Can you provide a citation for the France assertion? I think it’s wildly unlikely a protocol for acute stroke would favor mri over ct but could be wrong. It would take 20 minutes to transfer a pt to mri in a lot of stroke centers in the USA, as opposed to CT’s that are generally across the hall, where imaging should be read within 30 minutes of door time I believe.
Also I’m not sure what you increased “sensitivity” would get you. Acute stroke is a clinical diagnosis, the imaging determines the type of stroke and treatment.
> Can you provide a citation for the France assertion? I think it’s wildly unlikely a protocol for acute stroke would favor mri over ct but could be wrong.
https://www.sciencedirect.com/science/article/abs/pii/S00353... (there's free pdf available when you search for it):
"The first-line brain imaging at WH was MRI in 69 SU (56.1%), CT in
6 (4.9%), and either MRI or CT depending on delay and severity in 48 (39.0%). The first-line brain imaging at NWH was MRI in 54 SU (43.9%), CT in 16 (13.0%) and either MRI or CT in 53 (43.1%). In practice, the proportion of patients who really underwent first-line MRI was higher than 90% in 46
SU (37.4%) at WH and in 36 SU (29.3%) at NWH"
> Also I’m not sure what you increased “sensitivity” would get you. Acute stroke is a clinical diagnosis, the imaging determines the type of stroke and treatment.
Reading that couldn't be more clear, CT is the primary modality for stroke, worldwide.
> by sensitivity I mean sensitivity
You're a little confused. You're using "sensitivity" to mean sensitivity of detecting ischemic stroke. MRI is the obvious follow-up. When available, worldwide. But it doesn't guide emergency treatment.
> Reading that couldn't be more clear, CT is the primary modality for stroke, worldwide.
Well yes, it's primary modality for stroke worldwide and it's leading modality in France, just like I've said before.
> You're a little confused. You're using "sensitivity" to mean sensitivity of detecting ischemic stroke. MRI is the obvious follow-up. When available, worldwide. But it doesn't guide emergency treatment.
I would appreciate if you stopped using condescending tone. It does not guide emergency treatment decisions because in most cases it is not performed in emergency settings. When it is performed in this setting it is guiding treatment and MRI is included in stroke guidelines for cases where clinical diagnosis is not clear (and these cases are not that rare). Why is it not widely adopted? Mostly logistic reasons (which can be overcome - like they were in France) and because TOF-MRA is generally worse than CTA. It has others positives apart from higher sensitivity though, e.g. you can use FLAIR/DWI mismatch in wake-up strokes which are VERY common (obviously perfusion serves generally same purpose).
Bought by Microsoft who gradually nudged users to move to Access or SQLServer until they could quietly take it out back a shoot it in the head about 20 years ago.
My vague memory of it is that MS discontinued it because it detracted from their plans with MS Access on the low-end, and MS SQL Server on the high end. I think, maybe, that it may not have fit in with Visual Basic very well.
I do not have in-depth knowledge of traefik unfortunately. I tried it a while ago, but decided to switch to the setup mentioned above for the setup simplicity. For my use-case, the setup mentioned on github under "Basic usage example, using docker-compose" plus adding two lines to a docker-compose file has been enough for most of my use-cases, and never given me any trouble.
I've been using Caddy since the early days, and a few times looked into using Traefik, but it's config looked pretty complicated for what is a simple reverse proxy on Caddy.
TLDR; Mullenweg made a poorly received joke/trolling post on Reddit on Christmas. It could have been perceived as reconciliatory
/self deprecating or trolling depending on your perspective. That was the straw in the camel’s back that led the sustainability chief to resign. Mullenweg then disbanded the entire sustainability team which he announced by taunting them on slack.
Beat me to it. Relevant Derek Lowe quote from a different article.
But as I did when I wrote about the lecanemab data, let’s get some of the disclaimers out of the way at the beginning. I mentioned there that no Alzheimer’s drug candidate has ever stopped the progression of disease, and that of course means that no such candidate has ever reversed any of the damage, either. See below for more on that as it relates to donanemab, but what we’re looking for in all these cases is essentially slowing down the rate at which these patients deteriorate.
…
But here goes: lecanemab slowed decline by 27% on the CDR-SB scale, and donanemab slowed it by 29%. As you will can see from my earlier writeup on the former drug, opinion was very much divided on whether the lecanemab numbers would even be noticeable in real-world use (there is no standard for clinically meaningful efficacy in CDR-SB changes). So I would have to think that the same objections apply here. We cannot be sure that this drug will actually make a difference in the real-world care of patients with Alzheimer’s - not yet, anyway. This point is completely avoided in the Lilly press release, but it is nonetheless real and we will be hearing more about it from clinicians - well, if you listen closely above all the noise, that is.
This assumes anyone attempted to replicate it or otherwise pursue it. I guess the question would be where are the studies that failed to replicate it.
I have friends that work in the medical tech field. A device they started developing around 2009 is barely getting into the field now after animal trials and clinical trials around the globe. It's an extremely long process requiring a lot of capital. And you likely haven't heard of it either (it is pretty effective for treating some heart related issues).
There are plenty of animal studies that show some promise that are simply abandoned for various reasons.
All that said, I thought the hypothesis that those amyloids are the cause of Alzheimers hasn't really worked out, there were other drugs that targetted those and apparently didn't work that well.
Also I’m not sure what you increased “sensitivity” would get you. Acute stroke is a clinical diagnosis, the imaging determines the type of stroke and treatment.