Californians Need Beaches--Maybe Yours

Our nation faces a serious problem of congested recreational resources as a result of a rapid increase in population compounded by concomitant increases in urbanization and leisure time. These factors simultaneously increase the demand for more public recreational areas and reduce the amount of space available. Necessarily, this expending demand comes into conflict with the private property rights of those who hold title to lands particularly suited for public recreational purposes. A recently litigated aspect of this conflict involves the ownership of the beach areas of our nation\u27s sea coasts. Public interest demands public use, access, and enjoyment; traditional property concepts permit title to the vast majority of beaches to be privately held... It will be the purpose of this note to examine the effectiveness of some current judicial and legislative attempts to resolve this conflict. In addition, possible alternative approaches, in accordance with general public policy, will be suggested

PMD80 Preferences for a New Imaging Technique to Detect Breast Cancer

Objectives Currently, new techniques for the detection of breast cancer are being developed that cause less patient discomfort than X-ray mammography. These techniques might increase screening attendance, and therefore increase the health gains of the population of women in the Netherlands. One of these techniques is photo acoustic mammography (PAM). However, it is still unknown how important attributes such as discomfort, risks and health gains are to its implementation in breast cancer screening. Methods The Analytic Hierarchy Process (AHP), a technique for multi-criteria analysis, was used to estimate patient and health care professionals' preferences for three scenarios of PAM. These scenarios differed in the diagnostic performance that could be achieved by PAM. Preferences for the scenarios of PAM were compared with the preferences for X-ray mammography. Criteria related to the efficiency in applying the technique, diagnostic performance, patient comfort and safety. We elicited preferences of around 30 health care professionals and 300 patients. Results Health care professionals considered the sensitivity of the imaging technique to be the criterion of utmost importance in the selection of a new imaging technique to detect breast cancer. Advantages of less discomfort have relatively less meaning according to the laboratory workers and radiologists involved. However, preferences among patients and health care providers differed. Conclusions New techniques to detect breast cancer in screening programs should at least equal the diagnostic performance of X-ray mammography. Additional advantages could slightly increase screening attendance. X-ray mammography has a relatively lower diagnostic performance for patients with dense breasts. This subpopulation of patients could be the most promising area for new detection techniques with a working principle that differs from X-ray mammograph

A Major Asymmetric Dust Trap in a Transition Disk

The statistics of discovered exoplanets suggest that planets form efficiently. However, there are fundamental unsolved problems, such as excessive inward drift of particles in protoplanetary disks during planet formation. Recent theories invoke dust traps to overcome this problem. We report the detection of a dust trap in the disk around the star Oph IRS 48 using observations from the Atacama Large Millimeter/submillimeter Array (ALMA). The 0.44-millimeter-wavelength continuum map shows high-contrast crescent-shaped emission on one side of the star originating from millimeter-sized grains, whereas both the mid-infrared image (micrometer-sized dust) and the gas traced by the carbon monoxide 6-5 rotational line suggest rings centered on the star. The difference in distribution of big grains versus small grains/gas can be modeled with a vortex-shaped dust trap triggered by a companion.Comment: 25 pages, 7 figures (accepted version prior to language editing

Integrating patient preferences in efficiency frontier analyses using the analytical hierarchy process

OBJECTIVES: In comparative effectiveness research and economic evaluations, benefits of technologies are measured using multiple outcomes measures. Information lacks however about the importance of these endpoints for patients. We propose a new methodology to integrate patient weighted outcomes in a cost-efficiency frontier. We illustrate this methodology by means of an efficiency frontier analysis of five alternative treatments of patients with equinovarus deformity poststroke. METHODS: The Analytic Hierarchy Process (AHP) is a technique for multi-criteria analysis. The AHP supported 140 patients to prioritize the outcome measures of treatments of equinovarus deformity poststroke, and 10 professionals to prioritize the treatments regarding the outcome measures. These outcome measures include functional outcomes, risk and side effects, comfort, daily effort, cosmetics, and impact of the treatment. Sensitivity analysis is based on bootstrapping of the participants’ priorities. Relative costs include the device related costs and the care related costs of the treatments. RESULTS: The overall effectiveness of soft-tissue surgery (.41) is ranked first, followed by orthopedic footwear (.18), ankle-footorthosis (.15), surface electrostimulation (.14), and finally implanted electrostimulation (.12). Implanted electrostimulation (.35) and soft-tissue surgery (.34) are considered to be most expensive, followed by surface electrostimulation (.26), orthopedic footwear (.03) and ankle-foot orthosis (.02). Based on these priorities of the treatments’ overall effectiveness and costs, an efficiency frontier was drawn that includes decision uncertainty. CONCLUSIONS: The results suggest that the cost-effectiveness of implanted electrostimulation and surface electrostimulation are unfavourable. This new methodology for efficiency frontier analysis allows decision makers to integrate the outcomes about the diverse values and costs of health care technology, and can be applied broadly. It is particularly suitable in the field of early technology assessment, since the AHP supports a systematic estimation of priors about the effectiveness of alternative treatments

Public stated preferences and predicted uptake for genome-based colorectal cancer screening

Background Emerging developments in nanomedicine allow the development of genome-based technologies for non-invasive and individualised screening for diseases such as colorectal cancer. The main objective of this study was to measure user preferences for colorectal cancer screening using a nanopill. Methods A discrete choice experiment was used to estimate the preferences for five competing diagnostic techniques including the nanopill and iFOBT. Alternative screening scenarios were described using five attributes namely: preparation involved, sensitivity, specificity, complication rate and testing frequency. Fourteen random and two fixed choice tasks, each consisting of three alternatives, were offered to 2225 individuals. Data were analysed using the McFadden conditional logit model. Results Thirteen hundred and fifty-six respondents completed the questionnaire. The most important attributes (and preferred levels) were the screening technique (nanopill), sensitivity (100%) and preparation (no preparation). Stated screening uptake for the nanopill was 79%, compared to 76% for iFOBT. In the case of screening with the nanopill, the percentage of people preferring not to be screened would be reduced from 19.2% (iFOBT) to 16.7%. Conclusions Although the expected benefits of nanotechnology based colorectal cancer screening are improved screening uptake, assuming more accurate test results and less preparation involved, the relative preference of the nanopill is only slightly higher than the iFOBT. Estimating user preferences during the development of diagnostic technologies could be used to identify relative performance, including perceived benefits and harms compared to competitors allowing for significant changes to be made throughout the process of developmen

The properties of the inner disk around HL Tau: Multi-wavelength modeling of the dust emission

We conducted a detailed radiative transfer modeling of the dust emission from the circumstellar disk around HL Tau. The goal of our study is to derive the surface density profile of the inner disk and its structure. In addition to the Atacama Large Millimeter/submillimeter Array images at Band 3 (2.9mm), Band 6 (1.3mm), and Band 7 (0.87mm), the most recent Karl G. Jansky Very Large Array (VLA) observations at 7mm were included in the analysis. A simulated annealing algorithm was invoked to search for the optimum model. The radiative transfer analysis demonstrates that most radial components (i.e., >6AU) of the disk become optically thin at a wavelength of 7mm, which allows us to constrain, for the first time, the dust density distribution in the inner region of the disk. We found that a homogeneous grain size distribution is not sufficient to explain the observed images at different wavelengths simultaneously, while models with a shallower grain size distribution in the inner disk work well. We found clear evidence that larger grains are trapped in the first bright ring. Our results imply that dust evolution has already taken place in the disk at a relatively young (i.e., ~1Myr) age. We compared the midplane temperature distribution, optical depth, and properties of various dust rings with those reported previously. Using the Toomre parameter, we briefly discussed the gravitational instability as a potential mechanism for the origin of the dust clump detected in the first bright ring via the VLA observations.Comment: Accepted for publication in A&A (10 pages