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There is a widely and deeply held belief on the part of the author's white colleagues that racism is something done by individuals through overt or covert actions against other individuals. Sometimes this belief is tied to one specific characteristic--skin color. Some would believe that they cannot commit racist acts against anyone who looks like them regardless of the identified race of that person. As a clever trick of psychological avoidance, this worldview allows many mainstream faculty to remain comfortably aloof to the infrastructures, the cultural, social, and academic "standards," that contribute to the unseen barriers American Indian colleagues must surmount. In this article, the author describes the cultural and religious barriers of American Indian faculty in the academy. (Contains 34 notes.)

The Creator has told us 'Do more than survive, thrive. There is no Hell other than that people make for themselves.' (1) The following stories are real, and their telling [...]

Copyright of British Journal of Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusess a paper appeared in the February 27, 1864 issue of journal "The Medical and Surgical Reporter." Topics discussed include challanges faced by nostalgia patients in the field; furlough system adopted by General Hooker; and the Peninsula campaign entered by Lieut. Excelsior Regiment.

The International Space Station (ISS) has been operating in space for over 14 years and permanently crewed for over 12 years. Throughout this time, the ISS Program has implemented and continually improved its risk management process. This ISS risk management process identifies risks that may exist and alternatives for mitigation if the risks are significant. Risk management has provided input that has been essential to the program management decision making process. Risks can be reduced, mitigated or accepted and are prioritized to ensure program resources are used as efficiently as possible. The ISS risk management process has increased the probability of success of the ISS mission objectives and overall crew safety. This paper presents two case studies on how the ISS risk management process has been used to address specific areas of risk. The first case describes how the ISS Program has analyzed and mitigated the risk of Micrometeoroid Orbital Debris (MMOD) strikes to pressurized modules. MMOD has been a major safety concern since the beginning of the program. The second case study describes the risk assessment of Visiting Vehicle (VV) collisions. There has been a significant increase in the number of visiting vehicle flights to the ISS since the retirement of the Space Shuttle Program. This has caused an elevated cumulative risk of collision when considering the frequency of vehicle traffic to the ISS. [ABSTRACT FROM AUTHOR]

This is the second article of a two-part series about issues encountered in implementing a predictive modeling program. Part I looked at how to effectively implement a program and discussed helpful hints and lessons learned for case managers who are required to change their approach to patients. In Part II, we discuss the readiness to change model, examine the spirit of motivational interviewing and related techniques, and explore how motivational interviewing is different from more traditional interviewing and assessment methods. [ABSTRACT FROM AUTHOR]

Effective predictive modeling is a powerful, statistically valid tool, which identifies individuals at increased future risk of an untoward health event. This article looks at one company's experience in developing a successful program; the issues related to an effective implementation strategy; and lessons learned during the process. The goal is to implement the right intervention, at the right time, for the right patient. [ABSTRACT FROM AUTHOR]

Case management programs are a common approach to managing the quality and cost of services in managed care organizations. Once developed these programs may grow stagnate as the managed care member population grows and changes. This article presents a redesign project initiated by a managed care organization located in a rural Southwest region of the United States. Nursing theory and case management standards of practice form the basis of the redesign project and will be discussed. The case management model, including roles and responsibilities of staff, are presented. Results and future implications are identified. [ABSTRACT FROM AUTHOR]

Although chronic obstructive pulmonary disease (COPD) is an increasingly important cause of morbidity and mortality in the US, it has been neglected by both the provider and disease management communities partly because of the difficulty in demonstrating financial returns on investment and an absence of evidence-based guidelines and economic evaluations of alternative therapeutic approaches. It is, however, a clinical entity that is amenable to structured disease management with achievable and measurable clinical, financial and health-related quality-of-life outcomes. Program design considerations, population identification and behavior modification approaches are discussed. With limited objective clinical improvement potential in COPD, risk stratification and outcome measurement based on symptom improvement are proposed. [ABSTRACT FROM AUTHOR]

Methicillin-susceptible Staphylococcus aureus (MSSA) is the most common pathogen recovered from osteomyelitis patients. The current standard therapeutic method for acute phase osteomyelitis is parenteral antibiotic therapy. However, parenteral administration has negative aspects, such as secondary infection, patient inconvenience and high cost. The use of single oral antibiotic therapy may alleviate these problems. Therefore, the purpose of this study was to compare the effectiveness of standard once per day dosing of oral levofloxacin with a standard parenteral antibiotic regimen (nafcillin four times daily) for the treatment of experimental MSSA osteomyelitis in rabbits. Nearly all tibias from untreated infected controls (n = 27) revealed positive cultures (93%) for S. aureus, while the levofloxacin-treated group (n = 20) demonstrated significantly lower percentages of S. aureus infection (50%). The infected tibias of the nafcillin-treated group (n = 20) demonstrated significantly lower percentages (10%) of infected tibias than either the controls or the levofloxacin-treated groups (P < 0.05). The inferior efficacy of levofloxacin may have been due to the pharmacokinetic profile of this fluoroquinolone. The serum kinetics demonstrated that following single dose administration, levofloxacin was almost undetectable after 12 h. Studies in which levofloxacin is dosed every 12 h or given at increased doses in order to obtain bactericidal concentrations throughout the treatment regimen are needed. [ABSTRACT FROM AUTHOR]

Background: Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting.Objective: To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting.Design: Randomized, single-blind feasibility study.Setting: University-based geriatric and internal medicine primary care clinics.Patients: 45 patients 66 years of age or older without a psychiatric diagnosis.Intervention: Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group).Measurements: The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs.Results: One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group.Conclusions: Findings support the feasibility of implementing the protocol as a primary care intervention. [ABSTRACT FROM AUTHOR]

Background: The role of bone morphogenetic proteins (BMPs) in osseous repair has been demonstrated in numerous animal models. Recombinant human osteogenic protein-1 (rhOP-1 or BMP-7) has now been produced and was evaluated in a clinical trial conducted under a Food and Drug Administration approved Investigational Device Exemption to establish both the safety and efficacy of this BMP in the treatment of tibial nonunions. The study also compared the clinical and radiographic results with this osteogenic molecule and those achieved with fresh autogenous bone.Materials and Methods: One hundred and twenty-two patients (with 124 tibial nonunions) were enrolled in a controlled, prospective, randomized, partially blinded, multi-center clinical trial between February, 1992, and August, 1996, and were followed at frequent intervals over 24 months. Each patient was treated by insertion of an intramedullary rod, accompanied by rhOP-1 in a type I collagen carrier or by fresh bone autograft. Assessment criteria included the severity of pain at the fracture site, the ability to walk with full weight-bearing, the need for surgical re-treatment of the nonunion during the course of this study, plain radiographic evaluation of healing, and physician satisfaction with the clinical course. In addition, adverse events were recorded, and sera were screened for antibodies to OP-1 and type-I collagen at each outpatient visit.Results: At 9 months following the operative procedures (the primary end-point of this study), 81% of the OP-1-treated nonunions (n = 63) and 85% of those receiving autogenous bone (n = 61) were judged by clinical criteria to have been treated successfully (p = 0.524). By radiographic criteria, at this same time point, 75% of those in the OP-1-treated group and 84% of the autograft-treated patients had healed fractures (p = 0.218). These clinical results continued at similar levels of success throughout 2 years of observation, and there was no statistically significant difference in outcome between the two groups of patients at this point (p = 0.939). All patients experienced adverse events. Forty-four percent of patients in each treatment group had serious events, none of which were related to their bone grafts. More than 20% of patients treated with autografts had chronic donor site pain following the procedure.Conclusions: rhOP-1 (BMP-7), implanted with a type I collagen carrier, was a safe and effective treatment for tibial nonunions. This molecule provided clinical and radiographic results comparable with those achieved with bone autograft, without donor site morbidity. [ABSTRACT FROM AUTHOR]

The article describes the life of John Stow of South Carolina, one of the first pioneer farmers to settle in North Louisiana. Establishing himself as a major planter, Stow was probably the first settler to reach Lincoln Parish in Ruston, Louisiana. He continued to be resident of Jackson Parish, Louisiana until his death on July 28, 1861 at the age of 81.

Ninety-seven patients with congenital esotropia with deviations of 50 prism dioptres or greater underwent large (6 and 7 mm) bimedial rectus recessions. The overall success rate with one operation was 83.5%. Judgment of final alignment was made at the last follow-up examination, six to 61 months (average 23.4 months) postoperatively. Large bimedial rectus recessions for congenital esotropia are an effective surgical treatment which does not significantly alter adduction. [ABSTRACT FROM PUBLISHER]

The success rate of large (6 and 7 mm) bimedial rectus recessions in 45 congenital esotropes with deviations of 50 prism dioptres or greater was found to be 91%. Judgment of final alignment was made six weeks postoperatively, with an average follow-up of 13 months. Large bimedial rectus recessions are an effective surgical treatment for congenital esotropia. This procedure does not significantly alter adduction, and leaves other muscles available should further surgery be necessary. These findings show that initial surgery on three or more muscles is unnecessary in congenital esotropia. [ABSTRACT FROM PUBLISHER]

Patients with nystagmus and an eccentric null point in lateral gaze may assume an abnormal head position to maximise visual acuity. Surgical procedures for this condition can result in significant undercorrection of the head turn. A follow-up of 15 patients for an average of 33 months revealed a sustained improvement in head position with the use of the augmented modified Kestenbaum procedure. [ABSTRACT FROM PUBLISHER]

The relationships among physicians' interviewing techniques, the amount and type of data gathered, and patients' perceptions of the interviewing process were studied. Thirty-one Internal Medicine house officers each interviewed one of three standardized patients. The house officers' thoroughness of data collection was assessed by the patients and by a trained evaluator. A videotape of each interview was analyzed at the National Board of Medical Examiners using the interaction analysis system for interview evaluation, ISIE-81, to define house officers' interviewing techniques. From the physicians' problem-solving perspective, data elicitation was positively related to the length of the interview, asking psychosocial questions, the use of narrow questions, and the amount of time the patient talked. The patients' assessments of house officers' data-gathering thoroughness were also positively influenced by interview length, the use of narrow questions, and inquiries about their psychosocial histories. The use of broad questions by the house officer was positively related to the patient's feelings about and reaction to the interaction. This study potentially explains some of the differences that appear to exist between patients' and physicians' judgments about and perceptions of the medical interviewing process. [ABSTRACT FROM AUTHOR]

Mycobacteria, both tuberculous and nontuberculous, are recognized as a cause of chronic bone and joint infection. However, the diagnosis of mycobacterial infection is easily missed because of the absence of systemic involvement. Moreover, specific microbiologic techniques are required to detect mycobacteria in clinical specimens. Infections due to uncommon pathogens such as mycobacteria are more likely to occur in the immunocompromised host. A case of septic arthritis of the ankle and osteomyelitis of the foot due to both tuberculous and nontuberculous mycobacteria in an immunocompetent host is reported here. [ABSTRACT FROM AUTHOR]

The article presents information on several meetings related to life sciences. The third Annual Rocky Mountain Bioengineering Symposium will be held at the University of Colorado, Boulder, Colorado, from May 2 to 3, 1966. The third International Fermentation Symposium on alkaloid production by microorganisms, hydrocarbon fermentations, and continuous fermentations will be held in New Brunswick, New Jersey, from September 3 to 6, 1966. Fifth Interscience Conference on Antimicrobial Agents and Chemotherapy which was held in Washington, D. C., from October 17 to 21, 1965, discussed various aspects of antimocrobial agents, infectious diseases, and chemotherapy.

An excerpt is presented from an article published in the August 22, 1863 issue of "The Medical and Surgical Reporter" on soldiers faking symptoms of disease during the U.S. Civil War.

An excerpt is presented from an article published in the August 15, 1863 issue of "The Medical and Surgical Reporter" on feigned insanity and discharge during the U.S. Civil War.