Structuring a clinic to provide patients with an effective and comprehensive smoking cessation program may not always be possible. However, we contend that it is always possible to provide a referral to such services when smokers have been identified and the risks of continuing to smoke have been discussed with them. Smoking cessation programs are available throughout the United States from the American Lung Association, the American Cancer Society, and the Seventh-Day Adventist Church. The American Heart Association also offers a self-help program. Many national and local commercial programs are also available. Developing a comfortable referral relationship with programs in your area can improve the care you provide for your smoking patients.
Before the early 1980s, FAP and UC (Ulcerative Colitis) were treated with total colectomy and ileo-rectal anastomosis (IRA) or total proctocolectomy and permanent ileostomy (TP). As this radical option involved the sacrifice of the anal sphincter, both the surgeon and patient tended towards a less invaliding option even when the indication was not correct. As demonstrated by Church et al. 11 , the risk of developing rectal cancer was higher before the early eighties before the introduction of restorative procto-colectomy with ileal pouch-anal anastomosis (IPAA) because the technical choice was not based only on clinical criteria, but was also conditioned by the desire to avoid a permanent ileostomy. However, the same author 12 outlined that, if the indication is correct, IRA is a good solution. In cases where there are few polyps in the colon and rectum, the risk of a subsequent proctectomy (because of the development of rectal cancer or of a high number of adenomas no longer...
Encourage patients and family members to build support networks outside the family. Stress to patients and family members the importance of having people available to provide emotional support in addition to those living in the household. Suggest that they start with people in existing networks, such as groups involved in neighborhood activities, local churches or synagogues, and the patient's workplace. Encourage families to use joint support groups or telephone help lines. This should begin early in the illness, as social networks must be built up and strengthened in the early stages of the illness so that they are available during crises. This advice may be even more important for men, for whom their spouse is often the primary or sole source of support. Men have fewer close ties and are less likely to seek support from them. Encourage male patients and male spouses to attend support groups and open up, even though it might be difficult.
Local food assistance programs are typically found in churches or other places of worship or are listed in the yellow pages under food pantries, food assistance, and food banks, or under social and human services. Nationwide programs such as Worldsharc. Inc. (www.worldshare.org 1-888-742-7372) and Second Harvest (www.secondharvest. org 1-312-263-2303) have regional programs throughout the country. Additional North American programs are listed on the Winnipeg Harvest Website (www.winnipegharvest. org links).
Although Ethiopia's barley is all but unknown elsewhere, at least one overseas group has attempted to grow it, and with considerable success. In the dry southwestern quarter of the United States, the Ghost Ranch, a facility sponsored by the Presbyterian church, has been growing it as one of its main cereal crops since 1983. Following are comments by the farm's manager. The photograph was taken after the 1991 harvest.
Psychoanalysis, as we have seen, is a broad church. The concern in this section is to highlight common threads, which distil the essence of a psychoanalytic approach as compared to other therapeutic modalities, rather than to espouse a particular psychoanalytic stance. Wallerstein (1992) suggests that despite the theoretical plurality of psychoanalysis, there is common ground within clinical theory. Sandler & Dreher (1996) explain this phenomenon by drawing a distinction between therapists' ''implicit theories'', which they regard as more pragmatic than their explicit theories. They argue that this may account for the greater convergence amongst psychoanalytic therapists of differing theoretical persuasions at the level of practice.
Nuts are but a few of the foods obtained from shrubs. Many, such as blueberries and raspberries, are made into pies. Some currents and gooseberries are key components of jams and spreads. Still others, such as plums, cherries, and grapes, are eaten as fruits or used in the preparation of jams, jellies, pies, as cooking ingredients, or used for other baked goods. Some fruits are gathered only in the wild, but many others are cultivated. Cranberries, blueberries, and blackberries are cultivated varieties derived from hundreds of years of selecting and cultivating wild native shrubs. Fruits of plums, cherries, and especially the serviceberries, or Juneberries, are used to make fine and natural wines, and it may be that serviceberries were named because they provided the earliest fruits that could be made into wines for the Eucharist during church services.
As George Gaylord Simpson (1964) pointed out, many authors who write about the origin of life do not realize that they are writing fiction, humor, or religious apologetics. The Fathers of the Church who established the Nicene Creed speaking ex cathedra knew they were establishing a religious creed. Miller and Urey, also speaking ex cathedra, asked Destiny for confirmation of their faith. The editors of the journal Science did not realize that they were publishing religious apologetics.
Mice are anesthetized using a mixture of ketamine xylazine. When adequately anesthetized, the mouse is secured with tape in the supine position in a custom-built mold designed to maintain the mouse's natural body shape after fixation (Figure 5.8). The hair on the chest wall is removed with a chemical depilatory hair remover (Nair, Church and Dwight Co., Princeton, NJ, U.S.A.). Ultrasound gel is spread over the precordial region and the ultrasound biomicroscope with a 30-MHz transducer is used to visualize the left ventricle (Figure 5.9a). When the cross-section with the largest left ventricular chamber dimension is located, an i.v. catheter with needle is placed at the precordial area on the chest wall, with the longitudinal axis of the needle in the ultrasound imaging plane (Figure 5.9b). Under real-time image guidance, the needle is inserted into the left ventricle (Figure 5.9c). The needle is then removed, and the catheter secured in place by tape (Figure 5.9d) and connected to a...