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Beirut | |
Zach Condon of Beirut | |
Background information | |
Origin | Santa Fe, New Mexico, United States |
Genres | Balkan folk, world, indie folk, electronica, baroque pop |
Years active | 2006–present |
Labels | Ba Da Bing, Pompeii, Arts & Crafts México |
Associated acts | Alaska in Winter, A Hawk and a Hacksaw, Beirutando, Kidcrash, Kocani Orkestar, Owen Pallett, The Silent League, Sharon Van Etten |
Website | www.beirutband.com |
Members | Zach Condon, Perrin Cloutier, Nick Petree, Paul Collins, Kyle Resnick, Ben Lanz |
Past members | Jeremy Barnes, Heather Trost, Jason Poranski, Kristin Ferebee, Jon Natchez, Tracy Pratt, Greg Paulus, Jared van Fleet, Kelly Pratt |
Beirut | |
Zach Condon of Beirut | |
Background information | |
Origin | Santa Fe, New Mexico, United States |
Genres | Balkan folk, world, indie folk, electronica, baroque pop |
Years active | 2006–present |
Labels | Ba Da Bing, Pompeii, Arts & Crafts México |
Associated acts | Alaska in Winter, A Hawk and a Hacksaw, Beirutando, Kidcrash, Kocani Orkestar, Owen Pallett, The Silent League, Sharon Van Etten |
Website | www.beirutband.com |
Members | Zach Condon, Perrin Cloutier, Nick Petree, Paul Collins, Kyle Resnick, Ben Lanz |
Past members | Jeremy Barnes, Heather Trost, Jason Poranski, Kristin Ferebee, Jon Natchez, Tracy Pratt, Greg Paulus, Jared van Fleet, Kelly Pratt |
Beirut is an American band which was originally the solo musical project of Santa Fe native Zach Condon, and later expanded into a band. The band's first performances were in New York, in May 2006, to support the release of their debut album, Gulag Orkestar.[1][2] Despite their name, Beirut had never performed in Lebanon until they appeared at the Byblos International Festival in August 2014. Beirut's music combines elements of indie-rock and world music.
Zach Condon was born in Albuquerque, New Mexico on February 13, 1986. He grew up partly in Newport News, Virginia and partly in Santa Fe.[3][4] Condon played trumpet in a jazz band as a teenager and cites jazz as a major influence.[5]
Condon attended Santa Fe High School, where he was a student until he dropped out at the age of 17.[3] According to a 2011 interview[6] with David Dye on NPR, growing up in Santa Fe meant that Condon was exposed to Mexican music such as mariachi. He also worked at a cinema showing international films and this piqued his interest in Fellini arias and Sicilian funeral brass as well as providing his first experience of Balkan music.[6]
He later enrolled in community college, but only attended for a short period before traveling to Europe at the age of 17 with his older brother, Ryan.[7] This discovery and Condon's subsequent exploration of world music proved to be instrumental in the development of Beirut's melodic sound.[1] Zach's younger brother Ross Condon has also made a name in music, having played in the Brooklyn-based band Total Slacker.[8][9][10][11]
On his return from Europe, Condon enrolled at the University of New Mexico, where he studied Portuguese and photography.[3] Condon recorded the bulk of the material used for Gulag Orkestar by himself in his bedroom, going into the studio to finish the album with the assistance of Jeremy Barnes (Neutral Milk Hotel, A Hawk and a Hacksaw) and Heather Trost (A Hawk and a Hacksaw), who became early contributors to the band.
On the strength of the recordings, Condon was signed under the name of Beirut to Ba Da Bing! records, and Gulag Orkestar was given a May 2006 release. Condon recruited some friends to play the music live for the first shows in New York, and Beirut was born.
Beirut's first official music video was for the song "Elephant Gun". The second video, which was for the song "Postcards from Italy", was directed by Alma Har'el, and was released later. 2007 saw the first release of the full band with the Lon Gisland EP.
Beirut's second album, The Flying Club Cup, was recorded largely at a makeshift studio in Albuquerque and completed at Arcade Fire's studio in Quebec. The music on the album has a French influence due to Condon's interest in French chanson during its recording.[12] Condon has cited Francophone singers Jacques Brel, Serge Gainsbourg and Yves Montand as influences.[13] He also expressed interest in French film and culture, claiming this was his original reason for travelling to Europe.[14] The Flying Club Cup was officially released in October 2007. In September 2007 they did a Take-Away Show acoustic video session shot by Vincent Moon. A DVD, Cheap Magic Inside, was shot but quickly sold out; in December 2010, Beirut, BaDaBing, and Blogotheque authorized its dissemination via digital download.[15]
On April 3, 2008, Beirut canceled a previously announced summer European tour.[16] The band had already been touring and had completed the U.S. leg of the tour, but before the European leg, Condon stated that after two months of touring, he was suffering from exhaustion.[17] Zach Condon explained the cancellations in a post on the official Beirut website, stating that he wanted to put the effort into ensuring that any shows would be "as good as humanly possible".[18] In January 2009 the double EP March of the Zapotec/Holland EP was released, containing an official Beirut release based on Condon's recent trip to Oaxaca (March of the Zapotec), and electronic music under the "Realpeople" name (Holland).[19] On February 6, 2009 Beirut made their debut television performance in the United States on the Late Show with David Letterman, performing "A Sunday Smile".
In early June 2011, amidst touring the US, Beirut announced that their newest album, The Rip Tide, which had been recorded the previous winter in upstate New York,[20][21] was to be released on August 30.[20][22] The band simultaneously released a single from the album, "East Harlem" (which was first recorded on Live at the Music Hall of Williamsburg ), with the B-side "Goshen". The album was recorded, managed, and released under Condon's own Pompeii Records.[23] Reviewers and fellow musicians have noted that, unlike the prior albums which drew heavily on foreign music from Mexico, France, the Balkans, etc., this one has shown Beirut with its own, more pop-oriented sound; saying, "what emerges [on The Rip Tide] is a style that belongs uniquely and distinctly to Beirut, one that has actually been there all along."[24] One reviewer noted that "the Euro influences [of Beirut's previous albums] are still there, but the presiding spirit is old-fashioned American pop."[25] This album also differs from Beirut's previous albums in that the music was recorded as a band playing together rather than laying down individual tracks one at a time, though the lyrics were only added by Condon after all the music had been recorded.[6]
Condon plays a rotary valve flugelhorn and the ukulele as his main instruments. He bought the ukulele as a joke stage prop, but found he liked the sound and was able to play it despite a wrist injury that inhibited him from playing guitar. Condon also plays the trumpet, euphonium, mandolin, accordion, various keyboard instruments, and a modified conch shell that appears on The Flying Club Cup.[1][26][27][28]
Live, Beirut's roster generally consists of:
Past members include:
The majority of the members of Beirut have performed live as well as appeared on recorded material.
Realpeople is Zach Condon's electronic side-project. It was under this name that Condon made his first (unreleased) album, The Joys of Losing Weight, and the name to which the Holland EP is credited. The Joys of Losing Weight, which was made when Condon was fifteen, has never been released officially, but has been leaked on the internet.
Condon has also released an EP, Small-Time American Bats, under the name 1971. This was recorded with his friend, Alex Gaziano on guitar and vocals, when they were both around 16 years old (2002). Gaziano is a founding member of Kidcrash, another band originating from Santa Fe, New Mexico.
Soft Landing was a project started by Beirut members Paul Collins (bass) and Perrin Cloutier (accordion) and Mike Lawless.[29] Their eponymous debut album was released on October 12, 2010 on Ba Da Bing records,[30] and has been described as "a pop version of Beirut"[31] and freak-folk,[32] with a heavy emphasis on dance beats and sheer energy.[33]
Pompeii Records is the record label founded in 2011 by Zach Condon[34] in order to give the band and himself full control over their music. The first recordings released on the label were the band's third album, The Rip Tide,[35] and the preceding single, "East Harlem."
Condon plays mandolin, trumpet and ukulele on A Hawk and a Hacksaw's album A Hawk and a Hacksaw and the Hun Hangár Ensemble and trumpet and ukulele on Alaska in Winter's album Dance Party in the Balkans. He appears on Get Him Eat Him's album Arms Down, on the song "2×2".
Condon is featured on the song Found Too Low RMX by fellow Santa Fean Pictureplane and also appears on the first and last tracks of the Grizzly Bear EP Friend.
Condon also appeared on The New Pornographers' fifth album, Together.[36]
Rock group Blondie's 2011 album, Panic of Girls, features a ska cover of "A Sunday Smile" on which Condon plays trumpet. He also plays on "Le Bleu".[37][38]
On the benefit album album Red Hot + Rio 2, Beirut performed a cover of the Portuguese-language song O Leãozinho originally written by Brazilian composer and singer Caetano Veloso.
Condon is featured singing on the track We Are Fine on indie rocker Sharon Van Etten's 2012 album, Tramp.
Again in 2011, they contributed a cover of Caetano Veloso's song, "O Leãozinho," to the Red Hot Organization's most recent charitable album "Red Hot+Rio 2." The album is a follow-up to the 1996 "Red Hot+Rio." Proceeds from the sales will be donated to raise awareness and money to fight AIDS/HIV and related health and social issues.


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Story: Aunyawan Thongboonrod
Are you a person who is interested in health care but has been limited by expensive modern medicine or supplementary vitamins? If you say yes, we present you some solution that is so easy, cheap but great!
"Herb" (or "Sa-Mun-Prai" in Thai) is a medical plant that human has learnt how to apply its benefits for centuries. Especially Thailand, it is among the few places in the world that has the best herbal resources. Not only we consume vegetables to get high vitamins, some herbal plants can remedy human disease effectively. In this issue, we show 5 popular Thai herbs with theirs various benefits to let you choose some as an ingredient in your next cooking!
1. Turmeric ("Kha-min" in Thai)
One of member of the ginger family, Turmeric has been widely known among Thai people since the old days because it is easily found in almost every part of the country. Apart from its functioning as yellow coloring for Thai food, Turmeric has also numerous benefits for health and beauty. For skin treatment, it helps a wound to heal faster and cure skin desease caused from dermatophyte such as ring worm and chloasma. Some Thai women crush it to reduce it to powder and mixed with water to use as treatment mask for light-complexioned of face and body. For health, it can reduce cholesterol, inflammatory bowel disease, constipation and high blood pressure. So, if you are having fat problem, just provide Turmeric as an ingredient for next cooking, it is definitely good!
2. Aloe Vera ("Wan-Hang-Jo-Ra-Khae" in Thai)
Maybe there are only few people who know that Aloe Vera is a popular ingredient in many brands of shampoo and cosmetics nowadays because its extract is effective for both hair and skin. For example, it is useful in treatment of wounds, burns and skin infections. It can nourish your skin to be fresh, flawless and also eliminate acnes. Also, it can moisturize your hair and reduce oiliness. Moreover, not only in lotion, shaving cream, soap, make-up or shampoo that you can find Aloe Vera extract, it is also a popular ingredient in yoghurt, beverages and some desserts because it has a high content of Collagen protein so it can be used for weght loss and relief of digestive issues such as heartburn and irritable bowel syndrome.
3. Ripe Tamarind ("Ma-Kham-Piak" in Thai)
With the Tamarindus indica Linn as its scientific name, Tamarind tree is a long-lived tree that we can widely see in Thailand. Every part of Tamarind tree can be used for medicinal purposes: its leaves, flowers, fruits and seeds. First of all, its fruit which contains critic, tartaric, acetic and malic acids is very helpful for Alcoholic intoxication and digestive disorder such as loss of appetite, indigestion and constipation. Then, the leaf juice of tamarind is effective to treat heightened body temperature due to excess pitta. Tamarind flowers are also used in the treatment of various eye infections. Lastly, for beauty, it is very good to remove dirt, make skin smooth, fresh and balanced. Thai women ususally use Ripe Tamarind mixed with water and milk to cover rough skin such as ankle, elbow or knee to make it flawless and softer, or use it as hair treatment mask for 15-30 mins, it can kill louses and effectively strengthen roots of hair.
4. Garlic ("Kra-Thiam" in Thai)
In general, Garlic is used as a flavouring and condiment in Thai cuisine. Thai people know how to chop and fry it before cooking fish or meat to reduce fishy smell. Not only for better taste in cuisine, but garlic have also numerous benefits. First, it can assist in managing high cholesterol levels and have a powerful antioxidant, antimicrobial, diaphoretic, diuretic and expectorant effect. Also, it helps you get a good night's sleep by improving breathing and reducing snoring in some people, especially when you have a cold because garlic can dry up your nasal passages. Lastly, for skin benefits, raw garlic can treat the symptoms of acne and dermatophyte. Undoubtedly, garlic should be seen as part of a healthy lifestyle.
5. Kaffir lime ("Ma-Krut" in Thai)
There are evidences since the past that Thai people use kaffir lime as a spice for cuisine and medical herb. In "Klong Kam Suan" and "Kab Hor Klong Ni Rat Phra Baht", two well-known long lyrical Thai poetry and litteratures, it mentions that we cut a half of raw kaffir lime and squeeze it to get its juice to clean our hair. Not only squeaky clean and sweet-smelling, but the essential oils that are extracted from the lime and leaves can helps in reviving your scalp, anti-dandruf and reducing hair fall. Moreover, the extracted essential oils are used to produce various products such as soap, deodorant, body spray and air freshener with kaffir lime aroma to give a fresh feeling. For health, the oil is also used in tonics which aid in digestion and purify the blood. Bergamot leaves contain calcium, beta-carotene, and vitamins A, B2 and C. All of these benefits explain why you can find easily this plant in the backyard of Thai house.

subset: commoncrawl


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Welcome to the Family Friendly Farmacy.
We (Matthew and Rachel) have been farmers for a many years; raising milk, meat, eggs and vegetables for people using the principles of traditional farming practices invigorated by modern technology. During this time, Rachel got sick with an unknown allergen and stayed sick for five years. She was able to heal using nutrition. When we found essential oils we were smitten by how well they complement nutrition in the healing process. It was a match made in heaven and we started the Medicine Cabinet Makeover classes!
We love helping people achieve their highest potential. How can we help you?
- We have many posts sharing peoples experiences with essential oils. You will find them on the Blog pages. Please feel free to tell us about your experiences so we can all learn together.
- We have several articles written about the benefits of grassfed meat and milk, pastured eggs and pork and much more. Look for the Nutrient-Dense Food.
- Looking to get started in oils. Check out the Farmacy Friends to find a mentor. Introduce yourself and get started today!
- There is an opportunity for those interested to sign up a few friends and help pay for their oils or even turn it into a full time job. Check out the Business Opportunity.
- We spend a great deal time to make this site, our classes, emails and phone calls packed with information and helpful to you. Please support us by signing up for oils and ordering under us. Here is the page to Order Oils. If you have trouble feel free to call.
We are so glad you have found us and look forward to getting to know you better.
Please always be thoughtful. All material on these pages, links, images, testimonials, quotes, discussions, etc is for EDUCATIONAL purposes only. We are not doctors or lawyers but we know there are certain things we can not legally do.
- We can not diagnose what is wrong with you.
- We can not suggest a prescription for what ails you.
- We can not claim something cures anything.
Please see a physician before making any changes.
FDA Disclaimer: This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.


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In a sense, the DeSoto is the Chrysler that time forgot. Most people dont know that that DeSotos were built by Chrysler. So what... More
1931 desoto sedan v8 360 auto p.s p.d.b mustang 2 front end. nice driveing rod $23000. or trade for prowler. located in pownal vt... More
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1932 DeSoto 3 window rumble seat coupe - all steel original body, original engine, original trans, etc. Runs and drives excellent. One repaint in 1971.... More


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Journal of Amino Acids
Volume 2012 (2012), Article ID 831759, 14 pages
Amino Acids That Centrally Influence Blood Pressure and Regional Blood Flow in Conscious Rats
Department of Neurophysiology, Graduate School Biomedical Sciences, Hiroshima University, Kasumi-cho 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
Received 17 January 2012; Revised 11 March 2012; Accepted 22 March 2012
Academic Editor: Hieronim Jakubowski
Copyright © 2012 Yumi Takemoto. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Functional roles of amino acids have increasingly become the focus of research. This paper summarizes amino acids that influence cardiovascular system via the brain of conscious rats. This paper firstly describes why amino acids are selected and outlines how the brain regulates blood pressure and regional blood flow. This section includes a concise history of amino acid neurotransmitters in cardiovascular research and summarizes brain areas where chemical stimulations produce blood pressure changes mainly in anesthetized animals. This is followed by comments about findings regarding several newly examined amino acids with intracisternal stimulation in conscious rats that produce changes in blood pressure. The same pressor or depressor response to central amino acid stimulations can be produced by distinct mechanisms at central and peripheral levels, which will be briefly explained. Thereafter, cardiovascular actions of some of amino acids at the mechanism level will be discussed based upon findings of pharmacological and regional blood flow measurements. Several examined amino acids in addition to the established neurotransmitter amino acids appear to differentially activate brain structures to produce changes in blood pressure and regional blood flows. They may have physiological roles in the healthy brain, but pathological roles in the brain with cerebral vascular diseases such as stroke where the blood-brain barrier is broken.
1. Introduction
When the rat spontaneously performs an action such as grooming [1] or walking [2], changes in regional blood flows for head and legs are produced. The brain appropriately regulates blood supply to organs needed for planning of each behavior. For matching cardiovascular demand to each behavior, various kinds of potential neurotransmitters and neuromodulators should work in neuronal networks of the brain relating to the cardiovascular system and behavioral planning. A list of neurotransmitters includes the amino acids glutamate and GABA (gamma-amino-butyric acid) which are well established as endogenously produced excitatory and inhibitory agonists, respectively [3], and appear to play a pivotal role in the central nervous system relating to cardiovascular regulation [4–7]. However, it has been expanding to range the kind and the number of mediators between brain cells from classic neurotransmitter biogenic amines to gaseous neurotransmitters [8] and to gliotransmitters [9]. With respect to amino acids, the concentration of most amino acids in the cerebrospinal fluid is lower than those in the blood [10]. The blood-brain barrier effectively protects the brain from influence of fluctuating concentrations of plasma amino acids [11]. Why are the concentrations of amino acids kept lower in the cerebrospinal fluid? Amino acids other than the established neurotransmitter amino acids may have some functional roles in the brain as is the case with the established ones. The brain contains many nuclei regulating blood pressure and regional blood flow via several pathways [4, 12]. I have hypothesized that some amino acids influence the cardiovascular system through the brain. I have, therefore, begun examining the responses of the cardiovascular system to brain stimulations with amino acids [13, 14]. The anesthesia works at brain level to cause immobility and unconsciousness in animals mainly via GABAa receptors [15], resulting in modified states of the neural networks different from the un-anesthetized state [16]. Therefore, the un-anesthetized freely moving rat has been used in the examinations of brain stimulation with an intracisternal injection of amino acid solution. I will mention findings on several amino acids that modulate the cardiovascular system in this paper, after concisely describing the basic knowledge of central cardiovascular regulation. See references for details: hemodynamics [17, 18], central cardiovascular regulation [12, 19–21], or recent knowledge on amino acids including various functions [22]. In the following sections, I will summarize findings on several amino acids in addition to the established amino acid neurotransmitters (GABA, glycine, and glutamate) that show functional roles in modifying the cardiovascular system. Understanding the mechanisms of how the brain operates is still a great challenge. I would like to suggest that amino acids other than the established amino acid neurotransmitters and/or neuromodulators may have an important role in how the brain functions.
2. Why Are Amino Acids the Focus?
My first concern was roles of the blood-brain barrier. One of the roles is to help to maintain lower concentrations of amino acids in the cerebrospinal fluid than in the plasma [10]. Concentrations of L-proline and L-cystine (dimer of L-cysteine) in the cerebrospinal fluid are extremely low [10]. Why has the brain developed to maintain lower values of such amino acids in the cerebrospinal fluid? The brain tissue surrounding the route of the cerebrospinal fluid may be affected by higher concentrations of L-proline or L-cysteine. Central response to an amino acid might give a clue to decipher the neural wiring relating to proper blood flow shift in animal behaviors. This is the reason I have focused on the role of amino acids in the brain for cardiovascular regulation.
Our whole body uses only 20 amino acids to synthesize proteins and peptides, among more than 300 natural amino acids known at present [22]. One of those proteinogenic amino acids, L-glutamate, has been recognized as an endogenous neurotransmitter for excitatory amino acid receptors at synapses of the central nervous system for several decades [23–25]. Other established historical inhibitory amino acid agonists are GABA, and glycine, which is also one of 20 brick amino acids for proteins [25, 26]. Interestingly, evolutionary process utilizes the ubiquitous nutrient amino acids glutamate and glycine in the brain and spinal cord to signal and communicate between neurons with elaborate mechanisms. Extremely high tissue contents of L-glutamate, GABA, and glycine in the central nervous system [10, 27] would suggest a highly evolved control system that uses these amino acids for the basic common wiring plan to maintain homeostasis throughout the body. Research on the effects of amino acids in the central nervous system began in 1952 with a report from Hayashi on the central convulsive action of glutamate [28, 29]. A possible role of neurotransmitters for amino acids was discussed according to neurotransmitter criteria in 1974 by Curtis and Johnston [30]. They mentioned possible neurotransmitter roles of other amino acids in addition to the later established neurotransmitter amino acids.
With respect to cardiovascular control, GABA, glycine, and glutamate have been known to have an effect on blood pressure since 1954 [31–35]. Takahashi's group first reported a depressor effect of intravenously injected GABA in 1955 [31] and later identified acting sites of GABA as the central origin using various approaches such as ganglionic blocking, intracisternal injection, and direct stimulation with topical application of GABA solution on the dorsal medulla of the anesthetized animal [32]. Intracisternal injection of glycine, GABA, taurine, and L-α-alanine into ether-anesthetized rats produced a central depressor action [33]. As for a pressor response, intravenous injection of glutamate was reported to raise blood pressure of the dog by Itoga in 1954 [34] and of rabbits later by Takahashi's group [31]. Itoga had already suggested the vasomotor centre of the medulla as the active site for the pressor response to intravenously injected glutamate [34]. Intracisternal injection of glutamate was later examined and found to produce a strong pressor response in dogs [35]. In studies of central cardiovascular regulation, concern of most researchers appears to have focused on excitant amino acids mainly as tools of chemical stimulation for electrical stimulation to evoke excitation of only neurons but not axons related to blood pressure regulation. For example, homocysteic acid [29] has been repeatedly selected to stimulate neurons as a stimulant tool for targeting excitatory receptors [36–38]. Several groups nevertheless have continued to investigate the role of chemical mediators in central cardiovascular regulation [5–7]. In future, information on which neurons related to cardiovascular regulation have which neurotransmitters identified with classical criteria: storage, release, and inactivation, might become available [8].
3. Outline of How the Brain Regulates Blood Pressure and Regional Blood Flow
Blood pressure (specified for arterial blood pressure here) is determined by cardiac output and total peripheral resistance (Figure 1). The heart works spontaneously and propels the blood into the aorta depending on blood volume returned from the vena cava. The brain modifies the cardiac work with cardiac parasympathetic and sympathetic neurons, adrenaline released from the adrenal gland via sympathetic activation, and an increase in venous return with increased sympathetic activity to the capacitance venous vessels. Another variable of peripheral blood flow resistances consists of a lot of acting sites, arterioles all over the body, which are located just before the vascular (capillary) bed of each organ (Figure 2). The brain can modify the size of arterioles with vascular sympathetic neurons and release of several vasoactive factors into the blood stream as mentioned below in detail. For proper delivery of the blood into the demanding organ, regulation of the arterioles could be essential. Vasomotor sympathetic neurons are tonic at rest but regulated by increasing or decreasing activities (Figure 3), resulting in optimal blood flow shift among different vascular beds for demanding organs, in theory.
3.1. Brain Has at Least Four Possible Peripheral Pathways for Influencing Arterioles
Stimulation of central nervous system influences arterioles and/or blood pressure through at least four ways (Figure 4) [39]: one is the vasomotor sympathetic neurons in different vascular beds (Figures 2 and 4 circle 1), second is renal sympathetic neurons (Figure 4 circle 2) that release the enzyme renin from the renin-secreting granular cells in the afferent arteriole to finally produce a potent vasoactive peptide, angiotensin II, in the blood via the renin-angiotensin system [40, 41], third is adrenal sympathetic neurons (Figure 4 circle 3) that release adrenaline into the blood [42], and finally the hypothalamus-pituitary system that releases the vasoactive or antidiuretic peptide, vasopressin, in the blood (Figure 4 circle 4) [19]. Central excitatory stimulation of those pathways induces a simple pressor response through vasoconstriction by noradrenaline, angiotensin II, and vasopressin and/or increase in cardiac output with adrenaline, but inhibitory stimulation produces a depressor response where the corresponding tonic pathway at rest is deactivated. Because total vascular tone is mainly maintained by vasomotor sympathetic neurons in the animal with normal blood pressure, responses of regional blood flow resistances to inhibitory stimulation would affect vascular beds which are tonic at rest and responsible for maintaining the normal blood pressure. In the same way, genetically or experimentally produced hypertensive animals could be examined with blockade of the above-mentioned four possible peripheral pathways to elucidate the cause of prolonged hypertensive states.
3.2. Brain Nuclei Where Chemical Stimulations Produce Changes in Blood Pressure
Chemical stimulation of the brain has been used to produce changes in blood pressure, because they are expected to stimulate only the cell body of the neuron [44]. As stimulants, ionotropic excitatory amino acid receptor agonists, L-glutamate, DL-homocysteic acid, and kainic acid, have been chosen for most cases, but other chemicals such as serotonin, acetylcholine, GABA, glycine, angiotensin II, endothelin, and receptor agonists and antagonists have also been tested.
There are several well-examined neuronal groups which change blood pressure at medulla level when chemically stimulated (Figure 5); rostral ventrolateral medulla (RVLM) [16, 45–49], caudal ventrolateral medulla (CVLM) [47, 50–56], and nucleus tractus solitarii (NTS) [57–64]. Neural pathways of a reflex which detects changes in blood pressure and returns it to the original level via mainly sympathetic neurons (called the baroreceptor reflex) include NTS, RVLM, and CVLM. Baroreceptor afferent neurons of vagal and glossopharyngeal nerves terminate second-order neurons in the NTS [65–67] that send information to GABAergic interneurons in the CVLM [68]. When baroreceptors in the aortic arch and carotid sinus detect an increase in blood pressure, excited GABAergic neurons in the CVLM inhibit presympathetic neurons in the RVLM, leading to a decrease in sympathetic activity and resulting in restoration of original blood pressure [21]. RVLM is believed to contain the most essential neuronal group to maintain the resting and tonic vasomotor sympathetic activity, since lesion or inhibition of RVLM produces severe hypotension equivalent to a spinal transection [50, 69] and blockade of many cardiovascular-related reflexes [12].
Other parts of the brain that produce changes in blood pressure with chemical stimulation include caudal pressor area (CPA) (Figure 5) [70], area postrema [71], rostral ventromedial medulla [72–74], caudal raphe nuclei [75–79], nucleus ambiguous [80], cerebellar sublobule IX (lateral and medial uvula) [81–85], and the fastigial nucleus [4, 44, 86–89] at the medulla and cerebellum. The others are A5 noradrenergic cell group [90–92], locus coeruleus (A6 group) [93, 94], parabrachial area [95–100] in the pons, ventral tegmental area [101–103] and periaqueductal gray matter [104–106] at the midbrain level, and lateral and posterior hypothalamic regions [105, 107–110], amygdala [111, 112], septal nuclei [113], and insular cortex [114, 115] at the forebrain level. Vasopressin-containing neurons in the supraoptic nucleus and paraventricular nucleus of the hypothalamus are also responsible for the pressor response to chemical stimulation via vasopressin release even in awake rats [116, 117].
Neural networks made from the above-mentioned neuronal groups and yet unknown ones could regulate blood pressure and regional blood flow to the vascular bed, corresponding to various needs of the body. Synapses in the neuronal networks should have a lot of combinations of endogenous agonists and receptors like those in autonomic nerves [118], sympathetic preganglionic neurons [119], and medullary presympathetic neurons [7]. A lot of work has been devoted to finding the mechanisms for the appropriate responses to complicated body needs with expanding lists of neurotransmitters and their receptors related to cardiovascular regulation [4, 6, 7, 12, 119]. However, the details of in vivo body function at the synaptic level remain poorly understood.
4. Potential Diffused Parts of the Brain with Intracisternal Approach
Intracisternal injection of chemical solution has several merits for surveying central effects of a lot of amino acids. First, limited areas of the brain around the cisterna magna could be stimulated (Figure 5). The cerebrospinal fluid flows from the lateral ventricles to the cisterna magna through the third ventricle, the aqueduct, and the fourth ventricle, with weak positive pressure [10]. Potential diffused regions with intracisternal injections in the freely moving rat are the ventral medulla surface, excluding part of the dorsal brainstem, and the surface areas around the flow route of the cerebrospinal fluid [120]. The flow route includes the RVLM, CVLM, and CPA located in the ventral surface of the medulla and the NTS located in the dorsal surface of the medulla. The NTS neurons receive afferent information from the body [121] and contribute to keep blood pressure stable via mainly the CVLM then to the RVLM in the baroreceptor reflex [12, 21]. The CPA neurons appear to be included for maintenance of blood pressure but via the RVLM and/or CVLM [21]. Therefore, the RVLM and CVLM would have the greatest influence over changes in blood pressure with intracisternal stimulation of amino acids, as the final stations of the possible network. I have established the intracisternal injection method using polyethylene tubing that produces a minimal lesion of the brain, differently from a stainless steel tube. It was originally developed to take cerebrospinal fluid from freely moving rats [122, 123]. For injection of amino acid solution, the tip was inversely oriented from a caudal side to a rostral side. With respect to acting sites, my recent studies with c-Fos expression [124] and another study using a radioisotope [125] suggest the supraoptic vasopressin-containing nuclei situated in the ventral surface area of the brain in addition to RVLM and CVLM.
5. Amino Acids with a Pressor Action
In the first experiment [13], while blood pressure and heart rate were observed, the following amino acid solutions were intracisternally injected in the freely moving rat: L-glutamic acid (59 nmol in 10 μL artificial cerebrospinal fluid, 5.9 mM), taurine (5 μmol), L-proline (10 μmol), L-α-alanine (10 μmol), GABA (10 μmol), L-aspartic acid (0.3 μmol), L-valine (7.6 μmol), L-serine (10 μmol), L-methionine (1 μmol), L-isoleucine (3 μmol), L-leucine (1 μmol), L-tyrosine (25 nmol), L-histidine (5 μmol), L-lysine (10 μmol), L-arginine (10 μmol), L-tryptophan (56 nmol), L-asparagine (1.4 μmol), L-glutamine (2 μmol), glycine (10 μmol), L-phenylalanine (0.18 μmol), and L-cysteine (10 μmol). Each dose depended on the solubility but was below 10 μmol in 10 μL. In the later detailed experiments, L-glutamic acid monosodium salt (0.2 M) was used for improvement of solubility [126], the concentration of L-cysteine was lowered to 0.2 M from 1 M due to its strong spasm causing effect [126], and the pH of basic L-arginine solution was adjusted to 7.4 [127]. To examine the stereoselectivity of the pressor response to L-arginine and L-proline, D-arginine [128] and D-proline [129] were injected in other experiments.
Intracisternal injections of the following amino acids produced pressor responses in the freely moving rat: L-proline, L-arginine, D-arginine, L-cysteine, L-glutamate, L-aspartic acid, and L-asparagine [13, 126–129]. The pressor responses were dose dependent, became maximal between 1 min and 10 min after injections, and returned to normal within 60 min at longest for all except D-arginine. An increase in heart rate was marked between 1 and 5 min after injection of L-cysteine, and a bradycardiac response was obtained 5 min after injection of L-proline [13].
An examination of stereoselectivity for the L-arginine response revealed unexpectedly a pressor response to D-arginine injected into the cisterna magna [128]. Because of a possible role of the enzymatic substrate L-arginine for nitric oxide [130], no response to D-arginine stimulation was predicted. Other possibilities as substrates are for kyotorphin (L-tyrosyl-L-arginine) [131] and agmatine [132]. The pressor responses common to both L-arginine and D-arginine apparently denied the possibility as a substrate of L-arginine for the converted different active principles, because of strict stereospecificity of the enzymes. However, as mentioned below, each mechanism for the pressor response was distinct. Active principles of L-arginine and D-arginine for their cardiovascular responses remain puzzling.
A weak depressor response to D-proline was obtained [129]. Therefore, it is suggested that the neurotransmitter candidate L-proline [133] itself acts on some receptors in the neuronal network relating to cardiovascular regulation.
6. Amino Acids with a Depressor Action
Intracisternal injection of the following amino acids produced depressor responses in the freely moving rat: L-serine, L-sarcosine (N-methyl-glycine), L-α-alanine, L-β-alanine, taurine, GABA, and glycine [14, 43, 134, 135]. The concentration was 1 M for all except taurine which was 0.5 M.
The depressor and bradycardiac responses were at max between 5 min and 30 min after injections, and blood pressure returned to the original level 60 min or later. The depressor response to L-serine was occasionally accompanied with transient pressor period between 5 and 10 min [14, 134], differently from other depressor amino acids. The mechanism of L-serine to induce two-phase changes in blood pressure could be different from others. Of these depressor amino acids, L-serine, L-α-alanine, and L-β-alanine have been introduced as electrophysiologically depressant amino acids related structurally to GABA, glycine, and taurine by Curtis and Johnston [30]. Then, L-β-alanine is suggested to be a neurotransmitter at present [136].
7. Regional Blood Flow Changes with Several Amino Acids of the Pressor Action
Regional blood flow measurement in three arteries (Figure 6) was performed for L-proline, L-arginine, and D-arginine. Information on changes in regional blood flow will give a clue to decipher how an amino acid modifies regional peripheral resistance and changes blood pressure.
Before seeing the hemodynamic data, explanation of flow measurement and relationship among regional blood flow, regional blood flow resistance, and blood pressure would be needed. An electromagnetic flow probe set around the artery monitors the flow volume rate (not velocity) in the freely moving rat [137] (Figure 6). The blood flow rate (volume/min/100 g weight) measured in an artery just before the vascular bed of an organ reflects the net changes in sizes of arterioles within the organ. Namely, stronger arteriolar dilatation produces more arterial blood flow, but stronger vasoconstriction produces less flow. At rest, the size of arteriole is mainly determined by the basal tone of vascular sympathetic neurons (Figure 3). When the vascular sympathetic discharge is increased, the resultant vasoconstriction reduces flow to the corresponding artery. When arterioles in a particular vascular bed are not under the control of sympathetic neurons, higher blood pressure produces blood flow increase. Namely, when tube (artery) size is constant and head (blood) pressure is different, higher head pressure produces greater flow (Figure 7). Therefore, to take the influence of blood pressure changes into account, blood flow resistance or conductance is used to evaluate the net effect of the vascular bed. The studies have expressed blood flow resistance or vascular resistance that is blood pressure divided by flow. Changes in blood pressure always influence blood flow, but changes in blood flow can make changes in blood pressure when they influence the total peripheral flow resistance that is the net change in all the vascular beds. When liquid in a tank flows out from the exits, constricted tubes together produce high back pressure, but dilated tubes together produce low back pressure, and a combination of constricted and dilated tubes results in no change in back pressure (Figure 8). The final example shows what happened when the rat walked spontaneously. The flow was shifted from carotid artery to hindquarters (aortic terminal for legs) without changes in blood pressure that was also supported with an increase in cardiac output [2]. However, grooming behavior increased blood pressure slightly (by 10 mmHg) with blood shift in the opposite direction [1]. Here, we see changes in regional blood flow resistance when amino acids produce the pressor response.
Intracisternal injection of L-proline (1 M) produced a threefold increase in blood flow resistance in the superior mesenteric artery, double in renal artery, and no significant change in hindquarters [129]. With respect to each original blood flow with the pressor change (25%), superior mesenteric flow was decreased but there was no significant change in either renal flow or hindquarters flow [129]. If the pressor change is not considered, it appeared that vasoconstriction only in the superior vascular bed contributed to the pressor response. However, the resistance data indicate that L-proline stimulation of the brain produced strong superior mesenteric and minor renal vasoconstriction, resulting in the pressor response.
In the case of L-arginine (0.5 M), vasoconstriction in the superior mesenteric (80%) and renal arteries (60%) was almost equivalent, but hindquarters resistance was unchanged for 25% increase in blood pressure, suggesting an equivalent contribution of the splanchnic vasoconstriction to the pressor response [127].
The original aim of D-arginine injected into the cisterna magna was to examine the stereospecific effect of L-arginine, as mentioned above. However, the results indicated that pressor response to D-arginine was the same as L-arginine, but distinct changes in regional blood flows were observed. There were almost equivalent increases in superior mesenteric (60%) and renal resistances (45%) but a decrease in hindquarters resistance (35%) and an increase in total peripheral blood flow or cardiac output by calculation (23%), for the pressor response (25%) to D-arginine (1 M) [128]. The data suggested the major contribution of cardiac output with the minor one of total peripheral vascular resistance to the pressor response of D-arginine, differently from L-arginine. Each amino acid appeared to stimulate different brain nuclei relating to the cardiovascular regulation, resulting in the common pressor response.
8. Regional Blood Flow Changes with Several Amino Acids of the Depressor Action
Regional blood flow measurement in three arteries (Figure 6) was performed for GABA, L-β-alanine, and glycine, because of the similarity of the molecular structure [43, 135]. Three amino acids in common decreased hindquarters resistance alone without significant changes in superior mesenteric resistance or renal resistance [135].
Figure 9 shows an example of blood flow recordings in three arteries with depressor and bradycardiac responses to intracisternal injection of GABA [43]. The flow changes could be confusing, because hindquarters flow showed no change, but both superior and renal flow decreased almost in parallel to lowering blood pressure. It might be interesting to see autoregulation of renal artery to keep flow constant to some extent during initiating lowering blood pressure, compared with the exact parallel changes of superior mesenteric flow and blood pressure (Figure 9). It is the case that, when the vascular bed has no influence, flow is decreased depending on blood pressure lowering (Figure 7). GABA in the brain could inhibit the tonic resistance in the hindquarters vascular bed alone to reduce blood pressure, along with a bradycardia (probably cardiac output reduction). It appears that hindquarters resistance is regulated by glycine receptors and L-β-alanine-sensitive receptors in addition to GABA receptors.
Further detailed evaluation of vascular resistance responses to intracisternal GABA stimulation suggested that resting tone in the carotid in addition to hindquarters vascular beds but not the superior mesenteric, celiac, and renal vascular beds influenced by exogenously applied GABA possibly through GABA receptors not occupied with endogenous GABA [138, 139]. The grooming and walking behaviors produced blood shift between carotid artery and hindquarters [1, 2]. Receptors for GABA and other depressor amino acids may be involved in a program of neuronal networks for producing the proper blood flow shift during a behavior.
9. Peripheral Pathways Activated by Several Amino Acids with the Pressor Action
The pressor response to central amino acids could be produced by increases in total peripheral resistance and/or cardiac output. Vessels and heart are influenced by humoral substances and neural activation via the brain (Figure 4). When the pressor response is observed, we can differentiate possible pathways pharmacologically. Autonomic ganglionic blockade, receptor antagonists, and enzyme inhibitors have been effectively used for the pressor response to an intracisternally injected amino acid.
Regional hemodynamic behaviors responding to venous infusions of vasoactive agonists (vasopressin, angiotensin II, noradrenaline, and adrenaline), which are possibly released into the blood, are also useful to estimate central pathways activated by an amino acid (Figure 4) [39]. Exogenously infused vasopressin dose-dependently increased resistances of all the vascular beds investigated except the celiac vascular bed. Celiac resistance was unchanged while the other four resistances were increased by increasing doses of vasopressin, and it is abruptly increased only at the highest dose when blood pressure increased by 50%. Angiotensin II and noradrenaline infusions produced in common various levels of vasoconstriction in four arteries other than the hindquarters. Both vasoactive substances resulted in unchanged hindquarters resistance, and the order of actions among the other four arteries was distinctly different. For 20% increase in blood pressure, the most potent vasoconstriction was obtained in renal and celiac arteries with noradrenaline infusion and in renal artery with angiotensin II. Adrenaline infusion produced quite different hemodynamic changes. As expected from β-receptor stimulation for vasodilatation, hindquarter resistance was decreased in a wide range of adrenaline doses, but without increase in blood pressure in low doses. Surprisingly, a celiac resistance increase compensated for the lowered hindquarters resistance, maintaining blood pressure. Higher doses of adrenaline produced vasoconstriction of other renal and carotid arteries, especially of superior mesenteric artery.
With pharmacological data and regional vascular responses to circulating vasoactive substances, the distinct central pathways responding to each pressor amino acid are estimated. Ganglionic blockade effectively inhibited the pressor response to L-arginine [127] and D-arginine [128], suggesting that both amino acids could stimulate central pathways relating to autonomic neurons. Vasodilatation in hindquarters produced by D-arginine was attenuated by a β-receptor inhibitor [128]. Taking hemodynamic data into account, it is suggested that L-arginine would activate central neurons relating to vascular sympathetic neurons in the superior and renal vascular beds. Because adrenaline could be released with the intracisternal injection, D-arginine appears to stimulate nuclei relating to adrenal sympathetic neurons.
With respect to L-cysteine [126], L-glutamate [126], and L-proline [129], ganglionic blockade augmented the pressor response. Additional intravenous injection of vasopressin V1 receptor antagonist, however, completely abolished the augmented pressor response to those amino acids. The data suggest involvement of vasopressin release with amino acids. Previous intravenous injection of vasopressin V1 receptor antagonist alone, without ganglionic blockade, significantly attenuated the pressor response to L-proline and L-glutamate but not to L-cysteine. Namely, intracisternally injected three amino acids are suggested to stimulate nuclei relating to vasopressin containing neurons as well as autonomic neurons. Pharmacological data suggest major involvement of vasopressin release and minor roles of autonomic neurons in the pressor response to applications of L-proline and L-glutamate but major involvement of autonomic nervous activation and minor role of vasopressin release in response to L-cysteine.
Intracisternal injection of L-proline likely released vasopressin but unchanged hindquarter resistance [129], although exogenously infused vasopressin produced strong vasoconstriction of hindquarters in a dose-dependent manner [39]. One explanation is that the dilatation additionally produced by adrenaline possibly released with L-proline stimulation counters the vasoconstrictor action of vasopressin, resulting in no change in resistance.
The findings indicate that each pressor amino acid listed here activates differential central nuclei relating to peripheral pathways of vascular sympathetic neurons, adrenal sympathetic neurons, and vasopressin release via hypothalamus-pituitary route. The amino acids other than D-arginine are nonessential amino acids that can be endogenously synthesized by enzymes for corresponding amino acids in all cells. L-Glutamate is the excitatory neurotransmitter, L-proline is a neurotransmitter candidate [140], L-cysteine could be a neuromodulator [141], and L-arginine, a possible precursor for nitric oxide, kyotorphin, and/or agmatine as above mentioned, is neuroactive.
These non-essential amino acids can be detective in all cells including neurons for protein synthesis. Therefore, it is not easy to identify which neurons contain which neurotransmitter amino acids. Of them, L-glutamate content in the brain tissue is known to be quite high, but it is a multiplayer for metabolism too. A specific transporter, vesicular glutamate transporter 2, for vesicular packing of L-glutamate in the neuronal terminal has been used to be a good marker of glutamatergic neurons to discriminate the transmitter function of glutamate from metabolite pool [142]. However, even vesicular glutamate transporter 2 coexists with neurotransmitters other than L-glutamate in several neurons [143], becoming a complex situation to clearly delineate a fixed marker of glutamatergic neurons. The localization of neurons containing specific neurotransmitter amino acids appears to need more efforts to be identified.
10. Receptors at Central Level in the Pressor Response
What receptors at central level are involved in the pressor response to L-glutamate, L-proline, and L-arginine injected into the cisterna magna of the freely moving rat? The pressor response to L-proline was blocked by coinjection of a broad spectrum antagonist of ionotropic amino acid receptors kynurenic acid, but the response to L-glutamate and L-arginine remained the same [144]. At least, the central receptor involved in the pressor response to L-proline injected into the cisterna magna could be ionotropic excitatory amino acid receptors.
11. Possible Pathological Roles of Amino Acids in the Stroke
So far, I have mentioned the differential effects of several amino acids directly applied to the brain on the cardiovascular system. The amino acid concentrations in the cerebrospinal fluid will return to and remain low with the help of the active role of the blood-brain barrier in the health [11]. However, there are several reasons the blood-brain barrier can be disrupted including clinical situations such as cerebrovascular diseases of ischemic stroke and intracerebral hemorrhage [145]. Recent studies have revealed that the connection of the barrier can be broken by a molecular cascade activated after ischemia, resulting in vasogenic edema and cell death [145]. With respect to amino acids, pathological amounts of L-glutamate are known to be released into extracellular space in brain ischemia and probably involved in toxic and lethal actions on neurons [146]. The acute cerebrovascular diseases frequently present with mild to moderate spontaneous elevations in blood pressure or acute hypertension [147]. Unlike chronic hypertension as a cause for the diseases, this accompanied hypertension is believed to be a natural process to maintain the blood flow for survived regions. The chemical disturbance produced by the ischemia might stimulate the nuclei responsible for vascular sympathetic activation to result in acute hypertension [148]. After opening of the blood-brain barrier, some amino acids leaked into extracellular space may be involved in additional chemical disturbance to stimulate neurons responsible for blood pressure regulation. Amino acids like L-cysteine derived after brain ischemia [149] might be additional substances causing cell death in addition to acute hypertension.
12. Conclusions
With respect to amino acids for which concentrations in the cerebrospinal fluid are lower than in the plasma, several amino acids among exogenously applied ones showed cardiovascular effects via central mechanisms, as my expectation or hypothesis that amino acids might have some physiological roles in the brain. The clue to initiate the current "amino acids investigation" was the timely blood flow shift in the rat while grooming or walking, and the examinations resulted in a list of additional neurotransmitter and/or neuromodulator candidates relating to the central cardiovascular regulation in freely moving rats. Several examined amino acids with pressor or depressor action differentially influenced regional blood flow and central pathways. There is still much work to be done to decipher how the brain controls blood flow shift for demanding organs. In order to develop hypotheses for future studies, more regional blood flow data together with nervous activity might be useful at the in vivo level. Determination of active sites in the brain responsible for the cardiovascular response to stimulation with each amino acid would be the most desirable for design of further experiments.
The current paper mainly discussed effects with proteinogenic amino acids on cardiovascular regulation. Mammalian cells can produce plentiful nonproteinogenic amino acids such as L-homocysteine by the related enzymes via several metabolic pathways. A survey of such amino acids for central cardiovascular regulation may provide additional possibilities to find new members for a list of mediators between brain cells or other substances responsible for producing chemical disturbance in brain diseases with disruption of the blood-brain barrier.
This work was supported partly by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sport, Science and Technology of Japan and by the Tsuchiya Foundation.
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text:
During the 2006 school year at Maryville Elementary in Maryville, IL, 12 children regularly walked or bicycled to school. One reason for the low number is the lack of sidewalks in the neighborhoods surrounding the school. An additional barrier, identified through parent surveys, is the perceived fear of predatory danger to children walking to school.
In March 2007, a Maryville Community Improvement Board member and the village police chief developed a Safe Routes to School (SRTS) program and applied for a SRTS grant.
In 2008, the Illinois Department of Transportation approved the SRTS application for $353,000 to initiate an infrastructure project in the neighborhoods surrounding Maryville Elementary School. Details In 2008, the Illinois SRTS Program approved $353,000 in SRTS funds for the construction of 10 sidewalks in the neighborhood adjacent to the school. The sidewalk will run along one side of each of the 10 streets and extend from the neighborhoods to the main street that leads to the school. At the school, a sidewalk will be installed around the circle drive where parents drop off students to provide them with access the school entrance from the west and avoiding the crossover of busy driveways. Construction of the sidewalks is anticipated to begin in spring 2009.
To address the parents' safety concerns, the school will host its first Walk to School Day in May 2008. Teachers, parents and community leaders will guide children from five meeting points throughout the village to the school. With Walk to School Day, the village SRTS leaders aim to show parents that it is safe for their children to walk to school and that volunteers will look out for the children's safety as they walk. When the sidewalk construction is completed, the school plans on creating a permanent Walk to School Day event and implementing Walking School Buses.
In the upcoming years, the village of Maryville will apply for additional SRTS funding. Members from the village, the Community Improvement Board and the school district currently are working together to develop ways to improve the educational and encouragement activities of their SRTS program. Upcoming efforts will focus on pedestrian safety campaigns, such as a poster contest, a bike rodeo and adult crossing guard training.
Tracy Fenton
Phone: (618) 345-7027
Email: email@example.com


text:
FOR IMMEDIATE RELEASE: Friday, November 15, 2013
Leslie Champlin
Senior Public Relations Strategist
American Academy of Family Physicians
(800) 274-2237, Ext. 5224
WASHINGTON — The United States could significantly reduce the maldistribution of physicians by changing the dissemination of graduate medical education funding, according to research in the Nov. 15 issue of American Family Physician.
The research, presented in a one-pager, "Migration After Family Medicine Residency: 56% of Graduates Practice Within 100 Miles of Training," by E. Blake Fagan, MD, and his colleagues, reviewed data from the American Medical Association Physician Masterfile to determine where newly minted physicians practiced after completing residency training. In addition to identifying 56 percent of residents who practiced within 100 miles of their residency training, they found that nearly 40 percent located within 25 miles of their training site and nearly 20 percent located within five miles.
"Where family medicine residents train has a big impact on where these new physicians will practice," said Fagan. "If the nation's workforce policy is to increase the number of primary care physicians in rural areas, then we need to increase funding to our rural family medicine training sites and establish new residency programs in those areas because the majority of graduates practice close to where they train."
Maldistribution of physicians has consistently plagued underserved Americans' access to care. The problem, Fagan writes, is compounded "by the limited volume of training outside of major metropolitan areas and large academic health centers."
Numerous studies have demonstrated the success of rural training tracks in graduating primary care physicians who practice in underserved areas. Most recently, research by Robert Phillips, MD, MSPH, and his co-authors reported that up to half of medical residents who trained in rural health clinics, critical access hospitals and federal qualified health centers — which serve most of the nation's uninsured and underinsured patients — returned to practice in those settings after completing residency training.
Other research on rural training tracks demonstrate that they almost double the percentage of primary care graduates and increase rural physicians almost sixfold.
"These findings seem to support current efforts to decentralize graduate medical education training through models such as teaching health centers and rural training tracks," Fagan and his colleagues conclude.
The Robert Graham Center for Policy Studies in Primary Care and Family Medicine conducts research and analysis that brings a family practice perspective to health policy deliberations in Washington. Founded in 1999, the center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians.
The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the AAFP.


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