Threshold Events Research Articles

Adaptive RL Optimized Bipartite Consensus Tracking for Heterogeneous Nonlinear MASs Under a Switching Threshold Event Triggered Strategy

Adaptive RL Optimized Bipartite Consensus Tracking for Heterogeneous Nonlinear MASs Under a Switching Threshold Event Triggered Strategy

Electronic Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: Long-Term Results of a Multicenter, Randomized, Controlled Trial.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We previously reported superior symptom control of electronic patient-reported outcome (ePRO)-based symptom management after lung cancer surgery for up to 1 month postdischarge. Here, we present the long-term results (1-12 months) of this multicenter, randomized trial, where patients were assigned 1:1 to receive postoperative ePRO-based symptom management or usual care daily postsurgery, twice weekly postdischarge until 1 month, and at 3, 6, 9, and 12 months postdischarge. Long-term patient-reported outcomes were assessed with MD Anderson Symptom Inventory-Lung Cancer module. Per-protocol analyses were performed with 55 patients in the ePRO group and 57 in the usual care group. At 12 months postdischarge, the ePRO group reported significantly fewer symptom threshold events (any of the five target symptom scored ≥4; median [IQR], 0 [0-0] v 0 [0-1]; P = .040) than the usual care group. From 1 to 12 months postdischarge, the ePRO group consistently reported significantly lower composite scores for physical interference (estimate, -0.86 [95% CI, -1.32 to -0.39]) and affective interference (estimate, -0.70 [95% CI, -1.14 to -0.26]). Early intensive ePRO-based symptom management after lung cancer surgery reduced symptom burden and improved functional status for up to 1 year postdischarge, supporting its integration into standard care.

Application of the patient-reported outcome-based postoperative symptom management model in lung cancer: a multicenter randomized controlled trial protocol

IntroductionLung cancer is the most common cancer in China, with the highest mortality rate. Surgery is the primary treatment for early lung cancer. However, patients with lung cancer have a heavy burden of symptoms within 3 months after surgery, which seriously affects their quality of life (QOL). The symptom management model based on the patient-reported outcome (PRO) is considered the best caregiving model. The clinical evidence about the symptom management of lung cancer within 3 months after the operation is very limited. Herein, we propose a randomized controlled trial to evaluate the PRO score-based monitoring and alert system for follow-up on psychological and physiological symptoms of lung cancer patients within 3 months after surgery and further investigate the effect of intervention measures based on this PRO score-based system.Methods and analysisThis multicenter, open-label, randomized, parallel superiority trial will be conducted at four hospitals in China. A total of 440 lung cancer patients will be recruited in this study, who will be randomly assigned to the intervention group or the control group in a ratio of 1:1. Any of the target symptoms reaches the preset threshold (score ≥ 4), the patients will accept the symptom management advices based on the PRO. The patients in the control group will follow the current standard procedure of symptom management. The symptom management system is an electronic management system based on WeChat mini programs. All patients will be evaluated for symptoms through the lung cancer module of the MDASI lung cancer-specific scale on the day before surgery, days 1, 3, 5, and 7 after surgery, and once a week during the 12-week post-discharge period. Simultaneously, the EORTC QLQ-C30 scale will be used to evaluate patients’ quality of life at baseline and the fourth and twelfth week after the surgery. The mean number of symptom threshold events of the intervention and the control groups were compared by t-test, and the changes of PRO were compared by a mixed effect model. The primary endpoint has been set as the 12-week post-discharge period.DiscussionThis study will test the feasibility of the symptom management system based on the mobile social media applet in postoperative caregiving and the efficacy of psychiatrist-assisted treatment and provide evidence in managing the symptoms of patients in the medium and long term.Trials registrationTrials registration number: ChiCTR 2200058876, Registered 18 April 2022

Decision Fusion-Based Nonintrusive Load Identification Involving Adaptive Threshold Event Detection

Decision Fusion-Based Nonintrusive Load Identification Involving Adaptive Threshold Event Detection

Disaster-driven climate adaptation: bringing institutions in

Previous scholarship broadly emphasizes weather disasters as threshold events to instigate climate adaptation. This study goes beyond the disaster-adaptation nexus by investigating its institutional conditionality. Drawing on the theory of institutional isomorphism, we examine how disasters interact with three isomorphic institutions – coercive, mimetic and normative – to influence cities' adaptation to climate change. Using survey data on California cities in 2013–2014, 2017 and 2018, the findings suggest that cities predominantly take reactive and top-town approaches to climate adaptation, with coercive isomorphism being the main driver of their adaptation efforts. Meanwhile, the three isomorphic forces differentially condition the impacts of disasters on adaptation: both coercive and mimetic pressures produce a diminishing marginal effect as the frequency of disasters surpasses a certain threshold, whereas normative pressure exhibits a positive and reinforcing marginal effect as disaster exposure goes up. We conclude with practical implications associated with the boundary conditions of disaster-driven adaptation, adaptation policy design as well as entry points to bottom-up adaptation initiatives.

Targeted treatment strategies for the control of gastrointestinal nematodes in a goat flock with anthelmintic resistant worm populations and poor nutrition

Combined targeted selective treatment schemes using FAMACHA©, body condition score (BCS), and faecal egg counts (FEC) can reduce the number of anthelmintic (AH) treatments per year in goat farms, which can slow down the selection of AH-resistant worm populations. Supplementary feeding can further reduce the FEC of goats at the farm level. A 19-month survey was implemented to (i) identify the number of times that goats crossed the thresholds of FAMACHA©, BCS, and FEC, (ii) identify the monthly FEC reductions of goats treated with AH in the targeted scheme, and (iii) identify the effect of a supplementation scheme on the goats’ FEC. The survey was performed at a goat farm in tropical México. Goats grazed natural vegetation four h/day and received concentrate feed daily (14% crude protein, 150 g each). Each month, goats (n = 88) were examined, and those with FAMACHA© ≥ 4, BCS ≤ 2, and FEC ≥ 750 eggs per gram of faeces (EPG) were identified (Day 0). From September 2018 to September 2019, goats crossing the FEC threshold (events) were allocated to two different groups distributed according to FEC values: deworming group (DG; n = 71 events) and supplemented group (SG; n = 72 events). From October 2019, all the goats were assigned only to the DG (n = 31 events) due to management problems in the study farm. The DG goats were individually weighed and treated with levamisole (LEV, 12 mg/kg body weight (BW), subcutaneous (sc)) and their normal diet. From November 2019 to March 2020, the DG goats were treated with LEV and benzimidazole (BZ, 7 mg/kg BW, sc). The SG goats were individually supplemented with an additional 300 g of concentrate feed for ten days. From the 88 goats surveyed, 70.5% crossed the FAMACHA©/BCS thresholds, with goats sampled 1–7 times. From the 369 sampled events, only 56% had ≥ 750 EPG. The FEC reduction of DG goats treated with LEV ranged from 46.7% to 96.1%, and with LEV+BZ combination was 100%. The FEC reduction in the SG goats ranged from 27.7% to 95.5%. Supplementation of SG goats had a positive impact on most goats and helped to limit the number of dewormed goats. To be effective, the supplement must be an addition to the normal diet.

Event-triggered adaptive finite time trajectory tracking control for Underactuated Vessel considering unknown time-varying disturbances

Abstract This paper aims to solve the finite-time trajectory tracking problem of underactuated surface ships under the influence of dynamic uncertainty, unknown external time-varying interference and limited communication resources, an event-triggered robust adaptive finite-time trajectory tracking control method for underactuated ships is designed by combing the existing trajectory tracking control methods and engineering needs in actual navigation. It can obviously improve the tracking accuracy of the ship, and complete the tracking task safely and efficiently. This scheme transforms the composite uncertain vector synthesized by uncertain parameters and external disturbances into a linear parameterized form. Next, considering the limitation of communication resources, a relative threshold event triggering mechanism is introduced to further extend the triggering time interval on the basis of the fixed threshold triggering scheme. Then, an event-triggered robust adaptive finite-time trajectory tracking control scheme is designed for underactuated ships, and a rigorous stability proof is provided for the finite-time trajectory tracking control scheme designed above through Lyapunov stability theory. Simulation experiment is carried out in MATLAB and the results show that the finite-time trajectory tracking control scheme proposed in this paper can effectively solve the problems of dynamic uncertainty, unknown time-varying interference from the outside world, and limitation of communication resources. This paper can provide theoretical support for the autonomous navigation of intelligent ships.

Adaptive threshold event detection method based on standard deviation

Event detection is the foundation of event-based non-intrusive load detection solutions. Conventional event detection methods require a comprehensive consideration of the rated power levels of all devices within the detection scenario to define an appropriate threshold value. However, it cannot accurately detect both high- and low-power load events because of their fixed thresholds when loads with widely varying power change amplitudes are present simultaneously. Thus, an adaptive threshold event detection method based on standard deviation is proposed in this study. First, the aggregated power data are intercepted by a sliding window for a short period of time, and the standard deviation is calculated for the aggregated power data within the window. The event ends when the standard deviation reaches its maximum value. Next, the threshold for event detection is calculated based on the standard deviation, and event detection based on the calculated threshold and on the bilateral sliding window cumulative sum method is performed. Finally, various load tests are performed with Electricity Consumption & Occupancy (Kleiminger et al 2015 Proc. 2015 ACM Int. Joint Conf. on Pervasive and Ubiquitous Computing) datasets and private datasets. The F1 values exceeded 90% in all three scenarios, namely, office, factory and laboratory, indicating that the proposed method in this study has high event detection performance.

Portal-time and wanderlines: What does virusing-with make possible in childhood research?

This paper emerged from the forces of a pandemic that invited us to wrestle with what ‘virusing-with’ might potentiate in educational research-creation (Manning, 2016a). We sense the Coronavirus perform its agency on childhood in the Capitalocene in new, troubling, and sometimes hopeful ways. Research-creation has compelled us to dwell upon how virusing-with makes attuning differently to the world possible. We contemplate how virusing-with as concept and method holds the potential to disrupt and reformulate ways to undertake research and ways to conceptualise the child. Inspired by Manning’s (2020) recent work in relation to the child of the wanderline, we explore how multiple wanderlines take shape and interweave through research processes. Through the curation of three threshold events we think-do qualitative research in ways that push ideas and practices about childhood in directions that attend to agentic relationalities between the human, non-human and more-than-human. We argue that practices of virusing-with in portal time provides space for coming-into-relations of differences (Manning, 2016a, p.11) as an ecology of practice that shapes how educational research might be conceptualised and practiced.

Carpe Communication: Seizing the Small Moments to Teach Interpersonal and Communication Skills on Inpatient Services.

Carpe Communication: Seizing the Small Moments to Teach Interpersonal and Communication Skills on Inpatient Services.

ENSO-driven extreme oscillations in mean sea level destabilise critical shoreline mangroves—An emerging threat

Recent ENSO-related, extreme low oscillations in mean sea level, referred to as ‘Taimasa’ in Samoa, have destabilised shoreline mangroves of tropical northern Australia, and possibly elsewhere. In 1982 and 2015, two catastrophic Taimasa each resulted in widespread mass dieback of ~76 km2 of shoreline mangroves along 2,000 km of Australia’s Gulf of Carpentaria. For the 2015 event, we determined that a temporary drop in sea level of ~0.4 metres for up to six months duration caused upper zone shoreline mangroves across the region to die from severe moisture deficit and desiccation. The two dramatic collapse events revealed a previously unrecognised vulnerability of semi-arid tidal wetland habitats to more extreme ENSO influences on sea level. In addition, we also observed a relationship between annual sea level oscillations and mangrove forest productivity where seasonal oscillations in mean sea level were co-incident with regular annual mangrove leaf growth during months of higher sea levels (March-May), and leaf shedding during lower sea levels (September-November). The combination of these periodic fluctuations in sea level defined a mangrove ‘Goldilocks’ zone of seasonal productivity during median-scale oscillations, bracketed by critical threshold events when sea levels became unusually low, or high. On the two occasions reported here when sea levels were extremely low, upper zone mangrove vegetation died en masse in synchrony across northern Australia. Such extreme pulse impacts combined with localised stressors profoundly threaten the longer-term survival of mangrove ecosystems and their benefits, like minimisation of shoreline erosion with rising sea levels. These new insights into such critical influences of climate and sea level on mangrove forests offer further affirmation of the urgency for implementing well-considered mitigation efforts for the protection of shoreline mangroves at risk, especially given predictions of future re-occurrences of extreme events affecting sea levels, combined with on-going pressure of rapidly rising sea levels.

Unity Human Eye Model for Gaze Tracking with a Query-Driven Dynamic Vision Sensor.

Objective measurement of gaze pattern and eye movement during untethered activity has important applications for neuroscience research and neurological disease detection. Current commercial eye-tracking tools rely on desk-top devices with infrared emitters and conventional frame-based cameras. Although wearable options do exist, the large power-consumption from their conventional cameras limit true long-term mobile usage. The query-driven Dynamic Vision Sensor (qDVS) is a neuromorphic camera which dramatically reduces power consumption by outputting only intensity-change threshold events, as opposed to full frames of intensity data. However, such hardware has not yet been implemented for on-body eye-tracking, but the feasibility can be demonstrated using a mathematical simulator to evaluate the eye-tracking ca-pabilities of the qDVS under controlled conditions. Specifically, a framework utilizing a realistic human eye model in the 3D graphics engine, Unity, is presented to enable the controlled and direct comparison of image-based gaze tracking methods. Eye-tracking based on qDVS frames was compared against two different conventional frame eye-tracking methods - the traditional ellipse pupil-fitting algorithm and a deep learning neural network inference model. Gaze accuracy from qDVS frames achieved an average of 93.2% for movement along the primary horizontal axis (pitch angle) and 93.1 % for movement along the primary vertical axis (yaw angle) under 4 different illumination conditions, demonstrating the feasibility for using qDVS hardware cameras for such applications. The quantitative framework for the direct comparison of eye tracking algorithms presented here is made open-source and can be extended to include other eye parameters, such as pupil dilation, reflection, motion artifact, and more.

Design of an NSMCR Based Controller for All-Electric Aircraft Anti-Skid Braking System

In this paper, a relative threshold event-triggered based novel complementary sliding mode control (NSMCR) algorithm of all-electric aircraft (AEA) anti-skid braking system (ABS) is proposed to guarantee the braking stability and tracking precision of reference wheel slip control. First, a model of the braking system is established in strict-feedback form. Then a virtual controller with a nonlinear control algorithm is proposed to address the problem of constraint control regarding wheel slip rate with asymptotical stability. Next, a novel approaching law-based complementary sliding mode controller is developed to keep track of braking pressure. Moreover, the robust adaptive law is designed to estimate the uncertainties of the braking systems online to alleviate the chattering problem of the braking pressure controller. Additionally, to reduce the network communication and actuator wear of AEA-ABS, a relative threshold event trigger mechanism is proposed to transmit the output of NSMC in demand. The simulation results under various algorithms regarding three types of runway indicate that the proposed algorithms can improve the performance of braking control. In addition, the hardware-in-the-loop (HIL) experimental results prove that the proposed methods are practical for real-time applications.

Event-Triggered Adaptive Tracking Control for Random Systems With Coexisting Parametric Uncertainties and Severe Nonlinearities

Comparing with traditional stochastic differential equations involving white noise, random differential equations (RDEs) with colored noise are claimed to have more practical meaning. This article considers the event-triggered adaptive tracking control for RDE systems with coexisting parametric uncertainties and severe nonlinearities. Combining a tracking error-based dynamic gain with a relative threshold event triggered control mechanism, the tracking control problem for the random systems is solved without Zeno behavior. The tracking error can be rendered small enough by tuning design parameters. First, a series of adaptive control laws are designed by using backstepping technique. Then, two special cases are considered and the main results are extended to MIMO systems. Finally, a simulation example confirms the validity of the results. To the best of the authors’ knowledge, this article serves as the first attempt of event-based control for RDE systems.

Trends in Quality Controlled Precipitation Indicators in the United States Midwest and Great Lakes Region

Changes in precipitation can have broad and significant societal impacts. A number of previous studies that analyzed changes in precipitation across the Great Lakes and Midwest for a variety of time periods and using a range of quality-control standards and methods observed increased precipitation rates and totals, although there was considerable site-to-site variability, even for sites in close physical proximity. Biases and discontinuities in precipitation observations may contribute to this variability. This study identifies and examines changes in precipitation utilizing a unique approach to observation series screening over a region encompassing the Great Lakes and broader Midwestern region of the United States for the period 1951–2019. A multiple tier procedure was utilized to identify high quality input data series from the Global Historical Climatology Network-Daily dataset. Annual and seasonal time series of precipitation indicators were calculated and subjected to breakpoint analysis as further quality control. Trends were analyzed across a broad range of related indicators, from totals and frequencies of threshold events to event duration and potential linkages with total precipitable water. Results indicate that annual precipitation has generally increased across the region in terms of totals, although there is substantial variation across the study domain in the significance and magnitude of annual trends by indicator. Annual trends were spatially most consistent across eastern areas of the study domain while relatively greater station-to-station variability in trend significance and magnitude was observed across northern and western portions. Significant trends were generally fewer in number for seasonal precipitation indicators and less spatially coherent. The greatest number of significant trends occurred in fall with the fewest in spring. Correlation of indicator trends with trends of mean total precipitable water suggests weak correlations annually and moderate correlations at the seasonal scale. The trends of the precipitation indicators in our study exhibited more coherent spatial patterns when compared with studies with different quality control criteria, illustrating the importance of quality control of observations in climatic studies and highlighting the complexity of the changing character of precipitation.

Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial.

We aimed to evaluate the efficacy and feasibility of patient-reported outcome (PRO)-based symptom management in the early period after lung cancer surgery. Before surgery, patients with clinically diagnosed lung cancer were randomly assigned 1:1 to receive postoperative PRO-based symptom management or usual care. All patients reported symptoms on MD Anderson Symptom Inventory-Lung Cancer presurgery, daily postsurgery, and twice a week after discharge for up to 4 weeks via an electronic PRO system. In the intervention group, treating surgeons responded to overthreshold electronic alerts driven by any of the five target symptom scores (score ≥ 4 on a 0-10 scale for pain, fatigue, disturbed sleep, shortness of breath, and coughing). The control group patients received usual care and no alerts were generated. The primary outcome was the number of symptom threshold events (any target symptom with a score of ≥ 4) at discharge. Per-protocol analyses were conducted. Of the 166 participants, 83 were randomly allocated to each group. At discharge, the intervention group reported fewer symptom threshold events than the control group (median [interquartile range], 0 [0-2] v 2 [0-3]; P = .007). At 4 weeks postdischarge, this difference was maintained between the intervention and control groups (median [interquartile range], 0 [0-0] v 0 [0-1]; P = .018). The intervention group had a lower complication rate than the control group (21.5% v 40.6%; P = .019). Surgeons spent a median of 3 minutes managing an alert. PRO-based symptom management after lung cancer surgery showed lower symptom burden and fewer complications than usual care for up to 4 weeks postdischarge.

283 His bundle pacing: safety, performance, and clinical outcomes in a single-centre experience

Abstract Aims Permanent His bundle pacing (HBP) is a more physiological technique for cardiac stimulation and has recently emerged as an alternative for anti-bradycardia pacing and cardiac resynchronization therapy (CRT). Its main advantages over ‘classical’ pacing are both its protective role over pacing-induced cardiomyopathy and the possibility of resynchronization by normalization of His-Purkinje activation. To evaluate the intermediate-term outcomes of HBP in terms of safety, performance, and clinical outcomes. Methods and results Between December 2018 and July 2020, we enrolled a series of consecutive patients with indication for pacing in whom HBP was attempted. A specific lead (3830 Select Secure MRI SureScan) and sheath (C315His) was used. At follow-up clinical, safety and performance outcomes were evaluated. A significant rise in HBP pacing threshold was defined as an increase of at least 1 V@1ms in the minimum voltage that could produce an effective myocardial depolarization. Remote or in-hospital device interrogation was performed by an experienced electrophysiologist. HBP was attempted in 99 patients and all implantations were performed by the same two operators. Eighty-two procedures were successful (83%). The main reasons for HBP failure were high pacing-thresholds (n = 8, 47%), infra-Hisian block (n = 5, 29,4%), difficult HB location (n = 3, 17,6%), unsatisfactory sensing (n = 1, 5,9%), or lead instability (n = 1, 5,9%). During a mean follow-up of 9.5 ± 5.9 months, the overall technical and clinical complication rates were 39% and 13.3%, respectively. Three (3.6%) patients underwent His lead extraction and subsequent conventional right ventricular septum (RV) lead implantation because of lead dislodgement (n = 2) or rise in pacing threshold (n = 1), while two (2.4%) patients required His lead repositioning because of lead dislodgement (n = 1) and phrenic nerve stimulation (n = 1). Nineteen patients (23.2%) experienced a significant rise in Hisian pacing threshold and 1 of these patients also had poor sensing parameters. Oversensing was noted in 8 (9.7%) patients and in 7 of them (87.5%) it was due to both atrioventricular and ventriculoatrial crosstalk events. As regards clinical outcomes, seven patients (8.5%) were diagnosed with new onset atrial fibrillation (AF), one of them complicated by stroke. Three patients (3.6%) were hospitalized for acute heart failure, one of them after His lead dislodgement. Finally, five patients (6.1%) died during follow-up, but no death was related to cardiovascular events. Conclusions HBP is an effective technique to obtain a more physiological cardiac pacing, but it is limited by a moderate rate of procedural failure and follow-up complications, mainly rising in pacing threshold and oversensing events. This is probably due to suboptimal implantation tools and lack of specific programming algorithms. New dedicated tools, increased experience, knowledge of device limitations, and optimal programming are needed to improve future outcomes.

Domestication is not an ancient moment of selection for prosociality: Insights from dogs and modern humans

Domestication is often portrayed as a long-past event, at times even in archaeological literature. The term domestication is also now applied to other processes, including human evolution. In such contexts, domestication means selection for friendliness or prosociality and the bodily results of such selective choices. Both such perspectives are misleading. Using dogs and modern humans as entry points, this paper explores why conceiving of domestication as a threshold event consisting of selection for prosociality is both incomplete and inaccurate. Domestication is an ongoing process, not a moment or an achievement. Selection in breeding, including for prosociality, is a part of many domestication histories, but it alone does not sustain this process over multiple generations. Further, much selection in domestication has little to do with human intention. Care, taming, commensalism, material things, and places are critical in carrying domestic relationships forward.

The Influence of In-Vehicle Subtasks on Driving Performance Using the Lane-Changing Test

To improve the specification and applicability of performance indicators for in-vehicle subtask impact experiments, additional driving performance indicators were added to the international standard test environment, the lane-changing test (LCT). The comprehensive characteristics of multiple indicators were studied using the C4.5 decision tree. The paired memory test was selected as a subtask, and data on driving trajectory, speed, and steering angle were collected and analyzed under three task conditions (baseline, easy task, and difficult task). The results showed that the newly added indicators such as lane offset times, initial lane-changing distance, and correct lane-changing ratio could reflect the new driving characteristics from the aspects of the times of lateral deviation over threshold events, driver response, error proportion, etc. Subjects with different driving states were grouped into the lane-keeping indicator and lane-changing indicator. By using the C4.5 decision tree, classification accuracies of 85.2% and 91.3% were achieved, respectively, which indicated a high accuracy rate of task state discrimination. The overall performance of lane keeping and lane changing was different under the action of the subtasks, especially the lane-changing performance.

His bundle pacing: safety, performance, and clinical outcomes in a single centre experience

Abstract Background Permanent His bundle pacing (HBP) is a more physiological technique for cardiac stimulation and has recently emerged as an alternative for anti-bradycardia pacing and cardiac resynchronization therapy (CRT). Its main advantages over “classical” pacing are both its protective role over pacing-induced cardiomyopathy and the possibility of resynchronization by normalization of His-Purkinje activation. Objective To evaluate the intermediate-term outcomes of HBP in terms of safety, performance, and clinical outcomes. Methods Between December 2018 and July 2020, we enrolled a series of consecutive patients with indication for pacing in whom HBP was attempted. A specific lead (3830 Select Secure MRI SureScan) and sheath (C315His) were used. At follow-up clinical, safety and performance outcomes were evaluated. A significant rise in HBP pacing threshold was defined as an increase of at least 1V@1msec in the minimum voltage that could produce an effective myocardial depolarization. Remote or in-hospital device interrogation was performed by an experienced electrophysiologist. Results HBP was attempted in 99 patients and all implantations were performed by the same two operators. 82 procedures were successful (83%). The main reasons for HBP failure were high pacing-thresholds (n=8, 47%), infra-hisian block (n=5, 29,4%), difficult HB location (n=3, 17,6%), unsatisfactory sensing (n=1, 5,9%) or lead instability (n=1, 5,9%). During a mean follow up of 9,5±5.9 months, the overall technical and clinical complication rates were 39% and 13,3% respectively. 3 (3.6%) patients underwent His lead extraction and subsequent conventional right ventricular septum (RV) lead implantation because of lead dislodgement (n=2) or rise in pacing threshold (n=1), while 2 (2.4%) patients required His lead repositioning because of lead dislodgement (n=1) and phrenic nerve stimulation (n=1). 19 patients (23,2%) experienced a significant rise in Hisian pacing threshold and 1 of these patients also had poor sensing parameters. Oversensing was noted in 8 (9.7%) patients and in 7 of them (87.5%) it was due to both atrioventricular and ventriculoatrial crosstalk events. As regards clinical outcomes, 7 patients (8.5%) were diagnosed with new onset atrial fibrillation (AF), one of them complicated by stroke. 3 patients (3.6%) were hospitalized for acute heart failure, 1 of them after His lead dislodgement. Finally, 5 patients (6.1%) died during follow-up, but no death was related to cardiovascular events. Conclusions HBP is an effective technique to obtain a more physiological cardiac pacing but it is limited by a moderate rate of procedural failure and follow-up complications, mainly rising in pacing threshold and oversensing events. This is probably due to suboptimal implantation tools and lack of specific programming algorithms. New dedicated tools, increased experience and knowledge of device limitations and optimal programming are needed to improve future outcomes. Funding Acknowledgement Type of funding sources: None.