WORK DISCUSSED IN THIS ESSAY
- Alberto Alesina and Geoffrey Carliner, eds.Politics and
Economics in the Eighties
(Univ. of Chicago Press, 1992).
- Joshua Cohen and Joel Rogers,"Democracy and
Associations",Social Philosophy and Policy,
- Gary Cox and Samuel Kernell, eds., The Politics of Divided
Government,(Westview Press, 1991).
- Alan Ehrenhalt,The United States of Ambition: Politicians,
Power, and the Pursuit of Office,
(Times Books, 1991)
- Morris Fiorina, Divided Government, (MacMillan
- Benjamin Ginsberg and Martin Shefter, Politics by Other
Means: The Declining Importance
of Elections in America (Basic Books, 1992).
- William Grieder, Who Will Tell the People: The Betrayal of
(Simon and Schuster, 1992).
- Gary Jacobson, The Electoral Origins of Divided
Government: Competition in U.S. House
Elections 1946-1990 (Westview Press, 1990).
- David R. Mayhew,Divided We Govern: Party Control,
Lawmaking and Investigations 1946-1990,
(Yale Univ. Press, 1991).
- James A. Morone, The Democratic Wish: Popular
Participation and the Limits of
American Government (Basic Books, 1990).
- David W. Rohde, Parties and Leaders in the Postreform
(Univ. of Michigan Press, 1991).
1981 American voters have kept the national government
divided between the two parties. We have had a Republican White
House and a Democratic Congress, except in 1981-87, when Repub
licans narrowly controlled the Senate. This pattern, of course,
could change if the Democrats retake the White House in 1992.
Polls suggest that voters increasingly approve of divided
government. In 1981, 47 percent of the electorate preferred
government, while 34 percent preferred divided government (the
taking an agnostic view). By 1989 these preferences had reversed:
Now 45 percent approved of divided government and only 35 percent
backed unified government, though very recent polls suggest some
second thoughts. Paradoxically, voters evidently dislike what
have wrought. As divided government has persisted, voter
frustration has increased. Indeed, divided government can be seen
as both a symptom of voter disaffection, and a cause.
Divided government appears to increase public cynicism about
politics in two ways. First, when divided partisan government
intensifies the separation of powers of the American
system, government becomes stymied. Citizens, like the Founders,
may think they are dividing government to keep the rascals from
doing damage. Yet the resultant policy inaction sows deeper
cynicism about politics and government. Second, divided
creates a climate of scandal-mongering, in which each branch of
government expends political resources embarrassing the other
(Watergate, Iran-contra, the S&L scandals, Iraqgate) rather than
jointly tending to the national business. Over time, this
discredits both parties, blurs responsibility, and generates
more voter contempt for government and politics generally.
This analysis is seductive, and at least partly true. However,
several recent books suggest it is overstated. Though we think of
it as a characteristic of the 1980s, divided government has
recurred regularly since the 1940s. In only eighteen out of the
past forty-six years has the same party controlled the White
and both houses of Congress. The Nixon presidency, a period of
legislative activism, coexisted with Democratic control of the
House and the Senate. Divided government was also common during
What's New, and What's Not
In a deeper sense, we have lived with divided government since
Founding. Reacting to the Articles of Confederation, the Founders
believed that the Constitution favored strong, if restrained,
government. But much of American political thought since then
Theodore Roosevelt and Woodrow Wilson to Richard Neustadt and
Walter Dean Burnham can be read as a recurring judgment that the
Founders constrained government far more than they empowered it.
takes strong politics and a mobilized electorate to overcome the
constitutional bias against government activism.
In the sweep of American history, bouts of effective governmental
activism have been rare: the Civil War and Reconstruction
Congresses, Woodrow Wilson's cooperation with party leaders in
Congress, Franklin D. Roosevelt's two strong working majorities
1933-34 and 1937-38, LBJ's partnership with the 89th Congress in
1965-66. The ticket-splitting of the 1980s is more the rule than
the exception a case of the constitutional chickens coming home
roost. Still, the current era has generated more than a normal
amount of squawking about accumulated problems that government
seems unable to solve. The federal deficit has deprived
of resources to address national concerns, and the magnitude of
deficit itself stands as a monument to government's failure to
So the electorate has evidently locked itself into a vicious
of ticket-splitting, policy inaction, discontent,
disaffiliation and more ticket-splitting and more paralysis. Even
if Bill Clinton should win the White House in November and enjoy
working majority in Congress, the process of political repair
have only begun.
to several new studies by political scientists, however,
we should not exaggerate the perils of divided government nor, by
implication, the virtues of unified government let alone more
radical reform proposals imagining a move toward parliamentary
government. These new studies add badly needed complexity to the
conventional views that blame divided government, willy nilly,
a multitude of sins.
Where most of the new studies fall somewhat short, however, is
their failure to explore adequately the connection between
government and perceived or real paralysis and the resulting
to public confidence in government itself and to key democratic
norms. For one thing, divided government yields less accountable
government. If both parties are the in-party, then policy
are everybody's fault and nobody's. Unified government may not be
sufficient to revive strong politics, but it is probably
at least in the current climate.
Divided government can also be a political red herring. For
example, Republicans have long insisted that their failure to
consummate a domestic program is the fault of Democratic control
Congress control that is itself illegitimate, reflecting
gerrymandering and the power of incumbency. The GOP 1992 platform
states: "After more than half a century of distortion by
power-hungry Democrats, the political system is increasingly
rigged." The platform blames the chronic deficit on Democratic
control of the Congress, and adds, "The only solution is to end
It is necessary to sort out the dynamics of divided
government where it came from, how it works, what can be fairly
blamed on it, what unified government might portend and what
reforms are needed to reclaim politics, irrespective of divided
government. One can begin by differentiating the causes of
government from its consequences.
Causes of Divided Government
Political scientists generally make two kinds of argument about
causes of recent divided government. The first argument
the behavior of politicians, contending that factors such
congressional incumbency, or candidate-recruitment, tends to
advantage one party over the other. Some of this literature views
the past decade as an aborted realignment. Voters gradually
their presidential allegiance toward Republicans, but for a
of structural or tactical reasons Democrats were able to cling to
their control of Congress. The second view emphasizes the
of voters, and concludes that the voters' choice of
government was rational, deliberate, and purposive.
A Rigged System? Drawing on three extensive academic
literatures (on the electoral effects of congressional
reapportionment politics, and realignment), Newt Gingrich and
key Republicans view divided government as the product of
Democratic success at riding out, through devious means, the
electoral "right turn" that began in 1980. The case has
plausibility, since professional politicians do rationally
their careers and incumbents have indeed gotten re-elected more
reliably than in the 1940s and 1950s.
Already advantaged by comfortable vote margins for all
congressional incumbents, House Democrats supposedly used their
committee positions to build up large war chests. Congressional
Democrats also blanketed their districts with newsletters,
up the name recognition that helps re-election. Another part of
same "rigged system" were state legislatures most of which are
controlled by Democrats. These legislatures supposedly
gerrymandered congressional districts to insulate House Democrats
from an increasingly suburban electorate that gave Ronald Reagan
landslide in 1984 and George Bush a strong victory in 1988.
But though incumbents do exploit office, the "rigged system"
largely fails to explain divided government. Its fallacies are
explored by Gary Jacobson and Morris Fiorina. If the system were
rigged, why have Democrats done better in open House races? Why
they lose the Senate in 1980 and win it back in 1986?
While gerrymandering does occur, it doesn't explain lingering
Democratic control of the House. Since 1952 Republican
candidates have received a significantly higher fraction of the
vote than have Republican House candidates. Reagan got 57 percent
of the national vote in 1984, but House Republicans got only 47
percent. For the most part, Republicans fail to capture the
legislative branch because they attract fewer voters.
Incumbents appear strong, but their longevity can be exaggerated.
Only 10 percent of those in the House in 1990 were there in 1968,
even though incumbent vote margins have grown since then. As for
campaign finance and incumbency, a big war chest can certainly
scare away a strong challenger, leaving a seat effectively
uncontested. But during the 1980s Republican challengers were
better endowed than Democratic challengers.
Do Democrats Have Better Candidates? A much more
argument holds that Democrats cling to legislative office, at all
levels of government, because they field more attractive
candidates. As both Alan Ehrenhalt and Gary Jacobson suggest, the
Republicans have had a serious problem in candidate recruitment
of the reasons why they have put effort into converting
conservative Southern Democrat office holders to the GOP.
Democrats obviously have a more visceral commitment to politics
government than government-bashing Republicans. With the
of able patricians like William Weld and James Baker, or such
serious, supply-side intellectuals as Phil Gramm and Jack Kemp,
talented conservatives tend to act on their creed and stay in the
private sector. But talented Democrats, because they actually
government, will put up with the stress, long hours, constituent
abuse, and the relatively low pay of local and state office,
in turn serves as a recruitment pool for congressional
So Democrats often do have better candidates a reality that grows
out of their ideology.
Are the Voters Fools? A very different brand of
for divided government centers not on politicians but on voters.
this view, the voters are getting roughly what they want.
Republican challengers were unlucky enough to pursue clear
realignment just when partisan loyalties, steadily weaker since
1950s, were becoming too thin to support such ambitions. Most
electorally active people have some kind of partisan loyalty, but
increasing numbers no longer buy the party's entire program. Thus
Republicans are split on cultural, social, and economic fault
lines and many Republican presidential voters hedge their bets by
backing Democrats for Congress.
Voter ambivalence may be all too genuine. The electorate
for instance, that deficits ought to be reduced but also agrees,
when asked by pollsters, that budgets for particular worthy
purposes, such as the environment and education, ought to go
Fiorina, Jacobson, and others suggest that increasingly the
active in both presidential and congressional elections, who
to be better informed voters in general, are adopting some basic
rules of thumb. There are quibbles among these analysts about the
degree of sophistication, but all agree, first, that voters see
parties as offering different policy benefits, and, second, that
voters associate their own preferences with a Republican
and a Democratic Congress.
Congress cannot face up to expansionist dictators and "evil
empires" nor can it broadly steer the economy, but the president
can hardly be an ombudsman for a constituent with a Social
problem. When weakened party loyalties and increasing distrust of
government are factored in, the result is enough ticket-splitting
to get divided government.
Fiorina is convincing when he notes the historic, system-wide
pervasiveness of divided government. Since 1946 divided
has also spread rapidly to state politics, often pitting
executives against Democratic legislatures. For Fiorina, this
suggests that more and more voters intend divided government and
have become sophisticated ticket-splitters. Unified government
well become the exception, not the rule.
While Jacobson and Fiorina offer quite believable arguments in
Fiorina's case, enhanced by simple but ingenious modelling the
direct evidence for sophisticated voting is still only inferred
from survey evidence. The great virtue of the thesis, however, is
that it treats voters as purposive: Voters are far more wary of
government and politicians than they used to be, and a near
plurality seems to like divided government even now, despite its
chaotic results. Fiorina rightly calls for more research into
ticket-splitting so that we can know just how much sophisticated
voting is going on, and, in the meantime, urges skepticism about
the view that divided government is an evil.
In short, political science research does not find much support
the contention that divided government is the result of
illegitimate tactics by careerist Democrats. The Democrats
effective career politicians, of course that's one of their
strengths as a party. But true electoral realignments sweep aside
yesteryear's "in party." We didn't have nor could we have had
a realignment in the dealigned 1980s. The real story is that
Democrats went into the 1980s with advantages in legislative
electoral arenas that the Republicans lacked, mirrored by
disadvantages on "presidential" issues and presidential
that Republicans exploited.
If this approach explains the rational causes of divided
government, what about the consequences? The ticket-splitters in
the electorate, after all, do not make up a majority. What if
unintentionally (and, for some, deliberately) stuck the rest of
with governmental deadlock and political decomposition? Does the
cool, rational logic assumed in the new analyses of divided
government's electoral origins also explain its consequences?
Consequences of Divided Government
Divided government seems to hobble governmental effectiveness in
variety of ways. However, these concerns are tempered when one
takes a longer historical view, as do political scientists David
Mayhew, David Rohde, and others. In the literature, three broad
problems are attributed to divided government: policy inaction or
incoherence, an obsession with political scandal, and an erosion
the political efficacy of the parties.
Policy Inaction, Flawed Legislation. The culpability of
divided government is strongest on government's deferral of
pressing problems, notably in economic and fiscal policy.
and Shefter provocatively connect the national-level divided
government of the 1980s to economic decline, fiscal
irresponsibility, policy inaction, a failure to plan for economic
competitiveness, and a subordination of national economic goals
a national security alliance with Japan. Each party is more
to retaining institutional strongholds than to fashioning as
coherent national strategy.
Just how convincing are such charges? To test the hypothesis,
Mayhew did much tedious work, compiling a list of "important"
legislation for the 1946-1990 period (during which the national
government was often divided), 267 statutes in all. Mayhew's list
was derived from the conclusions of leading reporters, policy
analysts, and historians. He found that the rate of important
policy making did not vary systematically across periods of
or divided government.
Mayhew notes that most important legislation in the postwar
186 laws, passed with either two-thirds support or bipartisan
majorities. He observes that Congress, contrary to its
is more of a problem-solving institution than we often think
because most of its members are committed to the ideal of making
good public policy, as well as to the goals of getting re-elected
and achieving influence within Congress. Also, legislation
come easily. To sustain a bill through all the veto points in the
process requires legislative leaders to fashion majorities much
larger than 51 percent.
Presidential skill, furthermore, doesn't neatly coincide with
unified government; it can be found during divided government, as
Reagan, Nixon, and Eisenhower showed. External events that demand
problem-solving do not coincide systematically with unified or
divided government. Finally, in a serious discussion of a
phenomenon often dismissed by political scientists as being too
soft for analysis, Mayhew shows that public moods demanding
government span periods of both divided and unified government.
There are constant policy making pressures in Washington, surges
activism, often that last many years. Over the long run, both
factors favor a rather high level of activism and policy making,
divided government or not.
Is this view of the matter dispositive? Not wholly. Consider
legislation in the 1980s. For many, the failure of government to
match revenues with expenditures is the signal failure of divided
government Democrats successfully defending outlays and
successfully cutting taxes. However, while divided government in
the 1980s made this straddle possible, no such fiscal default
occurred during the sixteen years of cumulative divided
under Truman, Eisenhower, Nixon, or Ford. The new element that
associated divided government with fiscal excess in the 1980s was
the fierce Republican embrace of what George Bush once aptly
"voodoo economics." None of Reagan's Republican predecessors
believed that you could cut taxes and increase revenues.
On the spending side, Mathew McCubbins' article in the Cox and
Kernell volume (written in the spirit of the volume's persistent
focus on parties) focuses on party conflict in a "bi-lateral veto
game" and its resolution. He conceptually strips spending
down to a stylized conflict over two types of programs, domestic
spending and defense spending. Democrats preferred increases in
and reductions in the other, and vice versa for Republicans. The
outcome is basic game theory: since neither side could get its
first preference (more for its side, less for the other side),
both agreed on the second preference (more for both sides). The
result, of course, was persistent, upward pressure on the
Historically, Mayhew finds no such clear relationships between
divided government and fiscal imbalance. But McCubbins' emphasis
defensive partisan behavior in a fragmented system nicely
the dynamic of fiscal blockage, at least in the supply-side
On the tax side, a key piece of legislation, the Economic
Tax Act (ERTA) of 1981, played a very important role. Startled by
the results of the 1980 elections, Democrats sought to shore up
business support for the next election. Both parties competed to
take credit for a supply-side bill that would spark economic
recovery, setting off an infamous "bidding war" that would have
been improbable in a unified government. In a concise article in
the volume edited by Alberto Alesina and Geoffrey Carliner,
Stewart analyzes ERTA and other tax legislation in the 1980s. He
estimates that about 90 percent of lost revenue over the 1980s
to tax cuts is attributable to ERTA. Given Reagan's resoluteness
blocking major tax increases, divided government made it
to recover lost revenue. Modest income and corporate tax
as well as a large increase in Social Security taxes occurred,
tax legislation after 1981 tended toward "revenue neutrality."
government from 1981 to 1992 invited, in other words,
complicated patterns of "gaming" between the two parties on
spending and taxing that, in turn, created a chronic deficit
problem. Its real economic consequences are still being
debated periodic fiscal imbalance has been common in U.S. history
since the Civil War, as Charles Stewart astutely points out in
Cox and Kernell volume. But in the current era of
government-bashing and festering economic and social problems,
fiscal imbalance has symbolized government failure.
Increased public cynicism has probably been reinforced by the
savings-and-loan scandal, a colossal case of bipartisan failure.
a lucid, sobering treatment of the "thrift debacle" in the
and Carliner volume, Barry Weingast and Thomas Romer show
convincingly the bipartisan, political origins of the crisis,
emphasizing incentives and informational biases. The public was
ill-equipped to assess the issue and was not cohesively organized
as the thrift industry was. Since every member of Congress had
thrifts in his or her district or state, Congress tended to
the available arguments. These favored, first, deregulation and,
later, forbearance letting the industry take time to work its way
out of its difficulties.
Explicit treatment of divided government plays little role in the
Weingast-Romer analysis. But their own account hints that
and the administration jointly delayed remedial action because
feared raising taxes or worsening the budget deficit itself
the product of divided government. In addition, the S&L scandal,
like the deficit itself, suggests how divided government permits
blame-sharing as well as credit-sharing. Both public deliberation
and accountability suffered as a result of a blame-avoidance
On balance, the contribution of divided government to policy
inaction and flawed legislation from 1946 to 1990 across many
policy domains is hard to prove, just as Mayhew says. But from
on its contribution to economic mismanagement gets stronger, a
point broadly consistent with more pessimistic analyses, such as
Ginsberg and Shefter's Politics By Other Means.
government has also been blamed for foreign policy
incoherence. During the Iran-contra hearings, former National
Security Adviser Robert McFarlane cited the Boland Amendment
(prohibiting aid to the contras) as destructive foreign policy
meddling. First Congress drew the line here, then it drew the
there. Circumventing Congress came easily for who knew what
Congress wanted? but the process of circumvention damaged policy.
Yet the problem with the general argument of foreign policy
incoherence, as Mayhew points out, is that the country is never
unified for long on foreign policy, even under unified
Divided government may well add healthy checks and balances as
the contras and the Sandinista party know.
In fact, divided government has often been associated with
initiatives now recognized as statesmanlike, the most famous case
being the Marshall Plan, launched during the "do-nothing" (read
Republican-controlled) 80th Congress. There is simply no way,
any imaginable set of criteria, to judge foreign policies
since 1946 under unified control as being consistently superior
those fashioned under divided control.
Scandal-mongering. Ginsberg and Shefter argue that divided
government in the 1980s encouraged "politics by other means." If
Democrats couldn't win the presidency, they investigated and
harassed the president's subordinates, while Republicans anxious
control the House used the ethics machinery to discredit the
leadership. If interest groups couldn't rally voters, they could
buy elected officials. In time, the public reasonably drew
unflattering inferences about people inside the Beltway: a plague
on both their houses.
For some observers of American politics, a continuing round of
ethics scandals feeds the kind of paranoia about government that
Oliver Stone exploited with "JFK," a plausible point about the
political origins of public cynicism. Equally serious, a certain
administrative incoherence and timidity can set in.
wary of scandal, became excessively cautious. Appointments go
unfilled, and talented people take a pass on a job offer because
some youthful indiscretion that could invite smears long
There are, then, three related claims about scandal-mongering.
Divided government increases the rate of political scandal; that
turn increases public cynicism and hobbles government's ability
implement policy. But the rate of scandal-making does not vary
systematically across periods of unified and divided government.
Mayhew counted for the period 1946-1990 the number of days that
congressional committee investigations of the presidency, or
executive response, were featured on the front page of The New
York Times. There is no systematic relationship between
of unified or divided government none at all.
Capitol Hill launches investigations for at least two other
reasons, factional and constitutional. Indeed, as Mayhew points
out, a period of unified government can be associated with
investigations that set the stage for tensions in a particular
administrative or policy domain that will last for decades. If
the case for a relationship between divided government and public
cynicism and administrative incoherence is weak.
Scandals during both divided and unified government often reflect
constitutionally mandated tensions. The Watergate and Iran-contra
affairs, both associated with divided government, of course had
political dimensions. But they also dealt with quite serious
constitutional issues. Moreover, to dismiss recent crises of
government as mere "scandals" is to trivialize the stakes. In
Watergate and Iran-contra, or in lesser imbroglios, crimes and
misdemeanors against democratic government all demanded scrutiny
and response. The rate of congressional investigation in the
post-World War II period (and probably the pre-World War II
is at best only weakly correlated with partisan divided
Party factions will go after one another as easily as different
parties. And concerned congressional leaders will walk away from
party loyalty toward the Constitution.
Death of Responsible Party Politics. An article of faith
among most political scientists is the unimportance of parties
within the Congress. As subcommittees and staff proliferated,
abetted by the collapse of deference to leadership or any
commitment to apprenticeship, such irrelevance grew. Congress is
therefore unruly, hence the recurrent magazine covers picturing
Congress as a baby in diapers. Mayhew summed it up best, in an
earlier, well-known book, Congress: The Electoral
Connection: "No theoretical treatment of the United States
Congress that posits parties as analytic units will go very far
we are left with ... 535 men and women rather than two
All of this is supposedly compounded by divided government.
President Bush has set a modern record of thirty-one vetoes in
fewer than four years. This has only sharpened the sense that
running Congress is not an advantage for the Democrats as a
and that minority status in the House has transformed Republicans
into a kind of Weather Underground in suits. Committee barons
freelance, Speaker Foley lacks fire in the belly, and everyone
hustles money, subverting the party's historic social
Meanwhile Newt Gingrich plots the fall of the Republic, or at
of the Congress.
There are two claims here: divided government thwarts partisan
cohesion, organizationally and programmatically, and it
illegitimate free-lancing, legislatively and in congressional
campaign finance or in a poisonous blend of the two. But this
picture is also overstated, or just plain wrong. Rohde's finely
counterintuitive analysis shows that party government is alive
well in the House of Representatives since the reforms of the
1960s and early 1970s. His work is part of a renewed interest in
congressional parties that can also be found in the Cox and
and Alesina and Carliner volumes.
Rohde demonstrates a marked increase in party government in the
House and Senate. To be sure, notwithstanding structural changes
legislative party cohesion, a Speaker's style can matter
enormously. (Speaker Wright was a strong partisan and Foley a
relatively weak one.) But, on the whole, far from weakening the
Democrats and Republicans as coherent legislative parties,
government has been associated with a strengthening. Rohde
convincingly constructs a party cohesion index that is, the
proportion of votes on which a House or Senate Democrat supports
the party position. The low for the House was reached in 1970, 27
percent, but by 1987 it had shot up to 64 percent; in the Senate
ranged from 35 percent to 52 percent in the same period. From the
92nd to the 94th Congresses, about 8 percent of the House was
involved in the Democratic whip organization, but the percentage
increased steadily to 40 percent by the 101st Congress.
this period the Speakership was strengthened, becoming the
apex of a system composed of regular whip planning meetings,
policy-planning task forces, a Steering and Policy Committee, the
Democratic Caucus, and the Democratic Study Group. The Rules
Committee changed from being an obstructionist body to an
that facilitated the Democratic Party agenda through increasingly
sophisticated and for Republicans oppressive use of rules.
aiding these changes was a sharp decrease in sectional tensions
within the congressional Democratic Party, the result of the
Rights Act's impact on Southern politics.
Speaker Wright used this new system during his brief tenure to
enact a party agenda, echoing earlier, now forgotten efforts and
successes by Carl Albert and Tip O'Neill, both of whom forced
strong, anti-recession measures on reluctant Republican
in 1975 and 1983. Both the Clean Water Act and the Highway
Reauthorization were enacted over Reagan's vetoes. Also passed
important savings and loan, welfare, farm credit, catastrophic
health insurance, trade, and homeless bills. Indeed, Rohde's
evidence suggests that policy-planning and programmatic cohesion
grew during the 1980s within the congressional Democratic Party.
Forthcoming work by James Shoch of Dartmouth College, on trade
policy, and Chris Howard of MIT, on social policy, will
this implication of Rohde's research.
Nor is it clear that divided government promotes corrupt campaign
finance. What does seem clear is that divided government in the
1970s helped stimulate the monitoring systems which generate the
data that public watchdog groups use to call public attention to
finance issues. On balance, public awareness of money's role in
politics seems to have been helped by divided government. This
isn't to dismiss the issue, which is too often ignored and
misunderstood. Greider's controlled outrage in Who Will Tell
People wakes one up to it. Yet it is not analytically clear
whether, or how much, divided government reinforces the power of
organized money and social class in politics.
The overall case that divided government destroys parties is at
best mixed. As Rohde suggests, party cohesion and ideological
coherence, as well as coordinated policy planning, may actually
grow under divided government. At the same time, party cohesion
does not assure party accountability; and parties that do not
accountable are parties that engender voter distrust.
Moreover, a party that shares governance may have difficulty
functioning as a clear opposition. Divided government can
collusion between the parties to avoid blame for policy inaction
failure, which in turn intensifies public cynicism against the
In sum, divided government cannot have been the sole foundation
the recent crisis of governance. Its critics are putting too much
explanatory weight on a pattern of electoral outcomes that has
recurred since World War II, and that was common from the end of
Reconstruction to the rise of McKinley. In the form it took from
1981 to 1992, divided government did, however, make it easier for
government to become associated with major symbols of political
failure, such as the chronic deficit and the S&L debacle. But
restoration of public confidence will require more than control
both branches by the same party.
Given America's constitutional institutions, political culture,
recent history, how shall we go about renewing politics? As James
Morone's exceptionally interesting book shows in rich, historical
detail, American political culture is deeply anti-political.
American history is punctuated by political surges full of
democratic yearning that well up from below. In many of them,
people seek to abolish the messiness of politics in the name of
"the people" and install a government founded in transcendental
values of American community. The popular base of the Perot
movement was a typical example.
Such democratic surges often ossify into the creation of new
interest groups, and new allied federal agencies, such as the
National Labor Relations Board in the 1930s, or the new
environmental agencies of the 1970s. Yet the proliferation of
constituencies and agencies only adds to the system's
ungovernability. Thus, the stage is regularly set for broad
disillusionment with politics, reinforcing the anti-governmental
thrust of American political culture.
In ground-breaking work, the late Jack Walker constructed the
first, reliable "census" across time of interest groups. He found
that the older view of "stable unrepresentation" in the group
system (to use a term coined by William Gamson of Boston College)
no longer captures interest group politics. Gaps in group repre-
sentation have closed steadily since the 1930s due to constant
intervention into the associational system by government and
private "patrons," such as foundations, philanthropies, and the
media. For example, when the Kennedy administration established
state-level commissions on the Status of Women, it laid the basis
for the formation of the National Organization of Women, just as
liberal foundations helped to finance the voter registration
of the early 1960s.
Indeed, since the 1960s, the political system has been
characterized by burgeoning interest groups and declining
participation. Voter turnout and partisan affiliation have both
decreased. As Ginsberg and Shefter observe, electoral politicians
no longer have to engage in mobilizing the electorate. Today's
politicians are all too comfortable with the "low voter turnout"
environment in which they compete. It is a predictable milieu,
changing it is against their career interests. Thus, as the
interest group system has become more pervasive and inclusive,
broader citizenry, paradoxically, has become more frustrated.
Perhaps, contrary to William Greider's title, The People don't
to be told they have already grasped the intractability of
representative government and have channeled their political
impulses into avenues outside those mediated by party and
Paradoxically, the number of political activists has increased
when millions have become electorally inactive. Reintegrating
activism with representative government and effective parties
be very tricky, for interest groups often seem to operate at the
expense of parties, treating them as flags of convenience. (See
Karen Paget, "Citizen Organizing: Many Movements, No Majority,"
TAP No. 2, Summer 1990, and John Judis, "The Pressure
Elite," TAP No. 9, Spring 1992.)
Moreover, as William Greider suggests, because of the
and particularism of interest group politics, the gain to
is no match for the power of money. Also, the crisis of the labor
movement the most embracing and aggregating group of ordinary
voters has reopened gaps in representation. Hence the paradox of
the contemporary system of representation: More Americans are
highly active in politics, via interest groups. Yet in an age of
partisan disaffiliation and group fragmentation, Americans are
disconnected than ever before. What gets lost, finally, is
appreciation of democratic politics and government as aggregative
and collectively valuable activities.
unfortunately, is the larger context for political renewal.
For some analysts, such as those who formed the Committee on
Constitutional Structure, the fate of the Carter Administration
the legislative and fiscal stalemate of the Reagan-Bush era
institutional and procedural reforms to create genuine unified
government. In this view strong parties, a strong presidency,
unified government, and responsible government all go together.
Hence key figures associated with the committees, such as Lloyd
Cutler and the Brookings scholar James Sundquist, call for
constitutional reforms that would make our system more like
parliamentary government. These include such ideas as "team
tickets" (that is, voting for presidential, House, and Senate
slates together), and changing congressional terms to give
presidents time to see a program through. But these reforms,
appealing, are improbable, and they beg the question of how to
redeem democratic citizenship under our present constitution.
One obvious inference is the need for stronger parties, to enlist
citizens in the business of politics and to bridge the
constitutional separation. Without strong parties, even "unified"
government can itself become a kind of divided government, as the
Democratic Party has often been throughout its history. Without a
strengthened Democratic Party, a Clinton administration could go
the way of the Carter administration, succumbing to the still
potent factionalism in the three party groupings the Democratic
Leadership Council, Jesse Jackson and his various constituencies,
and the AFL-CIO/Kennedy alignment. A Clinton administration, like
Reagan and unlike Carter would have to take advantage of the
party-building opportunities of White House incumbency.
Deepening voter alienation also reflects the widespread
that the political deck is stacked that only insiders have
influence, that money talks louder than votes, and that both
parties are corrupted. Greider's muckraking uncovers damning
details about how money talks and constricts national debate
what's feasible. Here again, ordinary people are denied political
influence for reasons deeper than the fact of divided partisan
government. Fundamental campaign finance reform is only the
beginning of a cure.
efficacy, citizen participation, strong parties, and
government competence are mutually reinforcing. In the heyday of
the New Deal coalition, notwithstanding its exclusions, each
operated in tandem with the other to make for a strong polity,
invited further inclusion. Since the late 1960s, that cycle of
reinforcement has ended. Divided government has compounded this
But unified government under the Democrats, at least would have
work mightily to repair the damage. Political renewal can perhaps
be built on the upsurge of citizen activism, but it will have to
take care that such activism does not come at the expense of
parties, or of voter confidence in the polity as a whole. Certain
measures, like the "motor voter bill" recently vetoed by
Bush, or fundamental campaign finance reforms, point in the right
direction. But they only whet one's appetite for a whole new
of strategies to reclaim politics.
When all is said and done, it is hard to imagine political
occurring in the absence of a strong president who has a working
majority in Congress and a healthy partisanship. In that sense,
those who associate democratic decay with divided government are
partly right after all.
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Short Circuits offers students opportunities to undertake physical computing projects, providing tools and methods for creating electronic puppets. Students learn how to incorporate microprocessors into everyday materials and use them to enhance their language and writing skills with shadow puppet shows featuring their own DIY flashlights.
This book provides great activities to help people make new and exciting e-textile and wearables projects while still being able to build a strong understanding of electronics basics.
- Author: Kylie Peppler, Katie Salen Tekinbas, Melissa Gresalfi, & Rafi Santo
- Publisher: MIT Press
- Hardback: 408 pages
- ISBN-10: 0-2620-2784-4
- ISBN-13: 978-0-2620-2783-0


An author uses a book's title to give important information about the contents of the book to the reader. Writers often claim that choosing a title is one of the most important aspects of publishing a written work.Continue Reading
There are several ways in which authors use titles to give the reader insight into the contents of a book. For example, titles in science journals are often a statement of the proposed hypothesis, which can be lengthy. Isaac Newton's book about the properties of light is titled, "Opticks: or, a Treatise of the Reflections, Refractions, Inflections and Colours of Light." Long titles have also been used by famous novelists such as Kurt Vonnegut.
In collected short works, such as Bukowski's "The People Look Like Flowers At Last," the title is often borrowed from the most significant piece in the collection. Titles can also function as teasers to pull the reader into a book. At first glance, "Fahrenheit 451" does not give away the contents of the book, but eventually the author reveals that books burn at 451 degrees Fahrenheit in a world where books are outlawed.
The significance of Lois Lowry's title "The Giver" is revealed in the book once the reader learns that the Giver is actually giving memories, a critical role in understanding the book's utopian society. When an intriguing title is used well, it can hold more significance for the reader upon finishing the book than starting it.Learn more about Literature


Why are spring-set brakes the most common emergency brakes around? They automatically stop drives when electrical power fails or when a safety switch is tripped to protect personnel and equipment.
Because brake-engaging springs immediately jump into action when power is cut, spring-set brakes are especially suitable for backup and protection applications. Widely used for static holding, general load stops, and occasional emergency stops, they’re also effective where VFDs, servos, and stepmotors slow loads first. While some use a diaphragm or bladder arrangement, most fluid power and electrically released types use springs for clamping when power is removed. The latter can be categorized into two groups.
Electrically released armature-activated brakes use springs to clamp the rotor (with attached friction pads) between a stationary end plate and a non-rotating armature. In these units a simple, fixedvoltage power supply keeps the brake released. With power applied to the brake coil, its magnetic force attracts the armature to compress the springs and release their hold.
Generally coils are rated for continuous duty and can be continually energized without overheating. When coils do heat up, they get hottest at coil engagement due to engaging, or pull-in amperage. For UL Class A insulation, coil temperatures shouldn’t exceed 105°C; Classes B and H limits are 130° and 180°C respectively. A high ambient temperature where the brake is actually mounted may limit the coil cycle rate. A coil temperature rating should include the wire, tape, insulation, and any coating materials.
Solenoid-actuated brakes are the second type of electrically activated springset brake. They come with either single or dual-voltage coils and can be wired to either single or three-phase motors. Compared to armature-actuated brakes, solenoid-actuated brakes have a crisp electrical response time. However, instantaneous rated voltage must be supplied to coils to ensure proper solenoid pull-in and maximum coil cycle rate.
It’s important to remember that these brakes must be wired separate from drives for proper control of each. Solenoid-actuated brakes are designed to a typical NEMA voltage range of 10% of the rated voltage and frequency. Equipment and system installers accustomed to typical NEMA design B motors may try to wire the coil across the motor windings; however, by design VFDs vary frequency, and that doesn’t work with a fixed-frequency product. An installation rule of thumb: Confirm wiring before powering. For example, suppose a brake is mounted to the accessory end of a drive intended for field-wire. An installer, familiar with standard motors, might assume the brake has been pre-wired, and begin to troubleshoot a faulty operation. In fact, in this situation the brake is not getting any electrical power. To prevent these misunderstandings, some drive manufacturers have a fixed voltage tap in their power box, which is a convenient arrangement for wiring a brake into the motor power box.
Emergency brakes cannot protect if they’re improperly selected; ISO and ANSI safety factors must be applied. So exactly how powerful should a specified brake be? It depends on whether the desired reaction is a very rapid emergency stop, or softer stop that sacrifices brakes to prevent disturbing loads or the overall system. Establishing maximum as well as typical conditions — from typical situations to worst-case scenarios — also influence requirements. The entire system (and not just one component) must have enough torque to meet the dominant prescribed condition: braking, clutching, tensioning, or limiting. The trick is knowing that condition ahead of time.
The easiest and most common method is to size a brake’s dynamic torque to the system’s motor torque. This technique does have limitations; motors can draw extra current for short bursts to provide more torque than their 100% rating. (This is especially important to remember for vertical applications, as brakes must be able to stop any falling of whatever items the motor lifts.) Even so, sizing to the system’s motor torque is a suitable method for the majority of cases.
Whether torque selection is robust or lean depends on design Driving a conveyor system intent. Because of the potential for fatigue or early wear of other system components (such as gearboxes or leadscrews) overdesigning is actually just as risky as under-designing. Specific industry standards — for automotive, packaging, medical, and general material hoisting applications — play a role in the type of planning required. In fact, each industry has different recommended sizing schedules. Motor manufacturer’s performance curves can be consulted for dynamic torque ratings at operating speeds that meet or exceed peak torques developed by the motor. Sometimes if the brake is small enough, the motor and load can drive through the brake.
Continue on page 2
When an application’s’ maximum conditions involve extreme speeds, brake selection must be re-evaluated against recommended maximum rpms for balance and resonance. Different from stopping rpm, freewheeling rpm is the typical speed to which a drive can ramp. In some designs, the drive manufacturer may permit some overspeed rpm beyond the design rpm. In those situations it’s safer to size to stopping — not maximum — rpm. Stopping rpm can be a lower rpm or even zero for holding- only uses.
After an over-speed or fullload stop following the loss or removal of power, maintenance in the form of part replacement or inspection may be needed.
Emergency stopping is generally a safety issue, but not always. When someone has caught clothing or body parts in a rotating piece of equipment, the hazard is obvious. However, less pressing situations can be dangerous too. Maybe misalignment is developing, a workpiece has dropped in upside down, or a load has shifted. Friction brakes are by far the most common solution for meeting these stopping requirements because their operation relies on offline mechanical mechanisms. There is a possible drawback to these brakes, though: The relative motion of slippage heats and changes friction materials, and can result in accelerated wear and torque loss. However, mating parts and friction materials themselves can be tweaked for improved performance if an application’s stops are predictable. New materials allow for technological advancements in these brakes: for example, compounded formula phenolic resin-based discs absorb more heat to improve part life and heat dissipation efficiencies. Spring-set brakes can also include an automatic wear-adjustment feature to keep brakes going strong even after they show some wear. In addition, specialty industries have spurred specialized design elements such as metal-to-metal disc contact, oil baths, and ceramic discs. These all aim to improve brake friction action.
• Torque is a measure of rotational force and in the case of a brake, is a retarding force.
• Emergency brakes functioning in failsafe use prevent shaft rotation when electrical power is cut off. When power is restored, brakes release.
• A user must know if an emergency brake is to be used once a year, once an hour, or at some interval in between. If a brake will not be used for extended periodsof time, the enclosure and related modifications can be adjusted. Brake selection should also consider the brake location and accessibility for maintenance and enclosure choice.
• Emergency brakes are everywhere — on escalators, airport baggage handlers, airport gate bridges, and even medical lifttables, or AGV. However, it’s important to prevent over-reliance on emergency stopping.
• Because most brakes require low current to keep brakes in the released position, the response time to set can be affected by emf voltages generated by motor windings. If this does occur, it may be necessary to isolate the brake coil from the motor winding and wire separately.
• Spring-set brakes are applied mechanically, so it’s easy to equip them with manual releases.
When it must stop
Variable frequency drives (VFDs) are growing in use for speed control. (A VFD determines rpm and can ramp loads down to zero rpm.) However, brakes remain crucial in applications when safety and compliance are concerns. A VFD can signal the motor to stop rotating, but an electromechanical brake can hold a load or rapidly stop and hold its gearbox and load when required. In fact, applications must often be fitted with rapid-stopping brakes to keep UL agency markings and to meet CE requirements; they are obligations already in place in many industries.
Besides quick stopping, emergency friction brakes guarantee secure loads at zero rpm so that nothing slips or causes workpiece waste, or worse, personal harm.
For more information, call the Stearns Division of Rexnord Corp. at (800)488- 9078 or visit www.rexnord.com/stearns.


The Yellowhammer War
The Civil War and Reconstruction in Alabama
Publication Year: 2014
During the first winter of the war, Confederate soldiers derided the men of an Alabama Confederate unit for their yellow-trimmed uniforms that allegedly resembled the plumage of the yellow-shafted flicker or “yellowhammer” (now the Northern Flicker, Colaptes auratus, and the state bird of Alabama). The soldiers’ nickname, “Yellowhammers,” came from this epithet. After the war, Alabama veterans proudly wore yellowhammer feathers in their hats or lapels when attending reunions. Celebrations throughout the state have often expanded on that pageantry and glorified the figures, events, and battles of the Civil War with sometimes dubious attention to historical fact and little awareness of those who supported, resisted, or tolerated the war off the battlefield.
Many books about Alabama’s role in the Civil War have focused serious attention on the military and political history of the war. The Yellowhammer War likewise examines the military and political history of Alabama’s Civil War contributions, but it also covers areas of study usually neglected by centennial scholars, such as race, women, the home front, and Reconstruction. From Patricia A. Hoskins’s look at Jews in Alabama during the Civil War and Jennifer Ann Newman Treviño’s examination of white women’s attitudes during secession to Harriet E. Amos Doss’s study of the reaction of Alabamians to Lincoln’s Assassination and Jason J. Battles’s essay on the Freedman’s Bureau, readers are treated to a broader canvas of topics on the Civil War and the state.
Jason J. Battles / Lonnie A. Burnett / Harriet E. Amos Doss / Bertis English / Michael W. Fitzgerald / Jennifer Lynn Gross / Patricia A. Hoskins / Kenneth W. Noe / Victoria E. Ott / Terry L. Seip / Ben H. Severance / Kristopher A. Teters / Jennifer Ann Newman Treviño / Sarah Woolfolk Wiggins / Brian Steel Wills
Published in Cooperation with the Frances S. Summersell Center for the Study of the South
Published by: The University of Alabama Press
Title Page, Copyright
List of Illustrations
Kenneth W. Noe
Born in Tennessee in 1833, the Rev. Dr. David Campbell Kelley lived a life full of adventure. After college he took a medical degree and then sailed for China as a Methodist missionary. By the time the Civil War began, however, Kelley was back in America, residing in Huntsville, Alabama. An ardent secessionist, he embraced the Confederate war effort, forming a company of cavalry known variously as the...
1. Precipitating a Revolution: Alabama’s Democracy in the Election of 1860
Lonnie A. Burnett
William Lowndes Yancey had a clear view of the future. In 1858, the longtime Alabamian wrote a letter to a young supporter revealing his personal agenda. Yancey expressed a desire to “fire the Southern heart, instruct the Southern mind, give courage to each other, and at the moment, by one organized, concerted action . . .
2. “The Aggressions of the North Can Be Borne No Longer”: White Alabamian Women during the Secession Crisis and Outbreak of War
Jennifer Ann Newman Treviño
On December 31, 1860, Elizabeth Rhodes of Eufaula penned the following in her diary: “There are dark clouds overspreading our National Horizon and we cannot yet know whether the fringes of prosperity will dispel them and the bright rays of peace and happiness once more [beam] upon us, [or] whether they will grow...
3. Confederate Alabama’s Finest Hour: The Battle of Salem Church, May 3, 1863
Ben H. Severance
From about 11:00 in the morning until well into the afternoon on May 3, 1863, Alabamians in Wilcox’s Brigade waged a frantic rearguard action, alone, against Union forces ten times their size. Edmund Patterson’s memory of the event was that of a race against time. A twenty-three- year- old lieutenant in the 9th Alabama Infantry, Patterson had been on the move for hours: “We had been running...
4. The Confederate Sun Sets on Selma: Nathan Bedford Forrest and the Defense of Alabamain 1865
Brian Steel Wills
The year 1864 had proven to be a trying and difficult one for the Confederate States of America. Powerfully constructed twin operations in Virginia and Georgia had seen Robert E. Lee’s Army of Northern Virginia driven into increasingly lengthy defenses around Petersburg and nearby Richmond, while Confederate defenders in Georgia had been unable to prevent the penetration of that state, costing...
5. Fighting for the Cause? An Examination of the Motivations of Alabama’s Confederate Soldiers from a Class Perspective
Kristopher A. Teters
On March 1, 1864, Confederate prisoner of war John Washington Inzer wrote in his diary: “Now fear we will be held as prisoners a long time. Well, we must bear it. Anything for our country. We must never think for one moment of giving up the contest. All we have to do is be true to our cause. We never can be subjugated.” Just...
6. Voices from the Margins: Non-Elites in Confederate Alabama
Victoria E. Ott
In 1865, John W. Brown returned from service in the Confederate army to discover his wife missing. Having conceived a child with another man, Ellen J. (Vandasdel) Brown had moved out of their residency in Pike County, Missouri, abandoning her marriage to John. The former Confederate soldier subsequently moved to Perry...
7. Augusta Jane Evans: Alabama’s Confederate Macaria - Jennifer Lynn Gross
Augusta Jane Evans (Wilson) was one of the nineteenth-century South’s most popular female authors. Born in Columbus, Georgia, on May 8, 1835, Evans spent some of her childhood in San Antonio, Texas, where her father moved the family after he went bankrupt in the early 1840s.1 By 1849, when many Americans were moving...
8. “The Best Southern Patriots”: Jews in Alabama during the Civil War
Patricia A. Hoskins
On April 26, 1861, two weeks after the firing on Fort Sumter, twenty-six- year- old Solomon Kahn of Montgomery, Alabama, enlisted in the 3rd Alabama Infantry. During the first week of May, the 3rd Alabama became the first Alabama regiment to report to Richmond, Virginia, in defense of the newly formed Confederate...
9. Every Man Should Consider His Own Conscience: Black and White Alabamians’ Reactions to the Assassination of Abraham Lincoln
Harriet E. Amos Doss
After four grueling years of civil war, by April 1865 Alabamians longed for peace. Union troops captured and occupied places from Huntsville in the north to Blakely in the south. As Confederate general Robert E. Lee was surrendering his army in Virginia, Mayor R. H. Slough of Mobile was surrendering his city to Union...
10. Alabama’s Reconstruction after 150 Years
Sarah Woolfolk Wiggins
Alabamians, like other Americans, love to celebrate anniversaries, especially those related to the history of our nation. In 1986 it was the centennial of the Statue of Liberty; in 1976 it was the bicentennial of the Declaration of Independence; and in 1961 it was the most elaborate one of all: a four-year- long celebration of the...
11. Of Ambition and Enterprise: The Making of Carpetbagger George E. Spencer
Terry L. Seip
In his final speech to the U.S. Senate in March 1871, the defensive Alabamian carpetbagger Willard Warner argued that men like him were “like men everywhere; there are some good and some bad among them.” That Warner counted himself and his supporters among the “good” perhaps goes without saying, but he also left...
12. “He Was Always Preaching the Union”: The Wartime Origins of White Republicanism during Reconstruction
Michael W. Fitzgerald
Historians have long been perplexed by the native white Republicans of the Reconstruction era, or “scalawags,” as the contemporary slur described them. At the turn of the twentieth century, the Dunning school demonized them as apostates. Postwar loyalists were “an unpleasant and violent part of the population,” as Walter Lynwood...
13. Labor, Law, and the Freedmen’s Bureau in Alabama, 1865–1867
Jason J. Battles
The Bureau of Refugees, Freedmen, and Abandoned Lands was established by an act of Congress in March 1865 and was vested with broad powers to assist three million blacks in the transition from slaves to citizens. More commonly known as the Freedmen’s Bureau, this division of the War Department operated in all of...
14. Freedom’s Church: Sociocultural Construction, Reconstruction,and Post-Reconstruction in Perry County, Alabama’s African American Churches
In “Reconstruction and Its Benefits,” a paper presented at the 1909 meeting of the American Historical Association, noted black scholar W. E. B. Du Bois recalled how necessity often drew enslaved blacks and free whites to the same churches before the Civil War. Following the war, white churchgoers quickly removed blacks, ...
Suggestions for Further Reading
Page Count: 320
Illustrations: 4 illustrations
Publication Year: 2014
OCLC Number: 864900234
MUSE Marc Record: Download for The Yellowhammer War


Artistic impression of an active volcano on Venus.
Beautiful Venus, jewel of the skies, the evening star, is the closest place to hell in our Solar System. It's atmospheric pressure crushes down with immense force, equivalent to a depth of 900 meters below our ocean's surface - enough to kill a nuclear submarine. The atmospheric temperature is hot enough to melt lead. It rains sulphuric acid. And as if that weren't enough, new data from the European Space Agency's (ESA) Venus Express orbiter suggest that it might have active volcanoes as well.
Venus Explorer has been orbiting the planet
since 2006, monitoring its atmosphere with an array of sophisticated instruments. Several years ago, it found evidence that Venus is geologically active
, in the form of volcanoes which must have formed within the past few million years (practically yesterday, in geological terms), but it wasn't clear whether those volcanoes were still active. But six years of atmospheric data have revealed large changes in the sulphur dioxide content of Venus's atmosphere, and active vulcanism seems to be a likely cause.
Venus is a lot closer to the Sun
than Earth, so it gets a lot more sunlight, which breaks down sulphur dioxide. This means that there is no SO2
in the upper layers of the atmosphere; it is only found below the upper cloud decks. Even this lower-level SO2
can't hang around for long, as it gradually mixes upwards, so something must be going on to keep replenishing the supply. Whatever it is, it seems to come in spurts as the data returned from Venus Express (and NASA's earlier Pioneer Venus mission) show that the levels of SO2
change rapidly over short times. Immediately after arriving at Venus in 2006, the spacecraft recorded a significant increase in the average density of sulphur dioxide in the upper atmosphere, followed by a sharp decrease. The levels today are only a tenth of those initial measurements. Pioneer Venus recorded a similar pattern during its mission when it orbited the planet from 1978 to 1992.
Trying to figure out exactly where the gas comes from is made difficult by the nature of Venus's atmosphere: Although the planet
has incredibly long days (it takes 243 Earth days to rotate just once about its axis), the atmosphere itself whips around in only 4 days, meaning it's average speed at the equator is close to 400km/h. Any volume of SO2
that's released into the atmosphere spreads out away from its source very quickly.
On the other hand, the scientists studying this problem are also considering that the variations we're seeing might just be caused by the turbulent atmosphere concentrating and then dissipating the gas in a long-term natural cycle. “If you see a sulphur dioxide increase in the upper atmosphere, you know that something has brought it up recently, because individual molecules are destroyed there by sunlight after just a couple of days,” says Dr Emmanuel Marcq of Laboratoire Atmosphères, Milieux, Observations Spatiales, France, and lead author of the paper published in Nature Geoscience.
“A volcanic eruption could act like a piston to blast sulphur dioxide up to these levels, but peculiarities in the circulation of the planet that we don’t yet fully understand could also mix the gas to reproduce the same result,” adds co-author Dr Jean-Loup Bertaux, Principal Investigator for the instrument on Venus Express that made the detections.
“Alternatively, and taking into account the similar trend observed by Pioneer Venus, it’s possible that we are seeing decadal-scale variability in the circulation of the atmosphere, which is turning out to be even more complex than we could ever have imagined,” Dr Marcq notes.
“By following clues left by trace gases in the atmosphere, we are uncovering the way Venus works, which could point us to the smoking gun of active volcanism,” adds Håkan Svedhem, ESA’s Project Scientist for Venus Express.


Mammograms May Lead To Breast Cancer 'Over-Diagnosis,' Study Finds
Norwegian scientists say as many as 1 in every 4 cases of breast cancer doesn't need to be found because it would never have caused the woman any problem.
It's a startling idea for laypeople (and many doctors) thoroughly indoctrinated with the notion that any breast cancer is medically urgent — and should be found at the earliest possible moment.
But in fact, the study published in the Annals of Internal Medicine is not the first to suggest that breast cancer is often "over-diagnosed" through mammography screening. This is when a tumor is found that would never have gone on to cause symptoms or death.
A review of seven similar studies last year concluded that 30 percent of women who get a diagnosis of breast cancer through mammography screening represent "over-diagnosis and over-treatment."
The Norwegian study avoids certain problems with those earlier studies, some of which combined different forms of breast cancer. It took advantage of the fact that mammography was introduced into Norway's 19 counties in a staggered fashion over a nine-year period rather than all at once.
That allowed the researchers to compare the rate of breast cancers diagnosed through mammograms and those found because a tumor was palpable or produced symptoms. Norway has data on virtually all women who get a diagnosis of breast cancer.
The study included nearly 40,000 women with invasive breast cancer but excluded those with a form called ductal carcinoma in situ. DCIS behaves differently, and study authors say it requires a separate analysis.
By comparing women who got mammograms and those who didn't at the same time – rather than at different time periods — the Norwegians were able to get around the fact that breast cancer incidence has changed over time. As in the U.S., breast cancer diagnoses went up when menopausal hormone therapy was widely used, and declined sharply when many women stopped using hormone replacement therapy.
The researchers concluded that 15 percent to 25 percent of breast cancers were overdiagnosed — meaning 6 to 10 women were overdiagnosed for every 2,500 offered screening mammograms.
Under current practice, those women get biopsies and treatment for breast cancers that would never have been detected otherwise. Either the cancers would have grown very slowly or not at all and never caused symptoms, or women would have died from something else before their breast cancer was diagnosed.
The Norwegian study authors also questioned a fundamental justification of mammography screening: that it finds more cancers when they're early and more curable. There was a reduction in late-stage breast cancers after Norway implemented universal mammography screening — but it occurred both in women who had mammography and those who didn't.
"Therefore, our findings suggest that enhanced awareness is probably the reason for the reduction of late-stage cancer, not screening," they write. By "enhanced awareness," they mean that women and doctors were more alert to suspicious lumps.
The problem of breast cancer overdiagnosis is similar to the dilemma faced by men diagnosed with prostate cancer because of a PSA test. Many of those men have a cancer that is so slow-growing that it would never have been found otherwise, which is why the U.S. Preventive Services Task Force has proposed that routine PSA screening be abandoned.
The task force says most men whose prostate cancers were detected through screening are overdiagnosed.
The Norwegian study leaves open the difficult question of what should be done about breast cancer overdiagnosis.
For one thing, there's no chance that researchers will ever assign women randomly to get mammography screening or not, then follow both groups for the rest of their lives to see how many screened women got needless cancer diagnoses. For obvious ethical reasons, the researchers say, "such a trial will never be done."
And there's no way at present for doctors to tell which breast tumors never needed to be found.
Nevertheless, an editorial that accompanies the new study declares that it's "time to agree that any amount of over-diagnosis is serious and to start dealing with this issue now."
Maybe those who interpret mammograms should be more cautious about calling something abnormal, say the editorialists, Dr. Joanne Elmore of the University of Washington and Dr. Suzanne Fletcher of Harvard.
And maybe doctors should hold off performing a breast biopsy in some women with suspicious mammograms and instead evaluate them over time with repeat mammograms. "This may be a tough sell for women with anxiety as a result of the 'watch-and-wait' approach," Elmore and Fletcher admit, "as well as for radiologists who do not want to miss any sign of disease and fear of malpractice lawsuits."
But at least women should be made aware of the overdiagnosis problem, they say. Because the chances it will happen to an American woman are higher than in Norway. That's because U.S. women often start regular mammograms in their 40s, a decade earlier than in Norway. And U.S. radiologists are more likely to report any abnormality on a mammogram.


An Easter Prayer
As religion speaks, on Monday 25th 2011 is this year's annual celebration of Easter in commemoration of Jesus Christ's resurrection on Easter Sunday. On this holy day, Pope Benedict XVI delivered an Easter prayer for diplomacy to prevail over warfare in Libya and for citizens of the Middle East to build a new society based on humanity.
He addresses to the overflow of a crowd of 100,000 of St Peter's Square "In the current conflict in Libya, may diplomacy and dialogue replace arms, and may those who suffer as a result of the conflict be given access to humanitarian aid."
With reference to the conflicts occuring in the Middle East and Libya, as well as encouraging Europeans to welcome refugees from North Africa, Pope Benedict XVI prayed that all citizens, especially young people, would work together to promote world peace, defeat of poverty and human rights where all political opinions are respected.
In other news, US Senator John McCain has summoned for an increase in military aid for Libya's rebels. This includes the supply of weapons, training and stepped-up airstrikes, in demand for a full on support in fight to oust Muammar Gaddafi.
Picture posted by user Sophia


Disease burden and health-care clinic attendances for young children in remote Aboriginal communities of northern Australia
Danielle B Clucas a, Kylie S Carville b, Christine Connors c, Bart J Currie d, Jonathan R Carapetis d, Ross M Andrews d
There is a disproportionate disease burden in remote Aboriginal communities compared with the general Australian population.1–5 These discrepancies begin at birth: the perinatal mortality rate for Aboriginal infants in Darwin is three times that of the non-indigenous population.6 Health problems in these communities are similar to those seen in developing-country contexts.1,7–9 Indigenous children suffer from a wide variety of diseases including some rarely, if ever, seen in the non-indigenous population since improvements in economic and living conditions led to a reduction in the burden of infectious diseases.1
Primary health care (PHC) centres, including both Aboriginal-community controlled health services and government-run clinics, are present in most remote communities in Australia. Staff numbers vary but usually include a nurse clinic manager and Aboriginal health workers. Additional clinical nursing staff members vary depending on the size of the PHC centre and are supported by either resident or visiting medical officers. Skin infections and infestations are among the most common reasons for children in these communities to present to PHC centres.10 These conditions remain a significant public-health problem in developing countries and among indigenous populations in industrialized nations. In resource-poor communities worldwide, scabies prevalence in the general population is up to 10%.11 In remote Aboriginal communities in Australia’s Northern Territory, scabies is endemic, with up to 50% of children and 25% of adults infested at some times.12,13
Secondary infection of scabies lesions is common. Group A streptococcal pyoderma is very common in Aboriginal children in the Northern Territory,14,15 with 50–70% of cases reported to be secondary to scabies.12,13 Group A streptococcal pyoderma leads to acute poststreptococcal glomerulonephritis,16,17 and underlies most cases of invasive group A streptococcal infections, especially in tropical regions.18,19 Links between scabies and high rates of acute rheumatic fever in remote Aboriginal communities in the Northern Territory have also been postulated.20 With rates of poststreptococcal disease in these communities being among the highest in the world,21,22 prevention of scabies and skin sores in this region could have far-reaching implications.
We aimed to review clinic presentations in the first few years of life within two remote Aboriginal communities of Australia to assess the level of health-care seeking behaviour in this context and to determine the burden of scabies, skin sores and other infectious diseases.
A retrospective review of clinic records was done in two PHC centres in the remote East Arnhem region of the Northern Territory, Australia. These were two of six communities participating in the East Arnhem Regional Healthy Skin Project, a regional collaboration to reduce the prevalence of scabies, skin sores and associated chronic diseases in the participating communities, located about 500 km east of Darwin.
The two communities included in the medical-record review each had a population of about 800 people. The clinics are the only PHC centres in the communities. For the purposes of the review, the study population comprised all children born after 1 January 2001, who were resident in the two communities as of 28 September 2005, for whom we had consent to review their health records (age range 0–4.75 years).
Ethics approval was obtained from The Human Research Ethics Committee of the Northern Territory Department of Health and Community Services and Menzies School of Health Research.
The record review was undertaken during October and November 2005. Data were collected for all presentations recorded in the child’s clinic file during a period of 3 years and 9 months (1 January 2002 to 30 September 2005).
Data collected were: the date of each presentation, the child’s height and weight, any infectious reason for presentation, antibiotic prescription and any referral to hospital. Recorded reasons for presentation and classifications used were the following: scabies (either noted specifically or with reference to scabies treatment given); skin sores (any mention of skin sores or other presumed bacterial infections of the skin including boils, carbuncles, abscesses, ulcers and pustules); tinea (tinea, ringworm, fungal skin infection or treatment with tinea medication); ear disease (mention of any middle-ear infection or symptoms of such an infection, including acute and chronic suppurative otitis media or otitis media with effusion); throat infection (throat or tonsils red, pink, sore, inflamed or infected or the presence of pharyngitis or laryngitis); acute poststreptococcal glomerulonephritis; acute rheumatic fever (probable or confirmed diagnosis); lower-respiratory-tract infection (presence of pneumonia, bronchitis, bronchiolitis, chest infection or crackles or a combination of symptoms suggestive of these conditions); upper-respiratory-tract infection (any mention of an upper-respiratory-tract infection, cold or flu or symptoms of an infection including cough, runny nose or blocked nose, but not including sore throat in the absence of other symptoms); diarrhoea (diarrhoea or fluid, loose or watery bowel motions recorded); and other febrile illness (temperature of > 37.5 °C or the child noted to be febrile with no temperature recorded). Multiple reasons could be recorded for each presentation.
Multiple presentations on the same day were recorded as the one presentation. Presentations with missing or incomplete dates were excluded.
Data were analysed in Stata version 9.1.23 Data were examined per child or per presentation. Continuous skewed data were expressed as medians (interquartile range) and dichotomous data as percentages. Median presentations in the first and fourth years of life are reported for children for whom data was collected for that entire year of life. Dichotomous data were compared by use of two methods: relative risk with 95% confidence intervals (CI); and generalized estimating equations.
There were 198 children in the study population. Clinic records were reviewed for 174 children (80%). In total, there were 7273 presentation records reviewed for these 174 children. The date was incomplete or missing for a further 75 presentations, which were excluded from the study. Due to the nature of the study, and the study period used, children were followed for varying lengths of time. Data were collected from birth for 126 children, and for the entire first year of life for 114 children (the remaining 12 children were aged < 1 year at the time of the record review). The study population was 55% male.
There was a median of 16 (interquartile range, IQR: 10–22) presentations per child per year over the study period. During the first year of life, the median number of presentations per child was 23 (IQR: 13.5–30). In contrast, older children presented less frequently, with those aged 3 years having a median of 5 (IQR: 3–9) presentations per child. At least one infectious condition was reported for two-thirds (65.7%) of presentations, with a median of 2 (IQR: 1–2) infection-related problems per presentation and up to 6 at a single consultation.
Upper-respiratory-tract infection was the most common reason for presentation among those specifically monitored, noted in 32% of presentations, and seen at least once in 172 (99%) children. The number of presentations for upper-respiratory-tract infections was almost equal to that for all non-infectious reasons (34%). Skin sores, scabies or both were the next most common reason for presentation, seen at 18% of presentations. Of the 174 children, 160 (92%) had at least one presentation over the study period with skin sores or scabies. The median number of presentations in the first year of life was 3 (IQR: 1–4) for scabies and 2 (IQR: 1–5) for skin sores. Other common reasons for presentation to the PHC centre were ear disease, febrile illness, diarrhoea and lower-respiratory-tract infection (Table 1).
Scabies was recorded in a higher proportion of presentations in children aged < 1 year than in those aged 1–4 years (8.8% versus 6.8%, P = 0.007), whereas skin sores were more common in the older age group (10.5% among those aged < 1 year compared with 19.0% among those aged 1–4 years, P < 0.001). Children aged < 1 year who had scabies were 6.9 (95% CI: 5.8–8.2) times more likely to have skin sores at that presentation than those without scabies. Having scabies increased the risk of skin sores by 4.4 (95% CI: 3.9–4.9) times in children aged 1–4 years.
Of the 126 children for whom data were collected from birth, 92 (73%) and 108 (86%) presented at least once with scabies and skin sores, respectively. All of these children had presented for the first time with scabies and skin sores before they reached 2 years, with the exception of one child whose first presentation with skin sores was at age 31 months. By the age of 1 year, 63% and 69% of all children (and 87% and 81% of those ever seen with the conditions) had presented with scabies and skin sores, respectively. A large peak in first presentations for both scabies and skin sores occurred at the age of 2 months (Fig. 1 and Fig. 2).
Fig. 1. Presentations for scabies in two remote communities in East Arnhemland, January 2002 to September 2005a
Fig. 2. Presentations for skin sores in two remote communities in East Arnhemland, January 2002 to September 2005a
Table 1. Reasons for presentation of children at two remote community health clinics, East Arnhemland, January 2002 to September 2005a
Access to primary health care is a critical component of a healthy start to life. However, Aboriginal children born into the two communities reviewed in our study spend substantial time in clinics in the first year of life. Some of these visits would be for well-baby checks, but with 50% of infants presenting 23 times or more in the first year of life – about twice each month – the disease burden is clearly very high. The high frequency of presentation for medical care is also a testament to the willingness of Aboriginal people to use health services and the high workload experienced by these health services. Others have shown that Aboriginal health services in other parts of the country are similarly faced with high work loads and complex health-care needs, with more problems being dealt with per consultation than in Australian general practice.24,25
Our study represents only those cases presenting for medical care, we did not review the records for 20% of the target population and were therefore unable to determine the disease burden among this group. Absence from the clinic does not mean absence of disease, and the true burden of disease may well be even higher. Given the extraordinarily high rates of clinic presentations among the study group, illness in childhood becomes the norm, and many more instances of ill health probably remain undiagnosed.
Although our study shows that children use the health services, access to specialist care is very limited. Aboriginal health workers make up 65% of health professionals working in the community-controlled sector, but often a lower proportion in government clinics.26 Very young children are accessing medical care more, and these barriers and weaknesses will therefore have a disproportionate impact on this vulnerable group.
We describe a very high burden of disease due to respiratory-tract infections, scabies and skin sores at a very young age, clearly demonstrating that skin infections or infestations are almost universal in young Aboriginal children, and one of the most common reasons for children to present to clinics in these communities.
Respiratory-tract infections are a prominent cause of hospitalizations among young Aboriginal children,27,28 and this study indicates that they also represent most of the infectious-disease burden at the PHC level. In order to ensure that hospitalization (necessitating removal of the child from their community) is minimized, there is a need for adequate treatment of children with these infections at PHC centres and early identification of patients more likely to have severe illness. Intervention to prevent respiratory-tract infections would result in a decreased workload at PHC centres. A better understanding of the causes of these infections, including the pathogens involved, is needed. Research before the introduction of the seven-valent pneumococcal vaccine in Australia showed that Aboriginal children are infected heavily with bacterial pathogens such as Streptococcus pneumoniae and Haemophilus influenzae, and that bacterial and viral coinfections are common in children with lower-respiratory-tract infections.29–31 Vaccination against bacterial pathogens alone will not reduce the burden of infections of the upper and lower respiratory tracts, viral vaccines (from respiratory syncitial virus and influenza to adenovirus and rhinovirus) are also likely to benefit these children.
Our study identified a previously undocumented burden of scabies and skin infections starting within the first few months of life. There are few longitudinal studies of scabies and many community-based studies are episodic and focus on the overall burden. While other studies also indicate that scabies is more common in young children than in older age groups,32,33 we believe this to be the first study to demonstrate the very early age at which scabies is first acquired by almost all infants in this setting. In addition to the individual burden, monitoring of scabies and skin infections among young infants may well be a useful indicator of scabies prevalence within the broader community.
The reliance on clinic data and population figures and the semi-subjective nature of a diagnosis of scabies are limitations of this study. Furthermore, clinic data might not accurately reflect the true burden of disease in a community because not all cases will present to the clinic. As such, levels reported here are likely to be an underestimate. Furthermore the diagnosis of illnesses based solely on clinic notes is problematic. Diagnoses and sufficient detail are often not recorded and classifications of diseases may thus underestimate or overestimate the actual disease burden. Data are likely to be more accurate for obvious health problems with objective signs (e.g. skin sores), but less so where diagnosis is more subjective, such as with scabies and upper-respiratory-tract infections. Nevertheless the skin-sore data reported here, and possibly the scabies data, are, if anything, likely to underestimate true levels.
Appropriate treatment of scabies in these communities is problematic. Recommended treatment of scabies in children ages < 2 months of age in these communities is with 3 days of 10% crotamiton cream,34 this is less efficacious than 5% permethrin cream, although failure rates with both crotamiton and permethrin might be higher in children under 1 year of age than in older children.35–38
Oral ivermectin has been successful in community-based treatment programmes for scabies in Papua New Guinea,39 the Solomon Islands40 and Vanuatu,41 and has been used to treat millions of adults for nematode infections.42 Although there are limited data on the safety of ivermectin in children, it is being increasingly used in children aged > 5 years for both individual therapy and in community scabies programmes. Ivermectin will probably have an increasing role in younger children as safety data accumulate. Because of their close personal contact with adults and other children, young children with scabies and skin sores can potentially spread infections to large numbers of community members. To achieve a sustainable decrease in scabies prevalence in communities, adequate treatment of these children is important.
Treating individual cases of scabies is time consuming, expensive and ineffective.43–45 A successful community-based scabies programme has been described in Panama,46 and this has been adapted and implemented in individual remote Aboriginal communities in the Northern Territory, Australia. These community based programmes involved mass treatment with 5% permethrin cream, community clean-up days, screening and education.12,43,47 A reduction in scabies from 32.3% to less than 10% was seen in children in one community and maintained for > 2 years, with incidence and severity of pyoderma also substantially decreased.12 However, in some communities initial reductions were achieved, but levels returned towards preintervention levels within 1 year.43 There is high mobility between houses and communities in this region, which is likely to result in the reintroduction of scabies. Treating communities in isolation is unlikely to produce a sustainable decrease. The East Arnhem Regional Healthy Skin Program is a regional collaboration to reduce scabies, skin sores and associated chronic diseases. An expansion of the previously mentioned programmes, it involves six communities in the region and began in 2004.
Recommendations from this work for improved control of scabies, pyoderma and other high-burden infections include syndromic treatment protocols, community child screening and treatment of cases and contacts where appropriate and a focus on regional coordinated approaches, such as the “healthy skin days”. In addition, it is crucial to continue efforts to address the underlying causes of these extremely high rates of scabies and bacterial skin infections: overcrowding, difficulties with sanitation and continuing socioeconomic disadvantage.13
The situation in these communities in remote tropical Australia is likely to be similar in other countries in the region and elsewhere where scabies remains a problem.11 In conclusion, this study found that very young children are at high risk of skin infections and especially scabies. Further research into safe and effective treatments for scabies in this age group is needed. ■
We gratefully acknowledge Lisa McHugh and Sophie La Vincente for their advice and helpful comments, Nyree O’Connor for assistance with data collection, Charmaine Hird for her help with data entry and Obioha Ukoumunne for statistical advice. Many thanks to the staff at the community health centres for their assistance and to community members for their participation in this study. The East Arnhem Regional Healthy Skin Project received funding support from the Rio Tinto Aboriginal Foundation, the Ian Potter Foundation, the Australian Government Office of Aboriginal and Torres Strait Islander Health, and the Cooperative Research Centre for Aboriginal Health.
- Thomson N. Australian Aboriginal health and health-care. Soc Sci Med 1984; 18: 939-48 doi: 10.1016/0277-9536(84)90264-8 pmid: 6740341.
- McNeilly J, Cicchini C, Oliver D, Gracey M. Infectious disease in Aboriginal infants and children in Western Australia. Med J Aust 1983; 2: 547-51 pmid: 6633391.
- Currie BJ, Brewster DR. Childhood infections in the tropical north of Australia. J Paediatr Child Health 2001; 37: 326-30 doi: 10.1046/j.1440-1754.2001.00661.x pmid: 11532049.
- Harris L, Knight J, Henderson R. Morbidity patterns in a general paediatric unit in rural Western Australia. Med J Aust 1986; 145: 441-3 pmid: 3773828.
- Gracey M, Dennison M, Burke V. Hospital admissions of Aborigines and non-Aborigines in Western Australia, 1977-1988. Trans R Soc Trop Med Hyg 1992; 86: 694-7 doi: 10.1016/0035-9203(92)90195-I pmid: 1287948.
- Matthias GS, Morgan G. Aboriginal and non-aboriginal perinatal deaths in Darwin: a comparative view. Med J Aust 1992; 156: 533-7 pmid: 1565045.
- Moodie PM. Mortality and morbidity in Australian aboriginal children. Med J Aust 1969; 1: 180-5 pmid: 5779046.
- Bartlett B. Central Australia: medical practice in Australia’s Fourth World. Med J Aust 1991; 155: 470-2 pmid: 1921817.
- Maxwell GM, Elliott RB. Nutritional state of Australian aboriginal children. Am J Clin Nutr 1969; 22: 716-24 pmid: 5789471.
- Couzos S, Currie B. Skin Infections. In: Couzos S, Murray R, eds. Aboriginal Primary Health Care, 2nd edn. Melbourne, Oxford University Press, 2003.
- Hengge UR, Currie BJ, Jager G, Lupi O, Schwartz RA. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis 2006; 6: 769-79 doi: 10.1016/S1473-3099(06)70654-5 pmid: 17123897.
- Carapetis JR, Connors C, Yarmirr D, Krause V, Currie BJ. Success of a scabies control program in an Australian aboriginal community. Pediatr Infect Dis J 1997; 16: 494-9 doi: 10.1097/00006454-199705000-00008 pmid: 9154544.
- Currie BJ, Carapetis JR. Skin infections and infestations in Aboriginal communities in northern Australia. Australas J Dermatol 2000; 41: 139-43 doi: 10.1046/j.1440-0960.2000.00417.x pmid: 10954983.
- Bessen DE, Carapetis JR, Beall B, Katz R, Hibble M, Currie BJ, et al., et al. Contrasting molecular epidemiology of group A streptococci causing tropical and nontropical infections of the skin and throat. J Infect Dis 2000; 182: 1109-16 doi: 10.1086/315842 pmid: 10979907.
- Van Buynder PG, Gaggin JA, Martin D, Pugsley D, Mathews JD. Streptococcal infection and renal disease markers in Australian aboriginal children. Med J Aust 1992; 156: 537-40 pmid: 1565046.
- Wannamaker LW. Differences between streptococcal infections of the throat and of the skin (second of two parts). N Engl J Med 1970; 282: 78-85 pmid: 4901868.
- Streeton CL, Hanna JN, Messer RD, Merianos A. An epidemic of acute post-streptococcal glomerulonephritis among aboriginal children. J Paediatr Child Health 1995; 31: 245-8 doi: 10.1111/j.1440-1754.1995.tb00795.x pmid: 7669388.
- Hanna JN, Heazlewood RJ. The epidemiology of acute rheumatic fever in Indigenous people in north Queensland. Aust N Z J Public Health 2005; 29: 313-7 doi: 10.1111/j.1467-842X.2005.tb00199.x pmid: 16222926.
- Carapetis JR, Currie BJ, Mathews JD. Cumulative incidence of rheumatic fever in an endemic region: a guide to the susceptibility of the population? Epidemiol Infect 2000; 124: 239-44 doi: 10.1017/S0950268800003514 pmid: 10813149.
- McDonald M, Currie BJ, Carapetis JR. Acute rheumatic fever: a chink in the chain that links the heart to the throat? Lancet Infect Dis 2004; 4: 240-5 doi: 10.1016/S1473-3099(04)00975-2 pmid: 15050943.
- Carapetis JR, Wolff DR, Currie BJ. Acute rheumatic fever and rheumatic heart disease in the top end of Australia’s Northern Territory. Med J Aust 1996; 164: 146-9 pmid: 8628132.
- Carapetis JR, Currie BJ. Clinical epidemiology of rheumatic fever and rheumatic heart disease in tropical Australia. Adv Exp Med Biol 1997; 418: 233-6 pmid: 9331640.
- Stata statistical software, release 9.1. College Station, TX: Stata Corporation; 2005.
- Thomas DP, Heller RF, Hunt JM. Clinical consultations in an aboriginal community-controlled health service: a comparison with general practice. Aust N Z J Public Health 1998; 22: 86-91 pmid: 9599858.
- Larkins SL, Geia LK, Panaretto KS. Consultations in general practice and at an Aboriginal community controlled health service: do they differ? Rural Remote Health 2006; 6: 560- pmid: 16863398.
- A national training and employment strategy for Aboriginal and Torres Strait Islander health workers and professionals working in Aboriginal and Torres Strait Islander health. National Health and Medical Research Council. Canberra: AGPS; 1997.
- Carville KS, Lehmann D, Hall G, Moore H, Richmond P, de Klerk N, et al., et al. Infection is the major component of the disease burden in aboriginal and non-aboriginal Australian children: a population-based study. Pediatr Infect Dis J 2007; 26: 210-6 doi: 10.1097/01.inf.0000254148.09831.7f pmid: 17484216.
- Williams P, Gracey M, Smith P. Hospitalization of aboriginal and non-aboriginal patients for respiratory tract diseases in Western Australia, 1988-1993. Int J Epidemiol 1997; 26: 797-805 doi: 10.1093/ije/26.4.797 pmid: 9279612.
- Jacoby P, Watson K, Bowman J, Taylor A, Riley TV, Smith DW, et al., et al. Modelling the co-occurrence of Streptococcus pneumoniae with other bacterial and viral pathogens in the upper respiratory tract. Vaccine 2007; 25: 2458-64 doi: 10.1016/j.vaccine.2006.09.020 pmid: 17030494.
- Torzillo P, Dixon J, Manning K, Hutton S, Gratten M, Hueston L, et al., et al. Etiology of acute lower respiratory tract infection in Central Australian Aboriginal children. Pediatr Infect Dis J 1999; 18: 714-21 doi: 10.1097/00006454-199908000-00012 pmid: 10462342.
- Watson K, Carville K, Bowman J, Jacoby P, Riley TV, Leach AJ, et al., et al. Upper respiratory tract bacterial carriage in Aboriginal and non-Aboriginal children in a semi-arid area of Western Australia. Pediatr Infect Dis J 2006; 25: 782-90 doi: 10.1097/01.inf.0000232705.49634.68 pmid: 16940834.
- Stanton B, Khanam S, Nazrul H, Nurani S, Khair T. Scabies in urban Bangladesh. J Trop Med Hyg 1987; 90: 219-26 pmid: 3669122.
- Marples MJ, Bacon DF. Observations on yaws and certain skin diseases in Manono, Western Samoa. Trans R Soc Trop Med Hyg 1953; 47: 141-7 doi: 10.1016/0035-9203(53)90067-4 pmid: 13077709.
- Skin Conditions. In: CARPA standard treatment manual, 4th edn. Alice Springs: Central Australian Rural Practitioners Association; 2003. pp. 313-21.
- Buffet M, Dupin N. Current treatments for scabies. Fundam Clin Pharmacol 2003; 17: 217-25 doi: 10.1046/j.1472-8206.2003.00173.x pmid: 12667233.
- Taplin D, Meinking TL, Chen JA, Sanchez R. Comparison of crotamiton 10% cream (Eurax) and permethrin 5% cream (Elimite) for the treatment of scabies in children. Pediatr Dermatol 1990; 7: 67-73 pmid: 2188239.
- Cubela V, Yawalkar SJ. Clinical experience with crotamiton cream and lotion in treatment of infants with scabies. Br J Clin Pract 1978; 32: 229-31 pmid: 728333.
- Amer M, Mostafa FF, Nasr AN, el-Harras M. The role of mast cells in treatment of scabies. Int J Dermatol 1995; 34: 186-9 doi: 10.1111/j.1365-4362.1995.tb01564.x pmid: 7538495.
- Bockarie MJ, Alexander ND, Kazura JW, Bockarie F, Griffin L, Alpers MP. Treatment with ivermectin reduces the high prevalence of scabies in a village in Papua New Guinea. Acta Trop 2000; 75: 127-30 doi: 10.1016/S0001-706X(99)00087-X pmid: 10708015.
- Lawrence G, Leafasia J, Sheridan J, Hills S, Wate J, Wate C, et al., et al. Control of scabies, skin sores and haematuria in children in the Solomon Islands: another role for ivermectin. Bull World Health Organ 2005; 83: 34-42 pmid: 15682247.
- Brooks PA, Grace RF. Ivermectin is better than benzyl benzoate for childhood scabies in developing countries. J Paediatr Child Health 2002; 38: 401-4 doi: 10.1046/j.1440-1754.2002.00015.x pmid: 12174005.
- Molyneux DH. Onchocerciasis control in West Africa: current status and future of onchocerciasis control programmes. Parasitol Today 1995; 11: 399-402 doi: 10.1016/0169-4758(95)80016-6.
- Wong LC, Amega B, Barker R, Connors C, Dulla ME, Ninnal A, et al., et al. Factors supporting sustainability of a community-based scabies control program. Australas J Dermatol 2002; 43: 274-7 doi: 10.1046/j.1440-0960.2002.00626.x pmid: 12423434.
- Taplin D, Rivera A, Walker JG, Roth WI, Reno D, Meinking T. A comparative trial of three treatment schedules for the eradication of scabies. J Am Acad Dermatol 1983; 9: 550-4 pmid: 6195201.
- Taplin D, Arrue C, Walker JG, Roth WI, Rivera A. Eradication of scabies with a single treatment schedule. J Am Acad Dermatol 1983; 9: 546-50 pmid: 6195200.
- Taplin D, Porcelain SL, Meinking TL, Athey RL, Chen JA, Castillero PM, et al., et al. Community control of scabies: a model based on use of permethrin cream. Lancet 1991; 337: 1016-8 doi: 10.1016/0140-6736(91)92669-S pmid: 1673175.
- Wong LC, Amega B, Connors C, Barker R, Dulla ME, Ninnal A, et al., et al. Outcome of an interventional program for scabies in an Indigenous community. Med J Aust 2001; 175: 367-70 pmid: 11700814.
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.
- Northern Territory Department of Health and Community Services, Darwin, NT, Australia.
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.