Family as the Conduit to Promote Indigenous Women and Men's Enculturation and Wellness: "I wish I had learned earlier".

The purpose of this article is to explore how food and other cultural traditions promote wellness, cultural continuity, enculturation, and family resilience within tribal communities in the U.S. Using the Framework of Historical Oppression, Resilience, and Transcendence (FHORT), this critical ethnography examines Indigenous peoples' perspectives on and experiences with food and cultural traditions.

"Living off the Land": How Subsistence Promotes Well-Being and Resilience among Indigenous Peoples of the Southeastern United States.

Indigenous peoples of the United States tend to experience the most severe social, behavioral, and physical health disparities of any ethnic minority. This critical ethnography uses the framework of historical oppression, resilience, and transcendence to examine indigenous peoples' perspectives on and experiences with subsistence living, investigating how subsistence living may contribute to well-being and resilience by promoting physical exercise, a healthy diet, and psychological health. Thematic analysis of data from 436 participants across two southeastern tribes reveals three overarching themes: fostering fond memories and family bonding through "living off the land," enabling experiential intergenerational teaching and learning, and promoting resourcefulness and offsetting economic marginalization.

Neuroanatomical Interpretation of the Painting Starry Night by Vincent van Gogh.

Gogh, Vincent Van (1853-1890). The Starry Night. Saint Rémy, June 1889.

The Statesmanship of William Crawford Gorgas, M.D., Surgeon General, Medical Corps, United States Army.

If statesmanship can be characterized as a bed rock of principles, a strong moral compass, a vision, and an ability to articulate and effect that vision, then the fortitude, tenacity, imperturbability, and resilience of William Crawford Gorgas cannot be overestimated. As Chief Sanitary Officer in Cuba and as Chief Medical Officer in Panama, he actualized strategies to eradicate the vectors of yellow fever and malaria. His superiors initially pigeonholed his requisitions, refused to provide him with any authority, and clamored for his dismissal.

Reduction in deep sternal wound infection with use of a peristernal cable-tie closure system: a retrospective case series.

Background: Deep sternal wound infections are a rare but serious complication after median sternotomy. We evaluated the incidence of deep sternal wound infection associated with two techniques for sternal closure.

Methods: In this retrospective case series, we recorded the method of sternal closure in consecutive patients undergoing a variety of cardiothoracic surgical procedures.

Pharyngostomy.

A retrospective analysis of a prospective observational study of a cohort of patients who required prolonged foregut/midgut decompression/intraluminal stenting and/or enteral nutritional support was conducted. Those patients were intolerant of protracted nasogastric intubation. They also manifested hostile peritoneal cavities and therefore were not candidates for a laparoendoscopic gastrostomy or jejunostomy.

Department of Surgery/College of Medicine University of South Alabama: historical and contemporaneous perspectives.

Many members of the medical profession in Mobile, Alabama, have exemplified a strong commitment to the education of their colleagues and successors, a tradition (L., traditio, "to hand over") that dates from the early 18th century. The Mobile General (city/county) Hospital (1830 to 1970) and its successor, the Medical Center, University of South Alabama (1971 to the present), were the institutional foci of those endeavors.

Re-membrance.

Traced sufficiently remotely, all people, profanum vulgus, share a common familial and linguistic heritage. Several Occidental and Oriental religiophilosophical traditions and General Systems (neuro-linguistic/neuro-semantic) Theory propound that resolution of personal illness and intra- and inter-generational psychological conflicts among individuals and within society mandates a figurative, if not a literal return, to the source of conflict or contention-to RE-MEMBER with that source-if healing, peace, resolution, concord, solace, sustenance, and wholeness are to be achieved. Words that communicate effectively, linguistic symbols such as water and the cross, and the action of laying-on-of-hands are methodologies that reaffirm a personal commonality among all traditions and facilitate RE-MEMBRANCE.

Prehospital clinical clearance of the cervical spine: a prospective study.

Physician clinical clearance of the cervical spine after blunt trauma is practiced in many trauma centers. Prehospital clinical clearance of the cervical spine (c-spine) performed by emergency medical services (EMS) personnel can decrease cost, improve patient comfort, decrease complications, and decrease prehospital time. The purpose of this study was to assess whether EMS personnel can effectively clinically clear the c-spine of injury in the prehospital setting.

Application of the core competencies after unexpected patient death: consolation of the grieved.

Objectives: To review and assess educational strategies and formats regarding communication with families/survivors in the aftermath of unexpected and untimely patient death. To propose an integrated curriculum designed and intended to foster proficiency, competence, confidence, and composure in relaying catastrophic information in the context of the professional experience of a cohort of seasoned surgeons.

Background: Unexpected and untimely patient death is emotionally and psychologically wrenching for families, surgeons, and healthcare providers.

Is helicopter evacuation effective in rural trauma transport?

Helicopter transport for trauma remains controversial because its appropriate utilization and efficacy with regard to improved survival is unproven. The purpose of this study was to assess rural trauma helicopter transport utilization and effect on patient survival. A retrospective chart review over a 2-year period (2007-2008) was performed of all rural helicopter and ground ambulance trauma patient transports to an urban Level I trauma center.

The core competencies of James Marion Sims, MD.

The concept of core competencies in graduate medical education was introduced by the Accreditation Council for Graduate Medical Education of the American Medical Association to semiquantitatively assess the professional performance of students, residents, practitioners, and faculty. Many aspects of the career of J. Marion Sims, MD, are exemplary of those core competencies: MEDICAL KNOWLEDGE: Author of the first American textbook related to gynecology.

Spirituality within the patient-surgeon relationship.

Objective: To assess the attitudes of general and orthopaedic surgical outpatients regarding inquiry into their religious beliefs, spiritual practices, and personal faith.

Design: Prospective, voluntary, self-administered, and anonymously-completed questionnaire, regarding religious beliefs, spiritual practices, and personal faith, March-August, 2009.

Setting: General and orthopaedic surgical outpatient settings, Health Services Foundation, College of Medicine, University of South Alabama, a tertiary care academic medical center in Mobile, Alabama.

Action of student-resident interaction during a surgical clerkship.

Background: This study is a qualitative assessment of the effect of clinical encounter documentation cards on medical student-surgical resident interaction during the core surgical clerkship, junior medical school year.

Methodology: The implementation of a clinical encounter documentation card system occurred during academic year 2009-2010. The results were compared with historical control medical student cohorts from antecedent academic years.

Retrograde jejunojejunal intussusception status following Roux-en-Y gastrojejunostomy.

Reported herein is an experience with retrograde intussusception. The index case was a 25-year-old African American woman who was status post-multiple previous intraperitoneal procedures, including a truncal vagotomy, distal gastrectomy, and Roux-en-Y gastrojejunostomy for the treatment of gastric outlet obstruction secondary to type 2 peptic ulcer disease. The patient presented most recently with symptoms and signs of a high-grade mechanical intestinal obstruction.

Clinical examination in complement with computed tomography scan: an effective method for identification of cervical spine injury.

Objective: The purpose of this study was to prospectively evaluate a protocol that assesses the efficacy and sensitivity of clinical examination in complement with computed tomographic (CT) scan in screening for cervical spine (c-spine) injury.

Methods: During the 26-month period from March 2005 to May 2007, blunt trauma patients older than 13 years were prospectively entered into a study protocol. If patients were awake and alert with Glasgow Coma Score (GCS) >or=14, clinical examination of the neck was performed.

Improving rural emergency medical service response time with global positioning system navigation.

Objective: Rural emergency medical services (EMS) often serves expansive areas that many EMS personnel are unfamiliar with. EMS response time is increased in rural areas, which has been suggested as a contributing factor to increased mortality rates from motor vehicle crashes (MVCs) and nontraumatic emergencies. The purpose of this study was to assess the effect of a global positioning system (GPS) on rural EMS response time.

Anatomic location of penetrating lower-extremity trauma predicts compartment syndrome development.

Background: Compartment syndrome of the lower extremity can be a difficult diagnosis to make with serious consequences if diagnosis and intervention is delayed. Identifying patients who are more likely to develop this syndrome can help prevent the associated complications. The purpose of this study was to evaluate whether the anatomic location of the penetrating lower-extremity injuries can predict development of compartment syndrome.

On-scene intravenous line insertion adversely impacts prehospital time in rural vehicular trauma.

Fatality rates from rural vehicular trauma are almost double those found in urban settings. Increased emergency medical services (EMS) prehospital time has been implicated as one of the causative factors for higher rural fatality rates. Advanced Trauma Life Support guidelines suggest scene time should not be extended to insert an intravenous catheter (IV).

Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis.

Background: Fatality rates from rural vehicular trauma are almost double those found in urban settings. It has been suggested that increased prehospital time is a factor that adversely affects fatality rates in rural vehicular trauma. By linking and analyzing Alabama's statewide prehospital data, emergency medical services (EMS) prehospital time was assessed for rural and urban vehicular crashes.

Increased rural vehicular mortality rates: roadways with higher speed limits or excessive vehicular speed?

Objective: The purpose of this study was to assess whether higher roadway speed limits and excessive vehicular speed were contributing factors to increased rural vehicular mortality rates in the State of Alabama.

Methods: During a 2-year period from January 2001 through December 2002, data were collected from Alabama police crash reports and EMS patient care reports. Police crash reports and EMS patient care reports were linked utilizing an imputational methodology.

Unexpected intraoperative patient death: the imperatives of family- and surgeon-centered care.

Conveying to family members that their loved one has unexpectedly died during an operation is perhaps the most stressful task a surgeon must perform. The loss of a patient's life precipitates enormous personal and professional anxiety and stress on a surgeon: profound grief, damage to self-esteem, loss of self-confidence and reputation, and the specter of litigation. Most surgeons feel unskilled in such a setting, yet how they communicate-what they say and how they say it-is extremely important for everyone involved.