His bundle pacing guided by automated intrinsic morphology matching is feasible in patients with narrow QRS complexes

Pace mapping and visual comparison of the local pacing response with the intrinsic QRS morphology form the mainstay of His bundle pacing (HBP). We evaluated the performance of a surface lead morphology match algorithm for automated classification of the pacing response in patients with narrow intrinsic QRS undergoing electroanatomic mapping (EAM)-guided HBP. HBP was attempted in 43 patients. In 28 cases with narrow QRS, the EnSite AutoMap Module was used for automated assessment of the QRS morphology resulting from pace mapping in the His cloud area with either a diagnostic catheter or the His lead. An intrinsic morphology match score (IMS) was calculated for 1.546 QRS complexes and assessed regarding its accuracy and performance in classifying the individual pacing response as either selective HBP (S-HBP), nonselective HBP (NS-HBP) or right ventricular stimulation. Automated morphology comparison of 354 intrinsic beats with the individual reference determined a test accuracy of 99% (95% CI 98.96–99.04) and a precision of 97.99–99.5%. For His-lead stimulation, an IMS ≥ 89% identified S-HBP with a sensitivity, specificity and positive predictive value of 1.00 (0.99, 1.00) and a negative predictive value of 0.99 (0.98, 1.00). An IMS between 78 and < 89% indicated NS-HBP with a sensitivity and specificity of 1.00 (0.99, 1.00) and 0.99 (0.98, 1.00), respectively. IMS represents a new automated measure for standardized individual morphology classification in patients with normal QRS undergoing EAM-guided HBP. Clinical trial registration: NCT04416958

Case study of spatial and temporal variability of snow cover, grain size, albedo and radiative forcing in the Sierra Nevada and Rocky Mountain snowpack derived from imaging spectroscopy

Quantifying the spatial distribution and temporal change in mountain snow cover, microphysical and optical properties is important to improve our understanding of the local energy balance and the related snowmelt and hydrological processes. In this paper, we analyze changes of snow cover, optical-equivalent snow grain size (radius), snow albedo and radiative forcing by light-absorbing impurities in snow and ice (LAISI) with respect to terrain elevation and aspect at multiple dates during the snowmelt period. These snow properties are derived from the NASA/JPL Airborne Visible/Infrared Imaging Spectrometer (AVIRIS) data from 2009 in California's Sierra Nevada and from 2011 in Colorado's Rocky Mountains, USA. Our results show a linearly decreasing snow cover during the ablation period in May and June in the Rocky Mountains and a snowfall-driven change in snow cover in the Sierra Nevada between February and May. At the same time, the snow grain size is increasing primarily at higher elevations and north-facing slopes from 200 microns to 800 microns on average. We find that intense snowmelt renders the mean grain size almost invariant with respect to elevation and aspect. Our results confirm the inverse relationship between snow albedo and grain size, as well as between snow albedo and radiative forcing by LAISI. At both study sites, the mean snow albedo value decreases from approximately 0.7 to 0.5 during the ablation period. The mean snow grain size increased from approximately 150 to 650 microns. The mean radiative forcing increases from 20 W m−2 up to 200 W m−2 during the ablation period. The variability of snow albedo and grain size decreases in general with the progression of the ablation period. The spatial variability of the snow albedo and grain size decreases through the melt season while the spatial variability of radiative forcing remains constant.</p

Reconstruction of a first-order phase transition from computer simulations of individual phases and subphases

We present a new method for investigating first-order phase transitions using Monte Carlo simulations. It relies on the multiple-histogram method and uses solely histograms of individual phases. In addition, we extend the method to include histograms of subphases. The free energy difference between phases, necessary for attributing the correct statistical weights to the histograms, is determined by a detour in control parameter space via auxiliary systems with short relaxation times. We apply this method to a recently introduced model for structure formation in polypeptides for which other methods fail.Comment: 13 pages in preprint mode, REVTeX, 2 Figures available from the authors ([email protected], [email protected]

Impact of light-absorbing particles on snow albedo darkening and associated radiative forcing over high-mountain Asia: high-resolution WRF-Chem modeling and new satellite observations

Light-absorbing particles (LAPs), mainly dust and black carbon, can significantly impact snowmelt and regional water availability over high-mountain Asia (HMA). In this study, for the first time, online aerosol–snow interactions are enabled and a fully coupled chemistry Weather Research and Forecasting (WRF-Chem) regional model is used to simulate LAP-induced radiative forcing on snow surfaces in HMA at relatively high spatial resolution (12&thinsp;km, WRF-HR) compared with previous studies. Simulated macro- and microphysical properties of the snowpack and LAP-induced snow darkening are evaluated against new spatially and temporally complete datasets of snow-covered area, grain size, and impurity-induced albedo reduction over HMA. A WRF-Chem quasi-global simulation with the same configuration as WRF-HR but a coarser spatial resolution (1∘, WRF-CR) is also used to illustrate the impact of spatial resolution on simulations of snow properties and aerosol distribution over HMA. Due to a more realistic representation of terrain slopes over HMA, the higher-resolution model (WRF-HR) shows significantly better performance in simulating snow area cover, duration of snow cover, snow albedo and snow grain size over HMA, as well as an evidently better atmospheric aerosol loading and mean LAP concentration in snow. However, the differences in albedo reduction from model and satellite retrievals is large during winter due to associated overestimation in simulated snow fraction. It is noteworthy that Himalayan snow cover has high magnitudes of LAP-induced snow albedo reduction (4&thinsp;%–8&thinsp;%) in pre-monsoon seasons (both from WRF-HR and satellite estimates), which induces a snow-mediated radiative forcing of ∼30–50&thinsp;W m−2. As a result, the Himalayas (specifically the western Himalayas) hold the most vulnerable glaciers and mountain snowpack to the LAP-induced snow darkening effect within HMA. In summary, coarse spatial resolution and absence of snow–aerosol interactions over the Himalayan cryosphere will result in significant underestimation of aerosol effects on snow melting and regional hydroclimate.</p

In vivo comparison of arterial lumen dimensions assessed by co-registered three-dimensional (3D) quantitative coronary angiography, intravascular ultrasound and optical coherence tomography

This study sought to compare lumen dimensions as assessed by 3D quantitative coronary angiography (QCA) and by intravascular ultrasound (IVUS) or optical coherence tomography (OCT), and to assess the association of the discrepancy with vessel curvature. Coronary lumen dimensions often show discrepancies when assessed by X-ray angiography and by IVUS or OCT. One source of error concerns a possible mismatch in the selection of corresponding regions for the comparison. Therefore, we developed a novel, real-time co-registration approach to guarantee the point-to-point correspondence between the X-ray, IVUS and OCT images. A total of 74 patients with indication for cardiac catheterization were retrospectively included. Lumen morphometry was performed by 3D QCA and IVUS or OCT. For quantitative analysis, a novel, dedicated approach for co-registration and lumen detection was employed allowing for assessment of lumen size at multiple positions along the vessel. Vessel curvature was automatically calculated from the 3D arterial vessel centerline. Comparison of 3D QCA and IVUS was performed in 519 distinct positions in 40 vessels. Correlations were r = 0.761, r = 0.790, and r = 0.799 for short diameter (SD), long diameter (LD), and area, respectively. Lumen sizes were larger by IVUS (P < 0.001): SD, 2.51 ± 0.58 mm versus 2.34 ± 0.56 mm; LD, 3.02 ± 0.62 mm versus 2.63 ± 0.58 mm; Area, 6.29 ± 2.77 mm2versus 5.08 ± 2.34 mm2. Comparison of 3D QCA and OCT was performed in 541 distinct positions in 40 vessels. Correlations were r = 0.880, r = 0.881, and r = 0.897 for SD, LD, and area, respectively. Lumen sizes were larger by OCT (P < 0.001): SD, 2.70 ± 0.65 mm versus 2.57 ± 0.61 mm; LD, 3.11 ± 0.72 mm versus 2.80 ± 0.62 mm; Area 7.01 ± 3.28 mm2versus 5.93 ± 2.66 mm2. The vessel-based discrepancy between 3D QCA and IVUS or OCT long diameters increased with increasing vessel curvature. In conclusion, our comparison of co-registered 3D QCA and invasive imaging data suggests a bias towards larger lume

Global snow mass measurements and the effect of stratigraphic detail on inversion of microwave brightness temperatures

Snow provides large seasonal storage of freshwater, and information about the distribution of snow mass as Snow Water Equivalent (SWE) is important for hydrological planning and detecting climate change impacts. Large regional disagreements remain between estimates from reanalyses, remote sensing and modelling. Assimilating passive microwave information improves SWE estimates in many regions but the assimilation must account for how microwave scattering depends on snow stratigraphy. Physical snow models can estimate snow stratigraphy, but users must consider the computational expense of model complexity versus acceptable errors. Using data from the National Aeronautics and Space Administration Cold Land Processes Experiment (NASA CLPX) and the Helsinki University of Technology (HUT) microwave emission model of layered snowpacks, it is shown that simulations of the brightness temperature difference between 19 GHz and 37 GHz vertically polarised microwaves are consistent with Advanced Microwave Scanning Radiometer-Earth Observing System (AMSR-E) and Special Sensor Microwave Imager (SSM/I) retrievals once known stratigraphic information is used. Simulated brightness temperature differences for an individual snow profile depend on the provided stratigraphic detail. Relative to a profile defined at the 10 cm resolution of density and temperature measurements, the error introduced by simplification to a single layer of average properties increases approximately linearly with snow mass. If this brightness temperature error is converted into SWE using a traditional retrieval method then it is equivalent to ±13 mm SWE (7% of total) at a depth of 100 cm. This error is reduced to ±5.6 mm SWE (3 % of total) for a two-layer model

Predictors of pain intensity and persistence in a prospective Italian cohort of patients with herpes zoster: relevance of smoking, trauma and antiviral therapy

Herpes zoster (HZ) is a common disease, characterized by rash-associated localized pain. Its main complication, post-herpetic neuralgia (PHN), is difficult to treat and may last for months to years in the wake of rash resolution. Uncertainties remain as to the knowledge of predictors of HZ-related pain, including the role of antiviral therapy in preventing PHN in ordinary clinical practice. This prospective cohort study was aimed at investigating pain intensity at HZ presentation and its correlates, as well as the incidence of PHN and its predictors