PCV96 - Acceptability of technological treatment and the effect of respondent characteristics on treatment preference

OBJECTIVES:\ud Surgical and/or technological treatment such as nerve stimulation is becoming increasingly popular in the treatment of acquired ankle-foot deformity in rehabilitation medicine. It is known that the older and impaired population can be technology adverse. The purpose of this study was to determine the acceptability of invasive technological treatment to patients and healthy controls and to study the influence of respondent characteristics on the preference for treatment.\ud \ud METHODS:\ud A total of 204 Respondents participated in a conjoint analysis discrete choice experiment. Ankle-foot impairment was related to either central neurological (n = 58), or peripheral neurological disease (n = 54). Healthy respondents were also included (n = 92). The amount of information on the decision problem\ud which was provided to the healthy controls varied. A multinomial logit regression model was used to estimate part worth utilities for the attribute levels of 8 criteria (treatment duration, treatment impact, duration and ease of use of aids, complication severity and rate, comfort & cosmetics, result type and success rate on choice of treatment) with 2–4 levels and attribute importance and to study the influence of age, gender, educational level, cognitive impairment, physical impairment and extent of information provision prior to the experiment on the fit of the regression model.\ud \ud RESULTS:\ud All treatment attributes have a significant influence on treatment choice. Most important are impact of treatment (20%) and duration & ease of use of aids (19%). No operation (0.46) and minimal use of aids (0.39) is preferred. Age has a significant influence (W = 4.92; p = 0.026). No effect of cognitive impairment or ankle-foot impairment was found.\ud \ud CONCLUSIONS:\ud It could be concluded that 1) surgical treatment and the use of technology are considered negative aspects of treatment, and 2) age-matched healthy respondents’ preferences can be used as predictors for cognitively and physically impaired patients

From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

Objectives Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors. Objectives of this study were to identify decision criteria and their frequency reported in the literature on healthcare decisionmaking. Method An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing multicriteria tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured. Results Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 40 studies included. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 360 different terms were identified. These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context. The most frequently mentioned criteria were: equity/fairness (32 times), efficacy/effectiveness (29), stakeholder interests and pressures (28), cost-effectiveness (23), strength of evidence (20), safety (19), mission and mandate of health system (19), organizational requirements and capacity (17), patient-reported outcomes (17) and need (16). Conclusion This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-settin

Remote sensing of coastal vegetation in the Netherlands and Belgium

Vegetation maps are frequently used in conservation planning and evaluation. Monitoring commitments, a.o. in relation to the European Habitat Directive, increase the need for efficient mapping tools. This paper explores methods of vegetation mapping with particular attention to automated classification of remotely sensed images. Characteristics of two main types of imagery are discussed, very high spatial resolution false colour images on the one hand and hyperspectral images on the other. The first type has proved its qualities for mapping of - mainly - vegetation structure in dunes and salt marshes. Hyperspectral imagery enables thematic detail but encounters more technical problems

Nitrogen deposition and grass encroachment in calcareous and acidic Grey dunes (H2130) in NW-Europe

We present an overview of high nitrogen deposition effects on coastal dune grasslands in NW-Europe (H2130), especially concerning grass encroachment in calcareous and acidic Grey Dunes. The problem is larger than previously assumed, because critical loads are still too high, and extra N-input from the sea may amount to 10 kg ha−1 yr−1. Grass encroachment clearly leads to loss of characteristic plant species, from approximately 16 in open dune grassland to 2 in tall-grass vegetation. Dune zones differ in grass encroachment, due to the chemical status of the soil. In calcareous and iron-rich dunes (Renodunal district), grass encroachment showed a clear gradient over the dune area. Grass encroachment is low in calcareous foredunes, due to low P-availability, and large grazers were not needed to counteract grass encroachment after 2001. In partly decalcified middle dunes, P-availability and grass encroachment are high due to dissolution of calcium phosphates, and grazing only partially helped to control this. In acidic, iron-rich hinterdunes, grass encroachment gradually increased between 1990 and 2014, possibly because P-availability increased with time due to increased soil organic matter content. In acidic, iron-poor dunes (Wadden district), grass encroachment is a large problem, because chemical P-fixation with Ca or Fe does not occur. Large grazers may however reduce tall-grass cover. High cumulative N-deposition could theoretically lead to increased N-storage and N-mineralization in the soil. Mineralization indeed increased with N-deposition, but in 15N experiments, most ammonium was converted to nitrate, and storage in soil organic matter was low. Soil N-storage is probably reduced by high nitrate leaching, which will favour dune restoration when N-deposition levels decrease

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

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