The main purpose of this research is to investigate Jordan and Israel's participation in the Red Sea – Dead Sea Water Convenience project from human security point of view. The Red Sea – Dead Sea Water Conveyance project is planned to desalinate water from Red Sea to the Dead Sea and provide fresh water to Jordan, Israel and possibly Palestine. I use a human security approach in this investigation because it has a broader people-centered security perspective. This approach guides the research to consider water related issues and challenges in Jordan and Israel to which the project can be a possible solution. I use qualitative content analysis to investigate the issues identified by Jordan and Israel, and how the project is estimated to address these challenges. I argue that the estimated benefits that the implementation of the project provides for human well-being in Jordan and Israel makes them to participate in this project.

Bakgrund: Ambulanssjuksköterskors uppdrag handlar till stora delar om att undersöka, bedöma, triagera och behandla patienter. Sjukdomsbilden spänner från svårt sjuka till enkla åkommor eller ibland helt oskadda patienter. Att hänvisa till rätt vårdnivå är viktigt då sjukvårdens resurser är begränsade och behöver användas på rätt sätt till rätt patienter. Rätt vårdnivå kan ibland innebära att patienten kvarstannar i hemmet, med råd till egenvård, eller att ta sig till vårdinstans med närståendes hjälp eller sjukresa, så kallad non-conveyance. Syfte: Syftet var att beskriva ambulanssjuksköterskors upplevelser av non-conveyance i glesbygdsmiljö. Metod: Kvalitativ studie med induktiv ansats. Från fem ambulansstationer i norra Sverige rekryterades åtta deltagare. Datainsamlingen utfördes genom individuella semistrukturerade intervjuer. Därefter analyserades intervjuerna utifrån kvalitativ innehållsanalys med manifest ansats. Resultat: Analysen resulterade i två kategorier, “Avståndet är en betydande del i beslutet” och “Stärka mötet vid non-conveyance genom omvårdnad”. Dessa två kategorier innehåller fem underkategorier “Beslutet att lämna hemma på gott och ont”, “Utmaningarna ökar med avstånd”, “Möta motstånd och bemöta det”, “Viljan att göra mer och det lilla extra” och “Ta hjälp av hemtjänst eller närstående när patienten inte medföljer”. Slutsats: Erfarenhet och god kunskap är viktigt för att kunna genomföra en god undersökning och bedömning. Avståndet är också en betydande faktor i beslutet att lämna hemma, dessutom är viljan att göra det lilla extra en betydande del i arbetet i glesbygdsmiljö. Att göra bedömningar och ta beslutet att inte transportera patienten upplevs som både utmanande och svårt.

Bakgrund: Att hänvisa patienter till adekvat vårdnivå ingår i ambulanssjuksköterskors arbetsuppgifter. Det är dock ingen enkel uppgift och tidigare forskning visar att det ofta är förenat med en känsla av otrygghet. Under hösten 2018 inleddes en samverkan mellan en ambulansorganisation i södra Sverige och 1177 vårdguiden, med målet att stärka sjuksköterskors trygghet vid hänvisning av patienter från ambulanssjukvård till egenvård. I samverkan ingick ett nytt beslutsstöd samt ett uppföljningssamtal för patienterna via 1177 vårdguiden. Syfte: Syftet med studien är att undersöka och beskriva hur sjuksköterskor upplever hänvisning av patienter från ambulanssjukvård till egenvård vid samverkan med 1177 vårdguiden. Metod: En mixad metod med kvantitativa enkäter och kvalitativa intervjuer med en förklarande sekventiell design har använts. Resultat: Resultatet visar på en positiv förändring av hur sjuksköterskorna upplever hänvisning av patienter till egenvård, efter utbildningsinterventionen upplever de en ökad trygghet. De upplever det tryggt både för sig själva och för patienterna att en tredje part följer upp och kontrollerar utförda bedömningar, därigenom erfar de trygghet i ett delat ansvar. Konklusion: Ett mångdimensionellt beslutsstöd, att patienterna får ett uppföljande samtal samt att bedömningen blir kontrollerad, är faktorer som samtliga bidrar till ökad trygghet för sjuksköterskorna. / Background: Referring patients to an adequate level of care is included in the assignments of ambulance nurses. However, it is not a simple task and previous research shows that it is often associated with a feeling of insecurity. In the fall of 2018 a collaboration between an ambulance organization in southern Sweden and the 1177 care guide where introduced. The aim of the collaboration was to strengthen the nurses feelings of safety when referring patients from ambulance care to self-care. The collaboration included a new decision support system and a follow-up call for the patients. Aim: The aim of the study was to explore and describe how nurses experience non-conveyance of patients who gets referred from ambulance care to self-care in collaboration with 1177 care guide. Method: A mixed method with quantitative surveys and qualitative interviews with an explanatory sequential design has been used. Results: The result shows a positive change in how the nurses experience referral of patients to self-care, after the training intervention they experience increased feeling of security. They find it safe both for themselves and for the patients that a third party follows up and verify the assessments, thereby they experiencing feeling of safety in a shared responsibility. Conclusion: A multi-dimensional decision support system, that the patients receive a follow-up call and that the assessment is controlled, are factors that all contribute to increased feelings of safety for the nurses.

Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.

Les actionneurs numériques sont composés d'une partie mobile pouvant se déplacer entre des positions discrètes précisément connues et répétables. Contrairement aux actionneurs analogiques classiques, le pilotage d'actionneurs numériques est réalisé très simplement à l'aide d'une commande impulsionnelle et en boucle ouverte. De ce fait, aucun capteur n'est nécessaire ce qui facilite leur intégration dans des systèmes hôtes. La qualité de fabrication de ces actionneurs est cependant primordiale car une éventuelle erreur ne peut pas être corrigée par la commande. Les travaux présentés porteront sur un réseau composé de 25 actionneurs numériques disposant chacun de quatre positions discrètes avec un plateau glissant. L'application visée est la réalisation d'un système de convoyage planaire dans laquelle les actionneurs permettent de déplacer un plateau selon les deux directions du plan. Les résultats de la simulation sont comparés avec les résultats expérimentaux. En suite, un réseau composé de quatre actionneurs numériques avec un plateau structuré est étudié. La conception du réseau d'actionneurs puis la stratégie de pilotage permettant de réaliser le déplacement du plateau structuré seront tout d'abord présentées. Un prototype de réseau d'actionneurs et des résultats expérimentaux de convoyage selon une direction sera ensuite détaillé et l'influence d'erreurs de fabrication sur le fonctionnement du réseau sera mise en évidence. / The open loop control is widely used by the digital systems to facilitate the integration in complex systems because no sensor is needed. The research is based on digital actuator which is composed of a mobile part and a fixed part. The actuator moves between the discrete positions. The discrete displacement consumes low energy, which is controlled by impulse only needed to switch the actuator between the discrete positions. However, the stroke of digital actuator is fixed at the manufacturing. So the digital actuators array is used to obtain variable strokes. A digital actuators array used here with a structured plate is applied as a 2D planar conveyance. Firstly, an actuators array composed of 25 elementary actuators with a flat plate is studied. The simulated results are compared with the experimental results. Then another actuators array composed of four elementary actuators with a structured plate is designed. The design and the plate displacement are firstly presented. Then the prototype of the conveyance is fabricated with laser cutting machine and 3D printer. The experiment is then tested in one direction to study the plate displacement. The open loop control is simple by using current impulse. The operation can be well functioned which is observed during the experiment. The experimental results are compared with the theoretical results.

El presente proyecto nace con el objetivo de solucionar las necesidades de las personas que utilizan la bicicleta como medio de transporte eco amigable y que realizan recorridos cortos o a distancia, con el desarrollo de un negocio viable y escalable. De esta manera, surge Bici Partners, enfocado en brindar un servicio de reparación, mantenimiento y auxilio de bicicletas en Lima Centro, donde se identificó el mayor tránsito de bicicletas y proyectos de futuras ciclovías. Asimismo, se identificó como mercado objetivo hombres y mujeres de 18 a 39 años, de N.S.E A, B Y C, que realicen trayectos en bicicleta por los distritos pertenecientes a este sector. Debido a lo mencionado, consideramos que el desarrollo de un servicio apoyado por las distintas herramientas digitales como la página web y un aplicativo móvil, logrará introducirse al mercado de manera óptima, con un servicio diferenciado e innovador, con el que el usuario podrá continuar con sus recorridos y contar con la seguridad de que existe alguien a quien solicitar ayuda en donde se encuentre y al instante. Cabe mencionar, que se realizó la validación de Bici Partners con diversos métodos cualitativos y cuantitativos de investigación, que confirman la existencia de un mercado objetivo que cubrir, como también, el potencial de crecimiento del sector, en el que se podrá desarrollar un plan de expansión con la ayuda de alianzas clave del mercado. / The present project was created with the aim of solving the need of people who use the bicycle as a means of eco-friendly transportation for short or long distance journeys, by developing a viable and scalable business idea. Thereby, Bici Partners emerged, focused on providing repair, maintenance and road assistance services for bicycles users in Lima Centro, area where most of bicycles transit and bicycle lanes projects were identified. Additionally, our target market was identified as men and women, between ages 18 to 39, from socio - economic levels A, B & C, whose bicycle routes are across Lima Centro’s districts. Due to the aforementioned, we consider that developing services supported by digital tools such as a website and application, will allow an optimal market entry, with differentiated an innovative services, by which the user will be able to continue with their journey and feel confident by knowing there is someone they can call for help, anywhere at any time. Further noted, the validation phase for Bici Partners was carried out through different qualitative and quantitative methods, which confirm the existence of a target market to cover, as well as, the growth potential of the sector, where an expansion plan can be developed with the help of key market alliances. / Trabajo de investigación

El objetivo del presente proyecto es demostrar la viabilidad de la empresa de servicio móvil de mantenimiento y reparación de bicicletas, denominada TOTAL BYKE. Para ello, se realiza una investigación de mercado, cuyos resultados evidencian que, existe una demanda insatisfecha por servicios de mantenimiento, reparación y adquisición de accesorios de bicicletas, ya que, los ciclistas deben recorrer largos tramos para ubicar un taller que brinde este tipo de servicios, los cuales, generalmente no brindan un buen trato al cliente, servicio de calidad ni cuentan con garantía. Asimismo, se ejecuta un diagnóstico con referencia al plan de marketing, operaciones, recursos humanos y financieros, mediante la aplicación de metodologías cualitativa y cuantitativa. Se realizaron entrevistas virtuales a usuarios acordes al grupo objetivo, para conocer su experiencia respecto al uso de bicicletas y los servicios relacionados que tienen a su alcance, tales como mantenimiento, reparación y compras de accesorios. Los resultados obtenidos suponen que existen diversos servicios dedicados al mantenimiento de bicicletas, los mismos que difieren grandemente con el valor agregado que el presente proyecto propone, un servicio técnico móvil itinerante, cuya naturaleza le permite estar cerca del segmento objetivo al que se dirige a través de los siguientes distritos, Jesús María, San Isidro, Miraflores, San Borja y Surco. El proyecto generaría un retorno de 61% como mínimo para los inversionistas, con un periodo de recuperación de 2 años y una rentabilidad del proyecto de 1.19 veces la inversión inicial. Por ello, consideramos que TOTAL BYKE es una idea de negocio viable. / The objective of this project is to demonstrate the viability of the mobile bicycle maintenance and repair service company, called TOTAL BYKE. To do this, a market research is carried out, the results of which show that there is an unsatisfied demand for maintenance, repair and purchase of bicycle accessories, since cyclists must travel long stretches to locate a workshop that provides this type of services, which generally do not provide good customer service, quality service or have a guarantee. Likewise, a diagnosis is carried out with reference to the marketing plan, operations, human and financial resources, through the application of qualitative and quantitative methodologies. Virtual interviews were conducted with users according to the target group, to learn about their experience regarding the use of bicycles and the related services available to them, such as maintenance, repair and purchases of accessories. The results obtained assume that there are various services dedicated to the maintenance of bicycles, the same that differ greatly with the added value that this project proposes, a mobile mobile technical service, whose nature allows it to be close to the target segment to which it is directed through from the following districts, Jesús María, San Isidro, Miraflores, San Borja and Surco. The project would generate a return of at least 61% for investors, with a payback period of 2 years and a project profitability of 1.19 times the initial investment. Therefore, we consider TOTAL BYKE to be a viable business idea. / Trabajo de investigación

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I Sverige pågår en reform för att etablera en nära vård som prioriterar att vården omkring patienten blir mer effektiv och patientfokus i vårdmiljön stärks. Kärnan i denna reform är övergången till ett mer personcentrerat arbetssätt. Dagens ambulanssjukvård motsvarar inte samhällets ökade krav och är inte rätt rustad och effektiv i sin nuvarande struktur. Ett personcentrerat förhållningssätt tydliggör patientens behov och unika situation. Examens-arbetets syfte var att analysera tillämpningar av personcentrerad vård i dagens ambulans-sjukvård. Åtta yrkesverksamma ambulanssjuksköterskor inkluderades utifrån bekvämlig-hets urval och individuella intervjuer genomfördes. Materialet analyserades med kvalitativ innehållsanalys. Resultatet presenteras i tre huvudkategorier och sex subkategorier. Kommunikationen mellan ambulanssjuksköterskan och patienten framkommer som ett centralt begrepp i förverkligandet av ett personcentrerat fokus i den prehospitala vårdmiljön. Viktiga insikter är att ambulanssjuksköterskans handlingar mot patienten har stor inverkan på patientens integritet och är av betydelse i vårdandet. / In Sweden, a reform is underway to establish easy to assess healthcare system, that in integrative way prioritizes brings healthcare closer to the patient to create a more efficient and patient-focused care environment. The core of this reform is the transition to a more person-centered approach. Today's ambulance healthcare does not meet society's increased demands and is not adequately equipped or efficient in its current structure. A person-centered approach highlights the patient's needs and unique situation. This one-year master thesis aims to analyze the applications of person-centered care in today's ambulance healthcare. A qualitative interview study was conducted with eight practicing ambulance nurses selected through convenience sampling. Communication between the ambulance nurse and the patient emerges as a central concept in realizing a person-centered focus in the prehospital care environment. Key insights reveal that the actions of the ambulance nurse regard the patient have a significant impact on the patient's integrity and subsequent care plan.