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Manual intramuscular epinephrine injection is the standard of care for treating severe allergic reactions and anaphylaxis. Epinephrine autoinjectors were approved on the basis of the assumption that their pharmacokinetic and pharmacodynamic profiles are equivalent to manual intramuscular injection; however, although there is emerging evidence for product-related differences in pharmacokinetic profiles, very little is known about the comparative pharmacodynamic profiles.To compare pharmacokinetic and pharmacodynamic profiles of epinephrine delivered through manual intramuscular injection, autoinjectors, and intranasal spray.This integrated analysis was based on data from 4 randomized cross-over phase 1 trials that compared the pharmacokinetics and pharmacodynamics of epinephrine using manual intramuscular epinephrine 0.3 mg injection, epinephrine 0.3 mg autoinjectors (Symjepi and EpiPen), and epinephrine 1 mg intranasal spray (neffy).Data from 175 participants showed that although neffy (1.0 mg intranasal spray) resulted in a maximum concentration (258 pg/mL) that was lower than or comparable with manual epinephrine intramuscular injection (254 pg/mL), Symjepi (438 pg/mL) and EpiPen (503 pg/mL), it led to comparable increases in systolic blood pressure (maximum effect [EIntranasal delivery of epinephrine using neffy increases systolic blood pressure more efficiently than do manual intramuscular injection and epinephrine autoinjectors, despite lower maximum plasma concentrations.

Historians have tended to treat Indian-Puritan relations in New England as though the Indian people were simple reactors to Puritan behaviors. Specifically, the behavior of the Mohegan Sachem, Uncas, has been interpreted in various ways, none of which, however, take into account the ongoing political system amongst the New England Indians. By applying simultaneously the principles of anthropology and history, the authors suggest an interpretation for Uncas' actions which reveals him as an active initiator of the Pequot War in 1637 for political purposes entirely within the realm of Indian social structure.

(1977). The diffusion of power and the control of force in a new international order. The Adelphi Papers: Vol. 17, The Diffusion of Power. Part II: Conflict and its Control Papers from the IISS 18th Annual Conference, pp. 9-16.

Russian and Chinese national interests tend to ward opposition. The Sino-Soviet alliance is wholly due to seizure of power by Chinese Communists and to conflict with the same enemies. Economic, military, and diplomatic dis parities have created a lopsided material dependence of Com munist China on the Soviet Union, resulting in divergent views on priorities within the alliance, and have caused them to dis agree on proper strategy in relation to the United States, anti- imperialist revolutionary movements, and independent neutral powers. Among states governed by totalitarian, ideological parties, these disagreements have naturally assumed the form of different interpretations of the common doctrine. Lacking other means of effective pressure on the Soviets, the Chinese have developed these differences into a systematic challenge to Soviet ideological authority. A Soviet attempt to evade this challenge and to preserve unity on the basis of toleration of in evitable differences and adjustment by compromise has failed; both sides have recognized the inevitability of factional schism for some time. They have built two rival Communist camps with separate policies. Underlying opposition of national in terests is increasingly appearing, and doctrinal differences are hardening. Though a serious attempt to return to policy co ordination is unlikely, the formal bond of the alliance may well continue as reinsurance against the common enemy so long as both countries are ruled by Communist party regimes.

One of the ugly facts of life which we now have to face fairly and squarely since the failure of the high-level discussions at Geneva in July and October I955 is that nuclear disarmament is still a long way off, though a measure of conventional disarmament may be nearer. Specifically, our defence policy must, I suggest, aim at three main objectives: to prevent all wars, small, medium, and large, and above all to ensure that the H-bomb is never used; to strengthen our hand in negotiations and in blocking Communist power politics, particularly in Germany but also all round the Communist perimeter; to pave the way for nuclear disarmament, and meanwhile to bring about and exploit any conventional disarmament that is practicable. Our present defence policy, which Mr Dulles has labelled 'massive retaliation', seems to be becoming much too drastic and inflexible for these objectives. Increasingly we are getting into a position where, in effect, we shall be forced to threaten, and if necessary initiate, the destruction of civilization in the event of any measure of aggression too powerful for our small conventional forces to combat. For, except in the most restricted areas, our conventional forces are unable to withstand the vast Communist conventional forces without the tactical use of atomic weapons, and there seems at present to be no distinctionbetween the tactical use of atomic weapons and the unlimited strategic use of the H-bomb. The proposition which I want to put forward is, that we should, in fact, establish a clear distinction between the tactical and strategic use of nuclear weapons, so that we can use our atomic weapons tactically without provoking the strategic use of hydrogen weapons.2 I suggest that we work out and declare in peace, without waiting for Communist agreement, some such distinctions as these: we regard the tactical use of nuclear weapons as confined to atomic weapons only, and we exclude the use of even these against towns and cities; strategic use of nuclear weapons would refer to the use of hydrogen weapons and to the mass destruction of towns and cities, even by atomic weapons. We might also add that, to conform to the moral principle of limiting the use of force

The policy declaration and the appeal to the peoples of the world adopted last December by the Moscow conference of eighty-one Communist parties mark the end of one phase in the dispute between the leaderships of the ruling parties of China and the Soviet Union—the phase in which the followers of Mao for the first time openly challenged the standing of the Soviet Communists as the fountain-head of ideological orthodoxy for the world movement. But the “ideological dispute” which began in April was neither a sudden nor a self-contained development: it grew out of acute differences between the two Communist Great Powers over concrete diplomatic issues, and it took its course in constant interaction with the changes in Soviet diplomatic tactics. Hence the total impact of that phase on Soviet foreign policy on one side, and on the ideology, organisation and strategy of international Communism on the other, cannot be evaluated from an interpretation of the Moscow documents alone, but only from a study of the process as a whole, as it developed during the past year on both planes.