Vitamin B12 Deficiency in the aged: Laboratory Diagnosis, Prevalence and Clinical Profile

B₁₂-vitamiinin puute iäkkäillä: laboratoriodiagnostiikka, yleisyys ja yhteys sairastavuuteen Tausta: B12-vitamiinin puute on yleistä iäkkäillä ja se tulisi todeta riittävän varhaisessa vaiheessa palautumattomien vaurioiden estämiseksi. On epäselvää pitäisikö diagnostiikka kohdistaa tiettyihin riskiryhmiin vai mahdollisesti seuloa valikoimatonta vanhusväestöä. Myöskään yksimielisyyttä laboratoriotutkimusten valinnasta ei ole. Tavoitteet: Tutkimuksen tarkoituksena oli evaluoida uutta HoloTC RIA menetelmää ja tuottaa viitearvot sille, selvittää B12-vitamiinin puutteen yleisyys, yhteys sairastavuuteen ja mahdolliset riskitekijät suomalaisessa vanhusväestössä, arvioida munuaisfunktion vaikusta B12-vitamiinin puutteen laboratoriotutkimuksiin ja näiden perusteella ehdottaa suomalaiseen terveydenhuoltoon sopivaa laboratoriotutkimusstrategiaa. Aineisto ja menetelmät: Liedon iäkkäät -tutkimuksen vanhusaineisto on edustava otos yhden kunnan yli 65-vuotiaasta väestöstä, yhteensä 1260 henkilöä. Tutkittavat kävivät lääkärintarkastuksessa, ja heistä on käytettävissä runsaasti laboratoriotutkimuksia sekä tiedot sairauksista, ruokavaliosta, lääkkeiden ja vitamiinivalmisteiden käytöstä, dementiaseula ja depressiokysely. Viitearvoaineistoa varten kerättiin näytteet 84 vapaaehtoisesta terveestä aikuisesta ja menetelmäevaluaatiota varten 107 sairaalapotilaasta. Tulokset: HoloTC RIA menetelmän toistettavuus oli hyvä manuaalimenetelmäksi. 95%:n viiteväli holotranskobalamiinille oli 37-171 pmol/l. Kaikilla tutkittavilla, joilla oli muilla laboratoriotutkimuksilla osoitettu todennäköinen B12-vitamiinin puute, myös holotranskobalamiini oli viitealueen alarajaa pienempi. Suurentuneella kystatiini C-pitoisuudella osoitettu munuaisten vajaatoiminta korreloi voimakkaasti homokysteiinin (rs=0.53, p<0.001) ja metyylimalonihapon (rs=0.27, p<0.001) pitoisuuksiin, mutta ei kokonais-B12-vitamiinin (rs=- 0.04, p=0.227) tai holotranskobamiinin (rs=-0.01, p=0.817) pitoisuuksiin. Suomalaisessa vanhusväestössä B12-vitamiinin puutteen prevalenssi oli 12%. Kokonais- B12-vitamiinin pitoisuus oli matala (<150 pmol/l) 6%:lla. Miessukupuoli (OR 1.9, 95% CI 1.2-2.9), ikä ≥75 (OR 2.2, 95% CI 1.4-3.4) ja maitotuotteiden välttäminen (OR 2.3, 95% CI 1.2-4.4) lisäsivät B12-vitamiinin puutteen riskiä, mutta anemia (OR 1.3, 95% CI 0.7-2.3) tai makrosytoosi (OR 1.2, 95% CI 0.6-2.7) eivät. Päätelmät: Diagnosoimaton B12-vitamiinin puute on yleistä iäkkäillä, mutta kliinisesti merkityksellistä spesifistä riskiryhmää ei löydy. Koska anemian ja makrosytoosin puuttuminen ei poissulje B12-vitamiinin puutetta ja munuaisten vajaatoiminta heikentää metabolisten merkkiaineiden käyttökelpoisuutta, kokonais-B12-vitamiinia suositellaan ensisijaiseksi laboratoriotutkimukseksi epäiltäessä B12-vitamiinin puutetta ja tarvittaessa varmentavina tutkimuksina käytetään homokysteiiniä ja holotranskobalamiinia.

Phylogeography and population genetics of north European Atlantic salmon (Salmo salar L.)

Although abundant in the number of individuals, the Atlantic salmon may be considered as a threatened species in many areas of its native distribution range. Human activities such as building of power plant dams, offshore overfishing, pollution, clearing of riverbeds for timber floating and badly designed stocking regimes have diminished the distribution of Atlantic salmon. As a result of this, many of the historical populations both in Europe and northern America have gone extinct or are severely depressed. In fact, only 1% of Atlantic salmon existing today are of natural origin, the rest being farmed salmon. All of this has lead to a vast amount of research and many restoration programmes aiming to bring Atlantic salmon back to rivers from where it has vanished. However, many of the restoration programmes conducted thus far have been unsuccessful due to inadequate scientific research or lack of its implementation, highlighting the fact that more research is needed to fully understand the biology of this complex species. The White and Barents Seas in northwest Russia are among the last regions in Europe where Atlantic salmon populations are still stable, thus forming an important source of biodiversity for the entire European region. Salmon stocks from this area are also of immense economic and social importance for the local people in the form of fishing tourism. The main aim of this thesis was to elucidate the post-glacial history and population genetic structure of north European and particularly northwest Russian Atlantic salmon, both of which are aspects of great importance for the management and conservation of the species. Throughout the whole thesis, these populations were studied by utilizing microsatellites as the main molecular tool. One of the most important discoveries of the thesis was the division of Atlantic salmon from the White and Barents Seas into four separate clusters, which has not been observed in previous studies employing nuclear markers although is supported by mtDNA studies. Populations from the western Barents Sea clustered together with the northeast Atlantic populations into a clearly distinguishable group while populations from the White Sea and eastern Barents Sea were separated into three additional groups. This has important conservation implications as this thesis clearly indicates that conservation of populations from all of the observed clusters is warranted in order to conserve as much of the genetic diversity as possible in this area. The thesis also demonstrates how differences in population life histories within a species, migratory behaviour in this case, and in their phylogeographic origin affect the genetic characteristics of populations, namely diversity and divergence levels. The anadromous populations from the Atlantic Ocean, White Sea and Barents Sea possessed higher levels of genetic diversity than the anadromous populations form the Baltic Sea basin. Among the non-anadromous populations the result was the opposite: the Baltic freshwater populations were more variable. This emphasises the importance of taking the life history of a population into consideration when developing conservation strategies: due to the limited possibilities for new genetic diversity to be generated via gene flow, it is expected that freshwater Atlantic salmon populations would be more vulnerable to extinction following a population crash and thus deserve a high conservation status. In the last chapter of this thesis immune relevant marker loci were developed and screened for signatures of natural selection along with loci linked to genes with other functions or no function at all. Also, a novel landscape genomics method, which combines environmental information with molecular data, was employed to investigate whether immune relevant markers displayed significant correlations to various environmental variables more frequently than other loci. Indications of stronger selection pressure among immune-relevant loci compared to non-immune relevant EST-linked loci was found but further studies are needed to evaluate whether it is a common phenomenon in Atlantic salmon.

Demographic Modelling of Human Population Growth

This work presents models and methods that have been used in producing forecasts of population growth. The work is intended to emphasize the reliability bounds of the model forecasts. Leslie model and various versions of logistic population models are presented. References to literature and several studies are given. A lot of relevant methodology has been developed in biological sciences. The Leslie modelling approach involves the use of current trends in mortality,fertility, migration and emigration. The model treats population divided in age groups and the model is given as a recursive system. Other group of models is based on straightforward extrapolation of census data. Trajectories of simple exponential growth function and logistic models are used to produce the forecast. The work presents the basics of Leslie type modelling and the logistic models, including multi- parameter logistic functions. The latter model is also analysed from model reliability point of view. Bayesian approach and MCMC method are used to create error bounds of the model predictions.

Use of preclinical and early clinical data for dose selection of a selective estrogen receptor modulator toremifene in treatment of breast cancer

In development of human medicines, it is important to predict early and accurately enough the disease and patient population to be treated as well as the effective and safe dose range of the studied medicine. This is pursued by using preclinical research models, clinical pharmacology and early clinical studies with small sample sizes. When successful, this enables effective development of medicines and reduces unnecessary exposure of healthy subjects and patients to ineffectice or harmfull doses of experimental compounds. Toremifene is a selective estrogen receptor modulator (SERM) used for treatment of breast cancer. Its development was initiated in 1980s when selection of treatment indications and doses were based on research in cell and animal models and on noncomparative clinical studies including small number of patients. Since the early development phase, the treatment indication, the patient population and the dose range were confirmed in large comparative clinical studies in patients. Based on the currently available large and long term clinical study data the aim of this study was to investigate how the early phase studies were able to predict the treatment indication, patient population and the dose range of the SERM. As a conclusion and based on the estrogen receptor mediated mechanism of action early studies were able to predict the treatment indication, target patient population and a dose range to be studied in confirmatory clinical studies. However, comparative clinical studies are needed to optimize dose selection of the SERM in treatment of breast cancer.

Very High Energy Gamma-Rays emitting BL LAC's Population Study

Context: BL Lacs are the most numerous extragalactic objects which are detected in Very High Energy (VHE) gamma-rays band. They are a subclass of blazars. Large flux variability amplitude, sometimes happens in very short time scale, is a common characteristic of them. Significant optical polarization is another main characteristics of BL Lacs. BL Lacs' spectra have a continuous and featureless Spectral Energy Distribution (SED) which have two peaks. Among 1442 BL Lacs in the Roma-BZB catalogue, only 51 are detected in VHE gamma-rays band. BL Lacs are most numerous (more than 50% of 514 objects) objects among the sources that are detected above 10 GeV by FERMI-LAT. Therefore, many BL Lacs are expected to be discovered in VHE gamma-rays band. However, due to the limitation on current and near future technology of Imaging Air Cherenkov Telescope, astronomers are forced to predict whether an object emits VHE gamma-rays or not. Some VHE gamma-ray prediction methods are already introduced but still are not confirmed. Cross band correlations are the building blocks of introducing VHE gamma-rays prediction method. Aims: We will attempt to investigate cross band correlations between flux energy density, luminosity and spectral index of the sample. Also, we will check whether recently discovered MAGIC J2001+435 is a typical BL Lac. Methods: We select a sample of 42 TeV BL Lacs and collect 20 of their properties within five energy bands from literature and Tuorla blazar monitoring program database. All of the data are synchronized to be comparable to each other. Finally, we choose 55 pair of datasets for cross band correlations finding and investigating whether there is any correlation between each pair. For MAGIC J2001+435 we analyze the publicly available SWIFT-XRT data, and use the still unpublished VHE gamma-rays data from MAGIC collaboration. The results are compared to the other sources of the sample. Results: Low state luminosity of multiple detected VHE gamma-rays is strongly correlated luminosities in all other bands. However, the high state does not show such strong correlations. VHE gamma-rays single detected sources have similar behaviour to the low state of multiple detected ones. Finally, MAGIC J2001+435 is a typical TeV BL Lac. However, for some of the properties this source is located at the edge of the whole sample (e.g. in terms of X-rays flux). Keywords: BL Lac(s), Population study, Correlations finding, Multi wavelengths analysis, VHE gamma-rays, gamma-rays, X-rays, Optical, Radio

Governance of Healthcare Data: International Standards and Recommendations

In the global phenomenon, the aging population becomes a critical issue. Data and information concerning elderly citizens are increasing and are not well organized. In addition, these unstructured data and information cause the problems for decision makers. Since we live in a digital world, Information Technology is considered to be a tool in order to solve problems. Data, information, and knowledge are crucial components to facilitate success in IT service system. Therefore, it is necessary to study how to organize or to govern data from various sources related elderly citizens. The research is conducted due to the fact that there is no internationally accepted holistic framework for governance of data. The research limits the scope to study on the healthcare domain; however, the results can be applied to the other areas. The research starts with an ongoing research of Dahlberg and Nokkala (2015) as a theory. It explains the classification of existing data sources and their characteristics with the focus on managerial perspectives. Then the studies of existing frameworks at international and national level organizations have been performed to show the current frameworks, which have been used and are useful in compiling data on elderly citizens. The international organizations in this research are selected based on their reputations and the reliability to obtain information. The selected countries at national level provide different point of views between two countries. Australia is a forerunner in IT governance while Thailand is the country which the author has familiar knowledge of the current situation. Considered the discussions of frameworks at international and national organizations level illustrate the main characteristics of each framework. At international organization level gives precedence to the interoperability of exchanging data and information between different parties. Whereas at national level shows the importance of the acknowledgement of using frameworks throughout the country in order to make the frameworks to be effective. After the studies of both international and national organization levels, the thesis shows the summarized tables to answer the fitness to the proposed framework by Dahlberg and Nokkala whether the framework help to consolidate data from various sources with different formats, hierarchies, structures, velocities, and other attributes of data storages. In addition, suggestions and recommendations will be proposed for the future research.