Talk:Huntington's disease/GA2

GA Review

I will be reviewing this article, so please expect a long list of constructive advice below. While I make my recommendations, could I quickly point out the following issues:

Done The article currently does not follow the header names suggested by WP:MEDMOS.
Done Several references (e.g. 79-84) are not templated. Others lack PMID, DOI or ISBN codes that would help the reader locate the source quickly.

These details have been filled up by numerous editors since review LeeVJ (talk) 15:03, 14 March 2009 (UTC)[reply]

Done Some sections are very short, suggesting that they should either be expanded or merged with others.

Apart from BDNF which is new. LeeVJ (talk) 15:03, 14 March 2009 (UTC)[reply]

Here is the continued review:

Here we go then. I will provide individual comments that are each signed, so it is easy to keep track of what I have had to say and what the response may have been. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

Done General: any hope of more pictures? JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
- would the ones in the todo list satisfy this? LeeVJ (talk) 23:12, 17 August 2008 (UTC)[reply]
  - Yes. JFW | T@lk 23:20, 17 August 2008 (UTC)[reply]
    - Global map and molecule will have to wait until they are available, CAG graph when a free image becomes available - or are created from scratch. L∴V 00:04, 2 April 2009 (UTC)[reply]
Done General: some of the secondary sources used are excellent, yet some sections seem to use primary sources where one would imagine the secondary sources to be able to supply the necessary background. I will flag this up whenever possible. Perhaps bring some of the sources from "Bibliography" into the footnotes apparatus? JFW | T@lk 23:21, 14 August 2008 (UTC) bibliography now incorporated into refs[reply]

Garrondo has done an epic job of secondary rerefercing and weeding out unneccesary primaries. L∴V 00:04, 2 April 2009 (UTC)[reply]

Done General: I was quite surprised to see no mention of Ian McEwan's excellent novel Saturday, in which HD plays a significant role and the literary description he makes is quite accurate. This is definitely not WP:TRIVIA. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
- This is listed in the media depictions subarticle, see later point...LeeVJ (talk) 21:13, 19 August 2008 (UTC)[reply]
Done Intro: perhaps a bit more clinical information (which mental abilities are affected?) and slightly less hard scientific terminology. The intro needs to be as plain as possible, however fascinating CAG repeats are. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

started LeeVJ (talk) 00:17, 20 October 2008 (UTC)[reply]

Done Intro: I feel that every statement should be supported by a single source, unless that is genuinely impossible. WP:CITE applies to the entire article, which includes the intro. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

bar first genetic test which is covered by another pointLeeVJ (talk) 13:23, 26 August 2008 (UTC)[reply]

Done Signs and symptoms - Intro: comment on the difference between JHD and HD should probably be moved to the physical symptoms section. I have rewritten the section a bit, and the statement can readily be moved. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
Done Signs and symptoms - Physical: when do bradykinesia & dystonia occur? Instead of, or in addition to, the choreatiform movements? Can anything be said about their signifcance, or should they just be mentioned alongside the chorea? JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

Expanded description, think it is clearer now L∴V 00:28, 6 April 2009 (UTC)[reply]

Signs and symptoms - Physical: "slurring of speech" - can anything be said about the nature of the dysarthria? "Slurring" is nonspecific and could be bulbar, ataxic etc. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

The wording slurring of speech does not appear any more in the article. What is left is "any function that requires muscle control is affected, resulting in physical instability, abnormal facial expression, and difficulties chewing, swallowing and speaking" Is it enough?--Garrondo (talk) 08:18, 2 April 2009 (UTC)[reply]

Done √ Sorry missed the question amongst the others - good point in that context I think it's ok L∴V 00:12, 6 April 2009 (UTC)[reply]

Done Signs and symptoms - Physical: entire section about TP53 is completely off-topic and needs to be moved. The sources are also more than doubtful, and probably fail WP:MEDRS. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
DoneSigns and symptoms - Cognitive: source definitely fails MEDRS. Can't readily comment on the content of the section. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

now referenced to Lancet. L∴V 01:47, 2 April 2009 (UTC)[reply]

Done Signs and symptoms - Psychopathological: rename section "psychiatric"? Less confusing, perhaps a bit more confrontational. Are there any good secondary sources here? JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
- Name changed, refs to come...LeeVJ (talk) 21:13, 19 August 2008 (UTC)[reply]
  - Now referenced by Garrondo.L∴V 00:04, 2 April 2009 (UTC)[reply]
Done Genetics: strong section, not much comments. Do we know why only paternal CAG repeats exhibit expansion and cause anticipation? If not, perhaps we should say that this is unknown. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

Done: I have added: This occurs because instability is greater in spermatogenesis than oogenesis (obtained from lancet seminar)--Garrondo (talk) 08:18, 2 April 2009 (UTC)[reply]

Mechanism: the Imarisio et al source seems underused. Being a secondary source in a core journal, it looks ideal, although it is unfree. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

Has been rereferenced, but I don't think anyone has had access to the ref suggested. L∴V 00:30, 2 April 2009 (UTC)[reply]

Done Mechanism: there are several very short sections that could probably be merged. In general, I would discourage level 4 headers if it can at all be helped. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
Done Mechanism - Degradation: this needs rewriting. In particular, the model needs to be sourced to a secondary source (with optional retention of the most crucial primary sources only), and most of the concepts discussed need to be clarified in lay terms (e.g. "knockin mouse"). It's not easy, but it is crucial for readability. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

Section has have several copyeditors and reduction in complexity. L∴V 00:30, 2 April 2009 (UTC)[reply]

Done Mechanism - Other systems: I think this section is irrelevant, unless you can demonstrate that other organs are clinically affected in HD (not to my knowledge). JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

Expanded slightly, does seem to be emerging evidence, but the section might be better placed in research directions. LeeVJ (talk) 16:14, 14 March 2009 (UTC)[reply]

Section has been disbanded. L∴V 00:30, 2 April 2009 (UTC)[reply]

Done Diagnosis: The actual content about counselling before testing, as well as restricting testing in children, has no reference. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
Done Management: Much more can be quoted from the Bonelli & Wenning review with regards to pharmacological treatment options. Just dropping the name of one drug is unhelpful. For instance, are there antipsychotics that also have antichoreatic properties? JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
Prognosis: some of the clinical content (e.g. heart failure and suicide risk) could possibly be moved to "signs and symptoms". JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
- Heart failure has moved and suicide risk seems to flow in its current place, so unsure. L∴V 00:30, 2 April 2009 (UTC)[reply]
Done Social impact: needs tightening, removal of weasel words, referencing. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
- References added. Can you specify which "weasel words" you find? Medical geneticist (talk) 18:50, 17 August 2008 (UTC)[reply]
  - "Some individuals have chosen" is unsourced; in general, there is much in this section that applies to other genetic diseases also. JFW | T@lk 22:28, 17 August 2008 (UTC)[reply]
    - Right, I'll add the reference for the individual preferences. You are correct that much of this applies to other genetic diseases as well -- it's just that HD has been THE paradigm for application of genetic testing, particularly in the presymptomatic, "at-risk" individual. Maybe I'll make that more clear, thanks. Medical geneticist (talk) 22:43, 17 August 2008 (UTC)[reply]
      - This section is always tricky to write sympathetically whilst dodging weasel words - I'll give it an ed LeeVJ (talk) 23:12, 17 August 2008 (UTC)[reply]
Done Epidemiology: some content belongs in the genetics section (e.g. the de novo mutation rate). Is there anything more we can do with the fact that JHD seems to have specific clinical characteristics (as well as having its own eponym)? Move it to the relevant section? JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
Done History: needs to be turned into prose, with sources for all presently unsourced landmarks. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
Society and culture: why on earth was List of Huntington's disease media depictions split off from here? Turned into prose with the Lancet source this could easily be merged back. I don't think the list of organisations and when they met is encyclopedic. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
- Sections turned into prose and put into context, the list of media depictions does seem to have has stemmed the flow of trivial references being added, so further deliberation required. L∴V 00:11, 2 April 2009 (UTC)[reply]
Done Research directions: will comment at a later date, but I'm certain that this needs secondary sources as a matter of urgency. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]
- Has been copyedited several times and referenced. L∴V 00:11, 2 April 2009 (UTC)[reply]

In conclusion, I think a large amount of work is still needed. I am particularly concerned about the fact that much information is inadequately sourced, and this is going to be an obstactle to GA unless this is addressed. I will try to help out if I can, but I have no access to the most promising secondary sources (the Bates/Harper/Jones book, the Imarisio and the Bonelli papers). Could I also point out a 2007 Lancet Seminar (doi:10.1016/S0140-6736(07)60111-1) that we really must cite prominently. JFW | T@lk 23:21, 14 August 2008 (UTC)[reply]

Comments on failing GAC. I feel uneasy about having to fail this once again, because so much excellent work has been done on it. It continues to receive much attention from some very dedicated editors, and I am in little doubt that it will reach GA status in the near future, and probably FA not much later. At present, however, there are some pretty significant impediments to GA. Most of them are outstanding issues that I listed above, such as the diversion into p53 in the "signs and symptoms" section. I'm also a bit surprised that the Lancet review I recommended was not used more often. Please keep me informed of signifant progress, and I will happily provide further input. JFW | T@lk 22:19, 27 August 2008 (UTC)[reply]