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This complication of hyperthyroidism is most frequent in middle age, and men are more susceptible than women Some degree of myopathy has been found in more than 50 percent of thyrotoxic patients The onset is insidious and the weakness progresses over weeks and months The muscular disorder is most often mild to moderate in degree, but it may be so severe as to suggest progressive spinal muscular atrophy (motor system disease) Muscles of the pelvic girdle and thighs are weakened more than others (Basedow paraplegia), though all are affected to some extent, even the bulbar muscles and rarely the ocular ones However, the shoulder and hand muscles show the most conspicuous atrophy (not an obligatory feature) Tremor and twitching during contraction may occur, but we have not seen fasciculations The tendon re exes are of average briskness, possibly more lively than normal.

which has a mean value of gb xa and Pf = cov( b (t2 )) = Ta I. Given g the available information, there is no means to distinguish the correct values of gb and xa . Therefore, the initial value assignments gb (t2 ) xa (t2 ) = gb (t2 ) = 0 (10.64) (10.65)

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Both the contraction and relaxation phases of the tendon re exes are shortened, but usually this cannot be detected by the clinician Serum concentrations of muscle enzymes are not increased and may be reduced Usually the EMG is normal, without brillation potentials, though occasionally the action potentials are abnormally brief or polyphasic Biopsies of muscle, except for slight atrophy of both type 1 and 2 bers and an occasional degenerating ber, have been normal Administration of neostigmine has no effect Muscle power and bulk are gradually restored when thyroid activity is reduced to normal levels..

We can find the zero or zeros of the function by applying the quadratic formula to the equation 4x 2 + 12x 9 = 0 In the general polynomial equation ax 2 + bx + c = 0 we have a = 4, b = 12, and c = 9. When we plug these into the quadratic formula, we get x = [ b (b2 4ac)1/2] / (2a) = { 12 [122 4 ( 4) ( 9)]1/2} / [2 ( 4)] = [ 12 (144 144)1/2] / ( 8) = ( 12 02) / ( 8) = 12/( 8) = 3/2 The equation has only one root, so the function has only one zero. If we call it r, then we have r = 3/2, and we know that the point (3/2, 0) is on the parabola. We also know that this point represents the extremum. The value of a, the coefficient of x 2 in the polynomial, is negative. That means the parabola opens downward, so (3/2, 0) is the absolute maximum, and the parabola hangs from the x axis. We can choose a negative number k and set it equal to y, getting a horizontal line that crosses the parabola twice. Let s try 5 for k, as shown in Fig. 24-7. The equation of the line is y = 5.

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donitis, subacromial bursitis, or tear of the rotator cuff, which is made up of the tendons of the muscles surrounding the shoulder joint The term bursitis is often used loosely to designate these disorders Shoulder pain, like spine and plexus pain, may radiate into the arm and rarely into the hand, but sensorimotor and re ex changes which always indicate disease of nerve roots, plexus, or nerves are absent Shoulder pain of this type is very common in middle and late adult life It may arise spontaneously or after unusual or vigorous use of the arm Local tenderness over the greater tuberosity of the humerus is characteristic.

This is preciselythe fbrmat that we empioyedwhen using Newton'slaw to developa force jumper tEq. ( 1.8)1. balance the bungee for Although simple,Eq. (1.14)embodies ways in which one of the most fundarnental conservation laws are used in engineering and science-that is. to predict changes with respect to time. We will give it a special name-the time-variable (or transient) computation. Aside from predictingchanges, anotherway in which conservation laws are appliedis fbr cases wherechange nonexistent. change zero,Eq. (I.14) becomes is If is Change: 0 : increases decreases or : Increases decreases

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