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Inhaled nitric oxide was effectively used to avoid the need for a second course of extracorporeal membrane oxygenation (ECMO) in a neonate with a congenital diaphragmatic hernia and recurrent pulmonary hypertension following ECMO.

Severe pulmonary hypertension is still a cause of morbidity and mortality in children after cardiac operations. The objective of this study was to compare the vasodilator properties of inhaled nitric oxide, a novel pulmonary vasodilator, and intravenous prostacyclin in the treatment of severe postoperative pulmonary hypertension.Thirteen children (aged 3 days to 12 months) with severe pulmonary hypertension after cardiac operations were given inhaled nitric oxide (20 ppm x 10 minutes) and intravenous prostacyclin (20 ng.kg-1.min-1 x 10 minutes) in a prospective, randomized cross-over study.Both nitric oxide and prostacyclin resulted in a reduction in pulmonary arterial pressure, although the mean pulmonary arterial pressure was significantly lower during nitric oxide therapy (28.5 +/- 2.9 mm Hg) than during prostacyclin therapy (35.4 +/- 2.1 mm Hg; p0.05). The mean pulmonary to systemic arterial pressure ratio was also significantly lower during nitric oxide than prostacylin administration (0.46 +/- 0.04 versus 0.68 +/- 0.05; p0.01), due mainly to only prostacyclin lowering systemic blood pressure.Inhaled nitric oxide was a more effective and selective pulmonary vasodilator than prostacyclin and should be considered as the preferred treatment for severe postoperative pulmonary hypertension.

We report successful treatment of adult respiratory distress syndrome (ARDS) with artificial surfactant (40mg/kg, Colfosceril Palmitate, ‘Exosurf’, Wellcome) in an infant with severePneumocystis carinii pneumonitis.

Background Adrenal dysfunction is associated with increased inotrope requirement and worse clinical outcome in children with sepsis. In children after bypass surgery a very low incidence of adrenal dysfunction is reported. However, use of hydrocortisone has been shown to improve hemodynamics of children requiring catecholamine after cardiac surgery. We aimed to evaluate the adrenal function of this subgroup of children requiring catecholamines after cardiac surgery. Methods Retrospective analysis of adrenal function testing of children requiring catecholamine after cardiac surgery at the Royal Brompton Hospital from 2006 to 2011. Adrenal function was assessed using a 250µg/1.73m 2 ACTH stimulation test. Two definitions of adrenal dysfunction were used: physiological (peak cortisol after ACTH stimulation Results 62 children were included in the study. Median (interquartile range) age was 3.2(0.9–6.5)months and weight 3.9(3.3–7.2)Kg. The mean RACHS was 2.5±0.7 and median catecholamine score 0.11(0.06–0.18). Seven (11.3%) children had adrenal dysfunction according to the physiological definition and 9 (14.5%) according to the critical care definition. Children with physiological adrenal dysfunction had significantly higher catecholamine requirement than children with normal adrenal function (p Conclusions In children requiring catecholamines after cardiac surgery, adrenal dysfunction according to a physiological definition (but not critical care definition) is associated with higher catecholamine requirement.

Inhaled nitric oxide was used successfully to treat a newborn infant with severe pulmonary hypertension complicating repair of congenital exomphalos. The infant had failed conventional treatment and extracorporeal membrane oxygenation was unsuitable because of the risk of bleeding from the recent laparotomy. Extended treatment with inhaled nitric oxide appears safe and may offer an alternative to mechanical life support in severe cases of neonatal pulmonary hypertension.

Objectives: To determine pre- and postoperative predictors of energy expenditure in children with congenital heart disease requiring open heart surgery; and to compare measured resting energy expenditure with current predictive equations. Design: Prospective resting energy expenditure data were collected, using indirect calorimetry, for ventilated children admitted consecutively to the pediatric intensive care unit after surgery for congenital heart disease. A 30-min steady-state measurement was performed in suitable patients. Resting energy expenditure was compared to pre- and postoperative clinical variables, and to predicted energy expenditure, using currently used predictive equations. Setting: Pediatric intensive care unit at the Royal Brompton Hospital, London. Patients: Children ventilated in the pediatric intensive care unit post surgery for congenital heart disease. Interventions: Measurement of energy expenditure by indirect calorimetry. Measurements and main Results: Twenty-one mechanically ventilated children (n = 17 boys, 4 girls) were enrolled in the study. Mean ± sd measured resting energy expenditure was 67.8 ± 15.4 kcal/kg/day. Most children had inadequate delivery of nutrients compared with actual requirements. Cardiopulmonary bypass had a significant influence on energy expenditure after surgery; in patients who underwent cardiopulmonary bypass during surgery, mean resting energy expenditure was 73.6 ± 14.45 kcal/kg/day vs. 58.3 ± 10.29 kcal/kg/day in patients undergoing nonbypass surgery. Children who were malnourished preoperatively had greater resting energy expenditure postoperatively. There was also a significant difference between measured energy expenditure and the Schofield (p = .006), World Health Organization (p = .002), and pediatric intensive care unit-specific formula (p < .0001). However, energy expenditure or a relative energy deficit in the early postoperative period was not associated with severity or duration of organ dysfunction. Conclusions: Poor nutritional status preoperatively and cardiopulmonary bypass were associated with a greater energy expenditure post cardiac surgery. None of the current predictive equations predicted energy requirements within acceptable clinical accuracy. Copyright

In the paediatric age group in the UK, there is an excess of donor organs over recipients. There are still deaths while waiting for transplantation. In an effort to extend the survival of children with dilated cardiomyopathy, we have employed a paracorporeal ventricular assist device (Medos HIA Assist, Medos, Stolberg, Germany) in patients who we felt were dying. We report our results here.

Policy studies has been one of the most dynamic parts of the social sciences over the past several decades. There has been substantial growth in the literature, the number of courses, the number of professionals who identify themselves with the field, and, arguably, in the impact on public sector policy and programs. The policy studies field is an eclectic one, claimed by public administrators, political scientists, economists, sociologists, psychologists, educators, environmental scientists, and many others. The policy studies enterprise, which I define here to include both "policy analysis" and "program evaluation," (more about this later) has struggled with its identity and with its image of itself. Ever self-critical, the field is as willing to hold up its failures as it is its successes. The assessment of the field in these books (as well as others) raises a number of issues: Does the field have an adequate and appropriate impact on decision making? Does it have credibility with both the academic community and policy decision makers? Is it overly vulnerable to political pressure? Or, alternately, unresponsive to decision maker needs? Does the policy studies field enhance the democratic process or undermine it? Can the field usefully address normative issues? Does it have adequate methodological power to answer key questions? Is it focusing on the key questions? Is the field appropriately organized and integrated or is it just a hodge-podge of sub-fields in the social sciences? How effectively do we convey the knowledge and skill in the field to new practitioners and students? In any field of study or practice (and public policy is both study and practice) it is desirable to have a sense of progress, a perception that the field is moving forward. Are we making progress in policy studies? To answer the progress question though, we need ways to gauge positive movement. These books provide clues about what it would mean to achieve progress in policy studies--partly by the criticism they make of the current state of the field, partly by the recommendations the books contain about what should be done, and partly from inferences which may be drawn from them. First, progress requires an effective way to incorporate values into the policy studies enterprise. To paraphrase Fischer in Evaluating Public Policy, the field needs not just to determine whether a goal has been achieved, but also whether the goal is worth pursuing in the first place. How to treat values has been a sticking point in policy studies and the social sciences generally for some time. Second, progress requires an improved process of deliberation and policy decision making. A key subpart is that the relationship between analysts and decision makers be improved. Policy studies typically are intended for "use." A good deal of discussion and inquiry over the years has focused on the extent to which policy studies are in fact used and the impact they do or do not have on decisions. While studies may make a contribution through enlightenment rather than instrumental use, a direct contribution to the deliberations of real decision makers remains the ideal. Decision makers in this case means not only those in "authorized" positions such as legislators and administrators, but citizens and policy recipients as well. Just how policy analysts should relate to policy participants is yet to be agreed upon. Third, progress in policy studies requires an improved linkage among a variety of fields and areas of study and practice. The linkages need to connect not only traditional disciplines like political science and economics, but also sub-areas under the policy studies umbrella like policy analysis, evaluation, auditing, performance measurement, and others. Linkages also should occur across content areas, e.g. learning from experience and analysis in health policy should assist in educational policy, and vice versa. The assertion that policy studies should be multi- or inter-disciplinary is longstanding, but how to achieve it in practice is still a concern. …

William Trumbull [1990] argues that the question of standing-who should be counted-in cost-benefit analysis can and should be settled by reference to the potential Pareto principle. He thus takes issue with our position [Whittington and MacRae, 1986] that the postulates of cost-benefit analysis do not determine standing. Trumbull's argument also raises more general questions as to the relation between cost-benefit analysis and policy analysis. We would therefore like to comment on Trumbull's article, and to expand on our position on the issue of who has standing in cost-benefit analysis, because the issues he raises are important ones for both economists and public policy analysts (and for those of us who try to be both). In his paper Trumbull develops two main arguments. The first is that the term "cost-benefit analysis" should be defined as the strict application of the potential Pareto improvement principle. The second is that the application of the potential Pareto principle requires, on technical grounds, that questions regarding standing be answered in specific ways. For example, Trumbull believes that a cost-benefit analyst must (1) accord standing to future generations and citizens of other countries, and (2) deny standing to criminals, because to do otherwise would be inconsistent with the potential Pareto principle, and thus the result of the cost-benefit analysis would be based on something other than an "economic criterion." We would like to comment on both of these points. It seems to us that the issue at stake is not really "standing" but the nature of economic expertise and its role in policy debate.

The long-debated issue whether social scientists should be concerned with improving the human condition, and if so how they should attempt this task, has been raised afresh in the exchange of views between Lee Benson (1978) and Warren Miller (1978) on “Changing Social Science to Change the World.” Before plunging into this debate, however, I should like to suggest that all of us who participate in it are viewing the world from a particular occupational perspective. Some years ago, when George Lundberg’s Can Science Save Us? (1947) was current, a friend suggested to me that a prior question was, “Should science save us?” He may have meant, as Miller suggests, that saving or changing the world is not the principal task of social scientists; or in another meaning, he may have been anticipating more recent critics in noting that a world “saved” by social science might not be one in which everyone would prefer to live. I hope that our efforts will not be counter-productive.

The comparison of objective and subjective social indicators can be illuminated by comparing their relations to individual choice, of which migration is an important instance. We have replicated for U.S. states Lowry's (1966) regression model of migration among SMSA's, and added an indirect subjective measure of quality of life in each state. This measure is based on a Gallup survey asking respondents about their preferences among states of the United States as places to live. A measure of collective preference for each state, as viewed by outsiders, is constructed from these responses. This new variable increases R2 from 0.798 to 0.828, and is itself predicted with an R2 of only 0.355 by objective variables. Objective indicators of well-being had increased R2 only from 0.762 to 0.798. We conclude that collective preferences — the subjective measure we have used — play an independent part in predicting migration.

Public policy analysis, a profession aimed at knowledge transfer, gives advice concerning public decisions. It can also recommend styles of reasoning, for citizens as well as analysts, to decrease the likelihood of misutilization of knowledge. These recommendations are more appropriate for an early stage of discourse reasoned proposal selection, than for the later stage of persuasion.

A technique of anaesthesia and surgery used in sheep, during insertion of ventricular asssist devices is described. Some animals also underwent double- reservoir cardiopulmonary bypass. Reference is made to previous reports of such techniques in sheep.

This paper extends the standard, urban, residential land-use model to analyze the effects of Federal Housing Administration (FHA) mortgage insurance. On the demand side, households are differentiated by income and tenure; on the supply side, the cost of housing is related to the asset prices of land and structure and the cost of capital. Hypothesizing that capital cost is a function of household tenure and income, tenure is chosen to minimize this cost. The effect of FHA, then, is to expand the housing consumption of moderate-middle income households, by reducing their capital cost, while displacing those whose cost is not reduced.

Two analogues of the aphid alarm pheromone (E)-β-farnesene, a trifluorofarnesene and a difluoro-1-norfarnesene, were found to be highly active and were more readily detectable than the parent compound. For (Z)-hexadec-11-enal, a component of some lepidopteran sex attractant pheromones, replacement of the carbonyl oxygen with a difluoromethyl group to give a difluoroheptadecadiene resulted in loss of activity. A trifluoroacetoxyhexadecanolide was a more volatile analogue of the mosquito oviposition pheromone (−)-(5R,6S)-6-acetoxy-5-hexadecanolide and was highly active.

Ever since policy analysis appeared on the scene as a field of higher education and practice, planners have been concerned about their relationship with it, at times claiming that planning and policy analysis are one and the same, at other times viewing the two as different fields. This article examines the relationship between the two fields in terms of their underlying assumptions and prevailing modes of practice, comparing them along eight dimensions. The conclusions show that some significant differences between the fields do exist, and there are trends both of convergence and divergence. Some directions for the future relations between planning and policy analysis are outlined.

The development of valid and useful social science requires social structures different from those of basic disciplines and departments. One such structure is a "technical community"; whereas a basic scientific community ideally looks only to its own members for definitions of problems, a technical community also looks to laymen. In planning to build or strengthen policy-related technical communities, we must systematically examine various aspects in which they differfrom scientific communities and may vary among themselves. These include the ways in which knowledge and expertise are relevant to policy; the boundaries between the expert knowledge of a particular technical community and other available knowledge; the balance between general and specific knowledge; the systems of careers and quality control needed; the types of organizations in which research and analysis are to be done; and the ways in which knowledge producers can be linked with users and practitioners. Although government policies can foster technical communities, their success requires the consent of members of present scientific communities. This consent in turn requires the dispelling of prejudices held by many basic social scientists, as well as careful testing as to what particular technical communities can accomplish.

The empirical validity of two propositions regarding FHA unsubsidized single-family activity are explored at the neighborhood level in this paper. The propositions are first that FHA serves moderate-to-middle-income families, not low-income families who live in the inner city nor high-income families who live in the outer suburbs; and second that all other things being equal, black owner-occupants are more likely to have an FHA-insured mortgage than are whites Two methods of analysis are performed: mapping and regression. First, 1974 FHA activity in the Philadelphia metropolitan area is mapped by race—black and white—and program—203(b), 221(d)(2), and 223(e)—at the census tract level. Then, the FHA activity by race and by program is regressed on 1970 neighborhood housing and population characteristics, again, using the census tract as the unit of observation. The results of the analysis provide support for both propositions. In Philadelphia in 1974, FHA is to a degree a border program differentially serving blacks.

Under the hypothesis of a myopic electorate, vote-loss-minimizing behavior by the party in power subject to a dynamic inflation-unemployment relation is shown to generate a stable electoral policy cycle. The pattern of unemployment and inflation in the United States during the four presidential election periods from 1957 through 1972 is then examined for evidence of whether or not the administration believes the electorate is myopic. The conclusion is that the myopic hypothesis does a superior job of explaining aggregate demand policy, as reflected by the unemployment rate, during the second and third election periods, while the hypothesis that the administration believes the electorate is rational does a better job in the first and fourth periods.

Since the theory of games was first made widely available, with application to economic behavior, its use has been suggested in many other areas, from the global to the individual. Several correspondences between game theory and certain aspects of political process have been noted.The contribution of game theory to substantive knowledge in the empirical sciences, however, has been modest; Luce and Raiffa judge that its impact has been greater in applied mathematics. The area of political behavior—despite the apparent applicability of the notion of conflict of interest—is similarly lacking in studies, although a few notable exceptions exist.

R OLL-CALL VOTES have attracted increasing interest as sources of information about issues in the legislative process.' The availability of computer programs for data processing has made it possible to search for salient issues by examining all the roll-call votes in a given Congress, rather than limiting analysis to pre-selected subsets of votes reflecting the judgment of the investigator. One particularly promising set of computer programs for this purpose is the BC TRY system, designed by R. C. Tryon.2 The purpose of the present paper is to illustrate the applicability of this system to roll-call analysis. Various procedures of multivariate analysis are applicable to the identification of legislative issues from roll calls. These include Guttman scaling, factor analysis, and cluster analysis. Computer programs are available for these procedures and several versions of them can be performed by particular programs in the BC TRY system.3 We select for presentation the procedure of non-communality cluster analysis, which is not widely available outside the BC TRY system, and which also has the advantage of making fewer assumptions about communalities than other methods. In addition we present the spherical analysis (SPAN) diagram, which can be computed for any three-dimensional factor space identified by the system. To illustrate these features, we shall use the votes of the Republican members of the U. S. House of Representatives in the 84th Congress (1955-56).

Persistent cleavages in the French body politic are analyzed by multiple regression methods. Religiosity, urban-rural differences, agricultural wealth, and agricultural proletarization are related to various divisions of the multiparty vote at three major elections. Common features of the regression coefficients at the three elections reveal lastings divisions in the electorate, while changes in the coefficients from one election to another reflect the rise of new political groups and the changing characteristics of the old.

The model of the U.S. economy developed by Arthur B. Laffer and R. David Ranson' of the Office of Management and Budget has received a great deal of attention from both economists and politicians. Inquiry has been devoted mainly to the effects of monetary and fiscal policy on nominal GNP. "The most unusual finding of the [Laffer-Ranson] model is that changes in the money stock work all of their effects on nominal GNP in the same quarter."2 However, Laffer and Ranson also have a striking conclusion regarding the relation between inflation and unemployment. "The evidence displayed here does not support a significant partial relationship between the rate of change of the GNP price deflator and the rate of unemployment. The results do not confirm the existence of a 'Phillips Curve.' " The purpose of this note is to examine the relation between unemployment and inflation in the Laffer-Ranson (LR) model. We will see that while there is no explicit relationship between the rate of change of the GNP price deflator and the rate of unemployment in the model, there is an implicit one, with the rate of change of the money stock being the connecting link. The note begins with a description of the variables and equations in the LR model. The relation between unemployment and inflation is examined in both the short run and the long run. Then an alternative relation is obtained by reestimating the price equation of the model.

Among the causes of the demise of the Fourth Republic, one prominently mentioned has been the incapacity of governments to govern. Not merely cabinet instability as such, but the association of premiers' popularity in the Assembly with their disinclination toward bold policy innovations, is the charge. Stability indeed there was: continuity of ministers under changing cabinets, relative persistence of cabinets (such as those of Queuille and Mollet) that maintained the existing political balance or even defended the Assembly against innovation. Stability, too, of policy: the continuation of the Indo-Chinese war and the Algerian war, for example, long after a policy change might have been considered. Underlying this sometimes artificial stability was the threat that an innovating premier or minister might soon find himself returned to the status of an ordinary denuty.

In the past seventy years, lasting reorientations of the national electorate have taken place in two periods, centering about the presidential elections of 1896 and 1918. Most other presidential elections have involved relatively uniform swings of states or counties toward one party or the other; Louis Bean summarized this phenomenon in his chapter title, "As Your State Goes, So Goes the Nation."' But the occasions when this uniform swing does not occur are of special interest, because if the reorientations persist they can mark the injection of new issues into national and state politics for a generation. Lubell noted the importance of the "Al Smith revolution" which preceded the "Roosevelt revolution" ;2 and Key, naming these phenomena "critical elections," went on to show that Bryan's candidacy in 1896 marked an earlier major reorientation of the electorate.3 He defined a critical election as one in which "the depth and intensity of electoral involvement are high, in which more or less profound readjustments occur in the relations of power within the community, and in which new and durable electoral groupings are formed."4 Since no sample survey data are available for either 1896 or 1928, the systematic study of voting in these elections must rest largely on analysis of voting statistics. These statistics can be interpreted more fully with the aid of

Macrae Duncan. Une analyse factorielle des préférences politiques. In: Revue française de science politique, 8ᵉ année, n°1, 1958. pp. 95-109.

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The houses in which Massachusetts state legislators lived in 1951, when rated according to Warner's models, showed differences as between their owners' political parties but only low associations with the voting record within each party. Socialization into the role of professional party politician reduced this association. Legislators in each party who were over 35 years old, and who had spent relatively little time in public office, tended more than others to "vote their houses."

Roll-call votes are being used increasingly to throw light on various aspects of the legislative process. As long as these votes are neither simply unanimous nor cast purely on party lines, they contain information that can often be rendered more intelligible by the simplification or condensation of many votes into fewer variables or dimensions. The researcher interested in a particular legislative decision can thus profit by seeing whether it exemplifies a more general and repeated type of occurrence. The techniques of analysis used in studying legislative votes are broadly applicable to collegial bodies of many sorts, including municipal, state, and national legislative bodies; party congresses and conventions; the U.S. Supreme Court; and the United Nations General Assembly.Two major questions have been asked which lead to the search for different kinds of simplifying variables in this analysis. One concerns theissuesthat divide a given group of legislators at a given time,i.e., what general matters are being argued about? The second concerns thesubgroupsof legislators within the group selected for study: what are the blocs, factions, cliques, and the like, whose more persistent existence is reflected by the division on a given vote?

The paper argues that ethical discourse is intimately involved in the research literature of social science, and especially of political science, but is relegated to a subsidiary position. It therefore shares some of the vagueness, flexibility, and potential self-contradiction of the discourse of everyday life, rather than being sharpened by rational criticism. The norms governing scientific discourse provide not only for empirical testing, but also for rational criticism in the formulation of theories; an analogous type of criticism is shared by legal discourse. Some of the norms of scientific communication may be transferred to ethics by the specification of rules for ethical argument, requiring that arguments derive from previously specified, clear and consistent “ethical hypotheses.” Within such rules, ethical systems formulated by social scientists and philosophers may be compared critically. Systems amenable to such comparison include those of welfare economics, cost-benefit analysis, and formal democratic theory. The discourse embodying this argument and criticism is particularly appropriate within the normative tradition of political science. Its possible benefits include clarity about our valuations; communication among disciplines that enlarges the perspectives of each discipline; and a more independent, self-conscious examination within the university of the criteria for policy formation.

“… [T]here is no necessary conflict among these three desires of the American social scientist: to be a scientist like physical and biological scientists, to provide useful technical services, and to be significant at the level of policy. The chapters of this symposium are intended to illustrate their compatibility.”This statement indicates a major theme of The Policy Sciences – a volume that marked, as of 1951, the aspirations of a group of leading American social scientists for the policy applications of their disciplines. The harmony of goals that it suggests is no longer evident today.The possible incompatibilities among the goals of pure science, applied science, and policy can be seen by examining The Policy Sciences in two decades' perspective. They are of three major kinds:1. To provide intelligent advice on practical problems, the social science disciplines need to include systematic valuative discourse in a way that natural science does not.2. Applied social science (like applied science generally) differs from pure natural science in stressing valuative dependent variables that may not be closely related to the conceptual schemes of pure science, and independent variables related to alternative choices open to the actor.3. Different roles and channels of influence are appropriate for pure and applied science; and for applied social science in democratic regimes, participation and consent on the part of those influenced are of vital significance.

The theory of fluid mechanics can be profitably applied to chemistry by simply noting that many fluids are substances. Certain equations of fluid mechanics then become the counterparts of equations in the theory of the chemical thermodynamics of systems at constant temperature. Consequently, some of the most valuable parts of this theory may, for some purposes, also be regarded as a part of elementary physics completely independent of thermodynamics.