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.

Training system for conceptual design and evaluation for wastewater treatment

Rising population, rapid urbanisation and growing industrialisation have severely stressed water quality and its availability in Malawi. In addition, financial and institutional problems and the expanding agro industry have aggravated this problem. The situation is worsened by depleting water resources and pollution from untreated sewage and industrial effluent. The increasing scarcity of clean water calls for the need for appropriate management of available water resources. There is also demand for a training system for conceptual design and evaluation for wastewater treatment in order to build the capacity for technical service providers and environmental practitioners in the country. It is predicted that Malawi will face a water stress situation by 2025. In the city of Blantyre, this situation is aggravated by the serious pollution threat from the grossly inadequate sewage treatment capacity. This capacity is only 23.5% of the wastewater being generated presently. In addition, limited or non-existent industrial effluent treatment has contributed to the severe water quality degradation. This situation poses a threat to the ecologically fragile and sensitive receiving water courses within the city. This water is used for domestic purposes further downstream. This manuscript outlines the legal and policy framework for wastewater treatment in Malawi. The manuscript also evaluates the existing wastewater treatment systems in Blantyre. This evaluation aims at determining if the effluent levels at the municipal plants conform to existing standards and guidelines and other associated policy and regulatory frameworks. The raw material at all the three municipal plants is sewage. The typical wastewater parameters are Biochemical Oxygen Demand (BOD5), Chemical Oxygen Demand (COD), and Total Suspended Solids (TSS). The treatment target is BOD5, COD, and TSS reduction. Typical wastewater parameters at the wastewater treatment plant at MDW&S textile and garments factory are BOD5 and COD. The treatment target is to reduce BOD5 and COD. The manuscript further evaluates a design approach of the three municipal wastewater treatment plants in the city and the wastewater treatment plant at Mapeto David Whitehead & Sons (MDW&S) textile and garments factory. This evaluation utilises case-based design and case-based reasoning principles in the ED-WAVE tool to determine if there is potential for the tool in Blantyre. The manuscript finally evaluates the technology selection process for appropriate wastewater treatment systems for the city of Blantyre. The criteria for selection of appropriate wastewater treatment systems are discussed. Decision support tools and the decision tree making process for technology selection are also discussed. Based on the treatment targets and design criteria at the eight cases evaluated in this manuscript in reference to similar cases in the ED-WAVE tool, this work confirms the practical use of case-based design and case-based reasoning principles in the ED-WAVE tool in the design and evaluation of wastewater treatment 6 systems in sub-Sahara Africa, using Blantyre, Malawi, as the case study area. After encountering a new situation, already collected decision scenarios (cases) are invoked and modified in order to arrive at a particular design alternative. What is necessary, however, is to appropriately modify the case arrived at through the Case Study Manager in order to come up with a design appropriate to the local situation taking into account technical, socio-economic and environmental aspects. This work provides a training system for conceptual design and evaluation for wastewater treatment.

Convergence and divergence in global economy and social development : global perspectives on the contents of economic and soical development policy and its effects on rich and poor countries

The study of convergence and divergence in global economy and social development utilises comparative indicators to investigate the contents of economic and social development policy and their effects on the global samples that represent the rich industrial, semi-industrial and the poor developing nations. The study searchesfor answers to questions such as "what are the objectives of economic growth policies in globalisation under the imperatives of convergence and divergence, and how do these affect human well-being in consideration to the objectives of social policy in various nations?" The empirical verification of data utilises the concepts of the `logic of industrialism´ for comparative analysis that focuses mainly on identifying the levels of well-being in world nations after the Second World War. The perspectives of convergence and divergence in global economy and social development critically examine the stages of early development processes in global economy, distinguish the differences between economy and social development, illustrate the contents of economic and social development policies, their effects on rich and poor countries, and the nature of convergence and divergence in propelling economic growth and unequal social development in world nations. The measurement of convergence and divergence in global economy and social development utilised both economic and social data that were combined into an index that measures the precise levels of the effects of economic and social development policies on human well-being in the rich and poor nations. The task of finding policy solutions to resolve the controversies are reviewed through empirical investigations and the analyses of trends indicated within economic and social indicators and data. These revealed how the adoption of social policy measures in translating the gains from economic growth, towards promoting education, public health, and equity, generate social progress and longer life expectancy, higher economic growth, and sustain more stable macro economy for the nations. Social policy is concerned with the translation of benefits from objectives of global economic growth policies, to objectives of social development policy in nation states. Social policy, therefore, represents an open door whereby benefits of economic growth policies are linked with the broader objectives of social development policy, thereby enhancing the possibility of extending benefits from economic growth to all human being in every nation.

Advanced epithelial ovarian cancer – studies on preoperative [18F] FDG PET/CT and HE4 profile during primary chemotherapy

Epithelial ovarian cancer (EOC) is usually diagnosed in an advanced stage. The prognosis depends highly on the amount of the residual tumor in surgery. In patients with extensive disease, neoadjuvant chemotherapy (NACT) is used to diminish the tumor load before debulking surgery. New non-invasive methods are needed to preoperatively evaluate the disease dissemination and operability. [18F] FDG PET/CT (Positron emission tomography/computed tomography) is a promising method for cancer diagnostics and staging. The biomarker profiles during treatment can predict patient’s outcome. This prospective study included 41 EOC patients, 21 treated with primary surgery and 20 with NACT and interval surgery. The performances of preoperative contrast enhanced PET/CT (PET/ceCT) and diagnostic CT (ceCT) were compared. Perioperative visual estimation of tumor spread was studied in primary and interval surgery. The profile of the serum marker HE4 (Human epididymis 4) during primary chemotherapy was evaluated. In primary surgery, surgical findings were found to form an adequate reference standard for imaging studies. After NACT, the sensitivity for visual estimation of cancer dissemination was significantly worse. Preoperative PET/ceCT was more effective than ceCT alone in detecting extra-abdominal disease spread. The high number of supradiaphragmatic lymph node metastases detected by PET/ceCT at the time of diagnosis brings new insight in EOC spread patterns. The sensitivity of both PET/CT and ceCT remained modest in intra-abdominal areas important to operability. The HE4 profile was in concordance with the CA125 profile during primary chemotherapy. Its role in the evaluation of EOC chemotherapy response will be clarified in further studies.

Reinventing the third way : towards new forms of economic and democratic conduct

Avhandlingen studerar samspelet mellan det politiska och det ekonomiska systemet genom det föregående seklet, med speciellt fokus på den nyliberala omdaning som utspelats de senaste tre årtiondena. Med en liberaliserad ekonomi och en individualiserad människa måste också det politiska systemet utformas på ett annat sätt. Gradvisa förändringar har varit synliga, som den växande nätverksorganiseringen, dvs. att olika typer av utvecklingspolitik allt mer genomförs som ett samspel mellan samhällssektorerna, istället för att enbart utföras av den offentliga sektorn som tidigare. Genom fyra fallstudier i Österbotten demonstreras hur arenor för samverkan kan konstrueras i enlighet med vad den aktuella frågan kräver. Ett exempel är det innovationsnätverk som skapats i Karleby-Jakobstad-regionen, där offentliga och privata intressenter deltar, och som samtidigt bryter traditionella administrativa gränser. Ett annat mer negativt exempel är omstruktureringsprocessen i Kaskö-regionen eft er Metsä-Botnia-fabrikens nedläggning, där småkommunproblemet tillsammans med att den privata intressenten inte haft skyldighet att samverka lett till att en tillräckligt regionalt förankrad arena för en långsiktig utvecklingspolitik inte har kunnat skapas. Det här visar på trögheten i det finska systemet, där en stark enhetsstat och en splittrad kommunal nivå ur ett historiskt perspektiv hindrat flexibla anpassningar till samhällsförändringar. Avhandlingen visar att nätverksorganiseringen bör vara en integrerad del av de representativa strukturerna för att kunna påverka processernas utfall. Avhandlingen visar framförallt att deltagande och funktionellt definierade regionala och lokala arenor har stor potential, både ekonomiskt och demokratiskt. Det handlar om att skapa en kultur med aktiverade och engagerade medborgare, vilket står i kontrast till det allt mer passiverande representativa systemet. ---------------------------------------- Väitöskirja tutkii viime vuosisadan poliittisen ja taloudellisen järjestelmän vuorovaikutusta keskittyen erityisesti kolmen viimeisen vuosikymmenen uusliberaaliseen muutokseen. Talouden liberalisoituminen ja ihmisen individualisoituminen edellyttävät myös poliittisen järjestelmän mukautumista. Asteittaisia muutoksia on ollut havaittavissa, kuten kasvava verkosto-organisaatio, toisin sanoen eri alojen kehityspolitiikkaa toteutetaan yhä enemmän eri yhteiskuntasektoreiden vuorovaikutuksena, kun aikaisemmin ainoastaan julkinen sektori vastasi kehityspolitiikan toteuttamisesta. Pohjanmaan maakunnan neljän tapaustutkimuksen avulla osoitetaan, miten vuorovaikutusareena voidaan rakentaa kulloinkin ajankohtaisen asiakokonaisuuden ympärille. Tästä esimerkkinä on Kokkola-Pietarsaari –alueen innovaatioverkosto, johon osallistuvat sekä julkiset että yksityiset sidosryhmät ja joka samalla rikkoo perinteisiä hallinnollisia rajoja. Toinen, kielteisempi esimerkki on Kaskisten alueen rakennemu utosprosessi Metsä-Botnian tehtaan sulkemisen jälkeen. Siellä pienkuntaongelma yhdistettynä siihen, että yksityinen sidosryhmä ei ole ollut velvollinen tekemään yhteistyötä, on johtanut siihen, että ei ole kyetty luomaan alueen pitkäaikaiseen kehittämiseen sitoutunutta vuorovaikutusareenaa. Tämä osoittaa suomalaisen järjestelmän kankeuden, jossa historiallisesta näkökulmasta vahva yhtenäinen valtio ja hajanainen kuntataso estävät joustavan yhteiskuntamuutoksiin sopeutumisen. Väitöskirja osoittaa, että verkosto-organisaation on oltava yhteiskunnassa vaikuttaviin rakenteisiin integroitu osa, jotta se voi vaikuttaa prosessien tuloksiin. Väitöskirja osoittaa ennen kaikkea, että osallistuvilla ja toiminnallisesti määritellyillä alueellisilla ja paikallisilla areenoilla on suuri taloudellinen ja demokraattinen potentiaali. Passivoivan edustavan järjestelmän tilalle on luotava aktiivisten ja tavoitteisiin sitoutuneiden kansalaisten vuorovaikutusjärjestelmä.

Deinking sludge utilization possibilities: technical, economic, and environmental assessments

This report introduces the ENPI project called “EMIR - Exploitation of Municipal and Industrial Residues” which was executed in a co-operation between Lappeenranta University of Technology (LUT), Saint Petersburg State University of Economics (SPbSUE), Saint Petersburg State Technical University of Plant Polymers (SPbSTUPP) and industrial partners from both Leningrad Region (LR), Russia and Finland. The main targets of the research were to identify the possibilities for deinking sludge management scenarios in co-operation with partner companies, to compare the sustainability of the alternatives, and to provide recommendations for the companies in the Leningrad Region on how to best manage deinking sludge. During the literature review, 24 deinking sludge utilization possibilities were identified, the majority falling under material recovery. Furthermore, 11 potential utilizers of deinking sludge were found within the search area determined by the transportation cost. Each potential utilizer was directly contacted in order to establish cooperation for deinking sludge utilization. Finally, four companies, namely, “Finnsementti” – a cement plant in Finland (S1), “St.Gobian Weber” – a light-weight aggregate plant in Finland (S2), “LSR-Cement” – a cement plant in LR (S3), and “Rockwool” – a stone wool plant in LR (S4) were seen as the most promising partners and were included in the economic and environmental assessments. Economic assessment using cost-benefit analysis (CBA) indicated that substitution of heavy fuel oil with dry deinking sludge in S2 was the most feasible option with a benefit/cost ratio (BCR) of 3.6 when all the sludge was utilized. At the same time, the use of 15% of the total sludge amount (the amount that could potentially be treated in the scenario) resulted in a BCR of only 0.16. The use of dry deinking sludge in the production of cement (S3) is a slightly more feasible option with a BCR of 1.1. The use of sludge in stone wool production is feasible only when all the deinking sludge is used and burned in an existing incineration plant. The least economically feasible utilization possibility is the use of sludge in cement production in Finland (S1) due to the high gate fee charged. Environmental assessment was performed applying internationally recognized life cycle assessment (LCA) methodologies: ISO 14040 and ISO 14044. The results of a consequential LCA stated that only S1 and S2 lead to a reduction of all environmental impacts within the impact categories chosen compared to the baseline scenario where deinking sludge is landfilled. Considering S1, the largest reduction of 13% was achieved for the global warming potential (GWP), whereas for S2, the largest decrease of abiotic depletion potential (ADP) was by 1.7%, the eutrophication potential (EP) by 1.8%, and a GWP of 2.1% was documented. In S3, the most notable increase of ADP and acidification potential (AP) by 2.6 and 1.5% was indicated, while the GWP was reduced by 12%, the largest out of all the impact categories. In S4, ADP and AP increased by 2.3 and 2.1% respectively, whereas ODP was reduced by 25%. During LCA, it was noticed that substitution of fuels causes a greater reduction of environmental impact (S1 and S2) than substitution of raw materials (S3 and S4). Despite a number of economically and environmentally acceptable deinking sludge utilization methods being assessed in the research, evaluation of bottlenecks and communications with companies’ representatives uncovered the fact that the availability of the raw materials consumed, and the risks associated with technological problems resulting from the sludge utilization, limited the willingness of industrial partners to start deinking sludge utilization. The research results are of high value for decision-makers at already existing paper mills since the result provide insights regarding alternatives to the deinking sludge utilization possibilities already applied. Thus, the research results support the maximum economic and environmental value recovery from waste paper utilization.

Economic and environmental evaluation of renewable energy systems

The main objective of this thesis is to evaluate the economic and environmental effectiveness of three different renewable energy systems: solar PV, wind energy and biomass energy systems. Financial methods such as Internal Rate of Return (IRR) and Modified Internal Rate of Return (MIRR) were used to evaluate economic competitiveness. Seasonal variability in power generation capability of different renewable systems were also taken into consideration. In order to evaluate the environmental effectiveness of different energy systems, default values in GaBi software were taken by defining the functional unit as 1kWh. The results show that solar PV systems are difficult to justify both in economic as well as environmental grounds. Wind energy performs better in both economic and environmental grounds and has the capability to compete with conventional energy systems. Biomass energy systems exhibit environmental and economic performance at the middle level. In each of these systems, results vary.