753 research outputs found
KundvÀrde som affÀrsidé i en internationell verkstadskoncern
Syftet med den hĂ€r uppsatsen Ă€r att fĂ„ en bĂ€ttre kunskap om hur en kundvĂ€rdesorienterad affĂ€rsidĂ© och strategi realiseras inom en multinationell verkstadskoncern, hur olika personer inom koncernen tolkar begreppet kundvĂ€rde och vilka de primĂ€ra drivkrafter antas vara som lett valet av en kundvĂ€rdesorienterad strategi. Det Ă€r ocksĂ„ att undersöka vilken roll IS/IT, enligt vĂ„ra informanter, har haft i den strategiska förĂ€ndringen. Vi har genomfört undersökningen i form av en fallstudie pĂ„ Sandvik AB, och det Ă€r framförallt genom intervjuer vi har insamlat empiriska datat. I en koncern av Sandviks storlek, med tre sĂ„ vitt skilda affĂ€rsomrĂ„den kan man diskutera om det överhuvudtaget Ă€r rimligt att tro att alla skall kunna enas runt en gemensam affĂ€rsidĂ©. Vi tror att kundvĂ€rdestanken som sĂ„dan Ă€r pĂ„ god vĂ€g att bli en generisk del i alla företags affĂ€rer. FrĂ„gan Ă€r hur varje skapare av kundvĂ€rde vĂ€ljer att se pĂ„ begreppet. HĂ€r finns en tolkningsfrihet Ă€ven inom Sandvik som ger de tre affĂ€rsomrĂ„dena utrymme att sjĂ€lva vĂ€lja hur de vill skapa sitt kundvĂ€rde Ă€ven om man, pĂ„ koncernnivĂ„, har enats om en övergripande definition. Givet divisionsindelningen och de skilda krav- och hotbilder som finns frĂ„n omvĂ€rlden pĂ„ Sandviks affĂ€rsomrĂ„den kommer de, ovillkorligen, att landa i skilda tolkningar. Det viktiga bidraget frĂ„n centralt hĂ„ll Ă€r det stĂ€ndigt pĂ„gĂ„ende arbetet med att pĂ„minna om att utan kundvĂ€rde stannar Sandvik, men affĂ€rsidĂ©n som sĂ„dan Ă€r mer av symbolisk natur eftersom den har sĂ„ vitt skilda betydelser i olika delar av Sandvik. Systematisering i hanteringen av det vĂ€rde man genererar för kunden som en följd av den verksamhet som man sjĂ€lv insett att man Ă€r expert pĂ„ Ă€r nyckeln. Det handlar till syende och sist om en kĂ€nnedom om den egna rollen i kundens ögon. Vad Ă€r det vi Ă€r bĂ€st pĂ„ att leverera (sammantaget bĂ€st utifrĂ„n en mĂ€ngd kriterier sĂ„som t ex kvalitet, pris, leveranstider, service etc.)? Utmaningen ligger i att hitta brytpunkten, dvs. att uppnĂ„ en optimal intern effektivitet som leder fram till att företaget vet precis vilket vĂ€rde de mĂ„ste leverera kunden för att bli optimalt lönsam och hĂ„lla konkurrenterna bakom sig. Ăr kundvĂ€rde ett relativt begrepp Ă€ndĂ„? Vi författare har resonerat kring var grĂ€nsen för kundvĂ€rdestanken gĂ„r. I föreliggande material talar vi om att företaget mĂ„ste vĂ€lja vilket kundvĂ€rde man tĂ€nker leverera. Per definition utgĂ„r dĂ„ detta, eller Ă„tminstone dess begrĂ€nsningar, frĂ„n leverantörens möjligheter och inte frĂ„n kundens behov. En kundvĂ€rdesorientering driven till sin spets skulle troligen hota ett företags lönsamhet som en naturlig följd av att kundens upplevda vĂ€rde skulle öka i takt med eftergifter frĂ„n leverantören (t ex genom sĂ€nkt pris), allt enligt uppoffring/nytta-modellen. Man kan frĂ„ga sig om kundvĂ€rde Ă€r ett modebegrepp som man anvĂ€nder sig av allt för lĂ€ttvindigt eller om svĂ„righeten i att hantera det handlar om begreppets mognad. De eviga förĂ€ndringarna i nĂ€ringslivet hĂ„ller företagen pĂ„ tĂ„rna och tvingar dem att gissa vad som kommer hĂ€rnĂ€st. SĂ„ledes krĂ€vs det att organisationen Ă€r flexibel och att informationen Ă€r vĂ€l definierad och strukturerad för att man snabbt ska kunna svara pĂ„ förĂ€ndringar. En sak Ă€r dock sĂ€ker, vi mĂ„ste stĂ€ndigt arbeta med att förbĂ€ttra vĂ„r verksamhet och fortsĂ€tta att vĂ€xa lönsamt. Hur vi gör det kommer att se olika ut i olika företag beroende pĂ„ inre och yttre omstĂ€ndigheter, styrkor, svagheter, möjligheter och hot
Sagittal Abdominal Diameter as a Screening Tool in Clinical Research: Cutoffs for Cardiometabolic Risk
Background. Waist girth and BMI are commonly used as markers of cardiometabolic risk. Accumulating data however suggest that sagittal abdominal diameter (SAD) or âabdominal heightâ may be a better marker of intra-abdominal adiposity and cardiometabolic risk. We aimed to identify cutoffs for SAD using a cardiometabolic risk score. Design. A population-based cross-sectional study. Methods. In 4032 subjects (1936 men and 2096 women) at age 60, different anthropometric variables (SAD, BMI, waist girth, and waist-to-hip ratio) were measured and cardiometabolic risk score calculated. ROC curves were used to assess cutoffs. Results. Among men SAD showed the strongest correlations to the majority of the individual risk factors; whereas in women SAD was equal to that of waist girth. In the whole sample, the area under the ROC curve was highest for SAD. The optimal SAD cutoff for an elevated cardiometabolic risk score in men was âŒ22âcm (95%CI; 21.6 to 22.8) and in women âŒ20âcm (95%CI; 19.4 to 20.8). These cutoffs were similar if the Framingham risk score was used. Conclusions. These cutoffs may be used in research and screening to identify âmetabolically obeseâ men who would benefit from lifestyle and pharmacological interventions. These results need to be verified in younger age groups
Associations between estimated fatty acid desaturase activities in serum lipids and adipose tissue in humans: links to obesity and insulin resistance
Fatty acid composition of serum lipids and adipose tissue triacylglycerols (AT-TAG) partly reflect dietary fatty acid intake. The fatty acid composition is, besides the diet, also influenced by desaturating enzymes that can be estimated using product-to-precursor fatty acid ratios. The interrelationships between desaturase indices derived from different serum lipid fractions and adipose tissue are unclear, as well as their associations with obesity and insulin resistance. We aimed to investigate cross-sectional correlations between desaturase indices as measured in serum lipid fractions (phospholipids; PL and free fatty acids; FFA) and in adipose tissue (AT-TAG). In a population-based sample of 301 healthy 60-year-old men various desaturase indices were assessed: stearoyl-CoA-desaturase (16:1n-7/16:0; SCD-16 and 18:1n-9/18:0; SCD-18, respectively), delta-6-desaturase (20:3n-6/18:2n-6; D6D) and delta-5-desaturase (20:4n-6/20:3n-6; D5D). Correlations with BMI and insulin resistance (HOMA-IR) were also examined. SCD-16 and D5D were significantly correlated between fractions and tissues (all r > 0.30), whereas SCD-18 and D6D were not. Desaturase indices in serum FFA and AT-TAG were significantly correlated; SCD-16 (r = 0.63), SCD-18 (r = 0.37), and D5D (r = 0.43). In phospholipids, SCD-16 was positively correlated to BMI (r = 0.15), while D5D negatively to both BMI (r = -0.30) and HOMA-IR (r = -0.31), all p < 0.01. D6D in both phospholipids and AT-TAG was positively correlated to HOMA-IR and BMI (all p < 0.01). In conclusion, SCD-1 and D5D activity indices showed overall strong correlations between lipid pools. SCD-1 activity index in adipose tissue is best reflected by 16:1/16:0-ratio in serum FFA, but associations with obesity and insulin resistance differ between these pools. D5D in PL was inversely related to obesity and insulin resistance, whereas D6D index showed positive associations
Increased prevalence of vulnerable atherosclerotic plaques and low levels of natural IgM antibodies against phosphorylcholine in patients with systemic lupus erythematosus
The role of inflammation in the development of atherosclerosis is now accepted and a focus of many studies because of its complex mechanisms. The risk of cardiovascular disease (CVD) and atherosclerosis is reported to be increased in systemic lupus erythematosus (SLE), especially in the group of young women. The introduction of statins in the 1990âs lowered considerably the morbidity and mortality in CVD. In the last decade, research efforts were concentrated on the immunological mechanisms of atherosclerosis and on the possibility to influence these mechanisms.
Our group recently reported a negative association between natural IgM-antibodies against phosphorylcholine (IgM anti-PC) and CVD outcome in the general population. Potential mechanisms considered include anti-inflammatory properties and inhibition of uptake of oxidized low density lipoprotein (oxLDL) in macrophages. The objective herein was to study mechanisms of atherosclerosis in SLE and the relation to traditional and non-traditional risk factors in an SLE cohort, in comparison with an age and sex matched control group. As systemic endothelial dysfunction is one of the earliest signs of atherosclerosis in the general population, we also assessed skin microvascular endothelial function in SLE patients and controls.
A total of 114 patients with SLE were compared with 122 age and sex-matched population-based controls. Common carotid intima-media thickness (IMT), calculated intima-media area (cIMa) and plaque occurrence were determined by B-mode ultrasound. Plaques were graded according to echogenicity. Anti-PC was assessed by enzyme-linked immunosorbent assay (ELISA). Endothelial function in skin was tested with local application of acetylcholine (ACh) and any concomitant increase in skin perfusion was measured with Laser Doppler Fluxmetry (LDF) in 84 of the SLE-patients and 81 of the age- and sex-matched controls.
Incidence of hypertension, presence of insulin resistance (determined by homeostasis model assessment of insulin resistance, HOMA-IR) and the levels of triglycerides and C-reactive protein (CRP) were increased in the SLE patients, while smoking, cholesterol and high density lipoprotein (HDL) did not differ from controls. Low levels of IgM anti-PC were more common in the SLE patients than in the controls. IMT and cIMa did not differ significantly between groups. However, plaques were more often found in the SLE patients. Age, LDL and IgM anti-PC were independently associated with plaque occurrence in the SLE patients. Furthermore, in the left carotid arteries echolucent plaques were more prevalent in SLE when compared to controls. There were no significant differences in skin microvascular endothelial function between SLE patients and controls. In the SLE group, endothelial function did not vary in relation to presence of skin manifestations, Raynaudâs phenomenon, nephritis or plaque occurrence. In SLE patients with CVD, however, endothelial function was impaired.
Conclusion: Plaque occurrence in the carotid arteries was increased in SLE and was independently associated with age, LDL and low anti-PC levels. Vulnerable plaques were more common in SLE than in controls. Anti-PC could be a novel risk marker for atherosclerosis with therapeutic potential in SLE. Skin microvascular endothelial function was associated with CVD but not with early signs of atherosclerosis in SLE-patients. The endothelial function was not different in SLE-patients, as compared to controls
Genetic loci on chromosome 5 are associated with circulating levels of interleukin-5 and eosinophil count in a European population with high risk for cardiovascular disease
IL-5 is a Th2 cytokine which activates eosinophils and is suggested to have an atheroprotective role. Genetic variants in the IL5 locus have been associated with increased risk of CAD and ischemic stroke. In this study we aimed to identify genetic variants associated with IL-5 concentrations and apply a Mendelian randomisation approach to assess IL-5 levels for causal effect on intima-media thickness in a European population at high risk of coronary artery disease. We analysed SNPs within robustly associated candidate loci for immune, inflammatory, metabolic and cardiovascular traits. We identified 2 genetic loci for IL-5 levels (chromosome 5, rs56183820, BETA = 0.11, P = 6.73Eâ5 and chromosome 14, rs4902762, BETA = 0.12, P = 5.76Eâ6) and one for eosinophil count (rs72797327, BETA = â0.10, P = 1.41Eâ6). Both chromosome 5 loci were in the vicinity of the IL5 gene, however the association with IL-5 levels failed to replicate in a meta-analysis of 2 independent cohorts (rs56183820, BETA = 0.04, P = 0.2763, I2 = 24, I2 â P = 0.2516). No significant associations were observed between SNPs associated with IL-5 levels or eosinophil count and IMT measures. Expression quantitative trait analyses indicate effects of the IL-5 and eosinophil-associated SNPs on RAD50 mRNA expression levels (rs12652920 (r2 = 0.93 with rs56183820) BETA = â0.10, P = 8.64Eâ6 and rs11739623 (r2 = 0.96 with rs72797327) BETA = â0.23, P = 1.74Eâ29, respectively). Our data do not support a role for IL-5 levels and eosinophil count in intima-media thickness, however SNPs associated with IL-5 and eosinophils might influence stability of the atherosclerotic plaque via modulation of RAD50 levels
Causal relevance of blood lipid fractions in the development of carotid atherosclerosis: Mendelian randomization analysis.
BACKGROUND: Carotid intima-media thickness (CIMT), a subclinical measure of atherosclerosis, is associated with risk of coronary heart disease events. Statins reduce progression of CIMT and coronary heart disease risk in proportion to the reduction in low-density lipoprotein cholesterol. However, interventions targeting triglycerides (TGs) or high-density lipoprotein cholesterol (HDL-C) have produced inconsistent effects on CIMT and coronary heart disease risk, making it uncertain whether such agents are ineffective for coronary heart disease prevention or whether CIMT is an inadequate marker of HDL-C or TG-mediated effects. We aimed to determine the causal association among the 3 major blood lipid fractions and common CIMT using mendelian randomization analysis. METHODS AND RESULTS: Genetic scores specific for low-density lipoprotein cholesterol, HDL-C, and TGs were derived based on single nucleotide polymorphisms from a gene-centric array in â5000 individuals (Cardiochip scores) and from a genome-wide association meta-analysis in >100 000 individuals (Global Lipids Genetic Consortium scores). These were used as instruments in a mendelian randomization analysis in 2 prospective cohort studies. A genetically predicted 1 mmol/L higher low-density lipoprotein cholesterol concentration was associated with a higher common CIMT by 0.03 mm (95% confidence interval, 0.01-0.04) and 0.04 mm (95% confidence interval, 0.02-0.06) based on the Cardiochip and Global Lipids Genetic Consortium scores, respectively. HDL-C and TGs were not causally associated with CIMT. CONCLUSIONS: Our findings confirm a causal relationship between low-density lipoprotein cholesterol and CIMT but not with HDL-C and TGs. At present, the suitability of CIMT as a surrogate marker in trials of cardiovascular therapies targeting HDL-C and TGs is questionable and requires further study
Chromosome 1p13 genetic variants antagonize the risk of myocardial infarction associated with high ApoB serum levels
PMCID: PMC3480949This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Alcohol consumption in relation to carotid subclinical atherosclerosis and its progression:results from a European longitudinal multicentre study
BACKGROUND/AIM: The association between alcohol consumption and subclinical atherosclerosis is still unclear. Using data from a European multicentre study, we assess subclinical atherosclerosis and its 30-month progression by carotid intima-media thickness (C-IMT) measurements, and correlate this information with self-reported data on alcohol consumption. METHODS: Between 2002-2004, 1772 men and 1931 women aged 54-79 years with at least three risk factors for cardiovascular disease (CVD) were recruited in Italy, France, Netherlands, Sweden, and Finland. Self-reported alcohol consumption, assessed at baseline, was categorized as follows: none (0 g/d), very-low (0â-â5 g/d), low (>â5 to ââ€â10 g/d), moderate (>â10 to â€â20 g/d for women, â>â10 to â€â30 g/d for men) and high (>â20 g/d for women,â>â30 g/d for men). C-IMT was measured in millimeters at baseline and after 30 months. Measurements consisted of the mean and maximum values of the common carotids (CC), internal carotid artery (ICA), and bifurcations (Bif) and whole carotid tree. We used quantile regression to describe the associations between C-IMT measures and alcohol consumption categories, adjusting for sex, age, physical activity, education, smoking, diet, and latitude. RESULTS: Adjusted differences between median C-IMT values in different levels of alcohol consumption (vs. very-low) showed that moderate alcohol consumption was associated with lower C-IMTmax[-â0.17(95%CI -â0.32; -â0.02)], and Bif-IMTmean[-â0.07(95%CI -â0.13; -â0.01)] at baseline and decreasing C-IMTmean[-â0.006 (95%CI -â0.011; -â0.000)], Bif-IMTmean[-â0.016(95%CI -â0.027; -â0.005)], ICA-IMTmean[-â0.009(95% -â0.016;â-â0.002)] and ICA-IMTmax[-â0.016(95%: -â0.032; -â0.000)] after 30 months. There was no evidence of departure from linearity in the association between alcohol consumption and C-IMT. CONCLUSION: In this European population at high risk of CVD, findings show an inverse relation between moderate alcohol consumption and carotid subclinical atherosclerosis and its 30-month progression, independently of several potential confounders
Intake of food rich in saturated fat in relation to subclinical atherosclerosis and potential modulating effects from single genetic variants
The relationship between intake of saturated fats and subclinical atherosclerosis, as well as the possible influence of genetic variants, is poorly understood and investigated. We aimed to investigate this relationship, with a hypothesis that it would be positive, and to explore whether genetics may modulate it, using data from a European cohort including 3,407 participants aged 54-79 at high risk of cardiovascular disease. Subclinical atherosclerosis was assessed by carotid intima-media thickness (C-IMT), measured at baseline and after 30 months. Logistic regression (OR; 95% CI) was employed to assess the association between high intake of food rich in saturated fat (vs. low) and: (1) the mean and the maximum values of C-IMT in the whole carotid artery (C-IMTmean, C-IMTmax), in the bifurcation (Bif-), the common (CC-) and internal (ICA-) carotid arteries at baseline (binary, cut-point >= 75th), and (2) C-IMT progression (binary, cut-point>zero). For the genetic-diet interaction analyses, we considered 100,350 genetic variants. We defined interaction as departure from additivity of effects. After age- and sex-adjustment, high intake of saturated fat was associated with increased C-IMTmean (OR:1.27;1.06-1.47), CC-IMTmean (OR:1.22;1.04-1.44) and ICA-IMTmean (OR:1.26;1.07-1.48). However, in multivariate analysis results were no longer significant. No clear associations were observed between high intake of saturated fat and risk of atherosclerotic progression. There was no evidence of interactions between high intake of saturated fat and any of the genetic variants considered, after multiple testing corrections. High intake of saturated fats was not independently associated with subclinical atherosclerosis. Moreover, we did not identify any significant genetic-dietary fat interactions in relation to risk of subclinical atherosclerosis
Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification
Background and aims: Carotid plaque size and the mean common carotid intima-media thickness measured in plaque-free areas (PF CC-IMTmean) have been identified as predictors of vascular events (VEs), but their complementarity in risk prediction and stratification is still unresolved. The aim of this study was to evaluate the independence of carotid plaque thickness and PF CC-IMTmean in cardiovascular risk prediction and risk stratification.Methods: The IMPROVE-study is a European cohort (n = 3703), where the thickness of the largest plaque detected in the whole carotid tree was indexed as cIMT(max). PF CC-IMTmean was also assessed. Hazard Ratios (HR) comparing the top quartiles of cIMT(max) and PF CC-IMTmean versus their respective 1-3 quartiles were calculated using Cox regression.Results: After a 36.2-month follow-up, there were 215 VEs (125 coronary, 73 cerebral and 17 peripheral). Both cIMT(max) and PF CC-IMTmean were mutually independent predictors of combined-VEs, after adjustment for center, age, sex, risk factors and pharmacological treatment [HR (95% CI) = 1.98 (1.47, 2.67) and 1.68 (1.23, 2.29), respectively]. Both variables were independent predictors of cerebrovascular events (ischemic stroke, transient ischemic attack), while only cIMT(max) was an independent predictor of coronary events (myocardial infarction, sudden cardiac death, angina pectoris, angioplasty, coronary bypass grafting). In reclassification analyses, PF CC-IMTmean significantly adds to a model including both Framingham Risk Factors and cIMT(max) (Integrated Discrimination Improvement; IDI = 0.009; p = 0.0001) and vice-versa (IDI = 0.02; p <0.0001).Conclusions: cIMT(max) and PF CC-IMTmean are independent predictors of VEs, and as such, they should be used as additive rather than alternative variables in models for cardiovascular risk prediction and reclassification.</p
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