Detection of vancomycin-resistant Enterococcus faecium (VRE) is hampered by low sensitivity of rectal swab cultures. This study aimed to define the number of screening cultures needed to increase... Show moreDetection of vancomycin-resistant Enterococcus faecium (VRE) is hampered by low sensitivity of rectal swab cultures. This study aimed to define the number of screening cultures needed to increase sensitivity to detect VRE transmission, and to determine time from presumed exposure to detectable colonization. In a tertiary care setting, we retrospectively analyzed data from 9 VRE outbreaks. As a proxy or estimation for time to detectable colonization, the time between first positive culture of the presumed index patient and that of their contacts was determined. Only 64% of secondary cases were positive in the first out of five cultures. By using the first three out of five rectal swabs, 89% (95%CI: 78-95%) of all secondary cases would have been identified. The median number of days between the positive culture of the index patient and the first positive culture of secondary cases was 9 days. Eleven percent of secondary cases would have been missed if only three rectal samples would have been obtained. Furthermore, our results show that one or more rectal swabs taken around day 9 after presumed exposure should at least be included in the screening approach. In our setting, obtaining a fourth and a fifth rectal swab showed a relevant additional value compared to only one to three swabs. Our findings are useful for determining the most effective VRE contact tracing approach to prevent transmission. Show less
Detection of vancomycin-resistant Enterococcus faecium (VRE) is hampered by low sensitivity of rectal swab cultures. This study aimed to define the number of screening cultures needed to increase... Show moreDetection of vancomycin-resistant Enterococcus faecium (VRE) is hampered by low sensitivity of rectal swab cultures. This study aimed to define the number of screening cultures needed to increase sensitivity to detect VRE transmission, and to determine time from presumed exposure to detectable colonization. In a tertiary care setting, we retrospectively analyzed data from 9 VRE outbreaks. As a proxy or estimation for time to detectable colonization, the time between first positive culture of the presumed index patient and that of their contacts was determined. Only 64% of secondary cases were positive in the first out of five cultures. By using the first three out of five rectal swabs, 89% (95%CI: 78–95%) of all secondary cases would have been identified. The median number of days between the positive culture of the index patient and the first positive culture of secondary cases was 9 days. Eleven percent of secondary cases would have been missed if only three rectal samples would have been obtained. Furthermore, our results show that one or more rectal swabs taken around day 9 after presumed exposure should at least be included in the screening approach. In our setting, obtaining a fourth and a fifth rectal swab showed a relevant additional value compared to only one to three swabs. Our findings are useful for determining the most effective VRE contact tracing approach to prevent transmission. Show less
Geukes, H.H.; Oudenhoven, A.P.E. van; Bodegom, P.M. van 2023
Nature-based solutions (NbS) are fast becoming the norm for multifunctional climate adaptation to the combined challenges of increased sea-level rise, coastal population densities, and erosion of... Show moreNature-based solutions (NbS) are fast becoming the norm for multifunctional climate adaptation to the combined challenges of increased sea-level rise, coastal population densities, and erosion of sandy shores worldwide, delivering functions such as flood prevention, recreation, and biodiversity benefits. However, it remains a challenge to the research field to inform decision-makers well on the outcomes and trade-offs of designing, planning, and managing the multifunctional NbS. This study set out to identify the information requirements by decision-makers on NbS for coastal climate adaptation. Using the Sand Motor in The Netherlands as a case study, we applied a policy science framework to distinguish four stages of decision-making to quantitatively analyse the content of functions and indicators utilized per stage in public policy documents. These stages are the ambition, political, bureaucratic, and provisioning processes. This study is the first comprehensive empirical investigation distinguishing these crucial stages of decision-making to analyse NbS information requirements. Our results show, most notably, that as the project developed through the decision-making stages, the content of the functions and indicators changed from abstract to concrete. And, with it, the content of the information required shifted significantly. These results suggest that it is crucial for academic researchers to recognize the decision-making process their information will be used in and adapt its content and level of abstraction accordingly to increase its uptake in decision-making. This study lays the groundwork for future research into the multiple dimensions of NbS decision-making and for the increased understanding of the information requirements on evaluation and trade-offs in planning, designing, and managing NbS, to increase the ability of NbS to deliver multifunctional coastal climate adaptation for sandy shores worldwide. Show less
BackgroundOwing to the rarity and heterogeneity in biology and presentation, there are multiple areas in the diagnosis, treatment and follow-up of soft tissue sarcoma (STS), with no, low-level or... Show moreBackgroundOwing to the rarity and heterogeneity in biology and presentation, there are multiple areas in the diagnosis, treatment and follow-up of soft tissue sarcoma (STS), with no, low-level or conflicting evidence.MethodsDuring the first Consensus Conference on the State of Science in Sarcoma (CSSS), we used a modified Delphi process to identify areas of controversy in the field of sarcoma, to name topics with limited evidence-based data in which a scientific and knowledge gap may remain and a consensus statement will help to guide patient management. We determined scientific questions which need to be addressed in the future in order to generate evidence and to inform physicians and caregivers in daily clinical practice in order to improve the outcomes of patients with sarcoma.We conducted a vote on STS key questions and controversies prior to the CSSS meeting, which took place in May 2022.ResultsSixty-two European sarcoma experts participated in the survey.Sixteen strong consensus (≥95%) items were identified by the experts, as well as 30 items with a ≥75% consensus on diagnostic and therapeutic questions. Ultimately, many controversy topics remained without consensus.ConclusionsIn this manuscript, we summarise the voting results and the discussion during the CSSS meeting. Future scientific questions, priorities for clinical trials, registries, quality assurance, and action by stakeholders are proposed. Platforms and partnerships can support innovative approaches to improve management and clinical research in STS. Show less
Karel, E.; Heyne, D.A.; Weerd, M. de; Halberstadt, R. 2022
Research signals the importance of promptly identifying and responding to emerging absenteeism, to prevent severe and chronic absenteeism. Prompt identification and response relies upon a good... Show moreResearch signals the importance of promptly identifying and responding to emerging absenteeism, to prevent severe and chronic absenteeism. Prompt identification and response relies upon a good system for recording, reporting, and using data related to students’ school attendance and absence. The current article provides an overview of law, policy, and practice in the Netherlands regarding the recording, reporting, and use of school attendance data. We then consider the ways in which current law, policy, and practice help and hinder the work of school personnel as they endeavour to promote attendance and reduce absenteeism. Thereafter, we propose modifications to current policy and practice that could enhance the prompt identification and response to emerging absenteeism. When school personnel have easy access to reliable attendance data, and when they become accustomed to using the data to inform their work to promote attendance and respond to absenteeism, they are in a stronger position to support positive developmental outcomes among young people. Show less
What explains nonresident citizens’ voter turnout and which effects do overseas votes generate in homeland politics? Using a multi-method strategy that encompasses 3 cross-sectional time-series... Show moreWhat explains nonresident citizens’ voter turnout and which effects do overseas votes generate in homeland politics? Using a multi-method strategy that encompasses 3 cross-sectional time-series datasets, 50 semi-structured interviews, the analysis of official documents and party manifestos, this dissertation examines nonresident citizens’ voter turnout in Latin America and Southern Europe. The results are abundant. First, the author finds that registration rules, compulsory voting, concurrent elections, voting methods, and democratic quality have a meaningful impact on nonresident citizens’ voter turnout. Second, in this dissertation, there is an in-depth understanding of the different incentives, opportunities, and constraints associated with nonresident citizens’ voter turnout, including the role of homeland authorities and de facto practices to promote and/or to organize elections abroad. Third, the author unpacks swing, interregnum, incumbency, and feedback effects from a comparative quantitative logic. Correspondingly, this study suggests that parties, homeland politicians, and policymakers seek to avoid unwanted consequences controlling or influencing the political agenda. Both a sizable nonresident population and a high number of overseas votes have a moderate but significant impact on election results, either changing or not the bargaining among party organizations to govern. Lastly, this dissertation explores three pathways to analyze non-resident citizens’ voter turnout over time. Show less
Background: While current public policy scholarship can take advantage of a decades-long accumulated knowledge base on the relationship between evidence and policy, it is hard to keep the overview... Show moreBackground: While current public policy scholarship can take advantage of a decades-long accumulated knowledge base on the relationship between evidence and policy, it is hard to keep the overview across different literatures. Over time, the ever more differentiated branches of public policy research have developed their own perspectives, languages, and conceptualisations of ‘evidence’ and ‘policy’, as well as their connections.Aims and objectives: Existing reviews have stressed that studies often do not provide clear definitions of ‘policy’ or ‘evidence’, and have outlined the importance of investigating underlying conceptualisations in the literature. Against this backdrop, this article investigates how present-day public policy scholarship approaches the concepts of ‘evidence’, ‘policy’, and their connections.Methods: We conducted a qualitative systematic review following the PRISMA method. Using a keyword search, we identified relevant articles (n=85) in eleven Q1 and Q2 policy journals included in Web of Science in the period 2015 to 2019.Findings: The synthesis confirms that ‘evidence’ and ‘policy’ are often not clearly defined, yet different trends regarding understandings can be identified. There are two approaches taken on the evidence and policy connection: a ‘use of evidence’ or a ‘use for policy’ perspective.Discussion and conclusions: Research on evidence and policy would benefit from more explicit conceptual discussions. This review may provide a heuristic for explicating conceptual choices when working with the notions of ‘evidence’, ‘policy’, and their connections. It also suggests several avenues that are worth exploring in future research. Show less
In de topsectoren spelen we een rol in een bijzonder soort innovatie: innovatie die plaatsvindt binnen publiek-private samenwerkingen. Deze triple helix bestaat uit overheid, bedrijfsleven en... Show moreIn de topsectoren spelen we een rol in een bijzonder soort innovatie: innovatie die plaatsvindt binnen publiek-private samenwerkingen. Deze triple helix bestaat uit overheid, bedrijfsleven en kennisinstellingen die elk hun eigen vraagstukken en belangen hebben, maar elkaar vinden bij het zoeken naar oplossingen voor maatschappelijke vraagstukken. Steeds vaker wordt dit model aangevuld met de burger als vierde element in de zogenaamde quadruple helix.Vaak is in deze samenwerkingen de overheid op een of andere manier financier. Echter, de overheid is ook een echte belanghebbende, op meerdere manieren. Natuurlijk bewaakt de overheid de maatschappelijke uitdagingen. Maar de overheid maakt ook beleid, bepaalt contouren van wat er wel en niet kan, en formuleert specifiek regels. Hiermee vormt de overheid als geen ander het speelveld waarin innovatie zich kan voltrekken.Deze publicatie gaat over die rol van de overheid bij innovatie. Meer specifiek gaat dit document over de invloed van beleid en wet- en regelgeving op logistieke innovaties. Een recent voorbeeld (mei 2021) omtrent de toelating tot de openbare weg van de Super EcoCombi vrachtwagen laat zien dat de overheid hierbij een belangrijke rol speelt.We hadden behoefte, in de Topsector Logistiek, om beter te begrijpen hoe vanuit de academische expertise die de overheid en overheidsbeleid centraal stelt – de bestuurskunde – naar de rol van de overheid als wegbereider voor innovatie gekeken wordt. Daarmee willen we over veelgehoordekritiek op de rol van de overheid heenstappen, en toewerken naar een reëel beeld van wat van de overheid verwacht mag en kan worden. Daarvoor hebben we een conceptueel kader nodig, waarmee we naar voorkomende problemen kunnen gaan kijken.Prof. Bram Klievink heeft in zijn bijdrage een flinke stap gezet in dit debat. Hij wijst op het belang van integraliteit, afstemming, en coördinatie tussen beleid en uitvoering als belangrijke richtsnoeren voor het beoordelen van effectief beleid voor logistieke innovatie. Zijn suggestie voor het ontwikkelen van adaptief beleid helpt in mijn optiek zowel de overheid als de verschillende belanghebbenden aan de kant van het bedrijfsleven om de discussie op een constructieve manier te vervolgen.prof. dr. Albert Veenstra Scientific Director TKI Dinalog Show less
A fuller understanding of drug-related violence requires good quality data. Having such data consistently up-to-date will provide benefit in policy-making and evaluation, as well as for operational... Show moreA fuller understanding of drug-related violence requires good quality data. Having such data consistently up-to-date will provide benefit in policy-making and evaluation, as well as for operational, monitoring and research purposes. For policy-makers, accurate data on drug-related violence will provide a fuller picture of the drugs trade and its societal impact — essential for planning and assessing policy responses, priority setting and resource allocation. Show less
Lips, S.R.; Molenaar, J.M.; Schuitmaker-Warnaar, T.J. 2020
Increasing continuity in Dutch maternity care is considered pivotal to improve safety and client-centeredness. Closer collaboration between the historically relatively autonomous professionals and... Show moreIncreasing continuity in Dutch maternity care is considered pivotal to improve safety and client-centeredness. Closer collaboration between the historically relatively autonomous professionals and organizations in maternity care is deemed conditional to reach this goal, both by maternity care professionals and policy makers. Governmental policy therefore strives for organizational and financial integration. One of the policy measures has been to stimulate interprofessional and interorganizational collaboration through local obstetric partnerships. This study aimed to gain insight into whether this policy measure supported professionals in reaching the policy aim of increasing integration in the maternity care system. We therefore conducted 73 semistructured interviews with maternity care professionals in the region Northwest Netherlands, from 2014 to 2016. Respondents expressed much willingness to intensify interprofessional and interorganizational collaboration and experienced obstetric partnerships as contributing to this. As such, stimulating integration through obstetric partnerships can be considered a suitable policy measure. However, collaborating within the partnerships simultaneously highlighted deep-rooted dividing structures (organizational, educational, legal, financial) in the maternity care system, especially at the systemic level. These were experienced to hinder collaboration, but difficult for the professionals to influence, as they lacked knowledge, skills, resources and mandate. A lack of clear and timely guidance and support from policy, counterbalancing these barriers, limited partnerships' potential to unify professionals and integrate their services. (C) 2020 Elsevier B.V. All rights reserved. Show less
Donati, F.; Aguilar Hernandez, G.A.; Sigüenza-Sánchez, C.P.; Koning, A. de; Dias Rodrigues, J.F.; Tukker, A. 2019
A circular economy is an industrial system that is restorative or regenerative by intention or design. During the last decade, the circular economy became an attractive paradigm to increase global... Show moreA circular economy is an industrial system that is restorative or regenerative by intention or design. During the last decade, the circular economy became an attractive paradigm to increase global welfare while minimizing the environmental impacts of economic activities. Although several studies concerning the potential benefits and drawbacks of policies that implement the new paradigm have been performed, there is currently no standardized theoretical model or software to execute such assessment. In order to fill this gap, in the present paper we show how to perform these analyses using Environmentally Extended Input-Output Analysis. We also describe a python package (pycirk) for modeling Circular Economy scenarios in the context of the Environmentally Extended Multi-Regional Input-Output database EXIOBASE V3.3, for the year 2011. We exemplify the methods and software through a what-if zero-cost case study on two circular economy strategies (Resource Efficiency and Product Lifetime Extension), four environmental pressures and two socio-economic factors. Show less
Honinx, E.; Dop, N. van; Smets, T.; Deliens, L.; Noortgate, N. van den; Froggatt, K.; ... ; PACE 2019
Many hunter-gatherer groups live on the outskirts of wider society, experiencing poor health outcomes with little access to medical care. From a development perspective, key interventions include... Show moreMany hunter-gatherer groups live on the outskirts of wider society, experiencing poor health outcomes with little access to medical care. From a development perspective, key interventions include the sedentarisation of these mobile peoples into camps nearby larger towns with sanitation infrastructure and medical care, as increased access to services is assumed to improve outcomes. However, recent research in the Agta (Philippine foragers from North-east Luzon) has demonstrated that individuals residing in more ‘developed’ communities suffer from increased morbidity and mortality. Here, using quantitative and ethnographic data on health collected between 2002 and 2014, we explore why this trend occurs by examining the relationship between key development initiatives with self-reported illness and the uptake of medical interventions with 415 Agta men, women and children. We demonstrate that health outcomes worsen as sedentarisation progresses, despite some increases in medical access. We argue this is because the development paradigm is not evidence-based, but rather stems from an ideological dislike of mobile hunter-gatherer lifestyles. Compounded by cultural insensitivity and daily discrimination, current interventions are ill-suited to the unique needs of hunter-gatherers, and thus ineffective. Based on our findings we offer future short and long-term policy suggestions which seek to reduce the Agta's vulnerability, rather than increase it. Show less
Wittendorp, S.; Bont, R. de; Bakker, E.; Roy van Zuijdewijn, J. de 2017
From the time when the problem of people travelling to areas of conflict in Syria and Iraq became a topical issue at the end of 2012, many European countries as well as the United States have taken... Show moreFrom the time when the problem of people travelling to areas of conflict in Syria and Iraq became a topical issue at the end of 2012, many European countries as well as the United States have taken measures to prevent actual or would-be travellers and to prosecute and/or monitor returnees. This report provides an overview of measures taken, and the instances in which they are being taken, focusing on "person-specific measures". The report shows that the reviewed countries generally take similar initiatives. Nonetheless, there are significant differences in terms of political organisation, powers and legal culture. In a broader sense, this report attempts to shed light on the changing toolbox states have at their disposal as they try to face up to potentially violent, internationally operating non-state actors. Show less
