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confusion, seizures, coma, ataxia, etc The spinal uid shows slight in ammation and elevation of protein sometimes a more intense reaction, and there are usually characteristic con uent bilateral lesions in the white matter in imaging studies, ndings that differ from those of viral encephalitis When there is no coexistent epidemic of encephalitis to suggest the diagnosis or the systemic illness is absent or obscure, a differentiation between the two may not be possible on clinical grounds alone The fever is generally higher in the infectious type but even this difference does not always hold in young children with ADEM Since ADEM is essentially a demyelinative process, we mention it in this chapter but discuss it more fully in Chap 36 We also place in special categories for later discussion the now rare postinfectious acute encephalopathy with hepatic failure that follows in uenza and other viral infections (Reye syndrome, page 969) and postinfectious cerebellitis, which is discussed further on page 641

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Whereas numerous viral, bacterial, fungal, and parasitic agents are listed as causes of the encephalitis syndrome, only the viral ones are considered here, for it is to these that one usually refers when the term encephalitis is used The nonviral forms of encephalitis (mycoplasmal, rickettsial, Lyme, etc) are considered in Chap 32 (page 601) and should be reviewed with this section According to the Centers for Disease Control and Prevention, about 20,000 cases of acute viral encephalitis are reported annually in the United States Death occurs in 5 to 20 percent of these patients and residual signs such as mental deterioration, amnesic defect, personality change, recurrent seizures, and hemiparesis are seen in about another 20 percent However, these overall gures fail to re ect the widely varying incidence of mortality and residual neurologic abnormalities that follow infection by different viruses In herpes simplex encephalitis, for example, approximately 50 percent of patients die or are left with some impairment, and in eastern equine encephalitis, the gures are even higher On the other hand, death and serious neurologic sequelae have been observed in only 5 to 15 percent of those with western equine and West Nile infections and in even lesser numbers of patients with Venezuelan, St Louis, and La Crosse encephalitides As with aseptic meningitis, the number of viruses that can cause encephalitis or a postinfectious autoimmune reaction is sizable, and one might suppose that the clinical problems would be in nitely complex However, the types of viral encephalitis that occur with suf cient frequency to be of diagnostic importance are relatively few HSV is by far the commonest sporadic cause of encephalitis and has no seasonal or geographic predilections Its age distribution is slightly skewed and biphasic, affecting persons mainly between ages 5 and 30 years and those over 50 Many other viruses, exempli ed by the arboviral encephalitides, have a characteristic geographic and seasonal incidence The most important of these is the Japanese encephalitis serogroup ( aviviruses), of which the West Nile virus is a member In recent outbreaks in the United States, the latter virus has been more frequent than any of the other arboviruses and has had a wide geographic distribution (Solomon) In the United States, eastern equine encephalitis, as the name implies, has been observed mainly in the eastern states and on both the Atlantic and Gulf coasts Western equine encephalitis is fairly uniformly distributed west of the Mississippi St Louis encephalitis, another arthropod-borne late-summer encephalitis, occurs nationwide but especially along the Mississippi River in the South; outbreaks occur in August through.

OLAP Universe Element Class A class with dimension and detail objects (detail objects for key and description) A class containing a dimension and detail objects for each hierarchy level Measure element in a class named key figures (information about the calculation is not available via the universe but the CKF is available to be used) Measure element in a class named key figures (information about the restriction is not available via the universe but the RKF is available to be used) Measure element in a class named key figures A class with dimension and detail objects (detail objects for key and description) Each display attribute becomes a detail object underneath the related dimension object Filters will be applied to the underlying query but are not visible in OLAP universe Query filter as predefined object, which can be optional or mandatory Dimension object

If options have elevated implied volatility in high volume, the value is justi ed by the demand of high-volume traders such as hedge funds and arbitrage traders High implied volatility in high volume creates more legitimacy to the theoretical option value In thin markets implied volatility can have a different skew because of the odd option trade at higher-than-expected implied volatility Thin markets also offer opportunity for the brave sellers who may choose to sell in uncharted territory When offering options that do not yet have trade established or where little trade has been established, you will be relying on your option model to provide a best-guess theoretical value for the option in question These are usually speculative opportunities and not necessarily part of any portfolio hedge strategy since they cannot be counted on to ll in a timely fashion On a broad basis if we look at active options as fairly valued most of the time because of the ability of large traders to take quick advantage of arbitrage opportunities between the underlying asset and the related options We mostly have to be concerned with why the implied volatility of an option is high and what forces would cause the volatility to remain high, go higher, or go lower The forces that drive markets are also what drive options, both technical and fundamental Options can have independent forces resulting from a particular high-volume trader or group of highvolume traders targeting a speci c strike price or group of strike prices In our bond example in the last chapter, we discussed selling call options on the December US T-bond 122 call option as a potential hedge for interest-rate changes Our example was on $1 million or 10 options What if a trader was doing 1,000 of those call options to cover $100 million in value One hundred.

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