The 2017 elections across Europe: facts, expectations and consequences. European democracy: baptism by vote or by fire? EPC Discussion Paper, 14 March 2017

In the upcoming weeks and months national elections will be held in four founding member states of the EU: the Netherlands, France, Germany and Italy. With radical, anti-establishment forces on the (far) left or (far) right side of the political spectrum riding the gusty populist headwinds across Europe (and beyond), many fear that the results will mirror earlier electoral upheavals such as Brexit and the election of Trump, raising the stakes of the votes for each national context, as well as for the EU as a whole. This Discussion Paper takes a closer look at the upcoming elections in all four countries, presenting the domestic political dynamics at play, assessing various possible governing coalitions in the aftermath of the vote and considering the potential implications of the different likely outcomes for national policymaking and European affairs. Although populists have a public mood of discontent on their side, mainstream politicians might be able to buy themselves some time, not least because Europeans seem currently hesitant about voting anti-establishment parties into office and risk adding to the geo-political and economic uncertainties prompted by the new US administration and the UK’s decision to leave the Union. However, without foresight and a persuasive narrative on why European integration continues to be a ‘win-win’ exercise for the member states and their citizens, mainstream politicians are also recklessly flirting with potential disaster looming in the future

Current training on the basics of robotic surgery in the Netherlands: Time for a multidisciplinary approach?

Introduction: The following research questions were answered: (1) What are the training pathways followed by the current robot professionals? (2) Are there any differences between the surgical specialties in robot training and robot use? (3) What is their opinion about multidisciplinary basic skills training? Methods: An online questionnaire was sent to 91 robot professionals in The Netherlands. The questionnaire contained 21 multiple-choice questions focusing on demographics, received robot training, and their opinion on basic skills training in robotic surgery. Results: The response rate was 62 % (n = 56): 13 general surgeons, 16 gynecologists, and 27 urologists. The urologists performed significantly more robotic procedures than surgeons and gynecologists. The kind of training of all professionals varied from a training program by Intuitive Surgical, master-apprenticeship with or without duo console, fellowship, and self-designed training programs. The training did neither differ significantly among the different specialties nor the year of starting robotic surgery. Majority of respondents favor an obliged training program including an examination for the basics of robot skills training. Conclusion: Training of the current robot professionals is mostly dependent on local circumstances and the manufacturer of the robot system. Training is independent of the year of start with robotic surgery and speciality. To guarantee the quality of future training of residents and fellows in robot-assisted surgery, clear training goals should be formulated and implemented. Since this study shows that current training of different specialities does not differ, training in robotic surgery could be started by a multidisciplinary basic skills training and assessment

Learning in the European Union: Theoretical Lenses and Meta-Theory

notes: This paper is based on research carried out with the support of the European Research Council grant on Analysis of Learning in Regulatory Governance, ALREG http://centres.exeter.ac.uk/ceg/research/ALREG/index.php. The authors wish to express their gratitude to the other authors in this special edition and in particular its editor, Nikos Zaharaidis and X anonymous referees.publication-status: AcceptedThe European Union may well be a learning organization, yet there is still confusion about the nature of learning, its causal structure and the normative implications. In this article we select four perspectives that address complexity, governance, the agency-structure nexus, and how learning occurs or may be blocked by institutional features. They are transactional theory, purposeful opportunism, experimental governance, and the joint decision trap. We use the four cases to investigate how history and disciplinary traditions inform theory; the core causal arguments about learning; the normative implications of the analysis; the types of learning that are theoretically predicted; the meta-theoretical aspects and the lessons for better theories of the policy process and political scientists more generally

Diagnostic Approach for the Differentiation of the Pandemic Influenza A(H1N1)v Virus from Recent Human Influenza Viruses by Real-Time PCR

BACKGROUND: The current spread of pandemic influenza A(H1N1)v virus necessitates an intensified surveillance of influenza virus infections worldwide. So far, in many laboratories routine diagnostics were limited to generic influenza virus detection only. To provide interested laboratories with real-time PCR assays for type and subtype identification, we present a bundle of PCR assays with which any human influenza A and B virus can be easily identified, including assays for the detection of the pandemic A(H1N1)v virus. PRINCIPAL FINDINGS: The assays show optimal performance characteristics in their validation on plasmids containing the respective assay target sequences. All assays have furthermore been applied to several thousand clinical samples since 2007 (assays for seasonal influenza) and April 2009 (pandemic influenza assays), respectively, and showed excellent results also on clinical material. CONCLUSIONS: We consider the presented assays to be well suited for the detection and subtyping of circulating influenza viruses

Perceptions of surgical specialists in general surgery, orthopaedic surgery, urology and gynaecology on teaching endoscopic surgery in The Netherlands

BACKGROUND: Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands. METHODS: Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25-item questionnaire. RESULTS: A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines. CONCLUSIONS: A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training course