I've programmed in Scheme on and off over the last decade or so. callcc comes in handy for "return" or "break" functionality. More sophisticated uses, like threading or coroutines, have been around for a long time. Obviously those operations are harder to implement but they do exist and are widely used.
That's absolutely splendid. In the user role, I get very irritated when programs do stupid things or interface elements don't do what they're supposed to do. Muttering to myself I'm asking a question: have the developers ever actually used this program? I'm convinced had they used it for real, there would be far less idiocy users have to deal with.
Your approach to developing software goes a long way to producing software that users appreciate. OTOH users may have no opinion about software sufficiently intuitive to use that it fails to bring attention to itself. Such transparency is an outcome developers should be proud to achieve.
I get what you're saying but I think there's a problem, gobs of common drugs have 2D6 as a metabolic pathway. Increasing 2D6 inhibition puts recipients at greater risk of serious adverse events or drug toxicity. Can't say much about pharmacodynamics of candidate compounds, that remains to be determined experimentally in live subjects including animal models and possibly phase 1 trials.
In any case I appreciate the interesting ideas in your comment and the article.
If you're OP and you're considering clinical trials... well.... I hate to be the bearer of bad news, but you've got another problem. The compound you've described was also described in the scientific literature (back in the 90s) and it's in at least one patent application:
Studies show Modafinil isn't effective in ADHD adults. It may have benefit in children with ADHD.
I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".
Yep. What you find often is that the drug is effective right away, at a 20-30-40% effectiveness level. But over time you learn to take advantage of the benefits more effectively, and get more used to the side effects, so it tends to increase significantly in effectiveness at the same dose over 6-8 weeks much like SSRIs, not because the effects last that long, but because you use the tools to improve the tools.
> ... I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
In ADHD (and most conditions) diagnosis by medication response is not acceptable. Response to drugs is highly variable and fails criteria for acceptable tests. Also drugs can produce side-effects. According to professional standards, it's unethical to expose people to nontrivial risks without good cause.
FWIW it's commonly the case with cancers of abdominal organs: stomach, pancreas, liver, kidney, etc. These cancers are frequently not diagnosed until at an advanced stage. Symptoms tend to be nonspecific, overlap with ubiquitous conditions like constipation, gastritis.
A goal of research is improving early detection of these cancers but it's an uphill battle. It's difficult to increase providers' "index of suspicion" of seemingly "minor" complaints.
That’s a generalization, pancreatic cancer is often extremely lethal, depending on the type and case the survival rate can be as or more grim than glioma. Bowel and urinary cancers including kidney cancer are often very treatable and survivable when discovered due to symptoms. I don’t think it’s helpful to group all abdominal cancers as being uniquely or especially bad or late discovered. Likewise for the particularly aggressive or advanced cancers these types of announcements and trials rarely translate to major changes in prognosis. More typical if there is any positive result it looks like additional weeks or at best months of aggressive treatments rather than significant ”cure” rates.
It can be disappointing to see that even a successful drug, like this one, is "only" extending life expectancy from 6.7 months to 13.2. But this is what the first steps towards a cure look like.
Childhood leukemia used to be overwhelmingly fatal, and early chemotherapy trials also only managed a couple months of remission. Researchers were even criticized for subjecting patients to harsh side effects to no apparent benefit. But thanks to that research, most patients are now cured; per capita death rates from childhood leukemia are down 14x from the 1950s, mostly driven by improved treatment.
Daraxonrasib is an incredible invention on a technical level, and a meaningful step forwards in the treatment of many cancers. We'll need a couple more equally incredible inventions to be able to cure pancreatic cancer.
Moderna is testing an mRNA vaccine that might be useful against bladder and kidney cancers. Hopefully the same technology can be applied to pancreatic and liver cancers. Fingers crossed.
mRNA vaccines are being studied for pancreatic cancer. To quote a post I wrote in April:
> First, the personalized mRNA vaccine autogene cevumeran, developed by BioNTech and Genentech, just reported 6-year follow-up results from their Phase 1 clinical trial. 16 patients were treated, 8 were responders (showed signs of immune reaction to vaccine), 8 were non-responders.
> 7/8 responders (87.5%) survived 6 years after surgery, 2/8 nonresponders survived (25%).
> The most important result in this small trial is that vaccine response is strongly correlated with better outcomes. But for context, the trial was restricted to patients with operable pancreatic cancer. Patients diagnosed with stage 1 or 2 pancreatic cancer have a 5-year survival rate of 12%. Patients who get their pancreatic cancer surgically removed have a 5-year post-surgery survival rate of 20%. This makes the overall 6-year post-surgery survival rate of 56% among the 16 trial patients pretty impressive. Keep in mind that the trial patients may have been healthier than average for other reasons, and small n is small n, so we shouldn't be too hasty until we see Phase 2 and 3 data.
We are able to early detect these cancers right now with routine targeted imaging. Perhaps we should be working to solve or improve on the drawbacks associated with doing this, some of which are:
CT scans emit ionizing radiation.
MRI contrast can buildup and be retained in the body over repeated administrations.
The scans can produce false positives, surface benign abnormalities which result in a wild goose chase, cause severe patient anxiety and healthcare burden, and result in over-treatment.
And of course doing this on a whole population level is not cost or time effective.
If you look at what practitioners and informed epidemiologists are saying the incidentaloma problem for any type of screening is huge and underestimated with no clear solution. It’s not only about finding and invasively testing benign masses, which can cause actual serious health problems (the associated anxiety and stress alone can actually kill, not to mention the cost and painful or damaging biopsies). But many true positive cancerous or malignant conditions can progress so slowly relative to the patient’s overall health that they do not shorten the patient’s life and/or the treatment may be worse than the “disease” that was detected. Hence why so many types of screenings that actually work can do positive harm for certain populations.
And once you find something with a screening you can’t unfind it. The patient or at least their doctor now has that knowledge and has to live with it and actively decide what to do about it.
> And by adulthood, height doesn't change significantly and you probably know it ...
But height does change in adulthood [0]. On average people living past 40 gradually lose height. At age 80, it's likely height loss will be >=2 inches. This loss is reflected in higher BMI even when body fat content hasn't changed. Average BMI increase isn't large, but think about a person losing 4 or 5 inches of height while maintaining body fat unchanged.
Self-reported height is generally greater than measured height. Adding 1/2 to 1 inch is common (per experience measuring height). "Height inflation" has modest effect on BMI but problematic in research and workup for medical procedures. In the latter cases, measuring height is necessary.
MDD is the "bread and butter" of psychiatric practice. I'm not really sure how much that's changed over decades. Of course, depression treatment options have evolved greatly since the late 80s, truly a blessing.
You're probably right that increased awareness, reduced stigma and improved attention to diagnosis play a role in apparent population rate increase. Interesting how the comments here put forth quite a few "theories" regarding sources of the increase.
AFAIK there's no definitive explanation of the observation. In passing we should note that many other psychiatric conditions have parallel rising incidences. The factors you cite apply to those conditions as well.
Psychiatric conditions in general are very complex, with associations to a wide array of factors. Most likely many small contributors add up to vulnerability to one or more of these conditions. Our brains are constructed to prefer lumping things into simpler categories. What we call MDD clearly enough is not a unitary disease but outcome of a messy set of myriad "causes" diagnostically lumped together.
The progress made in identifying and treating psychiatric disorders is impressive and gratifying. The more we accept the messy reality, the greater the level of progress we'll make.
Treating many ADHD adult students some did take advantage of accommodations available to them.
Problems with test-taking varied, but common issues were getting distracted by extraneous stimuli in "regular" classrooms. Frequently ADHD students were slow readers and really did need/use extra time. But the biggest problem was test-taking anxiety, often quite prominent, contributing to difficulty with tests.
Interestingly, more than not ADHD students were reluctant to ask for accommodations. Some never availed themselves of this benefit. Others only used part of the options they could use.
In my practice were a number of ADHD adults admitted to nursing school, some having serious academic difficulties and eventually asking for accommodations. The assistance was effective. Notably, none of these student-patients failed or dropped out, all graduated. A pleasant footnote to add is a subset of these nurses developed exceptional skill earning them leadership positions in their institutions.
Reputable clinicians wouldn't give an ADHD diagnosis or support academic accommodations without sufficient clinical evidence.
Part of the problem here is that this college has <5% acceptance rate. Very hard to get into and prestigious. The students who get in have been minmaxing and exploiting every advantage they can for their entire life.
> The students who get in have been minmaxing and exploiting every advantage they can for their entire life.
Not a school I'd be tempted to apply to. Scholastic competition is one thing, but scrapping for every conceivable speck of "I'm better than the next guy" is not a bit attractive. I wonder about the campus atmosphere. Seems likely contesting would be a hard to break habit. I feel tense just thinking about it :/
Of course, ADHD students are less likely to achieve near-perfect grades than non-ADHD peers. Though it's not impossible for an ADHD student to succeed. Anyway, not at all uncommon for a student to do very well until subjects become more complex and challenging. Conceivably a student could look promising, but then suddenly have great difficulty keeping up.
So a safe bet that at least a few students at the top-level school have ADHD. If the school offers little or no accommodation, affected students probably have to accept getting educated elsewhere. Fortunately, more than not ADHD treatment is effective, a favorable response can make a pivotal difference in the student's outcome.
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