We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To investigate differences in the rate of firstline antibiotic prescribing for common pediatric infections in relation to different socioeconomic statuses and the impact of an antimicrobial stewardship program (ASP) in pediatric urgent-care clinics (PUCs).
Design:
Quasi-experimental.
Setting:
Three PUCs within a Midwestern pediatric academic center.
Patients and participants:
Patients aged >60 days and <18 years with acute otitis media, group A streptococcal pharyngitis, community-acquired pneumonia, urinary tract infection, or skin and soft-tissue infections who received systemic antibiotics between July 2017 and December 2020. We excluded patients who were transferred, admitted, or had a concomitant diagnosis requiring systemic antibiotics.
Intervention:
We used national guidelines to determine the appropriateness of antibiotic choice in 2 periods: prior to (July 2017–July 2018) and following ASP implementation (August 2018–December 2020). We used multivariable regression analysis to determine the odds ratios of appropriate firstline agent by age, sex, race and ethnicity, language, and insurance type.
Results:
The study included 34,603 encounters. Prior to ASP implementation in August 2018, female patients, Black non-Hispanic children, those >2 years of age, and those who self-paid had higher odds of receiving recommended firstline antibiotics for all diagnoses compared to male patients, children of other races and ethnicities, other ages, and other insurance types, respectively. Although improvements in prescribing occurred after implementation of our ASP, the difference within the socioeconomic subsets persisted.
Conclusions:
We observed socioeconomic differences in firstline antibiotic prescribing for common pediatric infections in the PUCs setting despite implementation of an ASP. Antimicrobial stewardship leaders should consider drivers of these differences when developing improvement initiatives.
Cross-cutting cleavages have long moderated party conflict in American politics and thereby contributed to democratic stability. Over recent decades, however, many of these cross-cutting cleavages have declined, sorting Americans into mutually antagonistic camps. Here I present data on the social composition of the parties in Congress indicating that they are increasingly differentiated by race, gender, and religion. Drawing on comparative work on democracy-building in divided societies, I argue that the deeper social divide between the parties makes American democracy more dependent upon political institutions that routinely impose power-sharing requirements on the major parties. Although polarization stresses the political system in numerous ways, American institutions still tend to block one party from running roughshod over the other. Such a political system risks immobilism and ineffectiveness, but it also promotes democratic stability.
Does populism threaten American democracy, and if so, what is the nature of that threat? In dialogue with the comparative literature on populism, this article considers the opportunity structure available to populist parties and candidates in the American political system. I argue that compared to most other democracies, the US system offers much less opportunity for organized populist parties but more opportunity for populist candidacies. Today’s major parties may also be more vulnerable to populist insurgency than at other points in US history because of (1) changes in communications technology, (2) the unpopularity of mainstream parties and party leaders, and (3) representation gaps created by an increasingly racialized party system. Although no democratic system is immune to deterioration, the US constitutional system impedes authoritarian populism, just as it obstructs party power generally. But the vulnerability of the major parties to populist insurgency poses a threat to liberal democratic norms in the United States, just as it does elsewhere.
How politically powerful is business in American politics? Does the political power of business distort the quality of democratic representation? This chapter reviews the literature on these vital questions, discussing selected studies in political science, sociology, history, and other fields. It finds that assessments of business influence in American politics have varied considerably over time, but it also observes there has been a broad turn in recent scholarship toward the notion that business is “more equal” than other groups in the American political system. A small but growing number of studies—especially studies focusing on politics in our time—has begun to provide credible evidence of business influence. We have also seen the introduction of some exciting new ideas about the ways that business influence, economic inequality, and political representation may be theoretically connected. But definitive conclusions remain elusive. We do not really know whether business is disproportionately powerful and how business influence affects the performance of American democracy. The chapter concludes with some suggestions about the kind of studies that are needed going forward.
We provide an overview of the concept of the “policyscape,” a dense network of policies that structure the current political order, and then assess its relationship with four aspects of American institutional behavior: the creation of new policies; the maintenance of existing policies and programs; policy “thickening” that may lead to additional gridlock and dysfunction during what is an already laborious lawmaking process; and the monitoring of the current policyscape through executive oversight in Congress. We address, among other questions, why new and broad-reaching policy reforms have been scarce in recent years; why Congress has failed to update extant policies in accordance with social, economic, political, and technological developments; and how partisan polarization has affected Congress’ ability to oversee policy implementation and hold the executive branch accountable for administrative failures.
Calls for a return to a traditional method of lawmaking known as “regular order” have proliferated as unorthodox lawmaking has grown more dominant in Congress. Proponents claim regular order enhances deliberation on legislation. This chapter examines deliberation under one form of regular order: open rules permitting unlimited amending in the House of Representatives. We find evidence of substantial minority influence on the inputs and outputs of the appropriations process. Regular order gives the minority party members the opportunity to present and win adoption of their policy proposals. Our evidence also shows that ideological extremists play an outsized role in debate. They offer more amendments than other members, and their amendments tend to win less support and face defeat more often than moderates. The paradox of regular order is that it simultaneously offers the opportunity for bipartisan deliberation over legislation while exposing the majority party to problems that may make its management of the floor more difficult.
This volume analyzes how rising party polarization and economic inequalities affect the performance of American governing institutions. It is organized around two themes: (1) the changing nature of representation in the United States and (2) how changes in the political environment have affected the internal processes of institutions, as well as overall government performance and policy outcomes.
Scholars and observers worry that Congress has lost its capacity to perform its functions in the American political system. Drawing on an array of data on Congress’s activities and processes along with in-depth interviews with long-serving lawmakers and high-level staffers, we take stock of how changes to internal processes have affected Congress’s institutional capacities. In doing so, we make two interrelated arguments. First, we argue that Congress can take transformative action whether the legislative process is centralized and leadership-led or whether it is decentralized and committee-led. Second, we argue that Congress is better able than in previous eras to engage in conflict-clarifying representation in order to express and educate the public on the positions of the parties. We conclude that changes to congressional processes in recent years should be viewed as adaptations to the challenges of contemporary lawmaking. These adaptations help preserve Congress’s institutional capacity, but they have undoubtedly had negative consequences for open deliberation and individual member input into legislation.
This volume grows out of the well-documented psychological impulse to bring information to bear on sources of anxiety. In politics, as in other realms of life, anxiety triggers a quest for information. Perceived threats focus the attention (Marcus, Neuman, and MacKuen, 2000). Anxious citizens take more interest in politics, have more motivation to learn, and weigh the information they collect more judiciously (Marcus and MacKuen, 1993, MacKuen et al, 2010, Albertson and Gadarian, 2015). In these respects, worried citizens are better citizens (Brader, 2005, Valentino et al, 2008).
Can America Govern Itself? brings together a diverse group of distinguished scholars to analyze how rising party polarization and economic inequality have affected the performance of American governing institutions. It is organized around two themes: the changing nature of representation in the United States; and how changes in the political environment have affected the internal processes of institutions, overall government performance, and policy outcomes. The chapters in this volume analyze concerns about power, influence and representation in American politics, the quality of deliberation and political communications, the management and implementation of public policy, and the performance of an eighteenth century constitution in today's polarized political environment. These renowned scholars provide a deeper and more systematic grasp of what is new, and what is perennial in challenges to democracy at a fraught moment.
Majority leaders of the contemporary Congress preside over parties that are more cohesive than at any point in the modern era, and power has been centralized in party leadership offices. Do today’s majority parties succeed in enacting their legislative agendas to a greater extent than the less-cohesive parties of earlier eras? To address this question, we examine votes on all laws enacted from 1973–2016, as well as on the subset of landmark laws identified by Mayhew. In addition, we analyze the efforts of congressional majority parties to pass their agendas from 1985 to 2016. We find that enacting coalitions in recent congresses are nearly as bipartisan as they were in the 1970s. Most laws, including landmark enactments, continue to garner substantial bipartisan support. Furthermore, majority parties have not gotten better at passing their legislative programs. Contemporary congressional majorities actually fail on their agenda items at somewhat higher rates than the less-cohesive majority parties of the 1980s and 1990s. When majority parties succeed on their agenda priorities, they usually do so with support from a majority of the minority party in at least one chamber and with the endorsement of one or more of the minority party’s top leaders.