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The bankruptcy of tailor-made education. The need for pedagogic (work)places Education, youth work and youth care confront many challenges which are interpreted in many different ways and receive various responses. However, one type of response seems to be widely applauded: education and care should be tailor-made or become so: tailored to children and youngsters, to their talents and their lifeworld. This call for tailor-made education and care is often accompanied by an emphasis on the need for the development of talents and on the value of feeling-well. In this contribution we indicate how this response entails an approach to education as form of socialization. I.e. as practices that assist the (re-)production of a particular societal regime which calls upon us to conceive of ourselves as entrepreneurs and to permanently take care of our profile. The experience of a meaningful life risks thereby to become exclusively dependent on social recognition and comparison. In so doing tailor-made education risks to deny youngsters the chance for a pedagogical workplace i.e. a place where the world is presented and disclosed to them in such a way that it can provide them with a measure outside of themselves and allows them an experience of a meaningful life in relation to the work which is taking place there. ispartof: Pedagogiek vol:39 issue:3 pages:349-366 status: published

OBJECTIVE:: To compare if watchful waiting is noninferior to elective repair in men aged 50 years and older with mildly symptomatic or asymptomatic inguinal hernia. BACKGROUND:: The role of watchful waiting in older male patients with mildly symptomatic or asymptomatic inguinal hernia is still not well-established. METHODS:: In this noninferiority trial, we randomly assigned men aged 50 years and older with mildly symptomatic or asymptomatic inguinal hernia to either elective inguinal hernia repair or watchful waiting. Primary endpoint was the mean difference in a 4-point pain/discomfort score at 24 months of follow-up. Using a 0.20-point difference as a clinically relevant margin, it was hypothesized that watchful waiting was noninferior to elective repair. Secondary endpoints included quality of life, event-free survival, and crossover rates. RESULTS:: Between January 2006 and August 2012, 528 patients were enrolled, of whom 496 met the inclusion criteria: 234 were assigned to elective repair and 262 to watchful waiting. The mean pain/discomfort score at 24 months was 0.35 [95% confidence interval (CI) 0.28–0.41)] in the elective repair group and 0.58 (95% CI 0.52–0.64) in the watchful waiting group. The difference of these means (MD) was −0.23 (95% CI −0.32 to −0.14). In the watchful waiting group, 93 patients (35·4%) eventually underwent elective surgery and 6 patients (2·3%) received emergent surgery for strangulation/incarceration. Postoperative complication rates and recurrence rates in these 99 operated individuals were comparable with individuals originally assigned to the elective repair group (8.1% vs 15.0%; P = 0.106, 7.1% vs 8.9%; P = 0.668, respectively). CONCLUSIONS:: Our data could not rule out a relevant difference in favor of elective repair with regard to the primary endpoint. Nevertheless, in view of all other findings, we feel that our results justify watchful waiting as a reasonable alternative compared with surgery in men aged 50 years and older.

Background: Both mesh and suture repair are used for the treatment of umbilical hernias, but for smaller umbilical hernias (diameter 1–4 cm) there is little evidence whether mesh repair would be beneficial. In this study we aimed to investigate whether use of a mesh was better in reducing recurrence compared with suture repair for smaller umbilical hernias. Methods: We did a randomised, double-blind, controlled multicentre trial in 12 hospitals (nine in the Netherlands, two in Germany, and one in Italy). Eligible participants were adults aged at least 18 years with a primary umbilical hernia of diameter 1–4 cm, and were randomly assigned (1:1) intraoperatively to either suture repair or mesh repair. In the first 3 years of the inclusion period, blocked randomisation (of non-specified size) was achieved by an envelope randomisation system; after this time computer-generated randomisation was introduced. Patients, investigators, and analysts were masked to the allocated treatment, and participants were stratified by hernia size (1–2 cm and >2–4 cm). At study initiation, all surgeons were invited to training sessions to ensure they used the same standardised techniques for suture repair or mesh repair. Patients underwent physical examinations at 2 weeks, and 3, 12, and 24–30 months after the operation. The primary outcome was the rate of recurrences of the umbilical hernia after 24 months assessed in the modified intention-to-treat population by physical examination and, in case of any doubt, abdominal ultrasound. This trial is registered with ClinicalTrials.gov, number NCT00789230. Findings: Between June 21, 2006, and April 16, 2014, we randomly assigned 300 patients, 150 to mesh repair and 150 to suture repair. The median follow-up was 25·1 months (IQR 15·5–33·4). After a maximum follow-up of 30 months, there were fewer recurrences in the mesh group than in the suture group (six [4%] in 146 patients vs 17 [12%] in 138 patients; 2-year actuarial estimates of recurrence 3·6% [95% CI 1·4–9·4] vs 11·4% (6·8–18·9); p=0·01, hazard ratio 0·31, 95% CI 0·12–0·80, corresponding to a number needed to treat of 12·8). The most common postoperative complications were seroma (one [

In the age of web 2.0, the university is constantly challenged to re-adapt its ‘old-fashioned’ pedagogies to the new possibilities opened up by digital technologies. This article proposes a rethink...

There are no clear guidelines when an additional CT scan should be obtained for the treatment of displaced intra-articular distal radius fractures (DRF). This study aimed to investigate whether surgeons can predict the usefulness of CT scans to facilitate choice of treatment plan and/or pre-operative planning for DRF. Four surgeons evaluated 51 patients with displaced DRF. The choice of treatment (operative or nonoperative) was based on conventional radiographs. Subsequently, the surgeons were asked whether they would have requested an additional CT scan to determine this treatment choice, and also whether they required a CT scan for pre-operative planning. After 4 weeks, the additional CT scan was provided and the cases were assessed again. Based on these data, we calculated the number needed to scan (NNS) and number needed to harm (NNH) for two decision models. Model 1: Only provide a CT scan if the surgeon requested one based on their judgment of the X-rays. Model 2: CT scans for all displaced intra-articular DRF. For choice of treatment, the NNS was lower for model 1 than for model 2 (2.6 vs. 4.3) and the NNH is higher for model 1 (3.1 vs. 1.3). For pre-operative planning, the NNS (1.3 vs. 1.4) and NNH (3.7 vs. 3.4) were comparable for both models. Surgeons are able to predict the usefulness of an additional CT scan for intra-articular displaced DRF for OR indication. However, for pre-operative planning the usefulness of a CT scan is much harder to predict.

Background and purpose — The reliability of conventional radiography when classifying distal radius fractures (DRF) is fair to moderate. We investigated whether reliability increases when additional computed tomography scans (CT) are used. Patients and methods — In this prospective study, we performed pre- and postreduction posterior–anterior and lateral radiographs of 51 patients presenting with a displaced DRF. The case was included when there was a (questionable) indication for surgical treatment and an additional CT was conducted within 5 days. 4 observers assessed the cases using the Frykman, Fernández, Universal, and AO classification systems. The first 2 assessments were performed using conventional radiography alone; the following 2 assessments were performed with an additional CT. We used the intraclass correlation coefficient (ICC) to evaluate reliability. The CT was used as a reference standard to determine the accuracy. Results — The intraobserver ICC for conventional radiography alone versus radiography and an additional CT was: Frykman 0.57 vs. 0.51; Fernández 0.53 vs. 0.66; Universal 0.57 vs. 0.64; AO 0.59 vs. 0.71. The interobserver ICC was: Frykman: 0.45 vs. 0.28; Fernández: 0.38 vs. 0.44; Universal: 0.32 vs. 0.43; AO: 0.46 vs. 0.40. Interpretation — The intraobserver reliability of the classification systems was fair but improved when an additional CT was used, except for the Frykman classification. The interobserver reliability ranged from poor to fair and did not improve when using an additional CT. Additional CT scanning has implications for the accuracy of scoring the fracture types, especially for simple fracture types.

This paper discusses the constructivist, negotiated perspective to INGO accountability. According to this perspective, INGO accountability is a process of mutual negotiations between different INGO stakeholders who hold different accountability demands. Acknowledging that this perspective provides a good starting point for a better understanding of INGO accountability, we comment on this conceptualization of INGO accountability. Through an analysis of accountability instruments and procedures, we examine closely how the demands of the INGO’s stakeholders are embedded in particular relationships of accountability which are sustained by particular accountability logics. From this analysis, we point out that, due to the differences that exist between these accountability logics, processes of negotiation are likely to be filled with complex tensions and trade-offs. Moreover, as some accountability logics are much clearer and more compelling than others, a constructivist perspective on INGO accountability does not automatically coincide with an understanding of INGO accountability in which primordial importance is given to the beneficiaries. ispartof: Voluntas vol:28 issue:4 pages:1529-1561 status: published

During the last years, MOOCs (massive open online courses) are part of the most discussed developments in educational technology. MOOCs swept the landscape of educational technology in no time. However, through all this enthusiasm, it is difficult to see the contribution of MOOCs to computer-based education. Even though there is a surge in MOOCs as well as in MOOC-research, it is unclear how an effective MOOC-pedagogy can be developed. What is this MOOC-phenomenon? And how can we, as educators, teachers, pedagogues, educational researchers, develop MOOC-pedagogy? In the first part of this paper, we’ll start with an overview of the MOOC-phenomenon. In the second part, we’ll discuss the implicit philosophical attitudes towards educational technology that underlies much of the MOOC-debates. We then argue that, rather than a theoretically grounded approach to educational technology, common sense attitudes of essentialism and instrumentalism prevail. In the last part of the paper, we suggest to concentrate on the educational design of technology and on the development of practices of study necessary to deal with technology, in order to develop a meaningful educational practice.

Introduction: Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. Methods: An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group’s first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as “strong” (recommendations) or “weak” (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term “should” refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. Results and summary: The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with “watchful waiting” since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon’s expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10–12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation “Hernia Center”. From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. Conclusions: The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.

Objectives Current studies on the additional benefit of using computed tomography (CT) in order to evaluate the surgeons’ agreement on treatment plans for fracture are inconsistent. This inconsistency can be explained by a methodological phenomenon called ‘spectrum bias’, defined as the bias inherent when investigators choose a population lacking therapeutic uncertainty for evaluation. The aim of the study is to determine the influence of spectrum bias on the intra-observer agreement of treatment plans for fractures of the distal radius. Methods Four surgeons evaluated 51 patients with displaced fractures of the distal radius at four time points: T1 and T2: conventional radiographs; T3 and T4: radiographs and additional CT scan (radiograph and CT). Choice of treatment plan (operative or non-operative) and therapeutic certainty (five-point scale: very uncertain to very certain) were rated. To determine the influence of spectrum bias, the intra-observer agreement was analysed, using Kappa statistics, for each degree of therapeutic certainty. Results In cases with high therapeutic certainty, intra-observer agreement based on radiograph was almost perfect (0.86 to 0.90), but decreased to moderate based on a radiograph and CT (0.47 to 0.60). In cases with high therapeutic uncertainty, intra-observer agreement was slight at best (-0.12 to 0.19), but increased to moderate based on the radiograph and CT (0.56 to 0.57). Conclusion Spectrum bias influenced the outcome of this agreement study on treatment plans. An additional CT scan improves the intra-observer agreement on treatment plans for a fracture of the distal radius only when there is therapeutic uncertainty. Reporting and analysing intra-observer agreement based on the surgeon’s level of certainty is an appropriate method to minimise spectrum bias. Cite this article: Bone Joint Res 2015;4:190–194.

There is a substantial burden of disease in countries where the majority of the world’s groin hernia patients live. Although herniorrhaphy is one of the most commonly performed surgeries in undeserved areas, needs exceed capacity. This surgical “under-production” over time results in high hernia prevalence in populations. This in turn results in a high proportion of emergency surgery and significant morbidity and mortality. This, despite the fact that groin hernia repair is highly cost effective.

Over the last two decades, a sense of awareness has arisen that universities are facing important challenges. This article focusses on the challenge that could be broadly termed as ‘the digitization of academic work’, yet without assuming that this digitization would be an explanatory factor clarifying the precise nature of contemporary academic work. On the contrary, and adopting a relational actor-network theory (ANT) approach, this contribution stresses the concrete composition of academic work without making any general presumptions regarding how the university is looking like nowadays. Furthermore, by introducing a specific interview technique as methodological approach and different visualizations as (qualitative) analytical approach, this article offers a threefold exploratory textual and visual analysis of academic practice in the making. First, the constitution of an academic practice is discussed, showing the prevalence of multifarious human and non-human actors, and how each of these actors is embedded in a network of interactions with other actors. Second, we show how academic practice is distributed into different regions of interacting actors. Third, the association of these different regions is analyzed with special attention for boundary actors (between different regions) and digital actors. The article concludes, firstly, that it makes not much sense anymore to talk about academic practice in terms of humans or non-humans, material or digital, etc. Instead, perhaps it makes more sense to speak of actors in academic practice as being humandigital. Secondly, the article concludes that sociomaterial approaches might constitute a fruitful addition to more traditional research about the university that is inclined to focus on epochal changes that are suggested or expected to alter the position of academics and the university. ispartof: European Educational Research Journal vol:13 issue:1 pages:89-106 status: published

In current literature on the university it is generally accepted that processes of digitization play an important role regarding both the daily functioning of the university as an institution and the academics that give shape to it. This article contributes to our understanding of the role that digitization plays in contemporary academic practices and does this by adopting a relational theoretical framework informed by sociomaterial studies. Furthermore, the article introduces a specific interview technique as methodological approach and makes use of topological visualizations in order to qualitatively analyze the composition of academic work in digital times. As such, combining textual and visual analysis, the article should be conceived as an explorative atlas. The atlas gives an account of how daily academic practices are relationally composed, which sorts of spatiotemporal constellations are enacted in these practices and how the digital is enacted in these practices. Based on three profiles of academic practices, this atlas concludes by exploring whether contemporary academic practices are characterized by a typical mode of existence, and gives some pointers as to how this mode of existence of the university is typically enacted nowadays. ispartof: Open Review of Educational Research vol:1 issue:1 pages:116-143 status: published

The ongoing development of mobile devices like cell phones, iPods, PDAs, and so on is seen by an increasing number of educationalists as a chance to focus on a new kind of learning. This mobile learning, as it is called, should enable students to learn while on the move. Rather than giving a genealogy of the use of mobile equipment in education, this article tries to add understanding to the processes that made possible the emergence of this new research domain. In doing this, the authors use one specific theoretical approach, actor-network theory, which will lead to a profound elaboration of the processes involved in new, emerging research fields. ispartof: E-Learning and Digital Media vol:8 issue:1 pages:8-18 status: published

With the growth of the European Union – both in terms of its size and in terms of its influence and importance – questions have emerged about the relationship between the European Union and the inhabitants of its member states. These questions are increasingly being framed in relation to the idea of citizenship. The issue here is not only whether such a thing as European citizenship can exist. The issue is also what we should understand by European citizenship and, in relation to this, how European citizenship can be promoted and advanced. These questions are first of all considered to be important in relation to the democratic legitimacy of the European Union on the assumption that the legitimacy of democratic governance crucially depends on the extent to which it is supported and ‘owned’ by its citizens. But they are also considered to be important in relation to wider questions about social cohesion and integration and the emergence of something like a sense of a European identity. Whereas many opportunities for civic participation and identification are located at national and sub-national levels, there is at least one area where over the past decade something with a more European identity has been emerging. This is the field of higher education.[1] While compulsory education and, to a slightly lesser extent, vocational education have largely remained tied to national priorities, agendas and policies, the field of higher education is rapidly evolving into a sector which transcends national borders and agendas. Although the economic imperative is central in the policies that drive these developments, particularly in relation to the ambition of the European Community to become ‘the most competitive and dynamic knowledge-based economy in the world with more and better jobs and greater social cohesion’ (Lisbon European Council, 2000), policy makers are clearly aware of the wider potential of universities in relation to questions of social cohesion and European citizenship (see, for example, European Commission, 2003, 2006). This is also what has been emphasised by the European universities themselves, who have stressed that their role encompasses more than just the creation of the next generation of workers for the knowledge economy, but includes a responsibility for cultural, social and civic development at national and European level (see, for example, European University Association, 2003). There are indeed good reasons for focusing on the higher education sector in relation to questions about European citizenship. One reason goes back to the Humboldtian tradition, which has always given the university a special role in the development of the democratic nation-state, a line of thinking which is now extended to the European level. This line of thought traditionally stresses the unique role of ‘academic’ education, that is, the edifying potential of research-based education in institutions for higher education. A second reason for a focus on higher education has

This article presents and discusses the results of a literature review that was conducted in order to understand ambivalences observed in reflections on the research–teaching nexus. As a result of this literature review, it is possible to attribute these ambivalences to the mixed use of two approaches: on the one hand, a functional approach that regards research as a tool in the learning environment in order to develop competencies that are functional for the knowledge society, and, on the other hand, an idealistic approach that regards research as a process of edification and understands academic education as participation in research. This article examines these two approaches and discusses the critical issues that have to be taken into account in order to deal with the ambivalences.

The aim of this article is to argue that the evident exchange of information on performance (and its supply, demand and use) should be regarded as a symptom of a new governmental regime that installs less evident power relations. Educational policy in Flanders (Belgium), and in particular the need for feedback information from the Flemish government, will be used as a case to describe this regime. Based upon the analytical framework of ‘governmentality’ (Foucault), the article focuses on the ‘governmentalization’ of Europe and Flanders that accompanies the need for feedback information. The main result of the analysis of European and Flemish policy documents can be summarized as follows: government or the ‘conduct of conduct’ currently takes the form of ‘feedback on performance’. This means that the strategy of the governmental regime is to secure an optimal performance for each and all (member states, schools), and acts upon the ‘need for feedback’ and ‘will to learn’ of the actors involved. On the basis...

Background Inguinal hernias are a common entity with nearly 31,000 repairs annually in The Netherlands and over 800,000 in the USA. The aim of the present study is to determine whether a laparoscopically diagnosed patent processus vaginalis (PPV) is a risk factor for the development of groin hernia. Methods The study population was originally composed of 599 consecutive cases (189 male, 32%) of laparoscopic transperitoneal surgery for different indications performed in 4 teaching hospitals in The Netherlands between November 1998 and February 2002. During laparoscopy, the deep inguinal ring was inspected bilaterally. The PPV group was compared with the obliterative processus vaginalis (OPV) group. Results After a mean follow-up of 5.5 years, the studied population consisted of 337 cases (94 male, 28%). In this study 12% of the studied population appeared to have PPV in adult life. The percentage PPV of our study group is much higher than the percentage of hernia repairs performed in the Dutch population. A greater proportion (12%) of hernia repairs in the PPV group was found as compared with the OPV group (3%). The chance of developing an inguinal hernia within 5.3 years is four times higher in the group with PPV. No significant correlation between age and the prevalence of PPV was observed. Conclusion This study demonstrates that PPV is an etiologic factor and a risk factor for acquiring an indirect inguinal hernia in adults.

Traditionally, ‘education through research’ is understood to be a main characteristic of education at the university. In this article we will explore how ‘education through research’ is argued to be of major importance for the European knowledge society, how there is still a reference to the idea of Bildung or liberal education, and what research is presumed to be like if it is to have this edifying potential. It will be argued that the edifying potential of research is related to a normative component in the research activity and that this normative orientation and its presuppositions are problematic today. This lays the way for the exploration of alternative approaches to the edifying potential of research (with reference especially to Jurgen Mittelstrass and Jacques Derrida) and for the discussion of what could be at stake for ‘education through research’.

The ‘European Space of Higher Education’ could be mapped as an infrastructure for entrepreneurship and a place where the distinction between the social and the economic becomes obsolete. Using Foucault's understanding of biopolitics and discussing the analyses of Agamben and Negri/Hardt it is argued that the actual governmental configuration, i.e. the economisation of the social, also has a biopolitical dimension. Focusing on the intersection between a politicisation and economisation of human life allows us to discuss a kind of ‘bio‐economisation’ (cf. Brockling), a regime of economic terror and learning as investment. Finally it is argued how fostering learning, i.e. fostering life (as a learning process) could turn into ‘let die’ and even into ‘make die’.

This article explores the so-called studies of governmentality that address the field of education policy at the level of the enacted modes of government and self-government. Governmentality is a neologism introduced by Michel Foucault and refers to a perspective on the assembly of particular rationalities and forms of thought (‘mentalities’) with specific technologies and strategies to govern. ‘To govern’ is to be understood in a very broad sense: the structuring, guiding or shaping of people’s behaviour in very different contexts and in very different areas. Except for a specific approach of educational policy, the point of departure of studies of governmentality is a particular concern for the present and for how we live the present. The article reports on a research project that focuses on a particular region of what is considered to be important in ‘our’ present education: the collection and distribution of feedback information. By taking this case as a point of departure, the article discusses what is at stake in a so-called ontology of the present, the exact focus of an ‘interpretative analytics’ and the critical ambitions of studies of governmentality.

Objective: To assess the value of a written questionnaire in the follow-up of patients after inguinal hernia repair. Design: Prospective study. Setting: University and two district hospitals, The Netherlands. Subjects: 314 patients with 362 inguinal hernias. Main outcome measures: Correlation between answers to questionnaire and clinical examination in the diagnosis of recurrent hernias. Results: 13/24 recurrences (54%) after a mean follow-up of 33 months with a follow-up rate of 93% were not diagnosed by the questionnaire. Conclusion: Follow-up after hernia repair must be by physical examination. Copyright © 1998 Taylor and Francis Ltd.

We will focus on the recent concern — and even ‘obsession’ — with quality in education from the perspective of changes in how we are governed and governing ourselves. Therefore, we will explore advanced liberalism as a form of ‘governmentality’ and point out that (political) government has to submit itself to a ‘permanent economic tribunal’, i.e. judge everything constantly by the principles of entrepreneurship and competition. Furthermore, not only political government, but foremost self-government should be understood in relation to the tribunal: free people objectify within them skills and competencies, which are valuable in a (market) environment. Moreover we argue that management rationality and technology try to establish a double bond within the organization by regarding the worker as an enterprising self. Having pointed out the relationship between entrepreneurship and (self-)management, it is possible to describe how quality becomes a permanent obsession to those managing their life or an organization as an enterprise. After describing management and quality (and their relation) as a ‘function’ of entrepreneurship it is possible to understand how learning is part of it, and how quality management and schooling become entwined at all levels.

The article starts from the questions: what is it to be an inhabitant or citizen of a globalised world, and how are we to think of education in relation to such inhabitants? We examine more specifically the so–called ‘European area of higher education’ that is on the way to being established and that can be regarded as a concrete example of a process of globalisation. In the first part of the paper we try to show that the discursive horizon, and the concrete techniques and strategies that accompany the establishment of this space of higher education, invite the inhabitants of that space to see themselves as entrepreneurial and autonomous entities. In the second part we show how this specific kind of subjectivation (this production of subjects), related as it is to this globalised space, involves what we call an immunisation that also affects our thinking and our ideas in and about education. To refer to this as a kind of immunisation implies that globalisation could in fact be considered a closing or enclosing rather than an opening up. We argue, therefore, that this immunisation needs to be refused in favour of the invention of other kinds of subjectivity, other ways of speaking and writing about the world and about education, such that we relate to ourselves in a different way.

In this article, the focus is on educational governing in the making. Drawing on conceptual underpinnings of socio-technical approaches, this implies an interest both on the way in which a sound knowledge base for policy measures is created, as on the distribution of that knowledge through publically available instruments. Governing by evidence only is possible when it relies on concrete instruments, such as feedback reports, publically consultable audits and examples of good practice. Since knowledge-related practices increasingly make use of online tools where knowledge is accessible for each and all, three websites are analysed in a particular way to describe the making of evidence. First, considered as active devices, the websites are analysed as essential components of the governing by evidence: by publishing specific data and information in a particular way, they come to constitute what comes to count as evidence and the way in which it comes to count. By addressing their visitors in a particular way, moreover, they constitute for whom it comes to count as evidence. As such, we argue, it becomes visible that digital spaces of evidence actually make schools real, and, at once, that there are different modes for schools to exist. peerreview_statement: The publishing and review policy for this title is described in its Aims & Scope. aims_and_scope_url: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=tedp20 ispartof: Journal of Education Policy vol:29 issue:5 pages:617-639 status: published

The ascendancy of neoliberal modes of governing has caused a shift in accountability practices in the public sector, including in the field of education. This shift can be observed in the accountability regimes introduced into education systems around the world. They reflect a strong focus on quality assurance/control and efficiency in order for countries to be able to survive in a global competitive environment. Increasingly operating in a global context, Ecuador also engaged in a series of policy initiatives to restructure accountability in its educational system. Based on a critical analysis of recent accountability policies in Ecuadorian education, this article determines the regime ofaccountability that is promoted in Ecuador today and discusses the emerging tensions ispartof: Policy Futures in Education vol:11 issue:1 pages:1-12 status: published

Background Annually approximately 100.000 patients undergo a laparotomy in the Netherlands. About 15,000 of these patients will develop an incisional hernia. Both open and laparoscopic surgical repair have been proven to be safe. However, the most effective treatment of incisional hernias remains unclear. This study, the ‘INCH-trial’, comparing cost-effectiveness of open and laparoscopic incisional hernia repair, is therefore needed. Methods/Design A randomized multi-center clinical trial comparing cost-effectiveness of open and laparoscopic repair of incisional hernias. Patients with a symptomatic incisional hernia, eligible for laparoscopic and open incisional hernia repair. Only surgeons, experienced in both open and laparoscopic incisional hernia repair, will participate in the INCH trial. During incisional hernia repair, a mesh is placed under or on top of the fascia, with a minimal overlap of 5 cm. Primary endpoint is length of hospital stay after an incisional hernia repair. Secondary endpoints are time to full recovery within three months after index surgery, post-operative complications, recurrences, mortality and quality of life. Our hypothesis is that laparoscopic incisional hernia repair comes with a significant shorter hospital stay compared to open incisional hernia repair. A difference of two days is considered significant. One-hunderd-and-thirty-five patients are enrolled in each treatment arm. The economic evaluation will be performed from a societal perspective. Primary outcomes are costs per patient related to time-to-recovery and quality of life. The main goal of the trial is to establish whether laparoscopic incisional hernia repair is superior to conventional open incisional hernia repair in terms of cost-effectiveness. This is measured through length of hospital stay and quality of life. Secondary endpoints are re-operation rate due to post-operative complications or recurrences, mortality and quality of life. Discussion The difference in time to full recovery between the two treatment strategies is thought to be in favor of laparoscopic incisional hernia repair. Laparoscopic incisional hernia repair is therefore expected to be a more cost-effective approach. Trial registration Netherlands Trial register: NTR2808

Nowadays, the cell phone is omnipresent in our society, certainly amongst youngsters. Its presence, and the possibility to be in constant touch, have some profound consequences on our experience (of our selves, of others and the world) and self-understanding. It is important for educators and scholars in the field of education to understand such consequences and develop an awareness of how students relate to the world they inhabit. Starting from the observation that people often want to know the position of the party they call, this explorative study reports on an analysis of text messages of 10 participants and tries to couple this and related questions heuristically to an environmental self-understanding, wherein a particular environmental kind of positioning becomes a major need and/or obsession. Results point to a particular potential dealing with the present and the future. ispartof: International Journal of Qualitative Studies in Education vol:25 issue:6 pages:705-722 status: published

The feature films of the Belgian directors the Dardenne brothers are one of the most lauded bodies of work in contemporary world cinema (They have twice won the Palme d’Or at the Cannes Film Festival). Their films can be seen as educational cinema in a number of ways. On one hand, they investigate in an intriguing way the contemporary reality of education and, more particularly, the actual relationship between adolescents and adults. Their films can be seen as empirical philosophical studies that ask questions of essential educational situations and matters: What does it mean to be a child, an adult, a father, a son, a mother, a daughter, a teacher, a schoolmaster, a pupil? What does it mean, not in general, but in the concrete (and sometimes extreme) situations and conditions that society presents today? (See Masschelein 2011, in press).

With a view to meeting the demands of the knowledge economy and taking up a leading role in its further development, Europe and its member states are urging universities and institutions for higher education more generally to innovate and modernise themselves. Organisational structures, governance and management systems, curricula and teaching methods, and funding and incentives mechanisms are no longer considered to be adequate to guarantee that European universities can keep up with global competition in education, research and innovation. Innovation and modernisation are also considered to be necessary with regard to the public (i.e. social, cultural and political) role of universities. Today’s knowledge-intensive economies and societies are regarded as in need of up-to-date policies on equal opportunities, participation and access, and of strategies for knowledge-driven local and regional economic, social and cultural development. In addition to this and based on a concern about European citizenship, democratic involvement and social cohesion, there is a requirement for the development of curricula, extra-curricular activities and participation structures that offer students opportunities to develop civic competencies.

A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable., Comparative Study, Consensus Development Conference, Journal Article, Review, SCOPUS: ar.j, info:eu-repo/semantics/published

Although universities are asked to play a role in the European knowledge society, the precise scope and meaning of this role is still under discussion. A major issue in this debate is the trend to adapt universities to economic needs and demands of society. In view of taking a critical stance against a one-sided economic interpretation of activities and functions of universities, their so-called “public” role is increasingly stressed in the debate as a crucial responsibility of universities that should not be marginalized and therefore deserves our attention. In this paper, which is the introduction to a special issue on the public role of the university, we want to stress the importance of addressing the question of “the role of universities in the Europe of knowledge” in an open way and thus, without prejudices against or in favour of possible answers. It is our contention that a critical view of what is happening in universities today cannot simply rely on authoritative ideas or principles that are vaguely reminiscent of our university traditions. Consequently, this introductory paper pleas for a firmer argumentative and a richer empirical basis that takes account of the fact that our background (horizon) has thoroughly changed in comparison to traditions that still implicitly inform our judgement of what universities can do, should do or should not do. Finally, we will discuss the way in which the articles collected in this issue are intended stimulating and supporting the debate on the public role of the university in Europe.

In the Netherlands, approximately 30,000 inguinal hernia repairs are performed yearly. At least 15% are for recurrence. New procedures are being introduced creating discussion on which technique is the best. Currently it is not possible to choose on evidence alone because of the long follow-up that is needed. In 1996 an inventory was taken of all inguinal hernia repairs that were performed in the Amsterdam region (9 hospitals). These results were compared with the results from a similar study performed in 1994. Major changes in treatment strategy were noted. The Bassini repair was replaced by Shouldice and Lichtenstein techniques. There was a significant increase in the use of prostheses for both primary and recurrent inguinal hernias. There was no significant decrease in the percentage of operations performed for recurrent hernia from 19.5% to 16.8%. However, there was a significant decrease in operations performed for early recurrences (5.1%-3.4%) (p = 0.05). These results suggest that the Shouldice and Lichtenstein repairs may be superior to the Bassini repair in terms of early hernia recurrence.

The Shouldice technique for inguinal hernia repair has been suggested by some authors as the best conventional method against which other methods using prostheses should be compared. The paper which follows is a systematic review involving a comprehensive search of the medical literature to identify all clinical trials (article or abstract) evaluating the Shouldice repair. After assessment of certain quality criteria, the best studies were pooled in a meta-analysis. Nine publications were found with 11 study arms. In ten studies the results of the Shouldice technique were better than the results of the control arm. Six studies could be pooled in a meta-analysis of 2500 patients; Shouldice was significantly better than control methods (relative risk 0·62 (95 per cent confidence interval 0·45–0·85)). In spite of possible bias caused by different variables (modifications in operative technique, suture material, level of surgeon, follow-up methods and outcome measurement), the results of this systematic review suggest that the Shouldice method is the best current conventional technique for inguinal hernia repair.