The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation

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Examining the hierarchy of destination brands and the chain of effects between brand equity dimensions

ABSTRACT: This paper focuses on the customer-based brand equity for a tourist destination, and develops a model including the dimensions of this construct (i.e. awareness, image, perceived quality and loyalty). Accordingly, loyalty is considered the main dependent variable in the model developed here. A major contribution of this paper is that it takes into account the hierarchy of destination brands and analyzes not only the chain of effects between the dimensions of brand equity for a regional destination but also the influence of the country destination image (i.e. the country is considered to be an umbrella brand) on the perceived image of one of its regional destinations. Another significant contribution is made by examining the moderating effect of country familiarity on the relationship with both types of image. The empirical evidence obtained from a sample of 253 international tourists visiting a regional destination in Spain supports the hypothesis that loyalty towards a destination is positively influenced by the perceived quality of the destination, which in turn is directly influenced by the image and awareness of that destination. Additionally, the results support the idea that perceptions of a regional destination are positively influenced by the perceptions of the country destination in which the region is located. However, a moderating effect of country familiarity on the relationship with either type of image was not supported in this research. This could be because in a country where there are a lot of destination brands, being more familiar with the country does not necessarily imply a more accurate knowledge of its regional destinations

First report on the herpetofauna of Pulau Aur, Johor, West Malaysia

With the exception ofTweedie's (1983) account ofCalamaria lovii, published accounts on the herpetofauna of Pulau Aur, located 63 km off the south-east coast of peninsular Malaysia in the South China Sea did not exist prior to this report. The only species known from the island were based on the museum records ofLimnonectes blythii, Mabuya multi/asciata, Bronchocela cristatella, Gehyra mutilata, Varanus nebulosus and Ahaetulla prasina deposited in the Raffles Museum of Biodiversity Research. A short expedition to the island on 15-16 July 2001 yielded an additional 12 species, comprising 10 lizards and two snakes: Limnonectes blythii; Bronchocela cristatella; Cnemaspis cf. Nigridia; Cosymbotus platyurus; Cyrtodactylus consobrinus; Gehyra mutilata; Gekko monarchus; Hemidactylus frenatus; Dasia o/ivacea; Emoia atrocostata; Lygosoma bowring;;; Mabuya multi/asciata; Sphenomorphus scotophi/us; Varanus nebulosus; Varanus salvator; Ramphotyphlops cf. braminus; Calamaria lovii and Macropisthodon flaviceps

Immunogenicity of botulinum toxins

Botulinum neurotoxins are formulated biologic pharmaceuticals used therapeutically to treat a wide variety of chronic conditions, with varying governmental approvals by country. Some of these disorders include cervical dystonia, post-stroke spasticity, blepharospasm, migraine, and hyperhidrosis. Botulinum neurotoxins also have varying governmental approvals for cosmetic applications. As botulinum neurotoxin therapy is often continued over many years, some patients may develop detectable antibodies that may or may not affect their biological activity. Although botulinum neurotoxins are considered “lower risk” biologics since antibodies that may develop are not likely to cross react with endogenous proteins, it is possible that patients may lose their therapeutic response. Various factors impact the immunogenicity of botulinum neurotoxins, including product-related factors such as the manufacturing process, the antigenic protein load, and the presence of accessory proteins, as well as treatment-related factors such as the overall toxin dose, booster injections, and prior vaccination or exposure. Detection of antibodies by laboratory tests does not necessarily predict the clinical success or failure of treatment. Overall, botulinum neurotoxin type A products exhibit low clinically detectable levels of antibodies when compared with other approved biologic products. This review provides an overview of all current botulinum neurotoxin products available commercially, with respect to the development of neutralizing antibodies and clinical response

Life insurance companies : analysis of policyholders' perception and financial benefits.

This research project aims to find out which insurer is perceived by policyholders to be the “best insurance company”, the most important attribute(s) that an insurer should have and the most influential channel(s) of communication that affect(s) policyholder’s perception. In addition, we also try to identify the insurer that offers the highest financial benefits

Research on NBS undergraduates' proficiency in microsoft office applications

In order to determine whether NBS final-year undergraduates are competent in harnessing the tools of the MS Office applications to complete realistic computer tasks identified by the industry, a "task-based" MS Excel test was designed for this purpose

Real-world characteristics and readmissions among patients undergoing ablation for ventricular tachycardia: a retrospective database analysis of commercially insured patients in the USA

BACKGROUND: Radiofrequency catheter ablation is an effective treatment to alleviate symptoms and reduce recurrent implantable cardioverter-defibrillator (ICD/CRT-D) shocks in patients with ventricular tachycardia (VT). OBJECTIVE: To assess the characteristics and outcomes (complications, inpatient readmissions) of commercially insured patients in the USA undergoing ablation for ischaemic or non-ischaemic VT. METHODS: Patients aged 18-64 years with a primary diagnosis of VT who underwent ablation between 2006 and 2015 were identified using the IBM MarketScan Commercial Database. The rate of complications including vascular complications, pericarditis, pulmonary embolism and pericardial tamponade over a 30-day post-ablation period (including index admission) was examined. Inpatient readmissions (VT-related, heart failure (HF)-related and non-VT arrhythmia-related) over the 12-month post-ablation period were examined. A Cox regression model was used to determine factors associated with inpatient readmissions. RESULTS: 5242 patients (488 with ischaemic and 4754 with non-ischaemic VT) met the study criteria. The majority of VT ablations occurred in an outpatient setting (57% for ischaemic and 66% for non-ischaemic VT). Among complications, vascular complications were most frequent (2.05% among ischaemic and 1.6% among non-ischaemic VT patients) over the 30-day post-ablation period. Among ischaemic VT patients, 17%, 7.6% and 4.7% had VT-related, HF-related and non-VT arrhythmia-related inpatient readmissions, respectively in the 12-month post-ablation period. For non-ischaemic VT patients, these numbers were 7.5%, 1.7% and 3.1%, respectively. Inpatient setting (vs outpatient), baseline ICD/CRT-D implantation, HF comorbidity and ≥2 prior hospitalisations were associated with a higher risk of post-ablation VT-related inpatient readmissions among ischaemic VT patients. Similar factors also were associated with a higher risk of post-ablation VT-related inpatient readmission among non-ischaemic VT patients. CONCLUSION: Setting of ablation and comorbidity status were found to influence readmission rates. Complication and readmission rates following VT ablation were low indicating towards the favourable safety profile of VT ablation

Porous tip radiofrequency ablation catheter reduced heart failure-related complications and healthcare resource utilization in paroxysmal atrial fibrillation patients

Introduction: A 56-hole porous tip radiofrequency catheter was developed to provide more uniform cooling with less fluid delivery than a prior 6-hole irrigated design. This study aimed to evaluate the impact of contact force (CF) ablation with the porous tip on complications (congestive heart failure [CHF] and non-CHF related), healthcare resource utilization, and procedural efficiency in patients undergoing de novo paroxysmal atrial fibrillation (PAF) ablations in a real-world setting. Methods: Consecutive de novo PAF ablations were performed between February 2014 and March 2019 by six operators at a single US academic center. The 6-hole design was used through December 2016 with the 56-hole porous tip adopted in October 2016. The outcomes of interest included symptomatic CHF presentation and CHF-related complications. Results: Of 174 patients who were included, mean age was 61.1 ± 10.8 years, 67.8% were male, and 25.3% had a history of CHF. Ablation with the porous tip catheter significantly decreased fluid delivery (1177 vs. 1912 mL with the 6-hole design; p \u3c.0001). CHF-related complications within 7 days, particularly fluid overload, were substantially reduced with the porous tip (15.2% vs. 5.3% of patients; p =.0281) and the proportion of patients with symptomatic CHF presentation within 30 days postablation was significantly lower (14.7% vs. 32.5%; p =.0058). Conclusion: The 56-hole porous tip led to significantly reduced CHF-related complications and healthcare utilization in PAF patients undergoing CF catheter ablation when compared to the prior 6-hole design. This reduction likely results from the significant decrease in fluid delivery during the procedure