Storylines of family medicine VI: ways of being-in the office with patients.

is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.

Optimal management of on-farm resources in small-scale dairy systems of Central Mexico: model development and evaluation.

This study evaluates the available on-farm resources of five case studies typified as small-scale dairy systems in central Mexico. A comprehensive mixed-integer linear programming model was developed and applied to two case studies. The optimal plan suggested the following: (1) instruction and utilization of maize silage, (2) alfalfa hay making that added US$140/ha/cut to the total net income, (3) allocation of land to cultivated pastures in a ratio of 27:41(cultivated pastures/maize crop) rather than at the current 14:69, and dairy cattle should graze 12 h/day, (4) to avoid grazing of communal pastures because this activity represented an opportunity cost of family labor that reduced the farm net income, and (5) that the highest farm net income was obtained when liquid milk and yogurt sales were included in the optimal plan.

Farm and socio-economic characteristics of smallholder milk producers and their influence on technology adoption in Central Mexico.

In order to identify the factors influencing adoption of technologies promoted by government to small-scale dairy farmers in the highlands of central Mexico, a field survey was conducted. A total of 115 farmers were grouped through cluster analysis (CA) and divided into three wealth status categories (high, medium and low) using wealth ranking. Chi-square analysis was used to examine the association of wealth status with technology adoption.

Plasma and brain pharmacokinetic profile of cannabidiol (CBD), cannabidivarine (CBDV), Δ⁹-tetrahydrocannabivarin (THCV) and cannabigerol (CBG) in rats and mice following oral and intraperitoneal administration and CBD action on obsessive-compulsive behaviour.

Rationale: Phytocannabinoids are useful therapeutics for multiple applications including treatments of constipation, malaria, rheumatism, alleviation of intraocular pressure, emesis, anxiety and some neurological and neurodegenerative disorders. Consistent with these medicinal properties, extracted cannabinoids have recently gained much interest in research, and some are currently in advanced stages of clinical testing. Other constituents of Cannabis sativa, the hemp plant, however, remain relatively unexplored in vivo.

Free-range village chickens on the Accra Plains, Ghana: their husbandry and productivity.

A cross-sectional[4pc] survey investigating husbandry and productivity of free-range village chickens was carried out in four administrative districts within 60 km of Accra. Responses were provided by 101 men and 99 women. The mean (SD) household flock size was 28.

Free-range village chickens on the Accra Plains, Ghana: their contribution to households.

A cross-sectional survey investigating the contribution of free-range village chickens to household economies was carried out in four administrative districts within 60 km of Accra. Answers were provided by 101 men and 99 women. Nearly all respondents claimed to keep chickens for meat, with a far smaller percentage claiming to keep them for egg production.

Consumption of diets containing raw soya beans (Glycine max), kidney beans (Phaseolus vulgaris), cowpeas (Vigna unguiculata) or lupin seeds (Lupinus angustifolius) by rats for up to 700 days: effects on body composition and organ weights.

Feeding trials have been done with rats to assess the effects of long-term (700 d) consumption of diets based on raw cowpeas (Vigna unguiculata; moderate Bowman-Birk inhibitor content, low lectin content), lupin seeds (Lupinus angustifolius; low lectin and protease inhibitor content) or soya beans (Glycine max; high Kunitz inhibitor content, moderate Bowman-Birk inhibitor content, moderate lectin content) or diets containing low levels of raw kidney bean (Phaseolus vulgaris; high lectin content, low Bowman-Birk inhibitor content) on body weight and composition and organ weights. All the legume-based diets reduced feed conversion efficiency and growth rates during the initial 250 d. However, after 250 d the weight gains by rats given legume-based diets were similar to those of controls given the same daily feed intake.

Pancreatic enlargement is evident in rats fed diets containing raw soybeans (Glycine max) or cowpeas (Vigna unguiculata) for 800 days but not in those fed diets based on kidney beans (Phaseolus vulgaris) or lupinseed (Lupinus angustifolius).

Pancreatic weights and composition were studied with rats fed diets containing raw legume seeds for up to 800 d. Rapid pancreatic enlargement was induced by dietary soybeans (Glycine max) (high Kunitz and Bowman-Birk trypsin inhibitor contents, moderate lectin content) during the initial 150 d. Over the next 200 d the rate of pancreatic growth was similar to that in controls.

Simultaneous measurements of cardiac noradrenaline spillover and sympathetic outflow to skeletal muscle in humans.

1. Muscle sympathetic nerve activity (MSA) was recorded in the peroneal nerve at the knee by microneurography in ten healthy subjects and determinations were made simultaneously of intra-arterial blood pressure, and whole-body and cardiac noradrenaline spillover to plasma. Measurements were made at rest, during isometric handgrip at 30% of maximum power and during stress induced by forced mental arithmetic.

Norepinephrine spillover faithfully reflects renal sympathetic nerve activity in conscious rabbits.

The relationship between directly recorded renal sympathetic nerve activity (RSNA) and simultaneous renal norepinephrine (NE) spillover rate across the kidney at rest and in response to changes in mean arterial pressure (MAP) was examined in six conscious rabbits. Integrated RSNA and renal NE spillover rate at rest were 5.1 +/- 1.

Effects of desipramine on sympathetic nerve firing and norepinephrine spillover to plasma in humans.

In isolated organs, or when given in low dose intra-arterially, tricyclic antidepressant drugs are known to block reuptake of norepinephrine into sympathetic nerve varicosities, with a resultant increased norepinephrine washout. On the other hand, systemic administration of such drugs in humans reduces norepinephrine spillover to plasma. To clarify these seemingly contradictory findings, we have measured concurrently muscle sympathetic activity in the peroneal nerve (microneurography) and rates of norepinephrine spillover to plasma for the body as a whole and for the heart, the kidneys, and the forearm (radiotracer technique), both before and after intravenous infusion of desipramine, 0.

Differential effects of central and peripheral desipramine on sympathoadrenal function and heart rate in conscious rabbits.

The effects of the tricyclic antidepressant, desipramine, on the baroreflex regulation of renal sympathetic nerve activity (SNA) and heart rate (HR), the nasopharyngeal reflex, plasma epinephrine and blood pressure (BP) were studied in conscious rabbits. Renal SNA and HR were recorded during slow ramp changes in mean arterial pressure (MAP) and during inhalation of cigarette smoke. Intracisternal (i.

Central sympathoinhibition and peripheral neuronal uptake blockade after desipramine in rabbits.

Peripheral- and central nervous system (CNS)-mediated effects of desipramine (Des) on sympathetic nerves and the contribution of alpha 2-adrenoceptors to these effects were studied in conscious rabbits. Blood pressure, renal sympathetic nerve activity (SNA), and norepinephrine (NE) reuptake and spillover into plasma were measured before and after intracisternal (ic) or intravenous (i.v.

Influence of brain renin-angiotensin system on renal sympathetic and cardiac baroreflexes in conscious rabbits.

The role of the brain renin-angiotensin system (RAS) in the baroreflex regulation of renal sympathetic nerve activity (RSNA) and heart rate (HR) was studied in conscious rabbits. RSNA and HR were recorded during slow ramp changes in mean arterial pressure (MAP) before and after intraventricular infusion of 1) angiotensin II (ANG II), 2) ANG II receptor antagonist, [Sar1,Ile8]ANG II, or 3) converting enzyme inhibitor (CEI, enalaprilat). Central ANG II increased resting MAP and RSNA by 10.

Cardiac afferents attenuate renal sympathetic baroreceptor reflexes during acute hypertension.

We have studied the effect of acute hypertensive episodes on the renal sympathetic baroreceptor reflex in conscious rabbits and the role played by cardiac afferents and endogenous opiate mechanisms. Renal sympathetic nerve activity was recorded during brief perivascular balloon-induced ramp changes in mean arterial pressure before and during 40-minute elevations in resting pressure. Methoxamine infusion was adjusted to increase pressure by +30 and +45 mm Hg in the presence of autonomic blockade of the heart with atenolol and methscopolamine.

Influence of cardiac afferents on time-dependent changes in the renal sympathetic baroreflex of conscious rabbits.

1. The stability of the renal sympathetic baroreflex and nasopharyngeal reflex, and the role of cardiac sensory receptors, was studied in conscious rabbits over a 5 h experimental period. 2.

Differentiation of cardiac baroreflex properties by cuff and drug methods in two rabbit strains.

Sigmoidal mean arterial pressure (MAP)-heart rate (HR) curves were obtained in two genetically related strains of rabbits (groups I and II). We examined vagal (V) and sympathetic (S) effects on HR using perivascular cuffs and vasoactive drugs to alter MAP, and we studied the effects of intravenous naloxone, which affected only I. With the cuff method, both V and S components of gain were much greater in I than in II, and naloxone greatly reduced the difference.

Influence of endogenous opiates and cardiac afferents on renal nerve activity during haemorrhage in conscious rabbits.

1. We investigated the effects of the opiate antagonist naloxone on changes in renal nerve activity and the renal sympathetic baroreflex during haemorrhage and whether they could be mimicked by blocking afferent input from cardiac receptors. 2.

The effect of beta-agonists and antagonists on muscle growth and body composition of young rats (Rattus sp.).

1. The addition of the beta-selective adrenergic agonist clenbuterol to the diet was associated with an increase in the protein and RNA of skeletal and cardiac muscle, a reduction in fat deposition and an increase in energy expenditure. 2.

Reflex responses to baroreceptor, chemoreceptor and nociceptor inputs in single renal sympathetic neurones in the rabbit and the effects of anaesthesia on them.

Reflex responses of renal postganglionic neurones to stimulation of arterial baroreceptors, arterial and central chemoreceptors and cutaneous nociceptors, and the rhythmicity of their resting activity were studied in paralyzed, artificially ventilated rabbits, anaesthetized with either alfathesin or chloralose-urethane. A 'vasoconstrictor' response pattern was seen in all units. Perivascular balloon-induced falls in blood pressure increased firing while pressure rises silenced 90% of units and reduced firing in the rest.

Rapid resetting of rabbit aortic baroreceptors and reflex heart rate responses by directional changes in blood pressure.

In both anaesthetized and conscious rabbits, perivascular balloon inflations slowly raised or lowered mean arterial pressure (M.A.P.

The renal sympathetic baroreflex in the rabbit. Arterial and cardiac baroreceptor influences, resetting, and effect of anesthesia.

Curves relating renal sympathetic nerve activity and mean arterial pressure were derived in conscious rabbits during ramp changes in mean arterial pressure, elicited by perivascular balloon inflation. The renal sympathetic nerve activity-mean arterial pressure relationship consisted of a high-gain sigmoidal region about resting, where renal sympathetic nerve activity rose or fell in response to moderate falls and rises of mean arterial pressure. With larger pressure rises, renal sympathetic nerve activity first fell to a lower plateau and then reversed at even higher mean arterial pressure.

Blockade of cardiac nerves by intrapericardial local anaesthetics in the conscious rabbit.

Local anaesthetic drugs were instilled into the pericardial sac of conscious rabbits through a chronically implanted catheter. Twenty mg of procaine HCl always caused complete blockade of cardiac vagal and sympathetic efferent nerves, tested by eliciting the baroreceptor-heart rate reflex, and abolished the reflex depression of renal sympathetic nerve activity elicited by impeding left ventricular outflow. It also slowed heart rate by a direct effect on the sinoatrial pacemaker.

Central adrenoceptors modify hypothalamic thermoregulatory patterns of autonomic activity in conscious rabbits.

In conscious rabbits with indwelling intracisternal (i.c.) catheters i.