Operations In Sweden Research Articles

Swedish consensus regarding difficult pre-hospital airway management: a Delphi study

BackgroundThe aim of this study was to establish a consensus among experts in prehospital work regarding the management of difficult airways in prehospital care in Sweden. The results were subsequently used to develop an algorithm for handling difficult airway in prehospital care, as there was none available in Sweden prior to this study.MethodsThis two-round Delphi study was conducted by forming an expert panel comprising anesthesiologists and anesthesia nurses working in prehospital setting in Sweden. The expert panel responded digital forms with questions and statements related to airway management. The study continued until consensus was reached, defined as more than 70% agreement. The study took place from December 4, 2021, to May 15, 2022.ResultsIn the first round, 74 participants took part, while the second round involved 37 participants. Consensus was reached in 16 out of 17 statements. 92% of the participants agreed that an airway algorithm adapted for prehospital use is necessary.ConclusionsThe capacity to adapt the approach to airway management based on specific pre-hospital circumstances is crucial. It holds significance to establish a uniform framework that is applicable across various airway management scenarios. Consequently, the airway management algorithm that has been devised should be regarded as a recommendation, allowing for flexibility rather than being interpreted as a rigid course of action.This represents the inaugural nationwide algorithm for airway management designed exclusively for pre-hospital operations in Sweden. The algorithm is the result of a consensus reached by experts in pre-hospital care.

The Downside of Upkeep: Analysing Railway Infrastructure Maintenance Impact on Train Operations in Sweden

Efficient and seamless railway operations depend on the systematic and well-coordinated maintenance of both rolling stock and infrastructure. However, track maintenance, or ‘trackwork’, can cause substantial delays if not properly aligned with train schedules. This study comprehensively investigates how trackwork influences train operations in Sweden. It involves an in-depth analysis of an extensive dataset comprising over 225,000 recorded instances of planned trackwork and approximately 32.5 million train passages throughout the year 2017. Multiple logistic and negative binomial regression models showed that train running time delay occurrence is higher in the sections with scheduled trackwork. Trains passing through trackwork are 1.43 times more likely to experience delays compared to trains that do not pass through scheduled trackwork. The likelihood of an opportunity for the train delay recovery passing the section with scheduled trackwork is reduced by 11%. Additionally, the frequency of train delay increase is 16% higher, and delayed recovery is 4% lower in relation to trackwork. With the number of trackwork set to increase over the coming years, these results bring attention to train scheduling and the performance of trackwork.

Fuel consumption in logging operations in Sweden

ABSTRACT Fuel consumption is an important factor affecting both costs and environmental impact of a logging operation. Traditionally, fuel consumption has been estimated through studies of individual machines, through follow-up studies based on company records or through questionnaires. Using automatically collected data from machine computers, in the form of standardized harvester production (hpr), forwarder production (fpr), and machine operational monitoring (mom) files, offers a new way to estimate fuel consumption. This study aims to estimate fuel consumption in cut-to-length logging operations based on automatically recorded data, and to evaluate whether this data is sufficient on its own or needs to be supplemented with additional data. Average fuel consumption per harvested m3 varied from 1.4 to 3.4 l, depending on machine size, tree size, and transport distance. The study shows that fuel consumption per machine type or logging team can largely be explained using the machine data. Classification of machines into size classes is a challenge, as machine configurations vary between individual machines, but such classification may not be needed. Forwarded volumes are a source of error, since this data is manually fed into the machine computer and, therefore, often deviates from the felled volume in a harvesting block. This will probably cause a slight overestimation of forwarder fuel consumption.

P-057 EFFECTS ON SURGICAL QUALITY, TRAINING, AND RESEARCH ON INGUINAL HERNIA AFTER CENTRALIZATION OF PLANNED INGUINAL HERNIA SURGERY IN A REGION

Abstract Aims Evaluate the effects of centralization of inguinal hernia surgery in Region Halland in Sweden on surgical quality, training and research on inguinal hernia. Methods Comparison of outcomes for Region Halland in relation to the national average in the Swedish Hernia Register before and after centralization. Review of how training and research on inguinal hernia changed after centralization. Results The percentage of patients operated on by “inguinal hernia specialists” increased from nearly 40% in 2008 to 90% in 2019. 20% of the surgeons operating > 90 hernias/year in Sweden are active in Region Halland, even though Region Halland only performs 4% of all inguinal hernia operations in Sweden. The risk of reoperation 3 years after inguinal hernia decreased from nearly 100% greater to 30% less than the national average (4% to 1.7%). The percentage of women that underwent the recommended posterior mesh surgeries increased from 5% (2007) to 90% (2019). The percentage of patients with bilateral hernias operated with TEP-TAPP increased from 5% (2007) to 98% (2020). After centralization residents’ training was formalized including at least 30 operation/resident. Halland runs one of the two national courses on TEP/TAPP. Peer-review publications on inguinal hernias increased from 2 to 6 articles. Conclusion The quality of inguinal hernia surgery and training of residents became better after centralization. The number of region-conducted research projects on inguinal hernia increased after centralization.

Medical gamma cameras in radiological emergency preparedness: determination of calibration factors and MDA for the GE Discovery NM/CT 670 Pro

A survey was performed of the available gamma camera models and whole-body counters (WBCs) in Sweden, revealing that there are about 75 gamma cameras and 15 WBCs currently in operation in Sweden. One of the most common gamma camera models (GE Discovery NM/CT 670 Pro), with the collimators removed, was calibrated for 152Eu, 137Cs, 60Co and 40K in three different measurement geometries (supine, close-up sitting and distant sitting) for six different phantom sizes (12–110 kg). Minimum detectable activities (MDAs) were calculated for the gamma camera and a typical WBC, both at the Sahlgrenska University Hospital in Gothenburg, Sweden. An energy window of 30–510 keV was used to calibrate the gamma camera. The calibration factors for this gamma camera for supine and close-up sitting geometry, including all phantom sizes, were 138–208 cps kBq−1 for 152Eu, 63–83 cps kBq−1 for 137Cs and 99–126 cps kBq−1 for 60Co; the MDAs were 50–73 Bq for 152Eu, 125–198 Bq for 137Cs and 83–105 Bq for 60Co. The International Commission on Radiological Protection dose coefficients for members of the public were used to calculate the committed effective doses (CEDs) corresponding to the MDAs, showing that CEDs down to a few μSv can be estimated with this gamma camera for the inhalation of aerosols of absorption type M. The distant sitting geometry was used to enable the estimation of higher contamination levels, and a hypothetical maximum CED was calculated. This was shown to be 256–2000 mSv, depending on the radionuclide and phantom size. However, further investigations are needed into the dead time losses for higher activity levels for the radionuclides studied. The results show that the use of gamma cameras for radiological triage and, in some cases, to estimate the internal activity of relevant radionuclides in radiological and nuclear events, is feasible.

Effect of COVID-19 on cardiac surgery volumes in Sweden

Objectives. The coronavirus disease 2019 (COVID-19) pandemic, which commenced in 2020, is known to frequently cause respiratory failure requiring intensive care, with occasional fatal outcomes. In this study, we aimed to conduct a retrospective nationwide observational study on the influence of the pandemic on cardiac surgery volumes in Sweden. Results. In 2020, 9.4% (n = 539) fewer patients underwent open-heart operations in Sweden (n = 5169) than during 2019 (n = 5708), followed by a 5.8% (n = 302) increase during 2021 (n = 5471). The reduction was greater than 15% in three of the eight hospitals in Sweden performing open-heart operations. Compared to 2019, in 2020, the waiting times for surgery were longer, and the patients were slightly younger, had better renal function, and a lower European System for Cardiac Operative Risk Evaluation; moreover, few patients had a history of myocardial infarction. However, more patients had insulin-treated diabetes mellitus, hypertension, peripheral vascular disease, reduced left ventricular function, and elevated pulmonary artery pressure. Urgent procedures were more common, but acute surgery was less common in 2020 than in 2019. Early mortality and postoperative complications were low and did not differ during the three years. Conclusion. The 9.4% decrease in the number of heart surgeries performed in Sweden during the 2020 COVID-19 pandemic, compared to 2019, partially recovered during 2021; however, there was no backlog of patients awaiting heart surgery.

Excess probability of dwell time delays from train meets and passes

We introduce a novel measure of how a factor influences train delays: the excess probability of delays. Using some 50 million observations across two years of railway operations in Sweden we then investigate the role of train meets and passes in explaining dwell time delays, which are known from previous research to be behind most train delays. About 4% of observed train movements include either meets or passes at stations, with the former being much more frequent. On average, they are associated with a 30%-points higher probability of delay, more than double the baseline rate of 25%. Accounting for their frequency, this adds about 1%-point to the probability of dwell time delays, or about 4% of existing dwell time delays. As expected, these delays are mostly concentrated on single-track lines with relatively dense operations. Considering that the railway sector is mature and under pressure to cost-effectively improve both capacity and punctuality, these results suggest an encouraging potential for improvement. Reducing the probability of delays even by a single percentage point would be valuable, and quantifying this contribution is helpful when prioritising resources and measures across issues and geographies.

Sustainabilty integration in product portfolio for sustainable development: Findings from the industry

AbstractMany companies decide which services, products, and technologies to include in their product portfolio using evaluation criteria, which often consider cost, quality, risk, revenue, time, and market position. Incorporating sustainability in the portfolio evaluation criteria could ensure the development of sustainable solutions from the early stages of the product development process, where there is more room for innovation. The aim of this paper is to understand how sustainability can be integrated in the company portfolio development. Semi‐structured interviews were performed with experts in the field and representatives from multinational manufacturing companies with operations in Sweden. Main findings from this study include a proposed definition of a sustainability product portfolio concept and suggested portfolio evaluation criteria from an industry perspective. Future research will develop a method to guide manufacturing companies in sustainability integration and implementation in product portfolios.

Life cycle assessment of city buses powered by electricity, hydrogenated vegetable oil or diesel

This study explores life cycle environmental impacts of city buses, depending on the: (1) degree of electrification; (2) electricity supply mix, for chargeable options; and (3) choice of diesel or hydrogenated vegetable oil (HVO), a biodiesel, for options with combustion engine. It is a case study, which uses industry data to investigate the impact on climate change, a key driver for electrification, and a wider set of impacts, for average operation in Sweden, the European Union and the United States of America. The results show that non-chargeable hybrid electric vehicles provide clear climate change mitigation potential compared to conventional buses, regardless of the available fuel being diesel or HVO. When fueling with HVO, plug-in hybrid and all-electric buses provide further benefits for grid intensities below 200 g CO2 eq./kWh. For diesel, the all-electric option is preferable up to 750 g CO2 eq./kWh. This is the case despite batteries and other electric powertrain parts causing an increase of CO2 emissions from vehicle production. However, material processing to make common parts, i.e. chassis, frame and body, dominates the production load for all models. Consequently, city buses differ from passenger cars, where the battery packs play a larger role. In regard to other airborne pollutants, the all-electric bus has the best potential to reduce impacts overall, but the results depend on the amount of fossil fuels and combustion processes in the electricity production. For toxic emissions and resource use, the extraction of metals and fossil fuels calls for attention.

FROM COMMUNIST CADRE TO OUTSIDER

This article builds on recent research on Scandinavians in the international communist movement and on intelligence operations in Sweden before and during the Second World War. Through a microhistorical approach that centres around the Swedish communist cadre Ingvar Larsson, who was first an operative of the Comintern’s highly secret communications and courier network (OMS) and later was estranged from the communist movement, the article looks beyond structures and organizations, focusing instead on the choices and options of people driven by both ideology and opportunism. By exploring a diverse collection of Comintern, Soviet, and Swedish archival sources, the article highlights some of the peculiar challenges of intelligence history and of constructing a narrative in a way that illuminates both the agency of individuals and the wider culture of tensions and uncertainties between ideals and realities.

Costs for thinning and final felling operations in Sweden, 2000–2017

ABSTRACTWood supply is one of the most significant cost items for most forest industries, and costs of forest operations and sale prices of wood is vital information for forest owners. Cost trends between 2000 and 2017 in Swedish forestry is analysed, separately for final felling and thinning, and subdivided into ordinary and salvage operations. Data on costs for operations totalling 821 million m3 harvested roundwood were analysed, both as actual costs and after adjustment for the consumer price index. Adjusted costs for ordinary harvesting operations declined between 2000 and 2007, increased during 2008 and 2009 and have since been relatively constant. Costs of salvage logging operations performed as thinning were 21% higher than ordinary thinning, and when performed as final felling costs were 64% higher than in ordinary final felling. The relative logging cost trends in Sweden and Finland were similar during the period, and there are similarities with the US. However, while logging costs in Sweden and Finland increased in 2008 and 2009, they declined in the US and did not reach the same relative level as in Sweden until 2013. Results can be used for benchmarking logging costs between regions or larger buyers of logging services.

Welcome to the Annals of Laparoscopic and Endoscopic Surgery

Dear friends, It’s been a century since Dr. Hans Christian Jacobaeus performed the first clinical laparoscopic operation in Sweden. Owing to the extraordinary effort of numerous experts and the rapid development of modern technique, endoscopy has been moving forward in a fast pace, especially in the field of laparoscopic surgery.

Long-Term Outcome of Mustard/Senning Correction for Transposition of the Great Arteries in Sweden and Denmark.

The atrial switch operation, the Mustard or Senning operation, for the transposition of the great arteries (TGA) was introduced in the late 1950s and was the preferred surgery for TGA until the early 1990s. The Mustard and Senning operation involves extensive surgery in the atria and leaves the right ventricle as the systemic ventricle. The Mustard and Senning cohort is now well into adulthood and we begin to see the long-term outcome. All the 6 surgical centers that performed Mustard and Senning operations in Sweden and Denmark identified all operated TGA patients. Information about death was obtained in late 2007 and early 2008 from the Danish and Swedish Centralised Civil Register by using the patients' unique national Civil Registration Numbers. Four hundred sixty-eight patients undergoing the atrial switch operation were identified. Perioperative 30-day mortality was 20%, and 60% were alive after 30 years of follow-up. Perioperative mortality was significantly increased by the presence of a ventricular septal defect, left ventricular outflow obstruction, surgery early in the Mustard and Senning era. However, only pacemaker implantation is predictive of long-term outcome (hazard ratio, 1.90; 95% confidence interval, 1.05-3.46, P=0.04), once the TGA patient has survived the perioperative period. The risk of reoperation was correlated to the presence of associated defects and where the first Mustard/Senning operation was performed. The long-term survival of patients with Mustard and Senning correction for TGA appears to be primarily determined by factors in the right ventricle and tricuspid valve and not the timing of or the type of surgery in childhood. Cardiac function necessitating the implantation of a pacemaker is associated with an increase in mortality.

Potential savings and cost allocations for forest fuel transportation in Sweden: A country-wide study

Bioenergy is becoming a more important energy source. An important bioenergy assortment in Sweden is given by primary forest fuels. These account for about 14% of the biofuels or about 4% of Sweden's total energy. There are large volumes of forest fuel available. However, it is a low-value commodity and it is very sensitive to logistic cost to make it profitable. In this article, we analyse alternatives to lower the logistic costs. This includes the scheduling of the harvest and chipping operations in relation to transportation, delivered mix of assortments to customers and collaboration. We study these alternatives in a case that accounts for all operations in Sweden, involving 200,000 registered transports of about 6.1 million tons of forest biomass, equivalent to 17.4 TWh of energy consumption. We define a number of instances for these alternatives and formulate an optimization model based on linear programming. The solution is obtained by using a decision support system. We identify savings potential of about 22% from changing the operations. These savings can have a large impact on the industry and, more importantly, increase the use of bioenergy. We also test cost allocation methods to spread the savings based on cooperative game theory concepts.

License to Mine: A Comparison of the Scope of the Environmental Assessment in Sweden, Finland and Russia

The regulatory framework for mining operations is complex; the licensing process in particular typically involves several laws and a number of permits. This paper assumes that the regulatory framework is strongly influenced by the institutional framework of which it is part, and that it suffers from an institutional path dependence that may decrease the efficiency of the system as well as act barrier to the implementation of necessary environmental requirements. The paper provides: 1) a legal analysis of the regulatory framework governing mining operations in Sweden, Finland and Russia; and 2) a comparative analysis of the scope of the environmental assessment within the licensing process in the examined countries. The result of the analysis of the regulatory frameworks shows great similarity between the Swedish and the Finnish systems, both in terms of the overall structure and the implementation of substantive environmental rules. The Russian system differs in this respect, with more declarative rules and seemingly less substantive assessments. The results also indicate that the regulatory frameworks in all three countries show signs of institutional path dependence, but in very different degrees. Though Russia has indeed implemented major changes in the formal structure, very little has changed in practice. The Swedish regulatory framework for mining shows a deficient systematics and conflicting objectives, despite the implementation of a comprehensive environmental legislation. The recently reformed Finnish system seems to have a more holistic approach.

Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden.

The objective of this retrospective cohort study was to evaluate mortality rate and cause of death after tonsil surgery in Sweden. Two national registries were used, both run by The Swedish National Board of Health and Welfare, an agency of the Ministry of Health and Social Affairs. In the National Patient register all tonsil surgeries performed in Sweden from 2004 through 2011 were identified. The result from this search was matched with the National Cause of Death Register to identify all deaths that occurred within 30 days of tonsil surgery. Personal identity numbers were used to do the matching of registers. Details on the cause of death were obtained from the Swedish National Board of Health and Welfare. Two deaths were identified in 82,527 operations. Both patients were male, otherwise healthy, children under the age of five, operated due to tonsil-related upper airway obstruction/snoring with coblation technique. Cause of death was bleeding-related airway obstruction in both cases and hemodynamic failure caused by blood loss. Both deaths occurred after discharge from the hospital within the first postoperative week. No abnormal levels of analgesics were found in the postmortal investigations. Two deaths related to tonsil surgery (performed on benign indications) were identified in 82,527 operations (2004-2011) in a well-defined national population. Both deaths were due to postoperative bleeding. Based on our findings, the frequency of post-tonsil-surgery mortality in Sweden was 1/41,263, 2004-2011. Level of evidence 2b retrospective cohort study.

Are winter road maintenance practices energy efficient? A geographical analysis in terms of traffic energy use

Snow removal and anti-slip measures on roads are necessary to maintain road safety and a free-flowing transportation system. This is also interesting from an energy perspective as a free-flowing transportation system will use less energy than a congested one. These road maintenance measures focus, however, only on safety and not on energy use at all. This study will try to quantify the need for winter road maintenance in terms of energy in order to determine when, from an energy perspective, it would be best to remove snow or apply anti-icing agents. To explore this, parts of the VTI (Swedish National Road and Transport Research Institute) winter model were used. Several scenarios were set in different areas in Sweden in order to investigate a geographical divergence. It is possible to reduce 10.7% of traffic energy use if the starting criterion for snow removal is changed from 1cm to 2cm before action needs to be taken. If the speed limit is also reduced from 90km/h to 70km/h, the saving could be up to 17.2%. This paper aims to focus on the energy perspective of the winter maintenance operations in Sweden as well as on proposing other aspects of use for the model.

Public procurement in the european union: The case for national threshold values

The single-most important parameter of a public procurement system is the threshold above which the framework applies. The optimization problem consists of finding a reasonable trade-off between the gains from public procurement and the administrative costs associated with procurement rules. In the present study, based on a sample of central and local government procurement operations in Sweden, an optimal threshold value in the range of 5,000—6,000 EUR is computed based on the requirement that the average gain should supersede the average cost. If a larger proportion of procurements is required to gain from the regulation imposed, a threshold value of 20,000—25,000 EUR should apply. The general conclusion is that there are strong arguments for maintaining procurement rules below the European Union threshold.

Rail liberalisation in Sweden. Policy development in a European context

In 1988, rail infrastructure was vertically and institutionally separated from train operations in Sweden. This major reform became the starting point for a step-by-step liberalisation of the sector, with far-reaching implications for organisation and ownership. In this paper we trace the origin of the Swedish railway reforms and follow the subsequent development up until the completed deregulation in 2012. The later initiated (but also to some extent parallel) policy development in the European Union (EU) is studied in some detail, putting the Swedish reforms in context. A major part of the paper is devoted to an analysis of data on the development of the rail market in Sweden and EU as a whole, in an effort to show the impact of market opening and reform policy. The paper concludes with a discussion over the findings, leading to some policy-oriented and managerial conclusions.

In‐transit distribution strategy: solution for European factory competitiveness?

PurposeResearch work describes in‐transit distribution strategy by determining and analyzing key principles of it as well as by illustrating its application in practice. Emphasis on in‐transit distribution strategy is to turn transportation pipeline as a mobile inventory holding place, and actively dispatching goods to a destination, where there is a predicted demand before any customer orders are actually received. The use of this strategy is supported by current trade flows: emerging market trade has increased considerably, but simultaneously Swedish export prices, for example, have significantly decreased. The paper aims to address this issue.Design/methodology/approachIn‐transit strategy is examined through a multiple case study from industrial companies having main factory operations in Sweden as well as using a system dynamics simulation model, and Monte Carlo analysis. These are supported by the second hand data of trade flows between Sweden, and India and China.FindingsIn order to be successful with in‐transit strategy, the case studies show that excellent planning, working closely with customers, first‐class market knowledge, and an enterprise resource planning (ERP) system that is able to support the process sufficiently are required. Other highlighted requirements of this strategy are low variation in demand, and predictable distribution lead‐time. Simulation study of one hypothetical product group verified case study findings, but the authors find it interesting that manufacturing output variance especially is very sensitive regarding to the overall results. If variation increases, then in‐transit strategy is not able to deliver for customers with the necessary accuracy. Also increasing average customer demand, and longer transportation delays lead to undesired outcomes (e.g. too much inventory or out of stock situations).Research limitations/implicationsThe case study and second hand analysis is limited to one country, and further evidence is needed from other European, and possibly North American companies, to verify these findings.Originality/valueThere has been a rather limited amount of research works completed from the use of in‐transit strategy, even if increased trade activity and lower price of exported items is that of the old west in their exports to emerging markets, and continues to be so in the future (was even strong to China during credit crunch year 2009). Our research is seminal in terms of a developed system dynamics simulation model.