Applied Animal Behaviour Science 175 (2016) 50–55
Contents lists available at ScienceDirect
Applied Animal Behaviour Science
journal homepage: www.elsevier.com/locate/applanim
Management and design of hospital pens relative to behavior of the
compromised dairy cow: A questionnaire survey of Iowa dairy farms
Katrine K. Fogsgaard a , Mette S. Herskin a , Patrick J. Gorden b , Leo L. Timms b,c ,
Jan K. Shearer b , Suzanne T. Millman b,d,∗
a
Department of Animal Science, Aarhus University, Foulum, Tjele, Denmark
Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA
c
Department of Animal Science, Iowa State University, Ames, IA, USA
d
Department of Biomedical Science, Iowa State University, Ames, IA, USA
b
a r t i c l e
i n f o
Article history:
Received 6 August 2014
Received in revised form
22 November 2015
Accepted 6 January 2016
Available online 22 January 2016
Keywords:
Animal welfare
Dairy cattle
Hospital pens
Sickness behavior
a b s t r a c t
Compromised dairy cows, such as those suffering from illness or injury, are likely to have different behavioral priorities and needs compared to healthy cows. Although hospital pens are typically required in
animal welfare standards and assessment programs, there is surprisingly little information on best practices for housing and management of compromised cows. The purpose of this study was to provide
descriptive information about management and husbandry practices of compromised cows on dairy
farms in Iowa. A questionnaire-based survey was designed to examine demographic information, design
and management of hospital pens, as well as decisions concerning humane endpoints when euthanasia
is considered. The survey was sent to 300 Iowa dairy farmers including organic, large (>500 cows) and
ordinary (≤500 cows) dairy farms, with overall response rate of 41%. Eighty-two percent of respondents
had the possibility to house a sick or injured cow away from her normal pen. Hospital areas typically
involved pen housing (89% of farms), and bedded pack was the most common flooring used (88%). Compromised cows were frequently housed in the same enclosure as fresh cows (45%), calving cows (36%),
close up cows that are soon to calve (35%), dry cows (15%), or other cattle (8%), including heifers, calves
and bulls. Half of the farms had standard management protocols for non-ambulatory cows. Calving difficulties, injury, milk fever, lameness and displaced abomasum were the most frequently cited conditions
for moving cows into hospital pens. The present data can be used to formulate hypotheses and design
experiments in order to examine relationships between the behavior of compromised cows under different management strategies. Research is needed to formulate recommendations for effective design
and management of special needs areas and hospital pens, notably with respect to social groupings and
behavioral needs of ill and injured cows.
© 2016 Elsevier B.V. All rights reserved.
1. Introduction
Compromised cows include individuals that are injured or ill.
Within modern dairy farming, production diseases such as claw
lesions (Huxley, 2013) and mastitis (Bradley, 2002) are considered major welfare problems (Broom, 2006). Despite decades of
research into the welfare of dairy cows, questions about the behavior and welfare of compromised animals are only recently topics
of scientific investigation (European Food Safety Authority, 2009;
∗ Corresponding author at: Lloyd Veterinary Medical Center #2201, 1600 South
16th Street, Ames, IA 50011, USA. Fax: +1 515 294 1072.
E-mail address: smillman@iastate.edu (S.T. Millman).
http://dx.doi.org/10.1016/j.applanim.2016.01.016
0168-1591/© 2016 Elsevier B.V. All rights reserved.
Jensen et al., 2015; Weary et al., 2009). It has been suggested that
these dairy cows may have different behavioral priorities and needs
than healthy herdmates (Millman, 2008, 2013). In general, housing
and management protocols for dairy cows are designed for healthy
animals, whereas challenges affecting compromised cows might
be exacerbated by inadequacies in the home pen, such as during
competition for feed and access to lying space (Millman, 2007).
Typically, compromised cows are cared for in the home pen or
pasture, in special needs areas and more recently, in designated
hospital pens or infirmaries. Hospital pens are specifically designed
and equipped to facilitate management of compromised cows
(Smith et al., 2001), including inspection and treatment (Cook and
Nordlund, 2004). Although hospital pens are commonly required
in animal care guidelines, there are few recommendations about
K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55
how hospital pens should be designed or managed (e.g., NFACC,
2009; FASS, 2010; Humane Farm Animal Care, 2014). When managing sick or injured dairy cows, caregivers have to consider the
severity of the disease, disease or injury prognosis and biosecurity.
However, there has been little research to inform evidence-based
best practices for design and location of hospital pens within dairy
facilities, social groupings during treatment and recovery stages,
records for evaluating and tracking animal responses to treatment,
and humane endpoints to aid euthanasia decision making.
The aim of this study was to provide descriptive information on
design and use of hospital pens for compromised cows as a subcategory of “special needs” dairy cows, with the goal of identifying areas
where further research by applied ethologists and animal welfare
scientists is warranted.
2. Materials and methods
The protocol for this study was approved by the federally mandated Institutional Review Board for use of human subjects at Iowa
State University.
51
details of housing design, such as type of bedding, and management
decisions for special needs areas and hospital pens.
2.3. Distribution of the questionnaires and follow-up
The questionnaires were mailed to the farmers on January 19,
2010, with a postage-paid return envelope and an invitation letter
for informed consent as well as explanation of the confidentiality
agreement. A second copy of the questionnaire was mailed to 218
non-respondents on February 9, 2010. Follow-up phone calls were
made to participants who had not returned surveys as of February
22, when telephone contact information was available, and participants were encouraged to submit their completed questionnaires.
The Survey and Behavioral Research Service group at Iowa State
University was responsible for administration and management of
the questionnaires, and follow-up telephone calls.
2.4. Analysis of data
Data were manually transcribed from the paper surveys into an
Excel spreadsheet, and proportions were calculated manually.
2.1. Selection of dairy farms for participation
3. Results
Iowa dairy farmers were invited to participate in the study in
January 2010. The list of participants was drawn from a database
of 1600 Iowa dairy farmers provided by the Iowa Department
of Agriculture and Land Stewardship Dairy Bureau (2009) and a
database of farmers with United States Department of Agriculture organic certification as identified by two certifying bodies
(Iowa Department of Agriculture and Land Stewardship, and a
commercial organic milk processing company, 2009). From these
databases, three mutually exclusive groups of farms were compiled for a total of 300 invited participants, representing organic
dairy farms (n = 83), large dairy farms (>500 cows; n = 50) and ordinary dairy farms (neither organic nor large farms; n = 167). The
types of farms were selected in order to achieve data representing the most common types of farms in Iowa. Due to differences
in sample populations, all organic farms and large farms in the
databases were enrolled in the study, whereas ordinary farms were
randomly selected from the remaining database with consideration
to regional representation of the 99 counties in Iowa.
2.2. Questionnaire
We constructed a questionnaire, consisting of 51 questions,
focusing on design and availability of special needs areas and hospital pens, as well as the management of compromised cows,
assisted by the Survey and Behavioral Research Service team at
Iowa State University (ISU). As a component of the questionnaire
development, the researchers visited four Iowa dairy farms to
observe the special needs facilities and hospital pens, and to interview farm managers and veterinarians about common practices
and challenges facing the dairy industry. Prior to distribution, the
questionnaire was beta-tested by a convenience sample of ISU veterinarians, animal scientists and applied ethologists with expertise
in dairy production, and revised for clarity and terminology.
Within the questionnaire, an initial section focused on demographics of the dairy farm, including herd size and parity, marketing
stream (organic or non-organic), housing system (tie stall, free stall,
stanchion or pasture) and number of employees. Questions were
asked specifically relating to the most recent sick, injured or lame
lactating cow that was treated, regardless of outcome, as well as
questions related to on-farm euthanasia. For farms with the possibility to move compromised dairy cows from the home pen to a
special needs area or hospital pen, respondents were asked to complete a second part of the questionnaire, including questions on the
Of the 300 questionnaires mailed out, six were returned by the
postal service as undeliverable (1 large farm and 5 ordinary farms).
A further 20 questionnaires were returned with explanation that
the respondent was no longer farming dairy cattle (3 organic and
17 ordinary farms). Of the remaining 274 questionnaires delivered,
114 were returned by farmers who were actively engaged in dairy
farming in Iowa, two farmers chose not to participate (1 organic
and 1 ordinary farm), and partial or complete data was provided
for 112 Iowa dairy farms for a response rate of 41% of the delivered
questionnaires (40 organic, 20 large and 52 ordinary farms). The
types of housing used on these farms included free stall housing
(62% of farms), tie stalls (20% of farms) and stanchion stalls (13% of
farms). Other types of housing (e.g., bedded packs) were reported
on 3% of farms, and more than one type of housing was reported on
5% of farms. Pasture access was provided on 53% of farms, and was
identified as the sole housing on 9% of farms.
Of the 112 farmers responding to the questionnaire, 82% (n = 92)
had “facilities to house a sick or injured dairy cow away from her
normal pen or stall”. Of the 20 farmers without access to hospital
pens, 60% described how they managed compromised cows in the
comments section of the questionnaire. Three farmers housed sick
or injured cows in tie stalls, whereas 7 farmers described locations
where cows could receive individual treatment (such as the milking
parlour) and made provisions for compromised cows within their
home pens. Two farmers indicated that they had not experienced
compromised cows to date.
Among the 92 farmers with the possibility to move a compromised cow away from the home pen, sick or injured cows were
reported to be held in the same enclosure as fresh cows (45%),
calving cows (36%), close up cows (35%), dry cows (15%), or other
cattle, including heifers, calves and bulls (8%). Conversely, tailored
housing and management practices were provided on some farms,
with access to a designated hospital area provided on 66 of these
farms (72%), and designated lameness areas provided on 45 farms
(49%). Few farmers, only 19% of the full cohort of 112 respondents,
provided special rations for sick or injured cows.
Respondents were asked to score pre-determined “reasons for
moving a lactating cow to a special needs area/hospital pen”
on a 1–5 point Likert scale (1 = not important, 5 = very important). Table 1 lists the reasons according to those identified as
most important to least important. Cow-related factors (cow wellbeing and cow comfort) were identified as particularly important.
52
K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55
Table 1
The distribution of the pre-formulated goals underlying decision to move a dairy cow into a special needs area or hospital pen on Iowa dairy farm with aforementioned
facilities (n = 92).
Goal
1Not important
2
3
4
5Very important
No response
Cow well-being
Cow comfort
More frequent observation of cow
Ease of handling
Milk withdrawl
Reduce disease transmission
2%
8%
5%
5%
36%
17%
2%
5%
2%
4%
5%
23%
11%
13%
12%
16%
13%
16%
21%
21%
29%
35%
13%
16%
59%
49%
45%
33%
27%
21%
5%
4%
7%
7%
5%
7%
Table 2
The distribution of housing design and management of the hospital area on Iowa
dairy farms. The data are presented as the percentage of respondents that reported
using the following resources, and included only farms reported to have a designated
hospital area for ill and injured cows (n = 66).
Resources
Options
Proportion
Type
of
enclosuresa
Pen or box stall
Free stall
Stanchion
Tie stall
Other
Bedded pack
Concrete
Dirt
Rubber
Partially slatted concrete
Mattress
Straw
Sand
Sawdust
Other (corn stalks)
Compost
No bedding
89%
14%
11%
2%
2%
88%
23%
12%
3%
2%
0%
65%
15%
14%
11%
0%
0%
Flooringb
Beddingc
a
More than one type of enclosure may be present in the hospital area. Some
enclosures may be used for restraint and treatment, rather than housing.
b
More than one type of flooring may be present in the hospital area.
c
More than one type of bedding may be present in the hospital area.
A standard management procedure for non-ambulatory cows was
reported for 52% of farms; 41% did not have a procedure and 7% did
not provide a response to this question.
Possibility to milk cows in the special needs or hospital area was
provided on 32% of farms. Of the remainder, the distance between
the special needs/hospital area and the “milking facility where special needs cows are normally milked” was less than 15.2 m (50 ft)
on 51% of the farms, and less than 305 m (1000 ft) on 89% of the
farms. Data regarding the design of the hospital pens such as types
of enclosures, flooring, and type of bedding are presented in Table 2.
Respondents were asked to evaluate 13 different preformulated diagnoses and report the likelihood they would “move
cows with [these] conditions to [a] special needs area/hospital pen”.
Table 3 lists the diagnoses according to the likelihood for moving
cows to a special needs area or hospital pen for farmers that had
facilities to do so. Among the most commonly reported reasons for
moving a cow to a special needs area or hospital pen were calving
difficulties, normal calving, milk fever and displaced abomasum.
When reporting data for the most recently treated sick, lame
or injured dairy cow, farmers were asked to specifically describe
the reason for treatment. There was potential for overlap between
some of these conditions; for example, a cow reported with a
leg injury was presumably also lame. We categorized these cases
according to the primary reason provided by the farmer, which was
“injury” in the example above. For the 92 farms with special needs
or hospital pen facilities, the most common reasons for treating a
cow included lameness (27%), mastitis (18%), injury (9%), calving
difficulties (8%), displaced abomasum (7%) and milk fever (7%). The
percentage of these cows that were housed in a special needs or
hospital pen during part or all of the treatment period were 71%
Table 3
The distribution of the pre-formulated diagnoses underlying the decision to move
a dairy cow into a special needs area or hospital pen on Iowa farms with aforementioned facilities (n = 92).
Condition
Calving difficultiesa
Normal calving
Displaced abomasum
Milk fever
Injury
Ketosis
Retained placenta
Lamenessb
Open woundsc
Mastitis
Metritis
Respiratory diseases
Diarrhea
Proportion of farmers
Yes, always
Sometimes
No, never
No response
51%
41%
40%
40%
30%
21%
19%
14%
14%
13%
11%
10%
5%
34%
24%
35%
42%
53%
35%
26%
64%
46%
46%
35%
46%
44%
10%
28%
15%
13%
7%
34%
46%
17%
29%
35%
35%
35%
46%
5%
7%
8%
4%
10%
11%
10%
4%
11%
4%
15%
8%
5%
a
Included cows that were non-ambulatory as a result of calving difficulties, such
as paralysis.
b
Included cows identified as non-ambulatory unless a specific reason was provided for the cow being down.
c
Some injuries may have also been associated with open wounds, but was not
included unless specified in the description provided by the farmer.
for calving difficulties, 63% for injury, 52% for lameness, 50% for
displaced abomasum, 50% for milk fever and 35% for mastitis.
On 64% of the farms, the most recently treated cow recovered.
The recovered cow was moved directly to her home pen on 31%
of the farms, was placed in a fresh cow pen for a few days and
then returned to the home pen on 26% of farms, was moved into a
recovery group where she remained for some or all of her lactation
on 10% of the farms, was placed in a pen with cows in the same stage
of lactation on 10% of the farms and placed in any available pen on
5% of farms. For cows, that did not recover following treatment
in the special needs area or hospital pen, 26% were culled from
the herd, 41% were euthanized on farm and 30% died. Of the 11
euthanized cows, 73% were euthanized by the owner or manager
and the remainder were euthanized by a veterinarian.
4. Discussion
Farmers and veterinarians take care of food producing animals
with the aim to keep them healthy, productive and to avoid suffering. Although preventive care and identification of risk factors are
active areas of research, today only scant guidance on the design
and management of hospital pens exist. This report is among the
first to provide descriptive information on design and availability of
hospital pens and the management of compromised cows within
the dairy industry, using a subset of Iowa dairy farms as a study
population.
More than 80% farmers had the opportunity to move compromised cows from the home pen, and of these, 70% had access to
designated hospital pens. A diversity of approaches for managing
the needs of compromised cows was reported.
K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55
In general, the high prevalence of pen housing in designated
hospital pen areas, together with bedded pack flooring, likely provides comfortable spaces and traction to facilitate resting behavior.
A small number of respondents used tie stalls or stanchions for the
compromised cows, which are associated with restricted lunging
space for postural transitions (Krohn and Munksgaard, 1993). In
hospital pens, flooring as well as type and level of bedding may be
of even greater importance for the cows than in the home environment. Proudfoot et al. (2014b) kept cows on deep straw bedding
in the days after calving, and found that dairy cows with metritis,
mastitis or pneumonia tended to lie more than a healthy control
group. These results are in line with reports of sickness behavior
from other animal species (Hart, 1988). When an animal becomes
ill with an infectious disease, the immune system initiates strategic behavioral changes in order to facilitate conservation of energy
(Dantzer, 2001). Thus, it may be important for the welfare and
recovery of compromised dairy cows that they are able to express
their motivation to lie down. However, reports from Siivonen et al.
(2011) and Fogsgaard et al. (2012, 2015) showed decreased lying
behavior in cows with mastitis during the period of clinical illness.
In those studies, the animals were kept on relatively hard flooring (rubber mattresses and sawdust) and the authors speculated
whether the reduced lying time may be a reflection of the combination of the sore udder and the lack of softness of the flooring.
Similarly, Jensen et al. (2015) and Bak (2015) reported that lame
cows showed a clear preference for lying on the sand compared
to the rubber floor. At present, it is not known whether the recovery or welfare of compromised dairy cows can be affected by the
choices of flooring and/or bedding in hospital pens. These results,
combined with recent information about bovine sickness behavior
and its link to animal welfare (Fogsgaard, 2015; Proudfoot et al.,
2014a), calls for further research into the design of hospital pens.
There may be conditions where the relocation of compromised
cows away from the home environment is not beneficial for them.
As an example, Proudfoot et al. (2014a) showed that cows with
mastitis, metritis, pneumonia, or some combination seek isolation during illness. However, lame cows did not seek isolation in
another study (Jensen et al., 2015). Additionally, expression of sickness motivation is known to be context dependent, and may be
disrupted in the face of stressors (Aubert, 1999). Today, effects
of stressors on the expression of sickness behavior have not been
examined in cattle.
One-third of the respondents in the present study used their
hospital pens for calving, fresh or dry cows (or a combination of
these) as well as the sick or injured individuals. This practice is
contrary to the recommendations by Cook and Nordlund (2004),
because such “hospital pens” will be occupied by healthy transition cows or calving cows. Such mixing of ill and injured cows
with healthy periparturient cows is of concern due to potential
social stress, risk of transmission of infection and differing behavioral needs of convalescent and parturient cows. Agitation and
restlessness associated with calving (Sepúlveda-Varas et al., 2013)
are likely to pose increased risk of disturbance of convalescent
behavior of the compromised animals, particularly where there is
overstocking of pens. Further research is needed in order to establish effective management of the hospital pen in dairy production.
We recommend the use of precise terminology (“hospital pens”
versus “special needs pens” or “close up pens”) in order to emphasize the different function and care needed for the convalescent
cow as well as periperturient animals.
From our survey questions, we were unable to determine the
proportion of compromised cows that were regrouped or socially
isolated when moved into the special needs or hospital pen, or if
regrouping occurred during the convalescent period. However, 51%
of the newly recovered cows were introduced into a new social
group. The effect of regrouping with unfamiliar animals has been
53
investigated in healthy cattle and leads to increased adrenocortical activation (Herskin et al., 2004), aggression (von Keyserlingk
et al., 2008), reduced feed intake, reduced feeding time and reduced
rumination activity (Schirmann et al., 2011), as well as decreased
lying time (Munksgaard and Herskin, 2006). At present, the effects
of regrouping compromised cows have received limited scientific attention. Isolation seeking behavior in dairy cows during
illness (Proudfoot et al., 2014b) suggests that these animals are
more sensitive to regrouping than healthy animals. Thus, relocation from the home environment (with or without isolation) may
be beneficial. Based on the limited available knowledge concerning
social motivation in sick or injured dairy cows, it is not possible to give evidence-based recommendations concerning the use
of individual versus group hospital pens, or to advise an optimal
stocking density in hospital pens. Results from healthy animals
show that increased competition at the feed bunk leads to shorter
feeding times and more aggressive interactions (DeVries et al.,
2004), and that socially subordinate animals are displaced more frequently, particularly at high stocking densities (Huzzey et al., 2006).
Considering increased motivation for social isolation (Proudfoot
et al., 2014b) and decreased feeding motivation (Hohenbrink and
Meinecke-Tillmann, 2012), compromised cows are most likely to
benefit from hospital pens designs that provide reduced competition at the feed bunk.
Many cows kept in hospital pens are lactating and need to be
milked daily. In the present survey, approximately one third of the
respondents had the opportunity to milk their compromised cows
directly in the hospital pen, and an additional 51% of farms required
cows to walk less than 15 m (50 ft) to the milking parlour. Depending on the specific pathological condition, the milking process may
be a stressful event for compromised cows. Walking to the milking
parlour and queuing to enter the parlour may be painful to the lame
cow (Dyer et al., 2007). Furthermore, cows suffering from udder
pathology may experience pain during the milking (Fogsgaard et al.,
2015). Thus, opportunities to milk dairy cows close to or inside the
hospital pen, combined with increased surveillance during milking,
may be beneficial. Further research is needed to document possible consequences of the management of and facilities for milking
of compromised animals
When asked about conditions leading to the decision to move a
cow from the home pen, the answers were highly variable. This is
not surprising, given the diversity of causal factors for cow illness
or injury, and the limited recommendations on hospital pen use. In
the present dataset, the most prevalent conditions leading to the
relocation of the cows from the home pen were calving difficulties, injuries, lameness, milk fever and displaced abomasum. These
conditions are typically accompanied by standing and ambulation
difficulties (Kahn and Line, 2006), and hence relocation to a hospital pen at disease onset may be strategic in order to avoid the risks
of weakened and painful individuals becoming non-ambulatory in
the home environment.
Metritis and mastitis were among the conditions less likely to
result in relocation of cows to hospital pens. For metritis, these low
numbers may be surprising, since dairy farmers reported moderate
pain scores for metritis (6 on a scale from 1 to 10) in a Scandinavian study (Thomsen et al., 2012). Furthermore, metritis is a costly
disease, associated with decreased milk yield (Rajala and Grohn,
1998), increased risk of culling (Gröhn et al., 2003) and decreased
reproductive performance (Melendez et al., 2004; Opsomer et al.,
2000). Dairy cows suffering from metritis have been shown to eat
less than healthy animals (Huzzey et al., 2007; Urton et al., 2005),
thereby exposing themselves to slower recovery and increased risk
of complications. Thus, dairy cows suffering from metritis may benefit from a stay in a hospital pen with a low level of competition,
leading to a potential improvement in the production economy for
the farmer. Similarly, mastitic dairy cows spend less time eating
54
K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55
and more time standing idle (Fogsgaard et al., 2012, 2015; Siivonen
et al., 2011). Although these behavioral changes were not necessarily associated with competition or stocking density, relocation
to a less competitive hospital pen may facilitate feed intake and
improve recovery as well as animal welfare. However, no data exists
regarding the associations between hospital pen use and production benefits for any diagnosis of illness or injury.
In the present survey, after a stay in a hospital pen, recovered
cows were most frequently moved directly to their home pens. In
groups of cattle, social rank appears to be determined mainly by
height, age and weight (Beilharz and Zeeb, 1982; Houpt, 2005).
Consequently, in an established herd, the older cows tend to dominate (Houpt, 2005). Even though the exact temporal limits are not
known, when a cow leaves her social group and returns within a
short period of time, she will enter the same social status as before
(Houpt, 2005). Thus, depending on the duration of the stay in the
hospital pen, relocating recovered cows directly back to their home
pen might not affect their social rank in the group. However, if sick
cows change their social rank, their return to the home environment may represent unique social stressors during establishment
of a new rank order. No information exists regarding effects of
different management strategies for the return of recovered cows
from hospital pens.
One aspect of the management of compromised dairy cows
which was not examined in the present questionnaire, and which
has received limited scientific attention is the acceptable duration
of the recovery period. Further research focusing on the recovery
phase of prevalent bovine diseases is needed, including behavior
and animal welfare parameters, in addition to production economy. Research findings could help inform decision making about
humane endpoints as a component of the management of compromised dairy cows.
5. Conclusion
Sickness behavior is an emerging area of research for applied
ethologists, with particular relevance for the care of compromised
cattle. This questionnaire survey is among the first to provide
descriptive information on design and availability of hospital pens
and the management of compromised cows within the dairy industry, using a subset of Iowa dairy farms as a study population. Cow
well-being was considered either an important or very important
reason for moving cows into hospital pens by 80% of respondents,
and cow comfort was cited as important or very important by 70%
of respondents. However, one-third of farmers reported housing ill
and injured cows together with fresh, calving and close up cows.
Research is needed to determine impacts of social grouping on
expression of sickness behavior, particularly in regard to mixing
compromised and periparturient cattle.
Conflict of interest
None.
Acknowledgements
The authors gratefully acknowledge the participation of the
dairy farmers in Iowa, and the assistance provided by the Iowa
State Dairy Association, dairy extension agents and organic certifying agents for networking and beta-testing our questionnaire.
We are grateful to Kassi Miller, Becky Parsons, as well as Allison
Andersen and Janice Larsen from the Iowa State University’s Survey and Behavioral Research Service, for technical support for the
project. Dr. Annette O’Connor kindly provided helpful comments on
an earlier draft. Thanks to Birthe Houbak and Eric L. Decker from
Department of Animal Science, Aarhus University for the statistical
support. Thanks to Foundation of Oticon (Denmark), to The Faculty Foundation of the Faculty of Science at University of Aarhus,
Denmark and to Ellen, Christian & Anders Petersen’s Foundation
(Denmark) for financial support.
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