Understanding farmers' preferences for artificial insemination services provided through dairy hubs.

Africa has a shortage of animal products but increasing demand because of population growth, urbanisation and changing consumer patterns. Attempts to boost livestock production through the use of breeding technologies such as artificial insemination (AI) have been failing in many countries because costs have escalated and success rates have been relatively low. One example is Kenya, a country with a relatively large number of cows and a dairy industry model relevant to neighbouring countries. There, an innovative dairy marketing approach (farmer-owned collective marketing systems called dairy hubs) has been implemented to enhance access to dairy markets and dairy-related services, including breeding services such as AI. So far, the rate of participation in these dairy hubs has been slow and mixed. In order to understand this phenomenon better and to inform dairy-related development activities by the Kenyan government, we investigated which characteristics of AI services, offered through the dairy hubs, farmers prefer. To do so, we applied a choice experiment (CE), a non-market valuation technique, which allowed us to identify farmers' preferences for desired characteristics should more dairy hubs be installed in the future. This is the first study to use a CE to evaluate breeding services in Kenya and the results can complement findings of studies of breeding objectives and selection criteria. The results of the CE reveal that dairy farmers prefer to have AI services offered rather than having no service. Farmers prefer AI services to be available at dairy hubs rather than provided by private agents not affiliated to the hubs, to have follow-up services for pregnancy detections, and to use sexed semen rather than conventional semen. Farmers would further like some flexibility in payment systems which include input credit, and are willing to share the costs of any AI repeats that may need to occur. These results provide evidence of a positive attitude to AI services provided through the hubs, which could mean that AI uptake would improve if service characteristics are improved to match farmer preferences. The dairy hubs concept is currently in the implementation phase with most hubs at startup phase, hence understanding which AI service characteristics farmers prefer can inform the design of high-quality and cost-effective AI services in the future.

Determination of non-market values to inform conservation strategies for the threatened Alistana-Sanabresa cattle breed.

Livestock breed-related public good functions are often used to justify support for endangered breed conservation despite the fact that little is known about such non-market values. We show how stated preference techniques can be used to assess the non-market values that people place on livestock breeds. Through the application of a case study choice experiment survey in Zamora province, Spain, the total economic value (TEV) of the threatened Alistana-Sanabresa (AS) cattle breed was investigated. An analysis of the relative importance of the non-market components of its TEV and an assessment of the socio-economic variables that influence people's valuation of such components is used to inform conservation strategy design. Overall, the findings reveal that the AS breed had significant non-market values associated with it and that the value that respondents placed on each specific public good function also varied significantly. Functions related with indirect use cultural and existence values were much more highly valued than landscape maintenance values. These high cultural and existence values (totalling over 80% of TEV) suggest that an AS in situ conservation strategy will be required to secure such values. As part of such a strategy, incentive mechanisms will be needed to permit farmers to capture some of these public good values and thus be able to afford to maintain breed population numbers at socially desirable levels. One such mechanism could be related to the development of breed-related agritourism initiatives, with a view to enhancing private good values and providing an important addition to continued direct support. Where linked with cultural dimensions, niche product market development, including through improving AS breed-related product quality and brand recognition may also have a role to play as part of such an overall conservation and use strategy. We conclude that livestock breed conservation strategies with the highest potential to maximise societal welfare would be those that secure the breed-related functions that people value most, with appropriate in situ conservation interventions and strategies being identified accordingly.

Conserving large carnivores: dollars and fence.

Conservationists often advocate for landscape approaches to wildlife management while others argue for physical separation between protected species and human communities, but direct empirical comparisons of these alternatives are scarce. We relate African lion population densities and population trends to contrasting management practices across 42 sites in 11 countries. Lion populations in fenced reserves are significantly closer to their estimated carrying capacities than unfenced populations. Whereas fenced reserves can maintain lions at 80% of their potential densities on annual management budgets of $500 km(-2) , unfenced populations require budgets in excess of $2000 km(-2) to attain half their potential densities. Lions in fenced reserves are primarily limited by density dependence, but lions in unfenced reserves are highly sensitive to human population densities in surrounding communities, and unfenced populations are frequently subjected to density-independent factors. Nearly half the unfenced lion populations may decline to near extinction over the next 20-40 years.

Dose-dependent lowering of blood pressure by dairy peptides in mildly hypertensive subjects.

Clinical studies have demonstrated a beneficial effect on blood pressure for milk derived material containing isoleucyl-prolyl-proline (IPP) and valine-prolyl-proline (VPP) peptides. The aim of the present study was to evaluate the blood pressure lowering effect of three different IPP and VPP doses in products with a comparable electrolyte and protein composition. The present study was designed as a randomized, double-blind, parallel-group, dose-response trial: 166 subjects (>140/90 mmHg) received placebo during a 2-week run-in, 8-weeks intervention followed by a 2-week washout. Results indicate that materials containing IPP and VPP do lower blood pressure dose-dependently (p < 0.05 for diastolic blood pressure, DBP). The effect on systolic blood pressure (SBP)/DBP over 8 weeks compared with placebo was + 0.1/- 1.3, - 1.5/- 1.4 and - 2.5/- 1.9 mmHg for the low, medium and high dose of peptides, respectively. The percentages of subjects who showed a fall in SBP > 3 mmHg or who attained an SBP below 140 mmHg, were 54% (placebo), 64% (low), 76% (medium) and 71% (high dose) respectively. This effect can only be demonstrated for office pressure and not for home or ambulatory pressure. Furthermore, the results suggest that the magnitude of the fall in blood pressure is a function of baseline blood pressure. We conclude that IPP and VPP may have a modest dose-dependent effect on office blood pressure in mildly hypertensive subjects although this could not be confirmed with ambulatory or home blood pressure measurements.

Valuing goat genetic resources: a pro-poor growth strategy in the Kenyan semi-arid tropics.

Goats, "the poor man's cow", provide very important genetic resources that can be exploited for continued improvements of the livelihoods of poor livestock keepers in the semi-arid tropics. This study presents the evaluation of the economic values of goat genetic resources (GGRs) in terms of the important non-market traits embedded in goats and how this information can be utilised to improve livelihoods in semi-arid regions. The results obtained from mixed logit models derived from stated choice data collected from 314 respondents in the semi-arid Marsabit district of Kenya reveal that disease resistance is the most highly valued trait whose resultant augmentation results into a welfare improvement of up to KShs.2899. Drought tolerance and milk traits were found to be implicitly valued at KShs.2620 and 1179 respectively. The study further revealed that improvement in milk trait in does, body size and disease resistance traits in bucks, and drought tolerance trait in both does and bucks will collectively improve the producers' welfare hence should be given priority. However, improvement in the reproduction and production ("overall body condition/ meatiness" trait) potential of goats will be worthwhile only if issues concerning access to pasture and water resources are addressed prior and simultaneously.

Economic valuation of sheep genetic resources: implications for sustainable utilization in the Kenyan semi-arid tropics.

Sheep, recognised as one of the important livestock species especially in the semi-arid tropics with high genetic resource potentials, can be exploited through sustainable utilization in order to improve livestock keepers' livelihoods. This study presents the evaluation of the economic values of sheep genetic resources (SGR) in terms of the important non-market traits embedded in sheep and how this information can be utilised to improve livelihoods in semi-arid regions. The results obtained from mixed logit models results derived from stated choice data collected from 157 respondents in the semi-arid Marsabit district of Kenya reveal that disease resistance is the most highly valued trait whose resultant increment results into a welfare improvement of up to KShs.1537. Drought tolerance and fat deposition traits were found to be implicitly valued at KShs.694 and 738 respectively. The results further point out that for livestock stakeholders to effectively improve the livelihoods of poor livestock-keepers, development strategies for improving the management and/or utilisation of SGR in terms of drought tolerance, should not only be tailor made to target regions that are frequently devastated by drought but should also succeed other strategies or efforts that would first lead to the improvement of producers' economic status.

Fermented lactotripeptides-containing milk lowers daytime blood pressure in high normal-to-mild hypertensive subjects.

This study shows that consumption of fermented lactotripeptides (LTPs)-containing milk may have an acute daytime effect on blood pressure that appeared sustained with daily intake over a period of 4 weeks. Angiotensin 1-converting enzyme (ACE) inhibition by LTPs could not be confirmed in plasma.

Selective endothelin B receptor blockade does not influence BNP-induced natriuresis in man.

Brain natriuretic peptide (BNP) and endothelin-1 (ET-1) both exhibit natriuretic activity within the human kidney. Furthermore, they both act partly through activation of the endothelial nitric oxide pathway. Since ET-1 may cause vasodilation and natriuresis via stimulation of the ET-B receptor, the aim of the present study was to investigate whether renal ET-B receptors participate in the renal actions of BNP. In this placebo-controlled, crossover study, we infused BNP (4 pmol/kg/min) or placebo (i.v.) for 1 h, with or without co-infusion of the ET-B receptor antagonist BQ-788 (50 nmol/min) for 15 min on 4 separate days, in 10 healthy subjects (mean age 54+/-6 years.). During infusion, we measured effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) using PAH/inulin clearance. Cardiac output was measured before and after infusion, using echocardiography. Blood pressure and heart rate (HR) were monitored as well. Urine and plasma samples were taken every hour to measure diuresis, natriuresis, cyclic 3',5' guanosine monophosphate, and ET-1 levels. BNP with or without ET-B receptor blockade increased natriuresis and diuresis. In addition, BNP alone increased GFR and filtered load, without changing ERPF. BQ-788 infusion did not affect renal hemodynamics or natriuresis. Neither BNP nor BQ-788 altered cardiac output, blood pressure, and heart rate. In conclusion, the present study shows that selective ET-B receptor blockade has no effect on the BNP-induced natriuresis and glomerular filtration rate.

Barriers among nurses to providing smoking cessation advice to hospitalized smokers.

Nine focus groups were conducted with 75 staff nurses in three hospitals to determine the low participation rate of nurses in a smoking cessation programs directed at patients. Nurses felt that hospitalization was an appropriate time to offer quit-smoking advice to patients, particularly those with smoking related diseases. However, many felt advice should be given only to those receptive to it. The most common barriers to providing smoking cessation advice were lack of concrete techniques, or referral to provide and fear of alienating patients who were not receptive to hearing advice.

The failure of a controlled trial to improve depression care: a qualitative study.

BACKGROUND: The DIAMOND Project (Depression Is A MANageable Disorder), a nonrandomized controlled effectiveness trial, was intended to improve the long-term management of depression in primary care medical clinics. The project tested whether a quality improvement (QI) intervention could implement a systems approach-so that there would be more reliable and effective monitoring of patients with depression, leading to better outcomes. THE QUALITATIVE STUDY: A study was conducted in 1998-2000 to determine why a quality improvement intervention to improve depression care did not have a significant impact. Data consisted of detailed notes from observations of 12 project-related events (for example, team meetings and presentations) and open-ended interviews with a purposive sampling of 17 key informants. Thematic analytic methods were used to identify themes in the contextual data. PRINCIPAL FINDINGS: Overall, the project implementation was very limited. Five themes emerged: (1) The project received only lukewarm support from clinic and medical group leadership. (2) Clinicians did not perceive an urgent need for the new care system, and therefore there was a lack of impetus to change. (3) The improvement initiative was perceived as too complex by the physicians. (4) There was an inherent disconnect between the commitment of the improvement team and the unresponsiveness of most other clinic staff. (5) The doctor focus in clinic culture created a catch-22 dilemma-the involvement and noninvolvement of physicians were both problematic. CONCLUSION: Problems in both predisposing and enabling factors accounted for the ultimate failure of the DIAMOND quality improvement effort.

Hypertension exacerbates coronary artery disease in transgenic hyperlipidemic Dahl salt-sensitive hypertensive rats.

BACKGROUND: The mechanisms underlying the known interaction of two complex polygenic traits, hypertension and hyperlipidemia, resulting in exacerbation of coronary artery disease have not been elucidated. Identification of critical pathways underlying said exacerbation could identify mechanism-based targets for intervention and prevention. MATERIALS AND METHODS: To investigate hypertension- atherosclerosis interaction, we studied the inbred transgenic atherosclerosis-polygenic hypertension Dahl salt-sensitive (S) rat model (Tg53), which over-expresses human cholesteryl ester transfer protein (hCETP) in the liver, and exhibits coronary artery disease and decreased survival compared with control non-transgenic Dahl S rats. Using serial-section histopathological and immunohistochemical analyses, we analyzed the coronary artery disease phenotype of Tg53 rats at end-stage marked by cardio-respiratory compromise as the experimental equivalent of acute coronary syndromes, and determined the effects of reduction of blood pressure through low salt diet (0.008% NaCl) on the coronary artery disease phenotype and survival. RESULTS: End-stage Tg53 rats exhibit coronary artery lesions in the proximal right coronary artery system which exhibit "culprit plaque" features such as plaque inflammation, matrix degradation, apoptosis, neovascularization, thrombosis and hemorrhage recapitulating said features and heterogeneity of human coronary "culprit plaques". Comparative analysis of 6 month vs end-stage lesions reveals distinct lesion development profiles of proximal coronary lesions which quickly progress from eccentric non-occlusive foam-cell rich lesions at 6 months to occlusive "culprit plaques", compared with more distal coronary lesions which exhibit occlusive thick-cap atheroma that remain relatively unchanged from 6 months to end stage. Reduction of hypertension through a low-salt (0.008% NaCl) diet increased survival (P < 0.0001) of Tg53 rats and significantly attenuated the coronary artery disease phenotype detected at 10 months of age marked by diminished apoptosis, neovascularization, matrix degradation compared with end-stage lesions detected at <8 months of age. CONCLUSIONS: End stage coronary lesions in the Tg53 rats recapitulate many, albeit not all, features of "culprit plaques" in humans supporting proposed paradigms of plaque vulnerability implicating lesion macrophage enrichment, apoptosis, matrix degradation and pathological neovascularization. Comparative time course analysis of coronary lesions reveals that plaques which develop into end-stage "culprit plaques" are distinct from "stable plaques" by location and early lesion morphology, suggesting distinct lesion development and progression pathways. The significant effects of low-salt diet-induced decrease in hypertension on right coronary disease phenotype provides compelling evidence that polygenic hypertension accelerates coronary plaque progression and complication independent of cardiac hypertrophy, and more importantly provides paradigmatic support for public health policy.

Clinical integration at ground zero: perceptions of patients and families.

As an alternative to the administrative and management views of clinical integration, the perceptions and current research of patients and their families about integration initiatives are presented at "ground zero," i.e., the caregiving level. If there is no integration at ground zero, the other levels are of little merit. Contrary to the pervading opinion, clinical integration is not a value-added endeavor to boost satisfaction scores of patients and families or to make a health care system look good to regulators. Rather, clinical integration is fundamental to the precision, efficiency, and effectiveness of care delivery. Examples of the need for integration spanning situations from critical care to self-care are described.

Public opinion on alcohol policies in the United States: results from a national survey.

We surveyed the U.S. non-institutionalized population age 18+ on opinions regarding 23 alcohol control policies (N = 7,021). The cooperation rate among contacted households was 70% and the overall response rate was 54%. Results showed high levels of public support for most alcohol control policies. Over 80% support restrictions on alcohol use in public places, such as parks, beaches, concert venues, and on college campuses. Eighty-two percent support increased alcohol taxes, provided the funds are used for treatment or prevention programs. Over 60% support alcohol advertising and promotion restrictions, such as banning billboard advertising, banning promotion at sporting events, or banning liquor and beer advertising on television. Multivariate regression analyses indicated significant relationships between alcohol policy opinions and a variety of sociodemographic, political orientation, and behavioral measures. However, the absolute differences in alcohol policy support across groups is small. There is a strong base of support for alcohol control policies in the U.S., and such support is found among whites and ethnics of color, young and old, rich and poor, and conservatives, moderates, and liberals.

Effects of brain natriuretic peptide on forearm vasculature: comparison with atrial natriuretic peptide.

OBJECTIVE: The aim of the present study was to determine the vasoactive effects of brain natriuretic peptide (BNP) as compared to those of atrial natriuretic peptide (ANP) in normal man. METHODS: Ten healthy male subjects (median age 21 (20-23) year) were studied twice. In the first study equimolar doses (1, 3, and 10 pmol/dl/min) of both BNP and ANP (in random order and double blind) were infused into the brachial artery of the non-dominant arm with a 1-h wash-out period in between. In the second study two BNP (n = 5) or ANP (n = 5) dose-response curves were performed in order to assess the repeatability of the BNP/ANP infusions. To this end, BNP and ANP were infused in the same equimolar doses as in the first protocol. Forearm blood flow (FBF) was determined by venous occlusion plethysmography before and during infusions. RESULTS: BNP increased the FBF ratio (infused/contralateral arm) by 6%, 17%, and 48%, respectively (p < 0.05), while ANP increased the FBF ratio by 4%, 58%, and 133% (p < 0.001). The slopes of the BNP dose-response curves differed significantly from those of the ANP curves (18.1 versus 43.2; p = 0.022). No differences were observed between the repeated dose-response curves of either BNP or ANP. CONCLUSIONS: The present data demonstrate that BNP induces a dose-dependent vasodilatation in man. On a molar basis, however, this vasodilatation is significantly less than the vasodilatation induced by ANP. These differences may be related to differences in natriuretic-peptide-receptor affinity. Furthermore, our data show that the vasoactive effects of both BNP and ANP are repeatable in time.

Historical development of outcomes-based care delivery.

Outcomes-based care delivery is both a subtle and profound change in practice. It is proactive, patient-centered, data-generating, and establishes clear accountability. Most importantly, outcomes defined and managed at the patient-provider level will be the quality conscience as health care enters a new millennium.

C-type natriuretic peptide inhibits mesangial cell proliferation and matrix accumulation in vivo.

Local C-type natriuretic peptide (CNP) production and CNP receptor expression have been demonstrated in glomeruli. However, the glomerular (patho-)physiological functions of CNP are largely unknown. We therefore investigated the effects of CNP on mesangial cell proliferation and matrix accumulation in the rat mesangioproliferative anti-Thy 1.1 model. Over seven days rats received a continuous infusion (1 microgram/kg/min) of either CNP (N = 6), an irrelevant control peptide (N = 3) or buffer alone (N = 6). Kidney biopsies were performed on days 2, 4 and 8. Few significant differences between the groups were noted on days 2 and 4. Compared to buffer treated rats on day 8, those receiving CNP showed a 35% reduction of glomerular mitoses, a 62% reduction of glomerular uptake of the thymidine analogue BrdU and a significant reduction in glomerular expression of PDGF B-chain. Double immunoperoxidase staining also revealed blunting of proliferating, activated mesangial cells (515 reduction of alpha-smooth muscle actin-/BrdU-positive cells) and macrophage influx. Moreover, there was a marked reduction of mesangial collagen IV and fibronectin accumulation at the protein and mRNA level. Rats receiving the control peptide were indistinguishable from buffer treated rats. Systemic blood pressure was reduced by 10 to 20% in both CNP and control peptide treated rats on day 8, excluding that the findings were due to hemodynamic effects of CNP. Our findings demonstrate that CNP is involved in the regulation of mesangial cell proliferation and matrix production in vivo. The data suggest the existence of a glomerular natriuretic peptide system that may regulate tissue homeostasis and contribute to resolution of mesangioproliferative diseases.

Upper respiratory tract disease and mycoplasmosis in desert tortoises from Nevada.

A population of desert tortoises (Gopherus agassizii) at Yucca Mountain (Nevada, USA) was monitored during four sampling periods using enzyme-linked immunosorbent assays (ELISA) to determine the percentage of individuals that had been exposed to Mycoplasma agassizii, a causative agent of upper respiratory tract disease. Respiratory tract disease has been considered a significant factor in the decline of desert tortoise populations in the Mojave Desert (USA). Few differences between sexes in ELISA values or percentages testing positive were noted. From 15 to 23% of samples per period tested positive for exposure to the mycoplasma. However, we noted few clinical signs of upper respiratory tract disease. This is in contrast to an earlier study which reported a similar proportion of seropositive tortoises as well as a high percentage of tortoises with clinical signs. However, our results are consistent with that study's conclusion that seropositivity for M. agassizii was a poor predictor of the likelihood to exhibit clinical signs of upper respiratory tract disease. Earlier reported epizootics of mycoplasma-associated respiratory disease occurred mainly during times of drought. Our samples were collected during a period of average to above-average rainfall, suggesting that manifestation of clinical signs of the disease may depend upon the physiological condition of tortoises which, in turn, is related to environmental conditions.

Luteinizing hormone pulse characteristics in depressed women.

OBJECTIVE: Luteinizing hormone (LH) pulse characteristics in depressed and normal women were compared to determine whether hypothalamic dysregulation in depression extends to the hypothalamic-pituitary-gonadal axis. METHOD: The subjects were 10 depressed and 13 normal comparison women admitted to a clinical research center. For each woman, an intravenous line was started and blood was withdrawn every 10 minutes for 8 hours. Blood samples were assayed for LH and LH pulse characteristics determined by using the computerized cluster algorithm of Veldhuis and Johnson. RESULTS: The depressed women differed significantly from the comparison women in LH pulse amplitude, rhythmicity, and area under the curve. CONCLUSIONS: Major depressive disorder is associated with abnormal regulation of luteinizing hormone. Gonadotropin regulation may provide a hormonal link between major depressive disorder and impaired fertility.