Niki Vermeulen

ESHRE guideline: management of women with endometriosis

STUDY QUESTION What is the optimal management of women with endometriosis based on the best available evidence in the literature? SUMMARY ANSWER Using the structured methodology of the Manual for ESHRE Guideline Development, 83 recommendations were formulated that answered the 22 key questions on optimal management of women with endometriosis. WHAT IS KNOWN ALREADY The European Society of Human Reproduction and Embryology (ESHRE) guideline for the diagnosis and treatment of endometriosis (2005) has been a reference point for best clinical care in endometriosis for years, but this guideline was in need of updating. STUDY DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to January 2012 and consensus within the guideline group on all recommendations. To ensure input from women with endometriosis, a patient representative was part of the guideline development group. In addition, patient and additional clinical input was collected during the scoping and review phase of the guideline. PARTICIPANTS/MATERIALS, SETTING, METHODS NA. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 83 recommendations on diagnosis of endometriosis and on the treatment of endometriosis-associated pain and infertility, on the management of women in whom the disease is found incidentally (without pain or infertility), on prevention of recurrence of disease and/or painful symptoms, on treatment of menopausal symptoms in patients with a history of endometriosis and on the possible association of endometriosis and malignancy. LIMITATIONS, REASONS FOR CAUTION We identified several areas in care of women with endometriosis for which robust evidence is lacking. These areas were addressed by formulating good practice points (GPP), based on the expert opinion of the guideline group members. WIDER IMPLICATIONS OF THE FINDINGS Since 32 out of the 83 recommendations for the management of women with endometriosis could not be based on high level evidence and therefore were GPP, the guideline group formulated research recommendations to guide future research with the aim of increasing the body of evidence. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the implementation of the guideline. The guideline group members did not receive payment. All guideline group members disclosed any relevant conflicts of interest (see Conflicts of interest). TRIAL REGISTRATION NUMBER NA.

Mapping the biosphere: Exploring species to understand the origin, organization and sustainability of biodiversity

The time is ripe for a comprehensive mission to explore and document Earths species. This calls for a campaign to educate and inspire the next generation of professional and citizen species explorers, investments in cyber-infrastructure and collections to meet the unique needs of the producers and consumers of taxonomic information, and the formation and coordination of a multi-institutional, international, transdisciplinary community of researchers, scholars and engineers with the shared objective of creating a comprehensive inventory of species and detailed map of the biosphere. We conclude that an ambitious goal to describe 10 million species in less than 50 years is attainable based on the strength of 250 years of progress, worldwide collections, existing experts, technological innovation and collaborative teamwork. Existing digitization projects are overcoming obstacles of the past, facilitating collaboration and mobilizing literature, data, images and specimens through cyber technologies. Charting the biosphere is enormously complex, yet necessary expertise can be found through partnerships with engineers, information scientists, sociologists, ecologists, climate scientists, conservation biologists, industrial project managers and taxon specialists, from agrostologists to zoophytologists. Benefits to society of the proposed mission would be profound, immediate and enduring, from detection of early responses of flora and fauna to climate change to opening access to evolutionary designs for solutions to countless practical problems. The impacts on the biodiversity, environmental and evolutionary sciences would be transformative, from ecosystem models calibrated in detail to comprehensive understanding of the origin and evolution of life over its 3.8 billion year history. The resultant cyber-enabled taxonomy, or cybertaxonomy, would open access to biodiversity data to developing nations, assure access to reliable data about species, and change how scientists and citizens alike access, use and think about biological diversity information.

Understanding life together: a brief history of collaboration in biology

The history of science shows a shift from single-investigator ‘little science’ to increasingly large, expensive, multinational, interdisciplinary and interdependent ‘big science’. In physics and allied fields this shift has been well documented, but the rise of collaboration in the life sciences and its effect on scientific work and knowledge has received little attention. Research in biology exhibits different historical trajectories and organisation of collaboration in field and laboratory – differences still visible in contemporary collaborations such as the Census of Marine Life and the Human Genome Project. We employ these case studies as strategic exemplars, supplemented with existing research on collaboration in biology, to expose the different motives, organisational forms and social dynamics underpinning contemporary large-scale collaborations in biology and their relations to historical patterns of collaboration in the life sciences. We find the interaction between research subject, research approach as well as research organisation influencing collaboration patterns and the work of scientists.

Inspiratory muscle training to facilitate weaning from mechanical ventilation: protocol for a systematic review

BackgroundIn intensive care, weaning is the term used for the process of withdrawal of mechanical ventilation to enable spontaneous breathing to be re-established. Inspiratory muscle weakness and deconditioning are common in patients receiving mechanical ventilation, especially that of prolonged duration. Inspiratory muscle training could limit or reverse these unhelpful sequelae and facilitate more rapid and successful weaning.MethodsThis review will involve systematic searching of five electronic databases to allow the identification of randomised trials of inspiratory muscle training in intubated and ventilated patients. From these trials, we will extract available data for a list of pre-defined outcomes, including maximal inspiratory pressure, the duration of the weaning period, and hospital length of stay. We will also meta-analyse comparable results where possible, and report a summary of the available pool of evidence.DiscussionThe data generated by this review will be the most comprehensive answer available to the question of whether inspiratory muscle training is clinically useful in intensive care. As well as informing clinicians in the intensive care setting, it will also inform healthcare managers deciding whether health professionals with skills in respiratory therapy should be made available to provide this sort of intervention. Through the publication of this protocol, readers will ultimately be able to assess whether the review was conducted according to a pre-defined plan. Researchers will be aware that the review is underway, thereby avoid duplication, and be able to use it as a basis for planning similar reviews.

From Darwin to the Census of Marine Life: Marine Biology as Big Science

With the development of the Human Genome Project, a heated debate emerged on biology becoming ‘big science’. However, biology already has a long tradition of collaboration, as natural historians were part of the first collective scientific efforts: exploring the variety of life on earth. Such mappings of life still continue today, and if field biology is gradually becoming an important subject of studies into big science, research into life in the worlds oceans is not taken into account yet. This paper therefore explores marine biology as big science, presenting the historical development of marine research towards the international ‘Census of Marine Life’ (CoML) making an inventory of life in the worlds oceans. Discussing various aspects of collaboration – including size, internationalisation, research practice, technological developments, application, and public communication – I will ask if CoML still resembles traditional collaborations to collect life. While showing both continuity and change, I will argue that marine biology is a form of natural history: a specific way of working together in biology that has transformed substantially in interaction with recent developments in the life sciences and society. As a result, the paper does not only give an overview of transformations towards large scale research in marine biology, but also shines a new light on big biology, suggesting new ways to deepen the understanding of collaboration in the life sciences by distinguishing between different ‘collective ways of knowing’.

3D bioprint me : a socioethical view of bioprinting human organs and tissues

In this article, we review the extant social science and ethical literature on three-dimensional (3D) bioprinting. 3D bioprinting has the potential to be a ‘game-changer’, printing human organs on demand, no longer necessitating the need for living or deceased human donation or animal transplantation. Although the technology is not yet at the level required to bioprint an entire organ, 3D bioprinting may have a variety of other mid-term and short-term benefits that also have positive ethical consequences, for example, creating alternatives to animal testing, filling a therapeutic need for minors and avoiding species boundary crossing. Despite a lack of current socioethical engagement with the consequences of the technology, we outline what we see as some preliminary practical, ethical and regulatory issues that need tackling. These relate to managing public expectations and the continuing reliance on technoscientific solutions to diseases that affect high-income countries. Avoiding prescribing a course of action for the way forward in terms of research agendas, we do briefly outline one possible ethical framework ‘Responsible Research Innovation’ as an oversight model should 3D bioprinting promises are ever realised. 3D bioprinting has a lot to offer in the course of time should it move beyond a conceptual therapy, but is an area that requires ethical oversight and regulation and debate, in the here and now. The purpose of this article is to begin that discussion.

Rethinking the life sciences To better serve society, biomedical research has to regain its trust and get organized to tackle larger projects

The life sciences are at loggerheads with society and neither much trusts the other. To unleash the full potential of molecular life science, a new contract with society and more organized ways of doing research are needed.

Bio-objects and generative relations.

Working Group 3 of the COST Action IS1001 examines bio-objects and their generative relations. This group and its work seek to transcend disciplinary boundaries in humanities, social sciences, and life science and mingle with policy research as well. It also aims to envelop and synthesize various strands of research by taking life science and its relations as subject matter while crossing borders between research settings. One of the key reasons for this networked collaborative approach of Working Group 3 is the scale and nature of previous efforts investigating the development of the life sciences. Researchers in humanities and social sciences, regardless of their collaboration networks, are still far from large scale collaboration when imagining the future of our collective life alongside living objects produced in the technoscientific processes of today. And while there are highly interesting current approaches to studying transformations in understandings of life, they are found among disciplines within human and social sciences that do not interact sufficiently with each other. Philosophy (of biology and bio-ethics), anthropology (of science and medical communities), sociology (of science), political science (of institutional sense-making and deliberation), and legal studies (of jurisdictions), to name but a few, have their own lives in specific epistemic communities of practice. What we do know already is that when we want to think about life – as a vitalist notion, as a biochemical process, as a mechanistic system, or as the force underlying a social system and its politics – we immediately step into a field of competing discourses, framing “life” as an object of representation, intervention, and manipulation in a myriad of ways. In parallel with these academic debates, recent advances in the biological sciences, including new medical technologies, have, however, also led to the analysis of various transformations in the process and understanding of life. These are already articulated with/in diverse bodies – corpora from the literature; organic matter and its networks of circulation; and more “stable” institutions of economic, legal, or political import – with different effects. It appears that bio-objects (1) are rich in potential to destabilize old relations and fertile enough to create new connections that cross the boundaries of academic disciplines and between social institutions. The Working Group 3 has a unique opportunity to address the challenges outlined above and has a two-part main objective: 1) tracking new experimental relations that bio-objects bring about by 2) weaving relations among scholars otherwise unconnected to each other. Accordingly, the group not only investigates the relations that new objects of living and life are capable of generating but also attempts, with a more reflexive attitude, to become more experimental in its ways of working to address the challenges posed by bio-objects (Box 1). Box 1 Our work is characterized by three dimensions in the forming of new relations in the study of bio-objects 1. Global networks: The group attempts to go beyond single case studies in specific national contexts, by developing coherent international comparative frameworks built around the concept of the bio-object. We specifically aim to ground our international comparative framework in detailed local empirical work in which matters of life and living together play an important role. Consider this a call for collaborative research. 2. Common ground: By using the concept of bio-objects as a call for collaboration and, thereby, as a network-generating device, in our studies we explicitly focus on a wide range of experimental relations that are empirically traceable in different contexts. These include material, scientific, social, cultural, economic, and political relations embedded in processes by which bio-objects are becoming a central part of the relations that go into the everyday politics of living together in the 21st century. 3. Informative function: In line with the two dimensions outlined above, we also deliberately aim to cross the borders of the academic community, making our bio-object work relevant for policymaking. This may not always occur through normative modes of operation, but the group shall explore questions of policy in a more neutral, explorative tone. This comes about through provision of EU-wide coverage of bio-objects and their central role as a generative force behind much of today’s vital politics.

To make progress we must remember and learn from the past

The UK Higher Education Academy’s 2009 report ‘Developing undergraduate research and inquiry’ (see go.nature.com/WtYWpk) encourages greater student participation in departmental research. This is a welcome cultural shift from the traditional route of studying published research papers and undertaking research projects in separate undergraduate modules. It could also provide an ideal opportunity for mainstreaming interdisciplinary research in undergraduate science education. This would mean going beyond the occasional, often experimental, crossdepartmental module. Most undergraduate science courses can be designed and delivered so that subject-based theories are taught alongside research results arising from their interdisciplinary applications. Courses aimed at developing key research skills, such as literature review and communication, would be all the more useful if they embraced interdisciplinary research content. Students engage in the research process by tackling research problems based on published papers. The importance of interdisciplinary research through analysis and critical comparison of original published work cannot be overstated, given the predominant use of subjectbased textbooks in today’s undergraduate science education. To make progress we must remember and learn from the past

The choreography of a new research field: Aggregation, circulation and oscillation

This paper analyses how a group of researchers from different disciplines has been able to form creative collaborative spaces to model life together. Making mathematical models of life is a new way of creating biological knowledge – called systems biology – that ultimately aims to revolutionise medicine, by making it more effective through personalisation. By conceptualizing this interdisciplinary effort to create a new research field as a Scientific/Intellectual Movement, I analyse the entanglement of epistemic and social transformations, discussing how systems biology moved from the periphery towards the center of biology. Thereby, I am turning the focus on the spatial dimensions of Scientific/Intellectual Movements. More specifically, I introduce a topological approach detailing three interrelated spatial movements: aggregation, circulation and oscillation that together constitute the choreography of systems biology. They show how some strong, dispersed, local centers have effectively raised funds to build human capacity, organisations and infrastructures, while creating international networks. Through interaction with science policy makers, a global circulation of policies took place, stimulating the building of collaborative centers for systems biology, while the ending of funding programmes is now causing fragmentation again. As such, this paper argues that the choreography of systems biology as a Scientific/Intellectual Movement exemplifies how spatial (re-)configurations are fundamental to transformations in the knowledge landscape and the institutionalization of creativity.