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Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without damage to adjacent structures. Here in the MANIFEST-17K study we assessed the safety of PFA by studying the post-approval use of this treatment modality. Of the 116 centers performing post-approval PFA with a pentaspline catheter, data were received from 106 centers (91.4% participation) regarding 17,642 patients undergoing PFA (mean age 64, 34.7% female, 57.8% paroxysmal AF and 35.2% persistent AF). No esophageal complications, pulmonary vein stenosis or persistent phrenic palsy was reported (transient palsy was reported in 0.06% of patients; 11 of 17,642). Major complications, reported for ~1% of patients (173 of 17,642), were pericardial tamponade (0.36%; 63 of 17,642) and vascular events (0.30%; 53 of 17,642). Stroke was rare (0.12%; 22 of 17,642) and death was even rarer (0.03%; 5 of 17,642). Unexpected complications of PFA were coronary arterial spasm in 0.14% of patients (25 of 17,642) and hemolysis-related acute renal failure necessitating hemodialysis in 0.03% of patients (5 of 17,642). Taken together, these data indicate that PFA demonstrates a favorable safety profile by avoiding much of the collateral damage seen with conventional thermal ablation. PFA has the potential to be transformative for the management of patients with AF.

Purpose: The purpose of this article is to examine the factors that influence turnover intentions by examining the effect of congruent internal marketing on turnover intentions among restaurant employees in North Cyprus. The study also integrates work immersion variables to factor in the reduction of turnover intentions of employees. Design/methodology/approach: The quantitative study employed questionnaires distributed to 150 participants at various restaurants throughout Northern Cyprus. The study's results were utilized to examine the effect of several components of congruent internal marketing on turnover intention, including work engagement, job satisfaction, coaching and employee development structural equation modelling. Findings: The study confirmed a positive and significant relationship between congruent internal marketing and turnover intentions, work engagement, job satisfaction and management coaching. It is evident that congruent internal marketing is contingent on elements that minimize employees' turnover intentions. Given the increasing pace of voluntary and involuntary turnover, it is critical to provide concise research for both present and future analysis. Research limitations/implications: The data collection for this study was limited to the cities of Northern Cyprus, as it focuses on small business operations. Additionally, the researchers were able to collect data from only 30 establishments during the pandemic. Quintessential implication of the current study posits how internal marketing efforts coupled with coaching and engagement practises helps to reduce turnover. Originality/value: Recently, turnover intention has emerged as a major source of concern for business and organizational survivors, particularly during this COVID-19 pandemic. This had a detrimental effect on local and international enterprises, health, education, hotels and tourism. In essence, the current crisis has had a profound effect on both internal marketing and employee turnover intentions. Drawn from the POS and SET theories, the current study develops and tests parsimonious model in fostering avenues to reduce turnover. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) is an important cause of postoperative morbidity and, in severe cases, mortality.The epidemiology of SSIs varies depending on the type of surgery and the country. It is influenced by patient‐related, preoperative, intraoperative and postoperative risk factors.Prevention strategies target these risk factors and include measures taken before, during and after surgery. To understand how SSIs can be prevented, depending on the type of wound, especially perioperative measures including antibiotic prophylaxis, and when to institute repeat antibiotics or alter dosages.To understand the bases of and approaches to perioperative antibiotics in women with incidental infections (for example, lower genital and urinary tract) and in women with comorbidities, such as those who are immunosuppressed or with mechanical valvar heart diseases.To understand what specific measures to take to reduce the risk of SSIs in special cases in obstetrics and gynaecology, such as in morbidly obese women, those undergoing cancer surgery, or those with cardiac conditions or transplants. Should perioperative antibiotics be given to every woman undergoing surgery?What is the risk of antibiotic resistance as a result of administration of perioperative antibiotics?

Obesity is a major determinant of health outcomes and is on the increase in women worldwide. It predisposes to surgical site infection (SSI). Risk factors for the SSI include extremes of age, smoking, comorbidities such as hypertension and diabetes, inappropriate vertical abdominal and or uterine wall incisions, increased operating time, subcutaneous layer of 3 cm or more, and unnecessary use of subcutaneous drain. Most bacteria that cause SSIs are human commensals. Common organisms responsible for SSI include Staphylococcus aureusand coliforms such as Proteus mirabilis, and Escherichia coli. A surgeon's gloves post caesarean section in the obese has a preponderance of Firmicutes and Bacteroidetes, which increases SSI risk. The interaction of skin commensals and vaginal microbiome at the surgical incision site increases the risk of SSI in the obese compared to non-obese. Minimizing the risk of SSI involves modification of risk factors, timely treatment of SSI to prevent sepsis and compliance with the recommended care bundles.

Introduction:Diabetes Mellitus (DM) is a major risk factor for coronary artery disease (CAD) associated with a two-fold increase in mortality. We aimed to validate the performance of a machine learning based multi-biomarker diagnostic panel to predict obstructive coronary artery disease (oCAD) compared to high-sensitivity cardiac troponin-I (hs-cTnI) alone in a subset of patients with DM.Methods:A previously developed multiple biomarker scoring model was utilized. The pooled cohort included 132 patients at Inova Fairfax Hospital, 69 patients at Massachusetts General Hospital and 46 patients at the University Hospital Hamburg-Eppendorf with a mixture of acute and lesser acute presentations. Three clinical factors (sex, age, and previous coronary percutaneous intervention) and three biomarkers (hs-cTnI, Adiponectin, and Kidney Injury Molecule-1) were combined. oCAD was defined as >50% coronary obstruction in at least one coronary artery (for the University Hospital Hamburg-Eppendorf cohort) or >70% coronary obstruction in at least one coronary artery (for the other two cohorts). The multiple biomarker diagnostic panel’s performance to predict oCAD was also compared to hs-cTnI alone.Results:The multiple protein panel had an area under the receiver-operating characteristic curve of 0.77 (95% CI, 0.70, 0.84, p <0.001) for the presence of oCAD (Figure 1). At optimal cutoff, the score had 79% sensitivity, 57% specificity, and a positive predictive value of 81% for oCAD. The multiple biomarker panel had a diagnostic odds ratio of 4.82 (95% CI 2.68, 8.67, p<0.01). In comparison, in patients without an acute MI, hs-cTnI alone had an area under the receiver-operating characteristic curve of 0.53 (95% CI, 0.49, 0.57, p = 0.253) for oCAD (Figure 1).Conclusions:In this multinational pooled cohort, a previously described novel machine learning, multiple protein biomarker panel provided high accuracy to diagnose patients for oCAD in a subset of patients with DM.

Severe malnutrition is associated with septic infections. The concentrations of fibronectin, albumin, and transferrin in plasma were measured in three groups of children with protein‐energy malnutrition, aged 1‐3 years, each group comprising 20 children. The aim of which was to test whether plasma fibronectin, being an opsonic protein, was reduced in such children, and if it was a useful index for assessing the severity of malnutrition. The concentrations of fibronectin, albumin, and transferrin in plasma were studied by enzyme immunoassay/immunoblotting, spectrophotometry and immunoturbidimetry respectively. All values were significantly lower in the patients with malnutrition than in the age‐ and sex‐matched well‐nourished Nigerian reference children. Within the malnourished group, the fibronectin value was evenly reduced in all subgroups. Albumin and transferrin values were lowest in the patients with kwashiorkor, highest in the marasmic patients, and intermediate in the patients with marasmic kwashiorkor; the values correlated mutually in individual cases as well, but not with the fibronectin levels. Neither plasma fibronectin fragmentation nor tissue fibronectin was detected in any patient with malnutrition or in the reference subjects. The reduced plasma fibronectin values in these patients may be due to reduced synthesis by the liver, as evidenced by the equally reduced albumin and transferrin concentrations and/or to the multiple infections characteristic of the patients.