Diagnostic performance of gadobenate dimeglumine enhanced MR angiography of the iliofemoral and calf arteries: a large-scale multicenter trial

OBJECTIVE. The purpose of this study was to compare gadobenate dimeglumine\u2013enhanced MR angiography and unenhanced time-of-flight MR angiography for the detection of significant peripheral arterial occlusive disease using digital subtraction angiography as our reference standard. SUBJECTS AND METHODS. Two hundred seventy-two patients underwent MR angiography and digital subtraction angiography of the iliofemoral arteries. MR angiography was performed before (2D time-of-flight acquisitions) and after (spoiled gradient-echo acquisitions) the administration of 0.1 mmol/kg of gadobenate dimeglumine at 1\u20132 mL/s. Contrast-enhanced MR angiography and digital subtraction angiography of the calf arteries were performed in 241 of 272 participants. Images were evaluated on-site and by four blinded reviewers (three for MR angiography, one for digital subtraction angiography). Comparative diagnostic performance for the detection of significant ( 65 51% vessel lumen narrowing) disease was evaluated using the McNemar test and generalized estimating equations. Interobserver agreement was assessed with generalized kappa statistics. The chi-square test was used to compare technical failure rates. RESULTS. Digital subtraction angiography confirmed significant disease (597 stenoses, 386 occlusions) in 983 iliofemoral segments. The sensitivity (54\u201380.9%), specificity (89.7\u201395.3%), and accuracy (85\u201387.5%) of contrast-enhanced MR angiography for the detection of significant iliofemoral disease were significantly (p < 0.001, all reviewers) better than those of time-of-flight MR angiography (33.2\u201362.8%, 74.3\u201388.9%, and 68\u201377.3%, respectively). Similar diagnostic performance was obtained for the calf arteries. The technical failure rate with contrast-enhanced MR angiography (2.5\u20133.4%) was similar to that of digital subtraction angiography (1.4%) and significantly (p < 0.001) lower than that of time-of-flight MR angiography (6.2\u201318.0%). Significantly better reproducibility (p < 0.001) was obtained with contrast- enhanced MR angiography (82% vs 65.2% agreement; \u3ba = 0.66 vs 0.45). CONCLUSION. Improved diagnostic performance and reproducibility are achievable with gadobenate dimeglumine\u2013enhanced MR angiography in patients with peripheral arterial occlusive disease

Employee workplace effectiveness : implications for performance management practices and research

This article discusses the implications for senior managers and human resource management (HRM) specialists of operating a performance management system that takes into account employee workplace effectiveness. Performance management systems need to be compatible with, and complemented by, other HRM systems. If sub-par employee performance is diagnosed to reflect shortcomings of organizational culture, this is a call to top management to indicate, through acts of leadership, their commitment to building a culture that expects and values citizenship, emotional labor and intelligence, and ethics. At the level of organization, collective capabilities, such as gaining the trust of customers, or arriving at tailored solutions through cross-functional collaboration, may reflect core competencies that draw upon the non-task performance domains to provide sustained competitive advantage. A major contemporary challenge for strategic HRM is to realize the full gamut of capabilities and core competencies of organizations and their members. It is suggested that in order to achieve this, employee performance management systems should not focus narrowly on task performance, should emphasize employee development rather than control, and should consider judgments from all sides about employees\u27 actual and potential contributions in the supporting performance domains of citizenship, emotions, and ethics