A case of vitamin B12 deficiency neurological syndrome in a young adult due to late-onset cobalamin C (CblC) deficiency: a diagnostic challenge

Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic anaemia. We describe a case of late-onset cobalamin C deficiency which typically presents with normal serum vitamin B12 concentrations, posing an additional diagnostic challenge. A 23-year-old woman with decreased muscle strength and hallucinations was diagnosed with ‘catatonic depression’ and admitted to a residential mental health facility. She was referred to our hospital for further investigation 3 months later. Heteroanamnesis revealed that the symptoms had been evolving progressively over several months. Magnetic resonance imaging (MRI) of the brain showed diffuse symmetrical white matter lesions in both hemispheres. Routine laboratory tests including vitamin B12 and folic acid were normal except for a slight normocytic, normochromic anaemia. Over the next 6 weeks her symptoms deteriorated, and she became unresponsive to stimuli. A new MRI scan showed progression of the white matter lesions. The neurologist requested plasma homocysteine (Hcys) which was more than 8 times the upper limit of normal. Further testing revealed increased methylmalonic acid and the patient was diagnosed with adult-onset cobalamin C deficiency. This case illustrates that Hcys and/or methylmalonic acid should be determined in patients presenting with neuropsychiatric symptoms suggestive of vitamin B12 deficiency with a normal serum vitamin B12 to rule out a late-onset cobalamin C deficiency.     

Beyond the Blockbuster: Good Exhibitions in Small Packages

Many American and European art museums are now featuring small, highly-focused shows in their exhibition programs. In 1990, the Indianapolis Museum of Art organized an exhibition that reunited, for the first time in a century, the four landscape paintings created by neo-impressionist Georges Seurat during the last summer of his life. Using Seurat at Gravelines: The Last Landscapes as an example, this article addresses the advantages — for museums and their visitors — of the small temporary exhibition.     

School phobia and separation anxiety: Diagnostic and treatment comparisons

There exists substantial confusion regarding the comparative diagnostic criteria and treatment implications for school phobia and separation anxiety. A literature survey demonstrates the tendency of school personnel to put all youngsters exhibiting these disorders into one group called “school refusers.” Treatment issues are handled in a similar fashion despite accumulating evidence of treatment-relevant differences between the disorders. Variables that facilitate a finer diagnostic discrimination are presented. After reviewing pertinent treatment distinctions between the two disorders, specific behaviorally oriented methods are recommended.     

Maximizing recovery time between knock-out races improves sprint cross-country skiing performance

Background:In a sprint cross-country(XC)ski competition,the difference in recovery times separating the first and the second semi-final(SF)heats from the final(F)may affect performance.The aim of the current study was to compare the effects of longer vs.shorter recovery periods prescribed between the 3 knock-out races of a simulated sprint XC ski competition involving a prologue(P),quarter-final(QF),SF,and F.Methods:Eleven well-trained XC ski athletes completed 2 simulated sprint XC ski competitions on a treadmill involving 4×883-m roller-ski bouts at a 4°incline using the gear 3 ski-skating sub-technique.The first 3 bouts were completed at a fixed speed(PFIX,QFFIX,and SFFIX)corresponding to~96%of each individual’s previously determined maximal effort.The final bout was performed as a self-paced sprint time trial(FSTT).Test conditions differed by the time durations prescribed between the QFFIX,SFFIX,and FSTT,which simulated real-world XC ski competition conditions using maximum(MAX-REC)or minimum(MIN-REC)recovery periods.Results:The FSTT was completed 5.4±5.5 s faster(p=0.009)during MAX-REC(179.2±18.1 s)compared to MIN-REC(184.6±20.0 s),and this was linked to a significantly higher power output(p=0.010)and total metabolic rate(p=0.009).The pre FSTT blood lactate(BLa)concentration was significantly lower during MAX-REC compared to MIN-REC(2.5±0.8 mmol/L vs.3.6±1.6 mmol/L,respectively;p=0.027),and the pre-to-post FSTT increase in BLa was greater(8.8±2.1 mmol/L vs.7.1±2.3 mmol/L,respectively;p=0.024).No other differences for MAX-REC vs.MIN-REC reached significance(p>0.05).Conclusion:Performance in a group of well-trained XC skiers is negatively affected when recovery times between sprint heats are minimized which,in competition conditions,would occur when selecting the last QF heat.This result is combined with a higher pre-race BLa concentration and a reduced rise in BLa concentration under shorter recovery conditions.These findings may help inform decision making when XC skiers are faced with selecting a QF heat within a sprint competition.     

‘This could be our reality in the next five to ten years’: a blogpost platform as an expectation generation device on the future of insurance markets

William James (1919) characterises hypotheses as either live or dead. A hypothesis is live when it is taken into account as a ‘real possibility’. We follow James’ suggestion to not attribute intrinsic properties to hypotheses, but rather investigate how they came into being and look at the effects they generate. Expectations of digital technologies are a topic of vivid debate in the insurance industry. Before these expectations can become ‘live’, they have, in the first place, to be generated by market devices. We investigate how the reinsurance blogpost platform Open Minds functions as an ‘expectation generation device’ on the future of insurance markets. Combining Beckert’s work on the role of fictional expectations with the pragmatist turn in sociology of markets, we propose to study ‘expectation generation devices’, provoking expectations on economic markets. In our empirical analysis, we demonstrate the explicit fictional character of the Open Minds contributions, and analyse how a contained space of openness is generated to provoke expectations. We demonstrate how Open Minds can become live through circulation to other expectation generation sites in the insurance industry and beyond. We conclude by reflecting on the importance of expectation generation devices as a particular type of market devices.     

A novel sleep optimisation programme to improve athletes’ well-being and performance

Objectives: To improve well-being and performance indicators in a group of Australian Football League (AFL) players via a six-week sleep optimisation programme. Design: Prospective intervention study following observations suggestive of reduced sleep and excessive daytime sleepiness in an AFL group. Methods: Athletes from the Adelaide Football Club were invited to participate if they had played AFL senior-level football for 1–5 years, or if they had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >10), measured via ESS. An initial education session explained normal sleep needs, and how to achieve increased sleep duration and quality. Participants (n?=?25) received ongoing feedback on their sleep, and a mid-programme education and feedback session. Sleep duration, quality and related outcomes were measured during week one and at the conclusion of the six-week intervention period using sleep diaries, actigraphy, ESS, Pittsburgh Sleep Quality Index, Profile of Mood States, Training Distress Scale, Perceived Stress Scale and the Psychomotor Vigilance Task. Results: Sleep diaries demonstrated an increase in total sleep time of approximately 20?min (498.8?±?53.8 to 518.7?±?34.3; p?<?.05) and a 2% increase in sleep efficiency (p?<?0.05). There was a corresponding increase in vigour (p?<?0.001) and decrease in fatigue (p?<?0.05). Conclusions: Improvements in measures of sleep efficiency, fatigue and vigour indicate that a sleep optimisation programme may improve athletes’ well-being. More research is required into the effects of sleep optimisation on athletic performance.     

Is there really an eccentric action of the hamstrings during the swing phase of high-speed running? part I: A critical review of the literature

It is widely assumed that there is an eccentric hamstring muscle fibre action during the swing phase of high-speed running. However, animal and modelling studies in humans show that the increasing distance between musculotendinous attachment points during forward swing is primarily due to passive lengthening associated with the take-up of muscle slack. Later in the swing phase, the contractile element (CE) maintains a near isometric action while the series elastic (tendinous) element first stretches as the knee extends, and then recoils causing the swing leg to forcefully retract prior to ground contact. Although modelling studies showed some active lengthening of the contractile (muscular) element during the mid-swing phase of high-speed running, we argue that the increasing distance between the attachment points should not be interpreted as an eccentric action of the CE due to the effects of muscle slack. Therefore, there may actually be no significant eccentric, but rather predominantly an isometric action of the hamstrings CE during the swing phase of high-speed running when the attachment points of the hamstrings are moving apart. Based on this, we propose that isometric rather than eccentric exercises are a more specific way of conditioning the hamstrings for high-speed running.