Suchergebnisse

Purpose: This paper aims to report on a case in which encouraging climate-smart agriculture in the form of better irrigation techniques in India can contribute to both climate change mitigation and adaptation goals by improving resource-use efficiency. It provides grounded institutional analysis on how these transformations can occur. Design/methodology/approach: The authors based their research on three complementary approaches: institutional, sociological and technical. The institutional approach analyzed actors and interests in the water-energy nexus in India via over 25 semi-structured key informant interviews. The sociological approach surveyed over 50 farmers and equipment suppliers for insight into technology adoption. The technical component analyzed water and energy consumption data to calculate potential benefits from transitioning to more efficient techniques. Findings: Because policymakers have a preference for voluntary policy instruments over coercive reforms, distortions in policy and market arenas can provide opportunities for embedded actors to leverage technology and craft policy bargains which facilitate Pareto superior reforms and, thereby, avoid stalemates in addressing climate change. Enlarging the solution space to include more actors and interests can facilitate such bargains more than traditional bilateral exchanges. Practical implications: The analysis provides insights into crafting successful climate action policies in an inhospitable institutional terrain. Originality/value: Studies about climate change politics generally focus on stalemates and portray the private sector as resistant and a barrier to climate action. This paper analyzes a contrary phenomenon, showing how reforms can be packaged in Pareto superior formats to overcome policy stalemates and generate technology-based climate and environmental co-benefits in even unpromising terrain such as technologically laggard and economically constrained populations.

Comparison of hospital admission causes for previously known (group A) and HIV‐infected patients diagnosed during in‐ward stay (group B), from 2009 to 2011. Retrospective evaluation of demographic, epidemiologic, clinical, immunologic, virologic and treatment parameters at time of admission. 1167 patients were admitted; of those 617 (52,9%) were HIV‐infected: 92% HIV‐1 and 8% HIV‐2. 83% had previously known HIV infection and 15% were diagnosed during hospital stay (missing data in 2%). 66% were male, mean age was 46 years and 52% were Portuguese. The most frequent transmission routes were heterosexual exposure (36%) and iv drug use (29%). Mean length of hospital stay was 17 days (group A) and 28 days (group B) (p = 0,004). At admission, the mean TCD4+ count was 280 cells/mm3 in group A, and 132 cells/mm3 in group B (p<0,001). The majority of group B patients had clinical or immunological AIDS criteria at admission (84%) while group A presented a 71% rate for the same parameter (p=0,011). In group A, 52% of patients were on antiretroviral therapy but of those only 33% presented undetectable HIV plasma RNA, non‐adherence being an important cause of therapeutic failure identified in 40% of cases. Respiratory infection was the principal cause of hospital admission in both groups (33% in group A vs. 35% in group B). The most prevalent nosological entities were community acquired pneumonia in group A (18,1% vs. 11,5%‐p=0,118) and Pneumocystis jirovecii pneumonia in group B (4% vs. 18%‐p<0,001). Mycobacterium tuberculosis was frequently identified as an agent of opportunistic infection (10% in group A vs. 24% in group B‐p=<0,001). HCV coinfection was a comorbidity found in 37% in group A vs. 11% in group B (p<0,001). Other relevant comorbidities were psychiatric disturbances (16% vs. 3%‐p=0,001) and neoplastic conditions (11% vs. 0%‐p=0,001), mostly present in group A. Mortality rate was not significantly different between groups (10% group A vs. 11% group B) (p=0,773). This analysis evidenced that, a significant percentage of HIV patients diagnosed at admission were late presenters. Slightly a half of patients with previous known HIV infection were prescribed cARV and only a third presented undetectable HIV viral load. Non‐adherence was a major concern in this population. Respiratory infections had a significant clinical impact in both groups, justifying the importance of vaccination prevention strategies in immunocompromised individuals.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Background Currently, no validated clinical endpoints for treatment studies exist for intermediate age-related macular degeneration (iAMD). Objective The European MACUSTAR study aims to develop and clinically validate adequate clinical endpoints for future treatment studies in iAMD and to identify early determinants of disease progression to late stage AMD. Material and methods The MACUSTAR study protocol was developed by an international consortium of researchers from academia, the pharmaceutical industry and medical device companies. The MACUSTAR project is funded by the Innovative Medicines Initiative 2 (IMI2) of the European Union. Results The MACUSTAR study consists of a cross-sectional and a longitudinal investigation. A total of 750 subjects with early, intermediate and late AMD as well as control subjects with no signs of AMD will be included with a follow-up period of 3 years. Overall, 20 European study centers are involved. Conclusion The MACUSTAR project will generate large high-quality datasets, which will allow clinical validation of novel endpoints for future interventional trials in iAMD. The aim is that these endpoints will be accepted as suitable for medication approval studies by the regulatory authorities and that understanding of the disease process will be improved.

Background. Currently, no validated clinical endpoints for treatment studies exist for intermediate age-related macular degeneration (iAMD). Objective. The European MACUSTAR study aims to develop and clinically validate adequate clinical endpoints for future treatment studies in iAMD and to identify early determinants of disease progression to late stage AMD. Material and methods. The MACUSTAR study protocol was developed by an international consortium of researchers from academia, the pharmaceutical industry and medical device companies. The MACUSTAR project is funded by the Innovative Medicines Initiative 2 (IMI2) of the European Union. Results. The MACUSTAR study consists of a cross-sectional and a longitudinal investigation. A total of 750 subjects with early, intermediate and late AMD as well as control subjects with no signs of AMD will be included with a follow-up period of 3 years. Overall, 20 European study centers are involved. Conclusion. The MACUSTAR project will generate large high-quality datasets, which will allow clinical validation of novel endpoints for future interventional trials in iAMD. The aim is that these endpoints will be accepted as suitable for medication approval studies by the regulatory authorities and that understanding of the disease process will be improved.