Position, selective emphasis and framing:How parties deal with a second dimension in competition

This Special Issue aims to (1) theorise party strategies in multi-dimensional policy spaces; and (2) apply the theory to party competition in multinational democracies characterised by a salient territorial dimension alongside a more established economic dimension. The introductory article brings together recent contributions treating spatial and salience theories as compatible and policy spaces as two-dimensional to propose four party strategies that can be ranked from one- to two-dimensional competitive behaviour: uni-dimensionality, blurring, subsuming, and two- dimensionality. The remaining contributions operationalise these strategies and draw on a variety of data sources ranging from manifestos to parliamentary bill proposals and expert surveys to describe when and explore why parties use these strategies in competition, focusing on patterns of party competition in multinational democracies, selected as typical cases of multi-dimensional competition.publishe

Surpassing Simple Aggregation: Advanced Strategies for Analyzing Contextual-Level Outcomes in Multilevel Models

This article introduces two advanced analytical strategies for analyzing contextual-level outcomes in multilevel models: the multilevel SEM and the two-step approach. Since these strategies are seldom used in comparative survey research, we first discuss their methodological and statistical advantages over the more commonly applied approach of group mean aggregation. We then illustrate these advantages in an empirical analysis of the effect of citizens' support for democratic values at the individual level on a contextual-level outcome - the persistence of democracy - drawing on data from the World Values Survey and the Quality of Government project. Whereas we found no significant effect of support for democratic values in the model using simple group mean aggregation, citizens' support for democratic values was a significant predictor of democracies' estimated survival rate when applying latent aggregation in multilevel SEM and the two-step approach. The article corroborates previous concerns with simple aggregation and demonstrates how researchers can improve the validity of their analyses of contextual-level outcomes by using alternative strategies of aggregation

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Ethnic party competition beyond the segmented market

The outbidding model of ethnic politics focuses on party competition in an ethnically perfectly segmented electoral market where no party appeals to voters across the ethnic divide. The power sharing model retains this assumption, yet tries to prevent outbidding through moderation-inducing institutional design. Empirically, imperfectly segmented electoral markets and variance of ethnic party strategies beyond radical outbidding have been observed. To provide a stepping stone towards a more complete theory of ethnic party competition, this article introduces the notion of nested competition, defined as party competition in an imperfectly segmented market where some – but not all – parties make offers across ethnic divides and where competition in intra-ethnic arenas is nested within an inter-ethnic arena of party competition. The notion of nested competition helps explain why ethnic outbidding is not omnipresent in contemporary multi-ethnic democracies. A moderate position on the ethnic dimension that appears inauspicious from the perspective of intra-ethnic competition can turn into the strategically superior choice once ethnic parties take the whole system of competitive interactions within intra- and inter-ethnic arenas into account. A case study of nested competition for Hungarian votes in the Vojvodina region of Northern Serbia illustrates the conceptual innovations.publishe

Whose Mobilisation? : An Ontological Primer on the Mobilisation of National Minorities

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Beyond outbidding? : Ethnic party strategies in Serbia

The outbidding model of ethnic party competition predicts that ethnic parties adopt radical strategies to maximize support among voters of an ethnic group. In contrast, this article argues that ethnic parties have a wider range of strategies at their disposal. Integrating recent findings, ethnic party strategies are defined by the criteria of appeal and policy position as ‘static bidding‘, ‘ethnic underbidding‘, ‘ethnic outbidding‘, ‘lateral bidding‘, ‘lateral underbidding’ and ‘lateral outbidding‘. Empirically, a comparison of strategies adopted by ethnic parties competing for votes of the Hungarian and Bosniak minorities in Serbia shows variance of strategies within and across groups despite an environment conducive to outbidding and while holding institutional context factors constant. Factors causing this variance are explored through content analysis of 18 semi-structured interviews with ethnic party elites. An explanation that links strategies to parties' goals and the incentives of the structure of intra- and inter-ethnic competition is suggested for further research.publishe