Factors predicting mortality in type 2 diabetes. With special reference to physical exercise, blood pressure, proteinuria, inflammation and P wave duration

Background: Type 2 diabetes patients have a 2-4 fold risk of cardiovascular disease (CVD) compared to the general population. In type 2 diabetes, several CVD risk factors have been identified, including obesity, hypertension, hyperglycemia, proteinuria, sedentary lifestyle and dyslipidemia. Although much of the excess CVD risk can be attributed to these risk factors, a significant proportion is still unknown. Aims: To assess in middle-aged type 2 diabetic subjects the joint relations of several conventional and non-conventional CVD risk factors with respect to cardiovascular and total mortality. Subjects and methods: This thesis is part of a large prospective, population based East-West type 2 diabetes study that was launched in 1982-1984. It includes 1,059 middle-aged (45-64 years old) participants. At baseline, a thorough clinical examination and laboratory measurements were performed and an ECG was recorded. The latest follow-up study was performed 18 years later in January 2001 (when the subjects were 63-81 years old). The study endpoints were total mortality and mortality due to CVD, coronary heart disease (CHD) and stroke. Results: Physically more active patients had significantly reduced total, CVD and CHD mortality independent of high-sensitivity C-reactive protein (hs-CRP) levels unless proteinuria was present. Among physically active patients with a hs-CRP level >3 mg/L, the prognosis of CVD mortality was similar to patients with hs-CRP levels ≤3 mg/L. The worst prognosis was among physically inactive patients with hs-CRP levels >3 mg/L. Physically active patients with proteinuria had significantly increased total and CVD mortality by multivariate analyses. After adjustment for confounding factors, patients with proteinuria and a systolic BP <130 mmHg had a significant increase in total and CVD mortality compared to those with a systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with a systolic BP <130 mmHg and ≥160 mmHg. Among patients without proteinuria, a systolic BP <130 mmHg was associated with a non-significant reduction in mortality. A P wave duration ≥114 ms was associated with a 2.5-fold increase in stroke mortality among patients with prevalent CHD or claudication. This finding persisted in multivariable analyses. Among patients with no comorbidities, there was no relationship between P wave duration and stroke mortality. Conclusions: Physical activity reduces total and CVD mortality in patients with type 2 diabetes without proteinuria or with elevated levels of hs-CRP, suggesting that the anti-inflammatory effect of physical activity can counteract increased CVD morbidity and mortality associated with a high CRP level. In patients with proteinuria the protective effect was not, however, present. Among patients with proteinuria, systolic BP <130 mmHg may increase mortality due to CVD. These results demonstrate the importance of early intervention to prevent CVD and to control all-cause mortality among patients with type 2 diabetes. The presence of proteinuria should be taken into account when defining the target systolic BP level for prevention of CVD deaths. A prolongation of the duration of the P wave was associated with increased stroke mortality among high-risk patients with type 2 diabetes. P wave duration is easy to measure and merits further examination to evaluate its importance for estimation of the risk of stroke among patients with type 2 diabetes.

Early modes of exegesis : ideal figures in Malachi as a test case

Antikens judiska bibeltolkare hade ett annorlunda sätt att läsa Bibeln än den som moderna läsare är vana vid. Dessa tidiga exegeter tänkte att texten som nu finns i den hebreiska Bibeln, de kristnas Gamla Testamente, är helig ordagrant i den form som den fanns i under deras tid, att den inte innehåller några fel, och att Gud har en övergripande plan gällande helheten, så att man vid behov kan förklara ett Bibelställe med hjälp av ett annat. Dessa antaganden reflekteras i det sätt på vilket antikens exegeter läste och tolkade sin Bibel. Det här ser man då man läser deras texter, från 400-talet före vår tideräknings början till de första århundradena enligt vår tideräkning. Ett verktyg som antikens skrifttolkare ofta använde var den så kallade gezera shava -metoden, där de jämförde identiska ord och fraser i Bibeln för att skänka belysning åt oklara textställen. Hebreiskan, särskilt den ovokaliserade konsonanttexten, innehåller många homonyma ord, alltså ord som ser likadana ut men har olika betydelser. De tidiga exegeterna utnyttjade ofta de möjligheter till alternativa tolkningar som uppstår ur denna tvetydighet. Ibland kunde de dock tvärtom också dra paralleller ur kontextuella likheter, alltid efter behov. I denna avhandling står dessa tidiga anonyma bibeltolkare och deras tolkningar i fokus. Malakis bok, som härstammar från ca år 475 f.v.t., kan ses som ett viktigt tidigt exempel på denna tendens till nytolkning av traditioner. Boken själv har dock också blivit föremål till nytolkningar, redan i de tilläggsverser som finns i dess slut, men särskilt i senare judisk litteratur och i Nya Testamentet. I avhandlingen granskas de fem bibliska gestalter som nämns i Malaki: Jakob, Esau, Levi, Mose och Elia. Hur används de i boken och hur har senare traditioner som anknyter till dem influerats av Malaki? ------------------------------------------------ Antiikin juutalaiset raamatunselittäjät lukivat Raamattua eri tavoin kuin moderni lukija. Heidän näkemyksensä mukaan se teksti, joka nykyään löytyy heprealaisesta Raamatusta eli kristittyjen Vanhasta testamentista, oli pyhä juuri sellaisessa muodossa, jossa se oli heille välittynyt. Se oli virheetön, ja Jumalalla oli siitä kokonaisnäkemys, joka voisi selvitä myös tulkitsijalle, kun tämä vain tutkisi tekstiä riittävän tarkkaan. Nämä perusoletukset näkyvät tavassa, jolla antiikin eksegeetit lukivat ja tulkitsivat Raamattuaan. Se voidaan huomata heidän jälkeensä jättämistään teksteistä, alkaen noin 400-luvulta ennen ajanlaskumme alkua ja jatkuen ajanlaskumme ensimmäisiin vuosisatoihin. Antiikin raamatunselittäjät käyttivät yleisesti muun muassa metodia, joka rabbiinisessa kirjallisuudessa tunnetaan nimellä gezera shava. Raamatussa kahdessa tai useammassa kohtaa esiintyviä samoja sanoja ja ilmauksia verrattiin tällöin toisiinsa ja pyrittiin siten saamaan valaistusta epäselvinä pidettyihin tekstinkohtiin. Heprealle, etenkin sen vokalisoimattomassa muodossa, on tyypillistä homonyymisyys. Samannäköiset sanat voivat eri yhteyksissä tarkoittaa eri asioita. Varhaiset eksegeetit päätyivät usein tästä ilmiöstä nouseviin, keskenään vaihtoehtoisiin tulkintoihin. Toisaalta he saattoivat myös tarvittaessa selittää tekstinkohtaa toisella tekstinkohdalla ainoastaan näiden sisällöllisenkin yhtäläisyyden perusteella. Tässä väitöstutkimuksessa tarkastellaan näitä varhaisia, meille nimettömiksi jääneitä raamatunselittäjiä ja heidän tulkintojaan käyttämällä tutkimuksen lähtökohtana Malakian kirjaa. Malakiaa, joka on peräisin noin vuodelta 475 ennen ajanlaskumme alkua, voidaan pitää yhtenä tärkeimmistä ja varhaisimmista teksteistä, joissa traditioita yhdistellään ja kerrotaan uudelleen edellä mainittuihin perusajatuksiin nojaten ja niihin pohjautuvia menetelmiä käyttäen. Toisaalta Malakian kirjaa on myös tulkittu samojen periaatteiden mukaisesti jo sen myöhemmältä ajalta peräisin olevissa loppujakeissa, ja sittemmin muussa varhaisessa juutalaisessa kirjallisuudessa sekä Uudessa testamentissa. Väitöstutkimuksessa tarkastellaan erityisesti niitä viittä henkilöä, jotka mainitaan Malakian kirjassa: Jaakobia, Esauta, Leeviä, Moosesta ja Eliaa. Kirjoittaja tutkii, miten heidän hahmojaan on käytetty Malakian kirjassa, millaisiin heitä koskeviin traditioihin tämä käyttötapa perustuu, ja missä määrin Malakian kirjan vaikutus on havaittavissa myöhemmässä näihin henkilöihin liitetyssä perinteessä.

Entry Modes for Finnish Firms into the Zambian Renewable Energy Industry

The renewable energy industry in Zambia is poised for growth and offers many possibilities for Finnish firms willing to enter the market. The Zambian government’s deliberate policy measures aim at attracting foreign direct investment (FDI) into this sector. This study rationalises that this could be the pull factor for Finnish firms. The thesis gives an overview of the industry and investigates an appropriate mode of entry, basing its arguments on the comparison analysis of the two economies with the use of the world forum’s stages of economic development as a framework. The theoretical part of the study examines internationalisation theories, entry mode choice and factors influencing the choice. The multiple case study approach is implored, analysing four case companies from Finland with the use of extant literature on internationalisation relevant to the study. The research design involves the use of documentation, secondary data, interviews and observation. The results of the case analyses show that the Finnish firm’s most preferred entry mode initially is exporting because it is considered to be less risky. Additionally, the findings also reveal that the selection of a suitable mode of entry is dependent on the firms’ size, orientation and international experience and could therefore be considered to be subjective. Paramount is the act of gaining market knowledge. The study shows that only hydro-electrical, solar energies and biomass are by far the most used and known forms of renewable energy in Zambia, while other alternative sources still remain un-exploited thus highlighting a growth potential. However, policy formulation and the regulatory framework in the renewable energy sector were found to be wanting.

Defining the keyhole modes – the effects on the weld geometry and the molten pool behaviour in high power laser welding of stainless steels

Keyhole welding, meaning that the laser beam forms a vapour cavity inside the steel, is one of the two types of laser welding processes and currently it is used in few industrial applications. Modern high power solid state lasers are becoming more used generally, but not all process fundamentals and phenomena of the process are well known and understanding of these helps to improve quality of final products. This study concentrates on the process fundamentals and the behaviour of the keyhole welding process by the means of real time high speed x-ray videography. One of the problem areas in laser welding has been mixing of the filler wire into the weld; the phenomena are explained and also one possible solution for this problem is presented in this study. The argument of this thesis is that the keyhole laser welding process has three keyhole modes that behave differently. These modes are trap, cylinder and kaleidoscope. Two of these have sub-modes, in which the keyhole behaves similarly but the molten pool changes behaviour and geometry of the resulting weld is different. X-ray videography was used to visualize the actual keyhole side view profile during the welding process. Several methods were applied to analyse and compile high speed x-ray video data to achieve a clearer image of the keyhole side view. Averaging was used to measure the keyhole side view outline, which was used to reconstruct a 3D-model of the actual keyhole. This 3D-model was taken as basis for calculation of the vapour volume inside of the keyhole for each laser parameter combination and joint geometry. Four different joint geometries were tested, partial penetration bead on plate and I-butt joint and full penetration bead on plate and I-butt joint. The comparison was performed with selected pairs and also compared all combinations together.

Entry Modes of Finnish Food Enterprises in Chinese Market

China’s phenomenal economic growth and social development have brought along interesting opportunities for Finnish companies. One intriguing sector offering significant growth potential is the food industry. Due to the local food safety issues, rising disposable income level and changing consumer habits, the demand for foreign food is increasing. Finnish food companies have much to offer in terms of high quality, food safety in production, technological development and innovation. The purpose of this study is to examine how the Finnish food enterprises choose their entry modes in the Chinese market. This study increases understanding of entry modes the Finnish companies can use to successfully enter the unpredictable market of China in the food industry context. The study examines the industry specific challenges and the possible solutions to them. Qualitative research is selected as research methodology for this study because the intention is to understand the reasons behind the Finnish food enterprises’ entry mode choices in the Chinese market. The study is conducted as a qualitative case analysis. Six Finnish case companies operating in the food industry were interviewed. The results of the research indicate that most of the food industry companies use exporting as their entry mode to China; only one case company used an investment mode. This study illustrates the significance of the factors related to company’s background, mode concerns and Chinese market influences in the entry mode choice.

Real-time simulation of multibody systems with applications for working mobile vehicles

This dissertation describes an approach for developing a real-time simulation for working mobile vehicles based on multibody modeling. The use of multibody modeling allows comprehensive description of the constrained motion of the mechanical systems involved and permits real-time solving of the equations of motion. By carefully selecting the multibody formulation method to be used, it is possible to increase the accuracy of the multibody model while at the same time solving equations of motion in real-time. In this study, a multibody procedure based on semi-recursive and augmented Lagrangian methods for real-time dynamic simulation application is studied in detail. In the semirecursive approach, a velocity transformation matrix is introduced to describe the dependent coordinates into relative (joint) coordinates, which reduces the size of the generalized coordinates. The augmented Lagrangian method is based on usage of global coordinates and, in that method, constraints are accounted using an iterative process. A multibody system can be modelled as either rigid or flexible bodies. When using flexible bodies, the system can be described using a floating frame of reference formulation. In this method, the deformation mode needed can be obtained from the finite element model. As the finite element model typically involves large number of degrees of freedom, reduced number of deformation modes can be obtained by employing model order reduction method such as Guyan reduction, Craig-Bampton method and Krylov subspace as shown in this study The constrained motion of the working mobile vehicles is actuated by the force from the hydraulic actuator. In this study, the hydraulic system is modeled using lumped fluid theory, in which the hydraulic circuit is divided into volumes. In this approach, the pressure wave propagation in the hoses and pipes is neglected. The contact modeling is divided into two stages: contact detection and contact response. Contact detection determines when and where the contact occurs, and contact response provides the force acting at the collision point. The friction between tire and ground is modelled using the LuGre friction model, which describes the frictional force between two surfaces. Typically, the equations of motion are solved in the full matrices format, where the sparsity of the matrices is not considered. Increasing the number of bodies and constraint equations leads to the system matrices becoming large and sparse in structure. To increase the computational efficiency, a technique for solution of sparse matrices is proposed in this dissertation and its implementation demonstrated. To assess the computing efficiency, augmented Lagrangian and semi-recursive methods are implemented employing a sparse matrix technique. From the numerical example, the results show that the proposed approach is applicable and produced appropriate results within the real-time period.

Failure modes of passive decay heat removing safety systems of modern nuclear power plants

The purpose of this master’s thesis is to gain an understanding of passive safety systems’ role in modern nuclear reactors projects and to research the failure modes of passive decay heat removal safety systems which use phenomenon of natural circulation. Another purpose is to identify the main physical principles and phenomena which are used to establish passive safety tools in nuclear power plants. The work describes passive decay heat removal systems used in AES-2006 project and focuses on the behavior of SPOT PG system. The descriptions of the main large-scale research facilities of the passive safety systems of the AES-2006 power plant are also included. The work contains the calculations of the SPOT PG system, which was modeled with thermal-hydraulic system code TRACE. The dimensions of the calculation model are set according to the dimensions of the real SPOT PG system. In these calculations three parameters are investigated as a function of decay heat power: the pressure of the system, the natural circulation mass flow rate around the closed loop, and the level of liquid in the downcomer. The purpose of the calculations is to test the ability of the SPOT PG system to remove the decay heat from the primary side of the nuclear reactor in case of failure of one, two, or three loops out of four. The calculations show that three loops of the SPOT PG system have adequate capacity to provide the necessary level of safety. In conclusion, the work supports the view that passive systems could be widely spread in modern nuclear projects.