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circumscription to the territory of a root, and factors that excite it. The mechanism is stretching, irritation, or compression of a spinal root within or central to the intervertebral foramen. The pain is sharp, often intense, and usually superimposed on the dull ache of referred pain; it nearly always radiates from a paracentral position near the spine to some part of the lower limb. Coughing, sneezing, and straining characteristically evoke this sharp radiating pain, although each of these actions may also jar or move the spine and enhance local pain; jugular vein compression, which raises intra-
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By game time, he knew, the game was out of his hands and in the hands of his players. Of the 70 or so plays in a typical game, Lombardi sent in less than a dozen, and even then, his quarterback had the right to change the play with an audible at the line of scrimmage. It would be an exaggeration to say that the coach was now simply the cheerleader. But in a real sense, the coach was now fan number one of the team he had trained and equipped. My mother had an interesting perspective on this process. On Monday, Tuesday, and Wednesday, she used to say half jokingly, we don t talk, because on Wednesday, he has to go out there and convince himself, the coaches, and the players that they can win. On Thursday, we say hello. On Friday, he is civil. At the beginning of the week, in other words, the weight of the world was on his shoulders. By the end of the week, he had put that weight squarely on the shoulders of the players. He had made them accountable.
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tion of seizures, has been seen, rarely and with no explanation, in migraineurs, including two cases with which we are familiar. For intracranial internal carotid stenosis or for thrombi that extend into the siphon and stem of the middle cerebral artery, a transcranial (super cial temporal middle cerebral) anastomosis had in the past been employed. Though this operation is technically feasible, its therapeutic value has been discounted by the careful multicenter study of Barnett and collaborators, who found that it did not produce a reduction in TIAs, strokes, or deaths. There may still be particular circumstances that justify its use. Carotid angioplasty and stenting has been alluded to several times earlier. Its role in clinical practice is still being determined, but it offers an alternative to surgery if the patient is too ill to undergo an endarterectomy. Direct comparisons are being made to surgery in several organized studies. In one randomized trial reported by the CAVATAS investigators, the incidence of minor (nonstroke) complications was lower in patients who had angioplasty and stenting. This has not been our experience, where sizable groin hematomas have been common. Also, a higher proportion of these patients than those who had undergone endarterectomy had restenosis. Otherwise, the recurrent stroke rates were similar, 10 percent for both groups. Asymptomatic Carotid Stenosis Finally, there is the problem of the asymptomatic carotid bruit or incidentally discovered stenosis. The population study by Heyman and associates has shed some light on this. They found, not surprisingly, that cervical bruits in men constituted a risk for death from ischemic heart disease. They also noted that the presence of asymptomatic bruits in men (but not in women) did carry a slightly increased risk of stroke but, more importantly, that the subsequent stroke often did not coincide in its angioanatomic locus and laterality with the cervical bruit. Similar ndings have been reported by Ford and coworkers and by Chambers and Norris. On the other hand, Wiebers and colleagues found that patients with asymptomatic carotid bruits who were followed for 5 years were approximately three times more likely to have ischemic strokes than an age- and sex-matched population sample without carotid bruits. In an attempt to clarify the role of surgery for asymptomatic carotid stenosis, the Asymptomatic Carotid Atherosclerotic Study (ACAS), as reported by their Executive Committee, has suggested that the frequency of strokes can be reduced from 11 to 5 percent over 5 years by removing the plaque in asymptomatic patients in whom there is a stenosis greater than 60 percent (diameter). These ndings have been tempered by a reanalysis of the ACAS data, pointing out that almost half of the strokes in these patients were lacunar or cardioembolic in origin (Inzitari et al). Data from a recent European trial, encompassing 3120 patients, obtained similar results [MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group]. The latter study has indicated that asymptomatic carotid stenosis of over 70 percent carries only a 2 percent annual risk of stroke over a 5-year period and that the risk is reduced to 1 percent with endarterectomy. It was concluded that endarterectomy may be justi ed for asymptomatic carotid stenosis of this degree, but the authors emphasized that an audited surgical risk below 3 percent is required to obtain favorable results. From the results of several trials, it can be concluded that endarterectomy does not reduce strokes in patients who have asymptomatic carotid stenosis with luminal narrowing that is less than 70 percent of normal diameter. All these comments probably apply to patients who are about to undergo major surgery such as cardiac bypass
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SSH equivalence of the user executing the dcli commands on the remote host needs to be set with the Exadata Storage Server user that will be used to execute the commands. This configuration needs to be done on all Exadata Storage Servers that you will be managing from dcli. You can use the dcli utility itself to set up SSH equivalence. Refer to the Exadata Storage Server Software Users Guide Using the dcli for more details.
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Don t be fooled here! These examples don t represent changes in the order of magnitude. Instead, they all represent numbers that are very close to each other. The values approach the last number in either list, which is 0.72941. If that s as far as you want to go, then adding any more digits to the right of the 1 will only clutter the page with ciphers (zeros). The following numerals all represent exactly the same number to a pure mathematician: 0.72941 0.729410 0.7294100 0.72941000 0.729410000 0.7294100000 and so on, forever Physicists or engineers see the above numbers differently. To them, those extra ciphers are important, because they represent increasing precision or accuracy. They re extra significant figures. Let s not worry about that right now.
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1. Pick the Symbols and Arrows tab. Concentrate on the area titled Arrowheads. First sets the arrowhead for the rst end of the dimension line. Second sets the arrowhead for the second end of the dimension line. In most cases, you would use the same arrowhead style for both ends of a dimension, but AutoCAD gives you exibility in case you need to make them different. Leader sets the arrowhead for quick leaders a leader type that is different than a multileader. 2. To the right of First, pick the down arrow and review the types of arrowheads available. Some companies and individual architects use ticks instead of arrows at the ends of dimension lines. It would be rare to use None, but AutoCAD gives you that option. As you learned in the previous chapter, Arrow size displays and sets the size of the arrow. You also learned how to change the appearance of center marks in the Center marks area. 3. Make changes to the settings in the Arrowheads area and notice how the sample drawing changes.
Wohlers: Applying AutoCAD 2010
PRO Bridge loans can be used to overcome POINTER a common problem. Many people have If your customers are strong enough homes that they must sell before they financially, they should be able to can buy a new one. Sometimes homearrange a bridge loan that will allow buyers have a contract to sell their them to have a new house built house and are waiting for the closing while they are making arrangements to take place. If either of these types of to leave their existing home. If you people wants you to build a new house and your customers are not aware of for them, they may think that they have this option, you could lose months of to wait until their deals close to start production time waiting for one deal construction. This isn t always true. to close so that you can start a new Sometimes a bridge loan can be used deal. Check into bridge loans when to get the ball rolling on a new house you talk with lenders and be prewhile an old house is being sold or pared to share your knowledge with closed. customers; it could get you more If your customers are strong work. enough financially, they should be able to arrange a bridge loan that will allow them to have a new house built while they are making arrangements to leave their existing home. If you and your customers are not aware of this option, you could lose months of production time waiting for one deal to close so that you can start a new deal. Check into bridge loans when you talk with lenders and be prepared to share your knowledge with customers; it could get you more work.
Routing group masters or routing masters are also known as routing information daemon (RID) masters. In a mixed mode environment where Exchange 2000 and Exchange 5.5 servers are in the same routing group or site, the RID master can be an Exchange 2000 or an Exchange 5.5 server. There are considerations, however see Knowledge Base article Q254809 on Microsoft TechNet for more information.
AutoCAD allows you to draw two-dimensional (2D) and three-dimensional (3D) objects. For the next several chapters, you will learn how to enter commands, select objects, and navigate the user interface in the 2D drawing environment. For the purpose of learning to enter commands, we will use the LINE command. You will learn more about using various AutoCAD commands in the chapters that follow.
Sensory Loss Due to Suggestability and Hysteria (See also Chap. 56)
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