askscience 内の LWschool によるリンク How can any scientist ever disagree with the findings of another scientists study?

[–]arumbar 41ポイント42ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

I'll address this from the medical literature perspective, I'm sure those in the more basic/bench sciences will have their own tidbits to add.

Just because something was done 'with the scientific method' does not mean that the results are 'true'. Even with a 'perfectly designed' study, biological systems are inherently extremely complex so we end up using p-values of 0.05 commonly, such that the chance of a falsely rejected null hypothesis is still substantial (especially in light of the sheer volume of studies published). Now add in limitations of study design and there are often dozens of individual issues that can weaken a paper's conclusion.

Let's say we're looking at a randomized control trial trying to demonstrate whether drug A is better than drug B at treating disease X. Even before looking at the results, we would have to analyze their inclusion/exclusion criteria (what kinds of patients are eligible for this study?), the control/intervention arms (do the interventions make sense?), the outcomes measured (are they reasonable and/or clinically valuable measures? is the length of follow-up appropriate?), the statistical analysis (is the study adequately powered? is the statistical analysis appropriate for this type of data?), and procedural steps (how was randomization done? was the source of funding appropriately separated from the design, data acquisition, and analysis?).

So now we're past the methods section of the paper and on to the results. The first figure usually describes the patient flow within the study. We look at it to see how patients progressed through the study, whether dropout rates could skew the study, and identify any other issues with the design. The next table typically shows patient demographics and demonstrates the results of randomization. We check to see whether the study population is applicable to our clinical question, and whether randomization was successful. If there are major differences between the groups then confounding variables may be involved. We can look at the individual figures showing the primary and secondary outcomes and ask whether the way they are presented is reasonable and in-line with what the data show. Finally, when we reach the conclusions section we can disagree with how the authors interpret their results and its generalizability towards our patient practice.

Clearly this is a huge topic, with different specific issues with different types of papers (eg prognostic study vs treatment study vs risk factor study etc) and different study designs (RCT vs cohort vs case control etc), but hopefully this gives an idea for the complexity of 1) designing a good study and 2) successfully writing it up. Even if everything above was done with the best of intentions limitations such as funding, disease prevalence, patient availability, logistical resources, etc can interfere and make a study less believable. Feel free to ask any further questions and I'll try to answer them below.

askscience 内の rcko によるリンク How do doctors know which antibiotic to prescribe?

[–]arumbar 11ポイント12ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Antibiotic choice is predicated on a number of factors. Efficacy is certainly the first thing you look at - whether you have culture data showing microbe sensitivities to specific antibiotics, or just are treating empirically (eg if you suspect gram negative bacteria, you may choose an antibiotic from the aminoglycoside class). The next thing you would look at is the side effect profile. When many drugs can achieve the same primary goal of killing bacteria, you want to select one that damages the patient as little as possible. This includes things like avoiding certain classes of medicines in young children/pregnant women (tetracyclines and fluoroquinolones), not using a medicine the patient is allergic towards, avoiding nephrotoxic drugs in patients with preexisting renal impairment, watching out for possible medication interactions, etc. Finally, there is a new principle of antibiotic stewardship, where we try to use as narrow an antibiotic as possible to prevent further development of antibiotic resistance. This means that if two antibiotics are equally effective and safe, we choose the one that is most specific towards killing the bacteria currently infecting the patient, rather than using broad-spectrum coverage.

What this all boils down to is basically a fairly standard set of protocols for most infections. Many groups, such as the IDSA, publish consensus guidelines for which antibiotics are indicated for which infections. The typical strategy is to treat empirically until you get culture and sensitivity results, and then narrow according to individual patient requirements. For example, anyone presenting with community acquired pneumonia will likely receive ceftriaxone + azithromycin or levofloxacin monotherapy until culture results come back, while someone with a suspected GI source would likely get ciprofloxacin + metronidazole to cover a different subset of organisms.

askscience 内の headson2flips によるリンク Do multivitamins actually make people healthier? Can they help people who are not getting a well-balanced diet?

[–]arumbar 29ポイント30ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Just to add some more sources to the above answer:

The current consensus is that healthy individuals do not need any regular micronutrient supplementation. For example, this large RCT published in JAMA looked at cancer rates in male physicians over 50, and found a small (8%) reduction in overall cancer rates, without significant reductions in specific individual cancers. There was also no reduction in cancer mortality. The same study found no significant effects on cardiovascular events, cardiovascular mortality, or total mortality in 10 years of follow-up.

Similar cohort studies in postmenopausal women also found no significant benefit to cancer rates, cardiovascular disease, or total mortality.

This study of 13,000 French men and women found no effect on overall cancer risk, with a slight decrease (31%) in cancer risk in men, without any effect on cardiovascular disease.

Another study of 35,000 Swedish women found a small (19%) increase in risk of breast cancer associated with multivitamin use, while also finding a small (27%) decrease in new heart attack rates.

Large cohort studies and meta-analyses have repeatedly demonstrated no benefit in all-cause mortality.

There are some clear roles for vitamin supplementation (eg folic acid for women who may become pregnant, or supplementation for specific deficiencies), but on the whole it is not recommended that healthy individuals take multivitamins. Admittedly these studies are unable to identify benefits that take longer to develop (follow-up period for these studies is usually around 10 years), but as it stands there is no good evidence to recommend regular MVI use in healthy individuals given the conflicting data on specific health benefits and the unequivocal data showing no mortality benefit.

askscience 内の SadEaglesFan によるリンク I have been told that antibiotics can decimate someone's gut flora. Do the affected bacteria eventually repopulate, or can the make-up of one's guts be permanently altered?

[–]arumbar 8ポイント9ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

To speak to one specific example, a c. dificile infection is a potential consequence of antibiotic use. The antibiotics basically wipe out the native gut flora that would normally keep the c-diff infection in check, resulting in significant overgrowth of the pathogenic bacteria. While c-diff specific antibiotics can be used to treat most cases, refractory cases are sometimes treated with a fecal transplant to re-seed the gut microbiota.

askscience 内の _Plaka によるリンク How does HIV/AIDS actually kill people?

[–]arumbar 10ポイント11ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

It's a common misconception that the only consequence of HIV is from opportunistic infections. HIV can directly cause a number of potentially fatal disorders. For example, HIV nephropathy can lead to renal failure, HIV associated neurocognitive disorders can lead to dementia, HIV associated cardiomyopathy can lead to heart failure, etc.

To add on to that, HAART medications are not benign and are associated with any number of potentially serious adverse events as well.

askscience 内の waterbott によるリンク What actually kills you when you are dehydrated?

[–]arumbar 177ポイント178ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

The two most significant issues with severe dehydration are the loss of perfusion volume as well as the electrolyte abnormalities that develop. If someone is hypovolemic enough, they will not be able to maintain an adequate blood pressure to supply oxygen to their organs, which results in multi-organ failure (in particular, the heart, brain, kidneys, and liver are particularly vulnerable). In addition, changes in electrolyte concentrations in the blood (most typically sodium or potassium) can result in comas or seizures as well as cardiac arrhythmias.

askscience 内の Jew_Tube によるリンク How does a doctor determine what 'percentage' your organ, such as a liver or kidney, is working at?

[–]arumbar 6ポイント7ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

This is actually a hugely complex field. I'll try to give some examples of how various organ functions are quantified, but feel free to ask follow up questions.

Heart:

The most direct assay of how well your heart is functioning is to measure the cardiac output (this is the amount of blood pumped out of the heart per minute). This is most commonly measured via a right heart catheterization, which allows the collection of data that can be manipulated to give us an estimate for cardiac output. These values can still be skewed through anatomic abnormalities of the heart (eg shunts). A typical person's cardiac output should be around 5L/min, but this can drop dramatically with heart disease. A less invasive way of measuring cardiac function is to look at ejection fraction (how much of the end-diastolic volume actually gets pumped out during systole). This can be done using a simple echocardiograph to visualize and measure the chambers of the heart. Normally the heart is able to pump out over 60% of the blood in the left ventricle.

Lungs:

Pulmonary function tests are used to assess lung function by measuring the volumes, flow rates, and diffusion capacity within the lung. By measuring things like how much air you are able to forcibly blow out during the first second of expiration (FEV1), we can stage diseases like COPD (see Gold staging). Similarly, knowing what the total volumes in the lung are can also give information about the severity of restrictive or obstructive lung disease.

Kidney:

Kidney function is probably one of the most variable indicators that we track in patients because so many factors can affect it. It is generally assessed by measuring serum creatinine (a molecule that your body naturally produces and is almost entirely filtered and secreted by the kidneys). The serum creatinine can be used to measure creatinine clearance, which is then a surrogate marker for the glomerular filtration rate, which is the ultimate indicator for how well your kidneys are working. There are various formulas (MDRD, Cockcroft-Gault) for these calcuations, and typically a GFR<90 is abnormal. There are also a number of newer indices (eg cystatin C) that have not been completely studied/validated and are not standard of care yet.

Liver:

To my knowledge there's no real way to quantify % of liver function remaining, but there are various indices that we use to assess how functional the organ is. Various blood tests (AST/ALT/bilirubin) can qualitatively inform us of damage to the liver itself, while other tests (INR, PTT, albumin) can qualitatively tell us how well the liver's synthetic function is working. However I don't think it's common to describe liver failure as a %. One way to assess the severity of liver disease is to use the MELD score, which combines a number of different factors to risk-stratify the patient.

askscience 内の benderrules によるリンク What is the molecular biology behind an allele being recessive or dominant?

[–]arumbar 542ポイント543ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

The dominance of different alleles of a gene is largely determined by the nature of the protein that it encodes. For example, defects in structural proteins generally manifest as dominant traits because being heterozygous results in defective protein synthesis, which disrupts the native healthy protein. On the other hand, defects in enzymes tend to be recessive because there is a certain amount of compensation, such that heterozygotes may be asymptomatic (aka gene dosage effect). These rules do not always hold (eg haploinsufficiency with familial hypercholesteremia), but are useful generalizations.

Here's my attempt to simplify the above via analogy:

So think of structural proteins (very simplistically) as bricks. The allele (B) codes for a normal brick, while the allele (b) codes for a brick that is spherical instead of rectangular. You can have BB, which makes the wall all rectangular and normal, or you can have bb, which is just a pile of spheres. What about the heterozygote? Bb will lead to half normal bricks and half spheres, which ultimately does your wall no good. In this scenario, the heterozygote still has a loss of function, so we think of that trait as 'dominant'.

Now think of enzymes (very simplistically) as trucks carrying cargo from point A to point B. Again, you can have working trucks (T) or broken trucks (t). Having only working trucks (TT) is great - everything gets delivered on time. Having only broken trucks (tt) is bad. What about the heterozygote (Tt)? Well it depends on how much cargo you need to deliver! If you have a low cargo day, then the number of working trucks you have may be sufficient. In this case, the heterozygote is not affected, so we think of the trait of 'recessive'.

askscience 内の tonzayo によるリンク What exactly are 'birth marks' and how are they formed during the fetus' growth?

[–]arumbar 2ポイント3ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Here is an excellent free-to-access review on the topic. To summarize, there are three broad categories of birthmarks - pigmented, vascular, and other.

Pigmented Birthmarks

Congenital melanocytic nevi arise from abnormal migration of melanocyte (the cells that determine skin pigmentation) precursors. They are generally dark brown/black and flat, and has some association with development of melanoma.

Dermal melanosis (aka mongolian spots) are due to trapping of melanocytes deep within the skin. They are generally blue-grey and flat, and are more prevalent in certain ethnic groups.

Vascular Birthmarks

Hemangiomas (aka strawberry hemangiomas) are abnormal proliferations of blood vessels, for which the etiology is not completely understood. Basically, some trigger (for which there are many hypotheses) induces vasculogenesis (rather than angiogenesis, as was previously thought). They present as outpouchings of vascular tissue that often initially grow before shrinking down spontaneously.

Nevus flammeus (aka port wine stains) also do not have a great mechanism elucidated. There is some thought that there is a notable neural component rather than a purely venular disease (such as in the case of Sturge-Weber disease).

Nevus simplex (aka stork bites, angel kisses, or salmon patches) are perhaps the most common of all birthmarks. These are caused by teleangiectasias (small dilated blood vessels) in the dermis layer of the skin.

askscience 内の Undew_ によるリンク Whats the scientific reason for getting a stitch whilst or after you run?

[–]arumbar 83ポイント84ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

This phenomenon is known as 'exercise-related transient abdominal pain' (ETAP), and unfortunately while a number of theories exist we don't know definitively what its cause is. The leading hypotheses include 1) diaphragmatic ischemia, 2) peritoneal irritation, and 3) stress on ligaments supporting subdiaphragmatic viscera (notably, a muscle cramp of the abdomen/diaphragm is not considered likely to be related). Each of these theories has some evidence for and against it. It is thought that drinking fluids prior to exercising is related because it leads to extra weight on the supporting ligaments, but again much of this is still up in the air.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 0ポイント1ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage our panelists to include citations in their answers more, so keep up the good work on that front!

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Can you include a few more examples of answers you have given in /r/AskScience? As an aside, we're trying to encourage all our panelists to include citations in their answers more, so if you're able to keep that in mind when writing up answers that'd be really helpful.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage all our panelists to include citations in their answers more, so if you're able to keep that in mind when writing up answers that'd be really helpful.

Lastly, we warn all our medical panelists to be careful to avoid delving into medical advice, as the internet is no place for people to get information about their personal health situations. Comments like [this](www.reddit.com/r/askscience/comments/1vento/a/cevjts7/), while well-intentioned, should be avoided in the future. Thanks!

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage all our panelists to include citations in their answers more, so keep up the great work on that front.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

We don't evaluate panelist applications until we can see a few examples of types of answers that they give, so we'll revisit this once you've had a chance to comment more here.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage all our panelists to include citations in their answers more, so if you're able to keep that in mind when writing up answers that'd be really helpful.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Can you include a few more examples of answers you have given in /r/AskScience? As an aside, we're trying to encourage all our panelists to include citations in their answers more, so if you're able to keep that in mind when writing up answers that'd be really helpful.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage all our panelists to include citations in their answers more (leading by example and all that), so keep up good work on that front!

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage our panelists to include citations in their answers more (leading by example and all that), so if you're able to keep that in mind when writing up answers that'd be really helpful.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

It looks like you don't have too many answers here in /r/AskScience yet - we'd like to see some more examples of your activity in this specific subreddit, as the setting is so different from that of others. We also discourage commenting on individuals' pathologies like you did in the first link, and explicitly ban medical advice.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage our panelists to include citations in their answers more (leading by example and all that), so if you're able to keep that in mind when writing up answers that'd be really helpful.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage our panelists to include citations in their answers more (leading by example and all that), so if you're able to keep that in mind when writing up answers that'd be really helpful.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

You included mostly links to answers outside of /r/AskScience - we'd like to see a few more comments here before evaluating the application (because the rules and types of questions are so different between various subs). Thanks!

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Welcome to the panel! Be sure to subscribe to the panelist subreddit at /r/AskSciencePanel! As an aside, we're trying to encourage our panelists to include citations in their answers more (leading by example and all that), so if you're able to keep that in mind when writing up answers that'd be really helpful.

askscience 内の ren5311 によるリンク AskScience Panel of Scientists X

[–]arumbar[M] 1ポイント2ポイント  (0子コメント)

ごめんなさい。これは既にアーカイブしてあり、もう投票はできません。

Updated! FYI in the future it is a bit easier to just message us directly - you don't have to repost in these threads. Congrats on graduating!