This paper presents an analysis of GlobalGAP adoption by small-scale fruit and vegetable farmers in Thailand focusing on GlobalGAP group certification, the costs and perceived benefits of GlobalGAP adoption, and the factors influencing standard adoption. GlobalGAP is the most important private standard for producers in the Thai horticultural sector concerning access to high-value markets, especially to Europe. We find that support by donors, exporters and public-private partnerships is vital to enable small-scale farmers to adopt the standard. GlobalGAP group certification encourages the formation of new institutional arrangements between farmers, exporters and donors. In our sample only participants from a development program were successful in adopting GlobalGAP and within the program farmers were either organized in certification groups where the Quality Management System (QMS) was run by farmers themselves, by an exporter or by a donor. The results of the adoption analysis suggest that household characteristics (age, education, wealth, availability of family labor), farm characteristics (farm size, intensity of irrigation use), the number of agricultural trainings subjects attended, prior involvement in high-value supply chains, as well as exporter and donor support in terms of costs of compliance, technical advice and management of the QMS influence GlobalGAP adoption.

Chronic liver disease (CLD) is a major cause of morbidity and mortality worldwide. Non-invasive assessment of hepatic disease severity represents a relevant issue to further improve clinical management and therapeutic treatment. We retrospectively compared the diagnostic and prognostic performance of different non-invasive tools (LiMAx, transient elastography (TE), and biomarkers) in detecting different severity stages during the course of CLD. Patients were divided into four groups based on clinical parameters: (1) patients without CLD (control group), (2) patients suffering from CLD without having cirrhosis, (3) patients with CLD and compensated cirrhosis, and finally, (4) patients with CLD and decompensated cirrhosis. Patients with acute liver failure were excluded from the analysis. A total of 464 patients who underwent LiMAx measurement at the University Clinic of Essen between 10/2016 and 11/2017 were included in this study. Distribution of the different groups were n = 72 patients for group 1, n = 134 patients for group 2, n = 160 patients for group 3, and n = 98 patients for group 4, respectively. Median LiMAx values significantly declined with respect to increasing degree of CLD: (1) 510 µg/h/kg, (2) 390 µg/h/kg, (3) 264 µg/h/kg, and (4) 151 µg/h/kg (p < 0.001). When comparing the diagnostic accuracy of the LiMAx test in detecting patients with presence of cirrhosis (groups 1 and 2 vs. groups 3 and 4), an AUROC of 0.942 was found (cut-off 322 µg/h/kg, sensitivity 86.1%, specificity 91.3%, p < 0.0001). LiMAx was superior to TE and serum biomarkers in predicting patients’ outcome by 90-day mortality (AUROC 0.811, p < 0.001). Enzymatic liver function measured by LiMAx was closely associated with different severity stages of CLD and was a reliable diagnostic and prognostic tool with an accuracy comparable to current standard methods.

GlobalGAP is the most important private standard for producers in the Thai horticultural sector concerning access to high-value markets, especially to Europe. This chapter presents an analysis of GlobalGAP adoption by small-scale fruit and vegetable farmers in Thailand focusing on GlobalGAP group certification, the costs and perceived benefits of GlobalGAP adoption, and the factors influencing standard adoption. In our research area, GlobalGAP group certification has encouraged the formation of new institutional arrangements between farmers, exporters and donors. Farmers participating in a development program were organized in certification groups where the Quality Management System (QMS) was either run by the donor, by the exporter, or by farmers themselves. Results of our adoption model suggest that support by donors, exporters and public-private partnerships are vital to enable small-scale farmers to adopt the standard. Furthermore, farmers are more likely to adopt if they are better educated and more experienced, and if they have access to female family labor, improved farming technology, and information and extension services.