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In this article, we examine participation in floor debates by U.S. House Speakers in the First through Twenty-sixth Congresses (1789-1841). Consistent with the often-stated view that Speaker Henry Clay of Kentucky transformed the office of Speaker by using the prerogatives of the office more expansively than other early Speakers, Clay stands out among the Speakers of this period for the frequency and length in which he engaged in House debates. However, we also find that Speakers were regularly participating in floor debates over a decade before Clay held the office and that the five Speakers who succeeded Clay did not regularly participate in debate. Although Clay was not the first Speaker to participate regularly in floor debate, we propose that he transformed the office by effectively using all of the leadership tools available to the Speaker, demonstrating to his House colleagues the benefits of having the Speakership function as the central leadership institution for the chamber. [ABSTRACT FROM AUTHOR]

Competition in U.S. House elections has been declining for more than 50 years and, based on both incumbent reelection rates and the percentage of close races, the 2002 and 2004 House elections were the least competitive of the postwar era. This article tests three hypotheses that attempt to explain declining competition in House elections: the redistricting hypothesis, the partisan polarization hypothesis, and the incumbency hypothesis. We find strong support for both the partisan polarization hypothesis and the incumbency hypothesis but no support for the redistricting hypothesis. Since the 1970s there has been a substantial increase in the number of House districts that are safe for one party and a substantial decrease in the number of marginal districts. However, this shift has not been caused by redistricting but by demographic change and ideological realignment within the electorate. Moreover, even in the remaining marginal districts most challengers lack the financial resources needed to wage competitive campaigns. The increasing correlation among district partisanship, incumbency, and campaign spending means that the effects of these three variables tend to reinforce each other to a greater extent than in the past. The result is a pattern of reinforcing advantages that leads to extraordinarily uncompetitive elections. [ABSTRACT FROM AUTHOR]

The article discusses whether ketamine can be safely used for sedation in head injury. It describes the case of a 19-year-old man who was rescued by an emergency service unit after being buried when the walls of the trench he was digging collapsed. He was diagnosed with mild hypoxic brain injury and later on discharged without neurological deficit. It cites the characteristics of ketamine, such as having a positive effect on gut motility, which makes it ideal as an analgesic and sedative.

The article discusses the case of a male patient who underwent prehospital thoracostomy for thoracic trauma. The case demonstrates the importance of advanced chest decompression skills in the prehospital resuscitation of patients with critical trauma. Serious complications associated with chest drains will be minimal if appropriately trained and experienced practitioners perform the chest drains.