Sustained Positive Effect Research Articles

Evaluation of an Advanced Mindfulness Program Following a Mindfulness-Based Stress Reduction Program for Participants Suffering from Mental Fatigue After Acquired Brain Injury

Mental fatigue is, for many, a very distressing and long-term problem after a traumatic brain injury (TBI) or stroke. This will make it more difficult for the individual to return to work and resume social activities, and it can take several years to find the right balance between rest and activity in daily life, to find strategies and to accept the new situation. The aim of this study was to evaluate the effect of an advanced mindfulness program following a MBSR program, designed for subjects suffering from long-term mental fatigue after a brain injury. The advanced program was based on The Brahma Viharas, meditative practices known for cultivating four mental states: compassion, metta, appreciative joy, and equanimity. Fourteen participants followed the 8-month advanced mindfulness program, with group visits once a month and a final all-day retreat. All the participants were suffering from mental fatigue at least 1 year after a brain injury following a stroke or a TBI. The assessments after the advanced program showed a significant and sustained positive effect on mental fatigue and on tests measuring information processing speed and attention. With mindfulness practice it was possible to improve wakefulness during meditation and, above all, improve the mental fatigue levels. We propose that mindfulness is a promising treatment for mental fatigue after a stroke or TBI.

Argentine tango: Another behavioral addiction?

Background: Behavioral addiction is an emerging concept based on the resemblance between symptoms or feelings provided by drugs and those obtained with various behaviors such as gambling, etc. Following an observational study of a tango dancer exhibiting criteria of dependence on this dance, we performed a survey to assess whether this case was unique or frequently encountered in the tango dancing community. Methods: We designed an online survey based on both the DSM-IV and Goodman's criteria of dependence; we added questions relative to the positive and negative effects of tango dancing and a self-evaluation of the degree of addiction to tango. The questionnaire was sent via Internet to all the tango dancers subscribing to “ToutTango”, an electronic monthly journal. The prevalence of dependence was analyzed using DSM-IV, Goodman's criteria and self-rating scores separately. Results: 1,129 tango dancers answered the questionnaire. Dependence rates were 45.1, 6.9 and 35.9%, respectively, according to the DSM-IV, Goodman's criteria and self-rating scores. Physical symptoms of withdrawal were reported by 20% of the entire sample and one-third described a strong craving for dancing. Positive effects were high both in dependent and non-dependent groups and were markedly greater than negative effects. Long practice of tango dancing did not modify the dependence rate or reduce the level of positive effects. Conclusions: Tango dancing could lead to dependence as currently defined. However, this dependence is associated with marked and sustained positive effects whilst the negative are few. Identifying the precise substratum of this dependence needs further investigation.

The benefits of photodynamic therapy on vertebral bone are maintained and enhanced by combination treatment with bisphosphonates and radiation therapy

Photodynamic therapy (PDT) has been shown to ablate tumors within vertebral bone and yield short-term improvements in vertebral architecture and biomechanical strength, in particular when combined with bisphosphonate (BP) treatment. Longer-term outcomes of PDT combined with current treatments for skeletal metastases are essential to understand its therapeutic potential. The objective of this study is to evaluate the response of vertebrae to PDT after a longer (6-week) time period, alone and combined with previous BP or radiation treatment (RT). Sixty-three female rnu/rnu rats were randomized to six treatment groups: untreated control, BP-only, RT-only, PDT-only, combined BP + PDT and combined RT + PDT. L2 vertebrae were structurally analyzed through µCT-based analysis, axial compressive load-to-failure testing and histological analysis of morphology, osteoid formation and osteoclast activity. Combined BP + PDT treatment yielded the largest improvements in bone architecture with combined RT + PDT treatment yielding similar findings, but of a lesser magnitude. Mechanically, ultimate force and stress were correlated to stereological parameters that demonstrated a positive structural effect from combinatory treatment. Increased osteoid formation was observed in both combination therapies without any significant differences in osteoclast activity. Overall, multimodality treatment demonstrated a sustained positive effect on vertebral structural integrity, motivating PDT as a minimally-invasive adjuvant treatment for spinal metastases.

Effects of interferon beta-1b on cognitive performance in patients with a first event suggestive of multiple sclerosis

Background: Cognitive dysfunction occurs at the earliest stages of multiple sclerosis (MS), including the stage of clinically isolated syndrome (CIS). Methods: We evaluated the impact of interferon beta-1b (IFNβ-1b) 250 µg on cognitive performance during the CIS stage in the BENEFITstudy. Cognition was assessed by Paced Auditory Serial Addition Test-3” (PASAT-3”) scores. Results: Improvement in PASAT-3” score from baseline to year two was greater for IFNβ-1b treatment than placebo in patients not reaching clinically definite MS (CDMS) by year two. The treatment effect was maintained at year five and was statistically significant. Conclusions: To conclude, early IFNβ-1b treatment had a sustained positive effect on PASAT-3” score over the 5-year BENEFIT study.

Farmers’ Income and Production Responses to Rural Taxation Reform in Three Regions in China

AbstractThe relationship between agricultural taxation and production efficiency has been thoroughly explored for many countries. Recently, China has taken various measures including the rural taxation reform (RTR) to promote grain production and to increase farmer incomes. In this study, we investigate whether the Chinese policy of abolishing rural taxation has improved farm households’ incomes and affected their production decisions. Using household survey data obtained from three regions in China, we estimate the effect of the RTR on farmers’ income. Results show that the RTR has significantly improved farmers’ post‐tax net income by 9.2% in Shandong, 16.9% in Shanxi and 16.8% in Zhejiang. These increments, mostly from farm income rather than from off‐farm income, are much higher than the direct income increase from the tax savings. In addition, we examine the dynamic impact of farmers’ net income, and find that the RTR has a sustained positive income effect in Shandong and Shanxi, whereas its positive effect in Zhejiang appears temporary. We also examine farmers’ production responses to the RTR. Results show that farmers in the three regions respond in different ways: farmers in Shandong significantly increase their labour input, farmers in Zhejiang increase intermediate inputs, whereas Shanxi farmers augment their intermediate inputs and enlarge their crop acreage. It appears that the farmers’ responses to the taxation reform vary due to the agronomic and economic factors in these three regions, suggesting that diverse post‐RTR supplemental policies should be implemented in different regions.

Establishment, persistence and effectiveness of arbuscular mycorrhizal fungal inoculants in the field revealed using molecular genetic tracing and measurement of yield components

• Inoculation of crop plants by non-native strains of arbuscular mycorrhizal (AM) fungi as bio-enhancers is promoted without clear evidence for symbiotic effectiveness and fungal persistence. To address such gaps, the forage legume Medicago sativa was inoculated in an agronomic field trial with two isolates of Funneliformis mosseae differing in their nuclear rDNA sequences from native strains. • The inoculants were traced by PCR with a novel combination of the universal fungal NS31 and Glomeromycota-specific LSUGlom1 primers which target the nuclear rDNA cistron. The amplicons were classified by restriction fragment length polymorphism and sequencing. • The two applied fungal inoculants were successfully traced and discriminated from native strains in roots sampled from the field up to 2 yr post inoculation. Moreover, field inoculation with inocula of non-native isolates of F. mosseae appeared to have stimulated root colonization and yield of M. sativa. • Proof of inoculation success and sustained positive effects on biomass production and quality of M. sativa crop plants hold promise for the role that AM fungal inoculants could play in agriculture.

Sustainability of the Dissemination of an Occupational Sun Protection Program in a Randomized Trial

Sustainability of an occupational sun safety program, Go Sun Smart (GSS), was explored in a randomized trial, testing dissemination strategies at 68 U.S. and Canadian ski areas in 2004-2007. All ski areas received GSS from the National Ski Areas Association through a Basic Dissemination Strategy (BDS) using conference presentations and free materials. Half of the ski areas were randomly assigned to a theory-based Enhanced Dissemination Strategy (EDS) with personal contact supporting GSS use. GSS use was assessed at immediate and long-term follow-up posttests by on-site observation. Use of GSS declined from immediate (M = 6.24) to long-term follow-up (M = 4.72), F(1, 62) = 6.95, p = .01, but EDS ski areas (M = 6.53) continued to use GSS more than BDS ski areas (M = 4.49), F(1, 62) = 5.75, p = .02, regardless of timing of posttest, strategy × observation F(1, 60) = 0.05, p = .83. Despite declines over time, a group of ski areas had sustained high program use and active dissemination methods had sustained positive effects on implementation.

Long-Term Evaluation of a Trauma Center-Based Juvenile Driving Intervention Program

Motor vehicle-related trauma remains the leading cause of adolescent injury and death in the United States. We previously reported results from the Drive Alive (DA) program-a comprehensive juvenile prevention program that highlights risky driving behavior and consequences-and demonstrated a reduction in recidivism 6 months after its completion. We further evaluated the results of the original and subsequent participants on a long-term basis. Bureau of Motor Vehicle records of all individuals who had completed the DA program were prospectively reviewed. This 4-week, Level I trauma center-based program provides 10 contact hours of exposure to mock trauma sessions, drug and alcohol education, former trauma patients and their families, state troopers and other pertinent driving safety, educational, and prevention topics. The County Juvenile Court ordered participation after driving-related convictions. The driving records were compared with a control group consisting of adolescents convicted of similar driving offenses in the same period, not referred to the DA program. Comparisons were made at 6 monthly intervals up to 60 months using Fischer's exact test. A total of 488 teens (346 male and 142 female) completed the DA program between May 2003 and October 2008. Mean participant age was 17.4 years. Speeding and driving under the influence of alcohol were the most frequent reasons for referral. Consistent with our prior results, this interactive intervention for juvenile driving offenders resulted in a statistically significant reduction in driving-related offenses for the 6-month periods after its completion. This effect is lost in the long term. The role of booster interventions at 6 months and beyond, as adjuncts to initial interventional prevention initiatives, needs to be explored to aid sustained positive effects in this population of drivers.

Deterioration of Blood Pressure Control After Discontinuation of a Physician‐Pharmacist Collaborative Intervention

To assess blood pressure control after discontinuation of a physician-pharmacist collaborative intervention. Comparative analysis of data of the patients who received the intervention versus a control group from a prospective, cluster-randomized, 9-month efficacy trial and the same patients' data 18 and 27 months after completion of the trial, abstracted from their medical records. Five primary care medical offices operated by a university health system. One hundred four patients with hypertension; 65 were in the intervention group, and 39 were in the control group. In the prospective study, patients were randomized to receive a physician-pharmacist collaborative intervention to improve blood pressure control or to the control group. Systolic and diastolic blood pressures were measured by a research nurse at baseline and at the end of the study (9 mo later). In the current study, data were abstracted for blood pressure and blood pressure control at 18 and 27 months (9 and 18 mo, respectively, after discontinuation of the study). At baseline, mean +/- SD systolic blood pressure was 152.5 +/- 9.5 and 150.1 +/- 9.6 mm Hg in the intervention and control groups, respectively (p=0.22). At 9 months, systolic blood pressure decreased to 124.5 +/- 10.7 and 132.0 +/- 15.1 mm Hg (p=0.0038 between groups), and blood pressure was controlled in 78.5% and 48.7% (p=0.0017) of patients in the intervention and control groups, respectively. By 18 months, systolic blood pressure had deteriorated to 131.0 +/- 12.2 and 143.3 +/- 17.5 mm Hg (p<0.001), and blood pressure control rates decreased to 53.9% and 30.8% (p=0.02). By 27 months, systolic blood pressure was 131.3 +/- 13.0 and 141.2 +/- 15.8 mm Hg (p=0.0008), and blood pressure control was 55.4% and 35.9% (p=0.05). A sustained positive effect on blood pressure control was noted up to 18 months after discontinuation of a physician-pharmacist collaborative intervention, when compared with a control group. Blood pressure control did deteriorate at a similar rate in both the intervention and control groups, but the percentage of patients with controlled blood pressure remained significantly higher in the intervention group. These results suggest that continued interventions by pharmacists may be necessary to maintain high rates of blood pressure control, especially in those patients whose blood pressure begins to increase.

Tourism as a determinant of long‐run economic growth

This study investigates the relationships between tourism and economic growth. It does this by examining the South Tyrolean economy using the Johansen cointegration test to obtain a cointegrated vector among the relevant variables and the Granger causality test to investigate causality. Annual GDP data from 1980 to 2006, the number of foreign visitors to South Tyrol, and the relative prices (RP) between South Tyrol and Germany (the source of more than 60% of foreign tourists) are used. The Johansen cointegration test shows that the estimated long‐run elasticity of the real GDP with respect to tourism demand is 0.29 and the Granger causality test shows that causality goes unidirectionally from tourists and RP to real GDP. Therefore, the tourism‐led growth hypothesis is supported empirically in the case of South Tyrol. In other words, in South Tyrol, tourism reinforces long‐run economic growth but economic growth does not reinforce tourism. Impulse response analysis shows that a shock to the number of tourists and RP produces a continuous and sustained positive effect.

Five-year outcomes of patients with type 2 diabetes who underwent laparoscopic adjustable gastric banding

BackgroundEvidence of the positive effects of gastric banding on patients with diabetes has continued to increase. The long-term follow-up of such patients, however, has been limited. The purpose of the present study was to provide the long-term outcomes of patients with diabetes undergoing laparoscopic adjustable gastric banding at our institution. MethodsFrom January 2002 through June 2004, 102 patients with type 2 diabetes mellitus underwent laparoscopic adjustable gastric banding. The study parameters included preoperative age, gender, race, body mass index, duration of diabetes before surgery, fasting glucose level, hemoglobin A1c (HbA1c), and medications used. Preoperative data from all patients were collected prospectively and entered into an institutional review board-approved database. Beginning in 2008, efforts were made to collect the 5-year follow-up data. ResultsOf the 102 patients, 7 were excluded because they had not reached the 5-year follow-up point (2 patients had had the band removed early and 5 patients had died; 2 of cancer and 3 of unknown causes), leaving 95 patients for the present study. The mean preoperative age was 49.3 years (range 21.3–68.4). The mean preoperative body mass index was 46.3 kg/m2 (range 35.1–71.9) and had decreased to 35.0 kg/m2 (range 21.1–53.7) by 5 years of follow-up, yielding a mean percentage of excess weight loss of 48.3%. The mean duration of the diabetes diagnosis before surgery was 6.5 years. Of 94 patients, 83 (88.3%) were taking medications preoperatively, with 14.9% overall taking insulin. At 5 years postoperatively, 33 (46.5%) of 71 patients were taking medications, with 8.5% taking insulin. The mean fasting preoperative glucose level was 146.0 mg/dL. The glucose level had decreased to 118.5 mg/dL at 5 years postoperatively (P = .004). The mean HbA1c level was 7.53 preoperatively in 72 patients and was 6.58 at 5 years postoperatively in 64 patients (P <.001). Overall, diabetes had resolved (no medication requirement, with HbA1c <6 and/or glucose <100 mg/dL) in 23 (39.7%) of 58 patients and had improved (use of fewer medications and/or fasting glucose levels of 100–125 mg/dL) in 41 (71.9%) of 57 patients. The combined improvement/remission rate was 80% (64 of 80 patients). ConclusionOur data have demonstrated that laparoscopic adjustable gastric banding results in a substantial sustained positive effect on diabetes in morbidly obese patients, with a significant reduction in HbA1c and an 80% overall rate of improvement/remission.

Hormones, nicotine, and cocaine: Clinical studies

Nicotine and cocaine each stimulate hypothalamic–pituitary–adrenal and –gonadal axis hormones, and there is increasing evidence that the hormonal milieu may modulate the abuse-related effects of these drugs. This review summarizes some clinical studies of the acute effects of cigarette smoking or IV cocaine on plasma drug and hormone levels and subjective effects ratings. The temporal covariance between these dependent measures was assessed with a rapid (2 min) sampling procedure in nicotine-dependent volunteers or current cocaine users. Cigarette smoking and IV cocaine each stimulated a rapid increase in LH and ACTH, followed by gradual increases in cortisol and DHEA. Positive subjective effects ratings increased immediately after initiation of cigarette smoking or IV cocaine administration. However, in contrast to cocaine's sustained positive effects (< 20 min), ratings of “high” and “rush” began to decrease within one or two puffs of a high-nicotine cigarette while nicotine levels were increasing. Peak nicotine levels increased progressively after each of three successive cigarettes smoked at 60 min intervals, but the magnitude of the subjective effects ratings and peak ACTH and cortisol levels diminished. Only DHEA increased consistently after successive cigarettes. The possible influence of neuroactive hormones on nicotine dependence and cocaine abuse and the implications for treatment of these addictive disorders are discussed.

Point: Steady Progress and Current Challenges in Clinical Islet Transplantation

The field of β-cell replacement therapies has evolved substantially over the last decades. The lesson learned from recent islet transplantation trials in patients with unstable type 1 diabetes is that primary goals are the achievement of stable, normalized glycemic control in the absence of severe hypoglycemic episodes with improvement of quality of life and the prevention of progressive, chronic diabetes complications. Insulin independence, although desirable, should not be considered the main objective, particularly in light of the sustained positive effects achieved even with a “marginal” functional islet mass via restoration of C-peptide secretion and reduction of insulin requirements. As present limitations of islet transplantation are progressively overcome, the clinical application will greatly expand from the currently limited indication in controlled clinical research trials to more widely available cellular therapies and regenerative medicine solutions that will eventually be offered as standard treatment to the majority of patients with insulin-requiring diabetes. Vantyghem et al. (1) in the article in this issue of Diabetes Care evaluated the predictive value of primary graft function on long-term clinical outcomes of islet transplantation alone (ITA). Surrogate measures have been proposed to monitor or predict β-cell function, but they are not yet fully validated (2–4). In this report, the use of the β-score in the early posttransplant period allowed to quantify primary graft function that, when “optimal,” was associated with prolonged graft survival and better metabolic control following islet transplantation (1). In agreement with previous reports using the “Edmonton Protocol” (5–10), this trial resulted in a significant improvement of metabolic control and long-term graft function (∼70% having measurable C-peptide at 5 years). Importantly, the investigators also showed prolonged insulin independence in 57% of the patients at 5 years, with the subjects with optimal primary graft …

Mitigation of Medication Mishaps via Medication Therapy Management

In 2006, the Center for Medicare & Medicaid Services incorporated the requirement for a Medication Therapy Management Program (MTMP) for individuals with Part D coverage to ensure that drug regimens provide optimal therapeutic outcomes through improved medication use, thereby reducing adverse drug events. To evaluate the effectiveness of an MTMP implemented for Medicare Advantage Prescription Drug members enrolled with Health Alliance Plan (HAP) during 2006 and 2007. Patient eligibility for MTMP was searched electronically. Clinical pharmacists researched medication histories and adherence and, through telephone contact, ascertained the patients' healthcare goals and needs. A patient-centered pharmacotherapy plan was created and implemented collaboratively with the patient's physician(s). To ensure that therapy goals were met, pharmacists performed follow-up interventions. Clinical outcomes and cost savings were compared for MTMP enrollees versus those declining enrollment. Average enrollment rate for the MTMP was 20% for 2006 and 2007. Nearly 60% of interventions involved changing therapy to improve efficacy and greater than 40% involved changing therapy to improve safety. Analysis of 2006 data revealed an overall improvement in electronically measurable clinical outcomes for MTMP enrollees versus individuals who declined enrollment, including a trend toward improved adherence to drug therapy for heart failure, insulin use, and a significant reduction in gastrointestinal bleeds (p = 0.001). Cost-savings analysis indicated a greater reduction in total prescription per member per month costs ($PMPM) of 17.2% for MTMP enrollees versus a 7% reduction for those who declined MTMP (p = 0.001). Patients who enrolled into the 2006 MTMP also saw a sustained positive effect in lowered $PMPM for prescription drugs in 2007. The HAP MTMP, conducted through telephone contacts, produced positive trends in improving clinical outcomes, reductions in pharmacy costs, and sustained pharmacy cost savings for patients who enrolled in the MTMP compared with patients who declined enrollment.

Surgeon performance index: tool for assessment of individual surgical quality in total quality management

The surgeon's individual performance is a key component of total quality management (TQM) in cardiac surgery. Early mortality as well as postoperative complications can be stratified in order to develop a surgeon performance index (SPI). In three consecutive annual periods (3703 patients) data of board-certified cardiac surgeons were compared. Risk-adjustment of early mortality and postoperative complications was performed by logistical EuroSCORE (logES). Early mortality (EM), early rethoracotomy for bleeding (ReTh), sternal rewiring for instability (ReWr), and mediastinitis (Med) were assessed. ReTh, ReWr, and Med were weighted according to empiric data: (ReThx2; ReWrx1; Medx3). Surgeon performance index was computed as follows: SPI=(EM/logES+[((ReTh/logES)x2)+((ReWr/logES)x1)+((Med/logES)x3)]/6)/2. Ideal SPI was considered <or=1. SPI of the respective previous period was handed out to each surgeon and discussed by means of a structured dialogue. Patients from each period were allocated to 11 cardiac surgeons. Overall logES of the three periods were 6.6%, 9.1%, and 11.2% respectively; EM 5.7%, 6.6%, 5.6%; ReTh 5.8%, 7.3%, 10.9%; ReWr 2.4%, 1.9%, 1.4%; and Med 0.9%, 1.8%, 1.8%. SPI showed a mean of 0.71, 0.56, and 0.49. Comorbidity increased between periods 1 and 3 significantly whereas early mortality remained rather stable. SPI indicated improvement of the performance of the individual surgeon and a decrease of range and mean of the overall performance. SPI is therefore an effective tool to assess individual surgical quality and serves as an instrument for human resource management and development. Sustainable positive effects on overall performance can be expected.

Journal Digest

Journal Digest

Long-term Mother and Child Mental Health Effects of a Population-Based Infant Sleep Intervention: Cluster-Randomized, Controlled Trial

Maternal depression is an established risk for adverse child development. Two thirds of clinically significant depressive symptoms occur in mothers reporting an infant sleep problem. We aimed to determine the long-term effects of a behavioral intervention for infant sleep problems on maternal depression and parenting style, as well as on child mental health and sleep, when the children reached 2 years of age. We conducted a cluster-randomized trial in well-child centers across 6 government areas of Melbourne, Australia. Participants included 328 mothers reporting an infant sleep problem at 7 months, drawn from a population sample (N = 739) recruited at 4 months. We compared the usual well-child care (n = 154) versus a brief behavior-modification program designed to improve infant sleep (n = 174) delivered by well-child nurses at ages 8 to 10 months and measured maternal depression symptoms (Edinburgh Postnatal Depression Scale); parenting practices (Parent Behavior Checklist); child mental health (Child Behavior Checklist); and maternal report of a sleep problem (yes or no). At 2 years, mothers in the intervention group were less likely than control mothers to report clinical depression symptoms: 15.4% vs 26.4% (Edinburgh Postnatal Depression Scale community cut point) and 4.2% vs 13.2% (Edinburgh Postnatal Depression Scale clinical cut point). Neither parenting style nor child mental health differed markedly between the intervention and control groups. A total of 27.3% of children in the intervention group versus 32.6% of control children had a sleep problem. The sleep intervention in infancy resulted in sustained positive effects on maternal depression symptoms and found no evidence of longer-term adverse effects on either mothers' parenting practices or children's mental health. This intervention demonstrated the capacity of a functioning primary care system to deliver effective, universally offered secondary prevention.

The Use of Exenatide in Islet Transplant Recipients with Chronic Allograft Dysfunction: Safety, Efficacy, and Metabolic Effects

A current limitation of islet transplantation is reduced long-term graft function. The glucagon-like peptide-1 receptor agonist, exenatide (Byetta, Amylin Pharmaceuticals, CA) has properties that could improve existing islet function, prevent further loss of islet mass and possibly even stimulate islet regeneration. This prospective study evaluated the safety, efficacy, and metabolic effects of exenatide in subjects with type 1 diabetes mellitus and islet allograft dysfunction requiring exogenous insulin. Sixteen subjects commenced exenatide, 12 continue (follow-up 214+/-57 days; range 108-287), four (25%) discontinued medication because of side effects. At 6 months, exogenous insulin was significantly reduced with stable glycemic control (0.15+/-0.02 vs. 0.11+/-0.025 U/kg per day; P<0.0001); three subjects discontinued insulin from 4, 5, and 9 U/day, respectively, two sustained insulin independence with A1c reduction below graft dysfunction criteria. Postprandial capillary blood glucose was significantly decreased (129.4+/-3.8 vs. 118.7+/-4.6 mg/dL; P<0.001), C-peptide and C-peptide-to-glucose ratio increased significantly by 5th and 6th months of treatment (ratio, 1.09+/-0.15 vs. 1.52+/-0.18; P<0.05). Weight loss more than 3 kg occurred in 8 of 12 (67%) subjects. Stimulation testing demonstrated improved glucose disposal and C-peptide secretion (glucose area under the curve 52,332+/-3,219 vs. 42,072+/-1,965; P=0.002 mg x min x dL, mixed meal stimulation index 0.50+/-0.06 vs. 0.66+/-0.09; P=0.03 pmol x mL), with marked suppression of glucagon secretion and progressive increase in amylin secretion. Side effects were more frequent and severe compared with published reports in type 2 diabetes, tolerated doses were lower. Exenatide was tolerated in this patient population after appropriate dose titration and there appeared to be gradual but sustained positive effects on glycemic control and islet graft function.

Prospects for enhancing livelihoods, communities, and biodiversity in Africa through community-based forest management: a critical analysis

Myriad projects have been introduced in recent decades in tropical forest and forest-edge ecosystems to slow or reverse the rapid loss of biodiversity, deterioration of livelihood resources, and deepening of rural poverty – with markedly mixed results. This paper reports the results of a critical review of the literature and four case studies of community-based forest management (CBFM) in Malawi, Uganda, Kenya, and Tanzania, analysed in terms of sustainable livelihoods dimensions, participation and social institution strengthening, governance and linkages with external institutions, and outcomes assessment. Derived from the literature review and confirmed in the case studies, our central finding is that sustainable positive effects of CBFM can be achieved only through integrated approaches that simultaneously enhance social capital of households and local institutions, improve the productivity of forest-edge landscape resources, and foster livelihood diversification and increase incomes while reducing economic vulnerability.

Systemic Treatment of Subclinical Mastitis in Lactating Cows with Penethamate Hydriodide

A randomized controlled field trial was performed to evaluate the efficacy of a 3-d treatment regimen with i.m. penethamate hydriodide compared with no treatment in lactating cows with subclinical mastitis. To be included, a cow had to have 2 somatic cell counts (SCC) 300,000cells/mL at the last 3 monthly controls, 1 or more quarters with SCC >250,000cells/mL, and the same bacterial species isolated in 2 consecutive samples 2 to 4 d apart. A total of 151 quarters from 92 cows were monitored for 2 mo following treatment. Quarter milk samples were examined for bacteriological cure (BC) and SCC at 14, 28, and 60 d after treatment. Bacteriological cure was defined as not having the same bacterial species isolated from the quarter milk samples taken at 14 and 28 d posttreatment as in the samples taken before treatment. Systemic treatment with penethamate resulted in BC in 59.5% of quarters and 52.2% of cows, compared with 16.7 and 10.9% in the untreated cows. Somatic cell count decreased significantly in the penethamate-treated cows, steadily in the case of BC and transiently when the infections persisted. This study confirms that systemic treatment of subclinical mastitis with penethamate is effective and that BC of infected quarters has a sustained positive effect on milk SCC during the 2 mo following treatment.