Democracy is often described as a system in which a majority of electors choose one out of a number of competing parties to form a government and carry out its programme. Unfortunately, spontaneous majorities rarely form in support of one party. We generalize from a 'government' to a 'median' mandate, in which the median elector chooses the pivotal party in parliament, which then translates his or her preferences into public policy. To check this we investigate how accurately parliaments and governments represent the left-right position of the median voter in each of twenty parliamentary democracies. Distortions depend on the type of electoral arrangement, being relatively smaller under proportional representation than under single-member districts. Distortions do not equate to biased representation, however. Once we consider how distortions at one step or one time are compensated by distortions in the opposite direction at another, overall representation of the median voter position is reasonably accurate.Conventional mandate theory, sometimes termed majoritarian democracy, sees popular preferences being translated into public policy through voters choosing as their government the party whose policies a majority prefers. Crucially, this assumes that elections do decide which party forms the government. In fact, this seldom happens.If elections do not unambiguously designate governments, what do they do? One reaction, common to both classic representational theory and modern 'visions' of 'consociational' or 'consensus' democracy, is to limit their role to endorsing representatives. These then negotiate compromises on behalf of their constituents in a more considered way than election campaigning would allow. 1 Acknowledging that there is a restricted role for elections and hence for voters in the democratic process is certainly one possible reaction to the failure of elections to designate governments unambiguously. It may even have an upside, in terms of the better policy solutions that can be reached through autonomous discussion and bargaining between parties. 2 But it is not very democratic unless there is a mechanism to ensure that the preferences of citizens are necessarily taken into account.Our purpose here is to show that, even in proportional representation (PR) systems with many parties, elections do confer a popular mandate that shapes legislative decision making. This improves the democratic credentials of consensus democracy while respecting the elite bargaining processes that reportedly produce better policy. It also gets

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OBJECTIVE:To investigate plantar pressure differences between obese and non-obese adults during standing and walking protocols using a pressure distribution platform. SUBJECTS: Thirty-five males (age 42.4 AE 10.8 y; 67 -179 kg) and 35 females (age 40.0 AE 12.6 y; 46 -150 kg) divided into obese (body mass index (BMI) 38.75 AE 5.97 kg=m 2 ) and non-obese (BMI 24.28 AE 3.00 kg=m 2 ) sub-groups, respectively. MEASUREMENTS: Data collection was performed with a capacitive pressure distribution platform with a resolution of 2 sensors=cm 2 (Emed F01, Novel GmbH, München). The measurement protocol included half and full body weight standing on the left, right and both feet, respectively, and walking across the platform, striking with the right foot. Pressures were evaluated for eight anatomical sites under the feet. RESULTS: For both men and women, the mean pressure values of the obese were higher under all anatomical landmarks during half body weight standing. Significant increases in pressure were found under the heel, mid-foot and metatarsal heads II and IV for men and III and IV for women. Foot width during standing was also significantly increased in obese subjects. For walking, significantly higher peak pressures were also found in both obese males and females. CONCLUSION: Compared to a non-obese group, obese subjects showed increased forefoot width and higher plantar pressures during standing and walking. The greatest effect of body weight on higher peak pressures in the obese was found under the longitudinal arch of the foot and under the metatarsal heads. The higher pressures for obese women compared to obese men during static weight bearing (standing) may be the result of reduced strength of the ligaments of the foot.

Summary Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0.83, 95% CI 0.63–1.09; p=0.18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1.91, 1.06–3.44; p=0.0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0.82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0.41) and sepsis (seven [1%] vs six [1%]; p=0.79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians’ Services Incorporated.

Operationalized as a simulation and checked against 1,737 policy shifts in twenty-four post-war democracies, this theory of party position-taking offers both an explanation and specific postdictions of party behaviour, synthesizing some previous approaches and linking up with mandate theories of political representation. These wider implications are considered at the beginning and the end of the article. , Mapping Policy Preferences II (Oxford: Oxford University Press, 2006). Both books are sold with attached CDs containing documentation and data. As we use these for our own analysis, they are described in detail below. 8 The Manifesto dataset and the construction of the left-right scale, which we use in our own analysis, are described in more detail in our data section below. The claim of the scale to provide the best summary representation of public and party policy is buttressed by the spontaneous emergence of a powerful leading left-right dimension from factor analyses of the Manifesto data reported in Ian Budge, David Robertson and Derek J. Hearl, eds, Ideology, Strategy and Party Movement (Cambridge: Cambridge