific target levels of service are found and the optimal allocations of resources is discussed. Additionally, a brief literature review of operations strategies and how simulation tools can serve as decision support systems for operations strategy managers is conducted. / Akutmottagningen är en av de avdelningar på ett sjukhus som utsätts för högst ankomstintensiteter och bredast variationer av besöksorsaker vilket orsakar höga krav på att utveckla effektiva verksamhetsstrategier för att upprätthålla en kvalitativ sjukvård. Akutmottagningen på Karolinska Universitetssjukhuset i Huddinge har studerats genom patientdata. För att försöka förbättra servicenivåer och förkorta väntetider för patienter utvärderas verksamhetens organisation och struktur. En matematisk modell av verksamhetens organisation konstrueras och valideras, varefter effekterna av olika resursallokeringar analyseras genom matematiska simuleringar. Resultaten visar på att akutvården som den är organiserad idag lämnar utrymme för förbättring och optimering av resursallokering. Genom matematiska simuleringar identifieras marginella resursers specifika servicenivåer och relativa förändringar i servicenivåer. Slutligen kompletteras den matematiska analysen med en kortare litteraturstudie. Här presenteras hur simuleringar kan utgöra beslutsstödsystem för att planera resursallokering och introducera lean-strategier i sjukvården.

Additive manufacturing (AM), commonly known as 3D printing, has been attracting attention from practitioners as well as academicians with its continuous evolution from being used primarily for prototyping to now end-product production. Despite this technology's current and future potential, few studies indicate that AM has not been extensively used across all industries. This dissertation addresses knowledge gaps by providing theoretical and empirical support for adopting AM through three essays that study the role of AM in restructuring supply chains. Essay 1 provides systematic support for AM implementation by developing a typology derived from technology-specific potentials and challenges to adopting AM. This study uses an exploratory research approach to collect and analyze data from semi-structured interviews of practitioners with deep knowledge of AM and supply chains from diverse industries. In Essay 2, our results show that AM adoption positively influences supply chain responsiveness and, in turn, reshoring decisions. Essay 3 compares different supply chain configurations based on traditional and AM. We developed a hybrid simulation model combining discrete event simulation and agent-based simulation and compared the performance in terms of wait time and costs. Our results indicate that under certain conditions, the centralized configuration delivers spare parts faster than the distributed configuration, contrary to previous literature findings. However, a hybrid configuration (a combination of centralized and decentralized) provides a better response (reduced wait time) than the traditional, centralized, and decentralized configurations. Collectively, the three essays provide academicians and practitioners with a more comprehensive understanding of how AM creates value for supply chains.

To address emerging challenges in empowering patients through telehealth, this dissertation has the following objectives: (a) find the key characteristics that enable patient empowerment [PE], (b) determining when will PE work as a solution, (c) find the optimal telehealth care method that enables PE, and (d) evaluate the impact of telehealth on health care outcomes (such as, patient satisfaction, patient trust with primary care providers, etc.) that ultimately enhances PE. These objectives are addressed in three studies presented here as three essays. Collectively, these essays contribute to the knowledge on PE, patient trust, and telehealth by providing insights on leveraging PE towards better health care services and delivery systems. Essay 1 aims to systemically map the concept of PE using principles of systems thinking with the Boardman soft systems methodology that enables a graphical visualization (i.e., systemigrams). Essay 2 investigates the practical and theoretical implications of connecting patients to empowerment care plans and minimizing wait times in healthcare service delivery using electronic prescriptions (s-scripts), phone calls, and video calls. In Essay 3, the mediating role of telehealth services between patient empowerment and patient satisfaction was analyzed, along with patient trust was assessed as a moderator between telehealth usability and patient satisfaction. Two hundred sixty-two responses from patients in North America with chronic illnesses were collected through an online survey questionnaire were analyzed using partial least squares-structural equation modeling (PLS-SEM). The findings of the research show that patients with chronic illnesses in North America feel empowered by using telehealth as they can get diagnosis of the illness even in remote areas and face no obstacle.

År 2024 upplevde Sverige längre väntetider och sämre tillgänglighet inom både primär- och specialiserad vård jämfört med andra länder. Detta ledde till ökat tryck på akutmottagningar då många patienter sökte sig dit för vård som annars kunde hanterats på ordinära mottagningar om tillräcklig personal funnits tillgänglig. Denna studie fokuserar på att undersöka patientflöden vid Danderyds sjukhus genom att identifiera flaskhalsar inom akutmottagningen. Studiens syfte var att hitta flaskhalsar som kan åtgärdas för att minska väntetiderna och förbättra resursanvändningen genom att använda matematiska modeller och diskret händelsesimulering. Analysen baseras på data insamlad under det första kvartalet för åren 2022, 2023 och 2024. Resultaten från simuleringarna visar kritiska statistiska mått som är avgörande för att förstå systemets kapacitet och prestanda under varierande belastningar. Dessa resultat belyser även nödvändigheten av resursallokering och förväntade väntetider för patienter. Studien bidrar inte bara till en bra förståelse av de nuvarande processerna utan presenterar även strategier för att effektivt hantera de utmaningar akutmottagningarna står inför. Slutsatserna diskuterar de teoretiska och praktiska implikationerna med betoning på hur simuleringarna kan användas för att utforska nya arbetsmetoder för akutmottagningar framöver. Denna forskning lägger grunden för framtida innovationer inom sjukvårdens arbetsflöden och resursallokering, vilket kan leda till förbättrad patientvård och effektivare sjukhusdrift. / In 2024, Sweden experienced longer wait times and reduced accessibility in both primary and specialized care compared to other countries. This led to increased pressure on emergency departments, as many patients sought care there that could have been managed at regular clinics if sufficient staff were available. This study focuses on examining patient flows at Danderyd Hospital by identifying bottlenecks within the emergency department. The aim of the study was to find bottlenecks that can be addressed to reduce wait times and improve resource utilization through the use of mathematical models and discrete event simulation. The analysis is based on data collected during the first quarter of the years 2022, 2023, and 2024. The results from the simulations reveal critical statistical measures that are essential for understanding the system's capacity and performance under varying loads. These results also highlight the need for resource allocation and expected wait times for patients. The study not only contributes to a better understanding of the current processes but also presents strategies for effectively addressing the challenges faced by emergency departments. The conclusions discuss the theoretical and practical implications, emphasizing how the simulations can be used to explore new working methods for emergency departments in the future. This research lays the foundation for future innovations in healthcare workflows and resource allocation, which can lead to improved patient care and more efficient hospital operations.

Les rapports d’activité de l’Établissement Français du Sang (EFS) font état d’une demande croissante de produits sanguins labiles (PSL) tels les concentrés globules rouges (CGR), les plaquettes, et le plasma. Afin d’assurer la demande vitale en PSL, il est primordial d’optimiser la logistique liée aux activités de collecte du sang et de ses composants. Pour faire face à cette situation, l’EFS Auvergne-Loire mène une réflexion dans le but d’utiliser de manière plus efficiente les dispositifs de collecte en sites fixes et mobiles pour améliorer (i) la qualité de service rendue au donneur, et (ii) l’efficience de l’utilisation des ressources humaines. Dans ce contexte nous avons développé dans cette thèse des outils opérationnels pour (i) la modélisation des dispositifs de collecte, (ii) la régulation des flux de donneurs, et (iii) la planification de collectes mobiles.La méthode d'analyse des dispositifs de collecte est basée sur des techniques de simulation à événements discrets. Une modélisation préalable des flux de donneurs dans les systèmes de collecte en sites fixes et mobiles à l’aide de réseaux de Petri a été proposée. Pour la régulation de flux de donneurs, notamment pour la planification optimale des rendez-vous des donneurs et la planification de la capacité dans les systèmes de collecte au site fixe, deux approches ont été abordées: (a) Construction d'un algorithme basée sur techniques d'optimisation stochastique via simulation ; (b) Programmation mathématique: Modèle de programmation en nombres entiers non-linéaire (MINLP) basée sur réseaux de files d'attente et représentation et évaluation des systèmes à événements discrets à travers de programmation mathématique. Pour la planification de collectes mobiles. Deux types de modèles ont été développés : (a) Au niveau tactique : Modèles de programmation en nombres entiers linéaire (MIP) pour planifier les semaines de collectes pour chaque ensemble disponible sur un horizon de temps pour garantir l'autosuffisance à niveau régional des CGR. (b) Au niveau opérationnel : Modèle de programmation en nombres entiers linéaire (MIP) pour l’organisation du travail des équipes en charge de la collecte. / Activity reports of the French Blood Establishment (EFS) indicate a growing demand for Labile Blood Products (LBP) as red blood cells (RBC), platelets and plasma. To ensure the vital demand of labile blood products (LBP), it’s essential to optimize the logistics related with the collection of blood components. To deal with this situation, the EFS Auvergne-Loire carry out a reflection in order to use more efficiently the collection devices in fixed and mobile sites, to improve the quality of service offered to the donor and the efficiency of human resources. In this context we have developed in this thesis operational tools for (i) modeling of blood collection devices (ii) The regulation of flows donors (iii) Planning of bloodmobile collections.The method analysis of collection devices is based on techniques of discrete event simulation. A preliminary modeling of donors’ flow in fixed and mobile collection systems using Petri nets was conducted. For the regulation of flow of donors, i.e. the optimal capacity planning and appointment scheduling of blood collections, two approaches were considered: (a) Simulation based-optimization.(b) Mathematical Programming: Mixed integer nonlinear programming (MINLP) based on queuing networks and mathematical programming representation of discrete event systems. For planning of bloodmobile collections. Two models have been developed: (a) At the tactical level: Mixed integer linear programming (MIP) to determine the weeks in which the mobile collection must be organized in order to ensure the regional self-sufficiency of RBC. (b) At the operational level: Mixed integer linear programming (MIP) for the planning of human resources in charge of blood collections.

Distributed systems are everywhere. From large datacenters to mobile devices, an ever richer assortment of applications and services relies on distributed systems, infrastructure, and protocols. Despite their ubiquity, testing and debugging distributed systems remains notoriously hard. Moreover, aside from inherent design challenges posed by partial failure, concurrency, or asynchrony, there remain significant challenges in the implementation of distributed systems. These programming challenges stem from the increasing complexity of the concurrent activities and reactive behaviors in a distributed system on the one hand, and the need to effectively leverage the parallelism offered by modern multi-core hardware, on the other hand. This thesis contributes Kompics, a programming model designed to alleviate some of these challenges. Kompics is a component model and programming framework for building distributed systems by composing message-passing concurrent components. Systems built with Kompics leverage multi-core machines out of the box, and they can be dynamically reconfigured to support hot software upgrades. A simulation framework enables deterministic execution replay for debugging, testing, and reproducible behavior evaluation for large-scale Kompics distributed systems. The same system code is used for both simulation and production deployment, greatly simplifying the system development, testing, and debugging cycle. We highlight the architectural patterns and abstractions facilitated by Kompics through a case study of a non-trivial distributed key-value storage system. CATS is a scalable, fault-tolerant, elastic, and self-managing key-value store which trades off service availability for guarantees of atomic data consistency and tolerance to network partitions. We present the composition architecture for the numerous protocols employed by the CATS system, as well as our methodology for testing the correctness of key CATS algorithms using the Kompics simulation framework. Results from a comprehensive performance evaluation attest that CATS achieves its claimed properties and delivers a level of performance competitive with similar systems which provide only weaker consistency guarantees. More importantly, this testifies that Kompics admits efficient system implementations. Its use as a teaching framework as well as its use for rapid prototyping, development, and evaluation of a myriad of scalable distributed systems, both within and outside our research group, confirm the practicality of Kompics. / Kompics / CATS / REST

As redes ópticas estão passando por mudanças significativas, impulsionadas pelo crescimento exponencial do tráfego, principalmente advindo de serviços multimídia e armazenamento em nuvem. Esta demanda exigirá aumento da capacidade da taxa de transmissão para padrões como 400 Gb/s e 1 Tb/s. Nesse contexto, foi proposta uma arquitetura de rede com grade de frequências granular flexível chamada elastic optical network (EON). A EON divide o espectro de frequências em fatias (slots) de tamanho fixo e aloca grupos de slots contíguos estritamente de acordo com os requisitos de banda das demandas de conexão, implicando eficiência de uso do espectro. Com o aumento significativo da taxa de transmissão, acentuou-se a preocupação em manter a sobrevivência da rede, já que pouco tempo de queda no serviço pode acarretar uma imensa perda de dados. Neste trabalho, investigamos esquemas de proteção baseados em caminhos compartilhados (shared-path protection, SPP) e esquemas de restauração de tráfego. Avaliamos esquemas divulgados na literatura como o dynamic load balancing shared-path protection (DLBSPP) e esquemas de restauração como o traffic aware restoration (TAR) e bandwidth squeezed restoration (BSR). Avaliamos também uma heurística de alocação de slots chamada inverted dual stack (IDS). O DLBSPP utiliza balanceamento dinâmico de carga para computar os caminhos primários e de proteção compartilhados. O TAR executa a restauração dinâmica ordenando as conexões por granularidade de banda. O BSR utiliza a capacidade de contração de banda do EON para restaurar conexões por meio da política de melhor esforço ou de banda garantida, dependendo do acordo de níveis de serviço do cliente. O esquema IDS concentra o maior número possível de slots compartilhados em uma região do espectro. As medidas de desempenho dos algoritmos são avaliadas segundo as métricas: probabilidade de bloqueio, taxa de utilização do espectro, número médio de hops e taxa de restauração falha. As simulações computacionais mostram o bom desempenho da utilização do esquema IDS com DLBSPP. / Optical networks are undergoing significant changes driven by the exponentially growing traffic, especially coming from multimedia and cloud storage services. This demand will require increasing of the transmission rate capacity as high as 400 Gb/s and 1 Tb/s. Within this context, it was proposed the elastic optical network (EON), which is a network architecture with flexible granular frequency grid. EON divides the frequency spectrum into slices (slots) of fixed size and allocates groups of contiguous slots strictly according to the bandwidth requirement of the connection demands, providing high spectrum use efficiency. The significant increase in transmission rate put emphasis on the need to maintain the survival of the network, since the occurrence of faults in the network nodes or links can cause huge loss of data. In this work, we investigate protection schemes based on shared-path protection (SPP) and traffic restoration schemes. We evaluate schemes related in the literature, such as the dynamic load balancing shared-path protection (DLBSPP), and restoration schemes such as the traffic aware restoration (TAR) and the bandwidth squeezed restoration (BSR). The DLBP scheme uses dynamic load balancing to compute primary and shared protection paths. The TAR performs dynamic restoration ordering the connections based on band granularity. The BSR uses EON\'s band squeezing feature to restore connections by means of the best effort or guaranteed bandwidth strategy, depending on the customer\'s service level agreement. IDS scheme concentrates the maximum possible number of shared slots in a given region of the spectrum. Performance of the algorithms are evaluated according to metrics: blocking probability, spectrum utilization rate, average number of hops and failure restoration rate. Computer simulations show that the use of the IDS scheme improves the performance of the investigated algorithms.

Distributed systems are everywhere. From large datacenters to mobile devices, an ever richer assortment of applications and services relies on distributed systems, infrastructure, and protocols. Despite their ubiquity, testing and debugging distributed systems remains notoriously hard. Moreover, aside from inherent design challenges posed by partial failure, concurrency, or asynchrony, there remain significant challenges in the implementation of distributed systems. These programming challenges stem from the increasing complexity of the concurrent activities and reactive behaviors in a distributed system on the one hand, and the need to effectively leverage the parallelism offered by modern multi-core hardware, on the other hand. This thesis contributes Kompics, a programming model designed to alleviate some of these challenges. Kompics is a component model and programming framework for building distributed systems by composing message-passing concurrent components. Systems built with Kompics leverage multi-core machines out of the box, and they can be dynamically reconfigured to support hot software upgrades. A simulation framework enables deterministic execution replay for debugging, testing, and reproducible behavior evaluation for largescale Kompics distributed systems. The same system code is used for both simulation and production deployment, greatly simplifying the system development, testing, and debugging cycle. We highlight the architectural patterns and abstractions facilitated by Kompics through a case study of a non-trivial distributed key-value storage system. CATS is a scalable, fault-tolerant, elastic, and self-managing key-value store which trades off service availability for guarantees of atomic data consistency and tolerance to network partitions. We present the composition architecture for the numerous protocols employed by the CATS system, as well as our methodology for testing the correctness of key CATS algorithms using the Kompics simulation framework. Results from a comprehensive performance evaluation attest that CATS achieves its claimed properties and delivers a level of performance competitive with similar systems which provide only weaker consistency guarantees. More importantly, this testifies that Kompics admits efficient system implementations. Its use as a teaching framework as well as its use for rapid prototyping, development, and evaluation of a myriad of scalable distributed systems, both within and outside our research group, confirm the practicality of Kompics. / <p>QC 20130520</p>

As redes ópticas estão passando por mudanças significativas, impulsionadas pelo crescimento exponencial do tráfego, principalmente advindo de serviços multimídia e armazenamento em nuvem. Esta demanda exigirá aumento da capacidade da taxa de transmissão para padrões como 400 Gb/s e 1 Tb/s. Nesse contexto, foi proposta uma arquitetura de rede com grade de frequências granular flexível chamada elastic optical network (EON). A EON divide o espectro de frequências em fatias (slots) de tamanho fixo e aloca grupos de slots contíguos estritamente de acordo com os requisitos de banda das demandas de conexão, implicando eficiência de uso do espectro. Com o aumento significativo da taxa de transmissão, acentuou-se a preocupação em manter a sobrevivência da rede, já que pouco tempo de queda no serviço pode acarretar uma imensa perda de dados. Neste trabalho, investigamos esquemas de proteção baseados em caminhos compartilhados (shared-path protection, SPP) e esquemas de restauração de tráfego. Avaliamos esquemas divulgados na literatura como o dynamic load balancing shared-path protection (DLBSPP) e esquemas de restauração como o traffic aware restoration (TAR) e bandwidth squeezed restoration (BSR). Avaliamos também uma heurística de alocação de slots chamada inverted dual stack (IDS). O DLBSPP utiliza balanceamento dinâmico de carga para computar os caminhos primários e de proteção compartilhados. O TAR executa a restauração dinâmica ordenando as conexões por granularidade de banda. O BSR utiliza a capacidade de contração de banda do EON para restaurar conexões por meio da política de melhor esforço ou de banda garantida, dependendo do acordo de níveis de serviço do cliente. O esquema IDS concentra o maior número possível de slots compartilhados em uma região do espectro. As medidas de desempenho dos algoritmos são avaliadas segundo as métricas: probabilidade de bloqueio, taxa de utilização do espectro, número médio de hops e taxa de restauração falha. As simulações computacionais mostram o bom desempenho da utilização do esquema IDS com DLBSPP. / Optical networks are undergoing significant changes driven by the exponentially growing traffic, especially coming from multimedia and cloud storage services. This demand will require increasing of the transmission rate capacity as high as 400 Gb/s and 1 Tb/s. Within this context, it was proposed the elastic optical network (EON), which is a network architecture with flexible granular frequency grid. EON divides the frequency spectrum into slices (slots) of fixed size and allocates groups of contiguous slots strictly according to the bandwidth requirement of the connection demands, providing high spectrum use efficiency. The significant increase in transmission rate put emphasis on the need to maintain the survival of the network, since the occurrence of faults in the network nodes or links can cause huge loss of data. In this work, we investigate protection schemes based on shared-path protection (SPP) and traffic restoration schemes. We evaluate schemes related in the literature, such as the dynamic load balancing shared-path protection (DLBSPP), and restoration schemes such as the traffic aware restoration (TAR) and the bandwidth squeezed restoration (BSR). The DLBP scheme uses dynamic load balancing to compute primary and shared protection paths. The TAR performs dynamic restoration ordering the connections based on band granularity. The BSR uses EON\'s band squeezing feature to restore connections by means of the best effort or guaranteed bandwidth strategy, depending on the customer\'s service level agreement. IDS scheme concentrates the maximum possible number of shared slots in a given region of the spectrum. Performance of the algorithms are evaluated according to metrics: blocking probability, spectrum utilization rate, average number of hops and failure restoration rate. Computer simulations show that the use of the IDS scheme improves the performance of the investigated algorithms.

L’étude de la conflictualité armée dans les pays en développement et des effets des interventions extérieures visant à la circonscrire constitue un enjeu majeur et multidisciplinaire. La complexité des processus sociaux entrelacés dans de tels contextes génère des défis particuliers pour les approches de modélisation et simulation informatique. En effet la forme des conflits actuels, centrés autour des populations locales, a amené les forces de stabilisation à développer des actions dites d'influence, qui se donnent pour but de convaincre les locaux de la légitimité des opérations. Ce travail en retient trois (opérations psychologiques OMI/PSYOPS, opérations civilo-militaires et Key Leader Engagements) et propose une modélisation permettant de représenter la propagation de leurs effets au sein d'une population virtuelle réaliste. Cela nécessite une représentation détaillée des mécanismes psychologiques de persuasion et d’influence et des structures sociales considérées, et constitue donc un apport à l’analyse des processus de communication au sein de réseaux sociaux. On fait le choix d'une simulation sociale orientée agents permettant de représenter d'une part un échantillon composé uniquement d'individus (jusqu’à environ 10 000) dotés de mécanismes de traitement réalistes, et d'autre part la complexité des sphères de sociabilité collective en générant cette population sous forme d'un réseau multicouche. Le modèle conceptuel ainsi conçu permet d’intégrer pour chaque étape des critères pertinents pour la simulation des actions, mais aussi, eut égard à la nature même de celles-ci et de leurs enjeux, d’éclairer certains mécanismes sociaux caractéristiques d’un conflit armé / The study, analysis and understanding of armed violence phenomenons in developing countries and of the effects of international military interventions aimed at resolving them is a crucial contemporary issue. These situations coincidentally present, considering the plethora and complexity of the implicated and intertwined social processes, a challenge for social computing, modeling and simulation. A challenge but also an opportunity, as the evolution of the forms of conflict, today centered on the local populations, has prompted the armies tasked with implementing stabilization missions to develop influence actions. Such operations, overall concerned with persuading the locals of the legitimacy of the operations, allow a more comprehensive approach to conflict resolution, beyond the simple use of force. Modeling some of these specific actions (PSYOPS, CIMIC, and Key Leader Engagement) is a credible project and a contribution to analysis of communication and persuasion processes in social networks by taking into account detailed and specific social and cultural factors. This research thus presents a conceptual model allowing simulation of the effects of these specific actions of influence in a realistic civilian population. We chose an agent-based approach as these lend particularly well with this type of research, allowing us to generate a group of up to 10,000 agents, composed solely of individuals for a detailed cognitive treatment, and structured as a multilayer network for representing complex sociality. Given the nature of such actions and their context of application, such a model also highlights some social mechanisms typical of armed conflict situations