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Implementing precautionary measures that have obvious distributional consequences today but often only invisible future benefits is politically difficult. It requires that policymakers reconcile technocratic expertise with political consent. This paper traces attempts to enact such measures, focusing on countercyclical policies to limit the systemic risks of housing booms as proposed by financial stability committees in Germany, France, and the Netherlands from 2015 onwards. These committees bring together technocrats and political authorities in order to overcome the inaction bias inherent to these measures, seeking to forge both epistemic and political consensus on the need for action. We find that the work of these committees is characterized by lengthy processes of consensus‐building, during which technocrats amass evidence and search for politically acceptable solutions. We argue that whether this leads to meaningful steps crucially depends on the committee's institutional set‐up. What particularly matters is its capacity to engage the Ministry of Finance in binding discussions and the governance arrangements for the activation of precautionary instruments, which shape whether a shared framing of the problem and appropriate response emerges. [ABSTRACT FROM AUTHOR]

Background: Patient‐directed knowledge tools such as patient versions of guidelines and patient decision aids are increasingly developed to facilitate shared decision making. In this paper, we report how consensus was reached within the Netherlands on quality criteria for development, content and governance of these tools. Method: A 12‐month development and consensus study. The consortium worked on four work packages: (a) reviewing existing criteria; (b) drafting the quality criteria; (c) safe‐guarding the acceptability and feasibility of the draft criteria by participatory research in on‐going tool development projects; and (d) gaining formal support from national stakeholders on the quality criteria. Results: We reached consensus on a 8‐step guidance; describing minimal quality criteria for (a) the team composition; (b) setting the scope; (c) identifying needs; (d) the content and format; (e) testing the draft; (f) finalizing and approval; (g) dissemination and application, and (h) ownership and revision. The participants of the on‐going tool development projects were positive about the quality criteria in general, but divided as to the degree of detail. Whereas some expressed a clear desire for procedural standards, others felt that it would be sufficient to provide only general directions. Despite the different views as to the degree of detail, consensus was reached in three stakeholder meetings. Discussion: We successfully collaborated with all stakeholders and achieved formal support from national stakeholders on a set of minimum criteria for the development process, content and governance of patient‐directed knowledge tools. [ABSTRACT FROM AUTHOR]

Background: Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems? Methods: A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. Results: No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. Conclusions: In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery. [ABSTRACT FROM AUTHOR]

Introduction: Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. Methods: We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision‐making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. Results: A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self‐awareness; (5) consideration skills; (6) self‐efficacy; (7) emotional distress; and (8) experienced time. We developed the 20‐item ReadySDM to retrospectively measure these elements in an oncological setting. Conclusion: We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM. The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. Patient or Public Contribution: Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire. [ABSTRACT FROM AUTHOR]

Introduction: Quality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands. Methods: This mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement. Results: Forty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data. Conclusion: Barriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations. [ABSTRACT FROM AUTHOR]

In pluralistic modern societies, moral dissent will, to an increasing extent, be an inescapable fact in our lives. Moral dissent, however, involves various serious dangers: escalation of conflicts, the use of violence, flourishing of radical extremism and even civil war. There are basically two ways in which these threats can be addressed: coercive enforcement of consensus or tolerance. First, we could try to eliminate moral dissent by using more dictatorial forms of consensus formation, like propaganda, indoctrination and terror. This, however, would endanger or even destroy the open society. Therefore, from a moral point of view, tolerance appears to be the more desirable antidote to the unwanted effects of moral dissent. This paper aims to contribute to the discussions about the regulation of moral dissent and the formation of moral consensus by analyzing one of the most important and idiosyncratic elements of the Dutch way of handling these issues: pragmatic tolerance. First, some general thoughts are developed about moral consensus, moral dissent and tolerance as a means of regulating dissent. In addition, the characteristic Dutch policy of pragmatic tolerance is described. Finally, some of the pros and cons of pragmatic tolerance are analyzed from an ethical perspective. [ABSTRACT FROM AUTHOR]

Aim: To describe a Delphi study regarding practice variation in needs assessment by Dutch home care nurses, to define practice variation in home care nursing and explore which factors may have a role in this needs assessment. Design: A Delphi study was conducted with the participation of home care representatives. Method: A Delphi questionnaire was developed, preceded by literature research and an expert meeting. The Delphi study took place between December 2020 and February 2021. The goal was to achieve a consensus level of at least 70%. Results: After three rounds, 32 experts reached a consensus about definitions regarding variation in needs assessment, warranted and unwarranted variation. In total, 59 factors were determined related to (1) the client and health, (2) the clients' context, (3) nurses and (4) the nurses' context. Thirty‐four factors scored warranted of influence and 18 (of 34) were client related. Most of the factors that scored unwarranted influencing needs assessment (17 of 26) were related to the home care nurses' context. Conclusion: Having a consensus about the definition of practice variation in needs assessment and possible influencing factors support the professionals to discuss and improve the unity and quality of their decision‐making process in home care. This may contribute to more righteous care for clients in need of home care. Impact: Since 2015, home care nurses in the Netherlands are responsible for determining the amount, type and duration of care for clients in need of home care. This so‐called needs assessment legitimizes the payment by health insurers. Signals of practice variation in needs assessment are heard in home care field. Although practice variation may be justified, it can lead to over or underuse of care, which may affect clients' outcomes. If we can identify influencing factors and find patterns that contribute to practice variation, we might gain a better understanding of the process and improve home care. Patient or public contribution: In this study, there was no patient or public involvement. Client representatives were included in this research as experts in the home care field, and they participated in three rounds of the Delphi study. They contributed by sharing their expert opinion on the definitions presented and the factors possibly influencing needs assessment. [ABSTRACT FROM AUTHOR]

The high support needs of persons with profound intellectual and multiple disabilities hamper their possibilities for self-determination. To support their self-determination understanding of what this means for this group is necessary. A three-round Delphi procedure with international experts was undertaken to operationalise self-determination for persons with profound intellectual and multiple disabilities. The quantitative output of Likert scales guided us in finding consensus or differences in the qualitative data. First round qualitative data were analysed thematically. The analysis revealed four topics: (1) statements regarding the characteristics of the person with profound intellectual and multiple disabilities, (2) statements regarding characteristics of the social environment, (3) statements regarding the concept of self-determination, and (4) statements regarding the definition and operationalisation of concepts. Consensus was found on the assumption that persons with profound intellectual and multiple disabilities can live a self-determined life and on the importance of the interplay between persons with profound intellectual and multiple disabilities and the environment in order to experience self-determination. [ABSTRACT FROM AUTHOR]

In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example. [ABSTRACT FROM AUTHOR]

The push and pull between innovation and conservatism is a normal situation in Dutch coastal governance. In some cases this leads to conflicts over which policy solution to choose. This paper argues that coastal governance processes are shaped by policy frames. They influence what actors consider the policy problem, the appropriate solution, and the way to achieve this solutions. The paper features a Dutch coastal governance project called "Hondsbossche Duinen", in which the mismatching of heterogeneous policy framing foci almost led to breakdown of the process. After a phase leading to controversy and shifts in project management, the project eventually became realised successfully. This near-breakdown and eventual success is studied from the perspective of framing foci: policy substance, policy process, and actors' identities and relationships. In-depth interviews with policy actors allow for a nuanced analysis of those framing foci. We show that dynamics of emphasising and ignoring similarities and dissimilarities between actors' framing foci explain the developments in the case. Emphasising dissimilarities and ignoring similarities produced controversy in the first phase of the case. In the end, emphasising similarities and the emergence of a consensus framing focus led to policy consensus. • Tension between innovation and conservatism characterizes Dutch coastal governance. • Policy framing foci explain why governance processes lead to conflict or success. • Policy framing foci increase understanding of coastal governance processes. • (Mis-)Alignment of framing foci on its own does not explain process outcome. • Emphasising and ignoring framing foci describes the Hondsbossche Duinen case. [ABSTRACT FROM AUTHOR]

BACKGROUND: Assessing motor functioning is important to monitor the disease course of multiple sclerosis (MS). Video-assisted rating of classic neurologic tests and activities of daily living may improve the detection of changes in motor functioning. We investigated the value of using video-assisted composite measures for the detection of changes in mobility and upper extremity function (UEF). METHODS: Forty-three patients with MS were recorded performing motor function tests before and during treatment with fampridine. Patients were classified as improved or not improved on mobility composite (MOB-COM) and UEF composite (UEF-COM) measures based on neurologists' ratings of the tests. The proportional agreements between the composite measures and the conventional measures--the Timed 25-Foot Walk test (T25FW) and the Nine-Hole Peg Test (NHPT)--were determined and compared with patient-perceived improvement, which was determined using patient-reported ratings of changes in mobility and UEF. RESULTS: Agreement between MOB-COM and T25FW was 79.5%, and agreement between UEF-COM and NHPT was 82.1%. Twenty-six of 39 patients (66.7%) reported mobility improvement; 6 of these reports were confirmed by both T25FW and MOB-COM, 4 were confirmed by T25FW only, and 2 were confirmed by MOB-COM only. For UEF, 13 of 39 patients (33.3%) reported improvement; 3 of these were confirmed by the NHPT and 3 were confirmed by the UEF-COM. CONCLUSIONS: Compared with the conventional NHPT measure, the video-assisted composite measure of UEF detected additional patient-perceived improvement. This was less evident for mobility measures. Video-assisted composite measures may enhance the detection of treatment effects in MS clinical practice and trials. [ABSTRACT FROM AUTHOR]

Abstract: A Delphi study was performed to answer the question: Which global societal trends relate to future radicalization and subsequent terrorism in the Netherlands? An inventory of two hundred global societal trends and a literature study of radicalization together served as briefing of the participants in the Delphi study. The first two rounds were conducted in anonymous writing. The third round was a face to face focus group meeting. In the first and second round participants scored the trends, adjusted their scores relative to others and provided arguments, and in the focus group meeting, themes were discussed in which the participants remained to have strong opposite views. This approach emphasizes divergence in opinion (‘dissensus’), as opposed to convergence (‘consensus’). Consensus seeking to us seems to be the dominant application of Delphi, but we emphasize the value of seeking dissensus. We hypothesize that in those cases where the opposite views that were discussed kept their ground, this Delphi study may have found early warnings of future radicalization. The essence of this paper is that it is possible, with limited effort, to get a handle on the complex and poorly defined subject of global societal trends influencing future radicalization. Application of the Dissensus Delphi method provided a selection of early warnings that may be looked into with future research. [Copyright &y& Elsevier]

The Dutch consensus oriented model of negotiated environmental governance enjoys increasing popularity within the European Union because of its seemingly effective way of dealing with environmental problems. A closer look at the model does not reveal any better performance than European average. The article theoretically explains the strengths and weaknesses of the Dutch model as an iterative policy model in which three different modes of governance-competitive, cooperative, and authoritative-interact and compete to achieve effective efficient and legitimate policy results. The argument is empirically illustrated with findings of energy saving policies in the Netherlands. [ABSTRACT FROM AUTHOR]

This article examines whether the fundamental consensus between the central government and the provincial authorities exists in relation to Frisian language policy in the Netherlands. Government policy concerning the Frisian language and culture is based largely on the report of the Van Ommen Committee, although certain aspects of the policy follow the lines of other official papers. With respect to the preservation and the promotion of the Frisian language and the Frisian-language culture, the government has a function in resolving the specific problems caused by bilingualism of the Frisian culture. The basis on which the provincial authorities established their policy on Frisian language and culture was determined by a view defined in the 1951 Report of the Provincial Advisory Committee on the Decentralization Question: the special position of Friesland justified claims for adequate legislative and administrative authority to enable the preservation and development of the specific Frisian identity. Provincial policy concerning the Frisian language and culture is based on the principle of equality in terms of equal appreciation and equal rights. This means equal appreciation for both the Frisian and the Dutch language and equal rights for those who speak Frisian and Dutch respectively.

Background: Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Nevertheless, such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach. Methods: A questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES). This was delivered and answered live by acute care surgeons attending the 6th WSES congress in Nijmegen in 2019. A dedicated mobile phone application was utilized to collect the answers. All answers were evaluated for areas of discrepancy with an 80% threshold for consensus between respondents. Results: Three factors generated discrepancy in opinion for managing this pattern of injury: the patients' injury severity, the presence of a bleeding diathesis, and an associated intra-abdominal injury. Agreement was obtained for the other eight factors. Conclusion: Researchers should focus their efforts on the identified area of discrepancy. Clinicians should use additional care in the presence of the three factors for which discordant opinions were found. [ABSTRACT FROM AUTHOR]

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Fee‐for‐service, funding care on an hourly rate basis, creates an incentive for home‐care providers to deliver high amounts of care. Under casemix funding, in contrast, clients are allocated—based on their characteristics—to homogenous, hierarchical groups, which are subsequently funded to promote more effective and efficient care. The first step in developing a casemix model is to understand which client characteristics are potential predictors of home‐care needs. Nurses working in home care (i.e. home‐care nurses) have a good insight into clients' home‐care needs. This study was conducted in co‐operation with the Dutch Nurses' Association and the Dutch Healthcare Authority. Based on international literature, 35 client characteristics were identified as potential predictors of home‐care needs. In an online survey (May, 2017), Dutch home‐care nurses were asked to score these characteristics on relevance, using a 9‐point Likert scale. They were subsequently asked to identify the top five client characteristics. Data were analysed using descriptive statistics. The survey was completed by 1,007 home‐care nurses. Consensus on relevance was achieved for 15 client characteristics, with "terminal phase" being scored most relevant, and "sex" being scored as the least relevant. Relevance of the remaining 20 characteristics was uncertain. Additionally, based on the ranking, "ADL functioning" was ranked as most relevant. According to home‐care nurses, both biomedical and psychosocial client characteristics need to be taken into account when predicting home‐care needs. Collaboration between clinical practice, policy development, and science is necessary to realise a funding model, to work towards the Triple Aim (improved health, better care experience, and lower costs). [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to obtain consensus among physicians of several medical specialties on the level of limitations to work-related functioning of people with persistent 'medically unexplained' physical symptoms (PPS). Methods A modified Delphi study was conducted with 15 physicians of five different medical specialties. The study involved two email rounds and one meeting. In each round, the physicians prioritized the level of limitations in 78 work-related functioning items for four different PPS cases. These items were based on the Dutch Functional Ability List, national guidelines and scientific literature regarding the International Classification of Functioning. Results In all four cases, the physicians reached consensus on the level of limitations to work-related functioning in 49 items. The physicians reported the highest number and level of limitations for PPS of the back and lower extremities, but they reported hardly any limitations for PPS of the abdomen and genitals. For PPS of the head, they reported mainly limitations to personal and social functioning; for PPS of the neck, back and upper or lower extremities, they reported mainly limitations to dynamic movements and static postures. The physicians could not reach consensus on limitations in the category of working hours. Conclusion Physicians reached consensus on the level of limitations in a substantial part of work-related functioning items for PPS. There was a difference in the number and severity of limitations between different cases of PPS. The assessment of functioning seems to be based more on the specific impairment than on the disease. [ABSTRACT FROM AUTHOR]

As many drugs in paediatrics are used off-label, prescribers face a lack of evidence-based dosing guidelines. A Dutch framework was developed to provide dosing guidelines based on best available evidence from registration data, investigator-initiated research, professional guidelines, clinical experience and consensus. This has clarified the scientific grounds of drug use for children and encouraged uniformity in prescribing habits in the Netherlands. The developed framework and the current content of the Dutch Paediatric Formulary could be used as basis for similar initiatives worldwide, preferably in a concerted effort to ultimately provide children with effective and safe drug therapy. [ABSTRACT FROM AUTHOR]

Background Atypical speech and language development is one of the most common developmental difficulties in young children. However, which clinical signs characterize atypical speech-language development at what age is not clear. Aim To achieve a national and valid consensus on clinical signs and red flags (i.e. most urgent clinical signs) for atypical speech-language development in children from 1 to 6 years of age. Methods & Procedures A two-round Delphi study in the Netherlands with a national expert panel ( n = 24) of speech and language therapists was conducted. The panel members responded to web-based questionnaires addressing clinical signs. Consensus was defined as ≥ 70% of the experts agreeing on an issue. Outcomes & Results The first round resulted in a list of 161 characteristics of atypical speech and language development. The second round led to agreement on 124 clinical signs and 34 red flags. Conclusions & Implications Dutch national consensus concerns 17-23 clinical signs per age year for the description of an atypical speech-language development in young children and three to 10 characteristics per age year being red flags for atypical speech-language development. This consensus contributes to early identification and diagnosis of children with atypical speech-language development, awareness and research. [ABSTRACT FROM AUTHOR]

The complexity of the daily practice of social workers in the Netherlands has increased, while the social appreciation for their work has decreased. Stakeholders involved in social work practice agreed that a master's programme for social workers could be an important step to improve the quality of social work and enhance the professionalisation of social workers. However, stakeholders disagreed considerably on the objectives of this new programme. Hence, there was no focus for the programme or for its evaluation. In order to assess the purpose and intended goals of the master's programme in social work, a retrospective plan evaluation was conducted, consisting of a document analysis and concept-mapping procedure with thirty-nine stakeholders. The study resulted in a consensus-based conceptual framework in which practice development is considered the key domain of the programme. Practice development seems to fit the open domain of social work and meets the various and often ambivalent demands on social workers and their profession. It is regarded as a method in which the social worker with a master's degree has a new role and position in the interplay between clients, stakeholders and professionals. [ABSTRACT FROM AUTHOR]

Although a relatively new idea in the U.S., weighted student funding (WSF) for individual schools has a long history in the Netherlands. This country of about 16.5 million people has been using a version of WSF for all its primary schools (serving children from age 4 to 12) for 25 years. In this article we describe and evaluate the Dutch system and explore what insights there might be for the U.S., taking into account the very different cultural and normative contexts of the two countries. We find that, compared to those with few weighted students, Dutch schools with high proportions of weighted students have almost 60 percent more teachers per pupil as well as more support staff per teacher. Even these large resource advantages, however, are not sufficient by themselves to eliminate all quality shortfalls in the high-weight schools, where quality is measured by school policies and practices. We conclude that weighted student funding for schools within districts in the U.S. is not likely to deliver the same highly progressive funding patterns as in the Netherlands because of the complex, multilayered U.S. education system and the absence of a political consensus in favor of generous weights. © 2011 by the Association for Public Policy Analysis and Management. [ABSTRACT FROM AUTHOR]

By comparing the views of managers working at the interface of two consensus-oriented societies, Japan and the Netherlands, we show important differences between the consensus decision-making processes as seen by Japanese and Dutch managers. These differences relate to how complete the agreement of opinion should be in order to speak of consensus, with the Japanese managers demanding a more complete consensus than the Dutch. The processes and conditions that Japanese and Dutch managers see as leading to consensus also differ. Japanese consensus is based on a more ordered, sequential process than Dutch consensus. Our respondents differed deeply regarding the role of the hierarchy in their own and the others’ consensus processes, with both Japanese and Dutch managers seeing their own consensus process as less hierarchical. Our findings show that the concept of consensus is interpreted quite differently by Japanese and Dutch managers. This is an important warning for companies operating at the interface of these two societies. More in general our research illustrates the usefulness for international management research of detailed comparative studies focusing not on stark contrasts but on more subtle differences between management practices. [ABSTRACT FROM AUTHOR]

The 12th Meeting of the OSCE Ministerial Council (Sofia, 6-7 December 2004), ended with no less ambiguity than that of the previous year in Maastricht through what may be called escapism. Indeed, it adopted an extensive set of formal decisions and a few declaratory statements, a package which was obviously meant to downplay, if not conceal, the extent of the rift between Russia and most of the other participating States. The present article offers a critical account of the decisions which did not gain consensus as well as those whose formal adoption saved the meeting from collapse, while also assessing the consequence for the OSCE of repeated escapist diplomatic exercises. [ABSTRACT FROM AUTHOR]

The Health Council of the Netherlands is an independent scientific advisory board to the Dutch government in matters of public health. In this article we argue that even for an independent body such as the Health Council there seems to be no escape from the increasing intertwinement of scientific and societal processes. In order to produce a serviceable truth for policymaking, the council needs to reflect on what goes on in its socio-political surroundings. On the other hand, how could we ever come to understand the legitimacy of the council when notions of scientific objectivity dissolve in such a reflexive, inherently political stance? In a situation where science and society are thoroughly interrelated, the Health Council somehow succeeds in bringing about or re-claiming some sense of objectivity. Our central question will be how to conceptualise this notion of 'objectivity' without having to rely on idealized notions of objectivity that are criticized in philosophical, sociological and historical studies of science and society. In order to do so, we will regard the objectivity of advisory reports of the Health Council as being constructed out of heterogeneous elements and under complex circumstances. The theoretical point will be empirically underpinned with case material drawn from activities of the Health Council in the period 1985-2002 in predominantly the subject areas healthcare and medical technology. [ABSTRACT FROM AUTHOR]

The literature on welfare-state retrenchment generally argues that economics and institutions matter for the retrenchment scale used in different countries. This article argues that politics, in the sense of party competition and consensus, also matter. A study of retrenchment in Denmark and the Netherlands from 1982 to 1998 shows a greater extent of retrenchment has been implemented in the Netherlands. This occurred because the Dutch system of party competition with a pivotal center party, the Christian Democratic Appeal, produced party consensus about welfare-state retrenchment. The Dutch labor party had to accept retrenchment to regain government power, and Dutch governments were able to use this consensus to frame retrenchment as an economic necessity. In Denmark, vehement opposition from the Social Democrats made retrenchment a contested issue during the right-wing governments from 1982 to 1993. Following the Social Democrats' return to power in 1993, a party consensus emerged, leading to retrenchment measures. [ABSTRACT FROM AUTHOR]

A total of 158 citizens from Groningen and surrounding villages evaluated summary descriptions of four different policy scenarios (A-D) for metropolitan traffic in the next decades. Eighty subjects rank-ordered the scenarios following a multi-attribute evaluation method. The other 78 subjects provided an 'intuitive' rank-ordering. Of each group, half of the subjects did and the other half did not sketch their expected future consequences of each scenario. Multi-attribute evaluation of policy scenarios yielded a greater consensus among subjects and it led to another mean preference order than did intuitive evaluation. Of all preference orderings, 138 (87%) could be unfolded into one J(oint)-scale ranging from the 'alternative-friendly' scenario D to the 'car-friendly' scenario A. Individual subjects' ideal points and corresponding individual preference orders fell into seven different categories along this J-scale. Subgroups holding the seven preference orders significantly differed in traffic problem awareness, annual car-kilometrage and the percentage of multi-attribute evaluators. It is concluded that multi-attribute evaluation of complex preference objects may guide subjects towards greater consensus and towards another preference ranking than when policy scenarios are evaluated intuitively. This may be mediated by the set of value attributes used, whose structure of intercorrelations may reflect (or induce) a simple(r) preference foundation. The results are interpreted in terms of cognitive elaboration of choice alternatives which serves the construction of preferences about them. The importance of good 'scenario thinking' for complex policy making is emphasized. [ABSTRACT FROM AUTHOR]