Controls on the spatio-temporal patterns of induced seismicity in Groningen constrained by physics-based modelling with Ensemble-Smoother data assimilation

The induced seismicity in the Groningen gas field, The Netherlands, presents contrasted spatio-temporal patterns between the central area and the south west area. Understanding the origin of this contrast requires a thorough assessment of two factors: (1) the stress development on the Groningen faults and (2) the frictional response of the faults to induced stresses. Both factors have large uncertainties that must be honoured and then reduced with the observational constraints. Ensembles of induced stress realizations are built by varying the Poisson's ratio in a poro-elastic model incorporating the 3-D complexities of the geometries of the Groningen gas reservoir and its faults, and the historical pore pressure distribution. The a priori uncertainties in the frictional response are mapped by varying the parameters of a seismicity model based on rate-and-state friction. The uncertainties of each component of this complex physics-based model are honoured through an efficient data assimilation algorithm. By assimilating the seismicity data with an Ensemble-Smoother, the prior uncertainties of each model parameter are effectively reduced, and the posterior seismicity rate predictions are consistent with the observations. Our integrated workflow allows us to disentangle the contributions of the main two factors controlling the induced seismicity at Groningen, induced stress development and fault frictional response. Posterior distributions of the model parameters of each modelling component are contrasted between the central and south west area at Groningen. We find that, even after honouring the spatial heterogeneity in stress development across the Groningen gas field, the spatial variability of the observed induced seismicity rate still requires spatial heterogeneity in the fault frictional response. This work is enabled by the unprecedented deployment of an Ensemble-Smoother combined with physics-based modelling over a complex case of reservoir induced seismicity

Rate control drugs differ in the prevention of progression of atrial fibrillation

AIMS: We hypothesize that in patients with paroxysmal atrial fibrillation (AF), verapamil is associated with lower AF progression compared to beta blockers or no rate control. METHODS AND RESULTS: In this pre-specified post hoc analysis of the RACE 4 randomized trial, the effect of rate control medication on AF progression in paroxysmal AF was analysed. Patients using Vaughan-Williams Class I or III antiarrhythmic drugs were excluded. The primary outcome was a composite of first electrical cardioversion (ECV), chemical cardioversion (CCV), or atrial ablation. Event rates are displayed using Kaplan–Meier curves and multivariable Cox regression analyses are used to adjust for baseline differences. Out of 666 patients with paroxysmal AF, 47 used verapamil, 383 used beta blockers, and 236 did not use rate control drugs. The verapamil group was significantly younger than the beta blocker group and contained more men than the no rate control group. Over a mean follow-up of 37 months, the primary outcome occurred in 17% in the verapamil group, 33% in the beta blocker group, and 33% in the no rate control group (P = 0.038). After adjusting for baseline characteristics, patients using verapamil have a significantly lower chance of receiving ECV, CCV, or atrial ablation compared to patients using beta blockers [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.19–0.83] and no rate control (HR 0.64, 95% CI 0.44–0.93). CONCLUSION: In patients with newly diagnosed paroxysmal AF, verapamil was associated with less AF progression, as compared to beta blockers and no rate control

Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation

Background: The assessment of symptom-rhythm correlation (SRC) in patients with persistent atrial fibrillation (AF) is challenging. Therefore, we performed a novel mobile app-based approach to assess SRC in persistent AF.Methods: Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-s photoplethysmogram (PPG) and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings.Results: Of 88 patients (33% women, age 68 +/- 9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44-0.79). The study population was divided into SRC-index tertiles: low (= 0.73). Patients within the low (vs high) SRC-index tertile had more often heart failure and diabetes mellitus (both 24.1% vs 6.9%). Extrasystoles occurred in 19% of all symptomatic non-AF PPG recordings. Within each patient, PPG recordings with the highest (vs lowest) tertile of pulse rates conferred an increased risk for symptomatic AF recordings (odds ratio [OR] 1.26, 95% coincidence interval [CI] 1.04-1.52) and symptomatic non-AF recordings (OR 2.93, 95% CI 2.16-3.97). Pulse variability was not associated with reported symptoms.Conclusions: In patients with persistent AF, SRC is relatively low. Pulse rate is the main determinant of reported symptoms. Further studies are required to verify whether integrating mobile app-based SRC assessment in current workflows can improve AF management

Mobile health solutions for atrial fibrillation detection and management: a systematic review

AimWe aimed to systematically review the available literature on mobile Health (mHealth) solutions, including handheld and wearable devices, implantable loop recorders (ILRs), as well as mobile platforms and support systems in atrial fibrillation (AF) detection and management.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The electronic databases PubMed (NCBI), Embase (Ovid), and Cochrane were searched for articles published until 10 February 2021, inclusive. Given that the included studies varied widely in their design, interventions, comparators, and outcomes, no synthesis was undertaken, and we undertook a narrative review.ResultsWe found 208 studies, which were deemed potentially relevant. Of these studies included, 82, 46, and 49 studies aimed at validating handheld devices, wearables, and ILRs for AF detection and/or management, respectively, while 34 studies assessed mobile platforms/support systems. The diagnostic accuracy of mHealth solutions differs with respect to the type (handheld devices vs wearables vs ILRs) and technology used (electrocardiography vs photoplethysmography), as well as application setting (intermittent vs continuous, spot vs longitudinal assessment), and study population.ConclusionWhile the use of mHealth solutions in the detection and management of AF is becoming increasingly popular, its clinical implications merit further investigation and several barriers to widespread mHealth adaption in healthcare systems need to be overcome

The European TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Centre and patient experiences

Aims: TeleCheck-AF is a multicentre international project initiated to maintain care delivery for patients with atrial fibrillation (AF) during COVID-19 through teleconsultations supported by an on-demand photoplethysmography-based heart rate and rhythm monitoring app (FibriCheck® ). We describe the characteristics, inclusion rates and experiences from participating centres according the TeleCheck-AF infrastructure as well as characteristics and experiences from recruited patients.Methods: Three surveys exploring centre characteristics (n=25), centre experiences (n=23) and patient experiences (n=826) were completed. Self-reported patient characteristics were obtained from the app.Results: Most centres were academic (64%) and specialized public cardiology/district hospitals (36%). Majority of centres had AF outpatient clinics (64%) and only 36% had AF ablation clinics. The time required to start patient inclusion and total number of included patients in the project was comparable for centres experienced (56%) or inexperienced in mHealth use. Within 28 weeks, 1930 AF patients were recruited, mainly for remote AF control (31% of patients) and AF ablation follow-up (42%). Average inclusion rate was highest during the lockdown restrictions and reached a steady state at a lower level after easing the restrictions (188 vs 52 weekly recruited patients). Majority (>80%) of the centres reported no problems during the implementation of the TeleCheck-AF approach. Recruited patients (median age 64 [55-71], 62% male) agreed that the FibriCheck® app was easy to use (94%).Conclusions: Despite different health care settings and mHealth experiences, the TeleCheck-AF approach could be set up within an extremely short time and easily used in different European centres during COVID-19

Affix reduction in spoken Dutch: Probabilistic effects in production and perception

Contains fulltext : 30012.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 07 juni 2007Promotor : Baayen, R.H. Co-promotor : Ernestus, M.T.C.155 p

Frontline employees' intercultural competence: Does it impact customers' evaluations of intercultural service encounters?

Globalization has led to an exponential growth of intercultural service encounters. In view of the importance of customer-orientation in services, we investigate the effect of the frontline employee’s intercultural competence on customer’s affective and cognitive evaluations of intercultural service encounters. The focus of this study is on the effect of employee cultural competence, relative to employee technical competence and cultural distance. A 2x2x2 full-factorial design (N= 322) with video vignettes was used. MANOVA results show significant main effects of employee intercultural competence and employee technical competence on both types of customer evaluations. Moreover, employee intercultural competence positively moderates the effects of employee technical competence, and eliminates a negative effect of cultural distance. We conclude that employee intercultural competence is a powerful extra-role behavior with an additive effect on both the affective and cognitive evaluation of intercultural service encounters, even when ETC is at a low level