Strategi i icke-vinstdrivande organisationer

Examensarbetets titel: Strategiarbete i icke-vinstdrivande organisationer Seminariedatum: 2015-06-05 Ämne/kurs: FEKH19, Examensarbete kandidatnivå i Strategic Management, 15 hp Författare: Hanna Dahlberg, Niklas Olsson, Samuel Ryckenberg, Erik Thunström Handledare: Magnus Johansson Fem nyckelord: Icke-vinstdrivande organisationer, Marknadsprestation, Konkurrensfördel, Industrial organization, Resource-based view Syfte: Studiens syfte var att utöka förståelsen för hur icke-vinstdrivande organisationer förhåller sig till strategiarbete och vilket fokus som i huvudsak tas. Metod: Via en huvudsakligen deduktiv ansats utfördes en kvalitativ studie. Data samlades in via semi-strukturerade intervjuer och analyserades med hjälp av mönstermatchning mot ett teoretiskt ramverk. Teoretiska perspektiv: Ramverket baserades i huvudsak på två teorier inom strategi, industriell organisation och det resursbaserade perspektivet. Teorierna beskriver två förhållningssätt en organisation kan anta för en önskad marknadsprestation, via struktur och positionering (Porter, 1991) eller via interna faktorer och resurser (Barney, 1991). Applicering av teorierna på ickevinstdrivande organisationer har varit underrepresenterade i förhållande till företag, och vissa aspekter har antytts varit direkt förknippade med vinstdrivande organisationer, vilket vårt syfte utgick ifrån. Empiri: Friskvårdsbranschen i Lund innefattar olika former av icke-vinstdrivande organisationer och är en bransch där aktörer påverkas av trender och svängningar. Därför gjordes en flerfallstudie mellan den ideella träningsföreningen Friskis&Svettis Lund och det kommunalägda badhuset Högevall. Resultat: I studien framkom att skillnader mellan organisationerna till viss del kan förklaras med olikheten i deras organisationsformer, ett kommunalägt och en ideell träningsförening, och att ramverket behövde anpassas därefter. Gemensamt för organisationerna är ett fokus på interna faktorer, men den externa miljön enligt teori baserad på vinstdrivande företag kunde i större utsträckning appliceras på den ideella idrottsföreningen än den kommunala organisationen.Title: Strategic management in non-profit organizations Seminar date: 2015-05-06 Course: FEKH19, Degree Project Undergraduate level, Business Administration, Undergraduate level, 15 University Credits Points (UPC) or ECTS-cr) Authors: Hanna Dahlberg, Niklas Olsson, Samuel Ryckenberg, Erik Thunström Advisor: Magnus Johansson Key words: Non-profit organizations, Market Performance, Competitive advantage, Industrial organization, Resource-based view. Purpose: The purpose of this study was to broaden the knowledge of how non-profit organizations consider strategy and what focus they mainly apply, internal or external. Methodology: The study was made through a qualitative and mainly deductive approach. Data was collected through semi-structured interviews and analyzed through pattern-matching against a theoretical framework Theoretical perspectives: The framework is mainly based on two theories within strategic management, Industrial organization and the Resource-based view. The two theories describes two frameworks an organization could apply for a increased market performance, through structure and positioning (Porter, 1991) or via internal factors and resources (Barney, 1991). The application of the two theories on non-profit organizations has been underrepresented next to profit-seeking companies, and some aspects has been considered to be directly associated to the latter. Empirical foundation: The wellness industry in the Lund area has a population of non-profit organizations and is an industry where players are affected with trends and industry cycles. From this a multiple case study of the non-profit organization Friskis&Svettis Lund and the public sector wellness facility was made. Conclusions: This study shows that differences between the two compared organizations to a certain extent can be explained with their different organizational forms within the non-profit context, and that the framework needed to be revised thereafter. The two organizations share a focus on internal aspects, but the external environment previously applied to profit-seeking organizations could be applied to a larger extent on the non-profit organization than the public sector one

Adiabatic Approximation for weakly open systems

We generalize the adiabatic approximation to the case of open quantum systems, in the joint limit of slow change and weak open system disturbances. We show that the approximation is ``physically reasonable'' as under wide conditions it leads to a completely positive evolution, if the original master equation can be written on a time-dependent Lindblad form. We demonstrate the approximation for a non-Abelian holonomic implementation of the Hadamard gate, disturbed by a decoherence process. We compare the resulting approximate evolution with numerical simulations of the exact equation.Comment: New material added, references added and updated, journal reference adde

Obstructive sleep apnea and its malajemente in patients with atrial fibrillation: An International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT) global survey of practicing cardiologists

Background: Among international cardiologists it is unclear whether equipoise exists regarding the benefit of diagnosing and managing obstructive sleep apnea (OSA) to improve atrial fibrillation (AF) outcomes and whether clinical practice and equipoise are linked. Methods: Between January 2019 and June 2020 we distributed a web-based 12-question survey regarding OSA and AF management to practicing cardiologists in 16 countries. Results: The United States, Japan, Sweden, and Turkey accounted for two-thirds of responses. 863 cardiologists responded; half were general cardiologists, a quarter electrophysiologists. Responses regarding treating OSA with CPAP to improve AF endpoints were mixed. 33% of respondents referred AF patients for OSA screening. OSA was diagnosed in 48% of referred patients and continuous positive airway pressure (CPAP) was prescribed for 59% of them. Nearly 70% of respondents believed randomized controlled trials (RCTs) of OSA treatment in AF patients were necessary and indicated willingness to contribute to such trials. Conclusions: There was no clinical equipoise among surveyed cardiologists; a majority expressed certainty that combined OSA and AF treatment is superior to AF treatment alone for improving AF outcomes. However, a minority of surveyed cardiologists referred AF patients for OSA testing, and while half of screened AF patients had OSA, CPAP was prescribed in little more than half of them, reflecting the view that better clinical trial evidence is needed to support this practice. Our results underscore the need for larger, multi-national prospective studies of OSA treatment and AF outcomes to inform more uniform society guideline recommendations

Obstructive Sleep Apnea in Cardiovascular Disease - Mechanisms and Impact of Treatment

ABSTRACT Background: Scientific understanding of obstructive sleep apnea (OSA) has increased exponentially during recent decades, suggesting a link between OSA and cardiovascular disease. Few randomized controlled trials exist within the field. Aim: To study the effect of continuous positive airway pressure (CPAP) on mechanisms contributing to cardiovascular disease deterioration. Methods and Results: Paper I is a cross-sectional analysis of revascularized patients with coronary artery disease (CAD). Patients with concomitant OSA had higher levels of inflammatory markers, independent of obesity. In paper II, the effect of losartan on blood pressure (BP) was investigated in patients with new-onset hypertension and OSA compared to patients with hypertension only. In addition, the effect on blood pressure of CPAP treatment in addition to losartan was investigated. Losartan reduced BP significantly in OSA but the reductions were less than in patients without OSA. Add-on CPAP treatment reduced night-time blood pressure in OSA patients in the intention-to-treat population, and all 24-h measurements in those compliant with CPAP. Paper III demonstrates that inflammatory markers decreases after one year in all CAD patients, and this was independent of CPAP in OSA. In paper IV, hypertensive patients with OSA responded with smaller reductions in aldosterone than patients without OSA after losartan. Add-on CPAP treatment tended to lower aldosterone, but the reductions were more robust in the sympathetic activity. No effect was seen on the inflammatory markers. Conclusions: Inflammatory markers are high in newly revascularized CAD patients with OSA, but the levels decrease over time independent of CPAP treatment, suggesting that the initial increase in inflammatory activity in CAD with concomitant OSA is most probably driven by other factors. Blood pressure in new-onset hypertension seems to be reduced by CPAP as add-on treatment to losartan; this may be attributed mainly to sympathetic activity and, to a lesser extent, to RAAS activity, whereas inflammation seems to be of minor importance

Effect of Obstructive Sleep Apnea and CPAP Treatment on Cardiovascular Outcomes in Acute Coronary Syndrome in the RICCADSA Trial

We aimed to address the impact of OSA and its treatment with continuous positive airway pressure (CPAP) on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS). In this current analysis of the revascularized ACS subgroup (n = 353) of the Randomized Intervention with CPAP in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), participants with non-sleepy OSA (apnea-hypopnea-index [AHI] ≥ 15 events/h on a home sleep apnea testing, and Epworth Sleepiness Scale [ESS] score < 10; n = 171) were randomized to CPAP (n = 86) or no-CPAP (n = 85). The sleepy OSA patients (AHI ≥ 15 events/h and ESS ≥ 10) who were offered CPAP, and the ones with no-OSA (AHI < 5 events/h) were included in the observational arm. A post-hoc analysis was done to compare untreated OSA (no-CPAP; n = 78) and nonadherent sleepy/non-sleepy OSA (n = 96) with the reference group without OSA (n = 81). The primary endpoint (the first event of repeat revascularization, myocardial infarction, stroke or cardiovascular mortality) during a median 4.7-year follow-up was evaluated in time-dependent Cox proportional hazards models adjusted for confounding factors. The incidence of MACCE did not differ significantly in intention-to-treat population. On-treatment analysis showed a significant risk reduction in those who used CPAP for ≥4 vs. <4 h/day or did not receive treatment (adjusted hazard ratio [HR] 0.17; 95% confidence interval [CI] 0.03–0.81; p = 0.03). Compared with the reference group, nonadherent/untreated OSA was associated with an increased cardiovascular risk (adjusted HR 1.97, 95% CI 1.03–3.77; p = 0.04). We conclude that OSA is an independent risk factor for adverse cardiovascular outcomes in patients with ACS. CPAP treatment may reduce this risk, if the device is used at least 4 h/day

Effect of obstructive sleep apnea and CPAP treatment on cardiovascular outcomes in acute coronary syndrome in the RICCADSA trial

We aimed to address the impact of OSA and its treatment with continuous positive airway pressure (CPAP) on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS). In this current analysis of the revascularized ACS subgroup (n = 353) of the Randomized Intervention with CPAP in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), participants with non-sleepy OSA (apnea-hypopnea-index [AHI] ≥ 15 events/h on a home sleep apnea testing, and Epworth Sleepiness Scale [ESS] score < 10; n = 171) were randomized to CPAP (n = 86) or no-CPAP (n = 85). The sleepy OSA patients (AHI ≥ 15 events/h and ESS ≥ 10) who were offered CPAP, and the ones with no-OSA (AHI < 5 events/h) were included in the observational arm. A post-hoc analysis was done to compare untreated OSA (no-CPAP; n = 78) and nonadherent sleepy/non-sleepy OSA (n = 96) with the reference group without OSA (n = 81). The primary endpoint (the first event of repeat revascularization, myocardial infarction, stroke or cardiovascular mortality) during a median 4.7-year follow-up was evaluated in time-dependent Cox proportional hazards models adjusted for confounding factors. The incidence of MACCE did not differ significantly in intention-to-treat population. On-treatment analysis showed a significant risk reduction in those who used CPAP for ≥4 vs. <4 h/day or did not receive treatment (adjusted hazard ratio [HR] 0.17; 95% confidence interval [CI] 0.03–0.81; p = 0.03). Compared with the reference group, nonadherent/untreated OSA was associated with an increased cardiovascular risk (adjusted HR 1.97, 95% CI 1.03–3.77; p = 0.04). We conclude that OSA is an independent risk factor for adverse cardiovascular outcomes in patients with ACS. CPAP treatment may reduce this risk, if the device is used at least 4 h/day

Continuous positive airway pressure treatment and anxiety in adults with coronary artery disease and nonsleepy obstructive sleep apnea in the RICCADSA trial

Background: Anxiety and obstructive sleep apnea (OSA) coexist among adults with coronary artery disease (CAD) following revascularization. Continuous positive airway pressure (CPAP) is the first line treatment of OSA patients with daytime sleepiness. The current study evaluated the effect of CPAP on anxiety in CAD patients with nonsleepy OSA. Methods: Two hundred forty-four revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index ≥15/h, Epworth Sleepiness Scale score <10) were randomly assigned to CPAP or no-CPAP between 2005 and 2010. Zung Self-rating Anxiety Scale (SAS) was administered at baseline and after 3 and 12 months with higher scores suggesting more anxiety. Results: A total of 208 patients with complete SAS scores at baseline and 12-month follow-up were included (CPAP, n = 103; no-CPAP, n = 105). In the intention-to-treat analysis, CPAP had no significant effect on the SAS scores. On-treatment analysis revealed a significant increase in the median of delta SAS score (+3.75) after three months among the participants using the device 2.8 h/day or more while there was a decline in the median of delta SAS score (−1.25) in the non-adherent or no-CPAP group (p = 0.031). The increase in the SAS score (+1.25) in the adherent group, and the decline (−1.25 points) in the non-adherent/no-CPAP group remained significant after one year (p = 0.011). Baseline SAS score predicted non-adherence [adjusted odds ratio 1.11; 95% confidence interval (CI) 1.04–1.18; p = 0.003], and there was an association between the increase in the SAS scores and accumulated CPAP hours/day [standardized β = 0.144 (95% CI 0.005–0.695), p = 0.047]. Conclusion: Our results suggest that anxiety should be considered in the management of CAD patients with nonsleepy OSA following revascularization. Clinical trial registration: NCT00519597

Prognosis and outcome determinants after heart failure diagnosis in patients who underwent aortic valvular intervention

Aims To study clinical phenotype, prognosis for all-cause and cardiovascular (CV) mortality and predictive factors in patients with incident heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS). Methods and results In this retrospective, observational study we included patients from the Swedish Heart Failure Registry (SwedeHF) recorded 2003-2016, with AS diagnosis and AVI before HF diagnosis. The AS diagnosis was established according to International Classification of Diseases 10th revision (ICD-10) codes, thus without information concerning clinical or echocardiographical data on the aortic valve disease. The patients were divided into two subgroups: left ventricular ejection fraction (LVEF) &amp;gt;= 50% (AS-HFpEF) and &amp;lt;50% (AS-HFrEF). We individually matched three controls with HF from the SwedeHF without AS (control group) for each patient. Baseline characteristics, co-morbidities, survival status and outcomes were obtained by linking the SwedeHF with two other Swedish registries. We used Kaplan-Meier curves to present time to all-cause mortality, cumulative incidence function for time to CV mortality and Cox proportional hazards model to evaluate the relative difference between AS-HFrEF and AS-HFpEF and AS-HF and controls. The crude all-cause mortality was 49.0%, CV mortality 27.9% in AS-HF patients, respectively 44.7% and 26.6% in matched controls. The adjusted risk for all-cause mortality and CV mortality was similar in HF, regardless of LVEF vs. controls. No significant difference in factors predicting higher all-cause mortality was observed in AS-HFrEF vs. AS-HFpEF, except for diabetes (only in AS-HFrEF), with statistically significant interaction predicting death between the two groups. Conclusions In this nationwide SwedeHF study, we characterized incident HF population after AVI. We found no significant differences in all-cause and CV mortality compared with general HF population. They had virtually the same predictors for mortality, regardless of LVEF.Funding Agencies|Swedish government [ALFGBG-72900, 73400]; Swedish County Councils, the ALF agreement [ALFGBG-72900, 73400]; Regional Development Fund, Vastra Gotaland County, Sweden [VGFOUREG-931060, VGFOUREG-849081]; Gothenburg Society of Medicine [20/935037]</p