bluuebunny/crossref_metadata_2025 huggingface dataset:
Music Understanding Faith
Authors: Willcock Christopher
Published: July 2017

Our experience can either disclose or occlude the reality that lies at the heart of experience. The various forms of artistic expression are privileged pathways to that reality, and of these pathways music, as the most abstract of the arts, discloses the real presence in meaning in an utterly substantive way. The presentation is built upon three theses: (i) that music puts us in touch with that which transcends the sayable; (ii) that understanding, in both its substantive and verbal senses, is the act of translating an object of creative endeavour into one's personal “code”; and (iii) that faith is that mysterious condition or habit in which one is, to whatever degree, and with whatever constancy, familiar with God.
Why Historicity Still Matters: Raymond Brown and the Infancy Narratives
Authors: Dawes Gregory W.
Published: July 2017

The infancy narratives of Matthew and Luke pose in an acute form the question of the historical value of the Gospels. Raymond Brown suggests that redaction criticism can bypass this question by spelling out the theological message intended by the evangelists. But his own exegesis suggests this is to misunderstand the genre of this literature. Brown's indifference to historicity would be justified only if the evangelists were writing something resembling allegory, a form of narrative in which the literal sense of the story is the (dispensable) clothing of a spiritual message. But Brown's exegesis suggests that the evangelists do not regard the literal sense of these stories as dispensable; they regard their theological message as resting on a foundation of historical fact. It follows that if interpreters focus on the intention of the evangelists, they cannot avoid addressing the question of historicity.
Freedom from Fear: Christian Faith and Human Rights Today
Authors: Lorenzen Thorwald
Published: July 2017

The author argues - on theological, christological, biblical and historical grounds - that Christian faith must be seriously interested in the formation and implementation of human rights. After pointing to three fundamental temptations that faith has always encountered - withdrawal, accommodation and violence - the author shows that faith in Christ is not only passionately concerned with what is going on in the world, but that it also can make a positive contribution to shaping a fair and open society. Thereby Christians contribute to the world-wide soft revolution that trusts in freedom, peace and justice, rather than security and fear.
“Let Us Not Be Like Those … Who Want to Call God to Account.” John Calvin's Reading of Some Difficult Deaths
Authors: Parsons Michael
Published: July 2017

The stories of the deaths of Ananias and Sapphira in the New Testament and of Uzzah and Uriah in the Old Testament are fraught with difficulties: notably, the pastoral implications of divine judgement and/or allowing. A close reading of John Calvin's comments on these difficult passages shows that he consciously employs reading strategies to resolve the disturbing problems of the text - particularly as he faces the relationship and connection of God to the narrated deaths. The following examines his response.
Communion Ecclesiology: Foundations, Critiques, and Affirmations
Authors: Lennan Richard
Published: July 2017

Theologies portraying the church as a “communion” - with God and between believers - have become common in Roman Catholic thought in the last two decades. The ecclesiology of communion has been particularly influential in shaping Catholic approaches to ecumenism, where “communion” merges neatly with “unity” and “catholicity” to promote a church that is both united and diverse. Despite its popularity, the ecclesiology of communion has also been subject to some significant critiques. The critics warn against the danger of communion models reinforcing authoritarian attitudes, being too idealistic, or, most particularly, lacking a focus on “mission”. In the eyes of the critics, understanding the church as communion leads only to an inward-looking church unconcerned with the needs of history and the implications of the Incarnation. This article reviews the emergence of the ecclesiology of communion, especially its relationship to the teaching of Vatican II, identifies its major emphases, surveys the content of the critiques, and assesses whether the theology of communion contributes to a positive and challenging sense of church.
Respect, Tolerance and Reconciliation Rather than Opposition and Denial: Indigenous Spirituality, Land, and the Future of Religion in Australia
Authors: Calma Tom
Published: July 2017

This paper, composed by an Indigenous Australian, who has been for many years national Race Discrimination Commissioner, discusses the future of religion in Australian society from the perspective of the anthropological, cultural and spiritual heritage of Indigenous Australians, who comprise the longest surviving culture in the world (over 60,000 years). Pervasive in every aspect of Indigenous life is a traditional spirituality, “the Dreaming”, that is also essentially tied to the Land. While Indigenous culture and the Christianity brought by missionaries in the nineteenth and twentieth centuries can co-exist, contemporary Indigenous wellbeing is inseparable from spiritual wellbeing and in particular secure ownership of the land. Indigenous peoples of the world have a particular collective value as holders of a living heritage about the meaning of what it really is to be a human in relation to the natural world. The second half of the paper clarifies and reflects upon the reaction to research conducted by the author when Race Discrimination Commissioner and certain preliminary findings of that research. In the face of negative reaction in some quarters it is argued that people of faith should have nothing to fear about proposals to enshrine freedom of religion and belief in law.
Athanasius of Alexandria
Authors: Kannengiesser Charles
Published: July 2017

The Church today no longer generates heresies as it did in the past centuries of intolerant dogmatism. But it generates a worldwide indifference by its persistent incapacity to articulate God's revelation in Scripture within an adequately updated theological project. Athanasius bridged the gap between learned exegesis and common experience of faith, thanks to his remarkable sense of actualising the message of Scripture. He introduced into the Alexandrian tradition a truth of crystal clarity when interpreting Scripture, namely that true knowledge of God in Christian terms starts with Christ actualised in the present experience of faith and Church.
No Other Name? A Critique of Religious Pluralism
Authors: Hunt Anne
Published: July 2017

John Hick and Paul Knitter propose a radical attitude to the plurality of religions and religious truth-claims which they call religious pluralism. The strategy of relativising Jesus' salvific status, which they propose, has serious ramifications. Three issues emerge from the arguments concerning religious pluralism. The Christological issue is fundamental. Second is the essential task of assessment of religious truth-claims. Finally, the possibility of dialogue itself emerges as problematic for religious pluralism. Is religious pluralism an intellectually reasonable and ethically responsible attitude for Christians to adopt in regard to the plurality of religious traditions and their truth-claims? It is the author's conclusion that it is not.
From Headhunting to the Return of the Child: Christian Mission and Cosmic Religion
Authors: Prior John Mansford
Published: July 2017

The encounter between Christianity and cosmic religions in eastern Indonesia is both destructive and creative. An emicetic paradigm is used in order to discern the dynamics of both the spontaneous and the more formal encounters. Any formal encounter has to take cognisance of the ambiguous, spontaneous encounter of the people which is well expressed in their folk beliefs.
Easter Communion: The Local Church and the Universal Church
Authors: Hamilton Andrew
Published: July 2017

The dispute in the early church about the appropriate time to end the Easter fast is of particular interest because in it we see bishops of Rome defending the Apostolic Tradition against bishops of some other churches. The analysis of the Easter Dispute suggests that the theme of mutual interiority, in which the Roman primacy is said to be within each particular church, would be better expressed as mutual hospitality. This phrase more accurately accounts for history, and serves as a powerful corrective to the belief that particular churches relate to the Roman church as local branches of a company to their head office.
Life, Healing, and the Bible: A Christian Challenge
Authors: Moloney Francis J.
Published: July 2017

The Christian tradition uses the Bible as a point of reference in its response to challenges raised by the increasing complexity of the human situation. The first part of this paper describes an approach which respects the ancient nature of the biblical text and the newness of problems it is sometimes used to resolve. Does the Bible still say anything to our new world? Focusing upon life issues, the possible challenge of the Christian Bible is then presented under three headings: the centrality of life, the fundamental biblical belief that this life is not the only life, and the continuing relevance of the Gospel narratives which report the miracles of Jesus.
Thomistic Esse — Idol or Icon ? Jean-Luc Marion's God Without Being
Authors: Martis John
Published: July 2017

Jean-Luc Marion offered three suggestions as to how Thomas's God might be seen as liberated from Being. The first section of this article sketches the background to the quest for a God without Being. In the second section, it is argued that the meaning of Being, as given in Thomas by esse, fails to completely determine the meaning of esse, and, in fact, points intrinsically to the existence of further meaning for esse. “Being” is thus an icon rather than an idol of God, that which does not substitute itself for what it points to.
Positions of Leadership: Some Reflections from Matthew's Gospel
Authors: Doyle B. Rod
Published: July 2017

In the only gospel in which Peter is promised to be the foundation-stone of the church, few if any leadership positions are presented. They are not denied; rather, Matthew describes a higher priority, using the title “brother” to include disciple and church member without further distinction, expressing the relationship of members with one another as with their master. The Gentiles proffer an example of how not to lead; disciple members, however, are to become like their master. Their task is to make disciples of all nations, the emphasis of this universal commission placing squarely upon each one the responsibility of working towards this end.
The “Horrible Wrappers” of Aquinas' God
Authors: Kelly Tony
Published: July 2017

This reflection takes a look at Aquinas' notion of God as “Being”, especially as it emerges in the Summa Theologiæ. The author suggests that affirmation of God as Being functions within an explicitly theological context so as to preclude any idolic fixations in our thinking and language. The affirmation of divine “Being” serves to enhance the realisation of our understanding of God as love, and thereby underscores a theology of gift
Theodosius and Ambrose: The Church Reconciled and Reconciling
Authors: Hamilton Andrew
Published: July 2017

The centrality of reconciliation within the church's theology and the power of symbols of reconciliation within its life have paradoxically limited the church's ability to seek reconciliation for wrongdoing done in its name. In this article the author explores this apparent paradox by examining a particularly bold symbol of reconciliation developed within the church, namely the public penance performed by the Emperor Theodosius at the urging of St Ambrose.
Rule 4? Gender Difference and the Nature of Doctrine
Authors: Garrett Graeme
Published: July 2017

Any attempt to talk about God today must accept the challenge of feminist theology. This article examines some aspects of the feminist critique of traditional christology and suggests a possible response in terms of “rule 4”. That is, reflecting on George lindbeck's claim that there are three regulative principles at work in the shaping of the classic doctrines of the incarnation and the trinity, the author suggests that feminist theology has brought to light a fourth rule: only those things may be claimed as theologically essential in the interpretation of Christ as could equally well be claimed for an imaginative Christa.
The Dark Side of God? A Dialogue with Jung's Interpretation of the Book of Job
Authors: Boorer Suzanne
Published: July 2017

This article explores the valuable insights that Jung's perspective can contribute to the interpretation of Job, and offers a critique by setting Jung's interpretation of this text in dialogue with a different interpretation of significant aspects of the Book of Job. The whole movement of the Book of Job can be interpreted in terms of a movement from the polarising of opposites to the coming together of these opposites into an inseparable non-dualistic reality. The whole creation, and Job himself after his encounter with God, combine inseparably the opposites of chaos and life, darkness and light. Cannot this also, then, be said of God the creator, in line with Jung's basic premise that God combines all opposites within the divine being?
Variations in Correlates of Race-Specific Urban Homicide Rates
Authors: Smith M. Dwayne
Published: July 2017

Recent research has begun to address patterns and causes of homicide among African Americans, the population most at risk as victims and offenders. Seeking to add to this literature, a race-specific analysis of homicide rates and macrostructural variables among U.S. central cities is performed. A variety of factors from past homicide studies serve to predict white rates of homicide, allowing for the development of a broad profile of white communities with low rates of homicides. In contrast, only two factors (population size and residential segregation) are statistically-significant predictors of homicide rates among African Americans, resulting in an essentially non-descriptive community profile. The results suggest that the two groups may be subject to different social forces, and the ensuing discussion poses the possibility that understanding differences in homicide rates among African-American communities may require an incorporation of factors not normally considered in homicide research.
Cognitive-Behavioral Group Counseling to Prevent HIV Transmission in Gay and Bisexual Men: Factors Contributing to Successful Risk Reduction
Authors: Roffman Roger A. , Downey Lois , Beadnell Blair , Gordon Judith R. , Craver Jay N. , Stephens Robert S.
Published: July 2017

This study assessed the effectiveness of a 17-session HIV-prevention group intervention with gay and bisexual males. Participants were aged 18 years or older, had engaged in one or more instances of unprotected sex with other males during the preceding 12 months, and had responded to local publicity for a program to assist gay and bisexual men who were having difficulty being sexually safe. Following assessment, 159 individuals were matched and assigned to receive group counseling or remain in a wait-list condition. Treatment focused on skills training in coping with high-risk situations. The intervention appeared to be more effective with exclusively gay than with bisexual men. More positive outcomes were associated with safer behavioral patterns at baseline, higher self-efficacy for safer behavior, accurate personal assessment of HIV infection risk, the absence of alcohol/drug use in association with sex, and satisfaction with social support.
Drug Problems in the Geriatric Patient
Authors: Holloway Donald A.
Published: July 2017

Older persons have altered responses to drugs because of physiologic and anatomic changes which influence drug absorption, tissue localization, metabolism, receptor sites, homeostatic adjustments, and excretion. Deteriorating mental and physical faculties produce other untoward, bizarre, or exaggerated effect.

This paper reviews problems in the use of endocrines, antihypertensives, cardiac glycosides, analgesics, psychoactive drugs, antibiotics, antiparkinsonians, iron, anticoagulants, gastrointestinal agents, and ophthalmics and some factors involved in allergenics and drug-induced jaundice.

The elderly also often have problems involving the proper use of drugs, obtaining drugs, or in the improper use of non-prescription drugs. Suggestions are made for the physician and pharmacist to keep these problems to a minimum.
Report of a Case of: Suspected Digoxin Malabsorption
Authors: Koup Jeffrey R. , Tobias Dianne E.
Published: July 2017

A case involving suspected digoxin malabsorption is presented. Two clinical tests of malabsorption, D-xylose and serum carotene are explained. Several pharmacokinetic calculations are made to theoretically predict the patient's serum digoxin concentration. Other data is presented to compare with the patient's response. The significance of altered renal function and bioavailability of digoxin are discussed and the relationship between hyperthyroidism and serum digoxin determinations is mentioned. Several alternative therapies for use in cases of malabsorption are discussed.
Polydrug Detoxification Unit
Authors: Swanson Larry N. , Steiner Gilbert A. , Henderson H. Richard , Schooff Kenneth G.
Published: July 2017

In November 1973, a 16-bed polydrug detoxification unit was opened at Harper Hospital in Detroit, Michigan. The primary objective of the unit is to develop a better understanding of the polydrug abuser and to develop detoxification and psychological treatment procedures which can be applied in other settings. Criteria for admission to the unit includes primary dependency on abusable substances other than alcohol or heroin (i.e. barbiturates, other sedative-hypnotics, amphetamines, hallucinogens, etc.). Each patient is admitted to the program for a 30-day inpatient stay. The expertise of multiple health care disciplines is used collectively to provide intensive therapeutic management of the patient. Pharmacy participation began as a clinical rotation for Pharm.D. students. Subsequently, a full-time clinical pharmacist was hired by the project and his activities have become an integral part of the functioning of the program. Pharmacy involvement has included participation in the following areas: (1) obtain initial drug history to determine patient eligibility, (2) determine need for detoxification regimen, (3) aid in the development of individual patient drug withdrawal protocols, (4) monitor urine and blood drug levels for abusable substances and secondary drug interference, (5) serve as a drug information and drug abuse education resource person, and (6) tabulate pertinent individual patient drug abuse data. Participation on this unit has provided the pharmacist with valuable clinical expertise in the management of the polydrug abuser and has established another potentially useful role for the clinically-trained pharmacist.
Phenobarbital-Induced Hepatic Dysfunction
Authors: Evans William E. , Self Timothy H. , Weisburst Mark R.
Published: July 2017

Phenobarbital has infrequently been reported to cause hepatitis. The previously reported cases of barbiturate-induced jaundice are reviewed and data from two previously unreported cases are presented. A discussion of mechanisms of iatrogenic hepatotoxicity is presented with emphasis on idiosyncratic mechanisms. Hepatitis secondary to phenobarbital administration appears to be due to a hypersensitivity reaction. This mechanism seems most likely because of the commonly seen clinical picture of rash, fever and eosinophilia.

Speculation is made that phenobarbital hepatitis is possibly more common than the small number of reported cases would indicate. Criteria for the assessment and treatment of this iatrogenic disease are presented.
Some Legal Issues Presented in Clinical Pharmacy Practice
Authors: Fink Joseph L.
Published: July 2017

As the pharmacist's clinical role expands he is confronted with legal questions concerning actual or proposed activities. A number of papers have appeared in the literature of pharmacy which address the potential legal liability of the pharmacist who engages in clinical activity but most are written in terms of general principles of law with few specific circumstances addressed. In this article, legal questions raised by clinical pharmacists in the course of their everyday practices are evaluated and discussed. Among the issues presented are use of an FDA-approved drug for an unapproved use, informed consent in administration of unapproved drugs, the role of the pharmacist in managing hypertensive patients visiting a hospital-based clinic, the legality of a pharmacist administering injectible drugs, the legality of permitting Pharm.D. students to draw blood, and the application of the Federal Food, Drug and Cosmetic Act to the preparation of aluminum hydroxide cookies for dialysis patients. The specific questions are answered and the legal standard of care expected of pharmacists performing clinical functions is discussed. While no cases have been decided yet concerning newer clinical activities, some precedent can be found in past cases. Approaches to handling these questions should be of value in addressing future legal issues presented as pharmacists further seek to better utilize their knowledge.
The Impact of Drug Distribution Systems on Nurses' Time Involvement in Medication Related Activities in Long Term Care Facilities
Authors: Farner James , Hicks Charles I.
Published: July 2017

This investigation involves the impact of unit dose drug distribution systems upon nursing time involvement in medication related activities. Medication related activities included inventory and control, controlled substance activities, Kardex preparation, medication preparation, medication administration, and charting fulfillment. Two unit dose systems, one with a twenty-four hour medication supply and the other with a seventy-two hour medication supply were compared with a traditional drug distribution system using the time-motion study technique of work sampling. The traditional, twenty-four hour unit dose, and seventy-two hour unit dose required, respectively 3.22, 1.91, and 1.07 minutes per dose administered. The study found, using analysis of variance and t-tests, significant differences between the traditional and unit dose systems. The unit dose drug distribution systems significantly reduced nursing time involvement in controlled substance activities, medication preparation, medication administration, charting fulfillment, and total involvement in the medication cycle. Also, unit dose drug distribution systems might reduce nursing time involvement in inventory and controlled activities. In this study, the traditional system had an in-house pharmacy which assumed many inventory and control functions of the nurse that community pharmacies could not do under a traditional drug distribution system.

Significant differences exist between unit dose drug distribution systems as shown in this study. Before implementing any unit dose drug distribution system, the pharmacist, nursing home administrator and director of nursing should examine the impact of any unit dose drug distribution system upon the medication cycle in their nursing home to maximize the benefits of unit dose drug distribution systems.
Phenytoin Dosing in Infants a Report of three Cases
Authors: Rapp Robert P. , Young Byron , Perrier Donald , Cady William , Blacker H. Martin
Published: July 2017

Three case reports indicate that infants below 10 kg in weight require greater mg/kg doses of phenytoin than larger infants or adults in order to achieve therapeutic plasma levels between 10–20 mcg/ml. In the absence of access to plasma phenytoin assay services, alternative drug therapy would usually be considered when a dose of 8 mg/kg/day of phenytoin fails to prevent seizures. These case reports reinforce the need to monitor the plasma phenytoin level when the clinical response to normal doses is inadequate. The correlation of infant to adult doses agrees well when doses are based on body surface area rather than on body weight.
Trimethoprim/Sulfamethoxazole-Associated Pseudomembranous Colitis
Authors: Scott Steven A.
Published: July 2017

A case of TMP/SMX-associated pseudomembranous colitis is described in a patient being treated for a urinary tract infection. Pseudomembranes are visualized on proctosigmoidoscopy, and stool cultures identified Clostridium difficile as the causative organism. The patient was treated successfully with oral vancomycin. A review of this infrequently reported adverse reaction to TMP/SMX is presented, emphasizing etiology and treatment.
Reducing the Duration of Prophylactic Antibiotic Use through Computer Monitoring of Surgical Patients
Authors: Evans R. Scott , Pestotnik Stanley L. , Burke John P. , Gardner Reed M. , Larsen Robert A. , Classen David C.
Published: July 2017

The use of antibiotic prophylaxis for unnecessarily prolonged periods after surgical procedures can contribute to increased health care costs and adverse drug reactions as well as the development of antibiotic-resistant infections. Hospitals are under economic pressures to develop methods to control the excessive use of these drugs. We expanded the capabilities of our hospital information system to monitor the duration of surgical antibiotic prophylaxis. For six months during one year we used the computer system to monitor antibiotics received by every surgical patient and to identify patients receiving antibiotic prophylaxis longer than was deemed necessary according to generally accepted guidelines. For six months in the following year we used the system to monitor and identify the same types of patients and clinical pharmacists placed antibiotic “stop orders” in the charts of the patients identified by the computer. Surgical patients received an average of 19 doses of antibiotics in the first year compared with 13 doses in the second year (p < 0.001). The average cost of antibiotics received more than 48 hours after the operation was $42 less per patient in year 2 than in year 1, resulting in a potential cost savings of $44 562 in six months. The computer system was found to be an efficient tool for monitoring all antibiotics given to surgical patients and identifying patients receiving antibiotic prophylaxis longer than necessary. Clinical use of this system appears to have resulted in improved usage of antibiotic prophylaxis.
Clinical Utility of a Saliva Alcohol Dipstick Estimate of Serum Ethanol Concentrations in the Emergency Department
Authors: Rodenberg Howard D. , Bennett John R. , Watson William A.
Published: July 2017

Rapid determination of serum ethanol concentrations can be a useful adjunct in evaluating patients with decreased levels of consciousness. Previous reports suggest that saliva ethanol concentrations measured by a colorimetric saliva dipstick assay correlate well with serum ethanol concentrations and could be useful in the emergency department. We compared saliva dipstick assay results with concurrent serum ethanol measurements in 67 emergency department patients with altered mental status. Color changes of the stick are calibrated to reflect serum ethanol concentrations of negative (no color change), 4.3 mmol/L, 10.8 mmol/L, 21.7 mmol/L, and ≥ 65.1 mmol/L. Emergency department staff were instructed to conduct the measurement according to the manufacturer's directions and round up equivocal results to the next highest concentration. Serum ethanol concentrations (mean ± SD) grouped by dipstick results were: negative, 5.2 ± 13.1 mmol/L; 4.3 mmol/L, 29.1 ± 18.0 mmol/L; 10.8 mmol/L, 46.6 ±27.6 mmol/L; 21.7 mmol/L, 47.0 ± 18.5 mmol/L; and 65.1 mmol/L, 62.4 ± 24.2 mmol/L. There were 12 false-negative and 2 false-positive results. Correlation between dipstick results and serum ethanol concentrations was rho = 0.611 (p<0.0005). The lack of accuracy of the saliva dipstick measurements and the high number of false-negative results make it a poor choice for determining alcohol use in the emergency department patient.
Vancomycin-Associated Exfoliative Dermatitis
Authors: Forrence Elizabeth A. , Goldman Morton P.
Published: July 2017

We describe a 51-year-old patient with endstage renal disease who developed vancomycin-associated exfoliative dermatitis. After four weeks of vancomycin hydrochloride treatment for staphylococcal pericarditis this patient developed a hypersensitivity reaction characterized by intermittent fevers, lymphadenopathy, peripheral eosinophilia, and exfoliative dermatitis. The reaction persisted for five weeks, probably because of inability to rapidly eliminate vancomycin secondary to underlying renal failure. Maculopapular rashes have been reported in two to six percent of patients who receive this drug, with severe skin reactions rarely reported. In addition to this case report, a review of the literature including 11 Eli Lilly/Food and Drug Administration case reports is presented. Although severe skin reactions to vancomycin rarely occur, they prolong morbidity, particularly in patients with renal failure.
Triazolam—An “Abused Drug” by the Lay Press?
Authors: Schneider Philip J. , Perry Paul J.
Published: July 2017

For the second time in the past ten years adverse reports in the lay press have questioned the safety of triazolam. Anecdotal reports of central nervous system adverse reactions can be separated into four general categories: (1) delirium in psychiatric patients; (2) delirium in geriatric patients; (3) withdrawal reactions; and (4) anterograde amnesia. Of the four, the amnesia reactions are regarded as serious enough by the Food and Drug Administration that it is requiring hypnotic drug manufacturers to revise the labeling of temazepam and flurazepam along with triazolam to emphasize the potential for this class of drugs to cause traveler's amnesia.
Penbutolol: A New Beta-Adrenergic Blocking Agent
Authors: Schlanz Karen D. , Thomas Robert L.
Published: July 2017

Penbutolol is a new beta-adrenergic blocking drug approved for the treatment of hypertension. It is a noncardioselective beta-blocker and has intrinsic sympathomimetic activity. The drug is approximately four times as potent as propranolol when taken orally. After oral administration, it is almost completely absorbed and peak plasma concentrations are achieved within 1.0 to 2.25 hours. Penbutolol is extensively metabolized in the liver by hydroxylation and glucuronidation. Active metabolites have not been identified. Only four to six percent of the parent drug is eliminated in the urine unchanged and dosage adjustment in renal insufficiency does not appear to be necessary. The mean terminal half-life of penbutolol is 17.6 to 26.5 hours. The duration of the hypotensive effect is approximately 24 hours. Current dosing guidelines recommend initiating therapy with 20 mg/d administered once a day. Optimum hypotensive effect occurs at dosages of 20–40 mg/d with little additional benefit observed above this range. Penbutolol appears to be well tolerated. The adverse effect profile is similar to other beta-blockers.
Soft Tissue Calcification in Renal Failure
Authors: Southwood Robin L. , Mueller Bruce A. , Copley John B.
Published: July 2017

Disorders of phosphorus, calcium vitamin D are common in patients with renal failure. Medical management, including dietary phosphorus restriction, administration of phosphate binding agents calcium and vitamin D sterol supplementation, must be instituted to control serum concentrations of these substances because of the loss of normal homeostatic mechanisms. If these measures are not employed, soft tissue calcification and hyperparathyroidism may result. We report the case of a 22-year-old woman with endstage renal disease treated with continuous ambulatory peritoneal dialysis who developed secondary hyperparathyroidism and tumorous calcinosis as a result of noncompliance with dietary phosphorus restriction and phosphate-binding agent therapy. The etiology and treatment of soft tissue calcification in patients with renal disease are discussed. Compliance with dietary restrictions and phosphate binding agents is frequently problematic in this population. Pharmacists should play an active role in educating patients with renal disease on the consquences of noncompliance with dietary and drug therapy.
The Saskatchewan Program for Rational Drug Therapy: Effects on Utilization of Mood-Modifying Drugs
Authors: Blackburn Jim L. , Downey F. Winanne , Quinn Trevor J.
Published: July 2017

In 1978, the Joint Committee on Drug Utilization (JCDU) was appointed by the Saskatchewan Minister of Health to identify and analyze concerns related to drug use and to recommend appropriate methods for dealing with such concerns. Emphasis was placed on the quality of healthcare in the province and on the provision of information as a basis for education of the public and health professionals. Since 1978, 14 committee reports providing drug utilization statistics and specific recommendations for improving drug therapy have been distributed to Saskatchewan health professionals. The main focus has been on utilization studies of “mood-modifying” drugs (analgesics, minor and major tranquilizers, sedative/hypnotics, stimulants antidepressants). The JCDU initiated a program whereby drug profiles of certain patients were released to selected health professionals. Individuals who received daily doses in excess of JCDU guidelines for mood-modifying drugs over a three-month period were categorized as extreme users. Patient medication profiles of their drug use were forwarded on a quarterly basis to physicians who prescribed and the primary pharmacy that dispensed mood-modifying drugs to these patients. From the time of the first profiles (October—December 1979) until 1983, there was a 15 percent decrease in the number of extreme users. Between 1977 and 1985, there was a decrease in the percentage of the overall population receiving any prescriptions for these drugs (from 20 to 17.4 percent).
Ondansetron: A Serotonin Receptor (5-HT3) Antagonist for Antineoplastic Chemotherapy-Induced Nausea and Vomiting
Authors: Kohler David R. , Goldspiel Barry R.
Published: July 2017

Ondansetron represents a new class of drugs that exert their antiemetic activity by selective inhibition of a serotonin receptor subtype (5-HT3). Ondansetron has marked activity against emesis associated with cisplatin and other highly emetogenic drugs. Compared with high doses of metoclopramide, the antiemetic “gold standard.” it demonstrates equal or superior efficacy.

Although ondansetron is moderately well absorbed after oral administration, only a parenteral formulation will initially be available. Ondansetron is eliminated almost entirely by hepatic metabolism: less than five percent of an intravenously administered dose is recovered intact in urine. The half-life of ondansetron is approximately 3.5 hours: slightly shorter in children and prolonged in the elderly. Neither clinical efficacy nor adverse effects have correlated with serum concentrations.

Ondansetron is generally well tolerated. Clinically relevant adverse effects include headache, diarrhea or constipation, sedation, and transient minor elevations of liver function tests. It is not associated with extrapyramidal reactions.

Ondansetron is indicated as prophylaxis for nausea and vomiting associated with emetogenic chemotherapy. Studies to further evaluate and define its use are ongoing.
Retrospective Evaluation of Patient-Controlled Analgesia Use in a Large Teaching Institution
Authors: Smythe Maureen A. , Martin Susan E. , Schad Randy F.
Published: July 2017

Because of a significant increase in the number of patients receiving patient-controlled analgesia (PCA) therapy at our institution, we conducted a review of PCA use. Our objectives were to determine if a PCA recording document (monitoring form) could be used to identify potential problems associated with PCA therapy and to identify measures that could be taken to improve analgesic therapy with this method of administration. The PCA recording document for each patient was reviewed retrospectively to identify patients suspected of having problems with the therapy. Three criteria addressing duration of therapy, change in prescribed narcotic, and respiratory rate were used to evaluate PCA therapy. The standard was set at 100 percent. Complete patient records were reviewed for those patients not meeting the standard to determine whether problems actually existed. PCA recording documents were reviewed for 518 patients. Sixty-one patients did not meet the standard. Of these 61 patients, 41 (67.2 percent) were found to have problems with PCA therapy. Suspected adverse reactions occurred in 27 of these 41 patients and 14 experienced inadequate pain control. Nausea and vomiting were the most prevalent adverse reactions. Our results indicate that PCA therapy is discontinued in many patients because of inadequate pain relief and suspected narcotic-induced nausea and vomiting. To improve analgesic therapy, clinicians should be reeducated regarding ways to optimize analgesic therapy, and a prospective PCA monitoring service should be considered.
Hypertensive Crisis from Chronic Intoxication with Nasal Decongestant and Cough Medications
Authors: Heyman Samuel N. , Mevorach Dror , Ghanem Jihad
Published: July 2017

Cardiac hypertensive structural changes, catecholamine-related cardiomyopathy, and congestive heart failure (CHF) have been encountered in pheochromocytoma, as a result of prolonged exposure to high concentrations of endogenous catecholamines. A 34-year-old man presented with severe hypertension, cardiomegaly, and CHF, presumably as a result of continuous alpha-adrenergic intoxication with oxymetazoline hydrochloride, phenylephrine hydrochloride, and ephedrine hydrochloride, consumed in massive doses by an overuse of nasal decongestants and cough syrup (daily doses of 20, 100, and 300 mg, respectively). Coadministered chlorpromazine hydrochloride and trimeprazine tartrate may have also contributed to the clinical presentation through their anticholinergic and antihistaminic properties. The possibility of an overuse of these over-the-counter drugs should be considered in the differential diagnosis of hypertensive emergencies, especially with the simultaneous use of anticholinergic and antihistamine medications, beta-blocking agents, or monoamine oxidase inhibitors.
Reducing Time Delays in the Administration of Thrombolytic Therapy to Patients with Acute Myocardial Infarction
Authors: Hilleman Daniel E. , Gannon Joan M.
Published: July 2017

The extent of myocardial damage occurring during acute myocardial infarction is time dependent. Current approaches designed to reduce the time between symptom onset and the initiation of thrombolytic therapy have focused on increasing public awareness of the need to seek prompt medical attention, prehospital administration of thrombolytic agents, and reducing inhospital delays in initiation of therapy. Results from short-term, public awareness campaigns suggest that patient delays in seeking medical assistance can be reduced in some communities; however, these campaigns do not influence overall patient use of emergency rooms and emergency transport services. In addition, the long-term benefit of media campaigns has not been demonstrated. Prehospital thrombolytic therapy appears to be feasible and safe in certain communities, but definite therapeutic benefit of the small time savings realized in studies to date has not been seen. Even if prehospital thrombolysis is proven to benefit selected patients, it will not affect the large number of patients who choose not to use emergency medical transport services. Adherence to established protocols designed to facilitate rapid institution of thrombolytic therapy can reduce inhospital delays. Initiating thrombolytic therapy within 30 minutes of patient arrival in the emergency department is a goal that should be readily achievable in today's healthcare environment.
Carbamazepine Dosing for Pediatric Seizure Disorders: The Highs and Lows
Authors: Reed Michael D. , Gilman Jamie T.
Published: July 2017

Carbamazepine (CBZ) has become a commonly used antiepileptic agent in the pediatric population. It is considered a drug of choice for not only partial seizures but also for primary generalized tonic-clonic seizures. Although this agent is very effective, regulation of serum drug concentrations can sometimes be problematic in children. CBZ elimination is more rapid in children, necessitating the need for higher mg/kg doses than are commonly employed in adults. The accumulation of the pharmacologically active metabolite carbamazepine-10,11-epoxide is often higher in children due to more rapid conversion of the parent compound and may elicit either a better therapeutic response or neurotoxicities. CBZ absorption can also be somewhat altered in children and may be related in part to the dosage form used in small children. This article is intended to discuss some of the obstacles that may be encountered in CBZ therapy in children and to offer suggestions for improved therapy with this agent.
Clonal evolution and outcomes in myelofibrosis after ruxolitinib discontinuation
Authors: Newberry Kate J. , Patel Keyur , Masarova Lucia , Luthra Rajyalakshmi , Manshouri Taghi , Jabbour Elias , Bose Prithviraj , Daver Naval , Cortes Jorge , Kantarjian Hagop , Verstovsek Srdan
Published: July 2017

Key Points

Survival of patients with MF after ruxolitinib discontinuation is poor, with median survival of 14 months. Low platelets at the start or end of therapy or clonal evolution while on therapy are associated with an even worse prognosis.
Recalibrating the risks and benefits of lithium therapy
Authors: Berk Michael , Cowdery Stephanie , Williams Lana , Malhi Gin S.
Published: July 2017

Recent data might subtly recalibrate the risk/benefit ratio of lithium, the prototypical mood stabiliser for bipolar disorder. There are hints that lithium might be associated with a reduction in dementia risk and as noted in this Journal, a surprising reduction in the risk of cancer.
Paratactics (Pataquerics) of the Ordinary: The Course of the Comic in Charles Bernstein's Poetry
Authors: Bruns Gerald L.
Published: July 2017

This essay attempts to give a fairly comprehensive account of what Charles Bernstein calls his “Art and Practice of the Ordinary,” with particular attention to his poetics of the (stand-up) comic and especially to the complex changes that this poetics undergoes in his later works, Girly Man (2006), with its responses to the events of September 11, 2001, and Recalculating (2013), which is everywhere shadowed by the death in 2008 of his daughter, Emma.
Biomineralization-related specialization of hemocytes and mantle tissues of the Pacific oysters Crassostrea gigas
Authors: Ivanina Anna V. , Falfushynska Halina I. , Beniash Elia , Piontkivska Helen , Sokolova Inna M.
Published: July 2017

Molluscan exoskeleton (shell) plays multiple important roles including structural support, protection from predators and stressors, and physiological homeostasis. Shell formation is a tightly regulated biological process that allows mollusks to build their shells even in environments unfavorable for mineral precipitation. Outer mantle edge epithelial cells (OME) and hemocytes were implicated in this process; however, the exact functions of these cell types in biomineralization are not clear. The Pacific oysters Crassostrea gigas were used to study differences in the expression profiles of selected biomineralization-related genes in hemocytes and mantle cells, and the functional characteristics of hemocytes such as adhesion, motility and phagocytosis. The specialized role of OME in shell formation was supported by high expression levels of the extracellular matrix (ECM) related and cell-cell interaction genes. Density gradient separation of hemocytes revealed four distinct phenotypes based on the cell morphology, gene expression patterns, motility and adhesion characteristics. These hemocyte fractions can be categorized into two functional groups, i.e. biomineralization and immune response cells. Gene expression profiles of the putative biomineralizing hemocytes indicate that in addition to their proposed role in the mineral transport, hemocytes also contribute to the formation of the ECM, thus challenging the current paradigm of the mantle as the sole source of the ECM for shell formation. Our findings corroborate the specialized roles of hemocytes and the OME in biomineralization and emphasize complexity of the biological controls over the shell formation in bivalves.
Maturação biológica e imagem corporal; sua relação com o sobrepeso/obesidade em escolares de Cacoal, Rondonia
Authors: Romanholo Rafael Ayres , Belo Carine , Baia Fernando Costa , Pereira Joeliton Elias , Lucena Adriano Robson Nogueira da , Prestes Jonato , Almeida Fabricio Moares de
Published: July 2017

Introdução: Pesquisas de imagem corporal têm sido residuais e inconclusivas a respeito dos efeitos da morfologia do corpo sobre a insatisfação com o peso e a aparência física, que são o reflexo do amadurecimento individual. Objetivo: Verificar a relação da maturação biológica e imagem corporal com o excesso de peso em escolares de 7 a 12 anos de escolas municipais do município de Cacoal. Métodos: A amostra foi composta por 482 escolares de 7 a 12 anos, de ambos os sexos, sendo 111 da zona urbana e 371 na zona rural. Foram coletados valores referentes ao IMC Cole et al.,(2000), além de medidas de perímetro abdominal e foi identificada a maturação e a satisfação corporal dos escolares. O parâmetro para a mensuração da percepção da imagem corporal foi o protocolo proposto por Collins (1991), e para identificação dos estágios de maturação foi utilizado o protocolo de Tanner (1962). Para análise estatística, foi utilizado o programa SPSS 20.0 usando uma estatística descritiva em que foram calculados a média, o desvio padrão e o percentual; para comparar as médias dos grupos foi aplicada uma análise de variância para dois fatores (ANOVA) Two-way, e a aplicação do teste t-student. Resultados: Os resultados apontaram que a maturação nas meninas teve relação com a obesidade; o mesmo não foi evidenciado nos meninos. A satisfação com a imagem corporal também tem relação com a obesidade, circunstância em que as meninas são mais insatisfeitas com sua imagem corporal se comparadas aos meninos. Conclusão: Conclui-se que os resultados do presente estudo, mostram que a maturação nas meninas e sua imagem corporal têm relação com a obesidade.
When Is the Matching Polytope Box-Totally Dual Integral?
Authors: Ding Guoli , Tan Lei , Zang Wenan
Published: July 2017

Let G = (V, E) be a graph. The matching polytope of G, denoted by P(G), is the convex hull of the incidence vectors of all matchings in G. As proved by Edmonds [10] [Edmonds J (1965) Maximum matching and a polyhedron with 0, 1-vertices, J. Res. Nat. Bur. Standards Sect. B 69(1–2):125–130.], P(G) is determined by the following linear system π(G): x(e) ≥ 0 for each e ∈ E; x(δ(v)) ≤ 1 for each v ∈ V; and x(E[U]) ≤ ½|U|⌋ for each U ⊆ V with |U| odd. In 1978, Cunningham and Marsh [6] [Cunningham W, Marsh A (1978) A primal algorithm for optimum matching. Balinski ML, Hoffman AJ, eds. Polyhedral combinatorics. Mathematical Programming Studies, Vol. 8 (Springer, Berlin), 50–72.] strengthened this theorem by showing that π(G) is always totally dual integral. In 1984, Edmonds and Giles [11] [Edmonds J, Giles R (1984) Total dual integrality of linear inequality systems. Progress in Combinatorial Optimization (Academic Press, Toronto), 117–129.] initiated the study of graphs G for which π(G) is box-totally dual integral. In this paper, we present a structural characterization of all such graphs, and develop a general and powerful method for establishing box-total dual integrality.

The online appendix is available at https://doi.org/10.1287/moor.2017.0852 .
Emails made easy
Authors: Fowler John
Published: July 2017

John Fowler continues to explore the many uses of written communication. In this article, he examines the use and misuse of electronic communication
How to do a clinical audit
Authors: Hughes Kelly
Published: July 2017

Dental nurse Kelly Hughes considers the key components