Maximus the Confessor and John of Damascus on Gnomic Will (γνώμη) in Christ: Clarity and Ambiguity

For years I have been perplexed as to why Maximus the Confessor, in his articulate christological formulations in the seventh century, ultimately decided that Jesus Christ, as fully human, had only a natural human will (θέλημα φυσική), and so forcefully ruled against the possibility that he also had a "gnomic" (or "deliberative") will (γνώμη) in the manner of fallen human beings. In the words of Maximus' own beloved predecessor, Gregory Nazianzen, "what is not assumed is not healed." Though not alone in this concern, I’ve made a regular pest of myself broaching this issue in numerous patristics conferences (most recently the 2011 Oxford Patristics Conference) anytime an essay on Maximus would even remotely touch on the matter. The answer I get represents a fairly hardened scholarly consensus. Accordingly, Maximus, in working out his understanding of the Chalcedonian definition, still required a certain asymmetry in the composite hypostasis of Christ, since it is the divine hypostasis of the Son who united with and divinized the humanity of Jesus. In this case only a "natural" human will could be truly deified, not a gnomic will prone to vacillation. I agree with this consensus in general, and it has been strengthened all the more in an excellent recent study by Ian McFarland comparing Maximus’ doctrine of the will with that of Augustine. McFarland has cogently argued the plausibility of Maximus' denial of γνώμη in Christ as a function of his strong sense that "natural" human will, as modeled in Christ, is not antecedently "constrained" by the will of the divine Creator but a manifestation of the gracious stability of human will in concert with deifying divine grace. Indeed, Christ has effectively liberated human willing from the disastrous illusion of "autonomy" that characterizes human existence after the fall

Medicines prescribed by non-medical independent prescribers in primary care in Wales: a 10-year longitudinal study April 2011–March 2021

OBJECTIVES: The therapeutic classes of medicines prescribed by non-medical independent prescribers (NMIPs) working in primary care in Wales has not been studied in detail. The aim of this study was to conduct a 10-year longitudinal analysis of NMIP prescribing in Wales from April 2011 to March 2021. The study examined the British National Formulary (BNF) chapters from which medicines were prescribed by NMIPs, whether this changed over time, and whether there was variation in prescribing across the geographic regions of Wales. DESIGN: Retrospective secondary data analysis of primary care prescribing data. Monthly prescribing data for the 10 National Health Service financial years (April to March) from April 2011 to March 2021 were obtained from the Comparative Analysis System for Prescribing Audit software. Data were analysed according to BNF chapter, to identify in which therapeutic areas NMIPs were prescribing, and whether this changed over the study period. RESULTS: The number of items prescribed by NMIPs increased during the study period. From April 2011 to March 2021 prescribing in seven BNF chapters equated to approximately 80% of total items, with cardiovascular system medicines most prescribed. In the financial year 2011–2012 the BNF chapters with the greatest proportion of items prescribed were infection (18%) and respiratory system (13%), while in 2020–2021, these had changed to cardiovascular (23%) and nervous system (19%). The number of items prescribed in each health board in Wales varied, however, the BNF chapters contributing the largest percentages of items to the health board totals were broadly comparable. CONCLUSIONS: The BNF chapter with the most prescribed items changed from infection to cardiovascular during the study period, suggesting an increase in chronic disease management by NMIPs. The impact of this on the delivery of primary care services and patient outcomes is a focus for future work

Spatial trends on an ungrazed West Cumbrian saltmarsh of surface contamination by selected radionuclides over a 25 year period

Long term spatial and temporal variations in radionuclide activity have been measured in a contaminated ungrazed saltmarsh near Ravenglass, Cumbria. Over a twenty–five year period there has been a decrease in activity concentration with 106Ru and 137Cs showing the highest rate of change followed by Pu alpha and 241Am. A number of factors contribute to the reduction with time; including radiological half lives, discharge and remobilisation. For 241Am the lower reduction rate is partially due to ingrowth from 241Pu and partially as a result of transport of sediment from the offshore Irish Sea mud patch. Considerable spatial variation for the different radionuclides was observed, which with time became less defined. The highest activity concentrations of long-lived radionuclides were in low energy areas, typically where higher rates of sedimentation and vegetation occurred. The trend was reversed for the shorter lived radionuclide, 106Ru, with higher activity concentrations observed in high energy areas where there was frequent tidal inundation. Surface scrape samples provide a pragmatic, practical method of measuring sediment contamination over large areas and is a sampling approach adopted by most routine environmental monitoring programs, but it does not allow for interpretation of the effect of variation in sedimentation rates. This paper proposes a method for calculating indicative sedimentation rates across the saltmarsh using surface scrape data, which produces results consistent with values experimentally obtained

Spatial trends on an ungrazed West Cumbrian saltmarsh of surface contamination by selected radionuclides over a 25 year period

Long term spatial and temporal variations in radionuclide activity have been measured in a contaminated ungrazed saltmarsh near Ravenglass, Cumbria. Over a twenty–five year period there has been a decrease in activity concentration with 106Ru and 137Cs showing the highest rate of change followed by Pu alpha and 241Am. A number of factors contribute to the reduction with time; including radiological half lives, discharge and remobilisation. For 241Am the lower reduction rate is partially due to ingrowth from 241Pu and partially as a result of transport of sediment from the offshore Irish Sea mud patch. Considerable spatial variation for the different radionuclides was observed, which with time became less defined. The highest activity concentrations of long-lived radionuclides were in low energy areas, typically where higher rates of sedimentation and vegetation occurred. The trend was reversed for the shorter lived radionuclide, 106Ru, with higher activity concentrations observed in high energy areas where there was frequent tidal inundation. Surface scrape samples provide a pragmatic, practical method of measuring sediment contamination over large areas and is a sampling approach adopted by most routine environmental monitoring programs, but it does not allow for interpretation of the effect of variation in sedimentation rates. This paper proposes a method for calculating indicative sedimentation rates across the saltmarsh using surface scrape data, which produces results consistent with values experimentally obtained