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Sindelar (1982) recommended that seed orchards of European larch contain many clones in order to prevent excessive propagation of a few fertile clones can arthritis in fingers be fixed buy 20 mg feldene overnight delivery. A Scots race mentioned in older references probably developed in Scotland from plants of Sudeten origin (Rudolf 1974) arthritis drug for vitiligo order feldene 20mg online. European seed sources perform similarly in northeastern United States as in Great Britain arthritis pain and carpal tunnel order feldene 20 mg with amex, Germany arthritis mutilans feet order feldene 20mg with visa, and Italy (Genys 1960) arthritis treatments queensland discount 20mg feldene free shipping. Some varieties of Dahurian larch that are confined to definite areas appear to be geographic races (Debazac 1964) oligoarticular arthritis definition generic 20 mg feldene with amex. Tests in Finland showed marked differences in survival, growth rate, cold hardiness, and susceptibility to insect attack between trees from Korean and Sakhalin seed sources (Kalela 1937). Trees of Olga Bay larch seem suitable for planting in north central United States and adjacent Canada. Because of the extensive natural range of tamarack, geographic races probably exist. Studies by Cheliak and others (1988); Farmer and others (1993), and Park and Fowler (1987) reported differences in growth, such as total height based on latitude and late-season elongation. Two-year-old seedlings of tamarack grown in Minnesota from seeds from several origins showed significant differences in total height and a tendency for bud set to occur earliest in seedlings from northern sources (Pauley 1965). Japanese larch is native to a 363-km2 area in the mountains of central Honshu, where it grows in scattered stands at elevations of 900 to 2,800 m (Asakawa and others 1981). Despite this small native range, test plantings of Japanese larch in several parts of the United States and eastern Canada, Japan, China, Great Britain, and Germany have shown significant differences among seed sources in tree height, survival, terminal bud set on leader, number of branchlets, insect resistance, winter and spring cold damage, and susceptibility to sulfur fumes (Hattemer 1968; Heimburger 1970; Lester 1965; MacGillivray 1969; Wright 1965). Progeny of seeds from diverse sources respond differently to particular environments, so that no general recommendations can be made as to the best races for specific localities. However, seeds from sources in the northern part and the higher elevations of Honshu have produced progeny with earlier hardening off and less early frost damage than have seeds collected from farther south and at lower elevations (Hattemer 1968; Heimburger 1970; Lester 1965; Wright 1965). Siberian larch stock grown from seeds from the Altai region seem to be less cold hardy than stock grown from seeds from other parts of the range (Tkachenko and others 1939). Limited trials in North Dakota suggest that this species could be used as the tallest member of a multiplerow shelterbelt (Cunningham 1972). Cones are usually scattered throughout the non-shaded crown with seed cones more frequent higher in the crown and pollen cones more frequent lower in the crown (Eis and Craigdallie 1983), but there usually is considerable overlap. They occur randomly with the leaves on the sides of twigs or branches and usually open a few days before needle elongation. The male flowers are solitary, yellow, globose-to-oblong bodies that bear wingless pollen. The female flowers are small, usually shortstalked, erect, red or greenish cones that ripen the first year. However, the seed and pollen cone buds of tamarack (Powell and others 1984) and Japanese larch (Powell and Hancox 1990) can differentiate laterally on long shoots the year they elongate. Furthermore, as tamarack plantations go from 5, 6, to 7 years of age, the number of trees bearing seed and pollen cones and the number of cones per tree increased each year (Tosh and Powell 1991). Topgrafting buds of 2-, 5-, 9-, 45-, and 59-year-old Japanese larch on 17-year-old trees shortened the time to produce female and male strobili by about 5 years over untreated controls (Hamaya and others 1989). Loffler (1976) found that yield of European larch seeds in seed orchards usually increased with graft age and in comparison to the natural forest, the cones provided more and larger seeds of better quality. Ten years after planting in a common garden, western larch cone production was twice as great for trees grafted with mature scions as for seedlings and five times greater than for rooted cuttings (Fins and Reedy 1992). The number of seed and pollen cones increased on 30- to 32-year-old western larch as average spacing expanded from 2 m to 3 m and wider (Shearer and Schmidt 1987). The average number of cones produced per tree during a good cone crop increased 27 times as the diameter classes increased from 10 to 15 cm to 30 to 36 cm, a reflection of the greater crown volume (Shearer 1986). There was no relationship of the number of cone scales of Olga Bay larch or their color, shape, size, or structure to site characteristics, developmental stage of trees, or other biological factors (Suo 1982). Developing larch cones range in color from red to green with a range of intermediate shades. Raevskikh (1979) reported that red- and green-coned forms of Dahurian larch produced better quality seeds than did rosy-coned forms. Western larch cones are red, green, and brown in color, but no differences were detected in seed quality by color (Shearer 1977). Ripe cones become brownish and have woody scales, each of which bears 2 seeds at the base (Dallimore and Jackson 1967; Rehder 1940). The seed has a crustaceous, light-brown outer coat; a membranaceous, pale chestnut-brown, lustrous inner coat; a light-colored female gametophyte; and a well-developed embryo (figures 1 and 2) (Dallimore and Jackson 1967; Rehder 1940). Tosh and Powell (1986) identified and studied proliferated and bisporangiate cones on tamarack planted 5 or 6 years earlier. A 10-year phenological record of western larch in the Northern Rocky Mountains showed a wide range in time of bud-burst, pollination, and cone opening (Schmidt and Lotan 1980). A 21-year phenological study of subalpine larch showed that spring temperature, not photoperiod, was a chief factor that determined bud-burst date (Worrall 1993). Seedcoats of subalpine larch are thicker than those of western larch and may be a partial barrier to germination (Carlson 1994). Seeds of western larch carry long distances (Shearer 1959), but seeds of tamarack in Alaska fall close to the point of origin (Brown and others 1988). An embryological study of European, Japanese, and Siberian larches showed that the embryos attained full size by early- or mid-August and that the seeds were fully developed by the end of August. Larches often have a high proportion of hollow seeds, as reported by Shearer (1990) and Trenin and Chernobrovkina (1984). The time of pollination is critical to development of viable and highquality western larch seeds (Owens and others 1994). The high proportion of non-viable seeds was attributed to (1) underdeveloped ovules at pollination; (2) ovules that either were not pollinated or were not fertilized; (3) factors that prevented pollen germination, pollen tube growth, or fertilization; (4) problems associated with self-pollination; and (5) inhibited ovule development. Shin and Karnosky (1995) identified abortion of female strobili and embryo degeneration as major factors reducing seed yields of tamarack and European, Japanese, and Siberian larches in the upper peninsula of Michigan, although the previously mentioned 5 factors also caused seed loss. Factors contributing to empty seeds in European larch included lack of pollination, disturbances during megasporogenesis, failure of pollen to reach and germinate on the nucellus, and embryo degeneration (Kosinski 1986, 1989). Throughout much of the range of western larch, frost often limits the number of developing cones that mature (Shearer 1990). Lewandowski and Kosinski (1989) described spring frost damage to 14 grafted Polish clones in a seed orchard of European larch. In late May 1968, frost completely killed the cone crop of Olga Bay larch growing above 1,000 m in northeastern China (Suo 1982). Loffler (1976) found that late spring frost killed a high proportion of European larch cones. An inexpensive electrical resistance device that prevents frost damage has been used to protect pollinated female strobili of European and Dunkeld larches after controlled crossings (Ferrand 1988). Indoor (potted) orchards are used to produce western larch seeds and to control the environmental conditions that often limit cone production in natural or planted stands (Remington 1995). Seed cone flowering decreased per centimeter of branch length as ortet age increased from 1 to 74 years (Eysteinsson and Greenwood 1993). During poor cone crop years with some larch species, many of the seeds are destroyed by weevils (Rudolf 1974). The major cone feeding insects are the larch cone maggot (Strobilomyia laricis Michelsen), western spruce budworm (Choristoneura occidentalis Freeman), a woolly adelgid (Adelges viridis Ratzeburg), and cone scale midges (Resseliella sp. Turgeon (1989) determined that larvae of the larch cone maggot infested more tamarack cones in the upper and mid-crowns than cones in the lower crowns. Larvae of the larch cone maggot also feed on cones of Siberian, European, Dahurian, and Japanese larches and tamarack in southern and central Finland (Pulkkinen 1989). During infestations of the western spruce budworm, the insect larvae decrease cone production of western larch by severing cone-bearing twigs and also by damaging developing cones and seeds on the trees (Fellin and Schmidt 1967; Fellin and Shearer 1968). The eastern spruce budworm and cone fly (Lasiomma viarium Huckett) larvae caused most damage to seeds of tamarack in 1982 and 1983 in New Brunswick and Maine, whereas other insects caused lesser damage (Amirault 1989; Amirault and Brown 1986). A recent review of insects that may influence larch cones and seeds in Canadian seed orchards listed 19 species in 4 families: 1 insect species for subalpine larch, 17 species within 4 families for tamarck, and 4 species within 3 families for western larch (de Groot and others 1994). In British Columbia, neither tamarack nor western larch have major insect pests (Eremko and others 1989). Reproductive failure and mortality of tamarack in Newfoundland have resulted in their replacement by more tolerant species (Sidhu and Staniforth 1986). Micropropagation techniques can supplement reliance on larch seeds for a broad range of tree improvement and regeneration needs. Karnosky (1992) suggests biotechnology can help produce genetically superior larch by (1) mass propagation, (2) disease screening, and (3) transfer of genetic information through genetic engineering techniques. Organogenesis from young and mature larch callus tissues is reported (Bonga 1984; Chapula 1989). Lelu and others (1993) developed somatic embryogenesis techniques for several species and hybrids of larch. Thompson and von Aderkas (1992) successfully regenerated western larch from immature embryos. Protoplasts of Dunkeld larch can be effectively isolated from embryonal mass and cultured to produce somatic plantlets (Charest and Klimaszewska 1994). No universal maturation medium was recommended because of the interactive effects of these 3 factors. High plantlet survival was achieved in the greenhouse through either of 2 acclimatization methods (Lelu and others (1994c). In gymnosperms, gene transfer was first accomplished in European larch; transfer was mediated by Agrobacterium rhizogenes and subsequent regeneration of the transgenic plants (Huang and others 1991). Shin and others (1994a&b) reported that transgenic Table 2-Larix, larch: phenology of flowering and fruiting Species L. Larch cones should be collected as soon as they ripen; different species ripen at various times from August to December (table 2). Larch cones are picked from trees in forests, seed production areas, seed orchards, and potted tree collections or they can be gathered from felled trees, slash, or squirrel caches. In Tyrol, European larch seeds were picked from the snow by hand; they can also be gathered in late winter from canvas spread on the ground before the trees were shaken to release the seeds (Rudolf 1974). Often seeds mature earlier than expected and the period for cone collection for tamarack (Smith 1981) and western larch (Shearer 1977) can be expanded. Cones of Siberian larch should be harvested when needles start to turn yellow to assure high-quality seeds (Lobanov 1985). Data on height, seed-bearing age, seed crop frequency, and ripeness criteria are listed in tables 3 and 4. Freshly collected cones should be spread out in thin layers to dry in the sun or in well-ventilated cone sheds. The cones can be opened by solar heat, by heating in a cone kiln or room, or by tearing them apart mechanically (Rudolf 1974; Tkachenko and others 1939). Sometimes equipment must be modified to extract larch seeds (Saralidze and Saralidze 1976). Seeds can then be de-winged by a de-winging machine, by treading in a grain sack, or by hand-rubbing. The integument, which attaches the wing to the seed, is difficult to remove in normal processing without damage (Edwards 1987). A mechanical macerator is routinely used for processing tamarack cones and for de-winging larch seeds (Wang 1995). Seed yields for 5 species are listed in table 5 and the number of cleaned seeds for 7 species is shown in table 6. Simak (1973) reported that, although European larch seeds can be upgraded by flotation in 80% to absolute alcohol for 5 to 15 minutes with a loss of less than 5% germinability, he recommended using water as an optimal liquid for flotation. In addition, Simak (1966) also reported that a seed sample of Himalayan larch had 28% filled seeds and weighed 4. Cooling cones and seeds of western larch so that the resin forms globules and becomes less sticky facilitates extraction and cleaning (Zensen 1980). Purity of larch seedlots has ranged from 84 to 94%, but filled seed values have consistently been low at 50 to 70% (Rudolf 1974). The low percentage of filled seed may be attributed to the development of many unfertilized seeds and to woody or resin deposits in them. The woody tissue or resin hinders their removal in the cleaning process (Edwards 1987; Rudolf 1974). In lots of tamarack seeds from Ontario, 50% were sound; most of the unsound seeds had incompletely developed embryos and endosperm (Farmer and Reinholt 1986). Hall and Brown (1977) found similar conditions among seeds of European and Japanese larches and their hybrids. Seeds of western larch also have a high proportion of embryo failures (Owens and Molder 1979b). Use of X-radiography was recommended to evaluate the quality of tamarack seeds because flotation in 95% ethanol killed 52% of germinable seeds (Eavy and Houseweart 1987). Because larch seeds can be stored for long periods at seed moisture contents of 5 to 10% in sub-freezing temperatures, Bonner (1990) classifies them as "true orthodox" seeds.
In: Sugar maple research: sap production arthritis in dogs cold weather cheap feldene 20 mg without a prescription, processing arthritis in dogs cod liver oil buy cheap feldene 20mg online, and marketing of maple syrup arthritis neck yoga discount feldene 20 mg fast delivery. Four stratification media equally effective in conditioning sugar maple seed for germination arthritis x rays pictures purchase feldene 20mg otc. The influence of nitrogenous fertilizer applications upon seed production of certain deciduous forest trees arthritis diet wiki trusted feldene 20 mg. Reproductive behavior in sugar maple: self-compatibility rheumatoid arthritis differential diagnosis order 20 mg feldene fast delivery, cross-compatibility, agamospermy, and agamocarpy. Review of facts and observations made by naturalists, botanists, historians, and travelers on the properties and productions of the sugar maple tree; process of extracting its sap, converting it into sugar, &c. Impact of forest liming on growth and crown vigor of sugar maple and associated hardwoods. Intra-crown variation in leaf herbivory and seed production in striped maple, Acer pensylvanicum L. Effects of litter, distance, density and vegetation patch type on postdispersal tree seed predation in old fields. Autorotation, self-stability, and structure of singlewinged fruits and seeds (samaras) with comparative remarks on animal flight. Vine maple clone growth and reproduction in managed and unmanaged coastal Oregon Douglas-fir forests. Seed size and dispersal potential of Acer rubrum (Aceraceae) samaras produced by populations in early and late successional environments. The effect of desiccation on viability and phospholipid composition of Acer saccharinum L. Intraspecific variation in samara morphology and flight behavior in Acer saccharinum (Aceraceae). Seed dormancy in Acer: maturation in relation to dormancy in Acer pseudoplatanus L. Early patterns of flowering, winter injury, and flushing of red maple progenies grown in five locations. Originally from tropical Asia, this genus has spread to parts of tropical Africa and America that have 1,300 to 2,100 mm of rainfall, soil pH 5. It maintains a common abundance relative to other competitors (Francis and Liogier 1991). The medium-sized deciduous tree can be 13 m tall and 45 cm in trunk diameter, with brown, smooth bark (Little and Wadsworth 1964). The mature trees are good shade trees but not particularly ornamental (Neal 1965), although they are valued for their attractive feathery foliage and bright red seeds in Nyasaland (Streets 1962). It is used locally for poles and firewood as well as a source of red dye (Little and Wadsworth 1964). It gets its Asian common name-red sandalwood-from its use as a substitute for sandalwood. An interesting (but questionable) use is as commercial weights for goldsmiths and silversmiths, who claim each seed weighs a uniform 4 grains (Neal 1965). Flowers are borne on racemes (either lateral or terminal) on short stalks 3 mm long and may be pale yellow to white. The small, inconspicuous flowers have a sweet smell and form axillary clusters during the hot, humid season. The fruits mature in the dry season and remain on the tree several months as dark brown legumes (pods) that measure 10 to 20 mm wide and 15 to 20 cm long and are twisted. They readily split and show seeds (figures 1 and 2) attached to the smooth, yellow interior. There are about 3,500 seeds/kg (~1,580/lb) (Bailey 1941; Little and Wadsworth 1964; Neal 1965; Troup 1921). Although presoaking is helpful, seeds will germinate with no pre-germination treatment. Several reports do, however, suggest that germination is enhanced by hot-wire scarification (Sandiford 1988) and sulfuric acid exposure (Ahmed and others 1983; Xu and Gu 1985). Although there are no printed reports of nursery practices, seeds readily germinate along moist roadsides. The buckeyes- which occur in North America, southeastern Europe, and eastern and southeastern Asia-include about 25 species of deciduous trees and shrubs (Rehder 1940). They are cultivated for their dense shade or ornamental flowers, and the wood of some species is occasionally used for lumber and paper pulp. The horsechestnut was introduced into this country from southern Europe, and the Himalayan horsechestnut occurs naturally in the Himalayas. Seven of these 8 species are not used much in reforestation, but all are used for environmental forestry planting. Himalayan horsechestnut is used extensively for reforestation and the nuts are fed to sheep and goats (Maithani and others 1990). This is also true of horsechestnut, which has been widely planted as a shade tree in Europe and also in the eastern United States, where it sometimes escapes from cultivation (Bailey 1939). Ohio and yellow buckeyes are sometimes planted in Europe and the eastern United States, the former having been successfully introduced into Minnesota, western Kansas, and eastern Massachusetts. California buckeye is also occasionally planted in Europe and to a somewhat greater extent in the Pacific Coast states. Buckeye flowers are irregular in shape and white, red, or pale yellow in color; they are borne in terminal panicles that appear after the leaves. The Table 1-Aesculus, buckeye: nomenclature and occurrence Scientific name & synonym(s) A. Only those flowers near the base of the branches of the cluster are perfect and fertile; the others are staminate (Bailey 1939; Rehder 1940). The fruit is a somewhat spiny or smooth, leathery, round or pear-shaped capsule with 3 cells (figure 1), each of which may bear a single seed. Sometimes only 1 cell develops and the remnants of the abortive cells and seeds are plainly visible at maturity. The ripe seeds (figure 1) are dark chocolate to chestnut brown in color, with a smooth and shining surface and have a large, light-colored hilum resembling the pupil of an eye. The times of flowering and fruiting for 7 species of buckeyes are given in table 2. Bottlebrush buckeye rarely sets seed except in very hot, dry, late summers (Browse 1982). The fruits may be collected by picking or shaking them from the trees as soon as the capsules turn yellowish and begin to split open or by gathering them from the ground Figure 1-Aesculus, buckeye: capsules and seeds of A. The fruits may be dried for a short time at room temperature to free the seeds from any parts of the capsules that may still adhere to them, but great care must be taken not to dry them too long. When this occurs, the seedcoats become dull and wrinkled and the seeds lose their viability. There is ample evidence that buckeyes are recalcitrant in nature (Bonner 1969; Pence 1992; Tompsett and Pritchard 1993). Moisture contents at the time of shedding have been reported as 49% for horsechestnut (Suszka 1966) and 56% for red buckeye (Bonner 1969). The seeds of this genus should be sown at once in the fall or stratified promptly for spring-sowing. Buckeye seeds must be stored with moisture contents close to what they are shed with, but even then their viability cannot be maintained very long. This storage condition is the same as cold moist stratification because of the high moisture content of fresh seeds (Suszka 1966). Seeds of Ohio, yellow, and painted buckeyes and horsechestnut require stratification or prechilling to induce prompt germination (Rudolf 1974). In contrast, fresh seeds of California and red buckeyes can germinate satisfactorily without pretreatment (Rudolf 1974). Red buckeye seeds requires no stratification even though germination is delayed until spring. Cool winter temperatures suppress the germination, thus preventing autumn emergence (Browse 1982). Bottlebrush buckeye seeds exhibit a type of epicotyl dormancy in so far as the root system continues to develop, but the shoot becomes dormant after it has emerged (Browse 1982). Further development of the shoot system does not occur until the spring (Browse 1982). Presowing treatments of horsechestnut seeds increased germination 3 to 15% over the control. Prolonging the stratification period to 30 days resulted in 79% germination (Maithani and others 1990). A rec- ommendation for germinating seeds of horsechestnut without stratification is to soak them in water for 48 hours and cut off one-third of the seed at the scar end without removing the seedcoat. Under natural conditions, seeds of most buckeye species germinate in the early spring. California buckeye, however, germinates just after winter rains have begun, usually in November. In the nursery, buckeye seeds usually are sown in the fall as soon after collection as possible to prevent drying and loss of viability. If desired, however, the seeds of species having embryo dormancy can be stratified or placed in cold, moist storage promptly and then sown in the spring (Rudolf 1974; Suszka 1966). Himalayan horsechestnut seeds without any treatment showed 80% germination after 133 days (Maithini and others 1990). Seeds sown after 30 days of cold stratification showed 68% germination in 78 days (Maithini and others 1990). The seeds should be sown with the scar underneath so that the radicle emerges in the correct position to produce a normal seedling (Browse and Leiser 1982). If the seeds are variable in size, it is better to grade them so that small sizes are discarded or sown separately, as these rarely make large 1-year seedlings (Browse 1982). The beds should not be over-watered because the seeds rot rather easily (Rudolf 1974). Enhancement of seed germination and seedling growth of Aesculus indica by stratification. Boomzaden: handleiding inzake het oogsten, behandelen, bewaren en uitzaaien van boomzaden [Tree seed: handbook on the collection, extraction, storage, and sowing of tree seed]. Desiccation and the survival of Aesculus, Castanea, and Quercus embryo axes through cryopreservation. Conditions for breaking of dormancy of germination of the seeds of Aesculus hippocastanum L. Presowing treatment of seeds and its effect on the resisitance of seedlings of woody plants against drought. Water status changes during development in relation to the germination and desiccation tolerance of Aesculus hippocastanum L. The effect of storage period temperature and moisture on the germination of Aesculus hippocastanum seeds. Although it was originally considered a desirable ornamental tree, its desirability and usefulness are now questioned (Dirr 1990; Feret 1985) and many consider it an "invasive alien pest. Ailanthus was introduced into cultivation in England in 1751 (Feret 1985; Illick and Brouse 1926) and brought to America in 1784 (Little 1974). It has become naturalized in many parts of the United States-from Massachusetts to southern Ontario, Iowa, and Kansas, and south to Texas and Florida, as well as from the southern Rocky Mountains to the Pacific Coast (Feret and Bryant1974; Feret and others 1974; Little 1979). In some localities, ailanthus is so well-established that it appears to be a part of the native flora. There are a number of other Ailanthus species grown in other parts of the world for various purposes (Alam and Anis 1987; Beniwal and Singh 1990; Feret 1985; Rai 1985; Ramikrishnan and others 1990). Ailanthus is an aggressive, intolerant pioneer species with rapid juvenile growth of 1 to 1.
This may be done with either a well-controlled air separation or a specific gravity table arthritis in back after car accident buy feldene 20mg mastercard. Cypress seeds are orthodox in storage behavior and maintain viability very well at low temperatures and moisture contents yeast arthritis pain 20mg feldene amex. Seeds of most cypress species exhibit some dormancy arthritis pain base of thumb feldene 20 mg low price, and treatments are required for prompt germination best exercise for arthritis in feet feldene 20mg lowest price. Stratification for 60 to 90 days has been recommended for Monterey cypress (Von Carlowitz 1986) arthritis relief equipment feldene 20mg fast delivery. Goggans and others (1974) also found 30 days of prechilling effective in breaking dormancy of Arizona cypress arthritis in the knee home remedies purchase feldene 20 mg overnight delivery. When time was short, a 72-hour water soak gave some benefit over just a 24-hour water soak. Seeds are often heavily contaminated with mold and bacteria, but control of the mold is feasible with fungicides during stratification and germination. Local extension experts should be consulted for current treatment recommendations. Treated medium and seeds can then be stored in plastic bags, jars, or petri dishes for the duration of the stratification period. Test periods of 28 days are prescribed for Arizona and Italian cypresses and 35 days for Monterey cypress. Official test prescriptions have not been developed for the other cypress species, but similar conditions should be sufficient. Although light appears to be important, prechilling and alternating temperatures are the more significant promoters of germination. The seeds can be watered throughout the test with a mild solution of fungicide (the same formulation used above) with no phytotoxicity. Germination test results (table 4) have been low primarily because of the low percentages of sound seed that are common among seed lots of cypress. Good estimates of germination can be made with x-ray analysis of fresh seeds of Italian, Mexican, and Arizona cypresses (Bergsten and Sundberg 1990; Chavagnat and Bastien 1991). Fall-sowing of cypress seeds has been recommended (Johnson 1974; Wolf and Wagener 1948), but spring-sowing of stratified seeds is preferred. Zeide (1977) was successful in direct seeding Italian cypress in Israel-annual precipitation, 447 mm (18 in)-in plots that were "mulched" with light colored stones of 2 to 5 cm (3/4 to 2 in) diameters. Newly germinated cypress seedlings are particularly susceptible to damping-off fungus. Germination rate of Arizona cypress improved by better cone collection techniques and seed germination treatments. Exotic trees unsatisfactory for forestry in southern Arkansas and northern Louisiana. The Santa Lucia Cupressus sargentii groves and their associated northern hydrophilous and endemic species. An experimental inquiry into the edaphic restrictions of certain members of the California flora [thesis]. Experiments on the precocious flowering of western red cedar and four species of Cupressus with gibberellins A3 and A4/A7 mixture. Effects of environmental factors on germination and seedling growth in Quercus floribunda and Cupressus torulosa, tree species of central Himalaya. Some studies on the collection and extraction of Cupressus lusitanica seed at Lushoto,Tanzania. Many are cultivated as ornamentals, and several of these have become more or less naturalized in the United States, especially in California (Munz and Keck 1959). It has become the dominant species on several hundred thousand hectares of coastal and cis-montane vegetation, from Santa Barbara, California, north to British Columbia. It is a drought-deciduous shrub with angled, photosynthetic stems that is able to root-sprout following fire (Bossard and Rejmanek 1994; Gonzales-Andres and Ortiz 1997). It is largely useless as a browse-plant because of its toxic foliage, a feature that may permit it to increase at the expense of more palatable species (Bossard and Rejmanek 1994; Gill and Pogge 1974). It increases in response to disturbance of native vegetation and is also a serious weed problem in pine plantations in California and New Zealand. However, because of its beauty and exceptional summer drought-hardiness, Scotch broom is considered valuable as an ornamental shrub for low-maintenance landscapes. The species is very showy in flower and its evergreen stems add interest to winter landscapes. The perfect flowers are of typical pea-family form and appear on the plants in great profusion in May and June. Each flower must be "tripped" by an appropriate pollinator for fertilization to take place, so the mutualistic relationship with honey bees (Apis mellifera L. The result is that seed production may be severely pollinator-limited (Parker 1997). In spite of this, the plants may produce a prodigious number of seeds; the estimated mean annual production per plant was about 10,000 seeds in 2 California populations (Bossard and Rejmanek 1994). Host-specific pre-dispersal seed predators from Europe (a seed weevil and a bruchid beetle) have been introduced for biocontrol of Scotch broom in the Northwest, but so far these introductions have been largely ineffective, possibly because of asynchrony in the phenology of host and seed predator (Bravo 1980). The 5- or 6-seeded legumes (pods) ripen in August, and seeds are dispersed in September. The legumes open abruptly with a springing motion, vaulting the seeds some distance from the plant (Bossard 1991; Bossard and Rejmanek 1994). The seeds possess a strophiole or elaiosome at the hilar end (figure 1) and are secondarily dispersed by ants (Bossard 1991; Weiss 1909). At 2 California study sites, seeds were taken by mice and by ground-feeding birds, but these organisms were strictly seed predators and did not function as dispersers (Bossard 1991). Bossard (1993) found in seed retrieval experiments that 65% germinated the first year after dispersal, 20% germinated the second year, and 10% germinated the third year. After the fruits ripen but before they disperse, the legumes may be hand-stripped or picked up from beneath plants. They should be spread to dry, threshed, and screened to separate the seeds (Gill and Pogge 1974). Reported seed weights have averaged 125 seeds/g (57,500/lb) in 9 samples, and viability averaged 80% in 5 samples (Gill and Pogge 1974). Figure 1-Cytisus scoparius, Scotch broom: longitudinal section through a seed (bottom) and exterior view (top). Tarrega and others (1992) report that dry-heating the seeds was as effective as mechanical scarification in terms of final percentage. Abdullah and others (1989) reported that repeated brief (3-second) immersion in boiling water resulted in complete elimination of hard-seededness, but low germination percentages indicated that some damage was occurring. They found that alternating the boiling water treatments with freezing treatments (immersion in liquid nitrogen for 15 seconds) resulted in the highest germination percentages as well as in complete removal of hard-seededness. Scotch broom is normally propagated from cuttings for ornamental planting in order to preserve varietal characters (Wyman 1986). If seed propagation is desired, seeds should be pretreated to remove hard-seededness prior to planting (Gill and Pogge 1974). The roots are delicate, and plants are more easily produced in container culture than as bareroot stock (Wyman 1986). The role of habitat disturbance, seed predation, and ant disperal on the establishment of the exotic shrub Cytisus scoparius. Seed germination in the exotic shrub Cytisus scoparius (Scotch broom) in California. Herbivory, growth, seed production, and resprouting of an exotic invasive shrub Cytisus scoparius. Phenology of species belonging to the genus Cytisus and allies (Genisteae: Leguminosae). Pollinator limitation of Cytisus scoparius (Scotch broom), an invasive exotic shrub. Scotch broom seeds have water-impermeable (hard) seedcoats and require pretreatment in order to germinate. Once the seedcoats have been made permeable, the seeds germinate well over a wide range of temperatures and do not require any further pretreatment (Bossard 1993). A popular ornamental throughout the tropics, flamboyan-Delonix regia (Bojer ex Hook. The champion Puerto Rican flamboyan, however, is 32 m high and 105 cm in diameter (Francis 1994). It grows well in moist soil derived from limestone, where it is common and reproduces well, but it is also tolerant of well-drained and somewhat droughty conditions (Francis and Liogier 1991). Flamboyan has prominent buttresses and a broad, flat crown when grown in full sun. The tree is susceptible to termites, shoot borers, and heart rot (Webb and others 1984). Although the genus is reported to have 3 species, flamboyan is the most cosmopolitan. A native of Madagascar, it has been planted in nearly every country in frost-free areas and is perhaps the most important flowering ornamental tropical tree of the world (Meninger 1962). The flowers are predominantly red, although yellow and orange forms are cultivated; they are relatively shortlived as cut flowers. They are often seen planted along roadsides as living fence posts or as shade trees on both sides of the road that arch over the entire road. The wood is yellowbrown, weak, brittle, and soft, with a specific gravity of about 0. Although the species is not a good timber source, the wood is widely used as firewood. The legume (pod) is edible (Little and Wadsworth 1964; Menninger 1962; Webb and others 1984). Flowers are commonly red but may be white, yellow, orange, or yellow and vary from 8 to 25 cm across. The hard legumes are 35 to 50 cm long, 6 cm wide, and 5 mm thick, and they hang tenuously on trees year-round. When mature, the legumes split into 2 parts lengthwise and are dark brown to black (Little and Wadsworth 1964); seeds (figures 1 and 2) are shed at that time. There are about 4,500 seeds/kg (2,040/lb) from Puerto Rican sources (Marrero 1949), whereas Colombian sources report only 2,000 to 3,000 seeds/kg (900 to 1,360/lb) (Navarette nd). If unopened legumes are collected, they should be dried in the sun for 1 month; then the woody legumes should be forced open and the seeds removed. Dry seeds store very well in either open or closed containers and do not require refrigerated storage (Francis 1994). Webb and others (1984) reported viability after 4 years storage but do not give germination rate or percentage germination. Seedlings (figure 3) are ready for outplanting after 3 to 4 months of growth in plastic nursery bags during the wet season. Saplings are also grown to 2 m, then "balled and burlaped" for large ornamental potted plants. Mature flowering and fruiting trees may be grown in 3 to 5 years in good sites (Francis 1994). Scarification-with either hot water, sulfuric acid, or abrasion-is required for germination. Seeds subjected to the various scarification treatments reported here had germination values superior to those of their respective controls. Effect of hot water treatment on the germination of seed of Albizzia lebbeck and Delonix regia. Bushpoppies (also known as treepoppies) are openly branched, evergreen shrubs from 0.
As the prevalence of childhood obesity increases and risk of future medical complications that may lead to the begin ning of a healthcare challenge for society and the health system arthritis knee forum discount feldene 20mg without a prescription, should drug therapy be considered Orlistat rheumatoid arthritis in feet symptoms feldene 20 mg on-line, biguanides and metformin are occasionally prescribed at paediatric obesity clinics arthritis diet foods discount feldene 20mg with visa, in combination with diet and life style treatment plans [4] arthritis in dogs anti inflammatory drugs generic feldene 20mg visa. Comorbidities such as hypertension can arthritis in neck cause ear pain proven 20 mg feldene, hyperinsuli naemia arthritis diet prevention 20 mg feldene sale, dyslipidaemia, osteoarthritis and type 2 diabetes are risk factors in childhood obesity that may benefit from additional pharmacotherapy. However, childhood obesity can be aggravated by depression and other psychosocial problems, and the side effects of antiobesity drugs mean that they need to be introduced with caution. Drugs are not a cure for obesity, and compliance with a healthy life style remains a key component of therapy. As with other forms of treatment, drug therapy in childhood obesity involves behaviour change, and the family will need support from a multidiscipli nary team to manage this form of treatment. A sys tematic review of pharmacological interventions for the treatment of obesity carried out by Gray et al. However, most of the drugs described have been withdrawn due to adverse side effects. There may be a place for pharmacological interventions for the treatment of obesity if drugs can be developed that minimise the side effects; however, the evidence in children is limited [6]. Prescribe only in exceptional circumstances, if there are severe lifethreatening comorbidities. Prescribing should be started and monitored only in specialist paediatric settings. Prescribing should be started by specialist multidisciplinary teams with experience in prescribing for this age group. This comprises drug monitoring, psychological support, behavioural interventions, interventions to increase physical activity and interventions to improve diet. Drug treatment started in specialist care, may be continued in primary care if local circumstances and/ or licensing allow. Drug treatment may be used to help the child or young person to maintain weight loss, as well as to continue to lose weight. If concerned about micronutrient intake, consider a supplement that provides the reference nutrient intake for all vitamins and trace elements. There should be regular reviews throughout the period of use, including careful monitoring for side effects. Drug therapy may be considered in children under the age of 12 years if there are comorbidities, but local and national guide lines must be followed at all times. There is a need for dietetic advice regarding how to identify foods high in fat to minimise gastrointestinal side effects such as flatulence and steatorrhoea, in addition to the die tary guidance provided alongside the medication. Young children may struggle to identify fatty foods, and steatorrhoea and abdominal pain may lead to food aversions and nutritionally compromised diets. As fat is poorly absorbed, there is a risk of low vitamin D and other fatsoluble vitamins. There is also some evidence of low vitamin D status in obesity as increased blood concentrations are stored in adipose tissue, although the mechanism for this is poorly understood [9]. It is recommended that a multivita min and mineral supplement containing adequate doses of fatsoluble vitamins be taken at least 2 hours after the orlistat dose to maximise absorption. Alternatively, the patients can be advised to take orlistat for 3 weeks out of 4 weeks, and, during the off week, to take a multivitamin preparation. Side effects include hypertension, and the drug should be discontinued if blood pressure rises during treatment. In older children, it is possible that compliance with medication may become an issue as they may stop taking the drug if they wish to consume highfat foods. Metformin is the drug of choice in children with type 2 diabetes, in whom adherence to dietary restrictions has failed to control diabetes. Most of the clinical literature on metformin deals with its use in the treatment and prevention of diabe tes, but a frequently occurring side effect appears to be weight loss. Leptin and adiponectin are both secreted by adipose tissue, and leptin is involved in appetite regulation, while adiponectin improves insulin sensitivity [11,12]. Other studies have also shown metformin to aid weight loss of up to 4 kg, and metformin is increasingly being used in children [13]. Side effects of metformin include anorexia, abdominal pain, taste disturbances, nausea and vomiting. A starting dose of 250 mg/day for young children and 500 mg/day for older children is recom mended. Changing from standard metformin to modifiedrelease met formin may help prevent children with significant gastrointestinal disturbances from discontinuing therapy. Octreotide Hypothalamic obesity is a resistant form of obesity arising from damage to the satiety and appetite centres in the hypothalamus, resulting in hyperphagia and reduced energy expenditure. Octreotide may play an important role in helping to manage rapid weight gain as a consequence of hyperphagia due to the cranial insult. Patients with hypothalamic obesity exhibit insulin hypersecretion, and octreotide acts by suppressing insulin production. As with Qsymia, it is only licensed in adults at the moment, and may become available for use in children at some stage. However, this form of treatment requires regular subcutaneous injections, and side effects of diarrhoea, flatulence and vomit ing can limit compliance. Longacting preparations of octreotide have also been used with benefits in some, but not all, patients [16]. In adults, there have been increased success rates in those who have had bari atric surgery, but there is limited data in children. The children need to be able to cope psycho logically with the rigours of bariatric surgery and the consequences of such a radical procedure. Sibutramine, which is a serotonin reuptake inhibitor, was withdrawn due to concerns regarding its safety, despite displaying significant weight loss effects. Topiramate is an anticonvulsant that is approved for use in migraine and certain types of epilepsies, but a side effect is anorexia. Phentermine is thought to trigger the release of norepinephrine, which increases the blood concentrations of leptin, suppressing appetite. Used in combination, trials have shown positive results in weight reduction, with a mean weight loss of at least 10% [21,22]. Other combination therapies include bupropion and naltrexone, which in a Phase 2 trial demon strated greater weight loss (4. Obesity: the preventions, identification, assessment and management of overweight and obesity in adults and children. A systematic review and mixed treatment comparison of pharmacological interventions for the treatment of obesity. Clinical review: treatment of pediatric obesity: a systematic review and meta analysis of randomized trials. Threemonth toler ability of orlistat in adolescents with obesityrelated comorbid conditions. Randomized, con trolled trial of metformin for obesity and insulin resistance in children and adolescents: improvement in body composition and fasting insulin. Octreotide therapy of pediatric hypothalamic obesity: a doubleblind, pla cebocontrolled trial. A multi center, randomized, doubleblind, placebocontrolled, dose finding trial of a longacting formulation of octreotide in promoting weight loss in obese adults with insulin hypersecre tion. Phentermine/topiramate for weight reduction and treatment of adverse metabolic consequences in obesity. Comparison of combined bupropion and naltrexone therapy for obesity with monotherapy and placebo. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. Bariatric procedures for adolescents with severe obesity were first reported in the 1970s and 1980s [1,2]. These earlier experi ences with a variety of procedures provided insight regarding the risks of surgical care, and have helped to shape current thinking about bariatric surgical procedures for adolescents [3]. The acceptance of bariatric surgery for paedi atric populations varies across regions. A 2004 survey of European bariatric surgeons found that 39% offered laparoscopic surgery to patients less than 18 years of age [4]. The number of procedures performed yearly is rising; also, as evidence continues to show that bariatric procedures can be performed safely in the adolescent population, this trend is likely to continue [5]. With the expanding body of knowl edge available about weight loss surgery in adoles cents, several evidencebased guidelines are now available for clinicians treating obese children and adolescents [6]. Weight loss surgery for adolescents There are unique factors specific to adolescents that must be addressed before surgery is offered to a morbidly obese teen. It would be advantageous to know precisely which preoperative and postopera tive factors most influence successful outcome of surgery. Unfortunately, there are currently no estab lished criteria for determining which adolescents will benefit most from weight loss surgery, and no evidencebased criteria to predict which patients are at highest risk for postoperative complications. In the absence of agespecific predictors of outcome, most specialists who conduct adolescent bariatric surgery empirically advise that candidates be referred to centres with multidisciplinary weight management teams experienced in meeting the dis tinct physical and psychological needs of adoles cents. The many physical changes of the adolescent period are accompanied by a complicated psychoso cial developmental process that is impacted by envi ronmental and social factors, requiring thorough assessment in the context of bariatric surgery. The decisional capacity of the adolescent must be evalu ated to assess the ability to understand the risks/ben efits of an invasive, nonreversible, elective surgical procedure. Additionally, surgical care should be provided in conjunction with teams who are skilled in performing modern bariatric procedures. The multidisciplinary team should encourage appropriate independence and plan for eventual transition to adulthood. It is commonly recommended to postpone pregnancy until 18 months after weight loss surgery. All adolescents seeking weight loss surgery should receive a psychological assessment to assess developmental status, social support structure and presence of mental illness, and identify any behav ioural conditions that could interfere with adherence to the diet and lifestyle changes required after surgery. The evaluation is generally conducted as a semi structured interview, and may include screen ing inventories for depression, cognitive abilities and quality of life. Treatment of psychopathology and ongoing psychosocial support is essential prior to and after surgery [9] (Box 6. Nutritional assessment Nutritional management for adolescents consider ing weight loss surgery can be classified into three areas: nutritional assessment, education of the patient and family about nutritional requirements and postoperative monitoring of nutritional status. The multidisciplinary team should include a reg istered dietitian, preferably with experience in paediatric weight management and/or weight loss surgery. The preoperative nutritional assessment may ben efit from administration of a food/eating behaviours questionnaire and a review of the family/home envi ronment. This can help identify any nutrientpoor food choices, lack of dairy foods, and the amount of fruits and vegetables and whole grains intake. The energy requirements of the patient, based on height, ideal body weight and age, should be determined. At this time, behavioural strate gies for healthy eating should be introduced, such as eating from smaller plates, measuring portions with measuring spoons and measuring cups, meal plan ning and grocery lists, and journaling or tracking 6. Total score indicates moderate depressive symptoms in the clinically significant range. Results indicate severe impairment in physical functioning, and moderate impairment in esteem, social, distress, and school and family functioning. Results indicate severe impairment in physical functioning, moderate impairment in emotional functioning and mild impair ment in social and school functioning. Sizing Them Up: this questionnaire is a 22item, obesityspecific, parentproxy measure of health related quality of life. Six domains are assessed: emotional functioning, physical functioning, teasing/ marginalisation, positive social attributes, mealtime challenges and school functioning. Results indicate moderate to severe impairment in physical, emotional functioning and minimal to mild impairment in all other domains. The adolescent and family should receive information in written, visual and/or electronic form to accommodate different learning styles. This information will allow the dietitian to set realistic goals that are measurable and attainable, and specific to the ado lescent. A preoperative liquid diet initiated 2 weeks prior to surgery introduces the adolescent to the postoperative dietary regimen, and may well improve the safety and efficiency of the surgical procedure by reduction of intraabdominal fat stores and liver size [12]. Liquid meal replacement is most readily accomplished as a defined and prepared product, such as a readyto drink protein shake, or a protein powder added to water or lowfat milk.
All programmes resulted in a significant weight loss at 12 weeks arthritis toes discount feldene 20 mg with mastercard, with the commercial options resulting in a signifi cantly greater weight loss than the primarycareled options (mean difference 2 arthritis relief with celadrin cheap feldene 20mg amex. The authors suggest that arthritis in fingers medication purchase 20 mg feldene otc, because the primary care programmes were the more costly to provide managing arthritis with diet and exercise generic 20 mg feldene with amex, commercially provided weight management services are more costeffec tive treat arthritis neck buy cheap feldene 20mg on line. The 423 overweight/obese people were randomly assigned to one of the two interventions arthritis pain log purchase feldene 20mg otc, and weight loss compared over a 2year period. Loss of body fat and weight was significantly greater in all groups, compared with the control group. The weight rebound after the 6month intervention period was also higher in the unsupported programmes, although all diets resulted in a clinically useful (~10%) weight loss at 12 months for those partici pants who had continued with the weight manage ment programme allocated. More participants from the control group who decided to make changes to their diet and lifestyle after the 6month test period went on to choose groupbased support, achieving a mean weight loss of 6. For all programmes achieving successful weight loss over a short time period, there are concerns that the weight lost is easily regained [13]. From a sample of 1002 tar get members at 5 years after achieving their target weight, 19. Among the study population who had become more active (n = 718), 33% included their partners and 28% included their chil dren in their physical activity sessions. A qualitative study comparing commercial and health service weight loss groups suggests that health service leaders had less opportunity for supervision, peer support or specific training in how to run a group when compared to group facilitators from the commercial sector [21]. Selfesteem and mental wellbeing are important outcome measures of any weight management pro gramme. To sustain behaviour change, such as adopting healthier eating habits and increasing physical activity levels, selfesteem needs to be enhanced. Commercial programmes use many of the tech niques that are used in more intensive behavioural treatments, delivered by healthcare professionals, such as selfmonitoring, goal setting, problemsolv ing, stimulus control and relapse prevention [9]. A range of eating and activity behav iours was associated with weight loss maintenance, and the paper concluded that it was important to offer consumers flexible solutions that they can adapt to their individual lifestyle needs to support longterm weight control [22]. In the modern healthcare system, and given the scale of the obesity epidemic, finding costeffective solutions to obesity is of paramount importance. Sub group analyses showed that the programme is even more costeffective for men [24]. In many areas, be they public, private or voluntary sector weight management providers may be commis sioned to provide individual or group lifestyle weight management services. People can also selfrefer to voluntary or commercial lifestyle weight management programmes. Local policies vary, but funded referrals to a lifestyle weight management programme (in tier 2 services/usually in the community) generally lasts for around 12 weeks or 12 sessions. This would represent a quadrupling of exist ing levels of uptake for these programmes. The 1% increase equates to approximately 680 overweight or obese adults per 100,000 population. The experience and wealth of knowledge of these organisations should not be overlooked. This allows commissioning to provide local tier 2 weight management through subsidised referral packages. Feasibility and benefits of implementing a slimming on referral service in primary care using a commercial weight management partner. Tackling obesity in men: a prelimi nary evaluation of men only groups within a commercial slim ming organisation. Greater weight loss among men participating in a commercial weight loss pro gram: a pooled analysis of 2 randomised controlled trials. Longterm weight development in women: a 15year followup of the effects of pregnancy. Behavioural and motivational factors associated with weight loss and maintenance in a commercial weight manage ment programme. Economic evaluation of Weight Watchers in the prevention and management of obesity. Poster presenta tion at the Conference of the National Institute of Health and Clinical Excellence, December 2006. Weight outcomes audit for 34,271 adults referred to a primary care/ commercial weight management partnership scheme. Attendance and weight outcomes in 4,754 adults referred over 6 months to a primary care/commercial weight management partnership scheme. Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised con trolled trial. Comparison of a range of commercial or primary care led weight reduction programmes with minimal intervention con trol for weight loss in obesity: lighten up randomised con trolled trial. Weightloss mainte nance in overweight individuals one to five years following successful completion of a commercial weight loss program. Fad approaches will be cited but, given the diversity and everchanging nature of this classifica tion, the focus will be primarily on general, rather than regimespecific, issues. While it is easy to dismiss fads, it is essential that health professionals understand the regimes that their patients may be exposed and attracted to , and appreciate their motivation for following them, to effectively communicate risk and benefit. Many fad diets also avoid the facetoface contact that overweight or obese people may find intimidating, yet provide extensive support and encouragement via online forums, further encouraging their uptake. Fasting is an extreme but simple example of reduced intake whereby all food, and therefore all nutrients, are severely restricted. This usually results in rapid weight loss, but this is characterised by large losses of water, glycogen and muscle, and as such may be associated with greater sideeffects and greater regain once a normal diet is resumed than when predominantly fat is lost. There is, however, evidence that fasting may have longerterm benefits independent of weight loss per se. The ability of energy restriction, via various fasting protocols, to facilitate acute negative energy balance and/or to activate adaptive stress response pathways have been proposed as the potential mechanisms underlying the metabolic improvements seen [8]. In addition, fasting has numerous perceived advan tages above those of general fad diets. There may also be additional benefits for chronic disease risk, similar to those associated with longterm energy restriction (Figure 4. Regular dieting itself is associated with weight gain [14], possibly due to the adoption of negative behav iours such as binge eating, skipping breakfast and not exercising [15]. Persistent dieting attempts may be associated with weight cycling, itself associated with a number of physiological effects, including the suppression of natural killer cells necessary for immune response [16] and potential increased risk of hypertension, hypercholesterolaemia and gall bladder disease [17]. They fail to address the causes of poor eating behaviour and, therefore, are unlikely to help change underlying behaviours. They can be expensive and time consuming, and therefore may be inaccessible to a large proportion of the population who would benefit most from weight loss. Some fad diets can be difficult to sustain due to boredom, monotony, cost and unsociable eating practices, and consumers may blame themselves if they are unable to conform to the unrealistic expec tations of the fad diet, with a subsequent reduction in selfesteem and body image [2]. Many fad diets are nutritionally imbalanced, with lower diet quality scores, particularly where the focus is on macronu trient composition rather than micronutrient intakes [18,19]. The resulting ketosis may manifest itself as bad breath, and there may also be significant fluid losses, and therefore dehydration, itself a risk factor for impaired oral health. Supplements are largely unregulated, and, while some ingredients such as ephedra are now banned, their chemical alter natives are easily available online. No independent health check is required to purchase weight loss sup plements online, despite a number of potential vascu lar, hepatic and cardiacrelated contraindications. In terms of fasting regimes, these require drastic changes to eating patterns to reduce energy intake sufficiently, and support may therefore be essential for success in the freeliving environment (as com pared to clinical trials). Fasting cannot be used as a widespread public health strategy due to the potential medical issues, and because it is as yet unclear which strategies and/or characteristics are required to convert 4. Fasting will inevitably affect intakes of vital nutrients if not managed very carefully, and will likely require micronutrient supplementation to compensate. Fibre intakes may be inadequate, par ticularly where energy restriction is achieved via the use of liquid diets. Finally, there is a lack of longer term studies (>8 weeks) to investigate changes in the eating practices of fasters over time. Anecdotal evidence suggests that the level of restriction on fast days may diminish over time, but may be counter acted by a simultaneous reduction in intake on feed days. While there is lit tle support for the application of true fasts or starva tion practices, alternate or intermittent fasting has become increasingly popular, and may confer psy chological and physiological benefits compared to the more conventional chronic energy restriction. However, the evidence base is by no means com plete, focussing heavily on animal models. At best, these regimes may offer a novel and engag ing means of energy reduction, often accompanied by an active and supportive online community. However, at worst, they may be nutritionally imbal anced, medically unsuitable, unsustainable and una ble to effectively reeducate consumers about behaviour change, portion control, healthy eating and physical activity. It is essential that health professionals in the field of weight management maintain a working knowl edge of current trends and fads in order to have effec tive discussions with their clients and equip them to References 1. Use of nonprescription dietary supplements for weight loss is common among Americans. Frequent intentional weight loss is associated with lower natural killer cell cytotoxicity in postmenopausal women: possible longterm immune effects. The effects of intermittent or continuous energy restric tion on weight loss and metabolic disease risk markers: a ran domised trial in young overweight women. The effects of intermittent energy restriction on indices of cardiometabolic health. Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflam mation in overweight adults with moderate asthma. Dietary and physical activity adaptations to alternate day mod ified fasting: implications for optimal weight loss. Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss Medicines are required to be tested for efficacy and safety, and their benefits and risks assessed, before they are given a license for use. While products are required to go through rigorous testing and clinical trials, some rarer adverse effects are only recognised once many people have taken the medicine. There seemed to be a resurgence in devel oping drugs to treat obesity in the early twentyfirst century. However, as is clear from previous experi ence, this is an area of constant change, and there may be differences in indications in different areas. Exenatide, a glucagonlike peptide 1 receptor agonist, is in latephase clinical trials. It is available as a prescription product at a dose of 120 mg three times daily, and also as an overthecounter preparation at a dose of 60 mg three times a day. A recent systematic review found that orlistat at 120 mg three times a day caused weight loss of average 3. Patients were also participating in a behavioural weight control programme and had a lowerfat diet that contained around 30% of energy from fat. The review also found two trials of orlistat 60 mg three times a day that resulted in a pooled estimate of 2. It has also been shown in a 4year study to signifi cantly reduce the risk of developing type 2 diabetes. As orlistat acts by decreasing the fat that is absorbed, this can result in considerable gastrointestinal side effects, which may lead to discontinuation. The pos sibility of these effects being experienced increases if the patient continues with a highfat diet or if orlistat is taken with a meal that is very high in fat [3]. Within the licensed indication, orlistat should not be continued beyond 12 weeks if at least a 5% decrease from the initial body weight has not been achieved. Phentermine is an appetite suppressant/stimu lant, and topiramate is marketed as an antiepileptic, but has been found to have weight loss side effects. The main pivotal studies showed clinically relevant weight loss, but adverse effects have once again proven to be a concern [1]. In the pivotal trials in non diabetic patients, lorcaserin decreased body weight by about 3. However, there have been concerns about the adverse effects associated with lorcaserin, including about the risk of tumours and also the potential risk of psychiatric disorders and valvulopathy (problems with heart valves). It is licensed as a treatment option for chronic weight management, along with a lowenergy diet and physical activity. There were three clinical trials presented for licensing that includes obese and overweight patients with and without significant weightrelated conditions [11,12,13]. All patients received counsel ling regarding lifestyle modifications that consisted of a lowenergy diet and regular physical activity. The main pivotal trial, which was a 56week clini cal trial that enrolled 3731 patients without diabetes, showed a significant difference when compared to placebo, with patients having an average weight loss of 4. In this trial, 62% of patients treated with liraglutide lost at least 5% of their body weight, as compared to 34% of patients treated with placebo [11].
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