T H E PAT H TO C A R E G I V I N G 9 in .NET

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causes little pain and is not limited as long as the hamstrings are relaxed and there is no stretching of the sciatic nerve. Thus, with the knees exed to 90 degrees, sitting up from the reclining position is unimpeded and not painful; with knees extended, there is pain and limited motion (Kraus-Weber test). With vertebral disease (e.g., arthritis), passive exion of the hips is free, whereas exion of the lumbar spine may be impeded and painful. With the patient supine, passive straight-leg raising (possible up to 90 degrees in normal individuals) places the sciatic nerve and its roots under tension, thereby producing radicular radiating pain. This maneuver is the usual way in which compression of the L5 os S1 nerve root is detected (see further on); however, it may also cause an anterior rotation of the pelvis around a transverse axis, increasing stress on the lumbosacral joint and causing pain if this joint is arthritic or otherwise diseased. Consequently, in diseases of the lumbosacral joints and roots, passive straight-leg raising evokes pain and is restricted on the affected side (Lasegue sign). ` Straight raising of the opposite leg may also cause pain on the affected side and is believed by some to be an even more reliable sign of prolapsed disc than a Lasegue sign. It is important to re` member that the evoked pain is always referred to the diseased side, no matter which leg is elevated. While the patient is in the supine position, leg length (anterosuperior iliac spine to medial malleolus) and the circumference of the thigh and calf may be measured. Hyperextension of the lumbar spine may be performed with the patient standing or lying prone. If the condition causing back pain is acute, it may be dif cult to extend the spine in the standing position. A patient with lumbosacral strain or disc disease (except in the acute phase or if the disc fragment has migrated laterally) can usually extend or hyperextend the spine with little or no aggravation of pain. If there is an active in ammatory process or fracture of the vertebral body or posterior elements, hyperextension may be markedly limited. In disease of the upper lumbar roots, hyperextension is the motion that is most limited and reproduces pain; however, in some cases of lower lumbar disc disease with thickening of the ligamentum avum, this movement is also painful. In patients with narrowing of the spinal canal (spondylosis, spondylolisthesis), upright stance and extension may produce neurologic symptoms (see further on). Maneuvers in the lateral decubitus position yield less information as a rule. In cases of sacroiliac joint disease, abduction of the upside leg against resistance reproduces pain in the sacroiliac region, with radiation of the pain to the buttock, posterior thigh, and symphysis pubis. Hyperextension of the upside leg with the downside leg exed is another test for sacroiliac disease. Rotation and abduction of the leg evoke pain in a diseased hip joint and with trochanteric bursitis. Another helpful indicator of hip disease is the Patrick test: with the patient supine, the heel of the offending leg is placed on the opposite knee and pain is evoked by depressing the exed leg and externally rotating the hip. Gentle palpation and percussion of the spine are the last steps in the examination. It is preferable to rst palpate the regions that are the least likely to evoke pain. At all times the examiner should know what structures are being palpated (Fig. 11-3). Localized tenderness is seldom pronounced in disease of the spine because the involved structures are so deep. Nevertheless, tenderness over a spinous process or jarring by gentle percussion may indicate the presence of in ammation (as in disc space infection), pathologic fracture, a spinal metastasis, or a disc lesion at the site deep to it. Tenderness over the interspinous ligaments or over the region of the articular facets between the fth lumbar and rst sacral ver-
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For Series4, I changed the look and feel via the Refine view to the line chart type and also adjusted the format of the Area Property. In this configuration, I adjusted several items, as shown in the next illustration: I changed the Chart Type to Lines. In the Area Properties, I adjusted the two colors Color and Secondary Color. In the Area Properties, I adjusted the Marker Shape to Triangle.
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Table 1-2 shows all the fields available in the Information on Query tab. In the Query Documentation tab, any documentation or comments assigned to this Web query are available.
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Figure 12-6 Adding data to table
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rvhere volume 1mm3), : time (hr), k : the evapol'ation V: t rate(mm/hr), and A : surface area 1mmr). Use Euler's method conrputethe volume of the droplet from I : 0 to to l0 min using a step size of 0.2,5min. Assume that ft : 0.1mm/min andthat thedropletinitially hasa radiusof 3 mm. Assess validity oi your resultsby determiningthe radius the
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This rclationship, which is calledthe7.ero-onler uppntximatiorz, indicates that the valueof I at the new point is the sameas the valucat the old point.This resultmakesintuitivesense because r, andr;11 erecloseto eachother,it is likely thatthe new valueis probablysimif i l a r t o t h eo l d v a l n e . a if is, Equation(4.9; provicles perf'ect estinrate the functionbeing approxirnated in f'act, constant. our problcm,you would be right only if you happened be standing For a to on a pcrfectlyflat plateau. However,if thc functionchanges all over the interval,addiat tionaltermsof theTaylorseries required providea betterestimate. are to So now you are allowcdto get ofTthe plattbrrn and standon the hill surface with one leg positionecl tiont of you anclthe otherbehind.You immediately in sense that the front
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Thus, the pH is computedas 5.6279with a relativeerror of 0.0868%.We can be confident that the roundedresultof 5.63 is correctto two decimalplaces. This can be verifiedby performing anotherrun with more iterations. For example,settingmaxi t to 50 yields
Now you re going to create your first Visual Basic 2005 project. You not only will use this project for this lesson, but you also will use it as the starting point for the project in the next lesson. N OTE The following instructions assume you purchased Visual Studio 2005. However, the same basic information applies if you purchased Visual Basic 2005 Express Edition, though some of the screenshots may look slightly different.
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