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Coffee farmers face increasing challenges as competition for land, water, and other natural resources tightens and climate change brings new uncertainties. Traditional knowledge and experience gained over generations must be infused with new science and also extended through innovation. There is an ongoing revolution in the ways farmers learn to be more productive, sustainable, and resilient. Conservation and standard-setting organizations codify best practices into guidelines and provide training and market incentives to meet the standards. These groups, many other nongovernment organizations, government extension agencies, and coffee companies increasingly collaborate with farmers to improve training and information sharing methodologies. Farmers are shaping these techniques to ensure that the information they most need is included and that it is presented in ways they can comprehend and apply. Farmers are educating each other. The Internet, smart phones, and digital devices are becoming important tools, even for the most remote farmers. Consumers and markets are directly supporting the revolution in farmer knowledge by buying certified sustainable coffee.

Objective L-dopa is the most widely used and most effective therapy for Parkinson disease (PD), but chronic treatment is associated with motor complications in the majority of patients. It has been hypothesized that providing more continuous delivery of L-dopa to the brain would reduce the risk of motor complications, and that this might be accomplished by combining L-dopa with entacapone, an inhibitor of catechol-O-methyltransferase, to extend its elimination half-life. Methods We performed a prospective 134-week double-blind trial comparing the risk of developing dyskinesia in 747 PD patients randomized to initiate L-dopa therapy with L-dopa/carbidopa (LC) or L-dopa/carbidopa/entacapone (LCE), administered 4× daily at 3.5-hour intervals. The primary endpoint was time to onset of dyskinesia. Results In comparison to LC, patients receiving LCE had a shorter time to onset of dyskinesia (hazard ratio, 1.29; p = 0.04) and increased frequency at week 134 (42% vs 32%; p = 0.02). These effects were more pronounced in patients receiving dopamine agonists at baseline. Time to wearing off and motor scores were not significantly different, but trended in favor of LCE treatment. Patients in the LCE group received greater L-dopa dose equivalents than LC-treated patients (p < 0.001). Interpretation Initiating L-dopa therapy with LCE failed to delay the time of onset or reduce the frequency of dyskinesia compared to LC. In fact, LCE was associated with a shorter time to onset and increased frequency of dyskinesia compared to LC. These results may reflect that the treatment protocol employed did not provide continuous L-dopa availability and the higher L-dopa dose equivalents in the LCE group. ANN NEUROL 2010;68:18–27