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position). In other patients, all the leg muscles are affected more or less equally, and in a few, weakness appears to be most severe in the proximal muscles. Absolute paralysis of the legs is observed only rarely; immobility due to contractures at the knees and ankles is a more common occurrence. Tenderness of muscles on deep pressure is a highly characteristic nding, elicited most readily in the muscles of the feet and calves. Deep tendon re exes in the legs are almost always lost, even when weakness is slight in degree. In the arms, tendon re exes are sometimes retained despite a loss of strength in the hands. In those in whom pain and dysesthesias are prominent and motor loss is slight, the re exes at knee and ankle may be retained or even of greater than average briskness. Excessive sweating of the soles and dorsal aspects of the feet and of the volar surfaces of the hands and ngers is a common manifestation of alcohol-induced nutritional neuropathy. Postural hypotension is sometimes associated. These symptoms are indicative of involvement of the peripheral sympathetic nerve bers. Sensory loss or impairment may involve all the modalities, although one may be affected out of proportion to the others. One cannot predict from the patient s symptoms which mode of sensation might be affected disproportionately. In patients with impairment of super cial sensation (i.e., touch, pain, and temperature), the border between impaired and normal sensation is not sharp but shades off gradually over a considerable vertical extent of the limbs. Patients in whom pain is the outstanding symptom do not constitute a distinct group in terms of their neurologic signs. Pain and dysesthesias may be prominent in patients with either severe or slight degrees of motor, re ex, and sensory loss. The term hyperesthetic is used commonly to designate the exquisitely painful form of neuropathy but is not well chosen; as pointed out on page 118, one is usually able, by using nely graded stimuli, to demonstrate an elevated threshold to painful, thermal, and tactile stimuli in the hyperesthetic zone. Once the stimulus is perceived, however, it has a painful and diffuse, unpleasant quality (hyperpathia). Tactile evocation of pain or burning is an example of allodynia. In most patients with nutritional polyneuropathy, only the limbs are involved and the abdominal, thoracic, and bulbar muscles are usually spared; however, we have encountered two cases in which there was sensory loss in the pattern of an escutcheon over the anterior thorax and abdomen. In the most advanced instances of neuropathy, hoarseness and weakness of the voice and dysphagia due to affection of the vagus nerves may be added to the clinical picture. Some idea of the incidence of the motor, re ex, and sensory abnormalities and the combinations in which they occur can be obtained from Table 41-1, which is based on Victor s examination of 189 nutritionally depleted alcoholic patients. Noteworthy is the fact that only 66 (35 percent) of the 189 patients showed the clinical picture of polyneuropathy in its entirety i.e., a symmetrical impairment or loss of tendon re exes, sensation, and motor power affecting legs more than the arms and the distal more than the proximal segments of the limbs. In the remaining patients, the motor-re ex-sensory signs occurred in various combinations, as indicated in Table 41-1. Stasis edema and pigmentation, glossiness, and thinness of the skin of the lower legs and feet are common ndings in patients with severe forms of neuropathy. Major dystrophic changes, in the form of perforating plantar ulcers and painless destruction of the bones and joints of the feet (ulcero-osteolytic neuropathy; Charcot
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FIGURE 10-14
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activated before you can manage print servers from the comfort of your desk. You must make sure the Group Policy affecting print servers has the following setting: Allow Print Spooler to Accept Client Connections = enabled (Computer Configuration | Administrative Templates | Printers) This will allow you to manage the print server remotely even if no printers are shared on it yet. This policy is automatically activated when you share a printer on a server.
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The following example shows you how to use the OrElse logical operator. If the value of variable varl is less than the value of variable var2, then the first logical operator is true and the third logical expression is true. Therefore, ASP.NET skips the second logical expression:
33. Blocks
In some drafting applications, there is a need to draw a series of continuous arcs to represent, for example, a river on a map. If the line requires thickness, the ARC Continue option will not work, but the PLINE Arc option can handle this task. 1. Enter the PLINE command and pick a point anywhere on the screen. 2. Enter A for Arc. A list of arc-related options appears. 3. Move the crosshairs and notice that an arc begins to develop. 4. Enter the Width option and enter a starting and ending width of .1 unit. 5. Pick a point a short distance from the rst point. 6. Pick a second point, and a third. 7. Press ENTER when you are nished. 8. Enter UNDO and Back.
oy A. Edelfelt was the sole author of the rst three editions of Careers in Education. Alan J. Reiman has coauthored this edition. Dr. Reiman has had several careers in education. While studying for his undergraduate degree at Iowa State University from 1971 to 1975, he was actively involved in student personnel work, serving full-time as a residence hall adviser and part-time as the rst student liaison to parents of incoming students. From Iowa State, Mr. Reiman went to the University of Georgia, where he earned a master s degree. Subsequently he taught in rural elementary schools in Georgia and North Carolina for eight years. During that time he coedited a book on enrichment activities for elementary-school-age children. Also, he became interested in new teaching roles, such as mentor and curriculum designer. These interests eventually prompted him to earn a doctorate at North Carolina State University (NC State). Dr. Reiman then took a position as clinical assistant professor, a joint appointment with NC State and the Wake County (North Carolina) Public Schools. In that position his primary focus was design, implementation, and evaluation of an innovative mentor support program for beginning teachers. Experiences from 1988 to 1995 provided him with an opportunity to blend teaching, administration, and program evaluation. During these years he was promoted to clinical associate professor.
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Value 1,000 pF /.001 F 1,500 pF /.0015 F 2,000 pF /.002 F 2,200 pF /.0022 F 4,700 pF /.0047 F 5,000 pF /.005 F 5,600 pF /.0056 F 6,800 pF /.0068 F .01 .015 .02 .022 .033
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