Social validation in group decision making: differential effects on the decisional impact of preference-consistent and preference-inconsistent information

"Shared information has a stronger impact on group decisions than unshared information. A prominent explanation for this phenomenon is that shared information can be socially validated during group discussion and, hence, is perceived as more accurate and relevant than unshared information. In the present study we argue that this explanation only holds for preference-inconsistent information (i.e., information contradicting the group members’ initial preferences) but not for preference-consistent information. In Experiments 1 and 2 participants studied the protocol of a fictitious group discussion. In this protocol, we manipulated which types of information were socially validated. As predicted, social validation increased the decisional impact of preference-inconsistent but not preference-consistent information. In both experiments the effect of social validation was mediated by the perceived quality of information. Experiment 3 replicated the results of the first two experiments in an interactive setting in which two confederates discussed a decision case face-to-face with one participant." [author's abstract

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

An Approach to the Commercial Production of Highly Active Pharmaceutical Ingredients

To meet the requirements for production of highly active pharmaceutical ingredients (API) new approaches and technical solutions are required. Prior to the design and construction of a new multipurpose manufacturing facility, a process study was performed to clarify the future needs. During the planning phase, concepts were defined and elaborated to meet production, cleaning, health and safety standards. The ideas were taken into account and a small-scale manufacturing facility was designed and realized accordingly

Die Abflussregimes der Schweiz

Karte 1:500 000 - E 05°57-E 10°30/N 47°48-N 45°4

Hydrologischer Atlas der Schweiz

Das Wasser ist für die Schweiz als Wasserschloß Europas von zentraler Bedeutung. Die hydrologischen Elemente Regen und Schnee, Gletscher und Fließgewässer prägten und prägen die schweizerischen Landschaften. Der Mensch profitiert vom Segen des Wassers, er ist aber auch dessen Gefahren ausgeliefert. Gesellschaftliche Aktivitäten beeinflussen den Wasser- und Stoffhaushalt in mannigfacher Weise. Im „Hydrologischen Atlas der Schweiz" sind die aktuellen Kenntnisse über die Ressource Wasser zusammengestellt. Er ist im Sommer 1992 in einer ersten Lieferung erschienen. In vorerst 17 Tafeln wurden Erkenntnisse regionalhydrologischer Untersuchungen zu gesamtschweizerischen Ansichten zusammengeführt. Bei der praxisgerechten Umsetzung der Forschungsergebnisse stand das klassische Medium Karte im Mittelpunkt. Als Modelle der realen Umwelt zeigen Karten räumliche zusammenhänge in leicht verständlicher Form schnell, eindeutig und genau auf. Sie sind deshalb in unserer stark auf das Visuelle ausgerichteten Welt trotz elektronischer Medien ein wichtiger Bestandteil einer modernen praxisbezogenen Raumwissenschaft. Im vorliegenden Aufsatz werden Hintergründe des „Hydrologischen Atlas" aufgezeigt. gestalterische und konzeptionelle Aspekte vorgestellt und inhaltliche und kartographische Fragen diskutiert