Association of Heart Rate With Troponin Levels Among Patients With Symptomatic Atrial Fibrillation

This cohort study investigates heart rate and cardiac troponin levels in patients admitted to the emergency department with symptomatic atrial fibrillation.Non peer reviewe

Lineage-based identification of cellular states and expression programs

We present a method, LineageProgram, that uses the developmental lineage relationship of observed gene expression measurements to improve the learning of developmentally relevant cellular states and expression programs. We find that incorporating lineage information allows us to significantly improve both the predictive power and interpretability of expression programs that are derived from expression measurements from in vitro differentiation experiments. The lineage tree of a differentiation experiment is a tree graph whose nodes describe all of the unique expression states in the input expression measurements, and edges describe the experimental perturbations applied to cells. Our method, LineageProgram, is based on a log-linear model with parameters that reflect changes along the lineage tree. Regularization with L1 that based methods controls the parameters in three distinct ways: the number of genes change between two cellular states, the number of unique cellular states, and the number of underlying factors responsible for changes in cell state. The model is estimated with proximal operators to quickly discover a small number of key cell states and gene sets. Comparisons with existing factorization, techniques, such as singular value decomposition and non-negative matrix factorization show that our method provides higher predictive power in held, out tests while inducing sparse and biologically relevant gene sets.National Institutes of Health (U.S.) (P01-NS055923)National Institutes of Health (U.S.) (1-UL1-RR024920

Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation - the FinCV-4 study

BackgroundPatients with atrial fibrillation (AF) are selected for oral anticoagulation based on individual patient characteristics. There is little information on how clinical AF burden associates with the risk of ischaemic stroke or systemic embolism (SSE). The aim of this study was to explore the association of the frequency of cardioversions (CV) as a measure of clinical AF burden on the long-term SSE risk, with a focus on patients at intermediate stroke risk based on CHA(2)DS(2)-VASc score. For these patients, additional SSE risk stratification by assessing CV frequency may aid in the decision on whether to initiate oral anticoagulation.MethodsThis retrospective analysis of FinCV Study from years 2003-2010 included 2074 patients who were not using any oral anticoagulation (long term or temporary) after CVs and undergoing a total of 6534 CVs for AF from emergency departments of three hospitals. Two study groups were formed: high CV frequency (mean interval between CVs 12 months).ResultsA total of 107 SSEs occurred during a mean follow-up of 5.4 years. The event rates per 100 patient-years were 1.82 and 0.67 in high versus low CV frequency groups, respectively. After adjustment for CHA(2)DS(2)-VASc score, CV frequency independently predicted SSE (HR, 2.87 [95% CI, 1.47 to 5.64]; p = .002) at 3 years. Competing risk analysis also identified CV frequency (sHR, 2.70 [95% CI, 1.38-5.31]; p = .004) as an independent predictor for SSE. In patients with CHA(2)DS(2)-VASc score 1 and low CV frequency, the SSE risk was only 0.08 per 100 patient-years.ConclusionsFrequency of CVs for symptomatic AF episodes provides additional information on stroke risk in AF patients with CHA(2)DS(2)-VASc score 1. Key messages This retrospective study offers a unique opportunity to observe the natural course of AF patients with infrequent episodes of clinical arrhythmia when they were not using OAC (before introduction of CHA(2)DS(2)-VASc score). Stroke or systemic embolism rate was very low (0.08 per 100 patient-years) in patients with one CHA(2)DS(2)-VASc point who visited the emergency room for cardioversion less than once a year. Frequency of cardioversions can be used for additional risk stratification in patients at intermediate risk of stroke based on CHA(2)DS(2)-VASc score.</p

Usefulness of the CHA2DS2-VASc and HAS-BLED Scores in Predicting the Risk of Stroke Versus Intracranial Bleeding in Patients With Atrial Fibrillation (from the FibStroke Study)

CHA2DS2-VASc and HAS-BLED scores stratify the risk of thromboembolic and bleeding events respectively in patients with atrial fibrillation. There is only little information on how they differentiate which of the 2 clinically most important complications (ischemic stroke [IS] or an intracranial bleeding [IB]) the patient is more prone to suffer.We evaluated both scores in patients with either of these major complications. The FibStroke Study collected data on all patients with atrial fibrillation with either an IS or an IB event between 2003and 2012 in 4 Finnish hospital districts. Individual electronic patient records were manually reviewed to collect the study data. To assess the relative risk of IS and IB, an IS/IBratio was calculated by dividing the absolute number of ISs with the absolute number of IBs within each score category. A total of 3,816 (82.7%) ISs and 798 (17.3%) IBs were detected in 3,909 patients. In general, ISs occurred more often than IBs in patients on oral anticoagulation in each score category (ratio 1.6 to 5.1). The ratio decreased below 1, however,only with very high HAS-BLED scores (>4). Moreover, 221 ISs and 53 IBs occurred in patients with HAS-BLED > CHA2DS2-VASc, of whom only 19.7% were on anticoagulation. In conclusion, IS was the predominant intracranial event irrespective of CHA2DS2-VASc score, HAS-BLED score ≤4, or use of oral anticoagulation, also in patients with low estimated thromboembolic risk (CHA2DS2-VASc 0 to 1). Furthermore, the HAS-BLED score predicted the excess of IBs over ISs only at very high-risk levels.</p

BLOB : A Probabilistic Model for Recommendation that Combines Organic and Bandit Signals

A common task for recommender systems is to build a pro le of the interests of a user from items in their browsing history and later to recommend items to the user from the same catalog. The users' behavior consists of two parts: the sequence of items that they viewed without intervention (the organic part) and the sequences of items recommended to them and their outcome (the bandit part). In this paper, we propose Bayesian Latent Organic Bandit model (BLOB), a probabilistic approach to combine the 'or-ganic' and 'bandit' signals in order to improve the estimation of recommendation quality. The bandit signal is valuable as it gives direct feedback of recommendation performance, but the signal quality is very uneven, as it is highly concentrated on the recommendations deemed optimal by the past version of the recom-mender system. In contrast, the organic signal is typically strong and covers most items, but is not always relevant to the recommendation task. In order to leverage the organic signal to e ciently learn the bandit signal in a Bayesian model we identify three fundamental types of distances, namely action-history, action-action and history-history distances. We implement a scalable approximation of the full model using variational auto-encoders and the local re-paramerization trick. We show using extensive simulation studies that our method out-performs or matches the value of both state-of-the-art organic-based recommendation algorithms, and of bandit-based methods (both value and policy-based) both in organic and bandit-rich environments.Comment: 26th ACM SIGKDD Conference on Knowledge Discovery and Data Mining, Aug 2020, San Diego, United State

Sex vägar till hållbarhet: utgångspunkter för främjande av en systematisk omställning till hållbarhet i Finland

Den globala rapporten om hållbar utveckling visar att vi gör framsteg i fråga om de globala målen för hållbar utveckling enligt Agenda 2030, men att det går alldeles för långsamt. Ojämlikheten ökar, klimatförändringarna förvärras, den biologiska mångfalden minskar och avfallsmängderna fortsätter att öka. Bakom dessa fenomen finns många faktorer som påverkar varandra. Men det går att vända riktningen, förutsatt att de ömsesidiga beroendeförhållandena identifieras och en övergripande förändring i en hållbar riktning åstadkoms.202

Six paths towards sustainability: a toolkit to promote a systemic transformation towards sustainable development in Finland

The Global Sustainable Development Report shows that we are heading towards the sustainable development goals of Agenda 2030, but much too slowly. Inequality is increasing, climate change is advancing, biodiversity is decreasing, and waste volumes are growing. These phenomena are affected by several interconnected factors. However, we can change course if we identify the interlinkages between the aforementioned problems and steer our societies comprehensively in a more sustainable direction.202

Incidence and predictors of excessive warfarin anticoagulation in patients with atrial fibrillation-The EWA study

Vitamin K antagonist warfarin is widely used in clinical practice and excessive anticoagulation is a well-known complication of this therapy. Little is known about permanent and temporary predictors for severe overanticoagulation. The aim of this study was to investigate the occurrence and predicting factors for episodes with very high (>= 9) international normalized ratio (INR) values in warfarin treated patients with atrial fibrillation (AF). Excessive Warfarin Anticoagulation (EWA) study screened all patients (n = 13618) in the Turku University Hospital region with an INR >= 2 between years 2003-2015. Patients using warfarin anticoagulation for AF with very high (>= 9) INR values (EWA Group) were identified (n = 412 patients) and their characteristics were compared to a control group (n = 405) of AF patients with stable INR during long-term follow-up. Over 20% (n = 92) of the EWA patients had more than one event of very high INR and in 105 (25.5%) patients EWA led to a bleeding event. Of the several temporary and permanent EWA risk factors observed, strongest were excessive alcohol consumption in 9.6% of patients (OR 24.4, 95% CI 9.9-50.4, p<0.0001) and reduced renal function (OR 15.2, 95% CI 5.67-40.7, p<0.0001). Recent antibiotic or antifungal medication, recent hospitalization or outpatient clinic visit and the first 6 months of warfarin use were the most significant temporary risk factors for EWA. Excessive warfarin anticoagulation can be predicted with several permanent and temporary clinical risk factors, many of which are modifiable

Association of Heart Rate With Troponin Levels Among Patients With Symptomatic Atrial Fibrillation

This cohort study investigates heart rate and cardiac troponin levels in patients admitted to the emergency department with symptomatic atrial fibrillation