Suchergebnisse

In the UK, water supplies are under pressure from climate, population and lifestyle change. Showering is the largest component of domestic water consumption. Young adults are high water-users at a transitional life-stage, when practices are dynamic, and habits shaped. This paper presents the methodology, early findings and reflections on challenges of working with different data types and scales, to explore real-world water-saving through a mixed-methods approach, focusing on showering patterns of first year university students in campus accommodation at the University of the West of England, Bristol, UK. Combining household meter, logged water-fixture micro-component, personal-use questionnaire, user diary and stakeholder focus group data with the Scottish Government Individual-Social-Material model, typical showering demand reduction interventions were evaluated and insights into alternative interventions were generated. Results indicate Estates' routine equipment maintenance and database management affect data quality and consistency. Despite these issues a profile of daily student water use was derived (equivalent to 114 litres per person per day) but with high variability between different households (from 83 to 151 litres per person per day). Average shower durations (self-reported 10–12 minutes) were higher than reported UK norms, although frequency was similar to the UK daily shower norm. Average measured shower volumes (51 litres in one house) were not excessive, indicating shower fixtures provided a contribution to water saving.

Purpose of the studyIn the UK, an increasing proportion of individuals with HIV are women of childbearing age (WOCBA). Literature on the potential effects of antiretroviral therapy (ART) on certain risk factors for coronary heart disease (CHD), such as total cholesterol (TC), has not differentiated the reported ART‐associated risk by other risk factors for CHD (e.g. age and gender). Given the different age‐specific CHD risk estimates for men and women, particularly the low risk of CHD in WOCBA, the cost‐effectiveness of LPV/r vs ATV+RTV specifically among WOCBA warrants examination. Therefore, the objective of this study was to perform a cost‐effectiveness and budget impact analysis of two first‐line protease inhibitor‐based regimens, LPV/r versus ATV+RTV, among HIV‐infected, ARV‐naïve WOCBA in the UK.MethodsA modified version of a previously published Markov model was utilized [1]. CHD risk estimates were based on the Framingham risk score. Baseline assumptions were that 33% of women were smokers with a mean age of 25 years. Guidelines regarding therapeutic drug monitoring among pregnant women in the 3rd trimester who receive ATV+RTV were incorporated [2]. Age‐specific pregnancy rates were estimated in order to determine ARV utilization during gestation. The model employed a lifetime horizon under a NHS perspective and a discount rate of 3.5%. Costs were presented in 2011 GBP.Summary of resultsThe model predicted no appreciable difference in quality‐adjusted survival (in terms of QALYs) between the two regimens over a lifetime (0.2 days in favor of ATV+RTV) and an increased cost of £3,003 per patient on the ATV+RTV regimen. Cost savings of £1,977 over 5 years and £2,916 over 10 years were predicted for patients who initiated LPV/r. Furthermore, for every 100 patients started on LPV/r, the savings accrued after one year allow for the treatment of 6 additional patients. After 10 years, the number of additional patients that can be treated accumulated to 42. The model predicted a mean of 1.4 pregnancies per woman, and an overall difference between the regimens of 0.3% in CHD events after 10 years.ConclusionsInitiating HIV infected, ARV‐naïve WOCBA on a LPV/r‐based regimen compared to an ATV+RTV‐based regimen produces substantial short‐ and long‐term cost savings with similar life expectancy. These results warrant consideration, as selecting LPV/r over ATV+RTV may provide an opportunity for improving access to ART for WOCBA living with HIV in the UK.

Guidelines consider LPV/r a preferred protease inhibitor for use during pregnancy. When an HIV‐infected woman receiving DRV+RTV becomes pregnant, a switch to LPV/r may be warranted. The budget implications of proactively initiating LPV/r versus initiating DRV+RTV and then switching has not been examined. A cost‐minimization analysis was performed from the US healthcare perspective for HIV‐1‐infected, treatment‐naïve WOCBA comparing: initiating LPV/r in all patients versus initiating DRV+RTV and switching to LPV/r when pregnant. A discrete event simulation was employed to represent antiretroviral (ARV) therapy management. Healthcare utilization and clinical trial data [1] were used to model pregnancy rates [2], ARV regimen switch rates, and impact of treatment as a function of CD4‐cell count and viral load, adherence, treatment response, acquired resistance mutations, and ensuing treatment changes. Five‐ and 10‐year costs incurred due to ARV therapy, clinician visits and management of AIDS‐related, non‐AIDS related, and cardiovascular events were estimated. Base‐case analysis assumptions: switching to LPV/r can occur only once at first pregnancy, 30% of WOBCA switch to LPV/r circa time of pregnancy, and women's adherence to medication improves by 15% when becoming pregnant. Sensitivity analyses varied the rate of switching to LPV/r at time of pregnancy, pregnancy rates, adherence improvement, and healthcare costs. Daily drug cost of LPV/r + TDF/FTC was $56.59 while DRV+RTV+TDF/FTC was $73.89. Costs were discounted at 3% per annum. Survival was similar in both groups. Five‐ and 10‐year total healthcare costs of ARV‐naïve HIV‐positive WOCBA who initiate LPV/r were $108,200 and $192,600 per patient, respectively, compared to $132,200 and $234,400 when women initiated DRV+RTV and then 30% switched to LPV/r. Initiating with LPV/r resulted in 5‐ and 10‐year savings of $24,000 and $41,800 per patient, respectively. If 100% of patients who initiated with DRV+RTV switched to LPV/r upon pregnancy, the savings per patient were $21,300 at 5 years or $33,140 at 10 years, since a greater number of patients switch to the less expensive LPV/r. Sensitivity analyses showed that initiating with LPV/r was always cost‐saving relative to DRV+RTV. Initiating HIV‐infected, treatment‐naïve WOCBA on LPV/r was cost‐saving compared to initiating DRV+RTV. Limitations of the analysis include the uncertainty of long‐term outcomes projections driven by short‐term clinical trial endpoints.

Context
Oil spills cause significant detrimental impacts on many shoreline species. There is limited information in the scientific literature about the management and response of shorebirds to oil spills. Northern New Zealand dotterels (Charadrius obscurus aquilonius) were pre-emptively captured as part of the oiled wildlife response to the container vessel Rena oil spill, to ensure the survival of a regional population should there be a catastrophic release of oil. Previous attempts to hold dotterels in captivity have resulted in high mortality.

Aims
To describe the captive husbandry and veterinary management of wild-caught adult dotterels, to outline the common problems encountered, and make recommendations for future captive management.

Methods
The dotterels were caught by noose mat on beaches at risk of further contamination by oil. Initially, dotterels were kept individually indoors and force-fed until they converted to self-feeding on a diet of an artificial insect analogue, ox heart and mealworms. Once self-feeding, the birds were shifted to individual outdoor aviaries.

Key results
Sixty dotterels were caught. About half of birds had oil contamination of the legs, nine birds had light oil staining of feathers and only three of these birds required washing. The degree of oiling and washing did not affect survival. Dotterels took a median of 5 days (range 1–15 days) to convert to the captive diet. Common problems encountered in captivity included carpal and beak abrasions (61.7%) and pododermatitis (75%); however, these did not affect survival. Seven birds (11.7%) developed respiratory disease and six of these died from aspergillosis. The incidence of aspergillosis increased with length of time in captivity and was largely refractory to treatment. The 54 surviving birds were released at their capture sites after a median time of 49 days in captivity (with a range of 39–61 days).

Conclusions
The captive management of the dotterels achieved a 90% survival rate over a period of about 2 months. Deaths were solely due to respiratory aspergillosis, but intensive captive husbandry was required to convert the birds to a captive diet, to minimise traumatic injuries and to manage pododermatitis.

Implications
Although the captive management of shorebird species as a pre-emptive strategy to minimise the effects of oil spills carries significant costs and risks to the birds, it should be considered in the emergency management of high-priority species.