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.

Solution of aerospace problems using structured and unstructured strategies

Products developed at industries, institutes and research centers are expected to have high level of quality and performance, having a minimum waste, which require efficient and robust tools to numerically simulate stringent project conditions with great reliability. In this context, Computational Fluid Dynamics (CFD) plays an important role and the present work shows two numerical algorithms that are used in the CFD community to solve the Euler and Navier-Stokes equations applied to typical aerospace and aeronautical problems. Particularly, unstructured discretization of the spatial domain has gained special attention by the international community due to its ease in discretizing complex spatial domains. This work has the main objective of illustrating some advantages and disadvantages of numerical algorithms using structured and unstructured spatial discretization of the flow governing equations. Numerical methods include a finite volume formulation and the Euler and Navier-Stokes equations are applied to solve a transonic nozzle problem, a low supersonic airfoil problem and a hypersonic inlet problem. In a structured context, these problems are solved using MacCormack’s implicit algorithm with Steger and Warming’s flux vector splitting technique, while, in an unstructured context, Jameson and Mavriplis’ explicit algorithm is used. Convergence acceleration is obtained using a spatially variable time stepping procedure.

Tooth-Coil Permanent Magnet Synchronous Machine Design for Special Applications

This doctoral thesis presents a study on the design of tooth-coil permanent magnet synchronous machines. The electromagnetic properties of concentrated non-overlapping winding permanent magnet synchronous machines, or simply tooth-coil permanent magnet synchronous machines (TC-PMSMs), are studied in details. It is shown that current linkage harmonics play the deterministic role in the behavior of this type of machines. Important contributions are presented as regards of calculation of parameters of TC-PMSMs,particularly the estimation of inductances. The current linkage harmonics essentially define the air-gap harmonic leakage inductance, rotor losses and localized temporal inductance variation. It is proven by FEM analysis that inductance variation caused by the local temporal harmonic saturation results in considerable torque ripple, and can influence on sensorless control capabilities. Example case studies an integrated application of TC-IPMSMs in hybrid off-highway working vehicles. A methodology for increasing the efficiency of working vehicles is introduced. It comprises several approaches – hybridization, working operations optimization, component optimization and integration. As a result of component optimization and integration, a novel integrated electro-hydraulic energy converter (IEHEC) for off-highway working vehicles is designed. The IEHEC can considerably increase the operational efficiency of a hybrid working vehicle. The energy converter consists of an axial-piston hydraulic machine and an integrated TCIPMSM being built on the same shaft. The compact assembly of the electrical and hydraulic machines enhances the ability to find applications for such a device in the mobile environment of working vehicles.Usage of hydraulic fluid, typically used in working actuators, enables direct-immersion oil cooling of designed electrical machine, and further increases the torque- and power- densities of the whole device.

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.

Reusing repository technology for Cultural Heritage and Special Collections

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

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

Special passcharta öfwer een deel aff Österjöön begynnandes ifrån Calmarsund intill Stockholm, innehållandes jemwäl öjarna Gottland och Öland

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

Modulation of Signaling Molecules by Human Leucocyte Antigen B27; Special Reference to STAT1

Reactive arthritis (ReA) is an inflammatory joint disease, which belongs to the group of Spondyloarthritis (SpA). It may occur after infections with certain gram-negative bacteria such as Salmonella and Yersinia. SpAs are strongly associated with the human leucocyte antigen (HLA)-B27. Despite active research, the mechanism by which HLA-B27 causes disease susceptibility is still unknown. However, HLA-B27 has a tendency to misfold during assembly. It is possible that the misfolding of HLA-B27 could alter signaling pathways and/or molecules involved in inflammatory response in cells. We have earlier discovered that in HLA-B27-positive cells the interaction between the host and causative bacteria is disturbed. Our recent studies indicate that the expression of HLA-B27 may alter certain signaling molecules by disturbing their activation. The aim of this study was to investigate whether the expression of HLA-B27 disturbs the signaling molecules, especially the phosphorylation of transcription factor STAT1. STAT1 is an important mediator of inflammatory responses. Our results show that the phosphorylation of the STAT1 is significantly altered in HLA-B27-expressing U937 monocytic cells compared with control cells. STAT1 tyrosine 701 is more strongly phosphorylated in HLAB27- expressing cells; whereas the phosphorylation of STAT1 serine 727 is prolonged. Phosphorylation of STAT1 was discovered to be dependent on protein kinase PKR. Furthermore, we found out that the expression of posttranscriptional gene regulator HuR was altered in HLA-B27-expressing cells. We also detected that HLA-B27-positive cells secrete more interleukin 6, which is an important mediator of inflammation. These results help to understand how HLA-B27 may confer susceptibility to SpAs.

Prognostic Factors In Breast Cancer. With Special Reference to Cyclins A, B1, D1 and E, MMP-1 and Decorin

Breast cancer is a highly heterogenous malignancy, which despite of the similar histological type shows different clinical behaviour and response to therapy. Prognostic factors are used to estimate the risk for recurrence and the likelihood of treatment effectiveness. Because breast cancer is one of the most common causes of cancer death in women worldwide, identification of new prognostic markers are needed to develop more specific and targeted therapies. Cancer is caused by uncontrolled cell proliferation. The cell cycle is controlled by specific proteins, which are known as cyclins. They function at important checkpoints by activating cyclin-dependent kinase enzymes. Overexpression of different cyclins has been linked to several cancer types and altered expression of cyclins A, B1, D1 and E has been associated with poor survival. Little is known about the combined expression of cyclins in relation to the tumour grade, breast cancer subtype and other known prognostic factors. In this study cyclins A, B1 and E were shown to correlate with histological grade, Ki-67 and HER2 expression. Overexpression of cyclin D1 correlated with receptor status and non-basal breast cancer suggesting that cyclin D1 might be a marker of good prognosis. Proteolysis in the surrounding tumour stroma is increased during cancer development. Matrix metalloproteinases (MMPs) are proteolytic enzymes that are capable of degrading extracellular matrix proteins. Increased expression and activation of several MMPs have been found in many cancers and MMPs appear to be important regulators of invasion and metastasis. In this study MMP-1 expression was analysed in breast cancer epithelial cells and in cancer associated stromal cells. MMP-1 expression by breast cancer epithelial cells was found to carry an independent prognostic value as did Ki-67 and bcl-2. The results suggest that in addition to stromal cells MMP-1 expression in tumour cells control breast cancer progression. Decorin is a small proteoglycan and an important component of the extracellular matrix. Decorin has been shown to inhibit growth of tumour cells and reduced decorin expression is associated with a poor prognosis in several cancer types. There has been some suspicion wheather different cancer cells express decorin. In this study decorin expression was shown to localize only in the cells of the original stroma, while breast cancer epithelial cells were negative for decorin expression. However, transduction of decorin in decorin-negative human breast cancer cells markedly modulated the growth pattern of these cells. This study provides evidence that targeted decorin transduction to breast cancer cells could be used as a novel adjuvant therapy in breast malignancies.