Election proximity and representation focus in party-constrained environments

Do elected representatives have a time-constant representation focus or do they adapt their focus depending on election proximity? In this article, we examine these overlooked theoretical and empirical puzzles by looking at how reelection-seeking actors adapt their legislative behavior according to the electoral cycle. In parliamentary democracies, representatives need to serve two competing principals: their party and their district. Our analysis hinges on how representatives make a strategic use of parliamentary written questions in a highly party-constrained institutional context to heighten their reselection and reelection prospects. Using an original data set of over 32,000 parliamentary questions tabled by Portuguese representatives from 2005 to 2015, we examine how time interacts with two key explanatory elements: electoral vulnerability and party size. Results show that representation focus is not static over time and, in addition, that electoral vulnerability and party size shape strategic use of parliamentary questions

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700