The importance of input and output legitimacy in democratic governance: evidence from a population-based survey experiment in four West European countries

The study of subjective democratic legitimacy from a citizens’ perspective has become an important strand of research in political science. Echoing the well‐known distinction between ‘input‐oriented’ and ‘output‐oriented’ legitimacy, the scientific debate on this topic has coined two opposed views. Some scholars find that citizens have a strong and intrinsic preference for meaningful participation in collective decision making. But others argue, to the contrary, that citizens prefer ‘stealth democracy’ because they care mainly about the substance of decisions, but much less about the procedures leading to them. In this article, citizens’ preferences regarding democratic governance are explored, focusing on their evaluations of a public policy according to criteria related to various legitimacy dimensions, as well as on the (tense) relationship among them. Data from a population‐based conjoint experiment conducted in eight metropolitan areas in France, Germany, Switzerland and the United Kingdom is used. By analysing 5,000 respondents’ preferences for different governance arrangements, which were randomly varied with respect to their input, throughput and output quality as well as their scope of authority, light is shed on the relative importance of different aspects of democratic governance. It is found, first, that output evaluations are the most important driver for citizens’ choice of a governance arrangement; second, consistent positive effects of criteria of input and throughput legitimacy that operate largely independent of output evaluations can be discerned; and third, democratic input, but not democratic throughput, is considered somewhat more important when a governance body holds a high level of formal authority. These findings run counter to a central tenet of the ‘stealth democracy’ argument. While they indeed suggest that political actors and institutions can gain legitimacy primarily through the provision of ‘good output’, citizens’ demand for input and throughput do not seem to be conditioned by the quality of output as advocates of stealth democratic theory suggest. Democratic input and throughput remain important secondary features of democratic governance

Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial

The purpose of this study was to determine the possible benefit of dual antiplatelet therapy in patients with prior myocardial infarction (MI), ischemic stroke, or symptomatic peripheral arterial disease (PAD)

Mutational landscape and patterns of clonal evolution in relapsed pediatric acute lymphoblastic leukemia

Relapse of acute lymphoblastic leukemia (ALL) remains a leading cause of childhood death. Prior studies have shown clonal mutations at relapse often arise from relapse-fated subclones that exist at diagnosis. However, the genomic landscape, evolutionary trajectories and mutational mechanisms driving relapse are incompletely understood. In an analysis of 92 cases of relapsed childhood ALL, incorporating multimodal DNA and RNA sequencing, deep digital mutational tracking and xenografting to formally define clonal structure, we identify 50 significant targets of mutation with distinct patterns of mutational acquisition or enrichment. CREBBP, NOTCH1, and Ras signaling mutations rose from diagnosis subclones, whereas variants in NCOR2, USH2A and NT5C2 were exclusively observed at relapse. Evolutionary modeling and xenografting demonstrated that relapse-fated clones were minor (50%), major (27%) or multiclonal (18%) at diagnosis. Putative second leukemias, including those with lineage shift, were shown to most commonly represent relapse from an ancestral clone rather than a truly independent second primary leukemia. A subset of leukemias prone to repeated relapse exhibited hypermutation driven by at least three distinct mutational processes, resulting in heightened neoepitope burden and potential vulnerability to immunotherapy. Finally, relapse-driving sequence mutations were detected prior to relapse using deep digital PCR at levels comparable to orthogonal approaches to monitor levels of measurable residual disease. These results provide a genomic framework to anticipate and circumvent relapse by earlier detection and targeting of relapse-fated clones