Out of Step, Out of Office: Electoral Accountability and House Members’ Voting

Does a typical House member need to worry about the electoral ramifications of his roll-call decisions? We investigate the relationship between incumbents’ electoral performance and roll-call support for their party—controlling for district ideology, challenger quality, and campaign spending, among other factors—through a series of tests of the 1956–1996 elections. The tests produce three key findings indicating that members are indeed accountable for their legislative voting. First, in each election, an incumbent receives a lower vote share the more he supports his party. Second, this effect is comparable in size to that of other widely recognized electoral determinants. Third, a member’s probability of retaining office decreases as he offers increased support for his party, and this relationship holds for not only marginal, but also safe members

Readability Assessment of Patient Education Materials on Uro-oncological Diseases Using Automated Measures

Background and objectiveReadability of patient education materials is of utmost importance to ensure understandability and dissemination of health care information in uro-oncology. We aimed to investigate the readability of the official patient education materials of the European Association of Urology (EAU) and American Urology Association (AUA).MethodsPatient education materials for prostate, bladder, kidney, testicular, penile, and urethral cancers were retrieved from the respective organizations. Readability was assessed via the WebFX online tool for Flesch Kincaid Reading Ease Score (FRES) and for reading grade levels by Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Smog Index (SI), Coleman Liau Index (CLI), and Automated Readability Index (ARI). Layperson readability was defined as a FRES of ≥70 and with the other readability indexes <7 according to European Union recommendations. This study assessed only objective readability and no other metrics such as understandability.Key findings and limitationsMost patient education materials failed to meet the recommended threshold for laypersons. The mean readability for EAU patient education material was as follows: FRES 50.9 (standard error [SE]: 3.0), and FKGL, GFS, SI, CLI, and ARI all with scores ≥7. The mean readability for AUA patient material was as follows: FRES 64.0 (SE: 1.4), with all of FKGL, GFS, SI, and ARI scoring ≥7 readability. Only 13 out of 70 (18.6%) patient education materials' paragraphs met the readability requirements. The mean readability for bladder cancer patient education materials was the lowest, with a FRES of 36.7 (SE: 4.1).Conclusions and clinical implicationsPatient education materials from leading urological associations reveal readability levels beyond the recommended thresholds for laypersons and may not be understood easily by patients. There is a future need for more patient-friendly reading materials.Patient summaryThis study checked whether health information about different cancers was easy to read. Most of it was too hard for patients to understand

Laparoscopic Partial Cystectomy for Urachal and Bladder Cancer

PURPOSE: To report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy. MATERIALS AND METHODS: Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years). Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation. RESULTS: All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 mL (50-100). Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation. CONCLUSIONS: Laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients

Policy Uncertainty and Manufacturing Investment: Evidence from U.S. State Elections

We estimate the effect of electorally induced policy uncertainty on investment in the manufacturing sector. Because state governors exercise considerable influence over legislation and considerable discretion over regulation and permitting, and because the policies relevant to business investment vary systematically by party, uncertainty over the partisan affiliation of the future governor is a source of political risk to firms considering business investment. More importantly, the lack of an incumbent in a race due to term limits raises uncertainty over the outcome, providing a convincing instrument that allows us to estimate causal effects. We find that, in a state with average partisan polarization, in the calendar year of a gubernatorial election, the elasticity of investment to the eventual margin of victory is 0.027. Both the significance and magnitude of this result are robust to various controls, measures, and estimators. Importantly, the investment decline is not reversed the following year. We show that own-state uncertainty is associated with a large and significant rise in neighboring states’ investment, suggesting that rather than postponing investment to the future, the effect of policy uncertainty at the subnational level is to drive investment to alternative sites