Cholesterol, cardiovascular disease and statin use in older persons

Older age increases the risk of developing a chronic atherosclerotic cardiovascular disease (CVD), such as coronary heart disease. Complications of CVDs, myocardial infarction or stroke often lead to loss of functional capacity or premature death. Dyslipidemia, high serum levels of total or low-density lipoprotein cholesterol (LDL-c) and low levels of high-density lipoprotein cholesterol (HDL-c), is among the most important modifiable risk factors for CVDs; it can be treated with lifestyle modifications, and with lipid-lowering drugs, primarily statins. In older persons, however, the association of cholesterol levels with cardiovascular and all-cause mortality has been inconsistent in previous studies. Furthermore, the beneficial effects of statins in older persons without previous CVD are still somewhat unclear, and older persons are more prone to adverse effects from statins. This thesis presents a prospective cohort study (TUVA), exploring associations of cholesterol levels with mortality and the changes in cholesterol levels of a 70-year-old population in long-term follow-up. Further, prevalence of CVDs, risk factors and preventive medication use in the TUVA cohort is compared with respective prevalences in another age-matched cohort (UTUVA) 20 years later in order to examine the changes in cardiovascular risk over time. Additionally, to evaluate statin use patterns among older persons, an observational register study was conducted covering the total Finnish population aged 70 and older during 2000-2008. Based on individual-level data retrieved from national health registries, the population was classified into low, moderate and high risk groups according to estimated CVD risk. The prevalence, incidence and persistence of statin use among the risk groups was then evaluated based upon yearly statin purchases tracked from the Prescription Register. The prospective cohort study demonstrated that low total cholesterol, LDL-c and HDL-c were associated with higher mortality in a cohort of home-dwelling 70-year-olds. However, after adjusting for traditional cardiovascular risk factors and cancer this association disappeared. Further, low total cholesterol seemed to be protective, whereas low HDL-c strongly predicted increased risk of CVD death. Cholesterol levels of those elderly who remained available for follow-up and were still home-dwelling at the age of 85 seemed to improve with advancing age. Compared to the TUVA cohort, the later born UTUVA cohort had less CVDs and their risk factors were better controlled, which was reflected in the higher use of preventive medications such as statins and antihypertensives. The register studies confirmed that statin use has increased significantly during 2000-2008 among older persons, especially among the oldest (80+) age groups and among those at high risk for cardiovascular events. Two-thirds of new statin users persisted with their use during the four years of follow-up; the most discontinuations were made during the first year of use. In conclusion, statins are commonly used among older age groups in Finland. Most of the older statin users had a high cardiovascular event risk, indicating that the treatment is well directed towards those who are likely to benefit from it the most. No age-limits should be put on the screening and treatment of dyslipidemia in older persons, but the benefits and adverse effects of statin treatment should be carefully weighed based on an individual assessment of the person’s general health status and functional capacity. Physicians should pay more attention to medication adherence, especially when prescribing preventive medications.

Deep-hole drilling process, monitoring system and sensors modifications

 In the drilling processes and especially deep-hole drilling process, the monitoring system and having control on mechanical parameters (e.g. Force, Torque,Vibration and Acoustic emission) are essential. The main focus of this thesis work is to study the characteristics of deep-hole drilling process, and optimize the monitoring system for controlling the process. The vibration is considered as a major defect area of the deep-hole drilling process which often leads to breakage of the drill, therefore by vibration analysis and optimizing the workpiecefixture, this area is studied by finite element method and the suggestions are explained. By study on a present monitoring system, and searching on the new sensor products, the modifications and recommendations are suggested for optimize the present monitoring system for excellent performance in deep-hole drilling process research and measurements.

Particle detector link system modifications in RE1/1 sector

The large hadron collider constructed at the European organization for nuclear research, CERN, is the world’s largest single measuring instrument ever built, and also currently the most powerful particle accelerator that exists. The large hadron collider includes six different experiment stations, one of which is called the compact muon solenoid, or the CMS. The main purpose of the CMS is to track and study residue particles from proton-proton collisions. The primary detectors utilized in the CMS are resistive plate chambers (RPCs). To obtain data from these detectors, a link system has been designed. The main idea of the link system is to receive data from the detector front-end electronics in parallel form, and to transmit it onwards in serial form, via an optical fiber. The system is mostly ready and in place. However, a problem has occurred with innermost RPC detectors, located in sector labeled RE1/1; transmission lines for parallel data suffer from signal integrity issues over long distances. As a solution to this, a new version of the link system has been devised, a one that fits in smaller space and can be located within the CMS, closer to the detectors. This RE1/1 link system has been so far completed only partially, with just the mechanical design and casing being done. In this thesis, link system electronics for RE1/1 sector has been designed, by modifying the existing link system concept to better meet the requirements of the RE1/1 sector. In addition to completion of the prototype of the RE1/1 link system electronics, some testing for the system has also been done, to ensure functionality of the design.

Differential Regulation of c-FLIP Isoforms Through Post-translational Modifications

Cells are constantly responding to signals from the surrounding tissues and the environment. To dispose of infected and potentially dangerous cells, to ensure the optimal execution of developmental processes and to maintain tissue homeostasis, a multicellular organism needs to tightly control both the number and the quality of its cells. Apoptosis is a form of active cellular self-destruction that enables an organism to regulate its cell number by deleting damaged or potentially dangerous cells. Apoptosis can be induced by death ligands, which bind to death receptors on the cell surface. Ligation of the receptors leads to the formation of an intracellular death inducing signaling complex (DISC). One of the DISC components is caspase-8, a protease that triggers the caspase cascade and is thereby a key initiator of programmed cell death. The activation of caspase-8 is controlled by the cellular FLICE-inhibitory proteins (c-FLIPs). Consequently, sensitivity towards receptor-mediated apoptosis is determined by the amount of c-FLIP, and the c-FLIP levels are actively regulated for example during erythroid differentiation of K562 erythroleukemia cells and by hyperthermia in Jurkat leukemia cells. The aim of my thesis was to investigate how c-FLIP is regulated during these processes. We found that c-FLIP isoforms are short-lived proteins, although c-FLIPS had an even shorter half-life than c-FLIPL. In both experimental models, increased death receptor sensitivity correlated with induced ubiquitylation and consequent proteasomal degradation of c-FLIP. Furthermore, we elucidated how phosphorylation regulates the biological functions and the turnover of c-FLIP, thereby contributing to death receptor sensitivity. We mapped the first phosphorylation sites on c-FLIP and dissected how their phosphorylation affects c-FLIP. Moreover, we demonstrated that phosphorylation of serine 193, a phosphorylated residue common to all c-FLIPs, is primarily mediated by the classical PKC. Furthermore, we discovered a novel connection between the phosphorylation and ubiquitylation of c-FLIP: phosphorylation of S193 protects c-FLIP from ubiquitylation. Surprisingly, although all c-FLIP isoforms are phosphorylated on this conserved residue, the biological outcome is different for the long and short isoforms, since S193 specifically prolongs the half-lives of the short c-FLIP isoforms, but not c-FLIPL. To summarize, we show that c-FLIP proteins are modified by ubiquitylation and phosphorylation, and that the biological outcomes of these modifications are isoform-specifically determined.

Branding and Marketing Communications of Lifestyle Prescription Drugs in a Strict Legislative Environment

This thesis discusses the different possibilities to brand and promote a patented prescription lifestyle drug through different marketing communications practices. This thesis aims in explaining how branding procedures can be built in circumstances, where the legislative environment is strickt and furthermore, the environment consists of both B-to-B and B-to-C market characteristics simultaneously.

Feeling vs. Being like a Domestic Goddess: Cookbooks and Lifestyle Choices

Tämä pro gradu -tutkielma tarkastelee, miten keittokirjat muovaavat pääasiassa naispuolista lukijakuntaansa. Tärkein kysymys, johon tutkielmassa on etsitty vastausta on, että onko naisilla, menneiden sukupolvien taisteltua vuosikymmeniä tasa-arvon puolesta, oikeus valita viettää aikaa keittiössä ja oikeasti nauttiakin siitä. Kahtena päälähteenä tutkielmassa on käytetty brittiläisen Nigella Lawsonin keittokirjoja How to Eat ja How to be a Domestic Goddess. Näiden kirjojen analysoinnin ja muiden lähteiden avulla tutkielmassa on käsitelty ruuanlaiton ja leipomisen nautittavuutta ja sitä onko se ylipäätään sallittua vai syntistä. Lawson on julkaissut urallaan sitten vuoden 1998 yhteensä yhdeksän keittokirjaa, joiden lisäksi kirjojen tueksi on tehty useita televisiosarjoja. How to Eat on yleispätevä opas hyvän ruuan nautintoihin ja periaatteisiin, How to be a Domestic Goddess taas sisältää lähinnä leivontareseptejä. Nämä kaksi kirjaa ovat Lawsonin ensimmäiset keittokirjat. Nigella Lawsonin keittokirjat eivät ole vain reseptikokelmia eivätkä reseptit vain aineisosalistoja ja valmistusohjeita. Lawsonin kirjoja voi lukea kirjallisuutena eikä vain reseptien takia. Lawson viittaa usein naisen asemaan ja yrittää vakuuttaa lukijoitaan ruuanlaiton ja leipomisen nautittavuudesta.

Miesten lifestyle-myymälän imago ja tunnettuus: Case: Formale Oy

Tutkimuksessa tarkastellaan miesten lifestylemyymälä Formalen imagoa ja tunnettuutta Turun alueella. Tutkimuksessa selvitettiin, vastasiko Formalen asettama tavoiteimago kuluttajien mielikuvia yrityksestä sekä millainen tunnettuus yrityksellä Turun alueella on lahjanostopaikkana miehille. Lisäksi tutkimuksella haluttiin saada tietoa kuluttajien suhtautumisesta lahjojen antamiseen yleisesti. Tutkimuksen teoreettinen viitekehys muodostui yrityksen imagosta, yrityksen tunnettuudesta, lifestylesta, miesten ostokäyttäytymisestä sekä lahjan antamisesta että sen merkitystä käsittelevistä teorioista. Tutkimukseen valittiin kvantitatiivinen lähestymistapa. Aineistonkeruu suoritettiin 245 vastaajaa käsittävällä lyhyellä haastattelututkimuksella sekä 55 vastaajaa käsittävällä kyselytutkimuksella. Molemmat tutkimukset suoritettiin Raision Myllyssä, Turun Skanssissa ja Turun keskustassa keväällä 2012. Tutkimustulosten mukaan Formalen tunnettuus oli melko hyvä vastaajien keskuudessa mietittäessä lahjanostopaikkaa miehelle. Yli puolet vastaajista tunnisti Formalen joko spontaanisti tai autetusti. Formale halusi asemoida myymälänsä paikoiksi, joista miehen on helppo ostaa käyttö-, lahja- sisustustavaroita sekä asusteita itselle tai toiselle miehelle. Tulosten perusteella voidaan todeta, että Formale oli osannut asemoida itsensä lahjanostopaikaksi miehelle. Myymälät koettiin kuitenkin myös paikoiksi, joista voisi ostaa jotain naisille. Formale-myymälät lahjan ostopaikkana naiselle eväti kuitenkaan olleet vastausten perusteella niin vahvoilla kuin ostopaikkana miehille. Tutkimustuloksista selviää, että Formalesta voitiin ostaa erityisesti syntymäpäivälahjoja, mutta myös tupaantuliaiset, valmistujaiset sekä polttarit koettiin tilanteiksi ostaa jotain Formale-myymälöistä. Vastausten perusteella kuluttajien mielikuva myymälöistä oli yleisesti myönteinen. Lahjan antamiseen liittyvien tutkimusten mukaan naiset arvioivat lahjojen antamiskäyttäytymistään myönteisemmäksi kuin miehet ja sen lisäksi naiset myös ostivat lahjoja hieman useammin kuin miehet. Tulosten perusteella havaittiin myös, että kumppanin kanssa yhdessä lahjoihin kulutettu osuus nousi selkeästi yli puolta korkeammaksi kuin yksin kulutettaessa. Lisäksi lahjoihin käytetty summa nousi hieman korkeammaksi vastaajan tulojen sekä iän myötä. Tutkimuksen empiirisen aineiston perusteella Formalella olisi voinut, pienten imagomuutosten jälkeen, olla mahdollisuuksia Turun alueella, mutta tutkimuksen teon aikana vuonna 2013 Formale meni konkurssiin. Tutkimustuloksia voivat käyttää hyväksi yritykset, jotka suunnittelevat perustavansa miesten lifestyle-myymälän tai vastaavan osaston tavarataloon.