High Pacing Research Articles

WAYS TO FORM RESILIENCE AS A PERSONAL RESERVE OF A CHILD’S PSYCHOLOGICAL HEALTH

It is not by chance that the problem of personal resilience today comes to the forefront of scientifi c understanding. The high pace of modern life with ever more complex conditions places increased demands on a person, testing strength and “survivability.” Therefore, psychological health of the individual is of great importance. According to modern advances in medicine and human health-related research, the defi nition of health has now undergone many changes. Health is not simply the absence of disease, but a feeling of health and well-being that emphasizes a person’s quality of life. The purpose of the work is to study resilience as a personal resource of psychological health. Research methods include () S. Maddi’s vitality test (adapted by D. A. Leontyev, E. E. Rasskazova) which made it possible to study the parameters of vitality; () methodology for diagnosing psychological health of A.V. Kozlova, applied to study the individual model of psychological health of the respondents; () personal questionnaire compiled by I. B. Lasko and B. I. Thinlegged, allowing us to study indicators of psychological health, the level of neuroticism and psychopathization. The study involved  adolescents aged - years,  girls and  boys. We have proven that the more teenagers enjoy their own activities, the more they communicate with other people, are passionate about creative activities and have several different hobbies. The more adolescents are confi dent in themselves, convinced that struggle allows them to achieve the greatest success, the more they believe in their own strengths, the more stable their nervous system is, which contributes to their resilience.

Pacemaker Implantation for Low-Grade Conduction Abnormalities After Balloon-Expandable Transcatheter Aortic Valve Implantation.

A frequent complication after TAVI are postinterventional conduction abnormalities requiring permanent pacemaker implantation. In this study, we analyzed the characteristics of borderline conduction abnormalities leading to pacemaker implantation and the resulting ventricular pacing amounts. All patients who underwent balloon-expandable TAVI between 2014 and 2019 in our tertiary center were analyzed in a retrospective manner. One hundred and sixty-five patients of 1083 TAVI-patients developed postinterventional conduction abnormalities leading to pacemaker implantation. Of these 19 (11.5%) did not represent a clear indication for cardiac pacing according to current European guidelines. Patient characteristics, underlying conduction abnormalities, and the temporal change of ventricular pacing percentages at 24 h and 6 weeks after pacemaker implantation were analyzed. The dominating borderline conduction abnormalities leading to pacemaker implantation were new-onset persisting bundle-branch-blocks and new first-degree AV-blocks with progression of AV-delay. While pacemaker implantation was safe and without severe complications in all cases, only 6 of 19 patients had high pacing amounts (95%-100%) after 24 h while 11 patients had low to no pacing amounts (0%-5%). After 6 weeks, 8 patients showed decreasing pacing amounts, no patient had an increasing amount of ventricular pacing and all patients had an intrinsic ventricular rhythm > 30/min. In our cohort of 1038 TAVI patients, 19 patients underwent PMI for borderline CAs (11.5% of all PMI). Of these, only 2 patients had high pacing amounts after 6 weeks. The risk of complete persisting heart block in these patients is very low. Furthermore, algorithms to reduce ventricular pacing are highly effective to avoid ventricular pacing whenever reasonable.

The usefulness of His bundle pacing in a heterogeneous population of patients with impaired left ventricular systolic function.

His bundle pacing (HBP) maintains a physiological activation pattern of ventricular activation, and in patients with intraventricular conduction delay (IVCD) it can normalize wide QRS duration. A total of 181 patients from the HBP registry were enrolled into a the study, which was conducted at the Department of Electrocardiology in Katowice, Poland. The patients had left ventricular ejection fraction (LVEF) < 50% and were implanted between November 2015 and April 2019. The HBP indications were as follows: 1) bradycardia and atrioventricular conduction disturbances with expected high pacing burden, 2) IVCD, LVEF ≤ 35%, with an indication for resynchronization therapy, 3) the need to upgrade to resynchronization therapy due to pacing-induced cardiomyopathy. Pacing parameters and echocardiographic and clinical data were assessed for up to 2 years of follow-up (FU). His bundle pacing was successful in 154 (85.1%) patients. Eighty-two patients completed a 6-month FU. The mean age was 70.6 ± 9.23 years, and 79% were males. At 6 months FU LVEF improved from 35.3 ± 8.22% to 43.1 ± 10.14% (p < 0.0001), and indexed left ventricular end-systolic volume (LVESVi) decreased from 63.1 ± 25.21 mL/m² to 51.9 ± 22.79 mL/m² (p < 0.0001). In 53.1%, the LVESVi reduction was greater than 15%. The improvement in LVEF and LVESVi was also observed after 24 months of FU. His bundle pacing in permanently paced patients when LVEF is reduced below 50% is associated with improvement in LVEF and reverse left ventricle remodeling.

Correlation of prosthesis position on mid-term pacing burden in patients with new permanent pacemaker after TAVI

Abstract Background Prior studies suggest a strong correlation of the final prosthesis position on the occurrence of new conduction disturbances resulting in permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI). A high burden right ventricular pacing (PPM stimulation rate of &amp;gt; 20 %) is associated with poor long-term outcomes. So far, data about predictors influencing the PPM stimulation rate after TAVI are scarce. Purpose Thus, the purpose of this study was to evaluate the influence of the three-dimensional transcatheter heart valve (THV) position, as well as device landing zone characteristics or peri-/post-procedural factors on the stimulation rate in patients with new implanted PPM as TAVI complication. Materials: We evaluated the final THV position of 387 patients (106 with self-expanding Evolut R THV, 281 with balloon-expandable Sapien 3 THV) using fusion imaging of pre- and post-TAVI computed tomography angiography (CTA) to obtain a three-dimensional reconstruction of the THV within the native annulus region. The length of the THV above and below the native annulus was measured within the fused images to assess the implantation depth. PPM stimulation rates were examined pre-discharge and after 3 months. Patient’s clinical long-term outcome was evaluated over 5 years via standardized questionnaire as well as contacting general practitioners. Results Out of the 387 patients 112 (29%) received a new PPM pre-discharge after TAVI between 2014 and 2022. They were grouped into patients with stimulations rate below and above 20%. A stimulation rate &amp;gt; 20% in the PPM control before discharge and after three months was detected in 69 % and 67 % of them, respectively. Using uni- and multivariate logistic regression analysis, only new occurred third degree atrioventricular blocks (p=0.007) was identified as predictor for high burden right ventricular pacing after PPM-implantation as well as after 3 months. The implantation depth of the THV showed no influence on the PPM stimulation rate – neither the mean value nor the exact implantation depth adjacent the left, right and non-coronary cusp (P=0.455, P=0.108 and P=0.932, respectively). There were no significant differences regarding MACE between both groups during long-term follow-up; only the degree of dyspnea 5 years after TAVI was significantly higher in patients with a stimulation rate &amp;gt; 20% (p=0.01). Conclusion We detected no correlation of the exact three-dimensional THV position on mid-term pacing burden in 112 patients implanted with a new PPM after TAVI using CTA fusion imaging. Only a new occurred third degree atrioventricular block was a predictor for a high burden right ventricular pacing (stimulation rate &amp;gt;20%). These results provide important insights into which patients actually require PPM implantation after TAVI.

Larger QRS but better hemodynamic function after high output His bundle pacing in patients with heart failure and narrow QRS. A paradox or a new concept?

Abstract Background QRS duration is an important factor in determining Cardiac Resynchronisation Therapy (CRT) response and a useful surrogate for electromechanical dyssynchrony. However, we don’t have studies confirming this concept in conduction system pacing. Purpose We performed His Bundle Pacing (HBP) with high output (3.5V/1msec) in HF patients with dilated or ischemic cardiomyopathy and narrow QRS to evaluate hemodynamic benefit independent of the QRS duration or AV delay shortening. Methods 14 patients with dilated (7 patients) or ischemic (7 patients) cardiomyopathy (EF&amp;lt;35%) and narrow QRS (&amp;lt;120ms) were referred for implantation of a defibrillator. We implanted an ICD- HBP system, and we collected clinical, echocardiographic, and electrocardiographic data. Results We obtained HBP in all 14 patients successfully. PQ after implantation was shorter from 172±48 to 143±16 (P=0.048) so as to pace the ventricle. Baseline QRS duration increased after pacing from 110±15 to 123±16ms (P=0.008) as measured by ECG analyzer. Despite this increase in QRS duration basal mean EF increased from 30±4% to 46±10% (P&amp;lt;0.001) after a median follow-up of 17 months. Left ventricular end-diastolic diameter and left ventricular end-diastolic volume decreased from 62±5 to 57±5mm (P=0.013) and from 195±69 to 126±27ml (P&amp;lt;0.001), respectively. Left ventricular end-systolic volume decreased from 139±58 to 69±27 (P&amp;lt;0.001). TAPSE increased from 19±4 to 27±4. NYHA class decreased by one class in every patient after only one month. HBP threshold was 1.05V±0.7/1msec and raised to 1.33±0.93/1msec (due mainly to 2 patients with very high threshold). The impedance was 588±109 and decreased to 484±69 Ohms. R-wave at implant was 3.2±1.8mV. In 2 out of 14 patients, threshold increased but was still less than 3.5V/1msec. Conclusions HBP in HF patients with dilated or ischemic cardiomyopathy and narrow QRS improves hemodynamic function in right and left ventricle and decreases NYHA class. This benefit appears to be produced by a higher stimulation output despite a larger QRS after pacing. We exclude that a very short AV delay could be favorable, by measuring acute EF changes only after increasing the pacing output without AV delay modifications. To our knowledge these are the first cases of beneficial HBP in HF patients with narrow QRS. Interestingly, larger QRS corresponds to higher EF in patients with high output HIs Bundle Pacing.

The connection site of the Bachmann bundle to the left atrium affects atrial electrical and anatomical remodeling

Abstract Background A common route for the propagation of the conduction system from the right atrium to the left atrium (LA) is via the Bachmann bundle (BB) which is a parallel-aligned muscular structure. It is empirically known that the site of conduction from BB to LA differs depending on the patient. Purposes To clear the clinical significance of differences in the BB conduction sites in patients with atrial fibrillation (AF). Methods We studied 182 patients (90 non-paroxysmal AF, 121 males, and 68.2 ± 10.0 years) who received catheter ablation for AF. Clinical data, echocardiographic data, and blood samples were evaluated. High-density LA mapping during high right atrial pacing was constructed. The site of conduction from BB to LA, the global activation time, LA mean voltage, the abnormal conduction zone (ACZ), and the conduction block (CBZ) were evaluated. The conduction from BB was connected to the region surrounded by the left atrial roof line, the carina of the right pulmonary vein, and the base of the left atrial appendage in all patients (Figure 1). This area was divided into four regions (right-roof, mid-roof, right-anterior, and mid-anterior area), and BB conduction sites were classified into each area by three independent observers who did not know clinical data. Global activation time for the LA was calculated by subtracting the earliest from the latest activation within the LA. Isochronal activation maps were created at a 5-ms interval setting, and ACZ (Figure 2) and CBZ were identified on the activation map by locating a site with isochronal crowding of ≥3 isochrones and ≥8 isochrones, which were calculated as ≤27 cm/s and ≤10 cm/s. Results The conduction from BB was observed in 45 patients in the right-roof area, 24 in the mid-roof, 76 in the right-anterior, 23 cases in the mid-anterior, and 14 in multiple sites. Global activation time (right-roof 108±20, mid-roof 107±16, right-anterior 105±19, and mid-anterior 117±20ms, P=0.0781) was more prolonged and left atrium diameter was larger (42.1±6.6, 42.6±8.5, 42.5±6.6, and 46.4±6.6mm, P=0.0718) in patients with mid-anterior BB connections. LA mean voltage (4.90±1.94, 5.72±2.62, 4.13±1.58, and 4.88±1.96mV, P=0.0032) was higher and plasma brain natriuretic peptide level (139±138, 67±59, 128±139, and 164±197pg/mL, P=0.0861) was lower in patients with mid-roof BB connections. ACZ (41/45 91%, 20/24 83%, 73/76 96%, and 23/23 100%, P=0.0904) and CBZ (1/45 2%, 0/24 0%, 8/76 11%, and 2/23 9%, P=0.0850) appearance rates were lower in patients with mid-roof BB connections. Conclusion The connection site of the Bachmann bundle to the left atrium may affect atrial electrical and anatomical remodeling in patients with atrial fibrillation.

Impact of left atrial stiffness measurement as a pre-procedural predictor of an extensive left atrial low-voltage area

Abstract Background The presence of a left atrial (LA) low-voltage area (LVA) after pulmonary vein isolation for atrial fibrillation (AF) is a strong predictor of recurrence and LVAs are often an additional ablation target. However, predicting the presence of an LVA before the procedure remains challenging. Purpose To assess the LA stiffness index as a preprocedural predictor of an extensive LVA. Methods We prospectively evaluated 74 patients who underwent catheter ablation for AF and high-density bipolar LA voltage mapping during sinus rhythm or high right atrial pacing. "LVA" was defined as an area with bipolar electrograms (&amp;lt;0.5 mV), while "extensive LVA" was defined as the presence of an LVA that covered more than 15% of the LA surface. Echocardiographic measurements, including the LA volume index (LAVi), E/e' ratio, LA reservoir strain (LASr), and LA stiffness index, calculated as the ratio of E/eʹ to LASr, were performed prior to catheter ablation in all patients. Results Overall, 17 patients (23.0%) had an extensive LVA. Patients with extensive LVAs were older (73 ± 7 vs. 66 ± 8 years; P=0.003), predominantly female (59% vs. 23%; P=0.01), and more frequently showed persistent AF (59% vs. 30%; P=0.04) in comparison to patients without extensive LVAs. According to a receiver operating characteristic curve analysis, the LA stiffness index was more accurate than the LAVi or LASr for predicting extensive LVAs (Figure), allowing using a cutoff value ≥0.6 with 73% sensitivity and 91% specificity. A multivariate logistic regression analysis revealed that the LA stiffness index was an independent predictor of an extensive LVA (odds ratio [OR], 44.11; 95% CI 3.83–507.47, P=0.002). Conclusion The LA stiffness index was a robust predictor of the extent of LVAs in AF patients and thus could be useful for the preprocedural selection of candidates for catheter ablation and to determine the most effective ablation strategies.

Evaluating lesion integrity with diamond temp system

Abstract Background Pulmonary vein (PV) isolation by temperature-controlled (TC) radiofrequency ablation (RFA) is regaining popularity due to tissue-temperature feedback from thermocouples attached at the distal tip. The Diamond Temp (DT) ablation catheter system is uniquely able to monitor real time tissue temp during RFAs. The DT catheter tip has a 1.1 mm split tip electrode, allowing precise bipolar pacing during RFA. Loss of capture (LOC) with High output pacing (HOP) has been considered a surrogate to assess lesion transmurality [1]. This study evaluated the utility of DT catheter distal pacing to achieve durable lesions. Standard guidelines for TC ablation recommend achieving target tissue-temperature of 60ºC to produce durable lesions. The purpose of this study was to assess whether LOC is achieved at target tissue-temperature of 60ºC. Objective Pacing during ablation from distal tip micro electrode of the DT catheter and observing the time it takes for LOC at different segments around pulmonary veins. First pass isolation (FPI) percentage was also collected. Methods While target enrollment for this prospective study is 50 patients, these preliminary findings are based on analysis of the first 15 patients enrolled, all of whom had symptomatic, drug-refractory paroxysmal AF. Point-by-point RF lesions were delivered around ipsilateral PVs, divided into 4 segments: superior, inferior, anterior, and posterior. Ablation was performed in a TC mode with max temp setting of 60°C and max power of 50 watts. HOP was performed prior to start of ablation and discontinued once LOC was observed. Time taken to LOC around all 4 segments of PVs were recorded. Intracardiac echocardiography (ICE) was used to guide contact and monitor lesion formation. Results Overall mean time to LOC was 3.32 sec. Anterior sites exceeded this mean. Inferior, superior, and posterior sites generally had shorter times. 92.53% of locations achieved LOC within 2-5 sec of ablation. The right anterior PV had the longest time at 3.73 sec, exceeding the overall mean of 3.32 sec. All patient achieved FPI. Conclusion Reaching target therapeutic temp of 60°C alone may not be sufficient to achieve LOC around PVs. Ablation duration of 4 sec led to LOC in 92.53% of lesions. Certain anatomical regions like anterior locations required prolonged ablation time. Tissue thickness on ICE correlated directly with time required to LOC. This analysis shows that TC ablation with DT is effective; however, a therapeutic stable temperature of 60°C for at least 4 sec may be needed to achieve durable lesions around PVs. Tissue thickness on ICE and stability of temperature appear to be independent variables affecting duration prior to LOC.

Mechanical dyssynchrony and response to cardiac resynchronization therapy in heart failure patients with right ventricular pacing: a pre-specified subgroup analysis of the BUDAPEST CRT Upgrade trial

Abstract Introduction The BUDAPEST CRT Upgrade trial has established the strong clinical benefit of upgrading heart failure patients with a reduced left ventricular (LV) ejection fraction (HFrEF) and a high right ventricular pacing (RVP) burden to cardiac resynchronization therapy with defibrillator (CRT-D). Importantly, however, the CRT upgrade response is not homogeneous regarding LV reverse remodeling and associated clinical outcomes. The presence of mechanical dyssynchrony (MD) assessed by echocardiography has been linked to more CRT benefits; still, its change in response to CRT and added prognostic value in HFrEF patients with high RVP are scarcely investigated. Purpose Accordingly, we aimed to assess the prevalence, clinical characteristics, CRT response rate, and prognostic value of RVP-induced MD in the BUDAPEST CRT Upgrade cohort. Methods The multicentre, randomized, controlled trial enrolled 360 HFrEF patients with a pacemaker or implantable cardioverter defibrillator (ICD) and significant RVP (≥ 20%) who were randomly assigned to receive CRT-D upgrade or ICD in a 3:2 ratio. Protocol echocardiography was performed at baseline and at 12-month follow-up visits and was evaluated at a central core lab. Beyond LV end-diastolic (EDV) and end-systolic volumes (ESV), longitudinal strain-derived septal deformation patterns by speckle tracking were assessed to determine the presence of RVP-induced MD. The endpoints were volumetric non-response (defined by a relative decrease in LV ESV &amp;lt;15%) and the composite of volumetric non-response or HF hospitalization. Results The echocardiographic assessment was feasible in 325 patients at baseline; 133 (41%) patients presented with MD. Females were more likely to present with MD (female vs. male, 65% vs. 38%, p=0.003). MD patients had higher LV EDV (MD vs. no-MD, 248±78 vs. 219±78 mL, p=0.001) and LV ESV (190±67 vs. 165±64 mL, p&amp;lt;0.001) at baseline. In the CRT-D group, 126 (75%) patients were volumetric responders, and 41 (25%) were non-responders at 12 months. CRT patients with baseline MD were less likely to experience volumetric non-response (OR 0.35 [95% CI 0.15-0.82], p=0.015) or the composite endpoint (OR 0.37 [95% CI 0.17-0.77], p=0.008). Out of 57 CRT patients with baseline MD who had follow-up assessment available, 52 (91%) patients had a favorable change: the MD pattern disappeared. Patients with MD resolution at 12 months were less likely to experience volumetric non-response or the composite endpoint (OR 0.39 [95% CI 0.17-0.93], p=0.034; OR 0.38 [95% CI 0.16-0.86], p=0.021, respectively). CRT patients with resolved MD were less likely of ischemic etiology and had 100% posterior or lateral LV lead location. Conclusions The presence of RVP-induced MD and its resolution is associated with better clinical response in HFrEF patients undergoing CRT-D upgrade. MD assessment can refine patient selection algorithms of CRT.Figure 1

Hyperspectral acquisition with ScanImage at the single pixel level: application to time domain coherent Raman imaging.

We present a comprehensive strategy and its practical implementation using the commercial ScanImage software platform to perform hyperspectral point scanning microscopy when a fast time-dependent signal varies at each pixel level. In the proposed acquisition scheme, the scan along the X-axis is slowed down while the data acquisition is maintained at a high pace to enable the rapid acquisition of the time-dependent signal at each pixel level. The ScanImage generated raw 2D images have a very asymmetric aspect ratio between X and Y, the X axis encoding both for space and time acquisition. The results are X-axis macro-pixel where the associated time-dependent signal is sampled to provide hyperspectral information. We exemplified the proposed hyperspectral scheme in the context of time-domain coherent Raman imaging, where a pump pulse impulsively excites molecular vibrations that are subsequently probed by a time-delayed probe pulse. In this case, the time-dependent signal is a fast acousto-optics delay line that can scan a delay of 4.5ps in 25μs at each pixel level. With this acquisition scheme, we demonstrate ultra-fast hyperspectral vibrational imaging in the low frequency range [10cm-1, 150 cm-1] over a 500 μm field of view (64 x 64 pixels) in 130ms (∼ 7.5 frames/s). The proposed acquisition scheme can be readily extended to other applications requiring the acquisition of a fast-evolving signal at each pixel level.

COHERENCE AS A FACTOR IN THE EFFECTIVENESS OF JOINT ACTIVITIES OF OPEN-SOURCE DEVELOPERS

Coherence determines a team’s effectiveness, assuming an optimal combination of individual activities. To describe the content of coherence in teams of open-source software developers is the main aim of the study. A total of 114,016 sequences of interactions related to pull requests from 979 open-source projects make up the purposive sample of the research. An automated observation process utilising a large language model was used as a method of data analysis. According to the analysis, coherence as a characteristic of effective teams is defined by the unity of purpose, acceptance of functional differentiation between roles, and a high pace of software development. Each participant motivates one another to carry out the subsequent set of actions. Contributors make a clear addition, team members manage the procedure, respond quickly and approve the actions.

Multipoint pacing is associated with improved prognosis and cardiac resynchronization therapy response: MORE-CRT MPP randomized study secondary analyses.

Cardiac resynchronization therapy (CRT) via biventricular (BIV) pacing is indicated in patients with heart failure (HF), reduced ejection fraction, and prolonged QRS duration. Quadripolar leads and multipoint pacing (MPP) allow multiple left ventricle (LV) sites pacing. We aimed to assess the clinical benefit of MPP in patients who do not respond to standard BIV pacing. Overall, 3724 patients were treated with standard BIV pacing. After 6 months, 1639 patients were considered as CRT non-responders (echo-measured relative reduction in LV end-systolic volume (LVESV) < 15%) and randomized to MPP or BIV. We analysed 593 randomized patients (291 MPP, 302 BIV), who had BIV pacing >97% of the time before randomization and complete 12 months of clinical and echocardiographic data. The endpoint composed of freedom from cardiac death and HF hospitalizations and by LVESV relative reduction ≥15% between randomization and 12 months occurred more frequently in MPP [96/291 (33.0%)] vs. BIV [71/302 (23.5%), P = 0.0103], which was also confirmed at multivariate analysis (hazard ratio = 1.55, 95% confidence interval = 1.02-2.34, P = 0.0402 vs. BIV). HF hospitalizations occurred less frequently in MPP [14/291 (4.81%)] vs. BIV [29/302 (9.60%), incidence rate ratio = 50%, P = 0.0245]. Selecting patients with a large (>30 ms) dispersion of interventricular electrical delay among the four LV lead dipoles, reverse remodelling was more frequent in MPP [18/51 (35.3%)] vs. BIV [11/62 (17.7%), P = 0.0335]. In patients who do not respond to standard CRT despite the high BIV pacing percentage, MPP is associated with lower occurrence of HF hospitalizations and higher probability of reverse LV remodelling compared with BIV pacing.

Electromyographic analysis of bilateral upper trapezius muscles at different levels of work-pace among sewing machine operators

Workers are driven to work faster in the industrial work environment to meet high productivity targets. An increased work pace leads to increased muscle activation. However, the effect of work pace on bilateral upper trapezius muscles during sewing machine operation in an industrial work environment has not been thoroughly investigated in experimental studies. Therefore, this research aims to conduct an experimental study to analyze the bilateral upper trapezius muscle activity of industrial sewing machine operators at different levels of work pace. Thirty subjects (15 males, and 15 females) continuously performed the sewing operation for two hours in an industrial work environment. Experiments were conducted for two levels of work pace i.e. low pace (100% of standard cycle time) and high pace (120% of standard cycle time). Electromyographic signals were recorded from the bilateral upper trapezius muscles. The EMG amplitude (RMS) among the muscles was computed. A statistically significant (p < 0.05) increase in muscle activity was observed with an increased work pace. In this study, right upper trapezius muscle activity increased by 30.4% during high work pace tasks compared to low pace, while the left upper trapezius showed a 24.12% increase. The right upper trapezius showed a mean difference of 0.696 (%MVC), and the left upper trapezius showed 0.399 (%MVC), both indicating greater activity during high-pace tasks. The increase in muscle activity with time indicated the presence of muscle fatigue among sewing machine operators. Furthermore, higher muscular activity was observed among females than males. This research highlights the critical need to balance productivity goals with the health and safety of workers, reducing the risk of muscle fatigue and associated work-related musculoskeletal disorders.

A prospective longitudinal cohort study of the association between nurses' subjective and objective workload.

Critical care nurses have high workloads due to the severity of the disease and the complexity of the treatment and care. Understanding the factors that influence subjective workload as well as the association between subjective and objective workload could lead to new insights to reduce critical care nurses' workload. (1) To describe critical care nurses' subjective and objective workload per shift in a university-affiliated interdisciplinary adult intensive care unit in Switzerland and (2) to explore the association between objective and subjective workload. The study used a prospective longitudinal cohort design. Critical care nurses completed the adapted Questionnaire on the Experience and Evaluation of Work 2.0 (QEEW2.0) to assess the subjective workload after every shift for four weeks (0 = never loaded, 100 = always loaded). The objective workload was assessed with the Therapeutic Intervention Scoring System-28 (TISS-28), Nine Equivalents of Nursing Manpower Use Score (NEMS), Swiss Society for Intensive Care Medicine (SGI)-patients' categories and Patient-to-Nurse Ratio (PNR). Data was analysed using multilevel mixed models. The workload of 60 critical care nurses with a total of 765 shifts were analysed. The critical care nurses experienced a subjective high mental load (66 ± 26), moderate pace and amount of work (30 ± 25) and physical load (33 ± 25), and low emotional-moral load (26 ± 22). The one-time baseline subjective workload values were higher than the day-to-day values. The mean objective shift load using the TISS-28 was 43 ± 16 points, the NEMS 36 ± 14 points, the SGI-category 1.1 ± 0.5 nurses needed per patient and the PNR 1.2 ± 0.4. We found positive associations between day-to-day objective variables with subjective pace and amount of work, with physical and mental load but not with emotional-moral load and performance. Measured objective workload is associated with only certain subjective workload domains. To promote and retain critical care nurses in the profession, nursing management should give a high priority to understanding subjective workload and strategies for reducing it.

Patient engagement as a collaborative process in a large Dutch COVID-19 vaccination study (RECOVAC) – insight into the contribution of patient engagement and learnings for the future

BackgroundThe need for patient engagement in health research has been increasingly acknowledged and accepted in recent years. However, implementation is still limited due to lack of evidence on its value and lack of guidance on how to implement patient engagement. This study aims to provide insight into the contribution of patient engagement in the RECOVAC project, which studied COVID-19 vaccination in kidney patients, and formulate concrete practice-based action perspectives for patient engagement.MethodsWe used a qualitative participatory mixed methods approach, based on the Patient Engagement Monitoring and Evaluation (PEME) framework. Patient engagement and data collection were based on the Reflexive Monitoring in Action (RMA) approach. Data collection included participant observations, open ended questionnaires and interactive reflection sessions. Qualitative analysis was done via a thematic approach.ResultsWe have described the process of patient engagement systematically, provided insight in its value and found that there is a need for clear aims, expectations and preparations from the start of the engagement process. We have shown that reflection throughout the process is of utmost importance and the same applies to clear communication between researchers and patient representatives. By being part of the consortium patient representatives had direct access to information, straight from the source, on for example the vaccination schedule and medication availability and had indirect influence on decisions made by the National Institute for Public Health and the Environment (RIVM) on preventive measures and treatment against COVID-19. Having experienced patient representatives is important, otherwise training needs to be provided. We also found that patient engagement had impact on conduct and outcomes of research activities itself and may have impact on future research and patient engagement activities in general.ConclusionPatient engagement has changed the course of the project. Concrete practice-based action perspectives have been formulated, which are already being implemented by the Dutch Kidney Patients Association (NVN). Studying patient engagement in a high pace project with high public interest has resulted in lessons learned and will help prepare and implement patient involvement in future research projects.Clinical trial registrationThe RECOVAC studies in which the patient engagement took place are registered at clinicialtrial.gov (NCT04741386 registration date 2021-02-04, NCT04841785 registration date 2021-03-22 and NCT05030974 registration date 2021-08-20).

Left ventricular volumes and function in successful and failed His-BundLe Pacing. A comparative prospective study.

Initial data suggest that His Bundle Pacing (HBP) could preserve long-term cardiac structure and function better than Right Ventricular Pacing (RVP), but evidence is limited. We studied consecutive patients with baseline ejection fraction (EF) ≥ 50% who underwent HBP attempt, either successful (HBP group) or failed (RVP group). Two-dimensional (2D) and three-dimensional (3D) echocardiography were carried out at baseline and after 6 months of ventricular pacing burden > 20%. Among 68 patients, 40 underwent successful HBP, and 28 RVP. The HBP and RVP groups did not differ for age, sex and pacing indication. At baseline, the HBP and RVP groups did not differ for 2D EF (62% vs. 62%), 3D EF (60% vs. 63%), 2D (-19% vs. -19%) and 3D global longitudinal strain (GLS) (-15% vs. -16%). After 6 months, 2D EF (-3.86%) and 3D EF (-5.71%) significantly decreased in the RVP group and did not change in the HBP group (p for interaction .006 and <.001, respectively). 2D GLS (3.08%) and 3D GLS (2.22%) significantly increased in the RVP group, but did not change in the HBP group (p for interaction .013 and <.016, respectively). Pacing induced cardiomyopathy (PICM) (EF drop ≥ 10% and EF < 50%) occurred in 14% (RVP) versus 0% (HBP) of patients (p = .025). Successful HBP was superior to RVP in preserving LV systolic function despite a high ventricular pacing burden, and was less frequently associated with PICM.

The Role of Patient Organizations in Shaping Research, Health Policies, and Health Services for Rare Genetic Diseases: The Dutch Experience.

In 2023, the genetics scientific community celebrated two special anniversaries: the discovery of the double helix structure of DNA was published in 1953 and in 2003 the Human Genome Project was declared completed and made publicly available. To this day, genetics and genomics research is continuing to evolve at high pace and is identifying a steadily increasing number of genes as causal for distinct genetic diseases. The success story of genetics and genomics would not be complete without taking due account of the role of patient advocacy organizations in this process. This paper is based on the personal narrative (oral history) of a father whose daughter was born with a rare genetic disease (RGD) in the 1960s. The first-hand experience of living as a family with an RGD in those days made him a leading pioneer not only in the foundation of patient organizations at national, pan-European, and international levels but also in the development of multi-stakeholder co-operation and networking. Today, patient advocacy organizations play an active role in shaping health and research policies at national, EU, and international levels to ensure that their needs in regard to advancing RGD diagnostics, care, and treatment are addressed.

Analysis of rapid reconstruction airport pavements

The article discusses principles and guidelines for rapid reconstruction of military airfield pavements. The possible repair materials to be used as well as the basic types of lightweight collapsible pavements were defined . Various technologies and principles for organizing construction work related to the repair of damaged pavements in accordance with the STANAG 2929 standard are presented. The article presents selected scientific principles of work organization that affect the maintenance of a high pace of construction project implementation. Additionally, the article highlights the need to protect aircraft and other sensitive elements of airport infrastructure, suggesting the use of double-bent sheet metal structures. These structures are relatively inexpensive and can be erected in a very short time.

Comparison of clinical and echocardiographic outcomes between left bundle branch area pacing and right ventricular pacing in older patients.

Left bundle branch area pacing (LBBAP) is safe and effective, but studies in older patients are lacking. This study compared the clinical and echocardiographic outcomes of LBBAP and right ventricular pacing (RVP) in patients aged ≥75 years. This prospective observational study included older patients with symptomatic bradycardia who underwent LBBAP or RVP between 2019 and 2022. Clinical data, including pacing and electrophysiological characteristics, echocardiographic measurements, and device-related complications were collected. The primary endpoint was a composite of all-cause mortality, heart failure hospitalization, and upgrade to biventricular pacing. Secondary outcomes included changes in left ventricular ejection fraction (LVEF). Of 267 included patients, 110 underwent LBBAP and 157 underwent RVP. LBBAP was successful in 109 patients (success rate: 99.1%), with one patient eventually undergoing RVP. The pacing parameters of LBBAP were similar to those of RVP, except for a significantly narrower paced QRS duration (112.8±11.6vs. 138.3±23.9ms, p<.001). Ventricular lead implanting procedural duration was longer for LBBAP than RVP (14.0vs. 6.0min, p<.001), as was the fluoroscopy time (4.0vs. 2.0min, p<.001). During a mean follow-up period of 31.0±16.8 months, the primary outcome incidence was significantly lower following LBBAP than RVP (15.1%vs. 21.1%; hazard ratio, 0.471; 95% confidence interval, 0.215-1.032; p=.036) in 149 patients (55.8%) with ventricular pacing burden>20%. RVP reduced LVEF from 62.7±4.1% at baseline to 59.8±7.8% at the final follow-up (p=.001), whereas LBBAP preserved LVEF (61.4±6.3%vs. 60.1±7.4%, p=.429). LBBAP demonstrated improved clinical outcomes compared with RVP and maintained LVEF in older patients with high ventricular pacing burdens.

The green conundrum: Navigating the paradox of buffer farmlands of a mangrove forest landscape

Farmlands, positioned at the interface of mangrove forestlands and urban centers, serve as critical buffer zones. These areas play a pivotal role in determining the ecological fate of mangrove forests, acting as a cushion against mangrove deforestation. This study aims to study the spatiotemporal data from Landsat imagery whilst considering the geo-political and scocio-economic transformations of such a buffer region adjoining the Sunderban mangrove forest to understand the surreptitious reason for such expansive nature of the farmlands. Results indicate that these buffer farmlands are in a constant tug-of-war between the urban and forest ecosystems. The built up area adjoining the cities increases at a much higher pace than the areas adjoining the forest lands. Quite contrary to the popular belief, it is seen that the majority of cropland expansion in the mangrove adjoining regions arises from the use of fallow land rather than the clearing of vegetation. The study shows that the changes need to be addressed through the government’s policies and a restructure of governance is required. In policymaking, the collaborative action of scientists, governments, and local people should be involved. The lack of sustainable development and targeted improvement can increase the threat and risk nearby the mangrove farmlands.