Referendum campaigns can end up convincing voters that their preferred party is right

When people are deciding how to vote in a referendum, do they take their cue from party loyalty or by listening to the debate and making up their own minds? When Céline Colombo (University of Zurich) and Hanspeter Kriesi (European University Institute) analysed two Swiss referendums, they found that voters do pay attention to the arguments. But during the referendum campaigns they came ..

New survey evidence: Renzi’s support is damaging the chances of a Yes vote in Italy’s referendum

When the Italian constitutional referendum was called, Italy’s Prime Minister, Matteo Renzi, linked the result to the fate of his government, suggesting that he would resign in the case of a No vote. Based on new survey evidence, Céline Colombo, Andrea De Angelis and Davide Morisi write that this strategy appears to have been counterproductive. They illustrate that voter support for the reform declines when it is explicitly linked to the government, but that if the Yes campaign focuses solely on the content of the reform, they may find consensus among a majority of voters on some of the key elements of the proposal

HER3 as biomarker and therapeutic target in pancreatic cancer: new insights in pertuzumab therapy in preclinical models.

International audienceThe anti-HER2 antibody pertuzumab inhibits HER2 dimerization and affects HER2/HER3 dimer formation and signaling. As HER3 and its ligand neuregulin are implicated in pancreatic tumorigenesis, we investigated whether HER3 expression could be a predictive biomarker of pertuzumab efficacy in HER2low-expressing pancreatic cancer. We correlated in vitro and in vivo HER3 expression and neuregulin dependency with the inhibitory effect of pertuzumab on cell viability and tumor progression. HER3 knockdown in BxPC-3 cells led to resistance to pertuzumab therapy. Pertuzumab treatment of HER3-expressing pancreatic cancer cells increased HER3 at the cell membrane, whereas the anti-HER3 monoclonal antibody 9F7-F11 down-regulated it. Both antibodies blocked HER3 and AKT phosphorylation and inhibited HER2/HER3 heterodimerization but affected differently HER2 and HER3 homodimers. The pertuzumab/9F7-F11 combination enhanced tumor inhibition and the median survival time in mice xenografted with HER3-expressing pancreatic cancer cells. Finally, HER2 and HER3 were co-expressed in 11% and HER3 alone in 27% of the 45 pancreatic ductal adenocarcinomas analyzed by immunohistochemistry. HER3 is essential for pertuzumab efficacy in HER2low-expressing pancreatic cancer and HER3 expression might be a predictive biomarker of pertuzumab efficacy in such cancers. Further studies in clinical samples are required to confirm these findings and the interest of combining anti-HER2 and anti-HER3 therapeutic antibodies

Novel foods in the European Union: Scientific requirements and challenges of the risk assessment process by the European Food Safety Authority

The European Food Safety Authority (EFSA) has been involved in the risk assessment of novel foods since 2003. The implementation of the current novel food regulation in 2018 rendered EFSA the sole entity of the European Union responsible for such safety evaluations. The risk assessment is based on the data submitted by applicants in line with the scientific requirements described in the respective EFSA guidance document. The present work aims to elaborate on the rationale behind the scientific questions raised during the risk assessment of novel foods, with a focus on complex mixtures and whole foods. Novel foods received by EFSA in 2003-2019 were screened and clustered by nature and complexity. The requests for additional or supplementary information raised by EFSA during all risk assessments were analyzed for identifying reoccurring issues. In brief, it is shown that applications concern mainly novel foods derived from plants, microorganisms, fungi, algae, and animals. A plethora of requests relates to the production process, the compositional characterization of the novel food, and the evaluation of the product's toxicological profile. Recurring issues related to specific novel food categories were noted. The heterogeneous nature and the variable complexity of novel foods emphasize the challenge to tailor aspects of the evaluation approach to the characteristics of each individual product. Importantly, the scientific requirements for novel food applications set by EFSA are interrelated, and only a rigorous and cross-cutting approach adopted by the applicants when preparing the respective application dossiers can lead to scientifically sound dossiers. This is the first time that an in-depth analysis of the experience gained by EFSA in the risk assessment of novel foods and of the reasoning behind the most frequent scientific requests by EFSA to applicants is made

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Principled or pragmatic? Morality politics in direct democracy

Political scientists often distinguish between two types of issues: moral versus non-moral issues or social-cultural versus economic issues. The implication is that these types of issues trigger different types of reasoning: while economic issues rely on pragmatic, consequentialist reasoning, social-cultural issues are said to be dependent on principles and deontological reasoning. However, it is not known whether this distinction is as clear-cut from a citizen's perspective. Scholars agree that understanding the morality of voters’ political attitudes has implications for their political behaviour, such as their willingness to compromise and openness to deliberation. However, few studies have analysed whether citizens reason in principled or pragmatic ways on different issues. This study takes an exploratory approach and analyses the determinants of principled versus pragmatic reasoning in direct democracy, in which citizens make direct policy decisions at the ballot box. Using a unique dataset based on thirty-four ballot decisions in Switzerland, it explores the justifications voters give for their ballot decisions in open-ended survey answers. It distinguishes between pragmatic (or consequentialist) arguments and principled (or value-based) arguments. The analysis shows that principled justifications are not tied to particular issues. Voters use both types of justifications almost equally frequently. Moral justifications are more likely when an issue is personally relevant, as well as when a proposition is accepted, while pragmatic justifications prevail when a proposition is rejected. Furthermore, right-wing voters more often argue in pragmatic terms. Finally, the framing of the issue during the campaign significantly affects moral versus pragmatic justifications

Hearing the other side? Debiasing political opinions in the case of the scottish independence referendum

This study reports the effects of two debiasing strategies on the complexity of people’s thinking on a controversial policy issue – the question of Scottish independence. I start from the well-researched assumptions of motivated reasoning theory that individuals tend to protect their beliefs, are often not willing to hear the other side and fail to integrate contrasting arguments and different perspectives in their political considerations – although considering different viewpoints is a fundamental normative requirement for democratic decision-making. Two different debiasing techniques, which are meant to counteract this tendency and to evoke more integrative and complex thinking, were tested experimentally: a cognitive and a motivational strategy. The experiment was situated in the context of the Scottish independence referendum. The expectation of accountability – having to justify one’s opinion in front of unknown others – significantly enhanced integrative complexity of thinking about the issue, while inducing subjects to consider the opposite had no significant effect. Opinion strength and political knowledge did not affect the treatment effects significantly

Partisan, not ignorant : citizens' use of arguments and justifications in direct democracy

Defence date: 3 May 2016Examining Board: Professor Hanspeter Kriesi, European University Institute, Supervisor; Professor Alexander Trechsel, European University Institute, Co-Supervisor; Professor Diana Mutz, University of Pennsilvania; Professor Rune Slothuus, Aarhus University.A competent citizenry is the key to the legitimacy of direct democratic decisions, but just how competent are citizens in direct democracy? Understanding how citizens reason and how they make their decisions is ever more important as the use of direct democratic instruments is growing throughout the world. I propose a concept of citizen competence based on reason-giving. A competent citizen is one who bases his or her decisions on substantive, policy-related arguments, and who considers a diversity of arguments before taking a decision. In this thesis I use a multi-method approach, combining three different datasets to analyze citizen competence in direct democracy: cross-sectional post-ballot surveys from 34 popular votes in Switzerland; a panel dataset covering two referendum campaigns in Switzerland; and a lab experiment conducted in Scotland during the Scottish independence referendum in 2014. I found, that citizens have a surprisingly accurate knowledge of the policy-related arguments of the debate. Furthermore, arguments are significantly associated with vote intention, even when controlling for party preference. This first results highlight the importance of meaningful arguments in political opinion formation. However, a second finding of my project is that citizens tend to process arguments in a biased way, preferring arguments compatible with their prior beliefs and partisan attachments, and disregarding or devaluing incompatible information. Yet this tendency for directional, motivated reasoning can be discouraged by holding individuals accountable for their views, that is, by making them justify their position to others. The conclusions I draw for the legitimacy of direct democratic decisions are mixed. While citizens are not as uninformed and minimalist as they are often depicted in public opinion research, they are still partisan and find it difficult to process information impartially. Therefore, in order to enhance the legitimacy of direct democratic procedure, providing citizens with diverse and balanced information is necessary, but not sufficient. They need to encounter an environment where they are motivated to be accurate, for example, by being expected to justify themselves to others in cross-cutting discussions

Replication Data for: JUSTIFICATIONS AND CITIZEN COMPETENCE IN DIRECT DEMOCRACY – A Multilevel Analysis

While the popularity and implementation of direct democratic instruments is growing throughout the democratic world, the criticism that ordinary voters lack the necessary competence to make policy decisions persists. This paper presents novel and original a measure of voters’ level of justification as a possible, policy-specific, conceptualization of citizen competence in direct democracy. Using a unique dataset based on 34 ballot decisions in Switzerland, the study explores the levels and correlates of citizen competence by means of a multilevel analysis. The main findings are, first, that most voters know relevant policy-arguments. Second, the context is just as important as individual resources in determining voters’ competence. Finally, with regard to individual resources, motivation correlates more strongly with competence than ability