The differential diagnosis of Huntington's disease-like syndromes: 'red flags' for the clinician

A growing number of progressive heredodegenerative conditions mimic the presentation of Huntington's disease (HD). Differentiating among these HD-like syndromes is necessary when a patient with a combination of movement disorders, cognitive decline, behavioural abnormalities and progressive disease course proves negative to the genetic testing for HD causative mutations, that is, IT15 gene trinucleotide-repeat expansion. The differential diagnosis of HD-like syndromes is complex and may lead to unnecessary and costly investigations. We propose here a guide to this differential diagnosis focusing on a limited number of clinical features (‘red flags’) that can be identified through accurate clinical examination, collection of historical data and a few routine ancillary investigations. These features include the ethnic background of the patient, the involvement of the facio-bucco-lingual and cervical district by the movement disorder, the co-occurrence of cerebellar features and seizures, the presence of peculiar gait patterns and eye movement abnormalities, and an atypical progression of illness. Additional help may derive from the cognitive–behavioural presentation of the patient, as well as by a restricted number of ancillary investigations, mainly MRI and routine blood tests. These red flags should be constantly updated as the phenotypic characterisation and identification of more reliable diagnostic markers for HD-like syndromes progress over the following years

Human serum haptoglobin is toxic to Plasmodium falciparum in vitro

Innate immune responses are important in the control of malaria, particularly in those who have not yet mounted an effective adaptive response. Here we report that the human serum acute phase protein, haptoglobin is toxic to Plasmodium falciparum cultured in vitro. This effect is phenotype-dependent and occurs during the trophozoite phase of the asexual life cycle. We propose that the increased levels of haptoglobin seen in the acute phase response may be protective against malaria in humans

Absence of Localization in Certain Field Effect Transistors

We review some experimental and theoretical results on the metal-to-insulator transition (MIT) observed at zero magnetic field (B=0) in several two-dimensional electron systems (2DES). Scaling of the conductance and magnetic field dependence of the conductance provide convincing evidence that the MIT is driven by Coulomb interactions among the carriers and is dramatically sensitive to spin polarization of the carriers.Comment: 8 pages, LaTeX, figure label change

Multinationals and futures hedging under liquidity constraints

This paper examines the behavior of a multinational firm (MNF) under exchange rate uncertainty. The MNF has operations domiciled in the home country and in a foreign country. Each of these two operations produces a single homogeneous good to be sold in the home and foreign markets. To hedge the exchange rate risk, the MNF has access to an intertemporally unbiased currency futures market. All currency futures contracts are marked-to-market and thus require interim cash settlement of gains and losses. We impose a liquidity constraint on the MNF in that the MNF is forced to prematurely liquidate its futures position from which the interim loss exceeds a predetermined threshold level. If the MNF's utility function satisfies decreasing absolute risk aversion, we show that the MNF optimally opts for a short under-hedge. Furthermore, the MNF sells less (more) and produces more (less) in the foreign (home) country in response to the imposition of the liquidity constraint. © 2005 Elsevier Inc. All rights reserved.postprin

Force Majeure and Hardship in the Age of Corona

Source info: McGill Journal of Dispute Resolution, Forthcomin

Changes in construals of tic-producing situations following cognitive and behavioral therapy

12 clients suffering from chronic tics participated in one of two treatment programs, either a behavioral group using competing response therapy or a group using Beck-style cognitive restructuring. A repertory grid based upon the personal construct psychology of George Kelly was administered to all clients before and after treatment. The grid comprised a set of elements made up of situations with high, medium, and low risk of eliciting tics, and constructs were derived from comparisons between them. Clients' ratings of the elements on the constructs were subjected to a principal components analysis using an INGRID program. Following treatment the total variation around construct means decreased in both groups but significantly more in the cognitive group, indicating a narrowing of the difference in their perceptions of situations which formerly indicated high and low risk of inducing tics.postprin

Handwritten Chinese character recognition using spatial Gabor filters and self-organizing feature maps

So far the bottleneck of Chinese recognition, especially handwritten recognition, still lies in the effectiveness of feature-extraction to cater for various distortions and position shifting. In the paper, a novel method is proposed by applying a set of Gabor spatial filters with different directions and spatial frequencies to character images, in an effort to reach the optimum trade-off between feature stability and feature localization. While a classic self-organizing map is used for unsupervised clustering feature codes, a multi-staged LVQ with a fuzzy judgement unit is applied for the final recognition on the feature mapping result.published_or_final_versio

Underrecording of osteoarthritis in United Kingdom primary care electronic health record data

Purpose: Primary care electronic health records are increasingly used to estimate the occurrence of osteoarthritis (OA). We aimed to estimate the extent and trend over time of underrecording of severe OA patients in UK primary care electronic health records using first primary total hip and knee replacements (THR/TKR) – >90% of which are performed for OA – as the reference population. Patients and methods: We identified patients with a first primary THR or TKR recorded in the UK Clinical Practice Research Datalink between 2000 and 2015. We then searched for a diagnostic/problem code for OA up to 10 years prior to THR/TKR using 3 definitions: “diagnosed OA (joint-specific),” “diagnosed OA (any joint),” “clinical OA” (diagnosed OA or relevant peripheral joint pain symptom code). Results: Among 34,299 THR patients identified, 28.1%, 53.4%, and 74.4% had a prior record of diagnosed OA (hip), diagnosed OA (any), and clinical OA, respectively. Among 47,588 TKR patients, the corresponding figures were, 25.5% (diagnosed OA [knee]), 43.7%, and 74.8%. In the UK Clinical Practice Research Datalink, the proportion of patients with prior recorded OA decreased between 2000 and 2015. Conclusion: An increasing trend of underrecording of OA or joint pain among patients with THR or TKR (severe OA patients) between 2000 and 2015 was identified. An underestimate health care demand could be derived based on consultation incidence and prevalence of OA from electronic health record data that relies on osteoarthritis diagnostic codes. Further studies are warranted to investigate the validity of OA or joint pain recorded in primary care settings, which might be used to correct the consultation incidence and prevalence of OA

Microstructural imaging of high repetition rate ultrafast laser written LiTaO<inf>3</inf> waveguides

The microstructural changes associated with the formation of lithium tantalate waveguides after high repetition rate ultrafast laser inscription has been investigated by confocal micro-Raman experiments. While the laser beam focal volume is characterized by significant lattice damage, no reduction of Raman mode strength has been observed at the guiding region, suggesting the preservation of the nonlinear optical coefficient in the waveguide. A general blueshift of the Raman modes has been observed at the guiding region, suggesting lattice compression as the dominant mechanism of waveguide formation. © 2009 American Institute of Physics