bluuebunny/crossref_metadata_2025 huggingface dataset:
In Search of Heroines: Some Reflections on Normativity in Feminist Research
Authors: Davis Kathy , Gremmen Ine
Published: July 2017

Feminist research is explicitly committed to validating (women) informants' experiences, situating them in a context of gender and power relations, and explicating the researcher's own social and cultural position. Such commitments may not be enough, however, when our negative and positive feelings about our informants get in the way of doing our research. In this article, we draw upon our research on women in care professions and our own desire to find feminist heroines within their ranks. After describing our respective experiences of glorifying or dismissing our informants, we explore three strategies for coming to terms with implicit or ‘gut-level’ normativity in feminist research.
The interpretation of diagnostic tests
Authors: Shapiro David E
Published: July 2017

Laboratory diagnostic tests are central in the practice of modern medicine. Common uses include screening a specific population for evidence of disease and confirming or ruling out a tentative diagnosis in an individual patient. The interpretation of a diagnostic test result depends on both the ability of the test to distinguish diseased from nondiseased subjects and the particular characteristics of the patient and setting in which the test is being used. This article reviews statistical methodology for assessing laboratory diagnostic test accuracy and interpreting individual test results, with an emphasis on diagnostic tests that yield a continuous measurement. The article begins with a summary of basic concepts and terminology, then briefly discusses study design and reviews methods for assessing the accuracy of a single diagnostic test, comparing the accuracy of two or more diagnostic tests and interpreting individual test results.
Stable isotope metabolic labeling of Neisseria meningitidis lipooligosaccharide
Authors: Post Deborah M.B. , DeSheng Zhang  , Weiss Jerrold P. , Gibson Bradford W.
Published: July 2017

The lipooligosaccharide (LOS) of a Neisseria meningitidis acetate auxotroph was metabolically labeled with either [2-13C]-sodium acetate or [1,2-13C 2]-sodium acetate. In this study, we demonstrated that this label was efficiently incorporated into both the lipid A acyl moieties and the two N-acetylglucosamines present in the oligosaccharide branch of the LOS. The development of this efficient labeling protocol should prove useful in future structural studies analyzing the interactions between LOS and host proteins.
Towards an Inclusive Vision for Moral Theology Part II: An Agenda for the Future
Authors: Keenan James F.
Published: July 2017

In this article, which follows Part 1 published in the previous number of Pacifica, the author argues that that we need to reintegrate moral and practical theology so that the ordinary life of the Church addresses not only the matters that we should avoid but also the matters we should pursue. “We must propose to the Church ways to improve the character of our membership as ethically embodying the Gospel. Above all we must highlight how we are responsible for developing our relationality with God, nature and neighbour.” As a particular case, the author focuses on the church's failure to respond to violence against women.
What Do I Do with Contexts? A Brief Reflection on Reading Biblical Texts with Israel and Aotearoa New Zealand in Mind
Authors: McKinlay Judith E.
Published: July 2017

How does one “do” biblical studies contextually? If I begin by asking who am I, where am I situated, and what are the communities that have formed and continue to form who I am, what difference will this make to the way in which I “do” my biblical studies? This paper seeks to explore the issues that an engagement with texts which have their own contexts and interests brings for a Pakeha reader from Aotearoa New Zealander, recognising that this is not an easy or comfortable task, but an enterprise that continually raises questions and stretches boundaries.
Portraying the Face of the Nazarene in Contemporary Indonesia: Literature as Frontier-Expanding Mission
Authors: Prior John Mansford
Published: July 2017

Religious conflict is a key element in the ongoing turmoil in Indonesia. Reconciliation calls for authentic yet open religious identities. This essay introduces examples of Christian literature by socially engaged activists and politically aware mystics. These authors are creating a new language in which to re-picture the Jesus of the Gospels as authentically Asian at the heartbeat of popular Indonesian culture.
Ecumenics, Teaching Ecumenics and Ecumenical Formation
Authors: Falconer Alan
Published: July 2017

The article proposes that Ecumenics is an integrative focus for theological study, seeking as it does to study the theological foundations of unity and diversity, and the historic divisions of the churches and the attempts to overcome them. It explores methodologies appropriate to conflict resolution and reconciliation, and examines the history and character of ecumenical initiatives. It makes a key distinction between teaching ecumenically and ecumenics and then proposes three “types” for developing courses in ecumenics. Finally, it outlines particular opportunities and challenges afforded to ecumenical institutes. These include the ability to critically analyse the ecumenical agenda, and to hold the ecumenical memory by reminding churches of ecumenical studies, insights and initiatives already undertaken.
The Post-Modern Universal: An Incarnational View
Authors: Casey Damien
Published: July 2017

This essay outlines some suggestions for how the idea of the universal might be retrieved and rethought in the light of the contemporary experience of pluralism. It will do so by drawing upon the work of a diversity of thinkers, post-modern and modern, from philosophers such as G. W. F. Hegel, Luce Irigaray, Jacques Derrida, through to theologians such as Louis-Marie Chauvet, Bernard Lonergan, Raimon Panikkar and especially Edward Schillebeeckx. The latter part of the essay will explore the universality of human rights and discuss some of the possibilities for rethinking Christian universality in relation to sacramentality, inter-religious dialogue, and the priority of the poor.
Living in Difficult Times: Insights from Ancient Colossae
Authors: Trainor Michael
Published: July 2017

The current challenges facing Australian Churches in the light of national and international tensions are critical. A response is required, one that is spiritual and educational, that draws on the wisdom of the Christian tradition and speaks to the current lived experience of people. This response will also affirm the ongoing thirst for “spirituality” in our world. The tendency in some methodologies to emphasise doctrinal content needs to be balanced by one that affirms our cultural and historical present, and the spiritual quest of people. The Letter to the Colossians speaks a balancing voice to doctrinal exclusiveness. A study of the author's concern expressed in the letter reveals an emphasis on “knowledge” with its unique nuance, and a christological focus that reflects a desire to “educate” in difficult times. In addition, the author addresses the tendency to adopt a form of religious exclusiveness and asceticism divorced from the real world and the faith tradition into which the audience were baptised.
Church and World at the Second Vatican Council: The Significance of Gaudium et Spes
Authors: McEvoy James
Published: July 2017

In its Pastoral Constitution on the Church in the Modern World the Second Vatican Council put behind it the rejection of modernity that characterised the Roman Catholic Church's relationship with the world in the previous 150 years. Forty years after the publication of Gaudium et Spes, this article seeks to articulate the theological understanding of the church-world relationship contained in the final text of the document by examining the sequence of schemas which led to it.
Clapsticks and Karaoke: The Melting Pot of Indigenous Identity
Authors: Thompson David , Connolly Michael
Published: July 2017

In recent decades, a mixed-style dance festival has been held at camping grounds near the town of Laura on Cape York Peninsula, including contemporary forms of music and dance. The Laura Festival has its roots in the funding of Aboriginal dance festivals in the 1970s across northern Australia with the aim of fostering the sharing, recovery and maintenance of Aboriginal traditional dance forms. The range of cultural forms at the Festival clearly reflects a broad expression of Indigenous identity, from the classic traditional styles to creative forms that explore symbols and motifs, to modern cultural forms that adapt western forms with an Indigenous style. Questions the authors reflected on at the Festival were: “Where is God in the Laura Festival?” and “What does the Festival say about Aboriginal spirituality in general and Aboriginal Christian spirituality in particular?” In answer to these questions we felt that the Creator was very much present in the vitality and creativity of the Festival and in the shaping of new expressions of Indigenous identity in the modern world. Further, the Festival affirmed that there is a foundational place for Aboriginal spirituality in the formation of Aboriginal Christian identity and spiritualities through a combination of traditional spiritual foundations linking people to creation, culture and to the Creator known through Christ, and a creative shaping of contemporary expressions of belief and practice.
The Mutual Contributions of Church History and Systematic Theology: The Holocaust and Dietrich Bonhoeffer as a Case Study
Authors: Clements Keith
Published: July 2017

The issue of the relationship between Church History and Systematic Theology has become more pressing, not only in the context of the rise of the modern critical historical method, but above all because, to an unprecedented degree, church history is presenting challenges to Christian ethics that go right through to core tenets of Christian belief and therefore to systematics. Unique in this respect is the challenge presented by the Holocaust and the response of Christian theologians in the general context of anti-semitism that surrounded and promoted it. This article takes the German martyr theologian Dietrich Bonhoeffer as a test case of the relationship between systematic theology and history, assessing both the strengths and weaknesses of his response to the Nazi persecution of the Jews, in the light of his highly ethical approach to the theological task.
The Centrality of the Cross: Literary and Theological Reflections on Mark 15:20b-25
Authors: Moloney Francis J.
Published: July 2017

This study addresses two issues of exegesis and interpretation in the Gospel of Mark. It points to the presence of simple but elegant literary practices in the gospel, disputing the claim that the evangelist was merely the clumsy editor of prior sources. Mark's passion narrative (14:1–15:47) is an extended example of intercalation. At the centre of the story of the Roman crucifixion (15:1–47), the author locates the description of the crucifixion of Jesus (15:20b-25). Its central literary location reflects the heart of the Markan Christology: Jesus is the crucified Messiah and Son of God.
Mature Spirituality According to von Hügel: A Practitioner's Voice
Authors: Wrigley-Carr Robyn
Published: July 2017

Baron Friedrich von Hügel (1852–1925) is best known as a religious philosopher from the late nineteenth and early twentiethth century. Less well known is von Hügel's work as a spiritual director, which some have suggested underlies his entire religious philosophy. This article seeks to examine aspects of von Hügel's understanding of the nature of mature spirituality as exemplified in his practice of spiritual direction: his theology of God and the necessary response of adoration; the three elements of religion, suffering well, humility, cultivating non-religious interests and leisurely spirituality.
After Sorry: Towards a New Covenant of Solidarity and Embrace
Authors: Lewis Peter
Published: July 2017

On 13 February 2008, the Australian Federal Parliament delivered an Apology to the Stolen Generations. This article contributes a theological understanding of the relationship between Indigenous and non-Indigenous Australia in the context of this National Apology. To explore the theological ramifications of the Apology the article focuses on two key themes which are reflected in both Christian and Indigenous perspectives on the world: narrative and relationality. From these parallel perspectives the article explores what a new national covenant might mean — after “sorry”.
Should Christians Forgive Always; Does God Always Forgive?
Authors: Szablowinski Zenon
Published: July 2017

Christianity brings a substantial development in the concept of forgiveness when, by commanding to forgive even the enemy, it lessens the distance between divine and human forgiveness. But, while forgiving those who intentionally attempt to harm or destroy us or others, do we not condone or justify injustice; and as a result, do we not undermine our personal and the common safety and betterment? Can the State still punish the perpetrator if the victim forgives? This article discusses resentment, sin and crime, and forgiving as “letting go”, “love given before” and “absolution”. It also explores the significant difference between divine and human forgiveness and reconciliation.
Christian Discipleship and Interfaith Engagement
Authors: Pratt Douglas
Published: July 2017

Ever since the famous 1910 Edinburgh World Mission conference Christian individuals and the Christian Church have been increasingly challenged to relate in new ways to people of other faiths. Reflecting on the relationship between Christian discipleship and interfaith engagement this article addresses three questions. Can a biblical basis for such engagement be discerned? What is the impact of the “Great Commission” at the end of Matthew's gospel (28:18–20)? How might a new understanding of mission and discipleship relate to concerns about interreligious dialogue? In other words, can Christian discipleship actively enable positive interfaith relations and engagement with adherents of other faiths? In conclusion, the article points to a number of considerations that might indeed contribute to just such an understanding of discipleship.
The Good News of Restoration: Reading Luke-Acts Then and Now
Authors: Kitchen Merrill
Published: July 2017

After the destruction of Jerusalem in 70 CE many religious groups in the Judeo-Christian community engaged in processes of reform. A two-volume New Testament document, the Gospel of Luke and the Acts of the Apostles, is a voice that echoes through the ages in its appeal for a restoration of Israel's story. In calling for a restoration of Israel's creation ethic, it proclaims the creator God, as the parent of all humanity; God's Son, Jesus Messiah, as the harbinger for a new beginning; and God's Holy Spirit as the agent who has always dwelled indiscriminately amongst people of faith, actively stimulating a quest for global harmony and mutual respect in the midst of political, social and religious disorder.
Rethinking Eucharistic Origins
Authors: McGowan Andrew
Published: July 2017

Accounts of Eucharistic origins have usually been driven by concern to establish the genealogy of later liturgical practices, and reflect broader narratives of early Christian history as either smooth transition or radical fall from primitive ideals. A more comprehensive account of early Eucharistic practice must give attention to Greco-Roman meal conventions, acknowledge the diversity of form and meaning in early Christian meals, and be more cautious about grand narratives. It would allow for consideration not only of the explicit theologies of prayer texts, but of implicit meanings involved in ritual, foods and other elements of meals. Such an emerging new paradigm may provide both a more adequate narrative of the development of the Christian Eucharist in classical historical terms, and richer interpretations of meals as a key aspect of early Christian practice.
Reconciliation and the Church
Authors: Mostert Christiaan
Published: July 2017

This article explores the Christian doctrine of reconciliation with a particular focus upon reconciliation between the indigenous people of Australia and those whose ancestry lies in other continents. The Christian rhetoric of reconciliation, derived from its biblical roots, has to confront a tension between the theological truth and the historical reality of reconciliation. This leads to the question concerning the extent to which the church may claim to be a reconciled and reconciling community. While all claims about reconciliation are subject to the eschatological proviso, and hence to nuance, the church is nonetheless obliged and entitled to claim something for the power of the gospel of reconciliation, including the power to create a new, redeemed sociality. The biblical claim that Christ has brought Jews and Gentiles together in one body raises questions about the relationship between Christians and Jews today, as well as the relationship between Christians of different ethnicity. Though first a gift received, reconciliation confronts the church with many challenges.
Sarah Coakley: Systematic Theology and the Future of Feminism
Authors: Rees Janice
Published: July 2017

In recent years Sarah Coakley has begun, if only in fragments, to work towards a unified description of the particular sort of systematic theology that she will develop in her forthcoming four volume systematics. Simultaneously, trends in feminist theology have pointed towards the systematic enterprise as a fertile future ground for feminist enquiry. This essay considers in detail the approach of Sarah Coakley and the contribution she can make towards an ongoing project of Christian feminism.
Truth as Love: The Understanding of Truth According to Hans Urs von Balthasar
Authors: O'Donnell John
Published: July 2017

The key to Balthasar's logic is his understanding of truth as aletheia or unconcealedness. Theologically, the event of truth happens when the Word becomes flesh. Only a methodology from above can account for the leap which is implied in Jesus' affirmation: I am the truth. The unveiling of the truth in the Christ-event, and its presence in the Church through the Holy Spirit shows that the ultimate meaning of truth is love, the love of the three persons of the Trinity revealed in the missions of the Son and the Holy Spirit. Thus Balthasar argues that the only Christian logic is the logic of love, not verified by reason, but grasped through doing the truth in love.
Indigenous Peoples and the Experience of Christianity
Authors: Starkloff Carl
Published: July 2017

If Europeans have served as the most prominent stewards of the Gospel, it is not surprising that they have found it hard to distinguish between sharing the Good News and pushing their civilisation as if it were part of the gospel message. It has taken four centuries of pain for the churches to begin to be aware of the difference between culture and Christianity, and of the problem of distinguishing between them. Movements such as liberation theology and inculturation are demonstrating that it is not too late to change course. Europeans can, with the help of the peoples they colonised, escape their own cultural captivity.
Dead Spots or Living Texts? A Matter of Biblical Reading
Authors: McKinlay Judith E.
Published: July 2017

Parallel stories, such as the Genesis tales of the wife/sister ploys on the part of Abraham and Isaac, raise the questions of difference and relationship. Choosing which questions to ask of these texts is a methodological exercise which heightens the challenge of difference, for different questions will elicit different answers from the text. Our awareness of this challenge and our choice of questions will allow texts to challenge us in our own contexts. These tales told with difference can symbolise the task to be undertaken “again and again and again”.
Reconciliation with the Aboriginal Community: Some Theological Reflections
Authors: Prowse Christopher
Published: July 2017

This article explores the meeting points between the notion of reconciliation and an ecclesiology that exercises a ministry of reconciliation. The theological attitude of contrition and its moral implications is applied to the discussion. A link is then made between the fruits of reconciliation with Aborigines and the new evangelisation of Australia in the discovery of our soul.
Analogies, Metaphors and Women as Priests
Authors: Dawes Gregory W.
Published: July 2017

In discussions regarding the ordination of women to the priesthood in the Catholic Church reference is frequently made to the gender symbolism of Scripture. This article examines this gender symbolism, as it is found in Ephesians 5:21–33, to see what relevance it may have to the question of women's ordination. Its conclusion is that it has relevance only if one has already decided (on other grounds) that “headship” is an essentially male quality.
Sanctity of Life and the Death of “Baby M”: A Response to Helga Kuhse
Authors: Teo Bernard
Published: July 2017

In discussions regarding the withholding of extraordinary medical treatment for the severely incapacitated, appeal is often made to the “quality-of-life” rather than to the “sanctity-of-life”. This article explores the background to both theories and argues that the traditional “sanctity-of-life” doctrine remains viable and useful.
The Role of Post Mortem Visions in the Jewish Intertestamental Period
Authors: Crotty Robert
Published: July 2017

Maccabees recounts a vision in which Onias the Just commissions Judas Maccabeus as protector of Jerusalem and its Temple. This account belongs to a specific genre. Onias was a martyred zaddik or “righteous one” who, by means of the vision, nominated his successor. This genre is applied to the post-resurrection visions of Jesus to his disciples in an attempt to clarify their meaning. These stories can be understood as zaddik vision traditions which have been overlaid with apocalyptic imagery.
Towards a Systematic Theology of Ministry: A Catholic Perspective
Authors: Ormerod Neil
Published: July 2017

The author seeks to develop a systematic understanding of the orders of ministry within a broader framework of the mission of the Church. He uses Lonergan's notion of the functional specialty, systematics, and general and special categories initiated by Lonergan and further refined by Robert Doran. Specifically, he seeks to give a systematic account of the distinctions between episcopal, presbyteral and diaconal ministries in the Church. Further, he uses this account to analyse certain issues in the theology of ministry.
An Expanding Theology: A Colloquium
Authors: Rees Frank , Jenkins Margaret , Kelly Tony
Published: July 2017

In 1993 a group of theologians teaching within the Melbourne College of Divinity began to meet on an informal, ecumenical basis for the purpose of sharing their common interests in new areas of theological research and reflection. On one occasion the group met to discuss Tony Kelly's recent book An Expanding Theology. Two members of the group - Frank Rees and Margaret Jenkins — read papers and Tony Kelly offered a response to them. What follows here is a modified version of the conversation.
The Parable of the Lord and the Servant: A Soteriology for Our Times
Authors: Hide Kerrie
Published: July 2017

This article presents the soteriology of Julian of Norwich expressed in her Parable of the Lord and the Servant. In focusing on Julian's understanding of salvation four dimensions of the soteriology highlighted in the parable are considered: the experience of the fall, the relationship of the lord to the servant during the fall, the central role of the servant in bestowing grace on creation, and hope for eternal union with God. Each of these soteriological dimensions is then appraised in light of contemporary questions about the meaning of salvation.
Difficulties in Doing Liturgical Theology
Authors: Bradshaw Paul
Published: July 2017

This study critically examines some traditional methods in liturgical theology. The author argues that liturgy is as much a human artefact as a divine creation, and therefore that liturgical theology needs to take the fruits of historical research and the insights offered by the social sciences much more seriously than it has generally done. He also rejects the notion that there is a single theological meaning within every liturgical act which can be read out of it as a doctrinal norm. On the contrary, liturgies are essentially multivalent, and doctrine shapes both the liturgies themselves and people's interpretations of them at least as much as liturgical practice shapes belief.
Whither “Australian Theology”? A Response to Geoffrey Lilburne
Authors: Kelly Tony
Published: July 2017

This reflection offers a positive appreciation of Geoffrey Lilburne's call for a greater contribution from the Protestant traditions to a contextualised Australian theology. His critique of my own methodology suggests a number of clarifications of the meaning of “context”, “spirituality”, “the self” and the relationship of a specifically Christian theology to such issues.
Research Note: Drug Use in San Diego Arrestees
Authors: Pennell Susan , Curtis Christine
Published: July 2017

This research note describes the Drug Use Forecasting (DUF) program in San Diego jail facilities. Sponsored by the National Institute of Justice, the DUF program tracks drug use among arrestees through voluntary urine testing and a drug history interview. Results are used by policymakers to plan allocation of enforcement and treatment resources and link trends in drug use to intervention strategies.

In June of 1987, two-thirds of the male DUF sample had positive results for drug use, increasing to 75% three months subsequent. Female arrestees were more likely than their male counterparts to test positive and admit injection of illicit drugs. The drug testing results confirm what law enforcement has suggested for some time- namely, that there is an association between drug use and crime.
Ostomy Patient Care Program
Authors: Gebhardt Margaret C. , Caiola Stephen M. , Eckel Fred M.
Published: July 2017

The ostomate is often a forgotten patient with regards to proper psychological and emotional preparation for his surgery and proper continuing care of his ostomy. The pharmacist can play an important role in aiding the ostomy patient, especially in providing him adequate appliances and ostomy-care information. The development and implementation of the ostomy program of the N. C. Memorial Hospital Pharmacy is presented in detail. A brief explanation of why ostomy surgery is necessary, of the various types of ostomies and of the various appliances utilized is also presented.

The following services of the program are described:

Use of a patient profile card in order to have on record the patient's specific appliance and replacement parts; Fitting the new ostomate with the proper appliance and instructing him on its proper use; Interviewing patient on return clinic visits to determine if the patient is having ostomy-related problems or needs any replacement parts for his appliance; Providing patient's appliance needs through the mail or through communication with the patient's local community or hospital pharmacist, and Conducting a presurgical consultation with the future ostomate to briefly explain appliances and how their use will affect his life, plus answer questions which may be making him apprehensive.
Study on Bioavailability of Sulfadiazine Tablets in Man
Authors: Ritschel W. A. , Ritschel G. , Buncher C. R. , Rotmensch J.
Published: July 2017

Sulfadiazine Tablets USP, 500 mg, from 3 different manufacturers were tested in vitro and in vivo. Dissolution rate and disintegration time were measured in water, artificial gastric fluid, and artificial intestinal fluid. Disintegration and dissolution were fastest in artificial gastric fluid. Product I was superior in disintegration to the other two products, whereas product 2 was superior in dissolution. The in vivo study was designed as a Latin square so that each of the 3 treatments was given to each of the 3 subjects at each of the 3 time periods. Two-way analysis of variance was done using the cumulative urinary excretion of free and total sulfadiazine after 24 and 120 hours. Although the extent of bioavailability of product 1 and 2 was only 78 and 73 percent, respectively, statistically significant differences were found only at 24 hours. Judging from both rate and extent of bioavailability, product 3 was superior to products 1 and 2. The difference between in vitro and in vivo data is noted.
Pharmacy and Family Practice Concept, Roles and Fees
Authors: Davis Robert E. , Crigler William H. , Martin Henry
Published: July 2017

The concept, establishment, practice model procedure, patient flow, pharmacist's roles and fee charged for pharmacy consultation services within a privately financed primary care setting are described. The reasons for the pharmacy consultation fee are explained and the time spent in consultation is analyzed. The growth and community acceptance of this program indicates that it is a financially feasible undertaking.
Stability of Drugs with Enteral Nutrient Formulas
Authors: Strom J. Grady , Miller Susan W.
Published: July 2017

Experiments were performed to determine the chemical stability and compatibility of cephalexin, cimetidine, diazepam, or propranolol with full-strength and half-strength Isocal, Sustacal, and Sustacal HC (Mead Johnson). The enteral nutrient formulas (ENFs) containing the solid or liquid dosage forms were stored at 24°C and samples were taken at times 0, 1.5, 3, 6, 8, 10, and 24 hours. At each sampling time, the mixtures were visually examined for signs of incompatibilities such as precipitation, viscosity changes, and phase separation. Samples from each time period were analyzed by a stability-indicating high-performance liquid chromatography (HPLC) method. The drugs mixed with half-strength ENFs were also passed through ultrafiltration membranes to separate complexed from uncomplexed drug. Neither visual changes nor variations in pH were observed in any formula. With the exception of cephalexin suspension in half-strength ENFs, none of the drug concentrations changed appreciably throughout the study period. The assays performed for undecomposed drug at each sampling time for the various full- or half-strength ENF-solid drug mixtures stored at 24°C for 24 hours ranged from 92.3 to 103.4 percent for cephalexin, 96.2 to 103.0 percent for cimetidine, 93.9 to 106.2 percent for diazepam, and 95.5 to 102.2 percent for propranolol. For the liquid drugs, the concentration ranged from 86.5 to 102.1 percent for cephalexin, 97.0 to 101.1 percent for cimetidine, 98.2 to 103.0 percent for diazepam, and 97.4 to 104.8 percent for propranolol. Ultrafiltration studies showed varying percent binding dependent on the drug studied.
Severe Reversible Thrombocytopenia Resulting from Butoconazole Cream
Authors: Maloley Pierre A. , Nelson Elizabeth , Montgomery Howard A. , Campbell James R.
Published: July 2017

A 54-year-old woman with a 19-year history of rheumatoid arthritis developed life-threatening thrombocytopenia one week after beginning butoconazole therapy for a vaginal yeast infection. This was complicated by upper gastrointestinal hemorrhage that probably resulted from ibuprofen and methotrexate therapy. Sepsis, myelophthisic anemias, and other potential etiologies were ruled out. Once stabilized, the patient was rechallenged with other medications without incident. These findings indicate that a potentially serious thrombocytopenia may result from the administration of butoconazole vaginal cream or in combination with methotrexate and/or ibuprofen.
Imidazoles and Triazoles in Antifungal Therapy
Authors: Cleary John D. , Taylor Jerry W. , Chapman Stanley W.
Published: July 2017

Fungal infections range from superficial mycoses involving skin or mucous membranes to severe opportunistic infections that may be fatal. The selection of chemotherapeutic agents useful for the treatment of fungal infections includes many topical or systemic imidazoles and triazoles. This overview compares and contrasts the pharmacology and therapeutic use of these agents. This review will focus primarily on these agents' mechanism of action, pharmacokinetics, clinical studies, and adverse reactions.
Prolonged Labetalol Infusion for Management of Severe Hypertension and Tachycardia in a Critically ILL Trauma Patient
Authors: Goldsmith Tracey L. , Barker Donald E. , Strodel William E.
Published: July 2017

A trauma victim sustained multiple injuries including cervical spine injuries, splenic laceration, and left kidney fracture. His recovery was complicated by acute renal failure, resistant hypertension, and tachycardia refractory to multiple therapies. The patient was ultimately managed with continuous infusions of labetalol 2–3 mg/min for 14 days, with adequate control of both blood pressure and heart rate. The sustained labetalol infusion was not associated with clinically significant adverse effects although a progressive decrease in heart rate was noted near the end of therapy. This downward trend in heart rate was not associated with hemodynamic compromise and returned to pretreatment baseline of 90–110 beats/min upon discontinuation of parenteral therapy and initiation of oral labetalol. The prolonged use of labetalol infusions may be beneficial in certain patients. Further work needs to be done to identify the safety and efficacy of labetalol infusions.
Heparin-Induced Hyperkalemia
Authors: Aull Larry , Chao Helen , Coy Kevin
Published: July 2017

Heparin-induced hypoaldosteronism leading to hyperkalemia is an uncommon adverse effect. It appears as though heparin blocks an enzymatic step in the synthesis of aldosterone, and reduced aldosterone levels may be evident as early as four days after initiation of therapy. Although all patients who receive heparin may have reduced aldosterone levels, most are able to compensate through increased renin production and therefore remain asymptomatic. However, patients on prolonged heparin therapy or those unable to adequately increase renin production (e.g., patients with diabetes or renal insufficiency) may exhibit signs of hypoaldosteronism, such as hyperkalemia.

The assistance of Leanne Wierzbowski in manuscript preparation is acknowledged.
Aminoglycoside Volume of Distribution in Pediatric Patients
Authors: Shevchuk Yvonne M. , Taylor Deanna M.
Published: July 2017

Pharmacokinetic parameters of three aminoglycoside antibiotics were studied retrospectively in 218 pediatric patients to determine an apparent volume of distribution (Vd) for this age group and to determine if Vd is significantly different in pediatric patients compared with adults. Data on patients considered for inclusion in the study were obtained from the files of the aminoglycoside monitoring services at Saskatoon University Hospital and Regina General Hospital. Both services use a computer program that calculates pharmacokinetic parameters using the Sawchuk-Zaske method. Children between the ages of 1 and 16 years with normal renal function from whom serum concentrations had been obtained were included in the study. Exclusion criteria included abnormal or unstable renal function, cystic fibrosis, and pregnancy. The mean age of the pediatric group was 8.65 ± 5.37 years. Average values for Vd and half-life were 0.34 L/kg and 2.3 h, respectively. No strong correlation was found between the Vd (L/kg) and age. The patients were subdivided into three age groups: 1–4.9 years, 5–9.9 years, and 10–16 years. Group 1 (1–4.9 years) had a larger Vd than the other groups and the Vd of all three groups were significantly different from the estimated Vd of 0.20 L/kg for adult patients. A “normal” pediatric value for the Vd of aminoglycosides could not be determined; however, the Vd in children is significantly larger than the Vd in adults and dosage regimens should be adjusted accordingly.
Cimetidine: An Immunomodulator
Authors: Kumar Ashir
Published: July 2017

Suppressor T lymphocytes possess histamine2 (H2) receptors and contribute significantly to the function of the immune system. Experimentally, cimetidine, an H2-receptor antagonist, has been shown to enhance a variety of immunologic functions both in vivo and in vitro because of its inhibitory effects on suppressor-cell function. Successful tumor immunotherapy, as well as some protection from infection, has been reported in experimental animals. Patients receiving cimetidine have been shown to exhibit enhanced cell-mediated immunity as evaluated by increased response to skin-test antigens, restoration of sensitivity following development of acquired tolerance, and increased responses of lymphocytes to mitogen stimulation. Preliminary reports also indicate that cimetidine may offer therapeutic benefits for patients with Varicella zoster and Herpes simplex infections, as well as those suffering from mucocutaneous candidiasis and common variable hypogammaglobulinemia. These immunoregulatory effects are dose-related but are not always consistent. Because of its inhibitory effect on suppressor function, cimetidine treatment may be deleterious in patients with organ transplant and autoimmune disorders. Cimetidine should be used as an immunomodulator on an experimental basis only.
Clinical Issues regarding the Use of Total Nutrient Admixtures
Authors: Driscoll David F.
Published: July 2017

The introduction of total nutrient admixtures (TNAs) has offered several clinical advantages. Substituting a portion of the daily dextrose calories with lipids may reduce the incidence of carbohydrate-associated complications (e.g., disturbances in glucose control and immune function). In addition, providing intravenous lipids continuously over 24 hours as a TNA appears to be better utilized by the liver and less likely to interfere with reticuloendothelial system function when compared with conventionally administered, discontinuous lipid infusions. If the peripheral vein is used as a route for parenteral nutrition, the addition of fat to the admixture provides the advantage of enhancing caloric density, while contributing significantly less tonicity than dextrose. Certain pharmaceutical and microbiological issues need to be considered to ensure the intravenous administration of a safe and homogenous dispersion. Attention to established guidelines provided by the lipid manufacturers, as well as careful extrapolation of TNA stability data, will avert the dangers associated with infusion of coalesced lipid particles. This article reviews the evidence supporting the use of lipids as daily caloric sources, with particular emphasis on the role of the total nutrient admixtures as the primary vehicle for administration.
Adjusting for Clustering in Survey Research
Authors: Ferguson Joyce A. , Corey Paul N.
Published: July 2017

The current widespread application of cluster sampling in survey design presents concerns to the researcher regarding the chosen unit of study. The statistical power of a study could be spuriously increased or decreased, sample size could be altered dramatically, and the uniqueness of the individual unit under study (e.g., a patient) could be lost and substituted by average values of characteristics depending on which unit of study is selected. The 1985 National Ambulatory Medical Care Survey of the U.S. National Center for Health Statistics was used to illustrate research methodologies that would deflate spuriously high results due to clustered sampling. Using the individual patient as the study unit, correction factors ranging from 1.99 to 35.40 were calculated in order to deflate exaggerated t-tests, chi-square, and F values of predictor variables. The effect of clustering was more marked on (1) continuous rather than binary outcome variables, as the former provide a richer environment to form clusters; and (2) on outcome variables relating to the practice-related or personal style of physicians. Using the physician (who represented a cluster of patients) as the unit of study, it was realized that correction factors were relevant to physician-specific predictors but not patient-specific predictors. Using design effect correction factors developed from a simple univariate analysis of variance, pharmacoepidemiologists can analyze accurately the currently available large survey databases of clustered samples.
Safe Use of Codeine in the Recovering Alcoholic or Addict
Authors: Stock Christopher J.
Published: July 2017

The effect that codeine has on the process of addiction and recovery is unclear. Confusion about definitions, study endpoints, and a lack of well-controlled clinical studies has led to this uncertainty. Codeine addiction is uncommon in people who do not have existing vulnerability to addiction, including alcoholism. Codeine use can sustain addiction or increase the risk of relapse in patients afflicted with addiction. The risk of relapse must be considered when treating conditions such as pain or cough in a person recovering from addiction. Codeine use may be circumvented with the appropriate use of alternative treatments for pain or cough. If codeine use becomes necessary, cautious prescribing and reliance on the patient's recovery support network become imperative.
Therapeutic Monitoring and Pharmacokinetic Evaluation of Procainamide in Neonates
Authors: Reed Michael D. , Bryson Scott M. , Leson Cheryl L. , Irwin Danica B. , Trope Angela E. , Hosking Martin C.K.
Published: July 2017

Past experience with the disposition of procainamide hydrochloride (PA) in neonates is restricted to a single case study involving placental transfer. We studied aspects of PA pharmacokinetics in three neonates who received constant-rate infusion therapy. Results indicated that the total serum clearance of PA is similar to the adult value, but elimination half-lives of both PA and N-acetylprocainamide (NAPA) were slightly prolonged and volume of distribution was variable. Pharmacokinetic evaluations in a renally compromised neonate confirmed that total PA clearance and the renal clearance of both PA and NAPA were reduced, although not to the extent expected for the degree of renal impairment. Peritoneal dialysis was used concurrently and may have contributed to the elimination process. We believe that our experience provides important preliminary guidelines for the management of PA therapy in neonates.
Corticosteroids for Acute, Severe Asthma
Authors: Milavetz Gary , Kelly H. William , Kelly H. William , Murphy Shirley
Published: July 2017

Corticosteroids have been used in the therapy of acute, severe asthma since the early 1950s. Numerous randomized, double-blind, placebo-controlled trials in adults and children have proven corticosteroids to be efficacious. Only the results from less rigorously designed trials have failed to show a beneficial effect. The onset of response, dose, and mode of administration have been relatively well defined; however, other aspects (i.e., duration of therapy, need to taper the dose, and risks of multiple short bursts) require further study. Early institution of corticosteroids in well-defined patient populations will decrease the need for hospitalizations. However, administration of corticosteroids to every patient presenting to the clinician's office or emergency room prior to aggressive bronchodilator therapy is unwarranted. All patients demonstrating an incomplete response or the inability to maintain a complete response following one to two hours of aggressive bronchodilator therapy should receive a course of corticosteroids. Courses as short as three to five days have proven efficacy in outpatients, whereas hospitalized patients usually are treated for seven to ten days. The duration of therapy depends on the individual rate of response.
Steady-State Pharmacokinetics of Hydroxychloroquine in Rheumatoid Arthritis Patients
Authors: Miller Donald R. , Khalil Shoukry K.W. , Nygard Gloria A.
Published: July 2017

Steady-state pharmacokinetics of hydroxychloroquine (HC) sulfate (Plaquenil) were studied in five volunteers with rheumatoid arthritis who had taken 6 mg/kg/d of the drug for at least six months. Blood samples were drawn at 0, 1, 2, 4, 6, 8, 12, and 24 hours following an oral dose. Both whole blood and plasma were assayed by an HPLC method for HC and its metabolites desethylhydroxychloroquine, desethylchloroquine, and didesethylchloroquine. A 24-hour urine collection was obtained and assayed for the same compounds. The pharmacokinetics of HC and its metabolites conformed to the model predicted by single-dose studies. During the 24-hour period the absorption phase and both early and late distribution phases were seen. Variation in mean maximum/minimum concentration was 40 percent. Renal clearance accounted for only 16 percent of unchanged HC (22 percent of total drug and metabolites) and did not correlate with creatinine clearance.
Clinical and Pharmacokinetic Profiles of Digoxin Immune Fab in Four Patients with Renal Impairment
Authors: Allen Nancy M. , Dunham Gary D. , Sailstad Jeffrey M. , Findlay John W.A.
Published: July 2017

Minimal pharmacokinetic data on digoxin immune Fab are currently available, especially in patients with impaired renal function. The serum concentration-time profiles of total digoxin, free digoxin, and digoxin immune Fab in four patients with moderate to severe renal impairment who received digoxin immune Fab are presented. The calculated elimination half-life of digoxin immune Fab was 25–73 hours. The calculated elimination half-life of total digoxin was 24–72 hours. Free digoxin concentrations rebounded to a peak of 1–2.9 ng/mL 44–97 hours after the administration of digoxin immune Fab. The areas under the curve for digoxin immune Fab were 213–1026 μg·h/mL, and total body clearances were 2.3–7.1 mL/min. The total digoxin concentrations peaked at 14–33 times the pre-Fab digoxin concentrations 5–30 hours after digoxin immune Fab administration. In comparing these data with data available from patients with normal renal function, the half-life of digoxin immune Fab and total digoxin was longer, the peak total digoxin concentration occurred later, the ratio of the peak total digoxin concentration to pre-Fab digoxin concentration was larger, and the rebound in free digoxin occurred later in patients with renal impairment. The Fab dose should not be reduced in patients with renal impairment; however, post-Fab monitoring should be extended to compensate for the prolonged half-life of Fab and later rebound of free digoxin.