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acteristic clinical features. Probably this means that each disease has a distinctive mechanism and that the locus of the metabolic effect is somewhat different from one disease to another. The sudden and excessive neuronal discharge that characterizes an epileptic seizure is a common coma-producing mechanism. Usually focal seizure activity has little effect on consciousness until it spreads from one side of the brain (and the body if there is a convulsion) to the other. Coma then ensues, presumably because the spread of the seizure discharge to deep central neuronal structures paralyzes their function. In other types of seizure, in which consciousness is interrupted from the very beginning, a diencephalic origin has been postulated (centrencephalic seizures of Pen eld). Concussion exempli es another special pathophysiologic mechanism of coma. In blunt , or closed head injury, it has been shown that at the moment of the concussive injury there is an enormous increase in intracranial pressure, on the order of 200 to 700 lb/in2, lasting a few thousandths of a second. The vibration set up in the skull and transmitted to the brain was for many years thought to be the basis of the abrupt paralysis of nervous function that characterizes concussive head injury. Instead, it is more likely that the sudden swirling motion of the brain induced by the blow to the head, producing a rotation (torque) of the cerebral hemispheres around the axis of the upper brainstem, is the proximate cause of loss of consciousness. These same physical forces, when extreme, cause multiple shearing lesions or hemorrhages in the diencephalon and upper brainstem. The subject of concussion is discussed fully in Chap. 35. Yet another unique form of coma is that produced by inhalation anesthetics. The effects of general anesthesia had for many years been attributed to changes in the physical chemistry of neuronal membranes. More recently, it has been recognized that there are interactions with ligand-gated ion channels and alterations in neurotransmitter function that are of direct consequence in causing anesthesia-induced unconsciousness. Inhalation anesthetics are unusual among coma-producing drugs in respect to the sequence of inhibitory and excitatory effects that they produce at different concentrations. During anesthesia, suf cient inhibition of brainstem activity can be attained to eliminate the pupillary responses and the corneal re ex. Both return to normal by the time the patient is able to speak. Sustained clonus, exaggerated tendon re exes, and Babinski signs are common during the process of arousal. These ndings have been studied systematically by Rosenberg et al. Pre-existing focal cerebral de cits from strokes often worsen transiently with the administration of anesthetics, as is true to a lesser extent with other sedatives, metabolic encephalopathies, and hyperthermia. Recurring Stupor and Coma Aside from repeated drug overdose, recurring episodes of stupor are usually due to the decompensation of an encephalopathy from an underlying biochemical derangement, hepatic failure being the most common. A similar condition of periodic hyperammonemic coma in children and adults can come about from urea cycle enzyme defects, such as ornithine transcarbamylase de ciency. These are discussed in Chap. 37, in the section on inherited hyperammonemias. Under the title of idiopathic recurring stupor, a rare condition has been described in adult men who displayed a prolonged state of deep sleepiness lasting from hours to days intermittently over a period of many years. Despite the impression of a sleep disorder related to narcolepsy, the EEG showed widespread fast (beta) ac-
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Once you ve launched AppleScript Editor, make its icon stay in the Dock so that you can launch it instantly. CTRL-click or right-click the AppleScript Editor icon in the Dock, click or highlight Options, and then choose Keep In Dock from the shortcut menu.
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This is the same as the factor k that we defined a little while ago. It is always greater than or equal to 1. Look again at Fig. 16-4. As the space ship moves faster, it scrunches up. Imagine now that it also becomes more massive. The combination of smaller size and greater mass produces a dramatic increase in density at relativistic speeds. Suppose that the rest mass (the mass when stationary) of our ship is 10 metric tons. When it speeds by at half the speed of light, its mass increases to a little more than 11 metric tons. At 80 percent of the speed of light, its mass is roughly 17 metric tons. At 95 percent of the speed of light, the ship s mass is about 32 metric tons. At 99.9 percent of the speed of light, the ship s mass is more than 220 metric tons. And so it can go indefinitely. As the speed of the ship approaches the speed of light, its mass grows larger and larger without limit.
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SECURITY SCAN Don t worry if you feel you don t know enough about LDAP to define a query policy; AD includes a default query policy that can be used to protect your directory. To assign the default query policy to your directory: 1. Launch the Global MMC (Quick Launch Area | Global MMC) and move to Active Directory Sites and Services (Computer Management | Active Directory Sites and Services). 2. Click the name of a domain controller (Computer Management | Active Directory Sites and Services | Sites | sitename | Servers | DCname) where sitename and DCname are the names of the site where the DC is located and the name of the DC you want to view.
Row wants to maximize this, while Column wants to minimize it. What payoffs can they hope to achieve in rock-paper-scissors Well, suppose for instance that Row plays the completely random strategy x = (1/3, 1/3, 1/3). If Column plays r, then the average payoff (reading the rst column of the game matrix) will be 1 1 1 0 + 1 + 1 = 0. 3 3 3 This is also true if Column plays p, or s. And since the payoff of any mixed strategy (y 1 , y2 , y3 ) is just a weighted average of the individual payoffs for playing r, p, and s, it must also be zero. This can be seen directly from the preceding formula, Gij xi yj =
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