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- What proportion of medicine is evidence-based? There is a high bar for introducing a new intervention (social/behavioral, drug, device, etc). However, I suspect that many interventions, treatments, and decisions in medicine do not have a high level of evidence base (i.e. no formal trials, decisions are based on experience, practice, etc). Have there been studies that estimate what proportion of medicine is evidence-based?
Dr. Tabbara is correct in pointing out a key deficiency of EBM - that it provides generalized Tx, Dx and Px rules that force the clinician to use potentially faulty reasoning when making a treatment decision (e.g. Premise: for many Pts with Dx of X, a Tx of Y will produce the best outcome. Conclusion: For any individual with X, do Y.). This lack of personalization is just one of the many drawbacks of EBM, not to mention (a) the unrealistic time burden on the physician (exhaustive review of the literature for every clinical decision!?), (b) idiosyncratic study endpoints as to what constitutes the "best outcome for the patient" (c) highly subjective core data (grounding the "systematic research" at the core of EBM) which puts EBM on a shaky foundation, especially in specialties like psychiatry and pain management where almost all data collected is self-reported by the patient.
In the late 1980s and early 1990s, when EBM was developed, one could hardly imagine a world in which real-time, highly-granular OUTCOME data could be gathered cheaply and easily via ubiquitous smartphones (and wearable sensors) carried by OUTPATIENTS. In 1994, when I designed my very first Clinical Decision Support System (for Emergency Toxicology), it was EBM-rule-based, although it was based on an advanced AI inferential system that mitigated the "one-size-fits-all" problem with EBM Tx that Dr. Tabbara points out. But remember, EBM is currently "state of the art" for Dx, Tx and Px. As such, it has not kept up with technological advances.
In the 1990s, reliance on "systematic research" represented the only logical way for clinicians to make decisions. Today, such research can still be very valuable, but it should be augmented by real-time, data-driven, personalized predictive analytics and decision support systems which are "blind to etiology" - that is, they don't care about WHY a certain Tx is right for a *particular* patient, they are just good at calculating which Dx, Tx (intervention, etc), and Px (so as to intervene earlier and more cheaply) is RIGHT. This is a "whatever works is right" philosophy to the practice of medicine that I call Outcome-Based Medicine (OBM) than can serve as a useful complement to EBM in giving the clinician actionable knowledge when treating a patient.
Also, sufficiently flexible OBM e-HPA (electronic-Healthcare Predictive Analytics, to borrow Dr. Patzer's term from a 2014 article in Health Affairs) can let the clinician, and indeed the patient, customize the meaning of "best possible outcome" (personalizing that as well) and select a treatment plan that (based purely on raw data analysis) is most likely to achieve that outcome. I believe that the combination of (a) our newfound ability to collect a plethora of objective, granular OUTCOME data from an enormous cohort of outpatients, and (b) our ability to analyze this data with the best statistical/AI tools, has the potential to substantially augment clinical decision making and relieve the clinician from the unrealistic burdens of conscientiously practicing traditional EBM. We need to start thinking about an EBM 2.0 that reflects massive advances in data-driven technology in the past two decades.Following
- Can we use SEM to see particular colloidal nanoparticles?
We are researching Pt, Pd, PtPd colloidal nanoparticles for catalysis and we want to characterize them. The sample preparation is simply to deposit them on Si and spin-coating. We were wondering if SEM would be able to see these nanoparticles. The mean size of these nanoparticles is about 5 nm. Is there any way to use SEM to get an image of these nanoparticles?
If you have a good SEM yes you can. But be careful and try to avoid the contamination of the SEM. Personally I check many metallic nanoparticles using the SEM. Also many SEMs are provided with STEM probe and this may also help. Feel free to contact me if you need any further help. Good luckFollowing
- How do you get a detailed profile of CUDA kernel?
How do you get a detailed Kernel profile using nvprof from the command line in Linux? What profiling option should be specified?
Just jaywalking thru google for this, combined with other nonrelevant general exp:
The -G option to nvcc forces the compiler to generate debug information
for the CUDA application. To generate line number information for applications without
affecting the optimization level of the output, the -lineinfo option to nvcc can be
This gives you two things: the -G option generates the additional info for the profiler (you probably already did that, otherwise could not use nvprof).
Then, -lineinfo will generate the info you point out in # 1. in your link. To go further, I'm just guessing you will have to look into the --events/metrics options in the documentation, and find exactly what you want to get.Following
- What is the advantage of using real time simulator in power system analysis?
Does using real time simulator is essential in large power system analyzing ? why?
As an example, if we were interested in an SVC, static var compensator, on a power system. Would the RTDS make a model of the SVC and a portion of the power system? Would the objective be to test the SVC controller or to test the power system performance with the SVC added?Following
- What are the is the paradigmatic stance of mixed methodological approach ?
My area of study is entrepreneurship. Burrel and Morgan(1979) study explained that existence of clear paradigmatic divisions and do not accept the possibility of transition between the paradigms.
it seems that you have to use triangulation method, Qualitative, quantitative, qualitativeFollowing
- Does anyone have a protocol for rhodamine-phalloidin staining in Drosophila ovaries?
The rhodamine-phalloidin staining is usually used for staining of F-actin.
I found playing with a Triton X-100 and BSA concentration really helpful for a good staining.Following
- Is it possible to remove EEG ocular artifacts, if we have data from only one electrode?
If we have data from only one electrode (e.g. Fp1), does an approach exist to improve the quality of this data, for instance, removal EEG ocular artefacts or noise?
I am interested in data from electrode Fp1, which has the ear electrode as a reference. Any suggestions are welcome.
Thank you all for extremely precious advices. Unfortunately, my EEG device is designed only for Fp1 area. Now, I am interested in improvement this signal (e.g. identify EEG artefacts, remove, repair etc.) New comments are welcome.Following
- Would you conduct the Least Significance Difference Test after results from ANOVA indicates that mean yield among treatments were highly significant?
The analysis of variance (ANOVA) shows that mean yield among treatments used in an experimental trial were highly significant. However, the result did not show which of five the treatments yield were significant. Thus, to figure that out I conducted the Fisher's LSD pairwise comparison and the results revealed interesting trends and now we are able to tell (apart from just yield data at face value) were the statistical significance lies within and between treatment groups and replications. Do you think there would be another analysis that we need to compute that could provide additional value and meaning to the data?
Yes definitely. Good luck with all that data.
At the Natural Resources Institute (University of Greenwich) we have a stats expert that can help us with stats dilemmas so I think we are very fortunate. Sounds like you are becoming an expert yourself.Following
- Does anyone have tools that can map Affy and/or other transcriptome chip data across other chip-based platforms and with RNAseq transcriptome data?
We would like to be able to download and compare outcomes from several tools using the same in-put datasets (initially Affy datasets then Illumina and Agilent chip and finally RNAseq data). Publicly accessible, open source tools would be most useful. Thanks...Bob
are you asking how to correlate the various platform data? for example taking affy and agilent and see i.e. which genes show the same pattern?Following
- What makes the man of today?
Is it the fast-paced, thrilling/cutting-edge life of modernization? Is it the state-of-the-art technology? Is it business, money and commercialization? In other words, what are the features of the contemporary man’s life and what makes his/her life unusual/ extraordinary/ abnormal/ bizarre should you think it is so?
Thanks Roland for being so wise and realistic as always!Following
- How to calculate functional divergence and posterior probability?
How to calculate the functional divergence and posterior probability of each position in a protein sequence based on a multiple sequence alignmentFollowing
- Do we have enough data about LCZ696 to change heart failure guidelines?
According to the results of PARADIGM-HF trial (presented in ESC congress and published in the NEJM in September 2014) the LCZ696 (ARNI-Angiotensin Receptor–Neprilysin Inhibitor) seems to be the new effective drug for patients with heart failure (HF) and a reduced ejection fraction. The result of the study was impressive, as LCZ696 reduced the risk of cardiovascular death or HF hospitalisation by 20% compared with enalapril. I was cautiously optimistic about these findings, but I must admit that I did not expect that these results would change the guidelines for the management of HF only 2 months after presented study. According to the Medscape news Canadian Cardiovascular Society guidelines for the management of patients with HF have been updated and are the first to include a recommendation on the use of the new angiotensin receptor-neprilysin inhibitor. Is only one trial enough to change guidelines recommendations? Is this only based on our extremely enthusiasm of the study or the study simply answered all our questions?
Indeed very good results in HF field that was somehow lacking new effective medications in the last years (ivabradine somehow failed to impress me with beta blockers around). Of course, having red the critiques of PARADIGM-HF i would agree that it is sill a bit early for LCZ696 to change the guidelines (it needs at lest one more big RCT), but I still feel the results of the study are impressive and the drug could play a role in future treatment of HF.Following
- Which is the best optoelectronic device simulation program? Laser, detector. simulation program? (free or not)
In terms of flexibility and ability " Matlab" is first and last word in my mind for a wide range of applications such as : Optoelectronic devices and so on ...Following
- What nano LC columns are there for peptide mapping that can tolerate abundant proteins? Would Zorbax C3 for small molecules work for such study?
Assuming anyone who has good experience doing limited proteolysis would have known what to use. Our major concern is common sample prep methods with any filters/cartridges will trap peptides of interest. So is there a LC column that can be used to bypass sample prep?Following
- How can the resolution of bands be improved using agarose gel electrophoresis?
For the gel electrophoresis a 2 % agarose gel is made up (dimensions 20x20cm, 3-4mm thick). The gel is run for 4hrs at 85V. As running buffer 0.5x TBE is used.
A band pattern of 5-10 different bands (200-600bp) is expected depending on the sample. Some of the bands can be very similar in size and very close to each other. The gel image is not clear at all and the different bands cannot be distinguished.
Would high resolution agarose be a solution?Following
- Are there any available clusters for research?
Ii want to conduct some researches in distributed-big data. I wonder if there are any available clusters ,with online access ,like Amazon?
I'll check the site- Thank you so much Mr.Sabeur!
- Can I use nanodrop to measure DNA concentration after PCR run? What is the blank used in this case? I want to know the concentration of DNA after PCR run. Can I simply use nanodrop or other component of mastermix would interfere with my result?
Yes, you can but not only the DNA but also other proteins and impurities will be measured.
The best tool is Qubit that measures specific targets such as DNA, RNA, or Protein.
- What are the best human neuronal cell lines available to study for functional characterisation of BDNF (Val66Met)?
In literature search for human neuronal cell lines, I've found HCN-1, HCN-2, SH-SY5Y, and human neural stem cells. I was wondering if there are other options and which cell line is the best to study for the functional characterisation of BDNF Val66Met.Following
- What supplements are good to promote cardiac fibroblast growth?
I have a cardiac fibroblast, but it seems that they grow slowly. I am using DMEM supplemented with L-glutamine, FBS, and PS.
I add up to 10ng/ml bFGF (also called FGF2) to DMEM supplemented with 10% FCS & Glutamine. The cells grow very well under these conditions. I used from 2 different companies (Peprotech and then a cheaper one, prospec) and both work fine!
All the best!Following
- Are insects expanding their distribution in Europe, Africa and N. America in response to global warming patterns? I have documented the westward expansion of a number of Himalayan butterflies and moths during the last 50 years, probably in response to milder winters and increased soil humidity. This has not been matched with a northern movement along the Western Ghats, as might have been expected. Has range extension in response to warming or contraction due to cooling been noticed on other continents? If so, have thermal tolerance and humidity tolerance parameters been discerned for the affected species?
The EXAMINE project , funded by the EU, followed aphid catches in succion traps all over Europe since the 1950s'1960s ( see http://www.rothamsted.ac.uk/examine/). The outcome was that the traps caught a 'new' species each year on average, mainly along a south to North gradient ( ie, mediterranean species coming into Europe). There have been several papers published based on the data of this project.
- Is it a routine in your critical care unit to perform chest ultrasonography?
Do we need the chest X-Ray?
Only in Trauma cases as a part of FAST.Following
- How can I build the parameters of concrete damaged plasticity model in ABAQUS ?
I would like to build parameters for my model that using concrete damaged plasticity model. I read the definition in ABAQUS' manual but I still have not found the steps to do this. Could you please share your experiences with me about this problem?
Thank you in advance!
Equations 7 to 10.Following
- What is your story?
Do you know a story about "Rich Man and Poor Man"? I am interested to know fables (short stories) about the rich man and poor man. I mean short stories that can illustrate (comapare and cotrast) a particular moral, belive, behaviour, ... between them and teach a lesson to children and kids. I am intrested in short stories that are "copy-righted" (original, specific, famous, popular and well-remembred) to your living area, city, country, religion, .... I hope you can share it with me (us) in RG.
Here I give an example to illustrate the idea. Once upon a time there was a poor man and a rich man. Every morning at 11 o’clock, a shiny Rolls Royce drove through Central Park in New York City. Inside the car sat a driver and his master, a well-known millionaire. Each morning the millionaire noticed a poorly dressed man sitting on a park bench. The poor man always sat staring at the hotel in which the rich man lived. One day, the millionaire was so curious about the poor man and ordered his driver to stop the car. He walked to the bench and said to the poor man, “Excuse me, I just want to know why you sit here and keep staring at hotel every morning.” “Sir,” said the poor man, “I have no money, no family, no home. I sleep on this bench, and every night I dream that one day I will sleep in that hotel.” The millionaire had an idea. He said, “Tonight your dream will come true. I’ll pay for the best room in that hotel for you for a whole month.” A few days later, the millionaire went by the poor man’s room in the hotel to see how he was enjoying himself. To his surprise, he found that the poor man had moved out of the hotel, and back to were he was before (his park bench). He then went to the poor man and asked for the reason. The poor man said, “You see, when I am down here sleeping on this bench, I dream I am up there, in that luxurious hotel. It’s a wonderful dream. But when I was up there, I dreamed I was back on this cold bench. It was a terrible dream, and I couldn’t sleep at all.”
Dear @Jeanan Thank you for your narration. Would you please amend it by adding your own conclusion about the moral behind your story at the end of it. Thank you.Following
- What are the psychological effects from inhabiting in a space with minimum windows?
i'm interested if this is a good research topic and is there any article related to this.Following
- What if there is a dual formula for the magnetic force? Since electricity and magnetism are unified, then the force between two current carrying conductors, Catapult force and the Lorentz force, can be expressed magnetically by Eq.1=3, Eq.4=5) and Eq.7=8), at: http://www.exmfpropulsions.com/New_Physics/MIH.pdf
What do you think about these new formulas, and its implications?
@ Kai. This is the second paper in the series titled “Electromagnetic Radiation Energy and Planck’ Constant.”
The paper gives among others:
- The condition under which Electromagnetic Radiation (EM-R) can be produced.
- The really formula for the speed of light (not based on permittivity and permeability of free space given by Maxwell).
- The EM-R energy.
- What is Planck’ constant?
- Best Tool to extract online forum user q&a data?
Hello, anybody doing research in data mining, text mining or web semantics, please help me out the best way to extract the user behavior from the online forums.
If you want to do that in a professional and repeating way, you should definitely use Python and in particular the Scrapy Framework.Following
- How reactive oxygen species (ROS) are generated from Ag nanoparticles or Ag ion in antimicrobial test?
As generated ROS has a major role in antibacterials activity of nanoparticles(Ag). I want to know how Ag species help to generate ROS?
A word of caution: most studies have neglected the long term effect of engineered nanoparticles as they enter the environment. These Duke studies should lead to more similar studies:
We should also take care to ensure that once a silver ENM has chemically changed, that its effects on root growth and micro-organism health has truly been mitigated.Following
- Polarisation resistance & anodic and cathodic polarisation resistance wildly different?
I carried out a Linear Polarisation Resistance test using an Autolab with software Nova 1.10. From the data, and using the software provided, I fitted curves to the data to generate information on the corrosion resistance from the samples. One of these results is polarization resistance (ohms).
Next I plotted the data [+/-20mV of the OCP vs. current (amps)] in excel to yield information on cathodic and anodic resistance (ohms) as well. My sample with the highest polarization resistance went on to have the lowest cathodic and anodic resistance. Why is this so? It seems to be the opposite trend to what is expected.
FYI: all samples were tested in the same solution of 3.5wt% NaCl with the same procedure applied in each case.
Many thanks in advance for any responses.Following
- Is Chalmers' so-called "hard problem" in consciousness real?
In his 2014 book "Consciousness and the Brain: Deciphering How the Brain Codes Our Thoughts" Stanislas Dehaene wrote "Chalmers, a philosopher of the University of Arizona, is famous for introducing a distinction between the easy and the hard problems. The easy problem of consciousness, he argues, consists in explaining the many functions of the brain: how do we recognize a face, a word, or a landscape? How do we extract information form the senses and use it to guide our behavior? How do we generate sentences to describe what we feel?
“Although all these questions are associated with consciousness,” Chalmers argues, “they all concern the objective mechanisms of the cognitive system, and consequently, we have every reason to expect that continued work in cognitive psychology and neuroscience will answer them. By contrast the hard problem is the “question of how physical processes in the brain give rise to subjective experience … the way things feel for the subject. When we see for example, we experience visual sensations, such as that of vivid blue. Or think of the ineffable sound of a distant oboe, the agony of an intense pain, the sparkle of happiness or the meditative quality of a moment lost in thought … It is these phenomena that poses the real mystery of the mind”."
Stanislas Dehaene's opinion is "that Chalmers swapped the labels: it is the “easy” problem that is hard, while the “hard” problem just seems hard because it engages ill-defined intuitions. Once our intuition is educated by cognitive neuroscience and computer simulations, Chalmers’ “hard problem” will evaporate".
Personally, I agree with Stanislas Dehaene's opinion.
Philosophy behind GR and SR is the same, Marc. I mean both of them.