Reliability Of A Novel Intracardiac Electrogram Method For AV And VV Delay Optimization And Comparability To Echocardiography Procedure For Determining Optimal Conduction Delays In CRT Patients

Background: Echocardiography is widely used to optimize CRT programming. A novel intracardiac electrogram method (IEGM) was recently developed as an automated programmer-based method, designed to calculate optimal atrioventricular (AV) and interventricular (VV) delays and provide optimized delay values as an alternative to standard echocardiographic assessment.Objective: This study was aimed at determining the reliability of this new method. Furthermore the comparability of IEGM to existing echocardiographic parameters for determining optimal conduction delays was verified.Methods: Eleven patients (age 62.9± 8.7; 81% male; 73% ischemic), previously implanted with a cardiac resynchronisation therapy defibrillator (CRT-D) underwent both echocardiographic and IEGM-based delay optimization.Results: Applying the IEGM method, concordance of three consecutively performed measurements was found in 3 (27%) patients for AV delay and in 5 (45%) patients for VV delay. Intra-individual variation between three measurements as assessed by the IEGM technique was up to 20 ms (AV: n=6; VV: n=4). E-wave, diastolic filling time and septal-to-lateral wall motion delay emerged as significantly different between the echo and IEGM optimization techniques (p < 0.05). The final AV delay setting was significantly different between both methods (echo: 126.4 ± 29.4 ms, IEGM: 183.6 ± 16.3 ms; p < 0.001; correlation: R = 0.573, p = 0.066). VV delay showed significant differences for optimized delays (echo: 46.4 ± 23.8 ms, IEGM: 10.9 ± 7.0 ms; p <0.01; correlation: R = -0.278, p = 0.407).Conclusion: The automated programmer-based IEGM-based method provides a simple and safe method to perform CRT optimization. However, the reliability of this method appears to be limited. Thus, it remains difficult for the examiner to determine the optimal hemodynamic settings. Additionally, as there was no correlation between the optimal AV- and VV-delays calculated by the IEGM method and the echo optimization, the use of the IEGM method and the comparability to the echo has not been definitely clarified

Meaningful moments of interaction with people with profound intellectual disabilities:Reflections from direct support staff

Background High-quality, affective relationships are built on meaningful moments of interaction, which are challenging for support staff to establish with people with profound intellectual disabilities. Therefore, we explored what makes a moment of interaction meaningful to support staff and what circumstances facilitate meaningful moments of interaction taking place. Method Five direct support staff took part in unstructured, in-depth interviews. The interviews were analysed using interpretative phenomenological analysis (IPA). Member checks were also conducted. Results Support staff experienced moments of interaction as meaningful because they felt a connection with a person with profound intellectual disabilities and/or they had the feeling of being meaningful for this person. Staff-related and contextual circumstances facilitating meaningful moments of interaction to take place were described. Conclusions Meaningful moments of interaction are highly valued by support staff, who believe these moments are valued by persons with profound intellectual disabilities as well. Implications for daily practice are described

Challenges in predicting the change in the cumulative exposure of new tobacco and related products based on emissions and toxicity dose–response data

Funding: This work was funded by the Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, the Netherlands. Project number 9.7.1Many novel tobacco products have been developed in recent years. Although many may emit lower levels of several toxicants, their risk in the long term remains unclear. We previously published a method for the exposure assessment of mixtures that can be used to compare the changes in cumulative exposure to carcinogens among tobacco products. While further developing this method by including more carcinogens or to explore its application to non-cancer endpoints, we encountered a lack of data that are required for better-substantiated conclusions regarding differences in exposure between products. In this special communication, we argue the case for more data on adverse health effects, as well as more data on the composition of the emissions from tobacco products. Such information can be used to identify significant changes in relevance to health using the cumulative exposure method with different products and to substantiate regulatory decisions.Publisher PDFPeer reviewe

The propargyl rearrangement to functionalised allyl-boron and borocation compounds

A diverse range of Lewis acidic alkyl, vinyl and aryl boranes and borenium compounds that are capable of new carbon–carbon bond formation through selective migratory group transfer have been synthesised. Utilising a series of heteroleptic boranes [PhB(C6F5)2 (1), PhCH2CH2B(C6F5)2 (2), and E-B(C6F5)2(C6F5)C=C(I)R (R=Ph 3 a, nBu 3 b)] and borenium cations [phenylquinolatoborenium cation ([QOBPh][AlCl4], 4)], it has been shown that these boron-based compounds are capable of producing novel allyl- boron and boronium compounds through complex rearrangement reactions with various propargyl esters and carbamates. These reactions yield highly functionalised, synthetically useful boron substituted organic compounds with substantial molecular complexity in a one-pot reaction

The impact of O/Si ratio and hydrogen content on ArF excimer laser ablation of fused silica

The impact of stoichiometry and hydrogen content on the ArF excimer laser ablation characteristics of fused silica is investigated. Nearsurface substoichiometic SiOx with x &lt; 2 diminishes the ablation threshold as a result of increased absorption. The ablation rate is raised by an elevated hydrogen content. As confirmed by mass spectrometric analysis, the laser-induced formation of substoichiometric near-surface layers within the ablation spot sustains absorption and ablation for consecutive laser pulses

Polishing of optical media by dielectric barrier discharge inert gas plasma at atmospheric pressure

In this paper, surface smoothing of optical glasses, glass ceramic and sapphire using a low-power dielectric barrier discharge inert gas plasma at atmospheric pressure is presented. For this low temperature treatment method, no vacuum devices or chemicals are required. It is shown that by such plasma treatment the micro roughness and waviness of the investigated polished surfaces were significantly decreased, resulting in a decrease in surface scattering. Further, plasma polishing of lapped fused silica is introduced. Based on simulation results, a plasma physical process is suggested to be the underlying mechanism for initialising the observed smoothing effect

Facilitating advanced Sentinel-2 analysis through a simplified computation of Nadir BRDF Adjusted Reflectance

The Sentinel-2 (S2) mission from the European Space Agency&rsquo;s Copernicus program provides essential data for Earth surface analysis. Its Level-2A products deliver high-to-medium resolution (10&ndash;60 m) surface reflectance (SR) data through the MultiSpectral Instrument (MSI). To enhance the accuracy and comparability of SR data, adjustments simulating a nadir viewing perspective are essential. These corrections address the anisotropic nature of SR and the variability in sun and observation angles, ensuring consistent image comparisons over time and under different conditions. The c-factor method, a simple yet effective algorithm, adjusts observed S2 SR by using the MODIS BRDF model to achieve Nadir BRDF Adjusted Reflectance (NBAR). Despite the straightforward application of the c-factor to individual images, a cohesive Python framework for its application across multiple S2 images and Earth System Data Cubes (ESDCs) from cloud-stored data has been lacking. Here we introduce sen2nbar, a Python package crafted to convert S2 SR data to NBAR, supporting both individual images and ESDCs derived from cloud-stored data. This package simplifies the conversion of S2 SR data to NBAR via a single function, organized into modules for efficient process management. By facilitating NBAR conversion for both SAFE files and ESDCs from SpatioTemporal Asset Catalogs (STAC), sen2nbar is developed as a flexible tool that can handle diverse data format requirements. We anticipate that sen2nbar will considerably contribute to the standardization and harmonization of S2 data, offering a robust solution for a diverse range of users across various applications. sen2nbar is an open-source tool available at https://github.com/ESDS-Leipzig/sen2nbar

Los Alamos Plutonium Facility Waste Management System

This paper describes the new computer-based transuranic (TRU) Waste Management System (WMS) being implemented at the Plutonium Facility at Los Alamos National Laboratory (LANL). The Waste Management System is a distributed computer processing system stored in a Sybase database and accessed by a graphical user interface (GUI) written in Omnis7. It resides on the local area network at the Plutonium Facility and is accessible by authorized TRU waste originators, count room personnel, radiation protection technicians (RPTs), quality assurance personnel, and waste management personnel for data input and verification. Future goals include bringing outside groups like the LANL Waste Management Facility on-line to participate in this streamlined system. The WMS is changing the TRU paper trail into a computer trail, saving time and eliminating errors and inconsistencies in the process

3D Fluid Flow Estimation with Integrated Particle Reconstruction

The standard approach to densely reconstruct the motion in a volume of fluid is to inject high-contrast tracer particles and record their motion with multiple high-speed cameras. Almost all existing work processes the acquired multi-view video in two separate steps, utilizing either a pure Eulerian or pure Lagrangian approach. Eulerian methods perform a voxel-based reconstruction of particles per time step, followed by 3D motion estimation, with some form of dense matching between the precomputed voxel grids from different time steps. In this sequential procedure, the first step cannot use temporal consistency considerations to support the reconstruction, while the second step has no access to the original, high-resolution image data. Alternatively, Lagrangian methods reconstruct an explicit, sparse set of particles and track the individual particles over time. Physical constraints can only be incorporated in a post-processing step when interpolating the particle tracks to a dense motion field. We show, for the first time, how to jointly reconstruct both the individual tracer particles and a dense 3D fluid motion field from the image data, using an integrated energy minimization. Our hybrid Lagrangian/Eulerian model reconstructs individual particles, and at the same time recovers a dense 3D motion field in the entire domain. Making particles explicit greatly reduces the memory consumption and allows one to use the high-res input images for matching. Whereas the dense motion field makes it possible to include physical a-priori constraints and account for the incompressibility and viscosity of the fluid. The method exhibits greatly (~70%) improved results over our recently published baseline with two separate steps for 3D reconstruction and motion estimation. Our results with only two time steps are comparable to those of sota tracking-based methods that require much longer sequences.Comment: To appear in International Journal of Computer Vision (IJCV