Bess the Christ Figure?: Theological Interpretations of Breaking the Waves

Is a woman who dies for love in order to save her husband, automatically a Christ figure? What about one who willingly submits to and is eventually killed by sexual violence and prostitution? And if she is seen as a Christ figure, would this be a progressive or a retrograde theological interpretation of a film with such a story line? The 1996 independent Scandinavian film Breaking the Waves, written and directed by Lars yon Trier, presents such a film and some have found Christological imagery there. I wanted to know how religious viewers, schooled in such imagery and devoted to it, would react to this film. Would they see allusions to Christ? Would they feel avant- in declaring a woman who sacrifices to save someone a Christ figure? Or would they react with distaste at such a seemingly bizarre sacrifice with its clear tones of sexual abuse and coercive stereotypes? And would any of this challenge or confirm their inherited views of Christ

The God Behind the Screen: Pleasantville and The Truman Show

Two films from 1998, The Truman Show and Pleasantville, provide a possible basis for theological discussion. They introduce questions of illusion and reality, control and freedom, viewing and being viewed. These two products of the media world themselves ask how much our own interpretations of reality are influenced by our culture\u27s modern media. Have Americans developed an obsessive interest in watching without being known (voyeurism)? Do the films portray society\u27s worst fears about God? What aspects of human freedom and what aspects of God are left out? Effectively raising the questions, the films require richer resources to provide answers regarding the character of God and the power of human freedom

Covariant Lagrangian Formulation of Chern-Simons and BF Theories

We investigate the covariant formulation of Chern-Simons theories in a general odd dimension which can be obtained by introducing a vacuum connection field as a reference. Field equations, Noether currents and superpotentials are computed so that results are easily compared with the well-known results in dimension 3. Finally we use this covariant formulation of Chern-Simons theories to investigate their relation with topological BF theories.Comment: 23 pages, refs. adde

Combined oral prolonged-release oxycodone and naloxone in chronic pain management

Introduction: The use of opioids is associated with unwanted adverse effects, particularly opioid-induced constipation (OIC). The adverse effects of opioids on gastrointestinal function are mediated by the interaction with opioid receptors in the gastrointestinal tract. The most common drugs used for relieving OIC are laxatives, which do not address the opioid receptor-mediated bowel dysfunction and do not provide sufficient relief. Areas covered: This paper discusses the role of a combination of prolongedrelease formulation of oxycodone (OX) and naloxone (N) in the prevention and management of OIC, reporting efficacy and safety outcome of controlled studies. In a therapeutic area of great unmet need, the combination tablet of prolonged release of OX and N (PR OXN) could offer patients effective analgesia, while improving opioid-induced bowel dysfunction. Expert opinion: PR OXN offers a unique and specific mechanism to control OIC in patients receiving chronic opioid therapy. This combination has the potential advantage of preventing OIC, particularly in subgroups of population, like elderly or advanced cancer patients. This approach can decrease the use of laxatives and additional medications, which represent a burden for patients presenting comorbidities requiring multiple medication

Prevalence of opioid-related dysuria in patients with advanced cancer having pain.

The aim of this study was to assess the prevalence of opioid-induced dysuria in patients with advanced cancer having pain and to evaluate the possible factors associated. A consecutive sample of cancer patients admitted to an acute pain relief and palliative care unit during 8 months was surveyed. Most patients (147, 86.5%) were receiving opioids at admission. The mean age was 65.1 (SD 12.2) and 106 patients were males. Twenty-five patients presented with dysuria at admission (of which 22 were taking opioids, 14.9%). Eleven patients were inserted a bladder catheter at admission for urine monitoring and 18 patients had urinary incontinence. During admission, 31 patients presented dysuria (19% of population was taking opioids). The prevalence of dysuria was more frequent in males, in patients presenting pelvic masses or who had pelvic surgery, and patients with neurological deficits. Opioid switching during admission was correlated to the occurrence of dysuria. Patients with chronic cancer pain receiving opioid therapy present a prevalence of bladder dysfunction of about 15%, which is influenced by several concomitant factors. Given the complex clinical picture of advanced cancer patients, further studies should be performed to explore the presence of dysuria in patients with no pain and not receiving opioids to know the real weight of opioid therapy with respect to other variables.</jats:p

The use of sublingual fentanyl for breakthrough pain by using doses proportional to opioid basal regimen.

Abstract OBJECTIVE: The aim of this study was to prospectively assess the efficacy and safety of sublingual fentanyl (SLF) in doses proportional to opioid doses used for background analgesia for the treatment of BTP of cancer patients. METHODS: A sample of patients admitted to an acute palliative care unit, presenting breakthrough pain (BTP) episodes and receiving stable doses of opioids for background pain was selected to assess the efficacy and safety of SLF used in doses proportional to the basal opioid regimen used for the management of BTP. For each patient, data from four consecutive episodes were collected. For each episode, nurses collected changes in pain intensity and adverse effects when pain got severe (T0), and 5, 10, and 15 minutes after SLF was given (T15). RESULTS: Seventy patients were recruited for the study. The mean age was 61.7 (\ub111.5). Forty-one patients were males. A total of 173 episodes of BTP were recorded (mean 2.5 episodes/patient). In 19 events, documentation regarding changes in pain intensity was incomplete. Of the 154 evaluable episodes, 143 were successfully treated (92%). Mean doses of SLF were 637 \ub5g (SD 786), and 51 patients (72.8%) received SLF doses 65800 \ub5g. When compared to younger adult patients, older patients received significantly lower doses of SLF (p < 0.0005) [DOSAGE ERROR CORRECTED], similarly to their lower basal opioid regimen. Pain intensity significantly decreased at T5, 10 and T15 (p < 0.0005). The number of patients with a pain reduction of more than 33% at T5, T10, and T15 were 11, 79, and 137, respectively, and the number of patients with a reduction in pain intensity of more than 50% were 1, 21, 114 at the same intervals, respectively. No differences in changes in pain intensity for gender (p < 0.9) or age (p < 0.85) were observed. No significant changes in the number of patients reporting adverse effects of mild-moderate intensity were reported after SLF administration in comparison with baseline, and no adverse effects severe enough in intensity to require medical intervention were observed. Limitations of this study are represented by the uncontrolled design. CONCLUSION: This study suggests that SLF given in doses proportional to the basal opioid regimen for the management of BTP is safe and effective in clinical practice

Breakthrough pain in patients with abdominal cancer pain.

Abstract OBJECTIVE: Characterization of breakthrough cancer pain (BTcP) in patients with abdominal cancer is lacking. The aim of this study was to assess the characteristics of BTcP in patients with abdominal cancer pain. PATIENTS AND METHODS: In an observational cohort study, from a consecutive sample of patients admitted to a pain relief and supportive care unit for a period of 13 months, patients with abdominal disease due to cancer, including primary cancer or metastases, were assessed for the presence of chronic abdominal pain; its mechanism, intensity of background pain, and pain flares, which were distinguishable from the baseline pain, were recorded. Patients presenting with pain flares were assessed regarding the causes and the possible factors associated with it. Patients were reassessed when background pain control was considered optimal. RESULTS: From a sample of 522 patients admitted to an acute pain relief and palliative care unit in a period of 13 months, 100 patients with abdominal disease were available. The mean age was 65.3 years (SD\ub111.4); of the 100 patients, 45 (45%) were males. The mean Karnofsky status was 47.7 (SD\ub111.1). At admission (T0), 67 patients (67%) had background pain with mean pain intensity of 4.9 (SD\ub11.6). Sixty-one patients of those with background pain (91%) had superimposed and well-distinguished pain flares. After analgesic optimization (T1), the mean background pain intensity was 1.7 (SD\ub11.2), and 55.2% of patients had BTcP episodes. The difference with T0 was significant (P<0.0005). CONCLUSIONS: This preliminary study provides new insights on the characteristics of BTcP in a subclass of patients with abdominal disease. It has been estimated that about 55% of patients with well-controlled background pain will develop BTcP episodes. This percentage was higher (about 90%) in patients who presented with uncontrolled background pain, underlying the need to better characterize patients with BTcP, only after a careful optimization of basal pain, as considered by the definition of BTcP

Changes of QTc interval after opioid switching to oral methadone.

Abstract A consecutive sample of patients who were switched from strong opioids to methadone in a period of 1 year was surveyed. QTc was assessed before switching (T0) and after achieving adequate analgesia and an acceptable level of adverse effects (Ts). Twenty-eight of 33 patients were switched to methadone successfully. The mean initial methadone doses at T0 were 67.1 mg/day (SD \ub180.2, range 12-390). The mean QTc interval at T0 was 400 ms (SD \ub130, range 330-450). The mean QTc interval at Ts (median 5 days) was 430 ms (SD \ub126, range 390-500). The difference (7.7 %) was significant (p\u2009<\u20090.0005). Only two patients had a QTc of 500 ms. No serious arrhythmia was observed. At the linear regression analysis, there was no significant association between mean opioid doses expressed as oral morphine equivalents and QTc at T0 (p\u2009=\u20090.428), nor between mean methadone doses and QTc at Ts (p\u2009=\u20090.315). No age differences were found with previous opioid doses (p\u2009=\u20090.917), methadone doses (p\u2009=\u20090.613), QTc at T0 (p\u2009=\u20090.173), QTc at Ts (p\u2009=\u20090.297), and final opioid-methadone conversion ratio (p\u2009=\u20090.064). While methadone used for opioids switching seems to be an optimal choice to improve the opioid response in patients poorly responsive to the previous opioid, the possible QTc prolongation should be of concern despite not producing clinical consequences in this group of patients. A larger number of patients should be assessed to quantify the risk of serious arrhythmia