Stimmensplitting und Koalitionswahl

Hat sich die Unabhängigkeitsstrategie der FDP bei der letzten Bundestagswahl ausgezahlt? Wäre die FDP erfolgreicher gewesen, wenn sie im Vorfeld klar signalisiert hätte, dass man eine Koalition mit der Union anstrebt? Wie war das bei den Grünen, die ja im Gegensatz zur FDP keine Zweifel aufkommen ließen? Natürlich können wir nicht wie in einer Simulation oder einem Experiment einfach den Wahlkampf wiederholen und noch einmal wählen lassen. Um eine befriedigende Antwort auf diese Frage zu finden, vergleichen wir den Kontext der Bundestagswahl 2002 mit den zurückliegenden Bundestagswahlen. Aus dem Längsschnittvergleich versuchen wir Rückschlüsse auf den substanziellen Einfluss von strategischem Stimmensplitting im Sinne einer Koalitionswahl auf das Wahlergebnis gerade der kleinen Parteien zu ziehen. Um unsere Forschungsfrage zu beantworten und substanzielle Schlüsse ziehen zu können, muss zuerst klar sein, in welcher Form und warum Stimmensplitting relevant sein kann, welche Rolle dabei Koalitionsabsprachen vor einer jeden Wahl spielen und, schließlich, welche alternativen Erklärungsmöglichkeiten die Literatur zum Thema Stimmensplitting und strategischem Wählen anzubieten hat. Nur wenn wir auch die Wirkung alternativer und zum Teil konkurrierender Hypothesen zulassen, können wir unserer Schlußfolgerungen sicher sein

Improving the use of research evidence in guideline development: 7. Deciding what evidence to include

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the seventh of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on what constitutes "evidence" in guidelines and recommendations. METHODS: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTION AND ANSWERS: We found several systematic reviews that compared the findings of observational studies with randomised trials, a systematic review of methods for evaluating bias in non-randomised trials and several descriptive studies of methods used in systematic reviews of population interventions and harmful effects. What types of evidence should be used to address different types of questions? • The most important type of evidence for informing global recommendations is evidence of the effects of the options (interventions or actions) that are considered in a recommendation. This evidence is essential, but not sufficient for making recommendations about what to do. Other types of required evidence are largely context specific. • The study designs to be included in a review should be dictated by the interventions and outcomes being considered. A decision about how broad a range of study designs to consider should be made in relationship to the characteristics of the interventions being considered, what evidence is available, and the time and resources available. • There is uncertainty regarding what study designs to include for some specific types of questions, particularly for questions regarding population interventions, harmful effects and interventions where there is only limited human evidence. • Decisions about the range of study designs to include should be made explicitly. • Great caution should be taken to avoid confusing a lack of evidence with evidence of no effect, and to acknowledge uncertainty. • Expert opinion is not a type of study design and should not be used as evidence. The evidence (experience or observations) that is the basis of expert opinions should be identified and appraised in a systematic and transparent way

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Effects of in-feed enzymes on milk production and components, reproduction, and health in dairy cows

Our objectives were to characterize responses in the field to a mix of fibrolytic enzymes using large commercial dairy herds and sufficient study power to evaluate milk production and reproductive responses to an enzyme treatment started during the precalving period. We hypothesized that the use of the enzyme treatment would increase milk production when provided to dairy cows precalving and for approximately 200 d of lactation. The study was conducted on 7,507 cows, in 8 replicates and 16 pens, at 3 dairies in the United States. Eight pens were randomly allocated as control pens and received no enzyme, and another 8 pens received enzyme treatment at a dose of 750 mL/t of dry matter feed. Milk production and energy-corrected milk yield were increased with the enzyme treatment by 0.70 and 0.80 kg/d, respectively, across a 5-month period. Milk fat percentage was not significantly increased by enzyme treatment, but milk fat yield was significantly increased by 0.040 kg/d, compared with controls. Milk protein yield increased 0.010 kg/d with enzyme treatment despite a small reduction of 0.020 percentage units in milk protein percentage. We found no evidence of an increase in the ln somatic cell count for the enzyme-treated cows. Body weight overall was not increased for enzyme-treated cows, but we did observe a numerical increase in dry matter intake (0.20 kg/head per day) for enzyme-treated cows. Most production responses to the enzyme treatment were influenced by dairy. Compared with controls, milk yield in enzyme-treated cows was significantly higher by 3.6 kg/d in dairy 2 and numerically higher by 0.60 and 0.20 kg/d in dairies 1 and 3, respectively. Reproduction, health, and risk of removal or death were not significantly influenced by treatment, apart from a reduced time to first breeding. Production responses to the enzyme treatment varied by dairy from substantial to minor increases, but variation among dairies was not evident in differences in dry matter intake or in partitioning of body weight among enzyme-treated and control pens and cows. It appears likely that the increase in production reflected increased digestibility of feed; however, further work is needed to identify factors influencing the variation in production responses to enzymes

Variation in milk production, fat, protein, and lactose responses to exogenous feed enzymes in dairy cows

Objective: Our objectives were to evaluate milk production and constituent responses to changes in the diet for pens of cows over time and whether differences in response were attributable to fibrolytic enzymes and dairy. Materials and Methods: A multiherd trial used 7,507 cows in 8 control and enzyme-treated (750 mL/t of DM feed) replicates (16 pens) on 3 dairies. Feed composition and milk production and constituents by pen (n = 12) were analyzed weekly. Time-series cross-correlation estimates by pen of feed component intakes (kg/d) and milk responses were pooled to produce effect size (ES) estimates. Results and Discussion: We observed differences between treatment and control pens for soluble protein (ES = 0.249) in the same week, acid detergent–insoluble CP (ES = 0.293) and lignin (ES = 0.237) 1 wk before with milk protein percentage, and acid detergent–insoluble CP (ES = 0.276) and lignin (ES = 0.246) 1 wk before with milk protein yield. These differences are consistent with enzymes improving feed digestibility, particularly for protein and fiber fractions. Differences in production responses to intake of feed components among dairies were observed. More significant and larger differences occurred among dairies than for treatments. The dairy that increased milk production most with treatment had an estimated MP excess from the diet, whereas the least responsive had an estimated MP-deficit diet and was the highest producing. Implications and Applications: We provide evidence for variability in enzyme response and that changes in dietary feed components influence production outcomes immediately and up to 3-wk later