Osteopathic Family Physician Journal

Each year, the U.S. Centers for Disease Control and Prevention (CDC) releases the adult vaccine schedule. The 2022 adult vaccine schedule has several changes which will be discussed in the following manuscript. The Advisory Committee on Immunization Practices reviews the preliminary sche...

Osteopathic medicine is recognized for training and parity with other medical fields that treat and take care of patients. And osteopathic medical schools continue to graduate accomplished physicians who use all aspects of their training to carefully consider the needs of their patients to treat ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF to view. ...

I have been asked, “How did you become involved in ACOFP?” The very short answer is simple: I was asked. When I was a medical school student in Kansas City, I began looking at leaders in my c...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A 70-year-old Caucasian male presented complaining of growths on his left toes for 5 months. He reported that they were enlarging, tender, irr...

This article was designed to be viewed and distributed as a PDF. Please download the PDF to view. CASE PRESENTATION A 24-year-old- healthy male soldier presented with a chief complaint of a rash that he first noticed 2–3 days prior. The lesions were noticed first ...

This article was originally published as a PDF. Please download the PDF to view the images. CASE REPORT A 56-year-old female presents with multiple painless but enlarging cutaneous nodules. The lesions rapidly developed on her face, torso, and legs (Figur...

As we embark on a new year with renewed hope that our scientific knowledge and public health awareness will continue to bring us closer to a sense of normalcy, it is time to reunite! We are excited to convene a “family reunion” of colleagues and friends at the ACOFP 59th Annual Convention & S...

To the editor: The journey to receiving a medical degree is marked by moments of incredible stress, with few more demanding than the MCAT and USMLE exams. Students spend many caffeine-fueled months preparing for an ominous day of reckoning, whose fateful moments of testing seemingly dictate their...

Context: Up to 15% of concussed patients experience persistent symptoms and functional impairment following injury. This is often related to headaches, dizziness, imbalance, and visual disturbances. Objectives: To perform a systematic review of the evidence for interventions used to mana...

Each day, physicians go to war against innumerable problems that patients have either self-created or that were created by the breakdown in the body on the macro or micro level. All of our bodies are aging, and systemsare likely to fail. Over the course of our careers, we have witnessed many ...

As we approach the end of my term as ACOFP president, I’m proud of what we’ve accomplished and how our organization is poised to excel in the future. My presidential theme of Legacy and our focus on: (1) increasing engagement among our members, (2) increasing collaborations with other organizations...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Acute back pain is a common condition that most people will experience at some point in their lives. Back pain is considered acute if it has been...

Giardiasis is an acute infection caused by Giardia lamblia, which produces profuse secretory diarrhea that can lead to dehydration and electrolyte derangement. Musculoskeletal manifestations resulting because of giardiasis occur due to prolonged inflammation and viscero-somatic reflexes ...

Infertility affects one in four female physicians in the United States, yet the topic of fertility among female physicians is understudied and warrants focused strategies to implement change. Factors that exacerbate the rates of infertility in female physicians include intentional delays...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHAT IS ADVANCED MATERNAL AGE Advanced maternal age (AMA) is the medical term to describe a woman who is pregnant over the age of 35. 1 Man...

With close to 2 billion people affected globally, anemia is a commonly seen condition worldwide. Diagnosed by a patient’s low hemoglobin, and then subsequently differentiated through red blood cell indices, a complete blood count should be performed on every patient presenting with the c...

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women and people of Hispanic, African, and Asian descent. The treatment goals are similar to other autoimmune diseases: preventing progressive damage to organs and decreasing disease activity to...

Urinary incontinence is a nuanced and stigmatized condition that causes significant challenges for a large number of people in the United States and imposes a large financial and community burden. We provide an overview of major categorizations of incontinence by type as well as potentia...

Many osteopathic textbooks include treatment modalities and techniques that could improve frequently experienced ailments of pregnancy, such as nausea, vomiting, gastroesophageal reflux disease, constipation, and edema. However, there is little scientific evidence to support the use of o...

According to the most recent national data from the U.S. Centers for Disease Control and Prevention (CDC), asthma is a chronic respiratory disease that affects approximately 8%–9% of the U.S. population and roughly 300 million worldwide. CDC data from 2019 shows 3524 deaths from asthma a...

CASE REPORT A 34-year-old Caucasian male with no past medical history presented to the emergency department for a bilateral lower-leg rash that began 3 days prior. The rash was not painful or pruritic. The area of involvement had expanded and the rash had darkened since on...

There is nothing that evokes such an emotional response as the illness and near death of a patient or loved one, and certainly illness in our practices’ families and children are times when we reach deep to understand and help our practice families cope. Children are a special case, as their liv...

There is nothing that evokes such an emotional response as the illness and near death of a patient or loved one, and certainly illness in our practices’ families and children are times when we reach deep to understand and help our practice families cope. Children are a special case, as their lives...

There is no better feeling of accomplishment than when a student matches into a desired residency program! This milestone means that students, faculty, administration, and staff have achieved a monumental task. All their planning, strategies, and work have culminated in that one special word: “Ma...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading WHAT IS PAP SMEAR SCREENING FOR? The Papanicolaou test, otherwise known as a “Pap test” or “Pap smear,” is used to screen for cervical cancer. WHY IS IT IMPORTANT TO SCREEN FOR CERVIC...

WHAT IS CERVICAL CANCER? Cancer can develop anywhere atypical cells divide without regulation (in an uncontrolled manner). In women, this can occur on the uterine cervix, which connects the vagina and uterus. The cancer can lead to tumor formation on the cervix and, as it advances, the cancer ca...

Dear Members, As I embark on my role as President, I am excited and deeply honored to guide us along a strategic path to fortify our profession and our impact together. This critical juncture provides a compelling chance to invigorate our collective initiatives and redefine the future of osteopath...

In the United States, obesity prevalence has surpassed alarming rates and reached epidemic proportions with increased body mass index and poor diet being among the top causes of morbidity and mortality. Approximately 18.5% of children in the United States have obesity. Childhood obesity ...

Chronic limb-threatening ischemia (CLTI) is an advanced form of peripheral vascular disease with high rates of morbidity and mortality. Patients often present with claudication, impaired walking, and ischemic pain. Screening for CLTI and peripheral arterial disease is recommended with an...

Polypharmacy is defined as use of multiple medications (>5) and is common in the elderly adult population. Polypharmacy typically results from the accumulation of treatments for chronic medical conditions such as hypertension, diabetes, coronary artery disease, and psychiatric illness...

Colorectal cancer is a leading cause of morbidity and mortality in the United States. Family physicians play an integral role in educating patients about the current screening recommendations and modalities of available screening to improve early detection and allow treatment at its earl...

This article is designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHAT IS COLORECTAL CANCER? Colorectal cancer is a form of cancer that affects the colon and/or rectum. Early detection of this cancer can be challenging as it does not typically present ...

Suicide rates are alarmingly higher among emergency responders than the general public, and it is estimated that 30% of first responders develop behavioral health conditions compared with 20% in the general population. Emergency responders experience their share of work-related stresses,...

Shoulder pain and shoulder disorders are commonly seen in the primary care setting. While many of these disorders can be managed by the primary care physician, some may pose a diagnostic dilemma. This article will review 10 common shoulder disorders, evaluating when conservative manageme...

Primary care physicians are crucial in diagnosing and managing hand and wrist pain. As the first point of contact for patients, primary care physicians develop individualized treatment plans, which may involve prescribing medications, recommending physical therapy, providing joint inject...

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily affects the joints. The condition causes inflammation, pain, stiffness, and sometimes deformity in the affected joints. RA can also affect other parts of the body, including the lungs, heart, and eyes, and it can lead to long-...

The novel coronavirus disease 2019 (COVID-19) has given rise to a global pandemic, as well as a multitude of long-term sequelae that continue to perplex physicians around the world, including in the United States. Among the most common and impactful long-haul symptoms experienced by surv...

Patients with asthma who have COVID-19 typically present with rhinitis, rhinosinusitis, cough, and shortness of breath and rarely with wheezing. Family physicians should consider a patient’s asthma subtype, pertinent medical history, and medications. Maintenance medications, including in...

Myocarditis has been increasingly recognized as a rare complication of COVID-19 mRNA vaccinations, especially in young adolescent males. According to the US Centers for Disease Control and Prevention, the incidence of myocarditis in males 16–29 years of age is approximately 10.7 cases pe...

Hemosiderosis is the deposition of hemosiderin, a storage form of iron derived from the breakdown of erythrocytes. This process commonly occurs in patients with chronic venous insufficiency (CVI) due to venous hypertension and vascular ectasia. Cutaneous accumulation of hemosiderin in CV...

An important aspect of any family medicine resident’s training is the ability to competently diagnose and manage common skin conditions, including differentiating between benign and potentially malignant skin lesions. This is particularly important for residents planning to practice in r...

Introduction: Atrial fibrillation is the most common postoperative arrhythmia and is associated with increased length of stay, cost, morbidity and mortality. The incidence of postoperative atrial fibrillation for noncardiac, nonthoracic surgeries ranges from 0.4% to 26%. The incidence in...

Ectopic pregnancy (EP) is a serious obstetric complication that can be life-threatening. Age-adjusted incidence of ectopic pregnancy is roughly 15.8 pregnancies per 1000. Despite this seemingly low value, EP remains one of the largest contributors to maternal mortality in the first trime...

"Standing on the shoulders of giants allows us to see far into the future with a clearer vision” is an often-quoted phrase attributed to John of Salisbury in the twelfth century (1159). We celebrate past leaders who made our learning and profession. The giants of the past moved through the educati...

Context: America is in the midst of a substance use disorder (SUD) epidemic, which has only worsened in the current COVID-19 pandemic. SUD is a public health crisis that affects an everincreasing proportion of the population and is extraordinarily difficult to treat. Misused substances i...

Being a member means being part of something. It means belonging. It means identifying with people who have similar ideas, concerns, passions, and desires, and even though you may use a different approach to achieve the same result, you are willing to work collaboratively with others who see the i...

Depending on your mood, time of day and Internet speed, the words scattered, smothered, and covered may make you head to a music website to listen to Hootie and the Blowfish or click on your favorite food delivery service to get a bite for breakfast from Waffle House. The study of food has alw...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Diabetes mellitus (DM) is a disease associated with increased glucose, or sugar, in blood vessels. High blood sugar can damage blood vessels, caus...

Context: Each generation has special characteristics brought out by the times in which they have lived, which have affected the way they communicate in both reception and expression of information. Objectives: This article looks at key differences between the generations and discusses th...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Gastroesophageal reflux disease (GERD) occurs when stomach contents backflow into the esophagus, such as regurgitation of stomach acid along wi...

Glaucoma is an insidious disease process that causes damage to the optic nerve head and retinal nerve fiber layer, resulting in progressive vision loss. Multiple factors play a role in its pathophysiology, but intraocular pressure is a significant yet modifiable risk factor and therefore...

Histiocytic sarcoma is a rare and frequently missed diagnosis. With unusual and varied presentations, it typically indicates a rapid patient decline and poor outcomes. The diagnosis requires a high degree of clinical suspicion. In this case, we explore the progression of illness in a 56-...

Diabetes affects more than 37 million Americans. More than one-third of American adults (96 million) have prediabetes, so it is anticipated that the prevalence of diabetes will continue to climb in the generation to come. There have been major advances in the options for home glucose mon...

In this issue of Osteopathic Family Physician , there is a focus on women’s health. We all know that the landscape of women's health is a mosaic of complex needs, which include reproductive health, maternal care, functional and lifestyle considerations, and other gender-specific medical conditions...

Human parechovirus (HPeV) infections have been increasing in the United States since May 2022, according to the Centers for Disease Control and Prevention. HPeVs are a member of the Picornaviridae family and share similarities with enteroviruses, though they differ in genomic structure. ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. TREATMENT OPTIONS Mild cases of hyperemesis gravidarum can be managed with rest, hydration, antacids, and avoidance of triggers su...

This article was originally published as a PDF. Please download the PDF to view the images. A 61-year-old African American female presents to an outpatient family health center with a hyperpigmented nodular rash of 2 months’ duration. The rash first appeared on her abdomen before s...

Introduction: Since its discovery, the novel coronavirus disease 2019 (COVID-19) has evolved into a global pandemic that has affected millions. The pediatric population was once thought to be mostly spared from the SARS-CoV-2 virus. However, a severe hyperinflammatory sequela of the virus known as m...

Osteopathic family physicians embody the philosophy of whole-person care, including using a biopsychosocial approach to incorporate mental health into patient care. The creation of the Behavioral Health Integration Collaborative increased support for a system-level adoption of whole-pers...

WHAT IS ANEMIA? Anemia is a condition where your body does not have enough red blood cells to circulate oxygen in the body. There are many different types of anemia, but the most common type is iron deficiency anemia. Iron is an essential component for red blood cells and is needed to make blood....

This article was originally published and designed to be distributed as a PDF. Please download the PDF for easiest reading. Joint injections are commonly used to help reduce acute or chronic pain and inflammation in patients with arthritis. Common areas for joint injections include the kne...

Acute knee dislocations are a relatively rare type of injury that can lead to serious neurovascular compromise and ligament instability. These injuries can be potentially limb threatening if not properly identified and managed. The following review discusses the relevant anatomy of the k...

Greetings! As the newly installed president of the ACOFP, I am honored to share my greetings with you as we look forward to an exciting year filled with unlimited potential! It is with great pride that I take on this responsibility, and I am excited to work with you all toward achieving our c...

The COVID-19 pandemic placed a spotlight on both the successes and the needs across the spectrum of the healthcare system. The trusting, enduring relationships developed within the primary care setting served as an important foundation on which to build response strategies throughout the...

This article was originally published and designed to be distributed as a PDF. Please download the PDF for easiest reading. Low-back pain is a common reason for some children and adolescents to see their doctor. The risk for low-back pain increases with increasing age, puberty ...

Low-back pain (LBP) is a common symptom presenting in adolescents. Most back pain in adolescents is benign and musculoskeletal in nature, due to trauma or congenital anomalies. Other less common causes include infection, inflammatory conditions or neoplasm. A comprehensive history and ph...

Low back pain (LBP) is a common complaint in adolescents and has been increasingly reported in recent years. Affecting roughly 40% of adolescents, it leads to negative overall health, higher incidence of LBP in adulthood, and greater utilization of health care resources over one’s lifeti...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. DO YOU SMOKE, OR HAVE YOU SMOKED IN THE PAST? Lung cancer is the number one cause of cancer-related deaths . Tobacco smoking is the cause of 90...

“I do hereby affirm my loyalty to the profession I am about to enter. I will be mindful always of my great responsibility to preserve the health and the life of my patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor ...

Difficult doctor-patient relationships are a recognized aspect of modern healthcare, but the actual incidence, risk factors, ethical issues, and management strategies are less well-known. The author queried PubMed, ScienceDirect, and the Education Resources Information Center. The inclus...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Melanoma is a type of skin cancer that arises from melanocytes, the pigment-producing cells in the skin. It is the most dangerous form of skin can...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHAT ARE MIGRAINES? A migraine is a type of headache that affects roughly 12% of people in the United States (up to 6% of men and 17% of women)...

What’s the difference between a DO and an MD? Have you ever been asked this question? How did you reply? If you’re like me, it was answered neither in a simple phrase nor one sentence. It became a discussion—and perhaps a complicated discussion, at that. What if the same question were asked of your...

Multiple sclerosis (MS) is an uncommon neurological pathology frequently initially discovered by primary care providers in their workup of new focal neurological deficits. Many cases go undiagnosed for years despite multiple flares, with risk of cumulative disability. Early treatment is ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF to see the images. CASE PRESENTATION A 78-year-old right-hand–dominant male presents to urgent care after experiencing sudden pain and popping in the right upper extremity while lifting an object in the ...

Hip pain and disorders are commonly seen in adults and children in the primary care setting. Primary care physicians can manage many of these disorders through physical examinations and basic radiographs, but some may pose a challenge requiring advanced imaging and specialist interventio...

It has long been felt that osteoarthritis is the result of wear and tear. Many physicians are not aware that biological science has now validated that this increased “wear and tear” on the joint is the result of loading-induced stresses that undermine cell function and aging. The loading...

Chronic pain is defined as pain that has persisted for greater than 6 months. This type of pain may last longer than 6 months and can continue even after the injury or illness that has caused it has healed or resolved. Pain signals can remain active in the nervous system for weeks to mon...

Bronchiectasis is an uncommon chronic obstructive lung disease caused by chronic airway inflammation leading to irreversible bronchial dilation and destruction of medium-sized airways. In this case, we treated a bronchiectasis patient with a combination of osteopathic manipulative treatm...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Pregnancy, or gestation, is defined as the period in which a fetus develops inside a female’s uterus. There are physiologic changes that occur as...

Introduction: Sinusitis affects more than 30 million Americans each year, with healthcare costs of $11 billion annually. Few studies explore osteopathic manipulative treatment (OMT) as an adjunct therapy for sinusitis. Our study aims to investigate the therapeutic benefits and safety of ...

Context: Chronic pelvic pain syndrome (CPPS) is a complex pain syndrome that affects 15%–30% of people of childbearing age (~10–20 million, US). Etiologies range from musculoskeletal conditions and visceral disease to neurological and psychological disorders. The interplay of many systems and disord...

Introduction: Domestic violence is a serious and preventable public health issue. Student Training on Preventing Domestic Violence (STOP-DV) is an extracurricular program that educates medical students on domestic violence. This study sought to determine if STOP-DV is an effective method...

At my workplace, we talk a lot about our hometown heroes—the physicians, nurses, and other medical professionals who go above and beyond every day. How do we find joy in the ever-changing medical environment as we see new diseases, illnesses, environmental health concerns, and issues that affect ou...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. This new feature will highlight the legacy of ACOFP past presidents. ...

...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. CASE REPORT A 92-year-old female presented with white nodules on her toes. Her nodules appeared approximately 3 weeks prior and had been slow...

This article was originally published as a PDF. Please download the PDF to view the images. A 37-year-old man reported to the eye clinic with irritation and pain on eye movement in his left eye for 15 days. He had associated symptoms of foreign body sensation, grittiness, itching...

Polypharmacy is the regular use of multiple medications and is often seen in older adults and individuals with multiple comorbidities. The commonly accepted definition of polypharmacy is the use of five or more medications by any individual. As patients become more multimorbid, the use o...

Dacryocystitis is the inflammation of the nasolacrimal sac and is due to obstruction of the nasolacrimal system or lacrimal stagnation, leading to favorable environments for infection. Any disruptions to the nasolacrimal pathway can increase the risk of dacryocystitis. Here is a unique c...

This article was originally published as a PDF. Please download the PDF to view the images. A 21-year-old G0P0 female with a past medical history of GERD and headaches presented to her primary care physician for abdominal distension and growth for the past 10 months....

Back pain is a common complaint addressed by family physicians. This is an uncommon case of a patient presenting with back pain and subsequent workup revealing a new diagnosis of metastatic prostate cancer with bone metastasis. This case can be used to highlight an unusual presentation a...

Physicians commonly encounter disorders of the prostate in the primary care setting, where shared decision making for prostate cancer screening should also occur. Hence, it is important for physicians to understand and differentiate the diagnoses of prostate disease. Initial evaluation s...

This lesion was followed at the patient’s subsequent 2-month well- child check and is depicted in Figure 2, with gradual changes noted in the lesion. Figure 3 shows the continuation of hyperpigmentation and verrucous transformation of the skin lesion at the 4-month well-child check. The pa...

...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A 16-year-old male presented to the emergency department for a chief complaint of right shoulder pain. He was riding a dirt bike prior to his arri...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHAT IS A ROTATOR CUFF? A rotator cuff is a group of muscles and tendons that hold the arm in the shoulder socket and allow the arm to ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHAT IS SEASONAL AFFECTIVE DISORDER (SAD)? SAD is a seasonal pattern of major depressive disorder, bipolar I disorder, or bipolar II diso...

This article was originally published as a PDF. Please download the PDF to view the images. A 31-year-old male presents with seizure activity and a diffuse rash. The patient has a known history of seizures beginning at age 11. He states that the previous day he developed lightheaded...

Over the past several months, I’ve had the privilege of visiting various ACOFP state society meetings and student chapter meetings at our Colleges of Osteopathic Medicine (COMs). These interactions have been inspiring, allowing me to connect with fellow osteopathic family physicians, residents, and...

Chronic scrotal content pain affects 100,000 men in the United States annually. Up to 50% of these cases do not resolve by following conventional treatment algorithms and are deemed to be idiopathic. There is little peer-reviewed literature supporting the specific cause and effect relati...

Recently in central Appalachia, there has been a resurgence of the more complicated form of black lung disease known as progressive massive fibrosis (PMF). This brief report was aimed at determining the effects osteopathic manipulative treatment (OMT) could have to improve the lives of t...

Climate change continues to have a detrimental effect on the overall health of people globally. The average yearly temperature has continually risen since the late 19th century and is projected to continue rising for decades ahead. Increased temperature has been linked to decreased sleep...

It was so heartwarming to have the opportunity to share the fellowship of my osteopathic family in Dallas. This period of separation and isolation has taken its toll, and the doctor couldn’t have written a better prescription than for us to be together. As I accepted the gavel from Dr. Bixler, I al...

The hot winds of spring and summer are upon us, storms and weather warnings abound. Tempers flare and misunderstandings are escalated. Across the United States, our patients and communities have been impacted by domestic violence, gun violence and weather disasters, while being terrorized by virus...

In my final letter as your ACOFP president, it is my opportunity to share what I believe have been our greatest achievements since March 2020—a pivotal point for the obvious reason that the COVID-19 pandemic has affected every single decision, program, committee, student, resident and physician of ...

Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth. Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted ...

There is historical and modern evidence for the use of osteopathic manipulative treatment (OMT) to treat patients with mental health disorders. The first section of this article examines the historical perspective, focusing intently on the Still-Hildreth Sanatorium. This hospital special...

As America continues to face the opioid epidemic, numerous people have made great strides in receiving formal treatment for their opioid use disorder (OUD). This research seeks to examine the effects of providing osteopathic manipulative treatment (OMT) along with traditional OUD pharmac...

The majority of women who initiate breastfeeding at birth do not meet long term exclusive breastfeeding recommendations. This early weaning is often the result of breastfeeding difficulties and misinformation. Access to lactation professionals is limited for many patients and family phys...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHAT IS VAPING? Vaping is the act of inhaling aerosols from battery-powered devices called electronic cigarettes, also known as vape...

To better serve you, Osteopathic Family Physician has moved to a quarterly publishing schedule beginning with the Winter 2023 issue. We've retooled to give you more high-quality, focused osteopathic content. Although we all have incredibly busy lives, marking time through the movement of the se...

Now is the winter of our discontent Made glorious summer by this sun of York; And all the clouds that lour'd upon our house In the deep bosom of the ocean buried. Those words, spoken as the opening lines of William Shakespeare’s Richard III , have been widely quoted to tag political and soci...