Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population

The coronary artery calcium (CAC) score is a readily and widely available tool for the noninvasive diagnosis of atherosclerotic coronary artery disease (CAD). The aim of this study was to investigate the added value of the CAC score as an adjunct to gated SPECT for the assessment of CAD in an intermediate-risk population. METHODS: Seventy-seven prospectively recruited patients with intermediate risk (as determined by the Framingham Heart Study 10-y CAD risk score) and referred for coronary angiography because of suspected CAD underwent stress (99m)Tc-tetrofosmin SPECT myocardial perfusion imaging (MPI) and CT CAC scoring within 2 wk before coronary angiography. The sensitivity and specificity of SPECT alone and of the combination of the 2 methods (SPECT plus CAC score) in demonstrating significant CAD (>/=50% stenosis on coronary angiography) were compared. RESULTS: Forty-two (55%) of the 77 patients had CAD on coronary angiography, and 35 (45%) had abnormal SPECT results. The CAC score was significantly higher in subjects with perfusion abnormalities than in those who had normal SPECT results (889 +/- 836 [mean +/- SD] vs. 286 +/- 335; P < 0.0001). Similarly, with rising CAC scores, a larger percentage of patients had CAD. Receiver-operating-characteristic analysis showed that a CAC score of greater than or equal to 709 was the optimal cutoff for detecting CAD missed by SPECT. SPECT alone had a sensitivity and a specificity for the detection of significant CAD of 76% and 91%, respectively. Combining SPECT with the CAC score (at a cutoff of 709) improved the sensitivity of SPECT (from 76% to 86%) for the detection of CAD, in association with a nonsignificant decrease in specificity (from 91% to 86%). CONCLUSION: The CAC score may offer incremental diagnostic information over SPECT data for identifying patients with significant CAD and negative MPI results.

Added value of dual-energy computed tomography versus single-energy computed tomography in assessing ferromagnetic properties of ballistic projectiles: implications for magnetic resonance imaging of gunshot victims.

OBJECTIVE The objective of this study was to assess the discriminative power of dual-energy computed tomography (DECT) versus single-energy CT (SECT) to distinguish between ferromagnetic and non-ferromagnetic ballistic projectiles to improve safety regarding magnetic resonance (MR) imaging studies in patients with retained projectiles. MATERIALS AND METHODS Twenty-seven ballistic projectiles including 25 bullets (diameter, 3-15 mm) and 2 shotgun pellets (2 mm each) were examined in an anthropomorphic chest phantom using 128-section dual-source CT. Data acquisition was performed with tube voltages set at 80, 100, 120, and 140 kV(p). Two readers independently assessed CT numbers of the projectile's core on images reconstructed with an extended CT scale. Dual-energy indices (DEIs) were calculated from both 80-/140-kV(p) and 100-/140-kV(p) pairs; receiver operating characteristics curves were fitted to assess ferromagnetic properties by means of CT numbers and DEI. RESULTS Nine (33%) of the projectiles were ferromagnetic; 18 were nonferromagnetic (67%). Interreader and intrareader correlations of CT number measurements were excellent (intraclass correlation coefficients, >0.906; P<0.001). The DEI calculated from both 80/140 and 100/140 kV(p) were significantly (P<0.05) different between the ferromagnetic and non-ferromagnetic projectiles. The area under the curve (AUC) was 0.75 and 0.8 for the tube voltage pairs of 80/140 and 100/140 kV(p) (P<0.05; 95% confidence interval, 0.57-0.94 and 0.62-0.97, respectively) to differentiate between the ferromagnetic and non-ferromagnetic ballistic projectiles; which increased to 0.83 and 0.85 when shotgun pellets were excluded from the analysis. The AUC for SECT was 0.69 and 0.73 (80 and 100 kV[p], respectively). CONCLUSIONS Measurements of DECT combined with an extended CT scale allow for the discrimination of projectiles with non-ferromagnetic from those with ferromagnetic properties in an anthropomorphic chest phantom with a higher AUC compared with SECT. This study indicates that DECT may have the potential to contribute to MR safety and allow for MR imaging of patients with retained projectiles. However, further studies are necessary before this concept may be used to triage clinical patients before MR.

Don't forget asking the others! - The added value of significant other's reports on patient interpersonal style for the prediction of therapy process and outcome

Theory: Interpersonal factors play a major role in causing and maintaining depression. It is unclear, however, to what degree significant others of the patient need to be involved for characterizing the patient's interpersonal style. Therefore, our study sought to investigate how impact messages as perceived by the patients' significant others add to the prediction of psychotherapy process and outcome above and beyond routine assessments, and therapist factors. Method: 143 outpatients with major depressive disorder were treated by 24 therapists with CBT or Exposure-Based Cognitive Therapy. Interpersonal style was measured pre and post therapy with the informant‐based Impact Message Inventory (IMI), in addition to the self‐report Inventory of Interpersonal Problems (IIP‐32). Indicators for the patients' dominance and affiliation as well as interpersonal distress were calculated from these measures. Depressive and general symptomatology was assessed at pre, post, and at three months follow‐up, and by process measures after every session. Results: Whereas significant other's reports did not add significantly to the prediction of the early therapeutic alliance, central mechanisms of change, or post‐therapy outcome including therapist factors, the best predictor of outcome 3 months post therapy was an increase in dominance as perceived by significant others. Conclusions: The patients' significant others seem to provide important additional information about the patients' interpersonal style and therefore should be included in the diagnostic process. Moreover, practitioners should specifically target interpersonal change as a potential mechanism of change in psychotherapy for depression.

The facility manager architect : the social responsability as an added value.

From the very first steps to execute a building, it is essential to analyze its life cycle. Similarly, we should consider the life cycle when projecting an urban intervention. Professionals of the Facility Management take part in construction projects, developing and managing DBFMO projects (Design, Build, Finance, Maintenance & Operate). Whatever the nature of the promoter is – private or public – promoters are leaders in projects of responsible management of spaces, whether these are work spaces, leisure spaces or residential spaces. They know and identify with the company and its performance, its values and its needs. These professionals give sustainable solutions in the life cycle of buildings (offices and housing), new ways to work and initiatives of innovations linked to current social changes: technology, social networks, and new habits. Concepts where innovation is essential should consider responsible values. Social, economic and sustainable aspects have to associate with the management performed by a Facilities Manager when considering the three groups of stakeholders with which it is linked: economic (shareholders), contractual (users), non-contractual (neighborhoods, organizations, etc.). Marcus Vitruvius Pollio, at the beginning of his book "The Ten Books on Architecture" describes and argues how the distribution in buildings must always adapt to their inhabitants. Let us build cities and buildings with responsible criteria, bearing in mind all its users and the needs of each one of them. Not to mention the need to adapt to future requirements with minimum cost and maximum profitability. These needs, under responsible management, are competencies developed by a Facilities Manager in his day to day. He cares and takes over the entire life cycle of buildings and their surroundings. This work is part of the PhD project whose main aim is to study the added value to the architectural profession when social responsibility criteria are applied in his/her role as Facility Manager.

Conflicting Role Conceptions: In Search of the European Union's Added Value for its Southern Neighbors. Bruges Regional Integration & Global Governance Paper 04/2014

Many scholars have analyzed the role of the European Union (EU) in its southern neighborhood by looking at the EU’s policy documents and strategies. As such, it is often argued that the EU is at best a useful partner in democratic reform and at worst an unsuccessful ‘normative power’. However, very few studies have analyzed the EU’s role from the recipients’ point of view: the southern neighboring countries themselves. This paper adopts an ‘outside-in approach’ and explores what the southern neighborhood countries believe the EU should be or do. On the basis of a set of 15 interviews with diplomats from the region and an analysis of 50 newspaper articles from the region on the EU’s relations with its southern neighborhood, this paper seeks to reveal the EU’s real ’added value’ for its southern Mediterranean partners. To what extent does the EU’s own perceived role in its southern neighborhood match the role conception of those countries? Based on the three case studies of Algeria, Jordan and Egypt, the paper finds that there is a clear divergence in role conceptions between the EU and its southern partners. While the EU sees itself as a ‘force for good’ and promoter of norms and democracy in the southern Mediterranean region, the three countries primarily believe that the EU perceives itself foremost as a provider of security and stability in the region, while they primarily expect it to act as a reliable partner for economic cooperation.

Macroeconomic Conditionality in Cohesion Policy: Added Value or Unnecessary Burden? European Policy Brief No. 13, November 2012

Macroeconomic conditionality has become one of the major elements in discussions on the future of EU cohesion policy. Such conditional-ity would make the cohesion budget dependent on EU economic governance rules. This would have advantages for economic governance and, to a lesser extent, the efficiency of cohesion policy and the EU’s Multiannual Financial Framework negotiations. Yet, conditionality also risks entailing serious disadvantages for the end beneficiaries and cohesion policy itself. If the EU decides to put macroeconomic conditionality in place, it needs to reconsider the design and agree on an ample cohesion budget.

The propriety of allowing a qualified exportation of wool discussed historically. To which is added an appendix: containing a table, which shews the value of the woolen goods of every kind, that were entered for exportation at the custom-house, from 1697 to 1780 inclusive, as well as the prices of wool in England, during all that period.

Mode of access: Internet.

The civil divisions of the county of Dorset, methodically digested and arranged, comprising lists of the civil ministerial officers, magistrates, and subordinate officers; with a complete nomina villarum, in four parts; a list of the county and other bridges; together with the annual value of real property; amount of the land tax ... and the rules and orders for regulation of the practice of the quarter sessions ... Also, an appendix, containing abstracts of returns of charitable donations ...

Mode of access: Internet.

The American builder's general price book and estimator, now first published to elucidate the principles of ascertaining the correct value of every description of artificers' work required in building, from the prime cost of materials and labour in any part of the United States ... to which are added, a variety of useful tables, memorandums, etc.

Microfilm. Ann Arbor, Mich., University Microfilms [n.d.] (American culture series, Reel 35.10)

The value of dividend imputation tax credits in Australia

A dividend imputation tax system provides shareholders with a credit (for corporate tax paid) that can be used to offset personal tax on dividend income. This paper shows how to infer the value of imputation tax credits from the prices of derivative securities that are unique to Australian retail markets. We also test whether a tax law amendment that was designed to prevent the trading of imputation credits affected their economic value. Before the amendment, tax credits were worth up to 50% of face value in large, high-yielding companies, but Subsequently it is difficult to detect any value at all. (C) 2003 Elsevier B.V. All rights reserved.

Customer value based entry decision in International markets the concept of International Added Customer Equity

Market entry decisions are some of a firm's most important long-term strategic choices. Still, the international marketing literature has not yet fully incorporated the idea of relationship marketing in general, and the customer value concept in particular, as a basis for market entry decisions. This article presents some conceptual ideas about a customer value based market selection model. The metric International Added Customer Equity (IACE), a straightforward decision criterion derived from the customer equity concept is presented as an additional decision criterion for export market selection and ultimately market entry.

The Future of EU Cohesion Policy. Endogenous Development – Added Value of Intervention – Regulatory Frameworks

The successful operation of the regional development – or cohesion – policy of the European Union has a strategic importance from the point of view of the whole integration process. Strengthening economic, social and territorial cohesion and decreasing disparities between member states and regions are not only one of the main priorities of the integration, but at the same time these are justified expectations of the people living in the member states of the union. The cohesion transfers should be spent on those factors which have the biggest contribution to the improvement of development prospects and competitiveness in the given regions. Theories on regional development have controversial conclusions about the long-term formation of development disparities. However, it has become evident that successful development policies are based on endogenous factors, innovation and well-functioning institutions. After examining theoretical considerations and regional disparities the study analyses the impacts of EU regional policy and evaluates the main elements of the proposed regulatory frameworks for the period 2014-2020.