Is there a role for thoracic aortic calcium to fine-tune cardiovascular risk prediction?

Screening asymptomatic subjects to streamline measures for the prevention of cardiovascular events remains a major challenge. The established primary prevention risk-scoring methods use equations derived from large prospective cohort studies, but further fine-tuning of cardiovascular risk assessment remains important as 25 % of individuals with low estimated risk may experience cardiac events. Independent studies provided evidence that extended risk assessment using coronary artery calcium quantification may improve risk stratification as it can lead to reclassification of persons at increased risk. Particularly in intermediate-risk subjects, coronary artery calcium scoring can help to correctly identify individuals at highest risk. Data on the extent of calcification of the ascending and descending thoracic aorta might be useful for additional cardiovascular risk stratification. Future analyses and studies will be required to answer the question of whether the implementation of such data may allow further fine-tuning of cardiovascular risk prediction in specific subpopulations—for instance in women or men with an increased risk of stroke and/or symptomatic peripheral vascular diseas

The Role of Attitude Strength in Marketing Intelligence Use Concerning Customer Satisfaction

attitude, marketing, customer satisfaction

Customer evaluations of after-sales service contact modes: An empirical analysis of national culture�s consequences

customer, service, culture, evaluation

Customer evaluations of after-sales service contact modes : an empirical analysis of national culture's consequences

Technological advances extend the after-sales services portfolio from traditional service encounters to voice- and bit-based services. Technology enables service organizations to transcend geographical as well as cultural boundaries. It might even result in geographical convergence, often treated synonymously with cultural convergence. In this paper we address this issue. This paper examines the interaction between perceived service performance and national cultural characteristics in the formation of customer satisfaction for three types of after-sales service contact modes. The results suggest that, in contrast to the traditional face-to-face service encounter, the perceived quality-satisfaction relationship is particularly moderated by national culture in case of an after-sales service contact mode mediated by technology

Are component endpoints equal?:A preference study into the practice of composite endpoints in clinical trials

Objectives: To examine patients’ perspectives regarding composite endpoints and the utility patients put on possible adverse outcomes of revascularization procedures. Design: In the PRECORE study, a stated preference elicitation method Best-Worst Scaling (BWS) was used to determine patient preference for 8 component endpoints (CEs): need for redo percutaneous coronary intervention (PCI) within 1 year, minor stroke with symptoms <24 hours, minor myocardial infarction (MI) with symptoms <3 months, recurrent angina pectoris, need for redo coronary artery bypass grafting (CABG) within 1 year, major MI causing permanent disability, major stroke causing permanent disability and death within 24 hours. Setting: A tertiary PCI/CABG centre. Participants: One hundred and sixty patients with coronary artery disease who underwent PCI or CABG. Main outcome measures: Importance weights (IWs). Results: Patients considered need for redo PCI within 1 year (IW: 0.008), minor stroke with symptoms <24 hours (IW: 0.017), minor MI with symptoms <3 months (IW: 0.027), need for redo CABG within 1 year (IW: 0.119), recurrent angina pectoris (IW: 0.300) and major MI causing permanent disability (IW: 0.726) less severe than death within 24 hours (IW: 1.000). Major stroke causing permanent disability was considered worse than death within 24 hours (IW: 1.209). Ranking of CEs and the relative values attributed to the CEs differed among subgroups based on gender, age and educational level. Conclusion: Patients attribute different weight to individual CEs. This has significant implications for the interpretation of clinical trial data