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Monogenic forms of diabetes that develop with autosomal dominant inheritance are classically aggregated in the Maturity-Onset Diabetes of the Young (MODY) categories. Despite increasing awareness, its true prevalence remains largely underestimated. We describe a Portuguese cohort of individuals with suspected monogenic diabetes who were genetically evaluated for MODY-causing genes.This single-center retrospective cohort study enrolled patients with positive genetic testing for MODY between 2015 and 2021. Automatic sequencing and, in case of initial negative results, next-generation sequencing were performed. Their clinical and molecular characteristics were described.Eighty individuals were included, 55 with likely pathogenic/pathogenic variants in one of the MODY genes and 25 MODY-positive family members, identified by cascade genetic testing. The median age at diabetes diagnosis was 23 years, with a median HbA1c of 6.5%. The most frequently mutated genes were identified in HNF1A (40%), GCK (34%) and HNF4A (13%), followed by PDX1, HNF1B, INS, KCNJ11 and APPL1. Thirty-six unique variants were found (29 missense and 7 frameshift variants), of which ten (28%) were novel.Our data highlights the importance of genetic testing in the diagnosis of MODY and the establishment of its subtypes, leading to more personalized treatment and follow-up strategies.

Rita, P., Tiago, M. T. B., & Caetano, J. (2023). The theory-practice research gains from big data: Evidence from hospitality loyalty programs. International Journal of Contemporary Hospitality Management. https://doi.org/10.1108/IJCHM-05-2022-0646 --- This work was supported by national funds through FCT (Fundação para a Ciência e a Tecnologia), under the project – UIDB/04152/2020 - Centro de Investigação em Gestão de Informação (MagIC)/NOVA IMS, research grants UIDB/04521/2020 of the Advance/CSG, ISEG – Lisbon School of Economics and Management; and UIDB/00685/2020 of the Centre of Applied Economics Studies of the Atlantic, School of Business and Economics of the University of the Azores. Purpose The hospitality industry values segmentation and loyalty programs (LPs), but there is limited research on new methods for segmenting loyalty program members, so managers often rely on conventional techniques. This study aims to use big data-driven segmentation methods to cluster customers and provide a new solution for customer segmentation in hotel LPs. Design/methodology/approach Using the k-means algorithm, this study examined 498,655 profiles of guests enrolled in a multinational hotel chain’s loyalty program. The objective was to cluster guests according to their consumption behavior and monetary value and compare data-driven segments based on brand preferences, demographic data and monetary value with loyalty program tiers. Findings This study shows that current tier-based LPs lack features to improve customer segmentation, and some high-tier members generate less revenue than low-tier members. Therefore, more attention should be given to truly valuable customers. Practical implications Hotels can segment LP members to develop targeted campaigns and uncover new insights. This will help to transform LPs to make them more valuable and profitable and use differentiated rewards and strategies. Originality/value As not all guests or hotel brands benefit equally from LPs, additional segmentation is required to suit varying guest behaviors. Hotel managers can use data mining techniques to develop more efficient and valuable LPs with personalized strategies and rewards. authorsversion epub_ahead_of_print

Purpose The hospitality industry values segmentation and loyalty programs (LPs), but there is limited research on new methods for segmenting loyalty program members, so managers often rely on conventional techniques. This study aims to use big data-driven segmentation methods to cluster customers and provide a new solution for customer segmentation in hotel LPs. Design/methodology/approach Using the k-means algorithm, this study examined 498,655 profiles of guests enrolled in a multinational hotel chain’s loyalty program. The objective was to cluster guests according to their consumption behavior and monetary value and compare data-driven segments based on brand preferences, demographic data and monetary value with loyalty program tiers. Findings This study shows that current tier-based LPs lack features to improve customer segmentation, and some high-tier members generate less revenue than low-tier members. Therefore, more attention should be given to truly valuable customers. Practical implications Hotels can segment LP members to develop targeted campaigns and uncover new insights. This will help to transform LPs to make them more valuable and profitable and use differentiated rewards and strategies. Originality/value As not all guests or hotel brands benefit equally from LPs, additional segmentation is required to suit varying guest behaviors. Hotel managers can use data mining techniques to develop more efficient and valuable LPs with personalized strategies and rewards.

The COVID-19 pandemic brought lockdowns upon consumers and firms alike, and social media became the vehicle by which brands attract more customers into their sales funnels. Accordingly, firm-generated content (FGC) has become a popular tool, allowing brands to use various content types to show consumers sharable, informative, and comment-worthy information. From the customer's perspective, this content type competes with, and complements, user-generated content (UGC). As current research focuses mainly on UGC, several questions regarding the social media marketing role of FGC, remain unanswered. Hence, this study aims to explain how FGC influences customer purchase intention, using online survey data. We use partial least squares structural equation modeling to analyze the data and determine users' attitudes toward FGC. The findings suggest that FGC negatively influences purchase intention and has little effect on brand equity and attitude. These results challenge marketers to rethink their online marketing strategies.

International audience; One of the aims of the European Human Biomonitoring Initiative, HBM4EU, was to provide examples of and good practices for the effective use of human biomonitoring (HBM) data in human health risk assessment (RA). The need for such information is pressing, as previous research has indicated that regulatory risk assessors generally lack knowledge and experience of the use of HBM data in RA. By recognising this gap in expertise, as well as the added value of incorporating HBM data into RA, this paper aims to support the integration of HBM into regulatory RA. Based on the work of the HBM4EU, we provide examples of different approaches to including HBM in RA and in estimations of the environmental burden of disease (EBoD), the benefits and pitfalls involved, information on the important methodological aspects to consider, and recommendations on how to overcome obstacles. The examples are derived from RAs or EBoD estimations made under the HBM4EU for the following HBM4EU priority substances: acrylamide, o-toluidine of the aniline family, aprotic solvents, arsenic, bisphenols, cadmium, diisocyanates, flame retardants, hexavalent chromium [Cr(VI)], lead, mercury, mixture of per-/poly-fluorinated compounds, mixture of pesticides, mixture of phthalates, mycotoxins, polycyclic aromatic hydrocarbons (PAHs), and the UV-filter benzophenone-3. Although the RA and EBoD work presented here is not intended to have direct regulatory implications, the results can be useful for raising awareness of possibly needed policy actions, as newly generated HBM data from HBM4EU on the current exposure of the EU population has been used in many RAs and EBoD estimations.

The recovery of degraded marine coasts and the improvement of natural habitats are current issues of vital importance for the development of life, both marine and terrestrial. In this sense, the immersion of artificial reefs (ARs) in the marine environment is a way to stimulate the recovery of these damaged ecosystems. But it is necessary to have a multidisciplinary approach that analyses the materials, designs and construction process of artificial reefs in order to understand their true impact on the environment. For this reason, this paper presents the manufacture of artificial reefs by 3D printing, proposing designs with a combination of prismatic and random shapes, with different external overhangs as well as inner holes. For the definition of the artificial reef designs, criteria provided by marine biologists and the results obtained from a numerical simulation with ANSYS were taken into account, with which the stability of the artificial reefs on the seabed was analysed. Three dosages of cement mortars and three dosages of geopolymer mortars were studied as impression materials. The studies included determination of the rheological properties of the mortars, to define the printability, determination of the cost of the materials used, and determination of the mechanical strength and biological receptivity in prismatic specimens that were immersed in the sea for 3 months. To evaluate the environmental impact of the materials used in the production of the mortars, a Life Cycle Assessment (LCA) was carried out. In order to choose the mortars that encompassed the best properties studied, Multi-Criteria Decision Making (MCDM) was applied and the two best mortars were used for the manufacture of the artificial reefs. Finally, the advantages and disadvantages of the 3D printing process used were analysed. The results of the studies carried out in this research show that cement mortars have better characteristics for artificial reef applications using 3D printing, and that the technique applied for the manufacture of the artificial reefs allowed the digital models to be faithfully reproduced. This work has been co-financed by the European Regional Development Fund through the Interreg Atlantic Area Programme, under the project “Artificial Reef 3D Printing for Atlantic Area - 3DPARE” (EAPA_174/2016). Besides, the authors want to thank the following companies for their contribution: Solvay, for supplying the fly ash and sodium hydroxide; BASF, for providing the additives used in the research; Abonomar S.L., for providing the seashells sand; FCC ámbito, for providing the crushed recycled glass and Grupo Cementos Portland Valderribas (Mataporquera plant) for providing the cement.

Objectives Pituitary apoplexy is a rare complication of Cushing’s disease (CD), especially in the paediatric age and even more rarely it can occur following anterior pituitary stimulation tests. Case presentation We report a case of a 14-year-old girl who was admitted to our Hospital for evaluation of a possible Cushing’s syndrome (CS). Her symptoms and initial laboratory tests were suggestive of CD. Magnetic resonance imaging (MRI) revealed a microadenoma of the pituitary gland. As part of her evaluation she was submitted to a corticotropin-releasing hormone (CRH) stimulation test. Two and a half months later the patient was re-evaluated and presented with both clinical improvement of CS, biochemical resolution of hypercortisolism and tumour size reduction in the MRI, also evidencing a haemorrhagic component favouring the diagnosis of pituitary apoplexy after CRH stimulation test. The patient denied any episodes of severe headache, nausea, vomiting or visual changes. Conclusions To our knowledge, the authors report the first case of a pituitary apoplexy after a CRH stimulation test in the paediatric age.

The relevance of sustainable tourism is unquestionable. Tourism and hospitality firms worldwide are moving toward more sustainable product offerings. However, not all firms communicate their achievements and commitments in this area. This study assesses the sustainable digital communication of small and medium accommodation firms and relates that information to the sophistication of their online presence. For this purpose, data were retrieved from the websites of 759 accommodation firms located in the Azores (São Miguel Island), classified as a sustainable island destination. The results indicate that international accreditations are less commonly adopted than local accreditations and that smaller firms tend to value eco-labeling when promoting their offers online. It is also noticed that sustainable achievements are highlighted on more sophisticated websites. This is one of the first studies to explore online sustainability communication; more specifically, the link with website sophistication among tourism SMEs. It is hoped that this study will stimulate further research on communication and SME practices on tourism sustainability and improve policy efforts to promote wider adoption of sound practices. We gratefully acknowledge financial support from FCT-Fundacao para a Ciencia e Tecnologia (Portugal), national funding through research grant UIDB/04521/2020 of the Advance/CSG, ISEG and (UID/ECO/00685/2016) of the Centre of Applied Economics Studies of the Atlantic, and the Project ACORES-01-0145-FEDER-000017 from ACORES 2020, through FEDER -European Union. info:eu-repo/semantics/publishedVersion

[EN] This study examines brands' vulnerability to fake news. The rapid spread of online misinformation poses challenges to brand managers, whose brands are cocreated online, sometimes to the detriment of the brand. There is a need to identify the information sources that are likely to be trustworthy and to promote positive consumer attitudes toward brands. The data for this study were taken from a Flash Eurobarometer of 26,576 respondents across 28 European countries. Cluster analysis and partial least squares structural equation modeling were used to analyze the data and unveil users' attitudes toward fake news. The findings show that users' attitudes toward fake news differ among European countries. Younger and tech-savvy users are more likely to recognize fake news and are consequently able to evaluate digital information sources without relying on policy interventions to limit the impact of fake news. Brand managers can use the findings of this study to better understand different kinds of users' susceptibility to fake news and reshape their social media branding strategies accordingly. It is hoped that this paper will encourage further research on brand management in relation to fake news and promote the widespread adoption of best practices in social media communication., Fundação Ciência e Tecnologia, Portugal, Grant/Award Numbers: IDB/00685/2020 CEEAplA, UIDB/04521/2020 Advance/CSG

In less than two decades, social media has become a part of life for many people, increasing the positive and negative effects of social relationships. In a sense, the traditional offline behaviors moved into a ubiquitous environment, enhancing the social phenomenon of cyberbullying. Thus, it attracted much attention from different fields within academia. To understand how research has been conducted in the last 20 years and the topics addressed, this study applied a bibliometric analysis to academic literature from 2000 to 2020 related to cyberbullying in social media, using techniques such as citation analysis, co-citation analysis, and content analysis. The growing interest of the field is confirmed, and some research gaps are unveiled. Since this is one of the first studies to explore cyberbullying that occurs in social media networks, it is hoped that this chapter will stimulate further research on this topic reinforcing the gaps found.

In the graduate course in Dentistry at the University Center of Patos de Minas, several in-person activities of the Teaching, Service, and Community Integration (INESC) internship had to be suspended due to the COVID-19 pandemic, as recommended by health authorities. This article aims to report the experience of applying the concepts of health education in remote education through the production of videos shared by eighth-period students enrolled in this internship. The steps for preparing a script, with language adaptation, and the use of the conative function were completed, as well as the use of playful resources. In general, teachers and students have perceived the power and reach of digital tools, which, in addition to transforming and enriching the academic training and preparing students for a new post-pandemic reality, are also perennial tools of social transformation, that can be used in different contexts and places, expanding the access of the population to educational measures in oral health. En el curso de pregrado de Odontología del Centro Universitario de Patos de Minas (UNIPAM), varias actividades de la pasantía Integración Docente, Servicio y Comunidad (INESC) tuvieron que ser suspendidas de su forma presencial, según recomendación de las autoridades sanitarias, debido a la pandemia de COVID-19. El objetivo de este artículo es relatar la experiencia de estudiantes de octavo período, matriculados en la pasantía Integración Docente, Servicio y Comunidad (INESC) del curso de Odontología del Centro Universitario de Patos de Minas (UNIPAM) con la aplicación de los conceptos de educación en salud en la enseñanza a distancia a través del uso de videos de creación compartida en acciones educativas en salud. Se cumplieron los pasos de elaboración de un guión textual, con lenguaje apropiado y uso de la función conativa, así como el uso de recursos lúdicos. En general, se percibió, tanto por parte de los profesores como de los alumnos, el poder y el alcance del material que utiliza las herramientas digitales, que a la vez que transforman y enriquecen la formación académica preparando a los alumnos para la realidad post-pandémica, también se convierten en herramientas perennes de transformación social, pudiendo ser utilizadas en diversos contextos y lugares, aumentando el acceso universal de la población a las medidas preventivas y educativas. No curso de graduação em Odontologia do Centro Universitário de Patos de Minas, diversas atividades do estágio Integração Ensino, Serviço e Comunidade (INESC) tiveram que ser suspensas em sua forma presencial, conforme recomendações das autoridades sanitárias, devido à pandemia da COVID-19. O objetivo deste artigo é relatar a experiência da aplicação dos conceitos de educação em saúde no ensino remoto por meio da confecção de vídeos de criação compartilhada por estudantes do oitavo período, matriculados no estágio INESC. As etapas de elaboração de roteiro textual, com adequação de linguagem e uso da função conativa foram cumpridas, bem como o uso dos recursos lúdicos. De maneira geral, foi percebido, tanto pelos docentes quanto pelos próprios alunos, a potência e o alcance do material utilizando as ferramentas digitais, que além de transformarem e enriquecerem a formação acadêmica, preparando os estudantes para uma nova realidade pós-pandemia, também são ferramentas perenes de transformação social, podendo ser utilizadas em diversos contextos e locais, ampliando o acesso da população às medidas educativas em saúde bucal.

Tourism and hospitality actors face an unprecedented challenge in reigniting these industries through digital communication. All past knowledge regarding tourist behavior and preferences has been rendered irrelevant since the outbreak of the COVID-19 pandemic and its resulting enforced changes. Several reports have pointed to the existence of a travel sentiment that may be actionable by communication. This work attempts to reveal some of the elements that may compose this travel sentiment. To pursue this aim, an online pilot survey was conducted among those who were regular travelers before the COVID-19 outbreak. The data was used to validate the conceptual model through a partial least squares structural equation model estimation. The findings revealed that travel constraints are the most influential dimension, along with social media and technology usage, in affecting tourist behavior. Thus, in their communication strategy, tourism and hospitality players should reinforce the health- and hygiene-related measures taken, while simultaneously promoting the trustworthiness of the shared information.

With the pandemic of COVID-19, and the social distancing imposed by it, there was the need to develop strategies for the teaching-learning process to be maintained. Thus, concepts such as ubiquitous learning and mobile learning have started to appear among students, professors, and the entire academic community, including dentistry courses. Thus, the understanding of these non-traditional forms of learning becomes necessary, so that their application can be done in a responsible way. The objective of this work was to characterize mobile and ubiquitous learning and its applications in dentistry. An integrative literature review was conducted using the PubMed and Scielo databases. The search strategy considered the terms: "mobile learning and dentistry" "ubiquitous learning and dentistry" and their corresponding terms in English "mobile learning and dentistry", over a period of 10 years (2011 to 2021). The descriptive analysis, in the light of the national and international scientific literature, allowed grouping a sample of eight articles with scientific evidence to characterize mobile and ubiquitous learning and its applications in dentistry, identify which tools are used for this purpose and their impact on the teaching-learning process. Based on the above, the new reality imposed and accelerated by the COVID-19 pandemic, regarding the use of digital teaching-learning tools, especially mobile and ubiquitous learning, is possible and has already proven to be effective, especially when associated with face-to-face meetings, although further studies are needed to verify its direct impacts on students and teachers. Con la pandemia del COVID-19, y el distanciamiento social que impuso, fue necesario elaborar estrategias para que el proceso de enseñanza-aprendizaje pudiera mantenerse. Así, conceptos como aprendizaje ubicuo y aprendizaje móvil empezaron a aparecer entre los estudiantes, los profesores y toda la comunidad académica, incluso en los cursos de odontología. Así, la comprensión de estas formas no tradicionales de aprendizaje se hace necesaria para aplicarlas de forma responsable. El objetivo de este trabajo fue caracterizar el aprendizaje móvil y ubicuo y sus aplicaciones en Odontología. Se realizó una revisión bibliográfica integradora utilizando las bases de datos PubMed y Scielo. La estrategia de búsqueda consideró los términos: "mobile learning and dentistry", "ubiquitous learning and dentistry" y sus correspondientes en inglés: "mobile learning and dentistry", "ubiquitous learning and dentistry", durante un periodo de 10 años (2011 a 2021). El análisis descriptivo, a la luz de la literatura científica nacional e internacional, permitió agrupar una muestra de ocho artículos con evidencia científica para caracterizar el aprendizaje móvil y ubicuo y sus aplicaciones en Odontología, identificar qué herramientas se utilizan para este fin y su impacto en el proceso de enseñanza-aprendizaje. A partir de lo expuesto, se puede notar que la nueva realidad impuesta y acelerada por la pandemia del COVID-19, en relación con el uso de herramientas digitales de enseñanza-aprendizaje, especialmente el aprendizaje móvil y ubicuo, es posible y ya es efectiva, principalmente cuando se asocia a los encuentros presenciales, aunque son necesarios más estudios para verificar sus impactos directos en los alumnos y profesores. Com a pandemia da COVID-19, e o distanciamento social imposto por ela houve necessidade de se elaborar estratégias para que o processo ensino-aprendizagem fosse mantido. Dessa forma conceitos como aprendizagem ubíqua e aprendizagem móvel passaram a figurar entre estudantes, professores e toda a comunidade acadêmica, inclusive nos cursos de Odontologia. Sendo assim a compreensão sobre essas formas não tradicionais de aprendizagem se torna necessária, no intuito de que sua aplicação seja feita de maneira responsável. O objetivo deste trabalho foi caracterizar a aprendizagem móvel e ubíqua e suas aplicações em Odontologia. Foi realizada uma revisão integrativa da literatura realizada por meio das bases PubMed e Scielo. A estratégia de busca considerou os termos:” aprendizagem móvel e odontologia” “aprendizagem ubíqua e odontologia” e seus correspondentes em inglês “mobile learning and dentistry”” ubiquitous learning and dentistry”, em um período de 10 anos (2011 a 2021). A análise descritiva, à luz da literatura científica nacional e internacional, permitiu agrupar uma amostra de oito artigos com evidências científicas de maneira a caracterizar a aprendizagem móvel e ubíqua e suas aplicações em Odontologia, identificar quais as ferramentas utilizadas para esse fim e seu impacto no processo ensino-aprendizagem. A partir do exposto percebe-se que a nova realidade imposta e acelerada pela pandemia da COVID-19, em relação ao uso das ferramentas digitais de ensino-aprendizagem, especialmente a aprendizagem móvel e ubíqua, é possível e já se mostra eficaz principalmente quando associada aos encontros presenciais, embora mais estudos sejam necessários para verificar seus impactos diretos sobre estudantes e docentes.

Hyaluronic acid is a substance that is becoming increasingly popular in minimally invasive aesthetic procedures on the face. Although the human body itself has endogenous hyaluronic acid, it becomes scarce over the years with the natural aging of the skin, resulting in loss of volume and decay throughout the face. Given this, hyaluronic acid dermal fillers appeared, which have the capacity of volumizing soft tissues and promoting harmony and aesthetics to the face. Therefore, this study aimed to investigate the knowledge of the use of hyaluronic acid in facial filling interventions taking into consideration its properties, the level of effectiveness and possible complications. This study consisted of a basic, qualitative, descriptive integrative review based on the PubMed and Virtual Health Library search platforms, exploring the terms hyaluronic acid, hyaluronan, dermal fillers, and aesthetics. Articles were included in the time range from 2016 to 2021 in the English language and the search yielded 16 articles. The selected articles showed that the use of hyaluronic acid brings great levels of effectiveness and satisfaction to patients, but evidenced the need for retreatment sessions months later for maintenance, it is safe, because the most common complications cease mostly within two weeks and without the need for intervention, besides being a substance with excellent properties and rheological characteristics. It can be concluded that the use of hyaluronic acid is effective, safe and has ideal properties in dermal facial filling. El ácido hialurónico es una sustancia cada vez más popular en los procedimientos estéticos mínimamente invasivos en el rostro. Aunque el propio cuerpo humano dispone de ácido hialurónico endógeno, éste va escaseando con el paso de los años con el envejecimiento natural de la piel, lo que provoca una pérdida de volumen y decaimiento en toda la extensión del rostro. Ante esto, aparecieron los rellenos dérmicos de ácido hialurónico, que tienen la capacidad de voluminizar los tejidos blandos y promover la armonía y la estética del rostro. Por lo tanto, este estudio tenía como objetivo investigar el conocimiento del uso del ácido hialurónico en las intervenciones de relleno facial teniendo en cuenta sus propiedades, el nivel de eficacia y las posibles complicaciones. Este estudio consistió en una revisión básica, cualitativa, descriptiva e integradora basada en las plataformas de investigación PubMed y Biblioteca Virtual em Saúde, explorando los términos ácido hialurónico, hialuronano, rellenos dérmicos y estética. Se incluyeron artículos en el intervalo de tiempo de 2016 a 2021 en lengua inglesa y la búsqueda arrojó 16 artículos. Los artículos seleccionados mostraron que el uso del ácido hialurónico aporta grandes niveles de efectividad y satisfacción a los pacientes, pero mostraron la necesidad de sesiones de retratamiento meses después para su mantenimiento, es seguro, pues las complicaciones más comunes cesan en su mayoría en dos semanas y sin necesidad de intervención, además de ser una sustancia con excelentes propiedades y características reológicas. Se puede concluir que el uso del ácido hialurónico es eficaz, seguro y tiene propiedades ideales en el relleno dérmico facial. O ácido hialurônico é uma substância que se torna cada vez mais popular em procedimentos estéticos minimamente invasivos na face. Apesar de o próprio corpo humano possuir ácido hialurônico endógeno, o mesmo torna-se escasso ao longo dos anos com o envelhecimento natural da pele, acarretando em perda de volume e decaimento em toda extensão facial. Dado isso, surgiram os preenchimentos dérmicos de ácido hialurônico os quais possuem capacidade de volumizar tecidos moles e promover harmonia e estética à face. Portanto, este estudo teve por objetivo investigar o conhecimento do uso do ácido hialurônico em intervenções de preenchimento facial levando em consideração suas propriedades, o nível de eficácia e as possíveis complicações. Este estudo consistiu de uma revisão integrativa de caráter básico, qualitativa, descritiva e teve por base as plataformas de pesquisa PubMed e Biblioteca Virtual em Saúde explorando os termos ácido hialurônico, hialuronano, preenchedores dérmicos e estética. Foram incluídos artigos no intervalo de tempo de 2016 a 2021 na língua inglesa e a busca decorreu em 16 artigos. Os artigos selecionados demonstraram que o uso do ácido hialurônico traz ótimos níveis de eficácia e satisfação aos pacientes, porém evidenciaram a necessidade de sessões de retratamento meses depois para manutenção, é seguro, pois as complicações mais comuns cessam em sua maioria, até duas semanas e sem necessidade de intervenção, além de ser uma substância com excelentes propriedades e características reológicas. Pode-se concluir que o uso de ácido hialurônico é eficaz, seguro e possui propriedades ideias em preenchimento dérmico facial.

A 14-year-old girl presented to our pediatric neurology clinic with complaints of hand jerks noticed since age 6. The girl reported jerky hand movements that became more severe with time and interfered with daily tasks, particularly eating and writing. Jerks worsened with action and with sudden sound stimulus, were not voluntarily suppressed, and sometimes resulted in accidental item dropping. Responsiveness to alcohol was unknown.