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Which issue-related motives underlie voters’ decision to switch parties at the polls? Do switchers stick to the newly chosen party, or do they oscillate in a short-term way at intermediate elections? Relying on the behavioral theory of elections, we assumed aspiration-based voting of boundedly rational voters. We elicited issue-related switch and stay motives in an open-ended survey question format to identify the individual dominant aspirational frame. We traced the respondents’ voting trajectories over three consecutive elections, including two state (2013 and 2018) elections in Bavaria (Germany) and one German federal election (2017). We focused on one of the most polarizing and salient issues in these elections, namely immigration. The case of reference is the 2018 Bavarian state election. Here, the incumbent majoritarian center-right party Christian Social Union tried to deter the entry of the right-wing populist party Alternative for Germany by adapting to it on the immigration issue in tone and position. The selected case allows assessment of the impact of issue-based adaptive behavior of the incumbent party at the level of the voters’ switch or stay choices. We estimated the direction and number of voter flows for two interelection sequences of different lengths between different types of polls (federal and state). Our transition estimates are based on the hybrid multinomial Dirichlet model, a new technique integrating individual-level survey data and official aggregate data. Our estimates uncover substantial behavioral differences in the immigration issue public.

Understanding normal aging of kidney function is pivotal to help distinguish individuals at particular risk for chronic kidney disease. Glomerular filtration rate (GFR) is typically estimated via serum creatinine (eGFRcrea) or cystatin C (eGFRcys). Since population-based age-group-specific reference values for eGFR and eGFR-decline are scarce, we aimed to provide such reference values from population-based data of a wide age range. In four German population-based cohorts (KORA-3, KORA-4, AugUR, DIACORE), participants underwent medical exams, interview, and blood draw up to five times within up to 25 years. We analyzed eGFRcrea and eGFRcys cross-sectionally and longitudinally (12,000 individuals, age 25-95 years). Cross-sectionally, we found age-group-specific eGFRcrea to decrease approximately linearly across the full age range, for eGFRcys up to the age of 60 years. Within age-groups, there was little difference by sex or diabetes status. Longitudinally, linear mixed models estimated an annual eGFRcrea decline of -0.80 [95% confidence interval -0.82, -0.77], -0.79 [-0.83, -0.76], and -1.20 mL/min/1.73m2[-1.33, -1.08] for the general population, “healthy” individuals, or individuals with diabetes, respectively. Reference values for eGFR using cross-sectional data were shown as percentile curves for “healthy” individuals and for individuals with diabetes. Reference values for eGFR-decline using longitudinal data were presented as 95% prediction intervals for “healthy” individuals and for individuals with diabetes, obesity, and/or albuminuria. Thus, our results can help clinicians to judge eGFR values in individuals seen in clinical practice according to their age and to understand the expected range of annual eGFR-decline based on their risk profile.

Objective: For chronic depression, the effectiveness of brief psychotherapy has been limited. This study is the first comparing the effectiveness of long-term cognitive-behavioural therapy (CBT) and long-term psychoanalytic therapy (PAT) of chronically depressed patients and the effects of preferential or randomized allocation.Methods: A total of 252 adults met the inclusion criteria (aged 21-60 years, major depression, dysthymia, double depression for at least 24 months, Quick Inventory of Depressive Symptoms [QIDS] >9, Beck Depression Inventory II [BDI] >17, informed consent, not meeting exclusion criteria). Main outcome measures were depression self-rating (BDI) and rating (clinician-rated QIDS [QIDS-C]) by independent, treatment-blinded clinicians. Full remission rates (BDI ≤12, QIDS-C ≤5) were calculated. An independent center for data management and biostatistics analyzed the treatment effects and differences using linear mixed models (multilevel models and hierarchical models).Results: The average BDI declined from 32.1 points by 12.1 points over the first year and 17.2 points over 3 years. BDI overall mean effect sizes increased from d= 1.17 after 1 year to d= 1.83 after 3 years. BDI remission rates increased from 34% after 1 year to 45% after 3 years. QIDS-C overall effect sizes increased from d= 1.56 to d= 2.08, and remission rates rose from 39% after 1 year to 61% after 3 years. We found no significant differences between PAT and CBT or between preferential and randomized allocation.Conclusions: Psychoanalytic as well as cognitive-behavioural long-term treatments lead to significant and sustained improvements of depressive symptoms of chronically depressed patients exceeding effect sizes of other international outcome studies.

Das bayerische Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) verfolgt seit Anfang 2014 die Etablierung eines Frühwarnsystems in der Lebensmittelüberwachung. Ziel ist es, durch eine umfassende Sicht auf die Lebensmittelproduktion Gesundheitsrisiken und Betrugspotentiale für Lebensmittel so früh wie möglich zu erkennen. Hierzu werden Einflussfaktoren, die potentiell mit Risiken assoziiert sein können, sogenannte Frühwarnindikatoren, aus einem weiten Umfeld der Lebensmittelproduktion identifiziert und analysiert. Ein Fokus des Frühwarnsystems liegt dabei auf der Analyse von Warenströmen (geographische Herkunft und Menge importierter Waren) und Preisen, da diese sensibel auf vielfältige Entwicklungen wie Angebotsengpässe, Ernteeinbrüche oder Veränderungen von gesetzlichen und politischen Rahmenbedingungen reagieren und sich somit als besonders relevant herausgestellt haben. Diese beiden Frühwarnindikatoren werden in einem ersten Ansatz anhand einer automatisierten Analyse der Daten zu Importpreisen und –mengen der Deutschen Außenhandelsstatistik für jede Produkt-Ursprungsland-Kombination auf signifikante Auffälligkeiten analysiert. Die Ergebnisse aus den Analysen werden in einem zweiten Schritt priorisiert und von Experten aus der Lebensmittelüberwachung bewertet. Die Erkenntnisse aus der Analyse identifizierter Frühwarnindikatoren fließen systematisch in die Lebensmittelüberwachung ein und erweitern diese um risikorelevante Aspekte.

Personal exposure to air pollution is associated with time- and location-specific factors including indoor and outdoor air pollution, meteorology and time activities. Our investigation aims at the description and identification of factors determining personal exposure to particle number concentration (PNC) in everyday situations. Ten volunteers recorded their personal exposure to PNC and kept an activity diary in three different seasons besides stationary measurements of ambient air pollution and meteorology. Background exposure to PNC was modelled using the most predictive variables. In a second step, the effects of the activities were calculated adjusted for the background exposure. The average personal PNC level was highest in winter and was three times higher than the mean stationary PNC level while staying indoors and two times higher while staying outdoors. Personal indoor PNC levels were significantly increased during the use of candles, cooking and the occurrence of smell of food. High stationary outdoor PNC levels and low dew point temperatures were associated with increased personal outdoor PNC levels. Times spent in public transport were associated with lower personal PNC levels than other times spent in transportation. Personal PNC levels in everyday situations exhibited a large variability because of seasonal, microenvironment-specific and activity-specific influences.

In most studies that estimate abundance of foxes from faeces counts, scanning is done along trails and roads or along linear features such as hedges, because it is supposed that foxes defecate mainly along these structures. As a consequence, only part (i.e. trails or linear features) of the total habitat is searched and results are possibly biased if usage by foxes of these searched features is subject to spatial or temporal variation. We therefore investigated three methods for counting red fox Vulpes vulpesfaeces, that differ in the shape of the sampling units: trails and two alternatives; i.e. transects and squares. We searched for faeces using these three methods in two study areas (the Upper Rhine Valley and the Black Forest valleys) at 61 study plots and found a total of 257 fox faeces. Methods for estimating abundance should ideally have high accuracy and high precision. As actual fox densities in the areas were unknown, we were unable to assess the accuracy of our sampling methods and thus focused on method precision. We fit separate negative binomial regression models for each method with the number of faeces found as the dependent variable and a set of landscape variables as possible explanatory variables. The transect method detected significant differences in the number of faeces found between the study areas and was most precise. Even though we did find more faeces with the trail method, the precision of this method was lower than that of the transect method. For the methods trail and square, variance in the number of faeces found was large in comparison to their mean. Bias caused by methods that only sample part of the habitat is not limited to faecal counts and red fox studies, but can also occur with other species and methods.

Predator-prey relationships are of general interest in ecology and have been studied extensively. They are also of interest for effective management and recovery of prey populations. However, quantification of these relationships in the field has remained difficult. We analysed the impact of the predation of red fox Vulpes vulpes on brown hare Lepus europaeus, grey partridge Perdix perdix and rabbit Oryctolagus cuniculus using yearly hunting bag records as population indicators in eight German provinces over a period of 41 years. Bag records were tested for deviation from properties of suitable population indicators. We quantified the association between prey and predator populations within the context of other variables such as weather and long-term trends. We used an overall regression model for each prey population and discussed three statistical approaches accounting for the time series structure of the data. Models for all prey species populations display a good fit. The fox population has a significant negative association to the hare population in all models. The results for the rabbit population show only a small effect of the fox population, though it is not significant. The effect of the fox population on the partridge population cannot be clearly distinguished from a general trend. Additionally, there is a strong long-term trend in the hare and partridge populations. This could be due to major changes in the agricultural landscapes over the last decades. It is important to note that this trend is much stronger than the association to the fox population. Our study suggests that habitat improvement could be much more effective in restoring prey populations than fox control due to the minor interactions between the fox and the prey populations.

Recent controlled studies that evaluated the efficacy of an adjuvant antithrombin (AT) III therapy in severe sepsis used a uniform AT-III dose and duration of therapy and did not adjust to the actual AT-III deficit. It was the aim of the present study to explore if surgical patients with severe sepsis might have a treatment benefit from an activity-guided AT-III therapy. We performed a retrospective cohort analysis using an intensive care unit (ICU) database. To examine the effect of AT-III on outcome and on red cell transfusion rate, multivariate generalized additive models (GAMs), Cox-type additive hazard regression models, and propensity score adjustments were used. Five hundred forty-five postoperative surgical patients requiring ICU therapy because of severe sepsis were analyzed. Antithrombin III was given to those patients believed to be at a high risk of dying. Antithrombin III therapy was guided by the individual AT-III activity and aimed at the maintenance of an activity of at least 100%. Antithrombin III supplementation was discontinued after the plasma AT-III activity had been persistently normal without simultaneous AT-III infusion. We found that patients receiving additional AT-III (n = 230) were sicker than those on standard therapy (n = 315; admission Acute physiology and chronic health evaluation II score, 19.8 ± 7.3 vs. 17.9 ± 7.1 mean ± SD; P< 0.005). Correspondingly, 28-day mortality was higher in patients who had an additional AT-III therapy than in those on standard therapy (46.3% vs. 36.9%; P< 0.03), as was the number of red cell units transfused during ICU stay (21.5 ± 26.7 vs. 9.3 ± 12.1; P< 0.001). At multivariate analysis, there was no significant effect of AT-III therapy on 28-day mortality (GAM odds ratio, 1.012; 95% confidence interval CI, 0.651 - 1.573; P= 0.957) and 90-day survival time (Cox-type additive hazard regression hazard ratio, 1.034; 95% CI, 0.779 - 1.387; P= 0.794). However, AT-III therapy was associated with a significantly higher frequency of red cell unit transfusion (GAM/zero-inflated Poisson estimate, 1.26; 95% CI, 1.15 - 139; P< 0.001). Our results suggest that there seems to be no relevant effect of an activity-guided AT-III therapy on the prognosis of surgical patients with severe sepsis. However, transfusion frequency rises by AT-III therapy.

Abnormalities in cardiocirculatory, respiratory, or coagulatory parameters are frequent after major surgery, but so far, no study has investigated their predictive value for early intensive care unit (ICU) mortality. We aimed to describe and quantify the relation between these parameters that are routinely determined on ICU admission and early death after complex surgery. Individual patient data were available from a local ICU database. We performed a retrospective observational cohort study using prospectively collected data from March 1, 1993, through February 28, 2005. A cohort of 4,214 cases who were admitted to the ICU immediately after operation was analyzed. We studied age, sex, number of red blood cell units transfused on admission day, and admission values for heart rate, systolic blood pressure, hemoglobin concentration, partial thromboplastin time, prothrombin time, respiratory function (Pao2/Fio2ratio), and body temperature for their association with 4-day mortality. Effects were adjusted for the underlying disease and for disease severity during the first 24 h after admission. We used generalized additive models to fit continuous variables individually before combining them into the final generalized model. We found an independent linear association between the number of transfused red blood cell units, partial thromboplastin time, and body temperature with acute outcome. A smoothed model described the independent interaction between admission blood pressure and early death. Only values of less than 80 mmHg were associated with an increased risk of 4-day mortality. According to these results, bleeding complications after ICU admission should be treated aggressively to prevent early death of the patient. However, normotensive conditions do not seem to be required to prevent early mortality. Whether rapid rewarming may improve outcome needs further rigorous study.

The typical pivotal experimental therapeutic study design in multiple sclerosis (MS) is a randomized, double-blind, placebo-controlled clinical trial with clinical primary outcomes. In earlier phase studies, primary endpoints are often not clinical and typically include changes in magnetic resonance imaging (MRI) parameters, such as the cumulative number of new gadolinium-enhanced lesions over six months of treatment. In this article, we compare two trial designs—a group sequential method and an adaptive method—with respect to differences in power level and required sample size to those of a classical one-stage study design without interim analysis. The results of a simulation study based on pooled MRI data from a large number of clinical MS trials show that using a group-sequential design provides a significant reduction in required sample size compared with the classical one-stage design. If the observed treatment effect on study is smaller than the assumed one, the power of the adaptive method is larger than in the classical approach.

The typical pivotal experimental therapeutic study design in multiple sclerosis (MS) is a randomized, double-blind, placebo-controlled clinical trial with clinical primary outcomes. In earlier phase studies, primary endpoints are often not clinical and typically include changes in magnetic resonance imaging (MRI) parameters, such as the cumulative number of new gadolinium-enhanced lesions over six months of treatment. In this article, we compare two trial designs—a group sequential method and an adaptive method—with respect to differences in power level and required sample size to those of a classical one-stage study design without interim analysis. The results of a simulation study based on pooled MRI data from a large number of clinical MS trials show that using a group-sequential design provides a significant reduction in required sample size compared with the classical one-stage design. If the observed treatment effect on study is smaller than the assumed one, the power of the adaptive method is larger than in the classical approach.

Background: Recombinant feline interferon‐ω (rFeIFN‐ω) was tested as a treatment option for cats with fibrosarcoma to assess safety and feasibility.

Background: Sepsis is still a major cause of death in both human and veterinary medicine. Early diagnosis is essential for appropriate treatment. Identification of patients at risk for developing sepsis is already possible in human medicine through the measurement of plasma interleukin-6 (IL-6) levels. In veterinary medicine, however, this has been investigated only in canine experimental models. Objectives: The purpose of this study was to measure IL-6 plasma levels in dogs with naturally occurring systemic inflammatory response syndrome (SIRS) and sepsis and to analyze the value of IL-6 as a predictive parameter for severity and mortality. Methods: Included in the study were 79 dogs that had been admitted to the small animal clinics of Munich and Berlin from July 2004 to July 2005 and that satisfied the diagnostic criteria for SIRS and sepsis as defined using established parameters. Measurement of plasma IL-6 levels on days 0, 1, and 2 was performed by the use of a colorimetric bioassay based on IL-6-dependent cell growth. Results: Septic foci were identified in 43 patients (septic group), and 36 patients were enrolled in the SIRS group. The frequency of positive blood cultures was 11. The overall mortality rate was 48. Higher plasma IL-6 levels on the day of admission were significantly correlated with a more severe degree of disease, increased mortality rate, and earlier fatality. Conclusions:Plasma IL-6 concentration is predictive of outcome in canine SIRS and sepsis and may be a valuable laboratory parameter for assessing critically ill dogs.

In contrast to randomized studies, previous cohort studies identified red cell transfusion as an independent predictor of mortality in critically ill patients. However, these cohort studies did not adjust for disease severity during intensive care unit (ICU) stay. We performed a retrospective, observational cohort study using prospectively collected data from March 1, 1993, through February 28, 2005. A cohort of 3037 consecutive surgical cases requiring intensive care therapy for more than one day was analyzed. We used two different sets of potentially confounding covariables (admission variables only or in combination with variables reflecting number and extent of organ dysfunction during ICU stay). We found that the total number of red cell units which a case had received during ICU stay, and the maximum number of units given on a single day, were independently associated with an increase in ICU mortality when only admission variables were considered for the analysis. After controlling for the additional effect of variables reflecting organ dysfunction during ICU stay, we found that red cell transfusion was no longer an independent risk factor for death. However, there was a significant effect of red cell transfusion on ICU LOS in survivors irrespective of the covariable sets used. We conclude that red cell transfusion during ICU stay may be only a surrogate marker for disease severity and is not causally related to ICU mortality. Relevant side effects of red cell transfusion are presumably small and may be only recognizable in surviving cases.

Objective: Previous studies have demonstrated an inverse association between meal frequency and the prevalence of obesity in adulthood. The aim of this study was to assess the relationship between meal frequency and childhood obesity. Research Methods and Procedures: Stature and weight of 4370 German children ages 5 to 6 years were determined in six Bavarian (Germany) public health offices during the obligatory school entry health examination in 2001/2002. An extensive questionnaire on risk factors for obesity was answered by their parents. Obesity was defined according to sex‐ and age‐specific BMI cut‐off points proposed by the International Obesity Task Force. The main exposure was daily meal frequency. Results: The prevalence of obesity decreased by number of daily meals: three or fewer meals, 4.2% [95% confidence interval (CI), 2.8 to 6.1]; four meals, 2.8% (95% CI, 2.1 to 3.7); and 5 or more meals, 1.7% (95% CI, 1.2 to 2.4). These effects could not be explained by confounding due to a wide range of constitutional, sociodemographic, and lifestyle factors. The adjusted odds ratios for obesity were 0.73 (95% CI, 0.44 to 1.21) for four meals and 0.51 (95% CI, 0.29 to 0.89) for five or more meals. Additional analyses pointed to a higher energy intake in nibblers compared with gorgers. Discussion: A protective effect of an increased daily meal frequency on obesity in children was observed and appeared to be independent of other risk factors for childhood obesity. A modulation of the response of hormones such as insulin might be instrumental.

The efficiency of bovine nuclear transfer using recipient oocytes recovered by ultrasound-guided follicle aspiration (ovum pick-up [OPU]) was investigated. Oocyte donors were selected from 2 distinct maternal lineages (A and B) differing in 11 nucleotide positions of the mitochondrial DNA control region. A total of 1342 cumulus-oocyte complexes (COCs) were recovered. The numbers of total COCs and class I/II COCs recovered from donors of lineage A were higher (P< 0.001) than those obtained from lineage B. Follicle aspiration once per week yielded a higher (P< 0.001) total number of COCs per session than aspiration twice per week, whereas the reproduction status of donors (heifer vs. cow) had no effect on OPU results. Of the 1342 oocytes recovered, 733 (55%) were successfully matured in vitro and used for nuclear transfer. Fusion was achieved in 550 (75%) karyoplast-cytoplast complexes (KCCs), resulting in 277 (50%) cleaved embryos on Day 3. On Day 7 of culture, 84 transferable embryos (15% based on fused KCCs) were obtained. After 38 transfers (10 single, 22 double, and 6 triple transfers), 9 recipients (8 double and 1 triple transfer) were diagnosed as pregnant on Day 28, corresponding to a pregnancy rate of 24%. The proportion of transferable embryos on Day 7 was significantly (P< 0.05) influenced by maternal lineage of oocyte donors and by the frequency of follicle aspiration. Our study demonstrates the feasibility of generating nuclear transfer embryos with defined cytoplasmic background. These will be valuable tools to experimentally dissect the effects of nuclear and cytoplasmic components on embryonic, fetal, and postnatal development.

We discuss Bayesian estimation of a logistic regression model with an unknown threshold limiting value (TLV). In these models it is assumed that there is no effect of a covariate on the response under a certain unknown TLV. The estimation of these models in a Bayesian context by Markov chain Monte Carlo (MCMC) methods is considered with focus on the TLV. We extend the model by accounting for measurement error in the covariate. The Bayesian solution is compared with the likelihood solution proposed by Küchenhoff and Carroll using a data set concerning the relationship between dust concentration in the working place and the occurrence of chronic bronchitis. Copyright © 2001 John Wiley & Sons, Ltd.

We discuss Bayesian estimation of a logistic regression model with an unknown threshold limiting value (TLV). In these models it is assumed that there is no effect of a covariate on the response under a certain unknown TLV. The estimation of these models in a Bayesian context by Markov chain Monte Carlo (MCMC) methods is considered with focus on the TLV. We extend the model by accounting for measurement error in the covariate. The Bayesian solution is compared with the likelihood solution proposed by Küchenhoff and Carroll using a data set concerning the relationship between dust concentration in the working place and the occurrence of chronic bronchitis. Copyright © 2001 John Wiley & Sons, Ltd.

Host-seeking Ixodes ricinus (L.) (Acari: Ixodidae) ticks were collected systematically, from May to September 2006, at selected sites in southern Germany, including a large city park in Munich. Polymerase chain reactions for amplification of genes of the rickettsial citrate synthase (gltA), the outer membrane proteins A and B (ompA and ompB), and the 16S rDNA were used to investigate 2,861 specimens (adults and nymphs). GltA sequences of spotted fever group rickettsiae were detected in 151 of all samples (5.3%; 95% CI = 4.3-6.2%). Sequencing revealed Rickettsia helvetica in 91.4% of the samples and R. monacensis in 8.6%. Amplification of ompA was not possible for R. helvetica, but in all except one of the R. monacensis. The results were analyzed statistically to test the effects of season, location, developmental stage, and gender of the tick on prevalence of Rickettsia spp. Although rickettsial DNA was detected in all investigated sites, sites in natural forest areas had significantly higher prevalences than sites in landscaped city parks. Adult female and male ticks had a similar prevalence and were significantly more often infected than nymphs. Monthly differences were not statistically significant. These results clearly show that R. helvetica is widespread throughout the study region and could result in a threat to public health in areas of high prevalence.

Introduction Various cohort studies have shown that acute (short-term) mortality rates in unselected critically ill patients may have improved during the past 15 years. Whether these benefits also affect acute and long-term prognosis in chronically critically ill patients is unclear, as are determinants relevant to prognosis.Methods We conducted a retrospective analysis of data collected from March 1993 to February 2005. A cohort of 390 consecutive surgical patients requiring intensive care therapy for more than 28 days was analyzed.Results The intensive care unit (ICU) survival rate was 53.6%. Survival rates at one, three and five years were 61.8%, 44.7% and 37.0% among ICU survivors. After adjustment for relevant covariates, acute and long-term survival rates did not differ significantly between 1993 to 1999 and 1999 to 2005 intervals. Acute prognosis was determined by disease severity during ICU stay and by primary diagnosis. However, only the latter was independently associated with long-term prognosis. Advanced age was an independent prognostic determinant of poor short-term and long-term survival.Conclusion Acute and long-term prognosis in chronically critically ill surgical patients has remained unchanged throughout the past 12 years. After successful surgical intervention and intensive care, long-term outcome is reasonably good and is mainly determined by age and underlying disease.