| 1. |
- Forsblad-D’Elia, Helena, et al.
(author)
-
Biomechanical properties of common carotid arteries assessed by circumferential 2D strain and β stiffness index in patients with ankylosing spondylitis
- 2021
-
In: Journal of Rheumatology. - 0315-162X. ; 48:3, s. 352-360
-
Journal article (peer-reviewed)abstract
- Objective. Ankylosing spondylitis (AS) is associated with an elevated risk of cardiovascular disease (CVD) related to atherosclerosis, preceded by arterial stiffness. We aimed to examine common carotid artery (CCA) biomechanical properties using ultrasound to calculate β stiffness index (indicating arterial stiffness) and, a more recently developed technique, 2-dimensional (2D) speckle tracking strain (indicating arterial motion and deformation, strain) to (1) compare with age- and sex-matched controls, and (2) analyze relationships between strain and stiffness with disease characteristics and traditional risk factors for CVD in patients with AS. Methods. In this cross-sectional study, a cohort of 149 patients with AS, mean age 55.3 ± 11.2 years, 102 (68.5%) men, and 146 (98%) HLA-B27–positive, were examined. Bilateral CCA were examined for circumferential 2D strain and β stiffness index. A subgroup of 46 patients was compared with 46 age- and sex-matched controls, both groups without hypertensive disease, diabetes, myocardial infarction, or stroke. Results. Mean bilateral circumferential 2D strain was lower in AS patients compared with controls (7.9 ± 2.6% vs 10.3 ± 1.9%, P < 0.001), whereas mean bilateral β stiffness index was higher (13.1 ± 1.7 mmHg/mm vs 12.3 ± 1.3 mmHg/mm, P = 0.02). In multivariable linear regression analyses, strain was associated with age, erythrocyte sedimentation rate, history of anterior uveitis, and treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARD) and/or biological DMARD (R2 0.33), while stiffness was associated with age (R2 0.19). Conclusion. Both CCA circumferential 2D strain and β stiffness index differed between patients with AS and controls. Strain was associated with AS-related factors and age, whereas only age was associated with stiffness, suggesting that the obtained results reflect different pathogenic vascular processes.
|
|
| 2. |
- Forsblad-d'Elia, Helena, et al.
(author)
-
Biomechanical properties of common carotid arteries assessed by circumferential two-dimensional strain and β stiffness index in patients with ankylosing spondylitis
- 2021
-
In: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 48:3, s. 352-360
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: Ankylosing spondylitis (AS) is associated with an elevated risk of cardiovascular disease (CVD) related to atherosclerosis, preceded by arterial stiffness. We aimed to examine common carotid artery (CCA) biomechanical properties using ultrasound to calculate β stiffness index (indicating arterial stiffness) and, a more recently developed technique, two-dimensional (2D) speckle tracking strain (indicating arterial motion and deformation, strain) to 1) compare with age- and sex-matched controls and to 2) analyze relationships between strain and stiffness with disease characteristics and traditional risk factors for CVD in AS patients.METHODS: In this cross-sectional study, a cohort of 149 patients with AS, mean age 55.3±11.2 years, 102(68.5%) men, 146 (98%) HLA-B27 positive, were examined. Bilateral CCAs were examined for circumferential 2D strain and β stiffness index. A subgroup of 46 patients were compared with 46 age- and sex-matched controls, both groups without hypertensive disease, diabetes, myocardial infarction or stroke.RESULTS: Mean bilateral circumferential 2D strain was lower in AS patients compared with controls, 7.9±2.6% vs 10.3±1.9%, p<0.001 whereas mean bilateral β stiffness index was higher, 13.1±1.6mmHg/mm vs 12.3±1.3mmHg/mm, p=0.018. In multivariable linear regression analyses strain was associated with age, erythrocyte sedimentation rate, history of anterior uveitis and treatment with csDMARD and/or bDMARD (R2 0.33), while stiffness was associated with age (R2 0.19).CONCLUSION: Both CCA circumferential 2D strain and β stiffness index differed between AS patients and controls. Strain was associated with AS-related factors and age while stiffness with age, suggesting that the obtained results reflect different pathogenic vascular processes.
|
|
| 3. |
- Smeds, Magdalena, Teknisk licentiat, 1990-
(author)
-
Exploring Tampering : Towards an Understanding of Why Improvement Efforts Sometimes Fail
- 2022
-
Doctoral thesis (other academic/artistic)abstract
- Ever-increasing competition together with increasing and changing customer demands place high demands on organisations to maintain and improve their current products and services while also developing and renewing their offerings. However, research claims that many improvement efforts carried out in organisations fail. A line of research in quality management focusing on process improvement proposes that tampering, i.e. attempts to solve problems without targeting the fundamental causes of the problem, may be one reason why some attempts to improve fail. This dissertation focuses on faulty identification of causes of problems, as well as responses to such problems made by individual employees in their day-today work.The purpose of this dissertation is to enhance knowledge on tampering as a means to understand why attempts to improve sometimes do not lead to the desired results. This dissertation also answers the research questions How is tampering manifested in various types of approaches to identifying and responding to problems? and How can customers cause employees to take tampering actions? Studying how tampering is manifested in different ways depending on how a problem is interpreted and consequently the approach taken to respond to the problem can enhance knowledge about which interpretations and actions may lead to tampering. In this dissertation, approaches are viewed as alternative courses of actions available to employees when responding to problems. Four different types of approaches are studied: inaction, workaround, local improvement and system change. In addition, possible connections between customers and tampering are discussed and in this dissertation, it is proposed that the customer may have a negative impact on employees’ improvement efforts. In addition to answering the two research questions, a contemporary understanding of the tampering concept is proposed.Three studies have been conducted: a narrative literature review, a qualitative interview study and a case study with data collection through interviews, observations and a document study. This dissertation includes five appended papers. To answer the first research question, the main findings from the papers have been analysed by applying flexible pattern matching. The flexible pattern matching process was conducted by developing a theoretical framework of approaches, summarising the findings from the papers, and then comparing the findings to the theoretical framework to identify similarities and differences. To answer the second research question, examples of tampering were studied where the customer affected which problem was to be remedied or how.The analysis in the first research question results in five manifestations of tampering in various approaches to identifying and responding to problems. Actions proposed to cause tampering are passivity/wait-and-see, symptomatic response, locally focused response, disproportionate vision and vicious spiral of firefighting. The analysis in the second research question shows multiple examples of customer-induced tampering. Customers do not tamper with an organisation’s processes, but may express demands or concerns about perceived problems or how to execute a process that the organisation complies with. The saying ‘the customer is always right’ seems to be applied especially when the demand is placed by customers who are considered particularly important for relational or economic reasons.This dissertation contributes to research on quality management in general and improvement efforts through employees approaches as well as the customers role in identifying and responding to problems in particular. This dissertation and the appended papers explore the concept of tampering, and suggest that there is a need for a revitalisation and a broader understanding of the concept in order to increase its applicability in contemporary contexts. This dissertation also explores the previously under-exploredperspective on how customers can cause organisations to take measures that – from a process perspective – create process deterioration.
|
|
