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The environmental pressure associated with contemporary modes of material provisioning in advanced countries suggests the need to foster more sustainable consumption. Despite growing interest in sustainability, the Netherlands currently has few effective and legitimate measures in place that focus on the role of citizen-consumers. Existing policy styles and instruments have not reduced significantly the environmental impacts of consumption. An explanation for this inadequacy resides in the technocratic origins of environmental policymaking and the pronounced tendency to rely on the presumed rationality of producers situated on the supply side of production-consumption chains. A central issue, therefore, becomes the organization of an overt politics of sustainable consumption. We explore here possible alternatives to facilitate sustainable consumption in the Netherlands and review the policy initiatives that non-governmental organizations and the Dutch government have to date undertaken. The analysis evaluates these efforts through a theoretical framework designed to chart the development of a democratic vision of sustainable consumption.

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Cat scratch disease (CSD) is usually a benign, self-limited lymphadenitis, characterized by suppurative granulomas. It can, however, produce a wide spectrum of clinical symptoms and cytologic changes and be the source of diagnostic dilemmas. Identification of pleomorphic bacilli (PB) with silver impregnation stains aids in the diagnosis, but this has not been well documented in cytologic preparations or in cases without the classic morphologic changes. We reviewed 13 aspirations from eight patients (aged 13-36 yr) occurring over a 15 mo time period, all clinically or cytologically suspicious for CSD. Sites included: axilla (6), parotid (3), epitrochlear (1), neck (1), submental (1), and intraclavicular (1) nodes. Neoplasia was initially suspected clinically in 38% of the cases. All but two patients had cat exposure on subsequent interview. The cytologic differential included bacterial abscess and lymphoproliferative disorders in 31%. Neither granulomas nor suppurative inflammation were seen in all cases. Changes included: granulomas (77%), PMNs (62%), dispersed epithelioid histiocytes (46%), and suppurative granulomas (38%). A modified silver stain (Modified Steiner, Sigma Diagnostics, St. Louis, MO) was performed on all specimens. Silver positive organisms were seen in 69% of cases and were not limited to those preparations with suppurative granulomas. Fine-needle aspiration biopsy (FNAB) is an effective method for diagnosing CSD despite its heterogeneous appearance; and, when combined with clinical information and silver staining, may obviate the need for excision.