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Syphilitic Nerve Deafness This may occur in either early or late syphilitic meningitis and may be combined with other syphilitic syndromes We and our colleagues have had little clinical experience with this disorder and have no pathologic material Treatment of Neurosyphilis The treatment of these tertiary forms of neurosyphilis consists of the administration of penicillin G, given intravenously in a dosage of 18 to 24 million units daily (3 to 4 million units every 4 h) for 14 days Erythromycin and tetracycline, in doses of 05 g every 6 h for 20 to 30 days, are suitable substitutes in patients who are sensitive to penicillin The so-called JarischHerxheimer reaction, which occurs after the rst dose of penicillin and is a matter of concern in the treatment of primary syphilis, is of little consequence in neurosyphilis; it usually consists of no more than a mild temperature elevation and leukocytosis The effects of treatment on certain symptoms of neurosyphilis, especially of tabetic neurosyphilis, are unpredictable and often little in uenced by treatment with penicillin; they require other measures Lightning pains may respond to gabapentin or carbamazepine Analgesics may be helpful, but opiates should generally be avoided Neuropathic (Charcot) joints require bracing or fusion Atropine and phenothiazine derivatives are said to be useful in the treatment of visceral crises In all forms of neurosyphilis, the patient should be re-examined every 3 to 6 months and the CSF should be retested after a 6month interval If after 6 months the patient is free of symptoms and the CSF abnormalities have been reversed (disappearance of cells as well as reduction in protein, gamma globulin, and serology titers), no further treatment is indicated Follow-up should include clinical examinations at 9 and 12 months and another lumbar puncture as part of the latter examination Satisfactory progress is judged by absence of symptoms and further improvement in the CSF These procedures should be repeated every 6 months until the CSF becomes completely negative In the opinion of most experts, a persistent weakly positive serologic (VDRL) test after the cells and protein levels have returned to normal does not constitute an indication for additional treatment Such a CSF formula assures that the disease is quiescent or arrested Others are not convinced of the reliability of this concept and prefer to give more penicillin If at the end of 6 months there are still an increased number of cells and an elevated protein in the uid, another full course of penicillin should be given Clinical relapse is almost invariably attended by recurrence of cells and increase in protein levels Rapid clinical progression in the face of a negative CSF suggests the presence of a nonsyphilitic disease of the brain or cord A proven maxim for treatment was that a syphilitic patient who has neither abnormal CSF nor aortitis needs no therapy (In the days of arsenical treatment, the therapy put patients at greater risk than did the disease) Finally, it may be said that even with the mild resurgence of the disease due to AIDS, the neurologist nds the various forms of neurosyphilis of more theoretical than practical importance But no other disease has portrayed more vividly the effects of a chronic, continuously active cerebrospinal meningitis on the entire neuraxis.

Lyme Disease (Erythema Chronicum Migrans; The Borrelioses)

Until comparatively recent times, the nonvenereal treponematoses were of little interest to neurologists of the western world Yaws, pinta, and endemic syphilis rarely if ever affected the nervous system Leptospirosis was essentially an acute liver disease, with only one variant causing a nonicteric lymphocytic meningitis; tick- and

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that the customer didn t know what they signed up for or didn t understand what it was we were going to deliver These discussions should be a fact-finding process and a development of a practical BI approach There are other aspects of the project that a meeting of this nature would benefit and allow everyone to flush out questions that may not have been considered by the stakeholders such as basic project type activities and milestones Define report requirements Discuss the requirements gathering process Instead of asking general questions such as Which reports do you want, and what should be in them ask specific questions such as What are you trying to achieve and What are your business goals Explore ad hoc querying This may be an entirely new concept to some customers, and universes (semantic layer for the sources of data for the BOBJ-BI components) that are made available for such ad hoc activity should be designed with the endusers in mind The universes should be easy to use and should cover a particular business process Discuss security Many times the customer is only thinking about data security, which is governed by existing roles and security inside BW However, none of that covers which universes and reports are visible to which users and groups, or which rights a user has in the InfoView portal (component used for business user viewing of reports, very similar to the BI portal) and what actions they can and cannot perform This could mean ad hoc querying, as opposed to only viewing or refreshing reports, but would also include the ability to export report contents or schedule particular reports for their own business area or department Plan scheduling and report distribution Most customers have not yet considered this in detail, so as the consultant, you need to be able to articulate what the options are and how scheduling may help reduce the load on BW during peak hours if a lot of users need to access the same report and information Not every report has to be run interactively, which is a key point to make with customers Discuss report design and visualization (including dashboards) Many things are possible, but the selected approach should be what is best for appropriate information delivery in the given use case On the other hand, those who are most comfortable in BEx might need additional time with all the different possibilities and options available in BOBJ You should have a comprehensive discussion about what makes sense in report design, which metrics comprise good items to display on dashboards, and which ones do not Again, this means that dashboard and report design needs to line up with business goals a novel idea but one that seems to escape many developers as they go through the process of developing these busy dashboards All of these points are still quite tactical However, they will help to set the stage for the project, and in many cases the customers will not understand what they are getting until they see the first reports and dashboards, a point at which it is probably too late to make substantial changes You can mitigate this risk with an upfront rapid scoping session and/or a pilot implementation The advantage to this approach is that, fundamentally, it tends to be business focused rather than IT focused, and it aligns with a simpler implementation Realize, though, that fudged demos on static data can leave customers with an impression.