Certification as an upgrading strategy for small-scale farmers and their cooperatives : a value chain analysis for Nicaraguan coffee

For many small producers in developing countries coffee is a major income source. However, the coffee market is characterized by high price volatility and increased power concentration among buyers in consuming countries. Due to the very low international coffee prices during the recent coffee crisis and an increased demand among consumers for healthy and ethical products as well as for high quality, interest in standards and certification has increased substantially in coffee producing and consuming countries. Responding to the demand for differentiated products and accessing these new and potentially more profitable markets is especially challenging for poor small-scale farmers in developing countries. Although certification schemes and standards are widely applied and promoted, little research has been conducted identifying the complete value chains for certified coffee, their structure and gross income shares among the different chain actors. The framework for this study is based on the value chain concept. The research analyses selected conventional and Fairtrade value chains in terms of prices paid at different levels, information flows among chain actors, governance structures and upgrading strategies. The focus is on Nicaragua?s small-scale coffee producers, organised in cooperatives, and their upgrading strategies with special attention paid to organic and Fairtrade certification. Qualitative interviews have been conducted with all relevant chain actors. Results show that the structure of the value chain has a major influence on the benefits for individual farmers and their involvement in upgrading strategies. Although higher prices are paid to producers for organic-Fairtrade coffee than for conventional or conventional Fairtrade coffee, the producers? share on the final retail price is substantially lower in the certified chains than in the conventional chain. Producers face limited bargaining power on the quality premiums paid by buyers in consuming countries. The paper emphasizes the need for transparency and appropriate chain management to improve small-scale farmers? integration in value chain upgrading activities. An enhanced knowledge transfer among chain actors could increase farmers? understanding of differentiated markets and provide them with information on the coffee attributes sought by consumers. Being able to meet consumer expectations on attributes and quality standards could empower farmers with greater bargaining power and enable them to demand adequately higher prices. Simultaneously, business skills and management capacity need to be enhanced especially at the level of producers and leaders of grassroot cooperatives, but also at second order cooperatives? staff

is there a relationship? An observational multicentre study

Einleitung: In der Bevölkerung leiden zwischen 0,1–0,4% an Cluster-Kopfschmerzen (C-KS) mit zum Teil täglichen Attacken, die vielfach im Schlaf auftreten. Eine der häufigsten Schlaf-bezogenen Erkrankungen mit einer Prävalenz von 3-4% ist das Schlafapnoe-Syndrom (SAS). Ergebnisse einer Studie an 37 Patienten mit episodischen C-KS zeigte, dass diese Patienten etwa 8mal häufiger von einem SAS betroffen waren als die Kontrollgruppe. Positive Effekte einer CPAP-Therapie zur Behandlung des SAS auf die Häufigkeit und Schwere von C-KS sind in Fallberichten beschrieben, es wurden jedoch keine systematischen prospektiven Studien durchgeführt. Fragestellung: Die aktuelle Studie ermittelt die Häufigkeit eines SAS bei Patienten mit chronischem C-KS mittels Berlin-Fragebogen (B-FB), einem validierten Fragebogen mit Spezifität von .89 und Sensitivität von .77 bei Apnoe-/Hypopnoe-Index >5 (Netzer et al. 1999. SAS Verdacht wird polysomnographisch überprüft und die Auswirkungen einer SAS Behandlungstherapie auf die CKS-Symptomatik werden ermittelt. Methodik: An 34 Patienten mit Diagnose chronischer C-KS >1 Jahr wurde der B-FB erhoben, der die wichtigsten SAS-Symptome befragt: Schnarchverhalten und Atempausen, Tagesschläfrigkeit, Bluthochdruck und Übergewicht. Des Weiteren wurden Kopfschmerztagebücher mit Angaben zur Attackenstärke, -dauer, -zeit plus weitere Skalen erhoben: Epworth Sleepiness Scale (ESS), MOS sleep scale (MOS-SS), SCL-90-R, Beck Depressions Inventar (BDI-II) und SF-36. Ergebnisse: 62% der Patienten (n=21) zeigten ein positives Ergebnis im B-FB, d.h. haben einen Verdacht auf SAS, 38% waren B-FB negativ (n=13). Die Gruppe der B-FB positiven Patienten unterscheidet sich im Schlafproblemindex der MOS-sleep scale signifikant von den B-FB negativen (p=.014; 59,3 +/- 18,9 vs. 40,8 +/- 21,9). Beide Gruppen unterscheiden sich signifikant im BMI (p=.003; 28,3 +/- 3,9 vs. 24,3 +/- 2,8). Ein Vergleich beider Patientengruppen bezüglich Clusterattackenintensität (Stärke * Dauer) zeigt keinen Unterschied zwischen den Gruppen. Berechnungen mit Kontrolle für BMI zeigen eine erhöhte Anzahl der Attacken nachts in der B-FB positiv Gruppe (p=0,033). Es zeigen sich keine Unterschiede auf Tagesmüdigkeit (ESS), bei der psychischen Beeinträchtigung in den SCL-90-Parametern oder in der gesundheitsbezogenen Lebensqualität (SF-36). Von 14 polysomnographisch untersuchten Patienten wurde bei 8 ein obstruktives SAS festgestellt. Die Behandlung mit CPAP führte bei einem Patienten zur fast vollständigen Remission der Attacken, leichte Verbesserungen in der Attackenintensität und -dauer zeigten sich bei einem zweiten Patienten, keine Verbesserung bei einem weiteren Patienten. Fünf Patienten brachen die Behandlung mit CPAP ab. Zusammenfassung: Die Ergebnisse ergeben den Hinweis, dass Patienten mit chronischen Clusterkopfschmerzen ein deutlich erhöhtes Risiko für ein Schlafapnoe-Syndrom haben. Eine CPAP Behandlung über Vollgesichtsmaske ist für viele chronische Cluster-Kopfschmerzpatienten schwer tolerierbar.Background and aims: Cluster headache (CH) attacks occur predominantly out of the sleep state. Oxygen desaturation during sleep apnoea syndrome (SAS) has been proposed as a possible trigger of CH attacks. We performed a multicentre prospective observational study to evaluate the relationship of SAS and chronic CH (CCH). Methods: Patients with CCH filled in a headache diary and were screened by the Berlin-Questionnaire for SAS. Patients with likely SAS were investigated polysomnographically. Results: Thirty four patients were included in the study. Twenty one patients were suspected to have an SAS. Patients with a likely SAS had higher BMI Scores (p=0.003) compared to those without suspicion of SAS and when controlled for BMI showed more attacks during nights (p = 0.033). Of the 14 patients with polysomnography, eight revealed an SAS. CH attacks resolved completely in one, moderately improved in another and persisted in a third patient during continuous positive airway pressure (CPAP) treatment of SAS. Five patients discontinued CPAP treatment because of intolerability to the mask. Conclusion: The number of CH patients with SAS was elevated and reported in the general population. Patients with CCH appear to have an increased frequency of SAS. Comorbidity of SAS and CH should be considered as treatment of SAS may improve CCH in some patients

Three-dimensional reconstruction and microanatomical analysis of large tissues with applications to the human pancreas

A central challenge in the study of disease progression is obtaining high-resolution, high-content information conveying the structural and molecular microanatomy of normal and diseased tissues. Towards this, researchers utilize techniques capable of three-dimensional (3D) imaging of tissues via tissue clearing and serial sectioning. In clearing, intact samples of micron or mm-scale are rendered transparent, labelled with 1-5 stains, and imaged using confocal or light sheet microscopy. In serial sectioning, samples of mm or cm-scale are thinly sliced, labelled with histological stains, and computationally reconstructed. Previous clearing and sectioning approaches generally fail in reconstruction of large, cm3 tissues, require expensive antibody labelling, and/or create volume renderings which are notoriously difficult to quantify. This dissertation focuses on CODA, a method designed to improve on previous 3D reconstruction techniques. CODA is a serial sectioning method capable of reconstruction and analysis of cm3 scale samples using deep learning labelling of hematoxylin & eosin (H&E) sections. As H&E is markedly cheaper than the antibody labelling used in tissue clearing and previous serial sectioning approaches, CODA offers a means of quantitative assessment of normal and diseased samples in large volumes without the need for expensive staining techniques. As a testbed, I assess the microanatomy of the human pancreas during tumorigenesis within the hyperbranched pancreatic ductal system. CODA empowers identification of distinct precancer phenotypes from lesions that vary in volume, cellularity, and three-dimensional morphology. I show that pancreatic cancer tends to spread along collagen fibers that are highly aligned to the existing ductal structure, allowing distant extension from the bulk tumor. Through utilization of intervening unstained sections, I integrate CODA with immunohistochemistry, imaging mass cytometry, and DNA sequencing for more detailed analyses such as heterogeneity of the immune microenvironment and mutational profiles of pancreatic cancer precursors. CODA establishes a means to transform the structural study of human diseases, provide fundamental quantitative metrics for improved design of model biological systems, and is a useful as a tool for medical education