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that the complete implemented solution will be more responsive and faster than is realistic Nevertheless, it can certainly help to provide the customer with a hands-on visualization of what things will look like in a full implementation In all cases, there should be a point to doing business intelligence, just as there was a reason for a customer to invest substantially in products and services to put a BI framework in place That is, BI should be part of a larger business strategy to enable more efficient, consistent, and targeted use of information assets captured in the SAP systems, legacy systems, and other relevant business data A lot of reporting is very tactical, whether it is operational reporting or regulatory and from an industry perspective, that is not really considered Business Intelligence, but rather a simple representation of only its most basic components We need to move the corporation to the next level, which is to encourage further analysis and provide ad hoc querying capabilities beyond a set of standard reports Ideally, though, a BI strategy ties such analysis in with existing or new business processes, where BI plays a role both in discovery (Q&A) and monitoring the effect of policies and business initiatives Most customers will have some sort of BI strategy defined Even exclusively operational reporting will have a thought behind it In many cases it is directly related to a business initiative that is very specific, while in other cases it may be a desire to really change the organization and its business processes It may not be always highly sophisticated, and if that is the case, you should help refine it further and propose a solution based on experience, as well as the customer s business needs Recognize that customer resources will usually have done their research, but may misrepresent certain product features or misunderstand concepts that are very familiar to experienced consultants, so always clarify what they mean with what they say Formulate the strategy and seek approval from the customer Where possible, try to get buy-in for a Business Intelligence Competency Center (BICC) to make sure there is a group that functions as a guardian of the BI solutions and applications post-implementation The BICC members should not only drive best practices and system governance, but also ensure that the actual implementation aligns with the BI strategy The BICC over time should help refine the strategy and drive it to ever further sophistication We have all seen this process go astray with all of the other system-specific activities around the go-live and the post-golive processes including critical issues with performance, business user additional needs, or just running out of budget or time but please look to drive this effort so that the BW system and the BI concepts can continue to proactively impact the corporation We have to keep in mind the critical position of information within our corporations It is very important that you educate the business user or your customer on using the right tool for the right job, as the wrong choice is more likely to lead to implementations that fall short of the initial success criteria You will have to manage not only which tool is more appropriate, but also the expectations with the customer, and what current product capabilities need to be considered when guiding the tool choice Even if the right choice is made, diverging expectations or lack of support for certain features may still lead to problematic implementations It is also clear, and this is the normal process with all new products, that a number of product changes have been, or are in the process of being enhanced, so all of these elements need to be taken into account when deciding on the right tool for the job at hand The SAP BusinessObjects components have some well-established guidelines on selecting tools based on both the existing customer landscape and business user information or what SAP calls a use case scenario In the process of analyzing the various categories of issues reported by the companies and business users apart from identified certain product issues the analysis shows some classifications that clearly indicate incorrect tool choices, which lead to misaligned expectations of the solution.

be an understatement to indicate that a number of patients are persuaded that various symptoms are the result of Lyme infection and seek and receive unnecessary treatment Serologic tests are of great value but again must be interpreted with caution if there has not been an inciting clinical syndrome of erythema chronicum migrans or arthritis or a well-documented tick bite The most valuable initial screening is performed by the enzyme-linked immunosorbent assay (ELISA); if both acute and convalescent sera are tested, about 90 percent of patients have a positive IgM response After the rst few weeks, most patients have elevated IgG antibody responses to the spirochete (Berardi et al); a positive test of this nature may simply re ect prior exposure False-positive tests do occur in some of the conditions that react to syphilitic reagin B burgdorferi speci c antibodies can also be demonstrated in the CSF Positive ELISA testing should be pursued further with Western blot or immunoblot analysis or other more speci c serologies in clinically uncertain cases Although these latter tests are dif cult to carry out and have not been standardized, the presence of both IgG and IgM antibodies is strongly supportive of a recent infection, whereas the IgG is useful in later cases These complex laboratory issues are discussed and put in perspective by Golightly In about 30 percent of cases, the organism can be detected in the spinal uid using PCR techniques In the chronic phase of the disease, CT and MRI in cases of encephalopathy may display multifocal and periventricular cerebral lesions (Fig 32-6), but these are by no means indicative alone of Lyme disease, as they also appear in numerous other conditions Treatment The recommended treatment in the rst stage of the disease is oral tetracycline (250 mg qid) or doxycycline (100 mg bid) CNS cardiac and arthritic disease can thereby be prevented Once the meninges and nervous system are implicated, high-dose penicillin, 20 million units daily for 10 to 14 days, or, probably more effective, ceftriaxone, 2 g daily, must be given intravenously for a similar period Tetracycline, 500 mg four times a day for 30 days, is recommended by Reik for patients who are allergic to these.

Described in the following pages are a number of infectious diseases, much less common than bacterial ones, in which a systemic infection may secondarily involve the CNS For the neurologist, the diagnosis rests on two lines of clinical information one, evidence of infection in the skin, lungs, or other organs, and two, the appearance of a subacute meningeal or multifocal encephalitic disorder Once demonstrated, the nature of the neurologic disorder is determined by identifying the infective agent in the CSF, by appropriate immunologic tests, and by the biopsy of nonneurologic tissue or brain Although a large number of fungal diseases may involve the nervous system, only a few do so with any regularity Of 57 cases assembled by Walsh and coworkers, there were 27 of candidiasis, 16 of aspergillosis, and 14 of cryptococcosis Among the opportunistic mycoses (see below), 90 to 95 percent are accounted for by species of Aspergillus and Candida Mucormycosis and coccidioidomycosis are far less frequent, and blastomycosis and actinomycosis (Nocardia) occur only in isolated instances However, all of these infections, particularly cryptococcal meningitis, are being seen more frequently, mainly in association with AIDS

Fungal infections of the CNS may arise without obvious predisposing cause, but frequently they complicate some other disease process such as AIDS, organ transplantation, severe burns, leukemia, lymphoma or other malignancy, diabetes, collagen vascular disease, or prolonged corticosteroid therapy The factors operative in these clinical situations are not fully understood, but interference with the body s normal ora and impaired T-cell and humoral responses are the most obvious ones Thus fungal infections tend to occur in patients with leukopenia, inadequate T-lymphocyte function, or insuf cient antibodies Infections related to impairment of the body s protective mechanisms are referred to as opportunistic and include not only fungal infections but also those due to certain bacteria (Pseudomonas and other gram-negative organisms,

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