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For Paul Molnar, “A Catholic Appraisal” unfairly holds Barth to be inconsistent in claiming that God has his being in his act of revelation, and he shows that Barth often says the opposite of this. This does not resolve the inconsistency, but simply makes it more apparent. For Paul Hinlicky, the essay unfairly assumes that Barth needs to be consistent in the first place. Reflection on the law of identity shows how unfruitful it is for theologians to think they can dispense with basic logical truths. The essay concludes with arguments on the saving significance of baptism, the human refusal of God, and what theology can accomplish, in response to Katherine Sonderegger.

At least two of Barth's main claims are incompatible with basic commitments of Catholic theology, though in neither case does seeing the problem in Barth depend on accepting uniquely Catholic beliefs. If carried through consistently (which Barth does not do) his claim that God has his being in his act of revelation proves incompatible with the insistence of Nicene trinitarianism that three distinct persons are one God, and that one divine person contingently became flesh as a free gift for our salvation. In soteriology, Barth's doctrine of election proves incompatible with the belief that we are participants in our own salvation, and not merely spectators of it.

The COVID-19 pandemic has had profound implications for continuing medical education. Travel restrictions, lockdowns and social distancing in an effort to curb spread have meant that medical conferences have been postponed or cancelled. When the Australian and New Zealand College of Anaesthetists made the decision to commit to a fully virtual 2021 Annual Scientific Meeting, the organising committee investigated the viability of presenting a virtual ‘Can’t intubate, can’t oxygenate’ workshop. A workshop was designed comprising a lecture, case scenario discussion and demonstration of emergency front-of-neck access techniques broadcast from a central hub before participants separated into Zoom® (Zoom Video Communications, San Jose, CA, USA) breakout rooms for hands-on practice, guided by facilitators working virtually from their own home studios. Kits containing equipment including a 3D printed larynx, cannula, scalpel and bougie were sent to workshop participants in the weeks before the meeting. Participants were asked to complete pre- and post-workshop surveys. Of 42 participants, 32 responded, with the majority rating the workshop ‘better than expected’. All except two respondents felt the workshop met learning objectives. Themes of positive feedback included being impressed with the airway model, the small group size, content and delivery. Feedback focused on previously unperceived advantages of virtual technical skills workshops, including convenience, equitable access and the reusable airway model. Disadvantages noted by respondents included lack of social interaction, inability to trial more expensive airway equipment, and some limitations of the ability of facilitators to review participants’ technique. Despite limitations, in our experience, virtual workshops can be planned with innovative solutions to deliver technical skills education successfully.

The Revised Conflict Tactics Scales (CTS2) is frequently used to assess intimate partner violence (IPV), but consistently yields low to moderate interpartner concordance of reports. Interpartner concordance on an alternative measure, the Event History Calendar Interview (EHCI), is largely unknown. We observed limited interpartner concordance of IPV reports on the CTS2 and EHCI, with wives generally reporting more IPV than husbands. Compared with the CTS2, the EHCI detected more cases of IPV, but not differential behavior counts. Partners’ posttraumatic stress disorder severity, a common respondent characteristic and focus of IPV research, was associated with low interpartner concordance of reports on the CTS2, but not the EHCI. Additionally, husbands’ posttraumatic stress disorder severity was associated with wives reporting more husband-perpetrated IPV on the CTS2 than the EHCI. Overall, the EHCI appears to mitigate some of the problems associated with the CTS2 as a measure of IPV, particularly among more highly traumatized samples.

Team science1—what a concept! To many, the idea that a group of scientists can work together on a common problem and seek collective answers leading to success seems almost intuitive. Yet the practicality and value of the concept is only now beginning to be fully recognized. Part of this may stem from classical training moors where basic scientists talk among themselves but seldom to clinical trialists who talk among themselves but not much to population scientists. And the nascent field of implementation science is in its relative infancy as a formal discipline. This creates a conundrum because relatively few translational scientists have cross-training between disciplines and, in many cases, have little idea of the methodologies or interpretation of data generated by these different research groups. For all of these reasons and more, a broader approach to training and interaction between physician scientists with diverse clinical and research backgrounds to give due consideration for the spectrum of translational science is desperately needed. The translational research continuum has expanded well past the traditional “bench-to-bedside” paradigm that has been used for decades.2 Currently, the paradigm is designed to engage research and development of a therapeutic entity from basic (“bench”) research (T0) that aims to define normal or pathologic physiological mechanisms that may become therapeutic targets. Preclinical animal models (T1) are designed to demonstrate in vivo therapeutic activity and various stages of clinical (“bedside”) trials (T2) seeking to verify adequate safety and efficacy properties of the therapeutic agent that may lead to FDA approval.3 The relatively new component of translational research called implementation science (T3) studies methods and potential obstacles to the successful utility of the targeted therapy in the population of interest.4 The final stage (T4) is population (“curbside”) research where the impact of the therapy on health …

Driveline infection is the most common infectious complication in patients with left ventricular assist devices. Minimum inhibitory concentration changes are not well described in relapsed driveline infections. This retrospective descriptive epidemiology study of patients with left ventricular assist device implantation between January 1, 2013, and August 1, 2017, who developed driveline infection with positive cultures aimed to describe minimum inhibitory concentration changes. Of the 330 patients underwent left ventricular assist device implantation, 30 (9%) met criteria for driveline infection. Median duration of follow-up was 26 months (interquartile range 16, 39) and time to first driveline infection was 171 days (interquartile range 83, 403). There were 74 driveline infections: 40 new and 34 relapsed. Staphylococcus aureus was most common in new and relapsed driveline infection. Thirteen patients comprised the 34 relapsed infections, 9 of which experienced a minimum inhibitory concentration change. Median time to first minimum inhibitory concentration change was 56 days (interquartile range 36–88), and type of minimum inhibitory concentration change was an increase in five cases, decrease in two cases, and both increase and decrease in two cases. Minimum inhibitory concentration changes did not result in resistance in S. aureus but did in Pseudomonas aeruginosa and Mycobacterium fortuitum relapsed driveline infection. Time to first relapse from initial infection was longer in those who received suppressive therapy, 60 days versus 83 days, p = 0.047. Relapsed driveline infections were most common with S. aureus. Minimum inhibitory concentration changes were quite variable and may not be the major contributor to relapsed infection in gram-positive driveline infection.

Increased computing power and greater access to online data have led to rapid growth in the use of computer-aided text analysis (CATA) and machine learning methods. Using “big data”, researchers have not only advanced new streams of research, but also new research methodologies. Noting this trend and simultaneously recognizing the value of traditional research methods, we lay out a methodology that bridges the gap between old and new approaches to operationalize old constructs in new ways. With a combination of web scraping, CATA, and supervised machine learning, using labeled ground truth data (i.e., data with known inputs and outputs), we train a model to predict CIP (Charismatic-Ideological-Pragmatic) leadership styles from running text. To illustrate this method, we apply the model to classify U.S. state governors’ COVID-19 press briefings according to their CIP leadership style. In addition, we demonstrate content and convergent validity of the method.

Background: The prevalence of opioid use disorder (OUD) has increased sharply. Office-based opioid treatment with buprenorphine (OBOT) is effective but often underutilized because of physicians’ lack of experience prescribing this therapy. Little is known about US residency training programs’ provision of OBOT and addiction medicine training. Methods: The authors conducted a survey of residency program directors (RPDs) at all US residency programs in internal medicine, family medicine, and psychiatry to assess the frequency with which their residents provide care for OUD, presence and features of curricula in OBOT and addiction medicine, RPDs’ beliefs about OBOT, and potential barriers to providing OBOT training. Results: The response rate was 49.5% (476 of 962). Although 76.9% of RPDs reported that residents frequently manage patients with OUD, only 23.5% reported that their program dedicates 12 or more hours of curricular time to addiction medicine, 35.9% reported that their program encourages/requires training in OBOT, and 22.6% reported that their program encourages/requires obtaining a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. Most RPDs believe that OBOT is an important treatment option for OUD (88.1%) and that increased residency training in OBOT would improve access to OBOT (73.7%). The authors also found that programs whose RPD had favorable views of OBOT were more likely to provide OBOT and addiction medicine training. Psychiatry programs were most likely to provide OBOT training and their RPDs most likely to have beliefs about OBOT that were positive. Commonly cited barriers to implementing OBOT training include a lack of waivered preceptors (76.9%), competing curricular priorities (64.1%), and a lack of support (social work and counseling) services (54.0%). Conclusions: Internal medicine, family medicine, and psychiatry residents often care for patients with OUD, and most RPDs believe that increased residency training in OBOT would increase access to this treatment. Yet, only a minority of programs offer training in OBOT.

BACKGROUND: Delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) was first introduced in 1996 by Bashir et al. as a method of indirectly evaluating glycosaminoglycan (GAG) changes in cartilage microstructure. Following publications originating from the Boston Children’s research group describing the association of early joint failure following periacetabular osteotomy (PAO) in patients with diminished preoperative cartilage T1 relaxation values, the interest in this imaging technique spread. dGEMRIC imaging was introduced into our clinical practice in 2013 with enrollment of both pediatric and adult patients. However, since the program’s apex in 2015, a marked decline in referral of adolescent patients for preoperative dGEMRIC imaging has occurred. Using data acquired during a quality analysis of the dGEMRIC program, this project was designed to investigate the utility of the dGEMRIC exam in our adolescent imaging cohort from 2013-2015 and to identify potential factors leading to decreased utilization from 2015-2018. METHODS: IRB approval was obtained for a HIPAA-compliant, retrospective cohort study which included all patients referred for dGEMRIC from May 2013- June 2015. 108 patients/112 exams/122 hips were identified. The study was designed in 4 parts including a. Blinded quantitative imaging review x 2 performed by 4 radiologists, b. Surgical review with 2 year post-operative follow-up completed July 2017, c. Patient phone interview, and d. Financial billing and reimbursement analysis. Subsequently, dGEMRIC utilization data from July 2015-May 2018 was compiled for comparative analysis of adolescent referral patterns. RESULTS: Of the 108 patients included in the comprehensive retrospective analysis, 56 were < 19 years of age with 43% of the adolescent patients participating in sports at time of presentation. 4 patients were excluded as the dGEMRIC data was either incomplete or could not be reprocessed. 61 hips were evaluated in the remaining 52 patients. The following summary data was compiled during the 4 part analysis. From the radiologist review: Siemens MapIt® T1 measurement software performed well at both 1.5 T and 3 T with good to excellent within rater ICC (0.79-0.92) but the between rater agreement was lacking particularly at 3.0 T (0.45) compared to 1.5 T (0.77) (p10 ($2300-$24,000). Following completion of the quality analysis and review of the results with the referring orthopedists, only 17 dGEMRIC exams have been performed in the adolescent age group in the subsequent 36 months. CONCLUSIONS: While the dGEMRIC exam holds promise as a prognosticating tool to guide surgical planning, in the adolescent practice environment, our historical data reveals that even when faced with abnormal T1 relaxation values, surgeons may opt to proceed with hip sparing surgical procedures simply because of the young age of the patient. From the radiologist’s perspective, dGEMRIC reporting is clouded by measurement variability. Inherent variability in the numbers reported brings to question the wisdom of using absolute T1 numeric thresholds to prognosticate joint failure risk. From the patient’s perspective, this imaging test comes with significant cost measured by time, pain, and financial burden. For all these reasons, utilization of this imaging study should be limited to the select few adolescent patients in whom documentation of an abnormal cartilage T1 value alone could substantially impact the surgical plan.

General procedures, including the estimation of annual average daily traffic (AADT) from short-duration counts, have not been established for nonmotorized traffic monitoring programs. Continuous counts of nonmotorized traffic were collected at six locations on the off-street trail network in Minneapolis, Minnesota, in 2011. A new approach for estimating AADT values from short-duration counts, the use of day-of-year factors, is demonstrated. Analyses of variability in count data can be used to design a monitoring program that uses both continuous and short-duration counts of nonmotorized traffic. Five core conclusions may be useful for developing nonmotorized monitoring programs: (a) day-of-year scaling factors have smaller error than does the standard (day-of-week and month-of-year) method of AADT estimation, especially from short-duration counts (

The authors discuss some of the unique aspects and lessons of the New Zealand post-earthquake building safety inspection program that was implemented following the Canterbury earthquake sequence of 2010–2011. The post-event safety assessment program was one of the largest and longest programs undertaken in recent times anywhere in the world. The effort engaged hundreds of engineering professionals throughout the country, and also sought expertise from outside, to perform post-earthquake structural safety inspections of more than 100,000 buildings in the city of Christchurch and the surrounding suburbs. While the building safety inspection procedure implemented was analogous to the ATC 20 program in the United States, many modifications were proposed and implemented in order to assess the large number of buildings that were subjected to strong and variable shaking during a period of two years. This note discusses some of the key aspects of the post-earthquake building safety inspection program and summarizes important lessons that can improve future earthquake response.

The earthquake that shook Hispaniola on 12 January 2010 devastated Haiti. The damage was widespread due to uncontrolled construction, poor material quality, and lack of rigorous engineering design. Post-event reconnaissance has brought to light serious deficiencies in these areas. Residential buildings in Haiti are typically constructed by their owners, who may or may not have the skills or resources to build a structure that is earthquake-safe. Few structures are designed by engineering professionals or are inspected for quality of construction. The two most common construction materials are masonry block and reinforced concrete. Masonry blocks, concrete cylinders, and reinforcing steel were taken from Haiti and tested in the United States. The concrete and masonry were shown to be of low strength and quality. The steel samples show expected strength properties with some specimens having reduced ductility due to bending. Building performance is demonstrated by reconnaissance photographs and case studies of the structures inspected by reconnaissance team members.

The Mw 7.0 earthquake that struck Haiti on 12 January 2010 exposed deeply rooted weaknesses of the built environment. Numerous factors contributed to the severity of this disaster, including building materials, design, construction, and oversight, all of which were deficient and represent a lower bound condition. Yet despite poor quality, some structures were undamaged. A minor change in construction sequence resulted in an altered load path and a drastically different outcome for some buildings. Infilled frame systems performed poorly and account for the majority of structural collapses. Buildings assembled in a manner similar to confined masonry, however, performed well and experienced little damage. Damage assessments conducted around Port-au-Prince reveal that 20% of the housing stock was completely destroyed and 27% was significantly damaged. These assessments illuminate Haiti's vulnerability to future and repeated devastation, since the remaining damaged and brittle structures could likely not sustain additional excitation.

This study presents a new interpretation of the evidence for Holocene lake-level changes from Hawes Water in NW England constrained by detailed stratigraphic data, radiocarbon chronology and palaeo-environmental evidence. Lake levels are seen to decline gradually from the start of the Holocene through to 9960 cal. yr BP, in response to lake infilling and the prevailing dry climatic conditions. Low lake levels then persist until 6000 cal. yr BP, punctuated by two transgressive phases. Rising sea levels during the Holocene high-level sea stand are thought to be responsible for a major rise in lake level at 6000 cal. yr BP driven by changes in the local water-table. The rise in lake level is coincident with a rise in anthropogenic activity across the site, possibly reflecting the migration of coastal Mesolithic communities inland in response to rising sea levels.

A 1000 year long subdecadal-resolution record of carbonate oxygen isotopes (δ18Oc) from Lough-na-Shade, Ireland, provides evidence for changing atmospheric circulation over northwest Europe. The total range of δ18Oc values (>5‰) is too large to be explained by changes in water temperature. Moreover, good correlation between the lake record and a previously published δ18O time series from an Irish speleothem indicates that the changes in oxygen isotopes are best explained by variations in the isotopic composition of precipitation. The amplitude of change during this period is too large to be explained by shifts in condensation temperature. Instead we suggest that there have been changes in vapour source and transport paths connected with shifts in atmospheric circulation. Changes from a source area from further south within the North Atlantic to one further to the north could explain the prominent positive shift in oxygen-isotope values between the early eighteenth and early nineteenth centuries, for example. Our results also demonstrate the value of a ‘multiple-archive’ approach to deconvolving lake-based carbonate isotope profiles, which are often complex.

This paper presents the first high-resolution chironomid-inferred mean July air temperature (C-IT) reconstruction for the early Holocene from England. The reconstruction is based on a core recovered from a terrestrialised carbonate bench at Hawes Water, a small hard-water lake in northwest England. The record shows that temperatures rose rapidly after the Younger Dryas with temperatures reaching 14.0°C at the beginning of the Holocene. Over millennial timescales, the temperature record points to a slight rise in temperatures towards the top of the sequence at around 8000 years before the year 2000 (b2k). The trend is punctuated by a series of cool oscillations (at 11 200, 11 400, 10 700, 10 400, 9300 and 8300 b2k) and by a short period (11 300 to 10 250 b2k) when temperatures were considerably warmer (up to 14.9°C). The five cool oscillations coincide with temperature reversals found elsewhere in the North Atlantic region and in the Greenland ice core records. These cool events correlate well with both meltwater fluxes from the Laurentide and Scandinavian ice sheets and periods of low solar activity. Two of these oscillations (at 9300 and 8300 b2k) vary significantly from the early-Holocene mean. C-IT shift rapidly during both these events and temperatures fall ~1.6°C below the early-Holocene mean trend for ~ 50—60 years. The results presented here provide an insight into the instability of the early-Holocene climate in the British Isles and demonstrate the sensitivity of chironomids to rapid climatic events during the early Holocene.

Many school districts in the United States allow parents to choose which school their child attends ('school choice' or 'magnet schools') while other school districts require students to attend their nearest ('neighborhood') school. Such policies influence children's transportation. We survey elementary-school parents in St. Paul and Roseville, Minnesota, to discover how children travel to school and underlying factors influencing parent's choice of their child's travel mode. From this information we develop a statistical model of travel mode choice. We find that children's commute mode and parental attitudes towards school selection differ by school type (magnet versus neighborhood), income, and race. Relative to neighborhood schools, magnet schools draw from broader geographic regions, have lower rates of walking, bicycling, and commuting by automobile, and higher busing rates. Parent attitudes towards transportation also differ by race and school type. For example, parents of nonwhite and magnet school students placed greater-than-average importance on bus service and quality. This paper highlights the potentially unintended influence of school district policy on school commute mode. KW: SR2S Language: en

In most metropolitan regions throughout the globe, urbanised land area is increasing to accommodate increasing population size. This article provides a simple yet powerful mathematical description of this urban expansion. Specifically, the following scaling relationship is proposed: land area (A) increases proportionally to population size (P) raised to a power (n)— i.e. A ∝ P n. During 1950—2000, this relationship is found to hold well for US Census urban areas (UAs) with a greater than 10 per cent increase in population. Values for the parameter n vary among UAs, with a central tendency value of ∼ 2, suggesting that, on average, newcomers to urban areas occupy about twice the land area per capita of existing residents. If n were exactly equal to 2, then the parameter group P/√A (called `linear population density', or LPD) would be constant over time. LPD (units: people per metre) is the number of people in a metre-wide strip across an urban area. LPD is distinct from, and behaves somewhat differently than, population density. Distributions of LPD values among US UAs during 1950—2000 show surprisingly little variability over multidecade time-scales. For example, from 1950 to 2000, average population, land area and population density changed by more than a factor of 2, but average LPD changed less than 10 per cent. Few, if any, other attributes of urban form have remained so constant during this half-century time-period. International data corroborate the finding that LPD distributions are roughly constant over multidecadal time-scales. These results suggest an underlying pattern to how people arrange themselves within and among urban areas. For US UAs, rank—size rules similar to the generalised version of Zipf's rule hold for population, land area, LPD and population density. LPD is an important predictor of the emissions-to-inhalation relationship for motor vehicle emissions. Results presented here are important for theoretical, practical and empirical investigations of urban form and of how urban areas expand over time.

Head Mounted Displays (HMDs) have traditionally been and are currently utilized in a variety of applications including training, entertainment, and military operations. Most applications of HMDs seek to provide the user with enriched information, that is, information beyond that of what a human can gather with only biological vision. The Land Warrior is an operational system that utilizes a HMD. For Land Warrior, the HMD provides the Soldier better battle field situational understanding through text by communicating command and control information. Other Land Warrior battlefield tasks include target detection and recognition. This paper evaluates the visual components of the current Ground Soldier System (GSS), Land Warrior HMD, analyzes embedded training requirements (specifically detection ranges for embedded virtual targets and human performance issues associated with HMDs), and proposes an optical model to overcome some of the limitations inherent to the current commercial version of the Land Warrior HMD and other commercially-available HMDs. The design quality of the Land Warrior HMD has a direct impact on a soldier's performance in the field. The varying stringent environment in which LW operates provides HMD visual component design challenges, due to the correlation between the equipment style, information formatting, and use environment. Information formatting affects a Soldier's workload. The current LW HMD visual implementation contains information formatting limitations based on its ability to scale to other resolutions and size linearly. By increasing the performance of the HMD of the Land Warrior System, the potential to improve readiness and survivability also increase. Forty-five thousand sets of Land Warrior equipment will be fielded between 2001 and 2014.

This article explores historic carbon dioxide (CO2) emission trends from road and air transportation of the United States and 26 developing and industrializing nations. It is argued that environmental trends in the newest industrializing countries do not follow the more sequential and long-term shifts experienced by the United States. The empirical analysis demonstrates that all rapidly developing countries analyzed exhibit comparable transportation CO2emissions per capita levels at lower levels of income per capita, or sooner, than the United States. For some developing countries (the most rapidly growing), these emissions also grow faster over time. Last, there is clear evidence that emissions from road and air sources are occurring more simultaneously compared to the United States. This pattern of changes is in contrast with the common interpretation of environmental Kuznets curves, which suggest that countries follow similar patterns of environmental impacts over time as they develop economically.

Parenterally administered human recombinant type I interferons (hrIFN) in relapsing-remitting multiple sclerosis (RRMS) decrease relapses and spontaneous in vitro IFN-gamma production, reduce clinical progression, and decrease magnetic resonance imaging (MRI)-defined disease activity and lesions. Parenterally administered type I IFN use is limited by clinical and chemical toxicities, and the induction of antibodies that abrogate their activity in vivo correlated with the loss of clinical benefit. Therefore, we determined whether ingested IFN-alpha was non-toxic and had biological effects in humans. Ingested hrIFN-alpha showed no toxicity in normal volunteers or patients with RRMS at doses ranging from 300 to 100,000 units. In subjects with RRMS, a significant decrease in Con A-mediated proliferation and serum soluble intercellular adhesion molecule-1 (sICAM-1), a surrogate measure for disease activity in MS, was found after ingesting 10,000 and 30,000 units IFN-alpha The RRMS subjects also showed decreased IL-2 secretion after ingesting 10,000 units IFN-alpha and decreased IFN-gamma, TGF-beta and IL-10 production after ingesting 30,000 units IFN-alpha. The decreased secretion of IFN-gamma and IL-2 by ingested IFN-alpha suggests that oral IFN-alpha may cause a functional inhibition of Th J-like T helper cells in RRMS, a potential site of intervention at the level of effector T cells in MS. Our studies support the oral use of human IFN-alpha as a biological response modifier in humans.

Case summary An 18-month-old, female spayed, Australian Mist cat presented with a 24 h history of muscle tremors and inappetence progressing to collapse with generalised muscle fasciculations. The cat was diagnosed with a hypochloraemic metabolic alkalosis due to a duodenal foreign body found to be a trichobezoar at coeliotomy. The cat made a complete recovery after enterotomy to remove the trichobezoar, with cessation of neuromuscular clinical signs and normalisation of its electrolyte and acid–base imbalances. Relevance and novel information Muscle fasciculations and tremors in cats can be caused by intoxications, metabolic derangements, encephalomyelitis, feline hyperaesthesia syndrome and cerebellar diseases. The presenting clinical signs of severe muscle fasciculations and tremors have not previously been reported in association with an intestinal obstruction in the cat.

The authors in this article report on and develop a methodology for producing a well-defined problem in policy analysis. The methodology, which is christened the "evaluative context, " is defined as an iterative process based on a series of checklist questions. It is given a theoretical background in the literature, and its genesis and development are discussed in connection with a number of practical projects in earlier sections of the article. Finally, the use of the method ology is exhibited in a recent project.

“Inscrutable states of affairs, like sameness of faith in the heart, ought not … to be ‘taken by themselves,’ as though the unity of the church consisted only of such invisible ties but should rather be taken as interior or structural aspects of a visible, empirical, community they help to unify.”

A sizeable minority of depressed patients, estimated at 15-20%, suffer chronic symptoms which often persist despite appropriate treatment. The search for new, more efficacious pharmacotherapies has included testing existing medications for additional therapeutic effects, such as in combination treatment. Four treatment- refractory patients who presented to the authors for clinical care are described, in which the combination of bupropion and sertraline was effective for a major depressive episode. None of the patients experienced adverse effects. Two carried the diagnosis of unipolar depression, and two, bipolar disorder. All had prior adequate, but ineffective, separate trials of buproprion and a selective serotonin re-uptake inhibitor (SSRI), including sertraline. All had chronic depression with multiple failed medication treatments, arguing against the alternative explanation that their improvement represented a placebo response or spontaneous remission. The efficacious combination of sertraline and bupropion may be due to synergism of its two distinct antidepressant mechanisms involving serotonergic, dopaminergic and noradrenergic systems.

Roberts, C. (2005). Heavy Words Lightly Thrown: The Reason Behind the Rhyme (2nd ed., U.S. ed.). New York: Penguin The foreword material to the book Heavy Words Lightly Thrown tells us that author Chris Roberts is a librarian and tour guide in London. Along the way, he has collected interesting histories of common rhymes such as “Jack Be Nimble” and “Three Blind Mice.” For the American edition of this book, he kindly included a glossary for his pithy British terms and added “Yankee Doodle” and “Rock-aBye Baby,” which have strong American roots. In our folk-song based curricula it is sometimes a struggle to keep children engaged in core songs with antiquated terms and sensibilities. This book may be a way to enliven the discussion and enrich students’ sense of history and culture with information such as the following insight into the refrain of “This Old Man.”

Rationale To report a case of latex allergy in a patient with seminal fluid (SF) allergy. Methods A 23-year-old female complained of dyspareunia with postcoital vaginal soreness and swelling. She also reported sore throat and lip swelling after oral sex and had experienced abdominal urticaria after ejaculate exposure. She also reported labial pain and swelling after protected sex with condoms. Following unprotected intercourse she experienced an episode of angioedema, generalized urticaria, and dyspnea that required an emergency room visit for treatment with antihistamines, steroids, and epinephrine. Ejaculate from her sexual partner was prepared for skin prick testing (SPT) on the patient and her partner (as a control) by filtration and centrifugation. MEDLINE was searched for case reports of concurrent latex and SF allergy. Results She was SPT positive to SF (1:1000) [6 mm wheal; histamine 8 mm; saline 0 mm]. Her partner was similarly tested and was found to be SF negative [histamine 7 mm]. Her latex RAST was positive. MEDLINE search revealed one report of associated latex and SF allergy. Conclusions To our knowledge, this represents the second reported case of concurrent SF and latex allergy. This patient initially volunteered information related to symptoms after exposure to ejaculate, but later admitted to similar symptoms when exposed to latex condoms. Such a history could lead away from SF sensitivity altogether or could lead to dismissing a role for latex. This may be more frequent than is commonly appreciated. Thus, careful history and latex testing should be considered for patients reporting SF-induced symptoms.

We describe an evaluation undertaken on contract for the New Zealand State Services Commission of a major project (the Administrative Decision-Making Skills Project) designed to produce a model of administrative decision making and an associated teaching/learning packagefor use by government officers. It describes the evaluation of a philosophical model of decision making and the associated teaching/learning package in the setting of the New Zealand Public Service, where a deliberate attempt has been initiated to improve the quality of decision making, especially in relation to moral factors.