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Bakgrund Palliativ vård syftar till att lindra och förebygga lidande, det är en vårdform som fokuserar på att förbättra och bibehålla människors livskvalitet i slutet av livet. Att känna igen personers behov i ett tidigt skede kan man ge vård av bättre kvalitet. Alla människor som är i behov av palliativ vård ska få tillgång till det. Delaktighet innebär att patienter får en chans att främja sin hälsa, stärka sin autonomi samt använda sina egna resurser. Det har visat sig att ett aktivt patientdeltagande kan vara till sin fördel, därför är det relevant att insamla mer kunskap om patienters erfarenheter för att sedan kunna använda sig av det utifrån ett hälsofrämjande perspektiv. Syfte Syftet var att belysa patienters erfarenheter av delaktighet vid palliativ vård. Metod Metoden till denna studie var en icke-systematisk litteraturöversikt. Det inkluderades 15 vetenskapliga artiklar med mixad metod, kvalitativ och kvantitativ design. Databaserna som användes var CINAHL och PubMed. Artiklarna kvalitetsgranskades utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. För att slutligen sammanställa resultatet användes en integrerad dataanalys. Resultat Två huvudkategorier identifierades i studiens resultat: Positiva erfarenheter av delaktighet och Negativa erfarenheter av delaktighet. Positiva erfarenheter av delaktighet delades upp i tre underkategorier som var god kommunikation, ökat välbefinnande och förtroende och trygghet. Även negativa erfarenheter delades upp i tre underkategorier som var känna sig förbisedd, känsla av meningslöshet och bristande information., Background Palliative care aims to ease and prevent suffering, it is a form of care that focuses on improving and maintaining people’s quality of life. If people’s needs are recognized at an early stage, better quality of care can be provided. All people in need of palliative care must get access to it. Participation means that patients get a chance to promote their health, strengthen their autonomy and use their own resources to do it. It has been shown that active patient participation can be beneficial, therefore its relevant to gather more knowledge about patients experiences to then be able to use it from a health promoting perspective. Aim The aim of this study was to highlight patients’ experiences of participation in palliative care. Method The method of this study was a non-systematic literature review. 15 scientific articles with mixed method, qualitative and quantitative design were included. The databases used were CINAHL and PubMed. The articles have been quality reviewed based on Sophiahemmet University´s assessment tool for scientific classification and quality. To finally compile the results, an integrated data analysis was used. Results Two main categories were identified in the study results: Positive experiences of participation and Negative experiences of participation. Positive experiences of participation were divided into three subcategories which were good communication, increased well-being and trust and confidence. Negative experiences were also divided into three subcategories which were feeling overlooked, sense of meaninglessness and lack of information. Conclusions The result showed the importance of a person-centered approach of participation in palliative care. It emerged that increased participation led to improved quality of life for the patients. As a health care professional, it is important to work person-centered because every situation and every patient is unique. Shared decision-making generally increased the sense of particip

Ports are striving to improve operational efficiency in the context of constantly growing volumes of trade. In this context, port terminal storage yard operation is key, since complexity and poor coordination lead to containers stacked without consideration of retrieval schedules, resulting in time and energy-consuming reshuffling operations. This problem, known as the block relocation (and retrieval) problem (BRP), has recently gained considerable attention. Indeed, there are promising solutions to the BRP. However, the literature views the problem in isolation, optimizing one operational parameter for one of the many port stakeholders. This often leads to efficiency losses since port processes involve different stakeholders and port parts. In this work, we explicitly focus on scheduling trucks for pick-up for hinterland distribution. Appointments are often postponed in order to minimize reshuffling operations, leading to losses for the transport forwarders and decreasing the competitiveness of the port. We discuss the trade-off between minimizing container reshuffling operations while maintaining scheduled time windows for container retrieval. We describe the multi-objective optimization problem as a weighted sum of the two objectives. Given the complexity of the problem, we also present a greedy heuristic. Our results indicate that the number of schedule deviations can be reduced without significantly affecting the number of relocations compared to solutions that consider only the latter. Ideally, a weighting of 0.4 and 0.6 should be applied, reflecting schedule deviations and relocations, respectively, to achieve the highest joint optimization potential. This demonstrates that in complex environments, such as ports, with multiple interacting stakeholders and processes, coordination of solutions yields significant benefits.

På Carolina Rediviva hittades för en tid sedan ett handskrivet blad som till en början tycktes vara rätt oansenligt. En närmare granskning av bladets innehåll visade emellertid att det rör sig om ett studieintyg utfärdat av Uppsala universitet år 1503. Fyndet väckte stor uppmärksamhet eftersom det är ett vittnesbörd från lärosätets allra första och nästan okända verksamhetstid. I den föreliggande skriften berättar forskarna Anna Fredriksson och Stefan Mähl om den uppseendeväckande upptäckten.

Densifying cities continuously call for new construction, renovation and demolition projects, each generating vast amounts of heavy goods vehicle (HGV) transports. However, how construction transportation affects the urban traffic network remains largely unexplored. This study addresses spatiotemporal network impacts from construction transport, by leveraging traditional traffic and transport simulation. To this end, a framework is presented including (i) a simulation model to compute traffic effects caused by varying off-site construction site transport demands, and (ii) conceptual applications of the simulation model showing construction logistic planning strategies to mitigate congestion disturbances. Simulations are conducted in MATSim using detailed secondary datasets describing site-specific transport arrivals from a case of six projects in Norrköping, Sweden. Subsequently, increasing transport demands were assessed on various time-window arrival scenarios against the baseline schedule, which can be used as decision support in urban planning. Results highlight how rigorous construction transport planning avoiding peak-traffic hours can significantly alleviate traffic congestion. This study also emphasizes the need to combine all simultaneous construction projects’ demands when evaluating disturbances on city-level, alongside the impact on individual links and microenvironments. This study adds knowledge by visualizing the traffic impact during urban transformation.

Increased demand for actionable knowledge in operations- and supply chain management has fuelled the interest in collaborative, action-oriented research design as well as modes of theorising that generate adaptable and actionable frameworks. Whilst action research (AR) design as well as middle-range theories (MRT) offer guiding principles herein, they are researcher centric in nature. It is taken for granted that practitioners that enter such an endeavour have a certain level of knowledge or experience prior to the initial stages of formalising the research problem. Practitioners in non-academic, operations management-intensive industries or craftsmanship-based industries, such as construction or carpeting (often in the SME range) are often neither prepared nor equipped with the principles necessary to convey their managerial challenges into collaborative research design. This risk limiting or even hindering altogether such participation. This paper elaborates on combining the logic of AR and MRT. By conceptualising a preparatory phase for initiating practitioner engagement, complementing the conventional AR cycle, a four-step approach is presented: (1) Identifying a joint interest; (2) Teaching ? Awakening interest in the topic through MRT frameworks; (3) Accepting buy-in to the AR cycle and determining the problem; and (4) Proposing MRT frameworks for analysis and entering the traditional AR cycle.

Construction logistics services can, if implemented with high quality, positively impact both efficiency and sustainability of construction projects. However, present quality management frameworks have not been developed for temporary multi-actor contexts, such as construction, which is largely lacking industrialised processes. Still, construction logistics service providers provide service offerings to temporary settings and could thus benefit from a service quality perspective. Applying this perspective, this study supports the quality improvement of construction logistics services by using a service modularity approach to identify the services to prioritise for improvement. Building on interviews, concept mapping, and a service blueprint of a construction logistics setup, a priority matrix for improvements is developed. The first step in using this matrix is to operationalise the construction logistics setup in modules based on blueprinting. Second, the matrix evaluates the modules against nine empirically derived improvement enablers such as practices and forums for learning, and data measurements enabling the comparison and followup of construction logistics services. In conclusion, the priority matrix helps focus the improvements on modules with high likelihood of successful improvements. Improvements that can become sustained over time through the reuse of standardised modules in upcoming projects.

Sweden is at EU bottom of circular soil and rock masses. The purpose of this study is to capture the relationship between the overall system and subsystems of circular soil and rock masses to identify barriers to establishing efficient circular soil and rock material flows. The main hinders are lateness of action, legislation, and lack of information sharing. This together creates a relational mess between the subsystems, leading to a lack of understanding of how to act. The relations must be clarified before public procurement will have its intended impact to increase circularity and decrease transport emissions., Cirkulär masshantering – planering och beslutsprocesser för ökad resurseffektivitet (CiMPla)

The purpose of this paper is to provide insights into how supply chain management canbe taught using megagames as a pedagogical motor. This study has had a longitudinalaction research approach to student centred learning as it builds on a previous paper onintroducing a theme of cross-functional decision-making through combining lectures,case assignment, and computer-based tools. Combining case work and the megagame hasled to activity independence and room for new reflections. What can be seen is thatexchanging the computer-based tool for a megagame has allowed students a deeperunderstanding of not only decision-making, but also decision-formulation.

Ports are striving for innovative technological solutions to cope with the increasing growth in demand of goods transport, while at the same time improving their environmental footprint. An emerging technology that has the potential to substantially increase the effectiveness of the multifaceted and interconnected port processes is that of digital twins. Recognizing the potential of twinning assets and processes, innovation-leading ports have already started working on it. However, since there is no clear consensus on what a digital twin of a complex system comprises and how it should be designed, deployed digital twin solutions for ports, as in multiple other domains, often differ significantly. We address this issue by initially identifying three core aspect underpinning digital twins of complex systems, grounding our work on the domain of ports, and outlining five successive maturity levels based on these aspects' instantiation. These identified aspects and the derived maturity levels are then used to examine real-world cases by critically evaluating existing digital twinning solutions in the port of Singapore, the Mawan port of Shanghai, and that of Rotterdam. Our work on maturity levels and core twinning aspects can provide a guideline for designing and benchmarking digital twinning solutions, applicable in any domain where a digital twin can be used. For ports, the capacity for innovation via twinning is highly contextual, with the key affecting factors being the availability of financial and technical resources.

Störningsfri stad har kombinerat kunskaper inom Trafikplanering, Visualisering, Bygglogistik, Sensorer och Offentlig planering och styrning. Projektet har letts av Linköpings universitet, Institutionen för Teknik och Naturvetenskap och finansierats av Vinnova, IHS. Projektet har löpt mellan slutet av 2018 och 2021 ut. Projektdeltagare har varit VTI, RISE, Norrköpings kommun, Linköpings kommun, Stockholm stad, Uppsala kommun, Trafikverket Projekt Ostlänken, LE Lundbergs Fastigheter, Wiklunds Åkeri, Wellsec, SanktKors, Byggföretagen, Telenor och Logistikia.Projektet har utvecklat en verktygsprototyp som stöttar kollaborativ planering av byggtrafik och stadsplanering genom att visualisera pågående byggprojekts sammanlagda mängd transporter och var i staden (i form av en kartvy) det uppstår störningar i form av förseningar pga dessa. Verktyget bygger på en MATSim trafikmodell (i nuläget Norrköping) inkluderande både persontransporter (modellerat baserat på mobilnätsdata) och byggtrafik (modellerat baserat på data från bygglogistiklösningar). Med hjälp av verktyget kan olika scenarier för att minska störningarna av byggtransporter testas. För att stötta användandet av verktyget har en kollaborativ planeringsprocess som visar på hur de olika aktörerna involverade i planeringen av byggtransporter och stadsutveckling behöver interagera med varandra utvecklats. Projektet också deltagit i utvecklingen av en sensorbox (partiklar, luftfuktighet, temperatur och ljud) samt slangmätningsmetodik för att öka kunskapen om byggtransporter. Baserat på de resultat som projektet har behovsägarna har påbörjat arbeten med att bättre hantera de störningar som uppstår pga byggprojekt i staden., Störningsfri stad

Byggtransporter står för en betydande andel av CO2-utsläppen i byggprojekt (ca 10%) och en bättre logistik leder till lägre utsläpp, mindre trängseleffekter och lägre kostnader. Projektet Fossilfri Bygglogistik, finansierat av Trafikverket genom Triple F, har 2019-2021 studerat potentialen i att minska utsläppen från byggtransporter med förbättrad logistik baserat på ett systemsynsätt. Projektet har varit ett samarbete mellan Linköpings universitet, VTI, Logistikia, Energifabriken, Renall, Almroths, SanktKors, Stångåstaden, Hyresbostäder, Peab, NCC, RagnSells, PreZero, Lambertsson och Byggföretagen. Projektet har utgått från tre frågeställningar: • Vad är potentialerna med samordnad bygglogistik och vad krävs för att hämta hem dessa? • Vilka metoder/lösningar är användbara för att nå målet om fossilfrihet? • Vad är rollfördelningen mellan aktörer. som är delaktiga i ett bygglogistiksystem, och behöver den förändras för att uppnå fossilfrihet Projektet har tre huvudsakliga resultat: 1) Utvärdering av piloter såsom nyttan av bygglogistiklösningar i olika projekt och för olika aktörer, mätetal för byggtransporter och möjliga data för att följa upp, samt effekterna av en HVO-tank på site. 2) Potentialerna i att arbeta med en fossilfri bygglogistik utifrån ett systemperspektiv där inte bara enskilda byggen studeras utan även större bygglogistiksystem samt hur man kan beräkna CO2 emissionerna från bygglogistiken för den samlade byggvolymen i en stad. 3) En beskrivning av hur aktörerna i bygglogistiksystemet och hur de påverkar olika åtgärder för att minska utsläppen genom sina respektive roller har också identifierats.En av de viktigaste slutsatserna är att det idag saknas rätt förutsättningarna för att implementera en fossilfri bygglogistik i stor skala. Det saknas gemensamma målbilder för logistiken., Fossilfri Bygglogistik

Byggtransporter står för en betydande andel av CO2-utsläppen i byggprojekt (ca 10%) och en bättre logistik leder till lägre utsläpp, mindre trängseleffekter och lägre kostnader. Projektet Fossilfri Bygglogistik, finansierat av Trafikverket genom Triple F, har 2019-2021 studerat potentialen i att minska utsläppen från byggtransporter med förbättrad logistik baserat på ett systemsynsätt. Projektet har utgått från tre frågeställningar: (i) Vad är potentialerna med samordnad bygglogistik och vad krävs för att hämta hem dessa? (ii) Vilka metoder/lösningar är användbara för att nå målet om fossilfrihet? (iii) Vad är rollfördelningen mellan aktörer. som är delaktiga i ett bygglogistiksystem, och behöver den förändras för att uppnå fossilfrihet; Transportation accounts for about 10% CO2-emissions caused by construction projects and improved logistics leads to lower emissions, less congestion and lower costs. The project Fossil Free Construction Logistics, financed by the Swedish Traffic Administration through Triple F, has between 2019 and 2021 studied the potential of reducing the emissions from construction transports, through improved logistics, based on a systems view. The project has worked with three main questions: (i) What are the potentials of coordinated construction logistics? (ii) What methods and solutions are suitable to reach the goal of fossil free construction logistics? (iii) What actors are part of the construction logistics system and what can these do to decrease the emissons from construction logistics?

Construction transport, in general, is not carried out efficiently, resulting in unnecessary costs and CO2 emissions. Although it has been found that there is a great potential to improve construction transport, little research has been conducted within this field. The purpose of this study is to contribute to the construction transport time efficiency by identifying non-value-adding activities and their causes from a freight forwarder perspective. A single case study was conducted and two flows, a goods delivery flow and a waste material flow, were mapped and analyzed with the help of value stream mapping (VSM). We ran two workshops to discuss the findings of the VSM. The results from this study show that there is large potential for improving construction transport time efficiency as over 40% of the time was used for non-value-adding activities. Although transport suffers from similar non-value-adding activities undertaken in other industries, this study identifies the transport activities with respect to construction transport. The findings further highlight areas of potential improvements, such as improved information sharing, planning, and coordination among all stakeholders. This knowledge can be used by the freight forwarder and the main contractor to improve construction transport time efficiency. The limitation of this study is that it is based on a single case of a freight forwarder. It does not provide a full picture of construction transport efficiency but rather a starting point for future studies., Funding Agencies|Trafikverket (Swedish Transport Administration) [2019.2.2.5]

The lack of coordination of the construction supply chain (CSC) creates a chain of problems. The purpose of this paper is to contribute to knowledge about coordination within CSCs and how the lack thereof can impact their supply chain performance. Coordination encompasses several different mechanisms, whereof focus here have been information sharing with the unit of analysis suppliers’ information availability. Four suppliers active within the CSC, delivering to several different projects have been studied. These represent two different delivery patterns, continuous and intermittent deliveries. Based on the analysis of their information availability are two propositions made; 1) due to the loose couplings and the lack of understanding among main contractors of the value of information sharing, suppliers with continuous supply have an information advantage due to their presence on site, 2) suppliers can enhance their information availability, by increasing their service offering to customers.

The intensity of urban development is presently high, creating a construction boom. The number of transports per project is a major consideration in urban goods transport and emissions from a project. Presently, the stakeholders take part in a “blame game” in assigning fault for the emissions from construction transport and the disturbances to society in the vicinity of construction sites. Incorporation of logistics into urban planning requires an increased understanding of the interaction between construction transport flows and urban land use, and the inclusion of different stakeholders. The purpose of the study is to support collaborative planning of construction transport in urban planning, and specifically to explore how a planning tool based on interactive visualization could be designed. An action research process has generated two prototypes of an interactive visualization tool for collaborative planning of construction transport. The prototype facilitates a “shared deliberation space” by identifying alternatives and assessing predicted consequences, which supports a collaborative urban planning process. Based on the research conducted, we claim that the responsibility of construction transport planning should be taken by the municipality, i.e., the urban planning and traffic planning functions, Störningsfri stad

Robotassisterad kirurgi har blivit alltmer förekommande som operationsmetod till fördel för dess kirurgiska precision. Utifrån den kirurgiska teknologin ställs ytterligare krav på anestesisjuksköterskan, som under operationerna ansvarar för patientens anestesi, upprätthållande av fri luftväg, hemodynamisk stabilitet. Tillsammans med teamet ansvarar anestesisjuksköterskan för patientens positionering och säkerhet. Syftet med studien var att belysa anestesisjuksköterskors vårdande av patienter som genomgick robotassisterad kirurgi. En kvalitativ ansats ligger till grund för studien och en ostrukturerad deltagande observationsstudie har genomförts. Sex anestesisjuksköterskor observerades vid tolv olika tillfällen. Materialet från observationer analyserades med Elo och Kyngäs induktiva kvalitativa innehållsanalys. Nio subkategorier och tre kategorier framkom efter analysen. I kategorin arbetsmiljön på operationssalen framkom bland annat att anestesisjuksköterskan arbetade i en miljö med begränsad åtkomst till patienten och utrustningen. I kategorin omtanke och vårdande observerades anestesisjuksköterskans lugnande samtal och stöttning till patienten samt handlingar för patientens välbefinnande. I tredje kategorin patientsäkert arbetssätt arbetade anestesisjuksköterskan tillsammans i teamet med förebyggande säkerhetsåtgärder. Slutligen arbetar anestesisjuksköterskan i en högteknologisk miljö, som kräver anpassning utifrån anestesiologiskt perspektiv. Trots den emellanåt besvärliga arbetssituationen som anestesisjuksköterskan befinner sig upprätthålls både patientsäkerhet samt ett gott teamarbete., Robot-assisted surgery has become increasingly prevalent, in favor of it´s surgical precision. The surgical technology additional requirements are imposed on the nurse anesthetist, who is responsible for the patient´s anesthesia, free airway and hemodynamic stability. Together with the team, the nurse anesthetist is responsible for the patient's positioning and safety. The purpose of this study was to shed light on the nurse anesthetists' care of patients who underwent robot-assisted surgery. A qualitative approach was used and an unstructured participatory observational study has been conducted. Six nurse anesthetists were observed on twelve occasions. The material was analyzed with Elo and Kyngäs inductive qualitative content analysis. Nine subcategories and three categories emerged. The category Work environment in the operating room showed that the nurse anesthetist worked in an environment with limited access to the patient. The Solicitude and caring category, showed the nurse anesthetist gave support to the patient and made actions for well-being. In the category Patient-safe working methods, the nurse anesthetist worked with the team on preventive safety measures. Finally, the nurse anesthetist works in a high-tech environment which requires adaptation. Despite the sometimes difficult work situation for the nurse anesthetist, both patient safety and good teamwork are maintained.

Purpose Lately, mass logistics centres (MLCs) have emerged to increase transport efficiency in soil and rock (mass) material transports. However, the impact of these MLCs has received limited attention. The purpose of this study is to explore the potential of MLCs to increase transport efficiency in terms of number of transports, distance travelled, transport work, and emissions. Design/methodology/approach The purpose is fulfilled through a scenario analysis of an MLC and its effect on distance travelled, transport work, fuel consumption, and emissions as well as the traditional measure of number of transports. Findings The study finds that the traditional transport efficiency measure “number of transports” is insufficient in describing transport efficiency in MLCs and similar logistics setups. A logistics centre will lead to more transports but with the correct setup, transport work, distance travelled, fuel consumption and emissions can be reduced. Research limitations/implications This study is limited to one MLC in Sweden. Future research should investigate other MLCs and go deeper into how MLCs should be designed to increase transport efficiency. Practical implications Contractors and municipalities can find support on how to evaluate the transport efficiency effects an MLC has. Social implications This study is an important step in analysing the potential of MLCs as a tool for reducing the negative impact of mass transports. Originality This is one of the first in-depth studies of how MLCs affect mass transport flows from a transport efficiency perspective.

The lack of coordination of the construction supply chain (CSC) creates a chain of problems. The purpose of this paper is to contribute to knowledge about coordination within CSCs and how the lack thereof can impact their supply chain performance. Coordination encompasses several different mechanisms, whereof focus here has been information sharing with the unit of analysis suppliers’ information availability. Four suppliers active within the CSC, delivering to several different projects have been studied. These represent two different delivery patterns, continuous and intermittent deliveries. Based on the analysis of their information availability are two propositions made; (1) due to the loose couplings and the lack of understanding among main contractors of the value of information sharing, suppliers with continuous supply have an information advantage due to their presence on site, (2) suppliers can enhance their information availability, by increasing their service offering to customers., Special Issue: Supply Chain Management in Construction and Engineer-to-order Industries.