Avdelningen för klinisk kemi vid Länssjukhuset i Kalmar analyserar läkemedel och alkoholer med BD Vacutainer® Plus Plastic Serum Tube (Serum Tube), som kräver en koagulationstid i upp till 60 minuter. BD Vacutainer® Rapid Serum Tube (RST™) innehåller trombin och kräver en koagulationstid på endast 5 minuter. Syftet med studien var att undersöka möjligheten att förkorta den preanalytiska väntetiden före centrifugering vid intoxikationsanalyser i serumrör från akutmottagningen. Studien utfördes genom att jämföra RST™ med Serum Tube vid analys av S-Paracetamol och S-Etanol. Totalt analyserades 70 prover för S-Paracetamol, varav 35 RST™ och 35 Serum Tube från 35 patienter. Analys av S-Etanol utfördes på 60 prover, varav 30 RST™ och 30 Serum Tube från 30 patienter. RST™ centrifugerades efter 5 minuter och Serum Tube efter 50 minuter, före kolorimetrisk analys på analysinstrumentet VITROS® 5,1 FS. Resultaten för S-Paracetamol var inom intervallet 74,9 – 198,7 µmol/L för RST™ och inom 76,6 – 195,3 µmol/L för Serum Tube. Resultaten för S-Etanol var inom intervallet 7,5 – 74,5 mmol/L för RST™ och inom 7,5 – 74,8 mmol/L för Serum Tube. Pearsons korrelationskoefficient var 0,9977 för S-Paracetamol och 0,9980 för S-Etanol och det fanns en liten positiv bias vid analys med RST™ för båda analyterna, men ingen signifikant skillnad (p>0,05) mellan provrören påvisades. Användning av RST™ på akutmottagningen medför en förkortad preanalytisk väntetid och en snabbare turnaround time (TAT). Hypotesen att S-Paracetamol och S-Etanol kan analyseras med RST™ på VITROS® 5,1 FS stämmer, med undantag för höga koncentrationer av S-Paracetamol som inte kunde utvärderas. För att RST™ ska kunna användas rutinmässigt bör därför ytterligare studier utföras.

Background Customer satisfaction is important for clinical microbiology laboratories and the most important service aspect is the reliability of responses. One important indicator of the quality of care is turnaround time for a sample referred to a laboratory. Aim This study describes and evaluates an improvement of the blood culture process and evaluates the staff’s experiences of the changes brought by the improvement project. Methods The blood culture process during evenings and nights was re-designed in a cooperation project between the laboratories of clinical microbiology and clinical chemistry in a mid-size Swedish county council. Typing with matrix-assisted laser desorption/ionization time of flight (MALDI ToF) and rapid antibiotic susceptibility testing were also introduced. To describe staff experi-ences semi-structured interviews were performed with twelve of the staff involved. Results The time from sampling to susceptibility testing and typing, for patients with cefotaxime resistant enterobacteriaceae, was before the improvement project on average 55 hours compared to 43 hours after closure of the project. In the qualitative content analysis four categories were found which represented the experience of the staff: patient focus, changed knowledge, cooperation and driving forces. Discussion The study of the implementation of the improvement showed that laboratory staff could handle the change well. The change from traditional biochemical typing, used for over 50 years, to MALDI ToF is indeed a paradigm shift. Nevertheless, nobody was disappointed over the fact that some of the fundamental previous microbiological laboratory work routines were laid to rest.

Today great efforts are made to record and reduce waiting times in cancer care. Long and variable turnaround times (TATs) delay the start of treatment and waiting contributes to mental anguish. The purposes of the QI intervention were to establish an effective and streamlined histopathology process with shorter TATs, to extend customer collaboration and to build knowledge of internal processes in order to lay the foundation for a learning environment. The goal was to raise the proportion of reported tissue samples from 50% to 90% within a 15 day period, ending 31th December 2014. The study of the QI intervention intended to identify factors that affect the introduction of novel working methods. Both quantitative and qualitative methods were used to achieve the goals. Improvement knowledge was combined with lean-inspired methods, and two focus groups were arranged in which data were analysed using qualitative content analysis. The goal to report 90% of tissue samples within 15 days was not achieved for all sample types, but improved TATs were clearly noted. Customer collaboration and visualisation of the processes had a positive effect on staff. The study resulted in six key factors important working with QI interventions; competence, compliance, feedback, interaction, patient- and customer focus and resources. Having motivated and dedicated staff is a key success factor for improvement work, in contrast to a lack of resources, and people that oppose change. To achieve future ambitious goals requires continuous improvement initiatives that involve optimisation of both human resources and equipment. / Stort fokus riktas idag på att kartlägga och reducera väntetider inom cancervården. För långa och variabla svarstider fördröjer behandlingsstart och väntan innebär dessutom psykiskt lidande. Syftet med förbättringsarbetet var att etablera en effektiv och stabil patologiprocess med kortare svarstider, utöka kundsamverkan samt bygga kunskap om interna processer för att lägga grunden till en lärandemiljö. Målet var att senast den 31 december 2014 höja andelen besvarade vävnadsprover från 50 % till 90 % inom 15 dagar. Studien av förbättringsarbetet syftade till att identifiera faktorer som påverkar införandet av nya arbetssätt. Såväl kvantitativa som kvalitativa metoder användes för att uppnå målen; förbättringskunskap kombinerades med lean-inspirerade metoder och två fokusgrupper där data analyserades med kvalitativ innehållsanalys. Målet att höja andelen vävnadsprover som besvarades inom 15 dagar på 90 % uppnåddes inte för samtliga provtyper, men tydligt förbättrade svarstider noterades. Kundsamverkan och visualisering av processerna hade en positiv effekt på personalen. Studien resulterade i sex viktiga faktorer; kompetens, inställning, återkoppling/feedback, interaktion, patient- och kundfokus och resurser. Motiverad och engagerad personal är nyckelframgångsfaktorer i förbättringsarbeten i motsats till resursbrist och människor som motsätter sig förändring. För att på sikt uppnå högt uppsatta mål krävs fortsatta förbättringsinitiativ som involverar optimering av både personalresurser och instrumentering.

The sustainability of air transport relies on proper and timely aircraft ground handling. Lack of manpower and current ground handling industry conditions makes innovation and automation the only way to support existing growth rates. This research presents the state of the art of aircraft ground handling at airports, identifying the challenges to overcome in building safe, efficient and environmental friendly automated ground operations. The greatest opportunity lies with automated docking of ground support equipment to aircraft, with further autonomous vehicles moving around the aircraft and automated systems within the aircraft later on. The problem formulation for resources assignment for ground handling in a fully automated environment is undertaken. On-line solutions for the fleet assignment problem are proposed and applied to an airport case. / La durabilité du transport aérien est basée sur le bon déroulement de la manutention des avions. Le manque de main d’œuvre et les conditions existantes sur l’industrie de la manutention au sol fait que l’innovation et l’automatisation sont la seule façon de maintenir le rythme de croissance actuel. Cette recherche présente l’état de l’art de la manutention au sol des avions, identifie les défis à résoudre pour parvenir à des opérations au sol sécurisées, efficaces et respectueuses de l’environnement. La meilleure opportunité est dans l’accostage automatique des matériels au sol à l’avion, avec des véhicules autonomes qui vont évoluer autour de l’avion et des systèmes automatisés dans l’avion lui-même. La formulation du problème pour l’allocation des ressources pour la manutention au sol des avions dans le cadre totalement automatisé est entreprise. Des solutions en ligne pour le problème d’assignation des flottes sont proposées et appliquées dans un aéroport.

In the mortgage industry, many mortgage lenders cannot manage mortgage workflow systems while meeting and exceeding organizational objectives. Organizations with an above-industry average turnaround time (ATT) to complete a retail mortgage transaction (RMT) from origination to funding experience revenue losses. Grounded in the proposition that mortgage loan purpose (MLP), mortgage loan type (MLT), and subject property type (SPT) impact ATT to complete an RMT, the purpose of this causal-comparative study was to assess the impact of MLP, MLT, and SPT on ATT to complete an RMT. Using archival data records (N = 146) from a selected mortgage institution in the state of Florida, the results of the 2 x 2 x 2 factorial ANOVA showed that there were no main or interaction effects F(5,140) = 0.42, p = .83. Implications for social change include the possibility for mortgage lenders to implement improved workflow processes to reduce costs and improve efficiency metrics and intrinsic value, thereby benefitting organizational stakeholders such as employees and consumers.

Maldives is an island nation that consists of around 1190 islands located in the Indian Ocean, southwest of Sri Lanka. The country virtually imports everything it consumes. Male’ Commercial Harbour handles all international sea cargo for the country. The land area assigned for the port is small; and there are frequent bottlenecks and congestion in the port. By using computer simulation techniques, this research investigates the situation of Male’ Commercial Harbour and identifies logistic bottlenecks that exist at the port. Accordingly, a field research was conducted at Male’ Commercial Harbour to collect required data. Both, qualitative and quantitative data were collected using focus group, interviews, on-site observations, and time and motion measures. The simulation models presented in this thesis were carried out with Arena software (Academic Version of Arena 10.0). The models were used to analyse the vessel turnaround time, berth capacity, yard capacity, container dwell time, queue values, utilisation of ship cranes and other container handling equipment. The results show that berth capacity seems to be the major bottleneck that creates longer queues and ship delays at Male’ Commercial Harbour. Several scenarios were tested to identify the best scenario regarding ship waiting time at berth. Based on the best scenario, a project was proposed focusing on the development of an extended alongside berth at Male’ Commercial Harbour. A cost benefit analysis was performed to see whether the project is financially feasible.

International Telemetering Conference Proceedings / October 17-20, 1994 / Town & Country Hotel and Conference Center, San Diego, California / The Aircraft Research and Development Unit (ARDU) of the Royal Australian Air Force (RAAF) is the only agency in Australia that performs the full spectrum of military flight testing and is the new custodian of the instrumented weapons range at Woomera. Receiving early attention will be the upgrade and integration of ARDU's telemetry systems with the meteorological and tracking data acquisition capabilities at Woomera to minimize overhead and data turnaround time. To achieve these goals, maximum modularity, extensibility, and product interoperability is being sought in the proposed architecture of all the systems that will need to cooperate on the forecast test programmes. These goals are also driven by the need to be responsive to a wide variety of tasks which presently include structural flight testing of fighter and training aircraft, weapons systems performance evaluation on a variety of combatant aircraft, and a host of other tasks associated with all fixed and rotary wing aircraft in the Army and Air Force inventory. Of all these tasks however, ARDU sees that responsiveness to future testing of F-111Cs fitted with unique Digital Flight Control Systems along with USAF standard F-111Gs may place the most significant demands on data handling —particularly in regard to providing an avionics bus diagnostic capability when performing Operational Flight Programme (OFP) changes to the mission computers. With the timely assistance and advice of Loral Test & Information Systems, who has long-term experience in supporting USAF F-111 test programmes, ARDU is confident of making wise design decisions that will provide the desired flexibility and, at the same time, minimize life-cycle costs by ensuring compliance with the appropriate telemetry and open systems standards. As well, via cooperative agreements with the USAF, the potential exists to acquire proven software products without needing to fund the development costs already absorbed by the USAF. This paper presents ARDU's perception of future needs, a view by LTIS of how best to meet those needs, and, based on ARDU data, a view of how LTIS' proposal will satisfy the requirement to provide maximum extensibility with minimum life-cycle costs.

La croissance de la taille des porte-conteneurs et leur déploiement sur les grandes routes maritimes mondiales est une réalité. Actuellement, la croissance de la capacité des porte-conteneurs a atteint 21 413 EVP, et les carnets de commandes laissent présager une tendance vers des navires encore plus grands. Par exemple, le transporteur CMA CGM devrait recevoir neuf nouveaux porte-conteneurs de 23 000 EVP d'ici la fin de l’année 2020. L’objectif de ce mémoire est de caractériser le mouvement des méga porte-conteneurs sur plusieurs routes maritimes, avec différents transporteurs et régions du monde. Cet objectif comporte deux volets; le premier porte sur l’analyse de la variabilité du temps des escales de méga-navires dans les ports, et le deuxième fait l’étude de la planification des routes de méga-navires pour les transporteurs maritimes. Les données historiques du mouvement d'un grand échantillon de méga-navires ont été analysées en vue de répondre à une série de questions permettant de structurer la recherche. Cette dernière permettra entre autres d’identifier les ports recevant des escales de méga-navires, d’évaluer la variabilité des temps d’escale ainsi que de présenter l’architecture des routes maritimes de ce type de navires. Enfin, cette étude permet de différencier la productivité des ports d'escale, des régions du monde et des transporteurs sur plusieurs routes maritimes. / The growth in the size of container vessels and their deployment is a reality. Currently, the growth of container ships is at 21 413 TEUs, and the order books for ever larger vessels portend an even greater trend towards larger vessels. For instance, CMA CGM will be delivered nine new 23 000 TEU container ships by the end of 2020. The objective of this paper is to characterize the movement of ultra-large container vessels (ULCV) on several shipping routes, with different carriers and regions of the world. This objective is two-fold; the first part deals with the variability of the dwell time of ULCV in the ports, and the second deals with the planning of ULCV routes for each maritime carrier. Historical data of the movement of a large sample of ULCV was analysed with a view to address a series of key issues. Here are some of these issues: What are the mains ports of call? What is the variability of dwell time between the ports of call? What are the routing patterns of mega containers vessels? This study will allow us to differentiate productivity of different ports of call, regions and shipping carriers on many shipping lanes.