The Consolidation of the White Southern Congressional Vote

This article explores the initial desertion and continued realignment of about one-sixth of the white voters in the South who, until 1994, stood by Democratic congressional candidates even as they voted for Republican presidential nominees. Prior to 1994, a sizable share of the white electorate distinguished between Democratic congressional and presidential candidates; since 1994 that distinction has been swept away. In 1992, a majority of white southern voters was casting their ballot for the Democratic House nominee; by 1994, the situation was reversed and 64 percent cast their ballot for the Republican. Virtually all categories of voters increased their support of Republican congressional candidates in 1994 and the following elections further cement GOP congressional support in the South. Subsequent elections are largely exercises in partisanship, as the congressional votes mirror party preferences. Republicans pull nearly all GOP identifiers, most independents, and a sizeable minority of Democratic identifiers. Democrats running for Congress no longer convince voters that they are different from their party’s presidential standard bearers—a group that has consistently been judged unacceptable to overwhelming proportions of the southern white electorate.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Procedural Experience and Comfort Level in Internal Medicine Trainees

BACKGROUND: The American Board of Internal Medicine (ABIM) has recommended a specific number of procedures be done as a minimum standard for ensuring competence in various medical procedures. These minimum standards were determined by consensus of an expert panel and may not reflect actual procedural comfort or competence. OBJECTIVE: To estimate the minimum number of selected procedures at which a majority of internal medicine trainees become comfortable performing that procedure. DESIGN: Cross-sectional, self-administered survey. SETTING: A military-based, a community-based, and 2 university-based programs. PARTICIPANTS: Two hundred thirty-two internal medicine residents. MEASUREMENTS: Survey questions included number of specific procedures performed, comfort level with performing specific procedures, and whether respondents desired further training in specific procedures. The comfort threshold for a given procedure was defined as the number of procedures at which two thirds or more of the respondents reported being comfortable or very comfortable performing that procedure. RESULTS: For three of seven procedures selected, residents were comfortable performing the procedure at or below the number recommended by the ABIM as a minimum requirement. However, residents needed more procedures than recommended by the ABIM to feel comfortable with central venous line placement, knee joint aspiration, lumbar puncture, and thoracentesis. Using multivariate logistic regression analysis, variables independently associated with greater comfort performing selected procedures included increased number performed, more years of training, male gender, career goals, and for skin biopsy, training in the community-based program. Except for skin biopsy, comfort level was independent of training site. A significant number of advanced-year house officers in some programs had little experience in performing selected common ambulatory procedures. CONCLUSION: Minimum standards for certifying internal medicine residents may need to be reexamined in light of house officer comfort level performing selected procedures