Policy Research Under Pressure:The Case of the Ministry of Justice in the Netherlands

In policy research, the search for the correct balance between proximity and independence has never been easy. Policymakers need proximity to the research in order to ensure that it is relevant. Yet, there are also concerns about the rigour of research. To analyze this relationship in more detail, this paper focuses on the ‘extreme case’ of the WODC in the Netherlands, an internal but formally independent research unit of the Dutch Ministry of Justice and Security. Research methods include semi-structured interviews and a survey (N = 673). We conclude that government leans on WODC researchers in all phases of the policy research process. In most cases, WODC researchers successfully resist pressure from policymakers, yet continuing pressure may easily lead to research methods, conclusions and press releases being altered for policy reasons. Finally, there are general lessons drawn from the WODC case that will assist in achieving a good balance between proximity and independence in policy research

A new instrument – motivational postures in practice:Action research into the role of motivational postures in the enforcement of social security legislation in the Netherlands

Based on previous research on enforcement of social security in the Netherlands, we introduced the perspective “smart enforcement” (Hertogh, Bantema, Weyers, Winter & De Winter). When we ignore other factors and circumstances, we see that the (experienced) sanctioning is not, but the (experienced) persuasion is related to compliance. The extent to which beneficiaries comply with the obligations of their benefit depends on the perceived chance of being caught and the profit that is expected from the violation. Our research shows that the motivational postures of beneficiaries are important for compliance. The individual profile of beneficiaries can be mapped based on five "motivational postures" distinguished by Valerie Braithwaite: commitment, capitulation, resistance, disengagement and game playing. The first two attitudes are characterized by a positive attitude toward the law and law enforcement, and the remaining three attitudes are characterized by an increasing negative attitude. A person can have multiple motivational postures at the same time. "Commitment" and "capitulation" have a positive relationship with compliance, while "resistance," "disengagement" and "game playing” are negatively related to compliance. The level of compliance in social security benefits not so much from "more" enforcement, but from "smarter" enforcement. In other words, the effectiveness of enforcement in social security is not only determined by tougher or softer measures, but also by the extent to which the enforcement style is tailored to the specific backgrounds and expectations of the beneficiary. The principle of "smart enforcement" is that the individual profile of the beneficiary must be taken into account as much as possible when setting up the enforcement relationship. Enforcers should be able to match their behavior to the profile of beneficiaries. To help employees determine the profile of their clients, we developed an electronic analysis tool (the ‘prototype’). We tested the prototype at one social assistance agency in the Netherlands. After the test-phase, we interviewed beneficiaries and employees about their experiences with the prototype

From metaplasia over dysplasia to early cancer : the pathologist’s view. What do clinicians need to know?

Introduction : L’incidence de l’adénocarcinome de l’oesophage est en croissance exponentielle dans les pays occidentaux. Depuis longtemps, l’oesophage de Barrett est considéré comme une lésion prénéoplasique. Il peut graduellement progresser vers la cancérisation en passant par différentes étapes morphologiquement identifiables correspondant aux lésions de dysplasie. Il faut toutefois noter que le diagnostic histopathologique de l’oesophage de Barrett et de la dysplasie pose certains problèmes spécifiques. Cette revue a pour but d’informer les cliniciens des difficultés et dès lors des moyens que le pathologiste utilise pour poser un diagnostic correct et utile à la clinique. Matériel et méthodes : Ce texte est fondé sur des articles sélectionnés (peer review publications) publiés sur l’évaluation microscopique des biopsies du bas oesophage prélevées dans un contexte de reflux. Toutes les références peuvent être consultées dans la base de données Pubmed. Résultats : Les sujets suivants sont discutés : 1) définitions de l’oesophage de Barrett utilisées dans la littérature et leurs implications cliniques ; 2) méthodes alternatives de comptes rendus utilisables par le pathologiste ; 3) problème du diagnostic différentiel et possibilités de solutions ; 4) concept de la dysplasie dans l’oesophage de Barrett ; 5) critères morphologiques de gradation de la dysplasie ; 6) techniques complémentaires morphologiques ou autres appliquées pour grader le risque de cancérisation de l’oesophage de Barrett. Conclusion : Les pathologistes jouent un rôle essentiel dans le diagnostic, le pronostic et le suivi des lésions précurseurs de l’adénocarcinome. Ils jouent également un rôle majeur dans l’évaluation des nouvelles techniques proposées comme complémentaires à l’histologie standard.Introduction: The incidence of esophageal adenocarcinoma is rapidly increasing in the Western world. Barrett’s esophagus has since long been recognized as the precursor lesion. It may show a stepwise neoplastic progression with a morphologically identifiable correlate: dysplasia. The histopathological diagnosis of Barrett’s esophagus and dysplasia poses particular problems. This review aims at informing clinicians about these hurdles and the ways how the pathologist can overcome them to arrive at a clinically meaningful diagnosis. Material and methods: The text is based on selected peerreviewed articles pertaining to microscopic evaluation of lower esophageal biopsies taken in a context of reflux disease. All references are accessible via the PubMed database. Results: The following subjects are discussed: 1) various definitions of Barrett’s esophagus and their clinical implications; 2) alternative ways of reporting which can be used by the pathologist; 3) differential diagnostic problems and suggested solutions; 4) the concept of dysplasia in Barrett’s esophagus; 5) morphologic criteria appropriate to each category of dysplasia; and 6) advanced morphologic or other techniques applied to risk stratification in Barrett’s esophagus. Conclusion: Pathologists play an essential role in the diagnosis, prognostication and follow-up of precursor lesions to esophageal adenocarcinoma. They are also indispensable in the evaluation of new techniques proposed as adjunctives to standard histolog

Unlocking system transitions for municipal solid waste infrastructure:A model for mapping interdependencies in a local context

Rapid global urbanization, urban renewal and changes in people's lifestyles have led to both an increase in waste generation and more complex waste types. In response to these changes, many local governments have invested in municipal solid waste infrastructure (MSWI) to implement circular strategies. However, matching and bridging the costly and logistically complex MSWI with the dynamic social context is a central challenge. In this paper we aim to explore the interdependencies between MSWI and the local social system, and then conceptualize and empirically validate the systemic nature of MSWI. We first review the current MSW treatment methods, corresponding infrastructure, and the challenges facing them. Then, we interrogate system-oriented concepts and use two key insights to set up a conceptual model for mapping the interdependencies in a MSWI system (MSWIS). Finally, a case study of the Dutch city of Almere is used to empirically validate the MSWIS model and identify the social systems that contribute to the development of the MSWIS. The analysis reveals that the development of MSWIS is beyond the municipality's control: efficient resource recovery facilities established by businesses under market rules and waste reuse facilities constructed by social organizations/individuals based on their own needs are key pieces of the puzzle to complete the MSWIS. This highlights the ability of the framework to capture interdependencies that go further than just the formal municipal sphere of influence.</p

Een handreiking voor familieleden over palliatieve zorg bij dementie: evaluatie door zorgverleners en familieleden.

De familie van verpleeghuisbewoners met dementie is meestal betrokken bij de zorg en bij behandelbeslissingen over de bewoner. Hiertoe dienen familieleden geïnformeerd te zijn over het beloop van dementie en mogelijkheden tot palliatieve zorg. Op basis van een Canadese brochure ontwikkelden wij een handreiking met schriftelijke informatie toegesneden op de Nederlandse situatie. Deze handreiking en mogelijke toepassing werden beoordeeld door specialisten ouderengeneeskunde (n = 30), verzorging/verpleging (n = 38), en familieleden (n = 59) na het overlijden van de bewoner. Alle respondenten gaven aan dat er grote behoefte bestaat aan een dergelijke handreiking. De meeste familieleden (93%) hadden de handreiking eerder willen hebben. De verzorging/verpleging dacht vergeleken met specialisten oudergeneeskunde vaker dat de handreiking nuttig zou zijn voor alle of veel families (p = 0,04). De acceptatie van de handreiking onder de respondenten, gemeten op een schaal met 8 stellingen, was het grootst onder familieleden en het kleinst onder specialisten ouderengeneeskunde. Veel respondenten beoordeelden het nut positief (gemiddeld 7,9 tot 8,3 op een schaal van 0-10; SD 0,9 tot 1,4) en het nut verschilde niet tussen de respondentgroepen (p = 0,29). Alle respondenten zagen een rol voor zorgverleners in het overhandigen van de handreiking. Daarnaast vond de helft van de respondenten (53%; geen significant verschil tussen de groepen) dat de handreiking ook zonder tussenkomst van zorgverleners beschikbaar moet zijn; soms zelfs al vóór opname. Concluderend is er grote behoefte aan schriftelijke uitleg over palliatieve zorg bij dementie. De handreiking wordt geschikt gevonden. Een op punten aangepaste versie kan mogelijk zorgverleners en familie in de praktijk ondersteunen