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In itself, CSR is not a grave sign It may occur during sleep in elderly individuals and can be a manifestation of cardiopulmonary disorders in awake patients Only when it gives way to more irregular respiratory patterns that implicate structural damage of the brainstem is the patient in imminent danger, as discussed below A number of other aberrant breathing rhythms occur with brainstem lesions (these are reviewed in Chap 26), but few are speci cally localizing The more conspicuous respiratory arrhythmias are associated with brainstem lesions below the level of the reticular activating system and are therefore found in the late stages of brainstem compression or with large brainstem lesions such as infarction, primary hemorrhage, or in ltrating tumor Lesions of the lower midbrain upper pontine tegmentum, either primary or secondary to a tentorial herniation, may give rise to central neurogenic hyperventilation (CNH).

where h : the spacingbetweenpoints. ,l9.5 EXAMPLE Usingu, .riii+rL for Differentiotion the that Problem Stotement. Use the qiradient tunctionto diflbrentiate samef'unction we analvzedin Example 19.4with the di tf function. a Solution. In the samefashionas Exanrple19.4,we can generate seriesof equally variables: and valuesof the independent dependent spaced > > f - @( x ) A . 2 + 2 5 * x - 2 0 O * x . ^ 2 + 6 15 * x . ^ 3 9 0 0 * x . ^ 4 + 40 t J * x .^ 5 ; > > x = 0 : 0 . 1 : O .B ; Y I rl; We can then use the graclient function to determinethe derivativesas >> dv_sradient1y,0.1) ^.,

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basic dimension deviation tolerancing feature control frames geometric characteristic symbols geometric dimensioning and tolerancing (GD&T) limits tolerancing material condition symbols Maximum Material Condition (MMC) projected tolerance zone surface controls symmetrical deviation symmetrical tolerancing tolerance

This disorder is characterized by an increase in the rate and depth of respiration to the extent that respiratory alkalosis results CNH is thought to represent a release of the re ex mechanisms for respiratory control in the lower brainstem It must be distinguished from hyperventilation caused by medical illnesses, particularly pneumonia and acidosis Mild degrees of hyperventilation are common after a number of acute neurologic events, notably head injury The neurologic basis of CNH is uncertain It has been observed with tumors of the medulla, lower pons, and midbrain However, North and Jennett, in a study of respiratory abnormalities in neurosurgical patients, found no consistent correlation between tachypnea and the site of the lesion It is also noteworthy that primary brain lymphoma without brainstem involvement has emerged as a curious cause of CNH (Pauzner et al).

8. Save the script under a name of your choice. 9. Press z-R or click the Run button on the toolbar to run the script. You ll see Word open,

Table 12-3

Low pontine lesions, usually due to basilar artery occlusion, sometimes cause apneustic breathing (a pause of 2 to 3 s in full inspiration) or so-called short-cycle CSR, in which a few rapid deep breaths alternate with apneic cycles With lesions of the dorsome-.

2 = 2 .

1. Enter 22 for the width and 17 for the length. Be sure to include the apostrophe for the foot mark. 2. Pick the Finish button. You have completed AutoCAD s Advanced Setup process. 3. Save your work in a le named tmp1.dwg.

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Finally, create a Click event procedure for the Paste toolbar button so it calls the Click event procedure of the Edit | Paste menu item (mnuEditPaste):

the fast component is a corrective movement The production of nystagmus by labyrinthine stimulation and other features of vestibular nystagmus are discussed further in Chap 15 Other Types of Nystagmus Convergence nystagmus refers to a rhythmic oscillation in which a slow abduction of the eyes in respect to each other is followed by a quick movement of adduction It is usually accompanied by quick rhythmic retraction movements of the eyes (nystagmus retractorius) and by one or more features of the Parinaud dorsal midbrain syndrome There may also be rhythmic movements of the eyelids or a maintained spasm of convergence, best brought out on attempted elevation of the eyes to command or downward rotation of an OKN drum These unusual phenomena all point to a lesion of the upper midbrain tegmentum and are usually manifestations of vascular disease, traumatic disease, or tumor, notably pinealoma that compresses this region.

notice that AppleScript automatically adds the get_user_name subroutine s name to the end statement, as shown in boldface here:

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