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Our approach to the patient with dyschromias is very similar to that for telangiectasias as these two components of photoaging often coexist. However, in patients for whom mottled pigmentation is the predominant component, we are more likely to use microdermabrasion as an adjunctive procedure. This is mainly to enhance the penetration of topical hydroquinones and retinoids, which is also essential for long-term success, especially in regions of the world where the sun is always intense. We may also change the settings of the various devices utilized to address differences in skin type and pigmentation, such as changing to a shorter pulse-duration cycle of 2.4 and 4 milliseconds with a 10-millisecond delay for a total duration of 16.4 milliseconds typically at a uence of 25 to 28 J/cm2. Our clinical experience has been that shorter pulse durations as well as lower cutoff lters with IPL improve the response to pigmentation. The lower cutoff lters of the V handpiece of the Starlux device may be used for residual pigmentation. We prefer not to use extended PDL lasers as the ef cacy can be less compared to devices with lower wavelengths that are more highly absorbed by melanin. We are more likely to suggest large spot size 532 nm for patients with considerable mottled pigmentation photoaging component, as melanin would effectively absorb 532 nm more effectively (Figure 4.3). If persistent pigmented spots remain following full-face IPL or 532-nm treatment, options include follow-up with more intense treatment using higher fluences, lower cutoff filters, and less skin-surface cooling. Alternatively, Q-switched alexandrite (755 nm) or Q-switched ruby (694 nm) lasers can be used for spot treatment of resistant lesions. Complications from device treatment of lentigines are similar to that of telangiectasias. Because these patients are more apt to have sun-tanned skin, it is critical to assess for this prior to treatment. To prevent tissue damage, it is important that Q-switched lasers are not used in a pulse stacking or overlapping fashion.
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This is undoubtedly the most dif cult part of the neurologic examination. Usually sensory testing is reserved for the end of the examination and, if the ndings are to be reliable, should not be prolonged for more than a few minutes. Each test should be explained brie y; too much discussion of these tests with a meticulous, introspective patient may encourage the reporting of useless minor variations of stimulus intensity. It is not necessary to examine all areas of the skin surface. A quick survey of the face, neck, arms, trunk, and legs with a pin takes only a few seconds. Usually one is seeking differences between the two sides of the body (it is better to ask whether stimuli on opposite sides of the body feel the same than to ask if they feel different), a level below which sensation is lost, or a zone of relative or absolute analgesia (loss of pain sensibility) or anesthesia (loss of touch sensibility). Regions of sensory de cit can then be tested more carefully and mapped out. Moving the stimulus from an area of diminished sensation into a normal area enhances the perception of a difference. The vibration sense may be tested by comparing the thresholds at which the patient and examiner lose perception at comparable bony prominences. We usually record the number of seconds for which the examiner appreciates vibration at the malleolus or toe after the patient reports that the fork has stopped buzzing. The nding of a zone of heightened sensation ( hyperesthesia ) calls attention to a disturbance of super cial sensation. Variations in sensory ndings from one examination to another re ect differences in technique of examination as well as inconsistencies in the responses of the patient. Sensory testing is considered in greater detail in Chaps. 8 and 9.
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In this section, much like the last, you will be creating an Activity for the EditText View. The steps for creating the Activities are identical to those in the preceding sections. Therefore you will be provided with the full code of the three main Activity files AndroidManifest.xml, edittext.xml, and These files are provided for you in the following sections.
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It should be noted that, in contrastto vectors,the 2 norm and the Frobeniusnorm for a matrix are not the same.Whereasthe Frobeniusnorm llAllf can be easily deterrnined by Eq. ( t I .5),the matrix 2 norm llA llz is calculated as l lA l l : : ( / r n ' " * ) ' ' " where4,,,"* the largest is eigenvalue [A]r[A]. In AppendixA, we will learnmore about of eigenvalues. the time being,the important For point is that the llAll2. or spectralnorm, is the mirrimum nonl and,therefore. providesthe tightestlreAsureof size (Ortega,1972).
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for Afier the matrix is decomposed. solutioncan be generated a panicularright-handa First, a forward-substitution stepis executedby side vector {b}. This is done in two steps. (10.8)for {d}. It is importantto recognize to solving Eq. that this merely amounts performside ing the eliminationmanipulations {bl. Thus, at the end of this step,the right-hand on
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