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.

Characterisation of waste for combustion : with special reference to the role of zinc

Waste combustion has gone from being a volume reducing discarding-method to an energy recovery process for unwanted material that cannot be reused or recycled. Different fractions of waste are used as fuel today, such as; municipal solid waste, refuse derived fuel, and solid recovered fuel. Furthermore, industrial waste, normally a mixture between commercial waste and building and demolition waste, is common, either as separate fuels or mixed with, for example, municipal solid waste. Compared to fossil or biomass fuels, waste mixtures are extremely heterogeneous, making it a complicated fuel. Differences in calorific values, ash content, moisture content, and changing levels of elements, such as Cl and alkali metals, are common in waste fuel. Moreover, waste contains much higher levels of troublesome trace elements, such as Zn, which is thought to accelerate a corrosion process. Varying fuel quality can be strenuous on the boiler system and may cause fouling and corrosion of heat exchanger surfaces. This thesis examines waste fuels and waste combustion from different angles, with the objective of giving a better understanding of waste as an important fuel in today’s fuel economy. Several chemical characterisation campaigns of waste fuels over longer time periods (10-12 months) was used to determine the fossil content of Swedish waste fuels, to investigate possible seasonal variations, and to study the presence of Zn in waste. Data from the characterisation campaigns were used for thermodynamic equilibrium calculations to follow trends and determine the effect of changing concentrations of various elements. The thesis also includes a study of the thermal behaviour of Zn and a full—scale study of how the bed temperature affects the volatilisation of alkali metals and Zn from the fuel. As mixed waste fuel contains considerable amounts of fresh biomass, such as wood, food waste, paper etc. it would be wrong to classify it as a fossil fuel. When Sweden introduced waste combustion as a part of the European Union emission trading system in the beginning of 2013 there was a need for combustion plants to find a usable and reliable method to determine the fossil content. Four different methods were studied in full-scale of seven combustion plants; 14Canalysis of solid waste, 14C-analysis of flue gas, sorting analysis followed by calculations, and a patented balance method that is using a software program to calculate the fossil content based on parameters from the plant. The study showed that approximately one third of the coal in Swedish waste mixtures has fossil origins and presented the plants with information about the four different methods and their advantages and disadvantages. Characterisation campaigns also showed that industrial waste contain higher levels of trace elements, such as Zn. The content of Zn in Swedish waste fuels was determined to be approximately 800 mg kg-1 on average, based on 42 samples of solid waste from seven different plants with varying mixtures between municipal solid waste and industrial waste. A review study of the occurrence of Zn in fuels confirmed that the highest amounts of Zn are present in waste fuels rather than in fossil or biomass fuels. In tires, Zn is used as a vulcanizing agent and can reach concentration values of 9600-16800 mg kg-1. Waste Electrical and Electronic Equipment is the second Zn-richest fuel and even though on average Zn content is around 4000 mg kg-1, the values of over 19000 mg kg-1 were also reported. The increased amounts of Zn, 3000-4000 mg kg-1, are also found in municipal solid waste, sludge with over 2000 mg kg-1 on average (some exceptions up to 49000 mg kg-1), and other waste derived fuels (over 1000 mg kg-1). Zn is also found in fossil fuels. In coal, the average level of Zn is 100 mg kg-1, the higher amount of Zn was only reported for oil shale with values between 20-2680 mg kg-1. The content of Zn in biomass is basically determined by its natural occurrence and it is typically 10-100 mg kg-1. The thermal behaviour of Zn is of importance to understand the possible reactions taking place in the boiler. By using thermal analysis three common Zn-compounds were studied (ZnCl2, ZnSO4, and ZnO) and compared to phase diagrams produced with thermodynamic equilibrium calculations. The results of the study suggest that ZnCl2(s/l) cannot exist readily in the boiler due to its volatility at high temperatures and its conversion to ZnO in oxidising conditions. Also, ZnSO4 decomposes around 680°C, while ZnO is relatively stable in the temperature range prevailing in the boiler. Furthermore, by exposing ZnO to HCl in a hot environment (240-330°C) it was shown that chlorination of ZnO with HCl gas is possible. Waste fuel containing high levels of elements known to be corrosive, for example, Na and K in combination with Cl, and also significant amounts of trace elements, such as Zn, are demanding on the whole boiler system. A full-scale study of how the volatilisation of Na, K, and Zn is affected by the bed temperature in a fluidised bed boiler was performed parallel with a lab-scale study with the same conditions. The study showed that the fouling rate on deposit probes were decreased by 20 % when the bed temperature was decreased from 870°C to below 720°C. In addition, the lab-scale experiments clearly indicated that the amount of alkali metals and Zn volatilised depends on the reactor temperature.

The Environmental Status of the Port of HaminaKotka

This study is a part of the Ecologically Friendly Port Ust-Luga (EFP) project. The purpose of this study is to examine the environmental status of the Finnish ports and, more specifically, the Port of HaminaKotka. An analysis of the environmental status is performed mainly as a literature review, because the Finnish ports must comply with Finnish and EU legislation and with the binding international regulations and conventions created by different organizations. The International Maritime Organisation (IMO) has done groundbreaking work in the field of maritime safety and maritime environmental protection. The MARPOL convention has a great impact on decreasing pollution from international shipping and it applies to 99% of the world’s merchant tonnage. Pollution prevention covers: Oil pollution, Chemical pollution, Air pollution and GHG Emissions, Dumping of Wasted and Other Matters, Garbage, Sewage, Port Reception Facilities, Special Areas under MARPOL and Particularly Sensitive Sea Areas. There is also Pollution Prevention for other treaties like anti-fouling systems used on ships, the transfer of alien species by ships’ ballast water and the environmentally sound recycling of ships. There are more than twenty different EU and international regulations that influence ports and port operations in Finland. In addition, there is also national legislation that has an effect on Finnish ports. For the most part, the legislation for ports is common in the EU area, but the biggest and most important difference between the legislation in Finland and other EU countries is due to the Act on Environmental Impact Assessment Procedure. The Act states that the environmental impact assessment procedure shall be applied to projects that may have significant adverse environmental impacts, due to the special features of Finland`s nature and environment. In this Act, the term environmental impact refers to the direct and indirect effects inside and outside Finnish territory of a project or operations on human health, living conditions and amenity; soil, water, air, climate, organisms, interaction between them and biodiversity; community structure, buildings, landscape, townscape and cultural heritage; utilization of natural resources. In Finland, the Environmental Permit requires that ports collect all necessary information concerning environmental effects and make required reports to the Finnish authorities, stakeholders and the public. Commonly, environmental reporting is public and environmental achievements are emphasized in reporting and in media. At the moment, the problem in environmental reporting is that it’s difficult to compare data from different ports. There is enough data concerning the environmental effects and performance, but the manner of reporting and the quality of the data varies between ports. There are differences in the units and codes used, in some cases the information is not sufficient and it can even be rather unreliable. There are also differences regarding the subjects that are emphasized in reporting.

Reframing the relationship between service design and operations: a service engineering approach

The significance of services as business and human activities has increased dramatically throughout the world in the last three decades. Becoming a more and more competitive and efficient service provider while still being able to provide unique value opportunities for customers requires new knowledge and ideas. Part of this knowledge is created and utilized in daily activities in every service organization, but not all of it, and therefore an emerging phenomenon in the service context is information awareness. Terms like big data and Internet of things are not only modern buzz-words but they are also describing urgent requirements for a new type of competences and solutions. When the amount of information increases and the systems processing information become more efficient and intelligent, it is the human understanding and objectives that may get separated from the automated processes and technological innovations. This is an important challenge and the core driver for this dissertation: What kind of information is created, possessed and utilized in the service context, and even more importantly, what information exists but is not acknowledged or used? In this dissertation the focus is on the relationship between service design and service operations. Reframing this relationship refers to viewing the service system from the architectural perspective. The selected perspective allows analysing the relationship between design activities and operational activities as an information system while maintaining the tight connection to existing service research contributions and approaches. This type of an innovative approach is supported by research methodology that relies on design science theory. The methodological process supports the construction of a new design artifact based on existing theoretical knowledge, creation of new innovations and testing the design artifact components in real service contexts. The relationship between design and operations is analysed in the health care and social care service systems. The existing contributions in service research tend to abstract services and service systems as value creation, working or interactive systems. This dissertation adds an important information processing system perspective to the research. The main contribution focuses on the following argument: Only part of the service information system is automated and computerized, whereas a significant part of information processing is embedded in human activities, communication and ad-hoc reactions. The results indicate that the relationship between service design and service operations is more complex and dynamic than the existing scientific and managerial models tend to view it. Both activities create, utilize, mix and share information, making service information management a necessary but relatively unknown managerial task. On the architectural level, service system -specific elements seem to disappear, but access to more general information elements and processes can be found. While this dissertation focuses on conceptual-level design artifact construction, the results provide also very practical implications for service providers. Personal, visual and hidden activities of service, and more importantly all changes that take place in any service system have also an information dimension. Making this information dimension visual and prioritizing the processed information based on service dimensions is likely to provide new opportunities to increase activities and provide a new type of service potential for customers.

Introduction of the T-10 static line parachuting capability to the NH90 helicopter

The purpose of this study was to investigate the suitability of the Finnish Defence Forces’ NH90 helicopter for parachuting operations with the T-10 static line parachute system. The work was based on the Army Command’s need to compensate for the reduction in the outsourced flight hours for the military static line parachuting training. The aim of the research was to find out the procedures and limitations with which the NH90 IOC+ or FOC version helicopter could be used for static line parachutist training with the T- 10B/MC1-1C parachutes. The research area was highly complicated and non-linear. Thus analytical methods could not be applied with sufficient confidence, even with present-day computing power. Therefore an empirical research method was selected, concentrating on flight testing supported with literature study and some calculated estimations. During three flights and 4.5 flight hours in Utti, Finland on 17−20 September 2012, a total of 44 parachute drops were made. These consisted of 16 dummy drops and 28 paratrooper jumps. The test results showed that when equipped with the floor mounted PASI-1 anchor line, the deflector bar of the NHIndustries’ Parachuting Kit and Patria’s floor protection panels the Finnish NH90 variant could be safely used for T-10B/MC1-1C static line parachuting operations from the right cabin door at airspeed range of 50−80 KIAS (∼90–150 km/h). The ceiling mounted anchor lines of the NHI’s Parachuting Kit were not usable with the T-10 system. This was due to the static lines’ unsafe behaviour in slipstream when connected to the cabin ceiling level. In conclusion, the NH90 helicopter can be used to meet the Army Command’s requirement for an additional platform for T-10 static line parachutist training. Material dropping, the effect of additional equipment and jumping from the rear ramp should be further studied.

Violations of children's rights in armed conflicts : international treaties, observations by peacekeepers and crisis management training in Finland

Ninety-nine Finnish peacekeepers, who had been serving in 15 different operations around the world, participated in the study (8 women, 27-52 years old, m = 37.4, SD = 8.9; and 91 men, 21-69 years old, m = 41.4, SD = 10.2). Three military crisis management trainers from the Finnish Defence Forces International Centre also participated in the study. The data was collected with two webbased questionnaires. In addition two interviews were made with specialists of civilian crisis management in Finland. The study also provides an overview of international treaties concerning children’s rights in armed conflict. The results show that 48.7 % of dangers for children in conflicts reported by the peacekeepers were related to physical injury (e.g. landmines and traffic), and 27.4 % were related to social problems (e.g. poverty, child soldiers, and trafficking). 24.1 % of the peacekeepers had made observations of children’s rights violations either often or very often during peacekeeping operations. 49.6 % of the observations were related to social problems (e.g. child labour or being forced to beg), and 33.0 % were related to physical injury (e.g. assault). Frequency of observation of children’s rights violations was not associated with either sex or military degree of the peacekeepers; instead it was significantly correlated with the peacekeepers’ degree of knowledge of EU’s child protection guidelines. On the basis of the results, it is recommended that knowledge about children’s rights and protection should be included in the training of Finnish crisis management personnel to a much higher degree than at the present.

Syvää vai pelkästään tiheää : neuvostoliittolaisen ja venäläisen sotataidollisen ajattelun lähtökohdat, kehittyminen, soveltaminen käytäntöön ja nykytilanne. Näkökulmana 1920- ja 1930-luvun syvän taistelun ja operaation opit

Sosialistisen vallankumouksen jälkeen Neuvosto-Venäjän oli monien muiden kysymysten ohella ratkaistava sosialismin saavutusten puolustaminen. Aluksi ratkaisuksi suunniteltiin vapaaehtoisuuteen perustuvaa punakaartia, mutta riittävän miesvahvuuden turvaamiseksi päädyttiin yleiseen asevelvollisuuteen. Pian Venäjän sisällissodan jälkeen sotataidon suunta painottui enemmän vanhan armeijan asiantuntijoiden näkemysten kuin vallankumoussankarien kokemusten mukaiseksi, vaikka Frunzen puna-armeijalle kirjoittama doktriini perustui luokkataisteluun ja korosti sisällissodassa hyväksi koettua operatiivista liikkuvuutta. Neuvostoliiton ja Venäjän sotataidon perustana on Pietari I:n aloittama länsimainen suuntaus, jota kuitenkin täydentävät vahvat kansalliset piirteet. Venäläisen sotataidon henkisenä isänä voidaan hyvällä syyllä pitää Aleksandr Suvorovia, jonka opetukset näkyvät tekstilainausten lisäksi myös periaatteissa ja sotilaskasvatuksessa. Napoleonin sotien jälkeen perustettu Keisarillinen yleisesikunta-akatemia loi Venäjälle sotatieteellisen tutkimuksen ja opetuksen. Sotatieteen mahdollisuuksia ei 1800-luvun Venäjällä osattu täysin hyödyntää. Aseistuksen kasvavan tehon merkitystä vähättelevä asenne johti sotataidon taantumisen ja katastrofiin Venäjän–Japanin sodassa. Sen kokemuksia analysoidessaan Aleksandr Neznamov kehitti edelleen saksalaista operaation käsitettä ja loi perustan Neuvostoliitossa 1920-luvulla kehitetylle operaatiotaidolle. Neuvostoliittolaisen sotataidon päämääränä oli kehittää taktinen ja operatiivinen ratkaisu aseistuksen tehon kasvun aikaansaamaan puolustuksen ylivoimaisuuteen. Ratkaisussa hyödynnettiin brittien kokemuksia ja tutkimusta. Neuvostoliittolainen taktiikka ja operaatiotaito eivät kuitenkaan olleet brittiläisen mekanisoidun sodankäynnin tai saksalaisen salamasodan itäinen kopioita vaan itsenäisiin ratkaisuihin pohjautuvia. Syvän taistelun ja operaation teoriaa kokeiltiin harjoituksissa, ja sitä kehitettiin Stalinin vuoden 1937 puhdistuksiin saakka. Toisen maailmansodan taisteluissa puna-armeija sovelsi alkuvaiheen katastrofin jälkeen syvän taistelun ja syvän operaation oppeja. Komentajien ja joukkojen taito ei riittänyt teorian vaatimusten mukaiseen toimintaan, siksi syväksi aiotusta taistelusta tuli ajoittain ainoastaan tiheää. Suuren isänmaallisen sodan kokemusten perusteella neuvostoliittolainen sotatiede kehitti yleisjoukkojen taistelun periaatteet, jotka ovat säilyneet muuttumattomina nykypäivään saakka. Kylmän sodan aikakaudella ydin- ja tavanomaisen aseistuksen merkitys sodan ja taistelun kuvassa vaihteli. Lännen sotataidon ja aseteknologian kehitys pakotti Neuvostoliiton siirtymään 1980-luvulla sotilaallisessa ajattelussaan hyökkäyksestä puolustukseen. Neuvostoliiton hajoamisen jälkeen Venäjän sotilaallisen turvallisuuden takaajana on ydinaseistus. Yhdysvaltain tavanomainen ilma-avaruushyökkäyskyky vaatii Venäjää kehittämään torjuntajärjestelmiä. Tavanomaisten joukkojen rakentamisessa Venäjä seuraa tarkasti läntisen sotataidon kehittymistä, mutta pitäytyy omaperäisiin ratkaisuihin, joiden kehittämisessä sen vahvalla sotatieteellisellä järjestelmällä ja dialektisen materialismin metodilla on edelleen olennaisen tärkeä merkitys.

Reusing repository technology for Cultural Heritage and Special Collections

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Kansallisen energia- ja ilmastopolitiikan toteuttaminen puolustushallinnossa

Tässä diplomityössä selvitetään kansallisen energia- ja ilmastopolitiikan toteuttamiseen vaikuttavia tekijöitä puolustushallinnossa. Tavoitteena on tunnistaa, minkälaisia haasteita ja edellytyksiä toteuttamiseen liittyy ja minkälaisia toimenpiteitä ja päätöksiä politiikan toteuttaminen hallinnossa edellyttää. Tutkimuskysymyksiä lähestytään strategiakirjallisuuden, olemassa olevan tutkimustiedon sekä kvalitatiivisen haastattelututkimuksen kautta. Tutkimuksen tarkoitus on edesauttaa hallinnon oman energia- ja ilmastostrategian laadintaa sekä toimia johdon työkaluna toteuttamispäätösten tekemisessä. Merkittävimmiksi toteuttamiseen vaikuttaviksi tekijöiksi tunnistettiin resursointikysymykset, johdon sitoutuminen sekä puolustustoimialan erityispiirteet. Lisäksi vaikutuksia tunnistettiin olevan muun muassa kiinteistö- ja energiasopimusjärjestelyillä, asenteilla sekä puolustusvoimauudistuksella. Kirjallisuuskatsauksen teoreettisille käsitteille löydettiin pitkälti vastineet empiirisestä tutkimuksesta, mutta osa haasteista nousi esiin nimenomaan puolustushallinnon toimintaympäristöstä. Osa tuloksista on yleistettävissä laajemmin energia- ja ilmastotoimenpiteille, valtiosektorille ja muille toimialoille. Saatujen tulosten perusteella on mahdollista määrittää reunaehdot hallinnonalan oman energia- ja ilmasto-ohjelman laadinnalle sekä ennakoida toteuttamisedellytyksiä. Ohjelman toteuttamista tukevina jatkotoimenpide-ehdotuksina esitetään yhteistyöverkoston yhteistä julkista sitoutumista energia- ja ilmastopolitiikan edistämiseen, konkreettisten toimintaohjelmien laatimista sekä tietoisuuden kasvattamista toiminnan ilmastovaikutuksista ja ilmastonmuutoksen vaikutuksista toimintaan viestinnän ja seurantajärjestelmien keinoin sekä osana päätöksentekoprosesseja.

Software development methods and quality assurance: Special focus on South Korea

The purpose of this study was to explore software development methods and quality assurance practices used by South Korean software industry. Empirical data was collected by conducting a survey that focused on three main parts: software life cycle models and methods, software quality assurance including quality standards, the strengths and weaknesses of South Korean software industry. The results of the completed survey showed that the use of agile methods is slightly surpassing the use of traditional software development methods. The survey also revealed an interesting result that almost half of the South Korean companies do not use any software quality assurance plan in their projects. For the state of South Korean software industry large number of the respondents thought that despite of the weakness, the status of software development in South Korea will improve in the future.

Percutaneous Coronary Intervention in Patients with Atrial Fibrillation: A Study of Factors Affecting Outcome, with a Special Emphasis on Periprocedural Antithrombotic Treatment

Antithrombotic treatment of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a delicate balancing between the risk of thromboembolism and the risk of bleeding. The purpose of this dissertation was to analyze current antithrombotic treatment strategies at the periprocedural stage and report outcomes in-hospital and at 1-month follow-up, and to evaluate the effect of renal impairment and predictive values of various bleeding scores on 1-year outcome after PCI in patients with AF. The first article was based on retrospective data from 7 Finnish hospitals between 2002–2006 (n=377), while the others were based on a prospective 17-center European register (AFCAS) gathered between 2008–2010 (n=963). The main findings in patients with AF undergoing PCI were: The use of glycoprotein IIb/IIIa inhibitors during PCI was associated with a four- to five-fold increase in the risk of major bleeding (I). Uninterrupted warfarin treatment did not increase perioperative complications and seemed to decrease bleeding complications compared to heparin bridging (II). Already mild renal impairment (eGFR 60–90mL/min) was associated with a 2.3-fold risk of all-cause mortality during the 12 months following PCI (III). Major adverse cardiac events occurred in 4.5% and bleeding complications in 7.1% of patients in the AFCAS register by 1-month follow-up (IV). In a study of patients in AFCAS register, all currently used bleeding risk scores were poor predictors of bleeding complications by 1-year follow-up (V). The findings will help improve treatment strategies for this fragile patient population with a high risk of bleeding and thrombotic complications.

Special charta öfver kusten från Söderhamn til Stockholm

Graverad af Fr. Akrel

Special passcharta öfwer een deel af Österjöön altifrån Sandhamn till Ryga : innehållandes jemwäl Moösund, samt öjarna Ösel och Dagon, med een deel af Gottland och den Curiske Wallen

Julkaisussa: General hydrographisk chart-book öfwer Östersjön och Katte-Gatt till sin raetta figur och stoorleek

Special passcharta öfwer een deel af Österjöön begynnandes ifrån Elsnabben att utwysa Stockholms-Skärgården medh heela cousten intill Gefle, samt och den Finska Skärgården till Åbo jemwäl heela Åland

Julkaisussa: General hydrographisk chart-book öfwer Östersjön och Katte-Gatt till sin raetta figur och stoorleek