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It is because of our knowledge of these natural developmental limitations that we believe it is important to offer families baby-friendly alternatives to especially complex ASL signs, alternatives that take advantage of babies physical assets rather than rely on their physical limitations The Baby Signs dictionary includes photo illustrations and written descriptions of thirty-five baby-friendly alternatives to exact ASL signs Those parents who like this more flexible approach can use as many ASL signs as they want.

Aside from the poliovirus (some of the data were gathered before 1959), the common infective agents in cases of both aseptic meningitis and encephalitis were group B Coxsackie virus, echovirus, mumps virus, lymphocytic choriomeningitis virus, arboviruses, HSV, and Leptospira, in that order In a later prospective virologic study of all children examined at the Mayo Clinic during the years 1974 to 1976, a diagnosis of aseptic meningitis, meningoencephalitis, or encephalitis was entertained in 42 cases and an infectious agent was identi ed in 30 of them (Donat et al) The California virus was isolated in 19 cases and one of the enteroviruses (echovirus types 19, 16, 21, or Coxsackie virus) in 8 cases; mumps, rubeola, HSV, adenovirus 3, and M pneumoniae were detected in individual cases (several patients had combined infections).

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48), and of the neuromuscular junction (Chap 53) Anatomic and Physiologic Considerations A highly coordinated sequence of muscle contractions is required to move a bolus of food smoothly and safely through the oropharynx This programmed activity may be elicited voluntarily or by re ex movements that are triggered by sensory impulses from the posterior pharynx Swallowing normally begins as the tongue, innervated by cranial nerve XII, sweeps food to the posterior oral cavity, and brings the bolus into contact with the posterior wall of the oropharynx.

As mentioned, recent outbreaks of West Nile virus, close to 3000 cases yearly in the United States, make it more important than most of the viral infections listed here The related Japanese encephalitis virus is even more ubiquitous on a worldwide basis, causing 10,000 deaths in Asia each year..

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As the food passes the pillars of the fauces, tactile sensation, carried through nerves IX and X, re exly triggers (1) the contraction of levator and tensor veli palatini muscles, which close the nasopharynx and prevent nasal regurgitation, followed by (2) the upward and forward movement of the arytenoid cartilages toward the epiglottis (observed as an upward displacement of the hyoid and thyroid cartilages), which closes the airway With these movements the epiglottis guides the food into the valleculae and into channels formed by the epiglottic folds and the pharyngeal walls The airway is closed by sequential contractions of the arytenoid-epiglottic folds, and below them, the false cords, and then the true vocal cords, which seal the trachea All of these muscular contractions are effected largely by cranial nerve X (vagus).

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(a /b)(b /a) = ab /ba The commutative law for multiplication can be used to switch around the factors in the denominator in the right-hand side of this equation, so you get (a /b)(b /a) = ab /ab Any nonzero quantity divided by itself is equal to 1. You have already been assured that a 0 and b 0, so you know that ab 0. Therefore (a /b)(b /a) = ab /ab = 1 This shows that the reciprocal of a /b is equal to b/a.

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The palatopharyngeal muscles pull the pharynx up over the bolus and the stylopharyngeal muscles draw the sides of the pharynx outward (nerve IX) At the same time, the upward movement of the larynx opens the cricopharyngeal sphincter A wave of peristalsis then begins in the pharynx, pushing the bolus through the sphincter into the esophagus These muscles relax as soon as the bolus reaches the esophagus The entire swallowing ensemble can be elicited by stimulation of the superior laryngeal nerve (this route is used in experimental studies) Re ex swallowing requires only medullary functioning and is known to occur in the vegetative and locked-in states as well as in normal and anencephalic neonates The integrated sequence of muscle activity for swallowing is organized in a region of brainstem that roughly comprises a swallowing center, located in the region of the NTS, close to the respiratory centers.

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