[ECG-gated chest CT angiography: value for atypical chest pain evaluation]

PURPOSE: The aim of this study was to evaluate ECG-gated whole chest CTA as a routine triage tool for patients with acute chest pain. MATERIAL AND METHODS: Whole chest CTA with retrospective ECG-gating was performed in 30 patients with acute atypical chest pain. The ten main segments of the coronary arteries, the pulmonary arteries, the aorta, and the myocardium (function, morphology) were independently analyzed by a resident and two senior radiologists. The inter-observer agreement between resident and senior radiologists was calculated. A final diagnosis was determined by consensus. RESULTS: Thirty patients were included. The coronary artery segments, myocardium and pulmonary arteries were considered analyzable in 84%, 90% and 97% of cases respectively. A final diagnosis for the cause of pain was retained in 19 patients: significant coronary artery stenosis (5), pulmonary embolus (5), aortic dissection (1), hypokinetic cardiomyopathy (2), lung parenchymal abnormalities (5), and hiatus hernia (1). Inter-observer agreement ranged from 0.76 to 1 between senior radiologists and from 0.76 to 1 between resident and senior radiologists. The average time of image interpretation ranged from 14 to 15 minutes. CONCLUSION: ECG-gated whole chest CT angiography appears as a promising tool for the evaluation of acute chest pain. Combined evaluation of appearance and function of the myocardium can reveal additional interesting information

Sociocultural valuation of ecosystem services for operational ecosystem management : mapping applications by decision contexts in Europe

Sociocultural valuation (SCV) of ecosystem services (ES) discloses the principles, importance or preferences expressed by people towards nature. Although ES research has increasingly addressed sociocultural values in past years, little effort has been made to systematically review the components of sociocultural valuation applications for different decision contexts (i.e. awareness raising, accounting, priority setting, litigation and instrument design). In this analysis, we investigate the characteristics of 48 different sociocultural valuation applications—characterised by unique combinations of decision context, methods, data collection formats and participants—across ten European case studies. Our findings show that raising awareness for the sociocultural value of ES by capturing people’s perspective and establishing the status quo, was found the most frequent decision context in case studies, followed by priority setting and instrument development. Accounting and litigation issues were not addressed in any of the applications. We reveal that applications for particular decision contexts are methodologically similar, and that decision contexts determine the choice of methods, data collection formats and participants involved. Therefore, we conclude that understanding the decision context is a critical first step to designing and carrying out fit-for-purpose sociocultural valuation of ES in operational ecosystem management