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A major concern of political theorists has been the definition of the proper role of legislators in relation to their constituencies. Yet relatively little analysis has been made of the uniformities of behavior that actually prevail in these relations. Such uniformities, if they could be found, would bear directly on the theory of the party system, on speculation about the nature of representative government, and on the feasibility of proposals for a reordering of party practices.It has been shown that the tendencies of Congressmen to vote with their party or to cross party lines are associated with the similarity or dissimilarity between party policy and presumed interest of constituency. One aim of this study is to test the applicability of this proposition to the Massachusetts House of Representatives, by examination of the relation between roll-call votes and constituency characteristics. The evidence indicates that a similar relation exists in this body, and has been present consistently throughout the last two decades.

Year in review in Intensive Care Medicine 2010 : I. Acute renal failure, outcome, risk assessment and ICU performance, sepsis, neuro intensive care and experimentals

Year in review in Intensive Care Medicine 2012. II : Pneumonia and infection, sepsis, coagulation, hemodynamics, cardiovascular and microcirculation, critical care organization, imaging, ethics and legal issues

Year in review in Intensive Care Medicine 2009. Part III : mechanical ventilation, acute lung injury and respiratory distress syndrome, pediatrics, ethics, and miscellanea

Year in review in Intensive Care Medicine, 2007. I. Experimental studies. Clinical studies : brain injury and neurology, renal failure and endocrinology

Year in review in Intensive Care Medicine 2012 : III. Noninvasive ventilation, monitoring and patient-ventilator interactions, acute respiratory distress syndrome, sedation, paediatrics and miscellanea

SummaryOver recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least ‘150 major procedures per year in children’ and must provide a ‘specialized paediatric intensive care unit’.

“A few scientists must leave their professions to pursue the hard course of elective politics.”The author is professor of political science and sociology at the University of Chicago, and author of Dimensions of Congressional Voting (University of California Press, 1958). During 1943–46 he was a staff member of the MIT Radiation Laboratory.

This is a report of cochleo-saccular degeneration found in temporal bones from a patient who had suffered from slowly progressive and total sensorineural deafness which had an inherited origin. At age 8, this patient began to complain of hearing loss, and by age 10 she was totally deaf. The patient was 1 of 3 female siblings who have suffered from an exactly identical progressive disease: deafness, absent gastric motility, small bowel diverticulitis and ulceration, and sensory neuropathy. The temporal bone pathology found in this case was the degenerative change in the cochlear duct and sacculus. No pathology was found in the utriculus and semicircular canals.

Pheromonal carbonyl compounds; (Z)-11-hexadecanal, (E)-citral, and 2-heptanone were treated with six alcohols to give acetals or ketals, some of which acted as propheromones by releasing the pheromonal carbonyl compounds in ultraviolet or simulated sunlight. Highest yields of pheromone were obtained from adducts prepared witho-nitrobenzyl alcohol ando-nitrophenylethane-1,2-diol. Adducts from (Z)-11-hexadecenal and these two alcohols were employed in lures to catch diamondback moths,Plutella xylostella (L.).

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Background There is increasing evidence that tight blood glucose (BG) control improves outcomes in critically ill adults. Children show similar hyperglycaemic responses to surgery or critical illness. However it is not known whether tight control will benefit children given maturational differences and different disease spectrum. Methods/Design The study is an randomised open trial with two parallel groups to assess whether, for children undergoing intensive care in the UK aged ≤ 16 years who are ventilated, have an arterial line in-situ and are receiving vasoactive support following injury, major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours, tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days, and lead to improvement in a range of complications associated with intensive care treatment and be cost effective. Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l. Children in the control group will be treated according to a standard current approach to BG management. Children will be followed up to determine vital status and healthcare resources usage between discharge and 12 months post-randomisation. Information regarding overall health status, global neurological outcome, attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI). A difference of 2 days in the number of ventilator-free days within the first 30 days post-randomisation is considered clinically important. Conservatively assuming a standard deviation of a week across both trial arms, a type I error of 1% (2-sided test), and allowing for non-compliance, a total sample size of 1000 patients would have 90% power to detect this difference. To detect effect differences between cardiac and non-cardiac patients, a target sample size of 1500 is required. An economic evaluation will assess whether the costs of achieving tight BG control are justified by subsequent reductions in hospitalisation costs. Discussion The relevance of tight glycaemic control in this population needs to be assessed formally before being accepted into standard practice. Trial Registration Current Controlled Trials ISRCTN61735247

Inhaled low-dose nitric oxide (2, 10, 20 ppm), together with high inspired oxygen concentration (0.80), was administered after corrective operations 13 times to 10 infants (median age 6 months) who were at risk of postoperative pulmonary hypertension because of their congenital heart disease and left-to-right shunt. Inhaled nitric oxide, even in a very low dose (2 ppm), caused selective pulmonary vasodilatation. The pulmonary/systemic artery pressure ratio was a predictor of the response to nitric oxide, with a greater response being seen in those with a high ratio (or = 0.50). In children with a high pulmonary/systemic pressure ratio, the mean pulmonary vascular resistance index fell by 37% to 42%, accompanied by only a 10% fall in the systemic vascular resistance index but a 14% to 16% rise in mean cardiac index. No toxicity was seen in any subject. This exciting new therapy may prove to be an important adjunct in the management of postoperative pulmonary hypertension in the child with congenital heart disease.

Objective: To delineate predictors of hospital survival in a large series of children with biventricular physiology supported with extracorporeal membrane oxygenation (ECMO) after open heart surgery. Results: 81 children were placed on ECMO after open heart surgery. 58% (47 of 81) were transferred directly from cardiopulmonary bypass to ECMO. Hospital survival was 49% (40 of 81) but there were seven late deaths among these survivors (18%). Factors that improved the odds of survival were initiation of ECMO in theatre (64% survival (30 of 47)) rather than the cardiac intensive care unit (29% survival (10 of 34)) and initiation of ECMO for reactive pulmonary hypertension. Important adverse factors for hospital survival were serious mechanical ECMO circuit problems, renal support, residual lesions, and duration of ECMO. Conclusions: Hospital survival of children with biventricular physiology who require cardiac ECMO is similar to that found in series that include univentricular hearts, suggesting that successful cardiac ECMO is critically dependent on the identification of hearts with reversible ventricular dysfunction. In our experience of postoperative cardiac ECMO, the higher survival of patients cannulated in the operating room than in the cardiac intensive care unit is due to early effective support preventing prolonged hypoperfusion and the avoidance of a catastrophic cardiac arrest.

The social indicator movement has always faced in two directions—toward academic disciplines that provide quality control and estimate causal relations, and toward the political system that chooses and uses indicator statistics. At worst, the movement has risked appearing to be peripheral to both theoretical social science and policy choice; such perceptions may have contributed to the movement's weakening. The use of noneconomic time series of data to guide the definition of public problems, however, did not and will not die away.

The draft constitution for the Association, presented to us by the Constitutional Revision Committee, responds to a widely expressed desire for assurance that our officers are representative of our membership. We live in a time of increasing demands on all of our institutions, including those of the APSA, An important purpose in devising workable democratic forms is therefore to insure that those who make these demands do not feel that they have been unheard because of biases in their institutions of government. Although this is not the only purpose of our constitution, it is an important one, and the central one that the framers of the proposed draft seem to have had in mind. I do not believe that this purpose can easily be attained by other alternatives before us, including our present constitution.

This article examines an area of cost-benefit methodology which has come under increasing philosophical scrutiny in recent years: the appropriate treatment of individuals' preferences. We illustrate some of the difficulties involved in assessing preferences in the context of a concrete example: the evaluation of a rural water supply project in southern Haiti. Four problems in the application of cost-benefit principles are discussed: (1) how to count the social value of private water taps connected to homes if they are preferred for prestige reasons, (2) how to assess husbands' preferences concerning the time savings by wives who previously carried water from more distant sources, (3) how to count preferences based on a respondent's desire to support general community welfare, and (4) how to evaluate a water project when people's preferences may change after the new water system is installed. We argue that policy analysis will be improved by presenting philosophical arguments as to why some preferences should be included in the evaluation and others ignored.