Suggestions to Improve the Comprehensibility of Current Definitions of Scientific Authorship for International Authors.

Much has been said about the need for improving the current definitions of scientific authorship, but an aspect that is often overlooked is how to formulate and communicate these definitions to ensure that they are comprehensible and useful for researchers, notably researchers active in international research consortia. In light of a rapid increase in international collaborations within natural sciences, this article uses authorship of this branch of sciences as an example and provides suggestions to improve the comprehensibility of the definitions of authorship in natural sciences. It assesses whether the definition of authorship provided by the European Code of Conduct for Research Integrity can deal with current issues and problems of scientific authorship. Notably, problems that are experienced in project groups with researchers coming from multiple countries. Using theories developed by Jürgen Habermas and Robert Merton, a normative framework is developed to articulate ethical authorship in natural sciences. Accordingly, enriching the current definition of authorship with normative elements and using discipline-specific metaphors to communicate them are introduced as possible ways of improving the comprehensibility of the definition of authorship in international environments. Finally, this article provides a proposal to be considered in the future revisions of the European Code of Conduct for Research Integrity.

The ventricular fibrillation waveform in relation to shock success in early vs. late phases of out-of-hospital resuscitation.

BACKGROUND: The amplitude spectrum area (AMSA) of the ventricular fibrillation (VF) waveform predicts shock success and clinical outcome after out-of-hospital cardiac arrest (OHCA). Recently, also AMSA-changes demonstrated prognostic value. Until now, most studies focused on early shocks, while many patients require prolonged resuscitations. We studied AMSA and its changes in relation to shock success, for both the early and later phase of resuscitation. METHODS: Per-shock VF-waveform analysis of a prospective OHCA-cohort (Nijmegen, The Netherlands). The absolute AMSA and relative AMSA-changes (ΔAMSA) were calculated from three-second VF-segments prior to defibrillation. Shocks were categorised as early (#1-3) or late (#4-8). Shock success was defined as return of organised rhythm. RESULTS: Shock success was 46% for early (131/286) and 52% for late shocks (85/162), p = 0.18. Early shock success varied from 23% to 70% with increasing quartiles of AMSA (p-trend<0.001). For late shocks, there also was an association with AMSA, with a narrower range in shock success from 43% to 68% (p-trend = 0.04). Higher values of ΔAMSA were associated with shock success in the early, but not in the later phase. CONCLUSION: AMSA relates to shock success during the entire resuscitation, but associations were most apparent for early shocks. AMSA-changes were also associated with shock success, but only in the early phase of resuscitation. In an era of smart defibrillators, absolute AMSA and relative changes hold promise for studies on early guidance of resuscitation, whereas additional studies are warranted to further characterize shock prediction in the later phase.

In the Beginning was the Genome: Genomics and the Bi-textuality of Human Existence.

This paper addresses the cultural impact of genomics and the Human Genome Project (HGP) on human self-understanding. Notably, it addresses the claim made by Francis Collins (director of the HGP) that the genome is the language of God and the claim made by Max Delbrück (founding father of molecular life sciences research) that Aristotle must be credited with having predicted DNA as the soul that organises bio-matter. From a continental philosophical perspective I will argue that human existence results from a dialectical interaction between two types of texts: the language of molecular biology and the language of civilisation; the language of the genome and the language of our socio-cultural, symbolic ambiance. Whereas the former ultimately builds on the alphabets of genes and nucleotides, the latter is informed by primordial texts such as the Bible and the Quran. In applied bioethics deliberations on genomics, science is easily framed as liberating and progressive, religious world-views as conservative and restrictive (Zwart 1993). This paper focusses on the broader cultural ambiance of the debate to discern how the bi-textuality of human existence is currently undergoing a transition, as not only the physiological, but also the normative dimension is being reframed in biomolecular and terabyte terms.

From playfulness and self-centredness via grand expectations to normalisation: a psychoanalytical rereading of the history of molecular genetics.

In this paper, I will reread the history of molecular genetics from a psychoanalytical angle, analysing it as a case history. Building on the developmental theories of Freud and his followers, I will distinguish four stages, namely: (1) oedipal childhood, notably the epoch of model building (1943-1953); (2) the latency period, with a focus on the development of basic skills (1953-1989); (3) adolescence, exemplified by the Human Genome Project, with its fierce conflicts, great expectations and grandiose claims (1989-2003) and (4) adulthood (2003-present) during which revolutionary research areas such as molecular biology and genomics have achieved a certain level of normalcy--have evolved into a normal science. I will indicate how a psychoanalytical assessment conducted in this manner may help us to interpret and address some of the key normative issues that have been raised with regard to molecular genetics over the years, such as 'relevance', 'responsible innovation' and 'promise management'.

National malnutrition screening days in hospitalised children in The Netherlands.

OBJECTIVE: Nationwide prevalence studies on malnutrition in hospitalised children have not been done. This study aimed to investigate the prevalence of malnutrition of all newly admitted children in The Netherlands during 3 consecutive days. DESIGN: Prospective observational study. SETTING: Paediatric wards of 44 hospitals (7 academic and 37 general). PARTICIPANTS: A total of 424 children aged > or = 30 days and hospitalised for > or = 1 day were included, 63% male, 86% non-white. Median age was 3.5 years and median hospital stay was 2 days. MAIN OUTCOME MEASURES: SD scores ,22 for weight for height and height for age were considered to indicate acute and chronic malnutrition, respectively. RESULTS: Overall 19% of the children had acute and/or chronic malnutrition at admission (academic 22% and general 17%). The proportion of children with chronic malnutrition was significantly higher in academic hospitals (14% vs 6%). Logistic regression analysis allowing for age, underlying disease, ethnicity, surgery and type of centre showed a significant relation between the presence of malnutrition at admission and underlying disease (odds ratio (OR) 2.2). For chronic malnutrition both underlying disease and non-white ethnicity were significantly related to a higher prevalence (OR 3.7 and OR 2.8, respectively). Multiple regression analysis showed that children with acute malnutrition stayed on average 45% longer (95% CI 7% to 95%) in the hospital than children without such malnutrition. CONCLUSIONS: This unique nationwide study shows that 19% of children admitted to Dutch hospitals are malnourished at admission. This high prevalence underlines the need for routine screening and treatment of malnutrition in hospitalised children.

Medicine, symbolization and the "real" body--Lacan's understanding of medical science.

Throughout the 20th century, philosophers have criticized the scientific understanding of the human body. Instead of presenting the body as a meaningful unity or Gestalt, it is regarded as a complex mechanism and described in quasi-mechanistic terms. In a phenomenological approach, a more intimate experience of the body is presented. This approach, however, is questioned by Jacques Lacan. According to Lacan, three basic possibilities of experiencing the body are to be distinguished: the symbolical (or scientific) body, the imaginary (or ideal) body and the real body. Whereas the symbolical body is increasingly objectified (and even digitalized) by medical science, the phenomenological perception amounts to an idealization of the body. The real body cannot be perceived immediately. Rather, it emerges in the folds and margins of our efforts to symbolize or idealize the body, which are bound to remain incomplete and fragile. In the first part of the article (section 1-section 3), Lacan's conceptual distinction between the symbolical, the imaginary and the real body will be explained. In the second part (section 4-section 5), this distinction will be further clarified by relying on crucial chapters in the history of anatomy (notably Mundinus, Vesalius, Da Vinci and Descartes).

The resurgence of nature-speak.

In contemporary bioethics, two vocabularies can be distinguished: person-speak and nature-speak. The first is built around the claim that a person's moral decisions are to be respected, while the other stands on the claim that moral decisions should comply with standards for human behaviour conveyed by nature. While most bioethicists have obtained a thorough mastery of person-speak, they are considerably less well-versed in nature-speak. Apparently, the latter has lost much of its former ability to capture important aspects of moral existence. In this paper I attempt to rehabilitate nature-speak from a hermeneutical perspective. I believe that the task of ethics is to enlarge our range of moral description and to rediscover neglected ways of speaking about human experience. The ethicist should enable individuals in health care settings to become more articulate about their moral experience. He should not content himself with applying those moral vocabularies which happen to be readily available, but should rather proceed by recovering forgotten vocabularies from within the philosophical tradition. Finally, one particular effort at restoring nature-speak is critically reviewed.

Kotz modular femur and tibia replacement. 28 tumor cases followed for 3 (1-8) years.

In the period 1984-1991, 33 lower limb reconstructions were performed with an uncemented Kotz modular femur tibia reconstruction (KMFTR) prosthesis after resection of 32 malignant bone tumors and 1 benign giant cell tumors. Tumor localization was proximal femur in 12, distal femur in 17, and proximal tibia in 4. The mean age of the patients was 38 years. 28 patients with a minimum follow-up of 1 year were studied after 3 (1-8) years. 7 patients were reoperated because of complications. Good or excellent results were obtained in 6 of the 10 proximal and 13 of the 14 distal femur reconstructions. In 2 of the 4 patients undergoing combined distal femur and proximal tibia resection, a deep infection developed, and above-knee amputation was performed. One local recurrence occurred after proximal femur resection.

Rationing in The Netherlands: the liberal and the communitarian perspective.

In the discussion on rationing health care in The Netherlands, a fundamental tension emerges between two ethical perspectives: liberalism and communitarianism. A Dutch government committee recently issued a report opting for a community-oriented approach. This approach proves less communitarian as compared to the views on rationing elaborated by Callahan. Moreover, the community-oriented approach is conceptualised in such a way that it seems compatible with some basic aspects of the liberal account of a just society.

Free-energy carriers in human cultured muscle cells.

Creatine phosphate (CrP), adenosine triphosphate (ATP), creatine kinase (CK), adenylate kinase (AK), protein, and DNA were quantified in human muscle cell cultures undergoing transition from dividing myoblasts to multinucleate myotubes. CrP is negligible in cultures grown in commonly applied media but increases rapidly when sufficient exogeneous creatine is available. The rise in CrP content precedes the rapid increase of CK and cessation of DNA synthesis found during cell fusion. The addition of creatine has no significant effect on the CK and protein content and on the fusion of the human muscle cells. ATP, AK, and protein increase gradually during proliferation and differentiation. When expressed per milligram of protein, ATP and AK are in the same range as in human skeletal muscle and are not correlated to the cell fusion. In contrast, CrP and CK per milligram protein are much higher in myotubes than in myoblasts but remain much lower than in muscle. These data indicate that only an early differentiation phase has been reached in the muscle cell cultures.

Uptake of triiodothyronine into cultured human muscle cells.

The uptake of T3 was measured in cultured human muscle cells at 37 degrees C and pH 7.4 in a medium containing albumin and glucose. The initial up]take increased linearly when the total T3 concentration was varied from 10(-9) to 10(-4) M. At prolonged incubation time the uptake decreased to virtually zero in about 30 min. These data indicate a rapid passive transport mechanism of T3 and a fast equilibration of the cellular T3 with the surrounding medium. In agreement with these conclusions the efflux of T3 was rapid and the initial uptake was not altered by pre-incubation in a T3-containing medium.