Parties and Ballot Access in Latin America: a new trend in a new political context

For the last ten years a group of Latin American countries have passed legal reforms raising ballot access requirements. Although each of these reforms have been profusely discussed in every one of the countries involved, so far, they have not been linked as constituting a regional trend. Firstly this paper shows that this trend actually exists, so reversing the dominant leaning on reforms in this field during the 1980s and 1990s. Secondly, the paper shows that the ongoing regional trend emerges in the aftermath of a legitimacy crisis which has been surmounted in every one of the cases. More specifically, the paper identifies a common sequence followed by four countries (Argentina, Colombia, Mexico and Peru) which leads to the raise of ballot access requirements. The sequence involves the following stages: first, a legitimacy crisis which paves the way to reforms opening up the political system; second, once the legitimacy crisis is left behind, a consensus emerges on the negative consequences of the previous reforms; and third, this consensus culminates with the introduction of the restrictive reforms which have dominated the Latin American landscape for the last decade. Every case is analyzed by observing the coalescence of what Matthew Shugart (2001) defined as the inherent and contingent conditions necessary to account for the passing of electoral reforms.Fil: Scherlis Perel, Gerardo Ezequiel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Bench-to-bedside review: The initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines – does one size fit all?

The Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock recommend that the initial hemodynamic resuscitation be done according to the protocol used by Rivers and colleagues in their well-known early goal-directed therapy (EGDT) study. However, it may well be that their patients were much sicker on admission than many other septic patients. Compared with other populations of septic patients, the patients of Rivers and colleagues had a higher incidence of severe comorbidities, a more severe hemodynamic status on admission (excessively low central venous oxygen saturation [ScvO2], low central venous pressure [CVP], and high lactate), and higher mortality rates. Therefore, it may well be that these patients arrived to the hospital in late untreated hypovolemic sepsis, which may have been due, in part at least, to low socioeconomic status and reduced access to health care. The EGDT protocol uses target values for CVP and ScvO2 to guide hemodynamic management. However, filling pressures do not reliably predict the response to fluid administration, while the ScvO2 of septic patients is characteristically high due to decreased oxygen extraction. For all these reasons, it seems that the hemodynamic component of the Surviving Sepsis Campaign guidelines cannot be applied to all septic patients, particularly those who develop sepsis during their hospital stay