Search

Context Pain is a common and significant symptom experienced by children with advanced malignant disease. There is limited research on pain management of these children at home. Objectives To describe and review the indications for using patient-controlled analgesia (PCA) in the form of a Computerized Ambulatory Drug Delivery device (CADD ® ) in the home setting. Methods A retrospective chart review was conducted in children discharged home with opioid infusions using a CADD. Charts from January 2008 to February 2012 were surveyed. Results Thirty-seven CADDs were dispensed during the study period, and of these, 33 were prescribed for patients with cancer-related pain. A third of the CADDs were commenced at home and almost all PCA CADDs were used for end-of-life care. Hydromorphone was the most commonly prescribed opioid. Patients remained at home and pain control was achieved by either increasing the opioid dose or switching the opioid and using adjuvant therapy. Sixteen patients were readmitted to hospital from home and three admissions were related to pain. The median duration on a PCA CADD at home was 33.7 days (range, 1–150 days), and the mean morphine equivalent dose was 2.13 mg/kg/day. Conclusion PCA with a CADD can be used to manage pain in the home setting. Dose adjustments and opioid switches were performed with no adverse incidents.

Objective Early childhood is a time of rapid development, particularly of the central nervous system, and can set a foundation for the entire life course. Complex pain in young children can impact the quality of life through limiting physical and social development, compromising psychological well-being, and disrupting sleep. The aim of this review is to identify the needs of young children who present to a tertiary-level pain service, what services they require, and their treatment outcomes. There are limited data on this vulnerable population, which may be due to small numbers represented and the complexities of pain assessment in this age group. Methods A retrospective chart review recorded demographics, gender, pain location and etiology, treatment, and outcomes of 28 children younger than age eight years attending a pediatric pain clinic over a three-year period. Results All but two young children had an obvious physical pathology as an explanation for pain; this is in contrast to studies of pain clinics servicing adolescents. A diverse range of conditions, some rare, were identified, requiring a high level of pediatric understanding of the disease process and an ability to work with primary teams with expertise in disease-modifying strategies.

Synopsis One of the key aspects of good health care for children and young people is the prevention and management of pain. The experience of persistent pain in children and adolescents not only has a major impact on physical, emotional, social, and developmental well-being, but also impacts the broader world, which includes family, school, and social networks. The multidisciplinary pediatric pain clinic adopts a holistic approach to care through a biopsychosocial model. One outcome of an initial pediatric pain clinic review is the creation of a pain management plan that addresses the pharmacological, physical, psychological, and other domains of care. Pediatric pain clinics are improving access by embracing technology through tele-health and internet-based treatment options. Outcome measurement will guide the development of models of care in the future. J Orthop Sports Phys Ther 2017;47(10):806-813. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7355.

Judaism is often understood as the way of life defined by the Torah of Moses, but it was not always so. This book identifies key moments in the rise of the Torah, beginning with the formation of Deuteronomy, advancing through the reform of Ezra, the impact of the suppression of the Torah by Antiochus Epiphanes and the consequent Maccabean revolt, and the rise of Jewish sectarianism. It also discusses variant forms of Judaism, some of which are not Torah-centered and others which construe the Torah through the lenses of Hellenistic culture or through higher, apocalyptic, revelation. It concludes with the critique of the Torah in the writings of Paul.

Paul’s attitude to the Law has been endlessly debated. Several scholars have argued in recent years that Paul’s critique of the Law only applied to Gentiles, and that he assumed its continued validity for Jews. But in fact Paul claimed to have a new revelation, which superseded the Law for Jews as well as for Gentiles. Neither circumcision nor uncircumcision ultimately mattered. Paul may not have objected to continued Jewish observance of the Torah, but he undermined its significance to a great degree. He arguably posed a greater threat to Jewish identity than had Antiochus Epiphanes in the Maccabean era.

Despite some attempts to argue the contrary, the Torah does not play a central role in the wisdom tradition before Ben Sira, in the early Enoch tradition or in Diaspora tales such as Esther and Daniel 1-6.

Much of the literature of the Greek-speaking Diaspora summarizes the Law in terms of its ethical teaching, emphasizing monotheism and sexual matters and passing over ritual requirements or interpreting them allegorically. Such practices as Sabbath observance and circumcision were widely observed, but the Law was not reducible to a code of rules. The Law of Moses does not appear to have served as the legal basis for Jewish communities. Both the possibility and the difficulty of conversion to Judaism are illustrated in the story of Joseph and Aseneth

The Torah in the Second Temple period included narratives as well as laws. Several compositions Aramaic compositions of the early Hellenistic period retell the stories to convey ethical messages. Some psalms, and also Ben Sira, treat the Torah as a source of wisdom

During the Maccabean crisis, residents of Jerusalem were forbidden even to admit that they were Ioudaioi. This chapter reviews the debate about the meaning of Ioudaioi in antiquity (Judeans or Jews?) and discusses the nature of ethnicity, and the ways in which it was formulated.

In the wake of the Maccabean revolt, the literature from the land of Israel takes a halakic turn, which is evident in Jubilees, the Temple Scroll, and the Dead Sea Scrolls. While the Law was the basis of common Judaism, it was also the basis of sectarian division.

The Torah played little part in the restoration after the Exile or in the prophets Haggai and Zechariah. It is absent from the Elephantine papyri, except for the so-called Passover Papyrus, which attempts to introduce the Priestly dates for the festival. It gained authority in Judah under Ezra, who used it selectively to enforce a separatist ideology.

Torah is first used in the sense of Law in Deuteronomy. The core of Deuteronomy dates from the late monarchy, but it was probably not promulgated by Josiah. It only became authoritative after the collapse of the monarchy.

The earliest apocalypses, in the books of Enoch and Daniel, appeal to a source of revelation that is independent of the Mosaic Torah. The sectarian Dead Sea Scrolls, however, combine a fundamental emphasis on the Torah with a claim of higher revelation, which guides the proper interpretation of the Torah. Similarly the apocalypses of the late first century CE, 4 Ezra and 2 Baruch, revere the Torah, but supplement it with apocalyptic visions.

“The Deuteronomic entity called ‘Israel’ is not coterminous with Judah or its population,” writes Carly Crouch.1 The problem was not that some Judahites lived outside of Judah, but that some of the native population did not conform to Deuteronomic ideals. From the beginning, the Torah of Moses was an attempt to mold Judean identity in a particular way. There had been Judahites before Deuteronomy was composed, identified as such by their place of residence and political loyalty, and also by shared cultural traits including the (not necessarily exclusive) veneration of the God of the land, YHWH. There would still be Judeans well into the Second Temple period who did not define themselves by reference to the Torah (as seen in the earlier wisdom literature), and some even (in the case of Elephantine) who may not have been aware of its existence. Eventually, however, the composite Torah, which combined Deuteronomic and Priestly traditions, would come to be the dominant expression of Judean identity....

The Book of Joshua poses problems for the current movement of “Theological Interpretation” of Scripture, and has given rise to various apologetic strategies. Scholars have come to accept that the book does not give a reliable historical account of the emergence of Israel in Canaan, but still accept the divine authorization of the conquest and try to justify it. If we take seriously the fictional character of much of biblical narrative, then we must recognize that these narratives do not provide privileged access to God, but only to the ways in which human beings have imagined God, in Israelite, Jewish and Christian tradition.

AimsSleep is considered an important time of healing and restoration during illness. The primary aim of this study was to determine the prevalence of self-reported sleep disturbance in children admitted to a tertiary children's hospital with a variety of medical diagnoses.

The most obvious change introduced by the WHO Guidelines for the Pharmacological Treatment of Persisting Pain in Children with Medical Illness, issued in 2012, is the advocacy of a two-step rather than three-step pain ‘ladder’. The guideline states that paracetamol and ibuprofen are the medicines of choice in the first step (for mild pain), and that the use of strong opioid analgesics is recommended for the relief of moderate to severe persisting pain in children with medical illnesses. The intermediate step, which dates from the 1986 and 1996 guidelines devised for adults, relied on the use of a weak opioid, notably codeine. This step is no longer advocated for children. However, there is much more than is new in the guidelines and they deserve careful consideration and deliberate action in order to ensure that children have access to the most appropriate pain relief. Hospital pharmacists are well-positioned to take a lead role in the implementation of the guidelines. They should also note the degree to which evidence to guide clinical practice is still lacking and contribute to efforts to address the priority research needs identified in the policy document.

This book reevaluates the biblical house of the father (bêt ’āb) in light of the anthropological critique of the patrilineal model. It uncovers and defines the contours of an underappreciated yet socially significant kinship unit in the Bible: “the house of the mother (bêt ’ēm).” Identified with what anthropologists call “the uterine family,” the biblical house of the mother comprised a mother, her maidservants, and her biological and adopted children. The house of the father subdivided into maternally named or maternally identified units. Members of a maternally named house formed an alliance within the larger house of the father and competed as a unit for succession within the house of the father. Biblical Hebrew recognizes these maternal units with kinship labels specific to a mother and keyed to female reproductive organs: “son of my womb,” “the child who opens the womb,” “my brother, the son of my mother,” “a brother, one who had nursed at my mother’s breasts.” We also find maternally delineated space within the house of the father described as a “house,” “chamber,” or “tent” of the mother, and this space is associated biblically with conception, birth, breastfeeding, and marriage negotiations. This book demonstrates that the Bible recorded its past in the form of idealized, founding-family narratives, and within those narratives, competing mothers and their sub-houses marked hierarchies within the house of the father and political divisions within the national house of Israel.

The analysis of the genre apocalypse published in Semeia 14 (1979) relied on a classificatory approach, which identified core features of the genre, listed features that were typical but not necessary, and distinguished different types of apocalypses. The main difficulty encountered by such an approach is that genres have fuzzy edges. Some works that fit the definition are atypical of the genre, while some that do not have much in common with it. The emergence of prototype theory as a method of analysis is helpful in this regard, and allows for a less rigid kind of classification, without lapsing into the indeterminacy of family resemblances. Genres are recognized on the basis of a few clear exemplars. Other works may resemble them to a greater or lesser extent.

Abstract While the Torah enjoys central importance in the sectarian scrolls, it is not nearly so central in the Aramaic texts found at Qumran. These texts show familiarity with the stories of Genesis and Exodus, but they treat them as sources for stories and wisdom instruction rather than for prescriptive law. The same is true of Ben Sira. Ancestral laws were very important in the Hellenistic world, but their importance was largely symbolic. Even Ezra seems to have focused primarily on a few issues of symbolic importance. Only after the Maccabean revolt do we begin to get sustained halakic discussion in such books as the Temple Scroll and Jubilees. The increased prominence of halakic disputes went hand in hand with the rise of sectarianism.

The authors of the pesharim clearly had traditions available to them, whether oral or written, that we do not now have in textual form. Figures like the “Man of the Lie” and “Wicked Priest” can not be dismissed as fictional, even if their identities are obscure. While the ostensibly historical allusions in the scrolls are always tendentious, they do at least permit us to infer the general context in which the sect developed. It is clear that conflict over the interpretation of the Torah was the primary reason for the formation of the sect. The conflict with the Wicked Priest should be located late in the Teacher’s career. A plausible occasion for that conflict is provided by the decision of Alexandra Salome and her high priest, Hyrcanus II, to follow the teachings of the Pharisees, after the death of Alexander Jannaeus.

Objective. This study reviewed opioid prescription for chronic severe nonmalignant pain in a multidisciplinary pediatric pain clinic. We looked at benefits and side effects of therapy, and compared our process of opioid prescription with the practice guidelines defined in adult literature. Design. Descriptive retrospective practice survey. Setting. Multidisciplinary pain clinic in a tertiary pediatric hospital. Patients. During a 12-month period, 104 patients were seen in the clinic, of which 49 received an opioid as part of their pain management; 11 received an opioid chronically, defined as more than 3 months in this study, and 5 of these were still on opioid at the end of the study period although data on one patient are lacking as she had been transferred to an adult clinic. Methods. Information about patients was obtained from chart review. Outcome Measures. Benefits and side effects of treatment, as well as the process of prescribing opioids and follow-up. Results. In the four patients studied, there seem to be better pain control and improved function in these patients while on opioid therapy, despite minor side effects. We identified some areas of improvement in our practice and made recommendations for the use of opioids in pediatric chronic severe nonmalignant pain. Conclusions. The evolution of our four patients seems to be in favor of treatment with an opioid for severe chronic nonmalignant pain in certain pediatric patients, in the context of prescribing in a multidisciplinary pain clinic with a multisystem approach to pain management although more data are needed to know if such therapy is safe and beneficial on a longer-term basis.