Implementation Between Tradition and Management: Structuration and Styles of Implementation

This article presents a diachronic perspective for implementation research. It analyzes implementation practices in relation to their changing institutional context. Therefore, a comparison is made between different styles of implementation.
The relationship between implementation practices and institutional context is analyzed as a structuration process, following Giddens's theory. Four styles of policy implementation are distinguished: a traditional, bureaucratic, professional, and managerial style. These four styles are connected with different phases in the development of the welfare state. This developmental model is illustrated with an analysis of policy implementation in Dutch public assistance between 1950 and the early 1990s.     

Cultural and economic prerequisites of democracy: Reassessing recent evidence

The purpose of this article is to reassess two influential theories of democratic development: the theory of democratic culture and the theory of economic development. The leading predecessors in each domain—Ronald Inglehart and Adam Przeworski—are the prime targets of analysis. We take issue with recent evidence presented by these authors on three grounds: the evidence (1) confuses “basic” criteria of democracy with possible “quality” criteria (Inglehart); (2) conceptualizes democracy in dichotomous rather than continuous terms (Przeworski); and (3) fails to account for endogeneity and contingent effects (Inglehart). In correcting for these shortcomings, we present striking results. In the case of democratic culture, the theory lacks support; neither overt support for democracy nor “self-expression values” affect democratic development. In the case of economic development, earlier findings must be refined. Although the largest impact of modernization is found among more democratized countries, we also find an effect among “semi-democracies.” Axel Hadenius is professor of political science at Uppsala University in Sweden. He is the author ofDemocracy and Development (Cambridge University Press, 1992) andInstitutions and Democratic Citizenship (Oxford University Press, 2001). Jan Teorell is associated professor of political science at Uppsala University. His articles on intra-party democracy, social capital, and political participation appear in international journals.     

The relevance of the detection of troponins to the forensic diagnosis of cardiac contusion

The forensic diagnosis of cardiac contusion has hitherto been based mainly on anamnesis, concomitant thoracic injuries and the detection of macroscopic changes to the heart. Parallel histological and serological investigations of the heart-specific troponins have been conducted with varying results. This paper aims to show whether heart-specific troponins are suitable as a means of securing the diagnosis in proven cases of cardiac contusion and of determining which of the three heart-specific troponins cTnT, cTnI and cTnC are most significant in serology and histology for postmortem diagnosis.In the study, 25 cases of known cardiac contusion and 11 controls without vital myocardial trauma taken from autopsy material were prospectively investigated. Investigation of the venous serum revealed significant differences in the concentrations of the case and control groups for troponin T (mean value 5.5056 versus 0.4982; p = 0.014), for troponin C (mean value 263.9280 versus 68.5640; p = 0.001) and for troponin I (mean value 1404.0560 versus 36.1650; p = 0.003). In histology there are also significantly different depletions between the groups investigated (cTnT: p = 0.002; cTnC: p = 0.003; cTnI: p < 0.001) taking into account the autolysis time.     

Birth spacing as a family strategy: evidence from 19th century Leuven, Belgium

This article investigates the hypothesis that 19th-century working class families in Leuven, Belgium, were controlling their fertility by means of birth spacing for household economic reasons. Detailed life-course data were collected in order to construct, on one hand, a set of covariates that represent the influences of natural fertility on birth intervals and, on the other, a number of family variables that represent the hypothetical, household economic motivation to space births. The findings strongly suggest that birth intervals were not merely a function of natural fertility differences and that family strategic spacing behavior also played a role.     

The influence of institutions and culture on health policies: different approaches to integrated care in England and The Netherlands

The concept of integrated care has assumed growing importance on the policy agendas both in England and The Netherlands and elsewhere. It is characterized as health and health care-related social care needed by patients with multi-faceted needs. This article compares policy approaches to integrated care in England and The Netherlands. Differing political strategies and conditions for integrated care correspond to the dissimilarities in the institutional structure and culture of their health care systems. Health care systems are understood as specific national and historical configurations. We review the last decade's relevant policy processes, using the concepts of hierarchy, market and network. The state health care system in England relies mainly on hierarchical steering, thus creating tight network structures for integrated care on the local level. The Netherlands, with its health care system in a public-private mix, has set incentives for voluntary, loosely coupled and partly market-driven cooperation on the local level. Implications for success or failure are mixed in both configurations. Policy recommendations have to be tailored to each systems' characteristics.