Left endpoint approximation
4 is called the left endpoint approximation or the approximation using left endpoints (of the subin-tervals) and 4 approximating rectangles We see in this case that L 4 = 0:78125 > A(because the function is decreasing on the interval) There is no reason why we should use the left end points of the subintervals to de ne the heights of the
Guidance for Determination and Documentation of Left-Turn
Left‐Turn Phasing Sequence – The order that the left‐turn movements at an intersection are serviced within the signal cycle (i e , lead‐lead, lag‐lag, or lead‐lag) Protected Only Mode – A mode of traffic control signal operation in which left turns can be
Vaccine Storage and Handling
that can compromise vaccine Forgotten vials of vaccine left out on the counter or doses of vaccine stored at improper temperatures due to a storage unit failure are other examples of how vaccines can be potentially compromised Protocols after an event will vary depending on individual state or agency policies Contact the local or state health
BBQ Roll for LEFT Horizontal Canal BPPV
BBQ Roll for LEFT Horizontal Canal BPPV 1 Lie on your left side and wait 30 seconds 2 Roll on to your back and wait 30 seconds 3 Roll on to your right side and wait 30 seconds 4 Tuck your chin down slightly Roll on to your stomach while propping yourself up on your elbows Wait 30 seconds 5 Roll on to your left side and wait 30
Coding for Amputations - apmaorg
Chronic multifocal osteomyeltis left ankle and foot M86 471 Chronic osteomyelitis with draining sinus, right ankle and foot M86 472 Chronic osteomyelitis with draining sinus, left ankle and foot 9
Embroidery Placement Guide
Polo/Golf Shirts (left chest) 7" - 9" down from left shoulder seam, centered between placket and side seam, or 4" - 6" to the right of placket T-Shirts (left chest, no pocket) 7" - 9" down from left shoulder seam, between center and side seam, or 4" - 6" to the right of center T-shirts (left chest, pocket) Centered above or on pocket
About Brain Injury: A Guide to Brain Anatomy
Parietal Lobe, Left - Damage to this area may disrupt a person’s ability to understand spoken and/or written language The parietal lobes contain the primary sensory cortex which controls sensation (touch, pressure) Behind the primary sensory cortex is a large association area that controls fine sensation (judgment of texture, weight,
Logo & Monogram Placement Chart - Apparel
Jacket Left or Right Chest - M 2 75" H X 4 50" W 7 1/2" down from the shoulder seam and 4" over from center Jacket Left or Right Chest - L 2 75" H X 4 50" W 8" down from the shoulder seam and 4 1/2" over from center Jacket Left or Right Chest - XL 2 75" H X 4 50" W 8 1/2" down from the shoulder seam and 5" over from center
Adding Tabs and Dot Leaders in Microsoft Word
3 Find the tab tool ( ) in the upper left-hand corner of your screen Click the tab tool until it changes to a right-justified tab ( ) 4 Click on the ruler at the top of your page to add a right-justified tab stop (just before the 6-inch mark on the ruler) The page numbers line up on the new tab stop as shown below Note: If the arrows and
Self-treatment of benign positional vertigo (right)
the left (without raising it) and wait again for 30 seconds Turn your body and head another 90° to the left and wait for another 30 seconds Sit up on the left side This maneuver should be carried out three times a day Repeat this daily until you are free from positional vertigo for 24 hours
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MNBIA Letterhead.pdf 1 9/26/13 16:07
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may not be photocopied for mass distribution.About Brain Injury: A Guide to Brain Anatomy
Information from http://www.waiting.com,
1997-2002, Becca, Ltd.
Brain anatomy Definitions
Brainstem: ?e lower extension of the brain where it connects to the spinal cord. Neurological functions located in
the brainstem include those necessary for survival (breathing, digestion, heart rate, blood pressure) and for arousal
(being awake and alert). Most of the cranial nerves come from the brainstem. ?e brainstem is the pathway for all
?ber tracts passing up and down from peripheral nerves and spinal cord to the highest parts of the brain.
Cerebellum:
?e portion of the brain (located at the back) which helps coordinate movement (balance and muscle coordination). Damage may result in ataxia, which is a problem of muscle coordination. Ataxia can interfere with a person's ability to walk, talk, eat, and to perform other self-care tasks.Frontal Lobe:
Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of "higher cognitive functions" including behavior and emotions.?e anterior (front) portion of the frontal lobe is called the prefrontal cortex. It is very important for the
"higher cognitive functions" and the determination of the personality.?e posterior (back) of the frontal lobe consists of the premotor and motor areas. Nerve cells that produce
movement are located in the motor areas. ?e premotor areas serve to modify movements. ?e frontal lobe is divided from the parietal lobe by the central culcus.Occipital Lobe:
Region in the back of the brain which processes visual information. Not only is the occipital lobemainly responsible for visual reception, it also contains association areas that help in the visual recognition of shapes
and colors. Damage to this lobe can cause visual de?cits.Parietal Lobe:
One of the two parietal lobes of the brain located behind the frontal lobe at the top of the brain.Parietal Lobe, Right - Damage to this area can cause visuo-spatial de?cits (e.g., the patient may have di?culty
?nding their way around new, or even familiar, places).MNBIA Letterhead.pdf 1 9/26/13 16:07
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may not be photocopied for mass distribution.Parietal Lobe, Left - Damage to this area may disrupt a person's ability to understand spoken and/or written
language.?e parietal lobes contain the primary sensory cortex which controls sensation (touch, pressure). Behind the
primary sensory cortex is a large association area that controls ?ne sensation (judgment of texture, weight,
size, and shape).Temporal Lobe:
?ere are two temporal lobes, one on each side of the brain located at about the level of the ears.?ese lobes allow a person to tell one smell from another and one sound from another. ?ey also help in sorting
new information and are believed to be responsible for short-term memory. Right Lobe - Mainly involved in visual memory (i.e., memory for pictures and faces). Left Lobe - Mainly involved in verbal memory (i.e., memory for words and names).About Brain Injury:
?e Areas of the Brain, ?eir Function, & Associated Signs & SymptomsAssociated Signs and
Symptoms
?e outermost layer of the cerebral hemisphere which is composed of gray matter. Cortices are asymmetrical.Both hemispheres are able to analyze
sensory data, perform memory functions, learn new information, form thoughts and make decisions.Cerebral Cortex
Left HemisphereSequential Analysis: systematic, logical interpretation of information. Interpretation and production of symbolic information: language, mathematics, abstraction and reasoning. Memory stored in a language format.
Brain StructureFunction
MNBIA Letterhead.pdf 1 9/26/13 16:07
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may not be photocopied for mass distribution.Holistic Functioning:
processing multi-sensory input simultaneously to provide "holistic" picture of one's environment. Visual spatial skills.Holistic functions such as dancing
and gymnastics are coordinated by the right hemisphere. Memory is stored in auditory, visual and spatial modalities.Corpus Callosum
Connects right and left hemisphere
to allow for communication between the hemispheres. Forms roof of the lateral and third ventricles.Damage to the Corpus Callosum may result in "Split Brain" syndrome.Frontal LobeCognition and memory. Prefrontal
area: ?e ability to concentrate and attend, elaboration of thought. The "Gatekeeper"; (judgment, inhibition).Personality and emotional
traits.Movement:Motor Cortex (Brodman's): voluntary motor activity.Premotor Cortex: storage of motor patterns and voluntary activities. Language: motor speechImpairment of recent
memory, inattentiveness, inability to concentrate, behavior disorders, di?culty in learning new information.Lack of inhibition
(inappropriate social and/or sexual behavior). Emotional lability. "Flat" a?ect.Contralateral plegia, paresis.
Expressive/motor aphasia.
Parietal LobeProcessing of sensory input,
sensory discrimination.Body orientation.
Primary/ secondary somatic
area.Inability to discriminate between sensory stimuli.Inability to locate and
recognize parts of the body (Neglect).Severe Injury: Inability to
recognize self.Disorientation of
environment space.Inability to write.
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may not be photocopied for mass distribution.Occipital LobePrimary visual reception area.Primary visual association area: Allows for visual interpretation. Primary Visual Cortex: loss of
vision opposite ?eld.Visual Association Cortex:
loss of ability to recognize object seen in opposite ?eld of vision, "?ash of light", "stars". Temporal LobeAuditory receptive area and association areas.Expressed behavior.
Language: Receptive speech.
Memory: Information retrieval.Hearing de?cits.
Agitation, irritability, childish
behavior.Receptive/ sensory aphasia.
Limbic System Olfactory pathways:
Amygdala and their di?erent
pathways.Hippocampi and their di?erent
pathways.Limbic lobes: Sex, rage, fear, and
emotions. Integration of recent memory, biological rhythms. Hypothalamus.Loss of sense of smell. Agitation, loss of control of emotion. Loss of recent memory.Basal GangliaSubcortical gray matter nuclei. Processing link between thalamus and motor cortex. Initiation and direction of voluntary movement. Balance (inhibitory), Postural re?exes.
Part of extrapyramidal system:
regulation of automatic movement.Movement disorders:
chorea, tremors at rest and with initiation of movement, abnormal increase in muscle tone, difficulty initiating movement.Parkinson's.
Altered level of
consciousness.Loss of perception.
Thalamic syndrome -
spontaneous pain opposite side of body.?alamusProcessing center of the cerebral
cortex. Coordinates and regulates all functional activity of the cortex via the integration of the a?erent input to the cortex (except olfaction).Contributes to a?ectual expression.
MNBIA Letterhead.pdf 1 9/26/13 16:07
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may not be photocopied for mass distribution. HypothalamusIntegration center of Autonomic NervousSystem (ANS): Regulation of body
temperature and endocrine function.Anterior Hypothalamus: parasympathetic
activity (maintenance function).Posterior Hypothalamus: sympathetic
activity ("Fight" or "Flight", stress response.Behavioral patterns: Physical expression
of behavior.Appestat: Feeding center. Pleasure center.Hormonal imbalances. Malignant hypothermia.Inability to controltemperature.
Diabetes Insipidus (DI).
Inappropriate ADH
(SIADH). Diencephalic dysfunction: "neurogenic storms".Internal Capsule
Motor tracts.Contralateral plegia (Paralysis of the opposite side of the body).Reticular Activating
System (RAS)Responsible for arousal from sleep, wakefulness, attention.Cerebellum Altered level of consciousness.
Coordination and control of
voluntary movement.Tremors.
Nystagmus (Involuntary
movement of the eye).Ataxia, lack of coordination.
Brain Stem:
Nerve pathway of cerebral
hemispheres.Auditory and Visual re?ex centers.
Cranial Nerves:
CN III - Oculomotor (Related to
eye movement), [motor].CN IV - Trochlear (Superior oblique
muscle of the eye which rotates the eye down and out), [motor].Weber's: CN III palsy and
ptosis (drooping) ipsalateral (same side of body).Pupils: Size: Midposition to
dilated. Reactivity: Sluggish to ?xed.LOC (Loss of consciousness):
Varies Movement: Abnormal
extensor ( muscle that extends a part).Respiratory: Hyperventilating.
CN (Cranial Nerve) De?cits:
CN III, CN IV.
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may not be photocopied for mass distribution. PonsRespiratory Center.Cranial Nerves: CN V - Trigeminal (Skin of face, tongue, teeth; muscle of mastication), [motor and sensory].CN VI - Abducens (Lateral
rectus muscle of eye which rotates eye outward), [motor].CN VII - Facial (Muscles of
expression), [motor and sensory].CN VIII - Acoustic (Internal
auditory passage), [sensory].Pupils: Size: Pinpoint
LOC:Semi-coma
"Akinetic Mute" "Locked In" Syndrome.Movement:
Abnormal extensor.
Withdrawal.
Respiratory:
Apneustic (Abnormal
respiration marked by sustained inhalation).Hyperventilation.
CN De?cits: CN VI, CN
VII.Medulla
Oblongata
Crossing of motor tracts.
Cardiac Center.
Respiratory Center.
Vasomotor (nerves having
muscular control of the blood vessel walls) Center Centers for cough, gag, swallow, and vomit.Cranial Nerves:
CN IX - Glossopharyneal
(Muscles and mucous membranes of pharynx, the constricted openings from the mouth and the oral pharynx and the posterior third of tongue.), [mixed].CN X - Vagus (Pharynx,
larynx, heart, lungs, stomach), [mixed].CN XI - Accessory (Rotation
of the head and shoulder), [motor].CN XII - Hypoglossal
(Intrinsic muscles of the tongue), [motor].Movement: Ipsilateral (same side) plegia (paralysis).Pupils:
Size: Dilated
Reactivity: Fixed.
LOC: Comatose.
Respiratory:
Abnormal breathing
patterns.Ataxic.
Clustered.
Hiccups.
CN Palsies (Inability to
control movement):Absent Cough.
Gag.MNBIA Letterhead.pdf 1 9/26/13 16:07
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may not be photocopied for mass distribution.About Brain Injury: Intracraniel Pressure
Does the brain always swell? How do you know if the brain is swelling? Doesn't the CT scan show swelling?
Is it possible that the person's brain did not swell because of the use of the drug manitol (protocol treatment
in all ICU's)? Is the chemical released if there is no swelling? If a person didn't need a shunt, can we assume
there was no swelling?Pretty much all tissues in the body swell when traumatized. ?ey also require more oxygen to heal. ?e brain
is unique in that it rests inside a bone case, so when it swells, it experiences more trauma.?e more damage the brain receives, the more it swells. ?is is caused by leakage from blood vessels. When
the brain swells, because it is housed inside the skull, it has no room to expand. ?is leads to a rise in
pressure within the brain. ?is rise in pressure rapidly equals the arterial pressure thereby a?ecting the blood
?ow to the brain. ?is di?use pressure which decreases blood ?ow a?ects the ability of the cells within the
brain to metabolize properly; the cells are unable to eliminate toxins which then accumulate. ?is phenomenon leads to a spiral e?ect which is what kills brain i njured people who don't get promptattention. One of the big breakthroughs that lead to the survival rate we have now for brain injury today
was learning to break this cycle. We are still very much in the stage of learning to break this cycle. ?e most signi?cant factor has been the use of monitoring devices to info rm treatments to prevent further damage.?e brain requires both oxygen and glucose. In response to the trauma, changes occur in the brain which
require monitoring to prevent further damage. ?e brain's size frequently increases after a severe head injury.
?is is called brain swelling and occurs when there is an increase in the amount of blood to the brain.
Water may collect in the brain which is called Brain Edema. Both Brain swelling and Brain Edema result in
excessive pressure in the brain calledIntracranial Pressure (ICP)
. Around-the-clock monitoring during thistime is essential in order that ICP can be immediately treated. Treatment of brain swelling can be di?cult.
Very strong medications are administered. Medications which help to draw ?uid back out of the brain and
into blood vessels may be useful. Some medications help by decreasing the metabolic requirements of the
brain. Other medications increase blood ?ow into the brain which can help diminish the spiral e?ect caused
by brain swelling.In some cases, removal of small amounts of ?uids or from the brain or surgery may be bene?cial. And in
some cases, removal of damaged tissue may prevent further damage.quotesdbs_dbs12.pdfusesText_18