Achieving Accountable Care: Are We on the Right Path?

Based on the Commonwealth Fund Commission on a High Performance Health System's ten recommendations, highlights considerations for the Centers for Medicare and Medicaid Services in finalizing rules for the Shared Savings Program, slated to begin in 2012

Fact or artefact : the impact of measurement errors on the farm size - productivity relationship

This paper revisits the role of land measurement error in the inverse farm size and productivity relationship. By making use of data from a nationally representative household survey from Uganda, in which self-reported land size information is complemented by plot measurements collected using Global Position System devices, the authors reject the hypothesis that the inverse relationship may just be a statistical artifact linked to problems with land measurement error. In particular, the paper explores: (i) the determinants of the bias in land measurement, (ii) how this bias varies systematically with plot size and landholding, and (iii) the extent to which land measurement error affects the relative advantage of smallholders implied by the inverse relationship. The findings indicate that using an improved measure of land size strengthens the evidence in support of the existence of the inverse relationship

Influence of seasonality on the comfort supplied by different materials used as cubicle flooring for dairy cows

The comfort provided by four different cubicle floorings was evaluated with a preference test in relation to winter and summer seasons. The test showed that polyethylene vinyl acetate and polypropylene vinyl acetate mats were preferred during winter, while solid manure and wood shavings assured more comfort than inorganic floorings during summer period. Results obtained suggest that the resting comfort of cubicle floorings may be evaluated also in relation to environmental microclimatic patterns

Milking the data: Measuring milk off-take in extensive livestock systems. Experimental evidence from Niger

Milk is an important source of cash and nutrients for many households in developing countries. Yet, our understanding of the role of dairy production in livelihoods and nutritional outcomes is hindered by the lack of decent quality household survey data. Data on milk off-take for human consumption are difficult to collect in household surveys for a number of reasons which make accurate recall challenging for the respondent (continuous production and seasonality among others), introducing possibly severe biases in the computation of full household incomes and farm sales, as well as in the estimation of the contribution of livestock (specifically dairy) production to agricultural value added and the livelihoods of rural households.This paper presents results from a validation exercise implemented in Niger, where alternative survey instruments based on recall methods were administered to randomly selected households, and compared to a 12-month system of physical monitoring and recording of milk production. The results of the exercise show that reasonably accurate estimates via recall methods are possible, and provide a clear ranking of questionnaire design options that can inform future survey operations

High Performance Accountable Care: Building on Success and Learning From Experience

Presents the rationale for creating accountable care organizations, promising models, and the Commonwealth Fund Commission on a High Performance Health System's recommendations for implementing ACOs widely to achieve improved quality and efficiency

The direct renin inhibitor aliskiren improves vascular remodelling in transgenic rats harbouring human renin and angiotensinogen genes

In the present study, we tested the hypothesis that chronic treatment with the direct rennin inhibitor aliskiren improves the remodelling of resistance arteries in dTGR (double-transgenic rats). dTGR (5 weeks) were treated with aliskiren (3 mg/kg of body mass per day) or ramipril (1 mg/kg of body mass per day) for 14 days and compared with age-matched vehicle-treated dTGR. BP (blood pressure) was similarly reduced in both aliskiren-treated and ramipril-treated rats compared with control dTGR (167± 1 and 169± 2 mmHg compared with 197± 4 mmHg respectively; P<0.05). The M/L (media-to-lumen) ratio assessed on pressurized preparations was equally reduced in aliskiren-treated and ramipril-treated rats compared with controls (6.3± 0.5 and 6.4±0.2% compared with 9.8± 0.4% respectively; P<0.05). Endothelium-dependent and -independent relaxations were similar among the groups. L-NAME (NG-nitro-L-arginine methyl ester) significantly reduced acetylcholine-induced dilation in drug-treated dTGR. This effect was significantly more prominent in aliskiren-treated rats. eNOS (endothelial NO synthase) expression showed a 2-fold increase only in aliskiren-treated dTGR as compared with controls (P<0.01) and ramipril-treated dTGR (P<0.05). Plasma nitrite, as an index of NO production, was significantly increased in dTGR treated with either aliskiren or ramipril compared with controls. Only aliskiren induced a 2-fold increase in plasma nitrite, which was significantly greater than that induced by ramipril (P<0.05). gp91phox expression and ROS (reactive oxygen species) production in aorta were significantly and similarly reduced by both drugs. In conclusion, equieffective hypotensive doses of aliskiren or ramipril reduced the M/L ratio of mesenteric arteries and improved oxidative stress in dTGR. However, only aliskiren increased further NO production in the vasculature. Hence, in dTGR, direct renin inhibition induces favourable effects similar to that induced by ACE (angiotensin-converting enzyme) inhibition in improving vascular remodelling through different mechanisms. © The Authors Journal compilation. 2013 Biochemical Society

Optimizing Peri-URban Ecosystems (PURE) to re-couple urban-rural symbiosis

Globally, rapid urbanization, along with economic development, is dramatically changing the balance of biogeochemical cycles, impacting upon ecosystem services and impinging on United Nation global sustainability goals (inter alia: sustainable cities and communities; responsible consumption and production; good health and well-being; clean water and sanitation, and; to protect and conserve life on land and below water). A key feature of the urban ecosystems is that nutrient stocks, carbon (C), nitrogen (N) and phosphorus (P), are being enriched. Furthermore, urban ecosystems are highly engineered, biogeochemical cycling of nutrients within urban ecosystems is spatially segregated, and nutrients exported (e.g. in food) from rural/peri-urban areas are not being returned to support primary production in these environments. To redress these imbalances we propose the concept of the Peri-URban Ecosystem (PURE). Through the merging of conceptual approaches that relate to Critical Zone science and the dynamics of successional climax PURE serves at the symbiotic interface between rural/natural and urban ecosystems and allow re-coupling of resource flows. PURE provides a framework for tackling the most pressing of societal challenges and supporting global sustainability goals