Patrick Henry College

Amidst the plethora of approaches to ecumenical dialogue and church reunion over the last century, a common theme has been the depreciation of the classic Protestant distinction between the “visible” and “invisible” church. Often seen as privileging an abstract predestinarianism over the concrete lives and structures of church communities and underwriting a complacency about division that deprives Christians of any motive to ecumenical endeavor, the concept of the “invisible” church has been widely marginalized in favor of a renewed focus on the “visible” church as the true church. However, I argue that this stress on visible unity creates a pressure toward institutional forms of unity that ultimately privilege Roman Catholic ecclesiologies at the expense of Protestant ones, and thus fails of its ecumenical promise. Renewed attention to Reformational understandings of the relationship between divine grace and human action and the centrality and uniqueness of Christ as the foundation of the church, I argue, dispels some misunderstandings of the church’s “invisibility” and demonstrates the indispensability of the concept. I argue that this Reformational framework, which refuses to accept the empirical divisions of the Church as definitive and summons us to an ecumenism that belongs to the church’s sanctification, provides the best theological ground for ecumenical endeavor.

Background The efficacy of aspirin in preventing cardiovascular events appears to be lower in DM patients than in general population. We have previously demonstrated a time-dependent aspirin efficacy suggesting that once daily aspirin does not provide 24h stable biological efficacy, mainly in patients with DM, inflammatory markers and active smokers. Objective: To compare biological efficacy of 150 mg/day aspirin given once daily (OPD) as compared to 150mg/day divided in 75 mg in the morning and 75 mg in the evening (BID) in a cross over study in patients with DM. Methods: A randomized monocentric prospective study with cross over is realized in 92 patients with DM and previous acute coronary syndrome with high risk of biological aspirin resistance (elevated hsCRP, elevated fibrinogen or current smoking). Blood samples are analyzed the morning just before aspirin intake in a blinded fashion. Primary endpoint is the percentage of aspirin resistant patients measured by light transmission aggregometry using arachidonic acid 0.5mg/mL (LTA-AA). PFA-100 testing, using epinephrine cartridges is also performed. Patients are considered resistant if aggregation is ≥20% with LTA-AA or if PFA-100 epinephrine closure time was ≤193 seconds. Results: Mean HbA1c is 7.4%±1.2% and 43% of patients are treated with insulin. Mean age is 64±10 y.o., 85% are male, 34% are active smokers and 52% are treated with clopidogrel. There is no difference in mean platelet count (270±78G/L), fibrinogen (3.6±1.0g/L) and hsCRP (5.5±6.9mg/L). Using LTA-AA, mean residual aggregation was 19.7±15.4% on OPD versus 11.9±10.4% on BID (p<0.001). Biological aspirin resistance (residual aggregation ≥ 20%) significantly decrease from 42% on OPD to 17% on BID corresponding to a decrease of 62% (p=0.0005). Interestingly, 24 patients resistant on OPD became sensitive on BID. Inversely, only one patient resistant on BID become sensitive on BID. Based on PFA-100, 41% of patients were resistant on OPD versus 29% on BID (p=0.12). Similar results are found in patients with or without clopidogrel. Conclusions In diabetic patients with elevated inflammatory markers or active smoking, the same dose of aspirin BID is biologically more effective than OPD.

The author asserts that the analyst's theory, personal and/or academic, is an important source of countertransference which complicates our traditional understanding of the analyst's emotional responses as being constructed from a mix of his transferences and the patient's effects on him. From this perspective, theory--because it has no intrinsic relevance to the essential phenomena of individual analytic processes--may be a confounding, as well as a necessary, factor in clinical work. Although the analyst's theory might be conceptualized as a component of his personality that shapes his emotional reactions to a patient, the author believes that there is a valuable increment of conceptual clarity and additional clinical utility to thinking about a more direct role of theory in the process of countertransference formation. He uses aspects of the clinical analysis of narcissistic resistances to illustrate how some theories might predispose an analyst to confounding unconscious enactments by generating either positive or negative countertransferences which can be used defensively by the patient and/or analyst. He also illustrates how, in some contexts, an analyst's theory might attenuate potentially informative countertransference reactions and interfere in this way with the analyst's apprehension of the patient's psychic functioning. Finally the author addresses the importance of 'fit' between an analyst's working theory and a patient's psychopathology, and considers implications of his ideas for psychoanalytic training and practice.