Key issues in diagnosing and treating acute aortic syndromes: results from the metropolitan area of Bologna network

Background: Survival of patients with Acute Aortic Syndrome (AAS) may relate to the speed of diagnosis. Diagnostic delay is exacerbated by non classical presentations such as myocardial ischemia or acute heart failure (AHF). However little is known about clinical implications and pathophysiological mechanisms of Troponin T elevation and AHF in AAS. Methods and Results: Data were collected from a prospective metropolitan AAS registry (398 patients diagnosed between 2000 and 2013). Troponin T values (either standard or high sensitivity assay, HS) were available in 248 patients (60%) of the registry population; the overall frequency of troponin positivity was 28% (ranging from 16% to 54%, using standard or HS assay respectively, p = 0.001). Troponin positivity was associated with a twofold increased risk of long in-hospital diagnostic time (OR 1.92, 95% CI 1.05-3.52, p = 0.03), but not with in-hospital mortality. The combination of positive troponin and ACS-like ECG abnormalities resulted in a significantly increased risk of inappropriate therapy due to a misdiagnosis of ACS (OR 2.48, 95% CI 1.12-5.54, p = 0.02). Patients with AHF were identified by the presence of dyspnea as presentation symptom or radiological signs of pulmonary congestion or cardiogenic shock. The overall frequency of AHF was 28 % (32% type A vs. 20% type B AAS, p = 0.01). AHF was due to a variety of pathophysiological mechanisms including cardiac tamponade (26%), aortic regurgitation (25%), myocardial ischemia (17%), hypertensive crisis (10%). AHF was associated with increased surgical delay and with increased risk of in-hospital death (adjusted OR 1.97 95% CI1.13-3.37,p=0.01). Conclusions: Troponin positivity (particularly HS) was a frequent finding in AAS. Abnormal troponin values were strongly associated with ACS-like ECG findings, in-hospital diagnostic delay, and inappropriate therapy. AHF was associated with increased surgical delay and was an independent predictor of in-hospital mortality.

Consumer Perception and Willingness to Pay for Local Food

A growing number of empirical studies recently investigated consumers' valuation for local food products. However, different aspects related to the local food consumption still remain vague or unexplored. As such, the objective of the present research is to fulfill the existing literature using a mixed methodological approach for the investigation of consumers' preferences and Willingness to Pay (WTP) for local food products. First of all, local food is still a blurred concept and this factor might be source of individuals' misperception for the local origin meaning. Therefore, a qualitative research has been performed in order to investigate the meaning and the perception of the local food in the Italian food market. Results from this analysis have been used as inputs for the building of a non-hypothetical Real Choice Experiment (RCE) to estimate consumers' WTP for locally and organically produced apple sauce. The contribution of this study is three-fold: (1) consumers' valuation for the local origin is interpreted in terms of regional borders, over the organic food claim in case of an unusual food product in the area of interest, (2) the interaction between individuals' personality traits and consumers’ preferences for local and organic foods is analyzed, (3) the role of Commitment Cost creation in consumers' choice making in case of uncertainty due to the use of a novel food product and of an unconventional food claim is investigated. Results suggest that consumers are willing to pay a higher price premium for organic over locally produced apple sauce, possibly because of the presence of a regulated certification. In accordance with Commitment Cost theory, the organic label might thus decrease consumers' uncertainty for the features of the product in question. Results also indicate that individuals' personality can be source of heterogeneity in consumers' preferences.