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Physical Therapists Physical therapists are not yet numerous in schools. But like occupational therapy, physical therapy has gained a foothold since the passage of the Education for All Handicapped Children Act and subsequent disability legislation. In schools the physical therapist has two primary roles. The rst, in sports, has a long history. In that role the therapist treats the injuries and the disabilities of athletes. The second role is more general. In this capacity the therapist serves all students. Often at the request of a teacher who recognizes a problem and calls for consultation, the physical therapist evaluates a student and identi es the dif culty. Consultation also is a prominent service of physical therapists in serving students with disabilities under the provisions of the Education for All Handicapped Children Act and subsequent legislation. Physical therapists may provide direct care (hands-on treatment) to students, but more often they help teachers develop a strategy to deal with the diagnosed problem and then monitor progress. In 2001, there were about 126,450 physical therapists. The Bureau of Labor Statistics projects that employment for physical therapists will grow faster than the average for all occupations through 2010. To practice, a physical therapist must hold a license in the state in which he or she works. Licensure includes passing a national examination administered by the Professional Examination Service. All physical therapists currently in practice have a license. Preparation for physical therapy is similar to the premedical curriculum. It includes a strong emphasis on the physical and biological sciences, along with study of psychology and the humanities. Theory and its appli-
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Because of the common and particularly the illicit use of opioids, poisoning is a frequent occurrence. This happens also as a result of ingestion or injection with suicidal intent, errors in the calculation of dosage, the use of a substitute or contaminated street product, or unusual sensitivity. Children exhibit an increased susceptibility to opioids, so that relatively small doses may prove toxic. This is true also of adults with myxedema, Addison disease, chronic liver disease, and pneumonia. Acute poisoning may also occur in addicts who are unaware that available opioids vary greatly in potency and that tolerance for opioids declines quickly after the withdrawal of the drug; upon resumption of the habit, a formerly well-tolerated dose can be fatal. Varying degrees of unresponsiveness, shallow respirations, slow respiratory rate (e.g., two to four per minute) or periodic breathing, pinpoint pupils, bradycardia, and hypothermia are the well-recognized clinical manifestations of acute opioid poisoning. In the most advanced stage, the pupils dilate, the skin and mucous membranes become cyanotic, and the circulation fails. The immediate cause of death is usually respiratory depression, with consequent asphyxia. Patients who suffer a cardiorespiratory arrest are sometimes left with all the known residua of anoxic encephalopathy. Mild degrees of intoxication are revealed by anorexia, nausea, vomiting, constipation, and loss of sexual interest. Treatment of Overdose This consists of the administration of naloxone (Narcan), or the longer acting nalmefene, both speci c antidotes to the opiates and also to the synthetic analgesics. The dose of naloxone is 0.7 mg/70 kg body weight intravenously, repeated if necessary once or twice at 5-min intervals. In cases of opioid poisoning, the improvements in circulation and respiration and reversal of miosis are usually dramatic. In fact, failure of naloxone to produce such a response should cast doubt on the diagnosis of opioid intoxication. If an adequate respiratory and pupillary response to naloxone is obtained, the patient should nonetheless be observed for up to 24 h and further doses of naloxone (50 percent higher than the ones previously found effective) can be given intramuscularly as often as necessary. Naloxone has less direct effect on consciousness, however, and the patient may remain drowsy for many hours. This is not harmful provided respiration is well maintained. Although nalmefene has a plasma halflife of 11 h, compared to 60-90 min for naloxone, it has no clear advantage in emergency practice. Gastric lavage is a useful measure if the drug was taken orally. This procedure may be ef cacious many hours after ingestion, since one of the toxic effects of opioids is pylorospasm and ileus, which causes much of the drug to be retained in the stomach. Once the patient regains consciousness, complaints such as pruritus, sneezing, tearing, piloerection, diffuse body pains, yawning, and diarrhea may appear. These are the recognizable symptoms of the opioid abstinence, or withdrawal, syndrome, described later. An antidote therefore must be used with great caution in an addict who has taken an overdose of opioid, because in this circumstance it may precipitate withdrawal phenomena. Nausea and severe abdominal pain, due presumably to pancreatitis (from spasm of the sphincter of Oddi), are other troublesome symptoms of opiate use or withdrawal. Seizures are rare.
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Answer 15-2
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The SourceArray is productsA and the SourceIndex is 0 because we are copying the first array element. The DestinationArray is productsB and the DestinationArray is 2 because we are copying the first array element of the ProductsA array to the third element (index 2) of the productsB array. The length is the number of elements that we're copying, which is 2. Here's the code segment that calls the Copy() method. The next table shows both arrays after values are copied to the productsB array.
pleocytosis of up to 3000 cells per cubic millimeter; red cells may be present in variable numbers; protein content is increased, but glucose values are normal. Diagnosis is greatly facilitated by CT scanning and MRI, which reveal bilateral but asymmetrical large, con uent, edematous lesions in the cerebral white matter with a myriad of punctate hemorrhages in gray and white matter (Fig. 36-4). The size of the lesions, their hemorrhagic character, and the extent of the surrounding edema distinguish them from the typical postinfectious ADEM. In many other ways they are similar except for their severity. Many cases terminate fatally in 2 to 4 days, but in others survival is longer. Patients with a similar clinical picture who are thought to have the same disease on the basis of brain biopsy examinations have recovered with almost no residual symptoms. In one of the fatal cases reported by Adams et al, the illness evolved more slowly over a period of 2 to 3 weeks while another patient died with temporal lobe herniation within 12 h. A single recurrence of the disease after an interval of 2 years was observed in one of our cases. Brain abscess, subdural empyema, focal embolic encephalomalacia, and acute encephalitis due especially to type 1 herpes simplex virus are the important considerations in the differential diagnosis.
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For operation of the PicBasic Pro Compiler, you will need a text editor or word processor for creation of your program source file, some sort of PICmicro programmer such as the EPIC Plus Pocket PICmicro Programmer, and the PicBasic Pro Compiler itself. Of course you also need a PC to run it. Follow this sequence of events: First, create the BASIC source file for the program, using your favorite text editor or word processor. If you don t have a favorite, DOS EDIT (included with MS-DOS) or Windows NOTEPAD (included with Windows and Windows 95/98) may be substituted. A great text editor called Ultraedit is available at: It is geared towards the software developer and does not add any undesirable formatting characters that will cause the compiler to error out.
Figure 12-23
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