Heart failure : studies of prognosis and advanced therapy

Background Heart failure (HF) is a major health problem affecting 2-3% of the Western population. The clinical syndrome of HF is associated with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Around 50% of the patients have HFrEF and despite advances in treatment, prognosis remains poor and treatments are underutilized. In HFpEF the prognosis is comparable to in HFrEF, but there is no evidence-based therapy. Aims -to investigate 1 The use of evidence-based therapy and survival over time in patients with HFrEF 2 The use of the inotropic drug levosimendan in HF in Sweden 3 a) Contemporary prognosis in patients with severe HFrEF 3 b) If simple predictors of prognosis can be identifid and used as criteria for referral to a HF center 4 Predictors of mortality in patients hospitalized with acute decompensated HFpEF Evidence-based therapy and survival We studied 5,908 HFrEF patients with New York Heart Association (NYHA) class II-IV registered in the Swedish Heart Failure registry (SwedeHF) between 2003 and 2012. The use of beta-blockers and renin angiotensin system (RAS) blockers was >85% and stable over time. There was a decrease in the use of mineralocorticoid receptor antagonists (MRA) from 53 to 42%. The use of cardiac resynchronization therapy (CRT) and implantable cardioverter defirillators (ICD) increased over time, but absolute numbers were low, less than 11% for both. In 2003 vs. 2012, the 30-day, oneyear, and 3-year survival was 92 vs. 94%, 81 vs. 77% and 58 vs. 54% respectively. The changes in survival were not statistically signifiant. Reported numbers are risk-adjusted. The use of levosimendan in Sweden In SwedeHF, 655 registrations were confimed with use of inotropes. Levosimendan alone was the inotropic drug of choice in 91% of the registrations. Of all levosimendan registrations, 38% were planned repetitive treatment. The proportion of planned repetitive to all levosimendan registrations ranged from 0 to 65% between hospitals. Who should be referred to a heart failure center? We studied 10,062 HFrEF patients with NYHA class III-IV from SwedeHF. One-year survival in the age groups ≤65 years, 66-80 years, and >80 years was 90, 79, and 61% respectively. Five prespecifid risk factors were assessed as potential triggers for referral to a HF center: systolic blood pressure ≤90 mmHg; creatinine ≤160 mmol/L; hemoglobin ≤120 g/L; no use of RAS antagonist; and no use of beta-blocker. In patients <80 years of age, the presence of 1, 2, or 3-5 of these risk factors were associated with a one-year survival of 79, 60, and 39% respectively. Risk prediction in HFpEF HF Surveillance data from four different communities in the United States were used to study 2,304 hospitalizations of HFpEF. Mortality at 28 days and one year was 11 and 34% respectively. The most powerful predictors of mortality were higher age, hypoxia, higher blood urea nitrogen and lower hemoglobin. Conclusions Patients with HF face a high risk of death. In HFpEF novel interventions are urgently called for, whereas improving implementation of existing evidence-based treatments should be emphasized in HFrEF. Specifially, the poor use of ICD and CRT needs to be recognized. Levosimendan was the dominant choice of inotrope in Sweden. Effects of the frequent use of planned repetitive levosimendan treatment in a non-acute setting need to be further evaluated. Few and simple risk factors used as referral criteria to a HF center, may increase the number of patients who can benefi from further therapy. In HFpEF, risk predictors may be used for discrimination of high risk patients and contribute to further characterization of this population

Construction of an Automatic Data Collecting System

No abstrac

Symmetric Ciphers for Fully Homomorphic Encryption

Fully homomorphic encryption is the latest addition to the world of cryptography. It is a type of encryption that allows operations to be done on ciphertexts, which is not possible with traditional encryption. The field has gained a lot of traction since it was first theoretically proved possible in 2009. This thesis goes through how fully homomorphic encryption works, from making a somewhat homomorphic encryption scheme, into a fully homomorphic scheme. We also explain in detail the different aspects required, such as bootstrapping and noise. Since 2009 several schemes and libraries to optimize homomorphic encryption have been suggested, so that it one day may be feasible to implement it in regular modern-day applications. Some libraries target regular developers without an extensive cryptographic background, so they may still be able to use homomorphic encryption in applications, while others aim for researchers to implement and discover the possibilities that come with fully homomorphic encryption. With a focus on the use for fully homomorphic encryption within cloud computing, this thesis focuses on how symmetric ciphers can make fully homomorphic encryption possible, also for use with small IoT devices. We look at several such ciphers that have been suggested and focus on the family of stream ciphers called Rasta. We have implemented one variant of the Rasta cipher using the software library HElib and timed its performance.Masteroppgave i informatikkINF399MAMN-INFMAMN-PRO

Construction of a Segmentator

No abstrac

Intelligent design and natural theology

Natural Theology is an attempt to provide arguments for the existence of God based on reason and ordinary experience of nature. It became quite popular with both orthodox Christians and Deists between about 1650 and 1850, inspiring much of the scientific fieldwork done during that period. However, Darwin’s theory of evolution brought about a temporary decline of this Christian apologetic tradition. Intelligent Design is a relatively new scientific research program that investigates the effects of intelligent sources, and challenges basic parts of contemporary Darwinism. Fred Hoyle first issued the ideas of Intelligent Design in modern times when he discovered the unique energy level of the carbon atom in the 1950s. On Copernicus’s 500th birthday in 1973, Brandon Carter presented the discovery that the fundamental constants of physics are fine-tuned to precise values for life permittance. In the 1990s, Michael Behe and others presented arguments for Intelligent Design in molecular biology, and irreducibly complex biochemical machines in living cells. In this paper, we briefly present Intelligent Design and discuss its possible application within a revitalized version of Natural Theology. The paper is mainly written from a scientific perspective

Changes in data collection procedures for process-generated data and methodological implications: the case of ethnicity variables in 19th century Norwegian censuses

'Um Variablen wie 'Ethnizität' als unabhängige Variable etwa in demographischen Analysen verwenden zu können, müssen sie über die Zeit und verschiedene Länder hinweg einheitlich klassifiziert sein. Am Beispiel der Messung der Ethnizität in norwegischen Volkszählungen zeigt der Beitrag, dass man bei prozessproduzierten Daten nicht notwendig von der räumlichen und zeitlichen Stabilität der Messinstrumente ausgehen kann. Hierauf aufbauend diskutiert der Beitrag Ursachen für diese Inkompatibilitäten und macht einen Vorschlag zur Harmonisierung der Daten.' (Autorenreferat)'This article discusses ethnic classification in the censuses in order to prepare its use as an independent variable in for instance demographic studies. The availability of census data and other public administrative data are increasing, also cross-nationally. In order to use these consistently in analyses, variables and categories have to remain the same over all measurement points, and the same type of person should whenever possible be classified and categorized in the same way. Using the case of ethnicity variables in Norwegian censuses, the article a) illustrates that with process-produced data, the contents of the original manuscripts are not necessarily comparable over time and space; b) it then discusses factors leading to these incompatibilities and c) suggests how to harmonize the inconsistencies.' (author's abstract

The Literary Adaptation of Vǫluspá in Hauksbók and Snorra Edda

The three versions of Vǫluspá display substantial differences in their references to speaker and audience. In 2013, the present author investigated such references in the Codex Regius version of the poem, and argued that the puzzling deictic peculiarities are, in fact, traces of oral performance. The present article concludes the study of speaker and audience in Vǫluspá by offering a detailed analysis of the other versions of the poem, found in Hauksbók and Snorra Edda. It is argued that we encounter higher degrees of literary adaptation in these two versions than that seen in the Codex Regius version. Vǫluspá is a rare case in which the process of the literary adaptation of an oral art form may be investigated in some detail. The adaptation is not primarily explained according to chronological development, but rather according to differing literary purposes and according to a waning understanding of the oral origins of the poem and the oral art form

The destinies of German-Born people in Russia at the turn of the millennium

This article studies the stories of Russian citizens who were born in Germany but reside in Russia. Most of them had relocated to Russia as a result of the withdrawal of Russian troops from Germany after 1990. Analysing individual data from the 2002 and 2010 censuses, the author traces the lives of children born into the families of Soviet military men based in East Germany after World War II. Over 140,000 such migrants can be found in the 2002 census, far more than from any other country that was not part of the Soviet Union. Repatriation was accomplished from 1991 to 1994; and even though Germany financed part of the operation, it was necessary to solve the problems of accommodation and employment of the military men and their families locally. As a result of the study, the author manages to determine the territories inhabited by Russians born in Germany in the early twenty-first century. The number of people among them who speak foreign languages and have post-secondary education is higher than average, which testifies to the fact that the joint effort of the two countries was more beneficial for the future of the people born in Germany than might have been expected. The competence and education they acquired, together with the social networks between those repatriated, added significantly to their human capital and their contributions to Russian society

Deictic Traces of Oral Performance in the Codex Regius Version of Vëluspá

This article offers an interpretation of the references to the speaker and audience in the Codex Regius version of Vëluspá. It is argued that these expressions can be explained from the background of oral performance, including the much debated references to the speaker in both first and third person. The immediate proximity between speaker and audience enables effects which are documented in oral storytelling from other contexts: the scene of performance is directly associated with the stories being told, even in deictic references. This articleââ¬â¢s point of departure is Lars Lönnrothââ¬â¢s suggestion that Vëluspá presents a double scene, a meaningful interplay between the concrete performance and the mythological frame story referred to in the poem. While Lönnroth commented mainly on Vëluspáââ¬â¢s first eight stanzas, this article investigates the entire poem, as preserved in the Codex Regius manuscript