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In a later heart attack flac torrent cheap coreg 12.5 mg mastercard, equally elaborate part of this ceremony blood pressure medication options generic coreg 25 mg with mastercard, the garments were carefully placed back onto the effigies inside the church heart attack movie online purchase 25 mg coreg overnight delivery. At specific times during the ceremony diastolic blood pressure 0 purchase 6.25 mg coreg with visa, participants of the ceremony recited prayers, played music, sang songs, and consumed food and beverages (Klein 1994). For comparative purposes, however, a few of the similarities between Mixtec codices and the present-day Maya ceremony will be described. Furst describes depictions in the Codex Vindobonensis of "preparatory" rituals, the function of which is to initiate the ceremonies to be performed. These are often indicated by depictions of groups of ritual objects and by the depiction of two men who hold xicolll (tunic-like garments) upright by the two top corners, as if the textiles are being offered (Furst 1977:195). As depicted in the codex, the Mixtec men who hold garments are in a position similar to that of the present-day highland Maya men receiving the washed garments from the women, as shown in a Gertrude Blom photograph (ca. In the Maya ritual the garments are hung on a clothesline to dry and later purified with the smoke of copal incense. In another Mixtec codex (Becker I), a seated man is shown playing music over a textile that appears to be draped over a small, freestanding (wooden? As shown in the Blom photographs of 1950, in the highland Maya community of Santa Magdalenas, the wet garments of the saints were turned inside out and hung on a clothesline. Three-dimensional wooden structures made of lashed branches - similar to those depicted in the codex -had been fitted inside the garments, perhaps allowing them to dry into the shape of the effigies. Conservation and Cultural Identity 13 Although women are not depicted in the Codex Vindobonensis as ritually washing textiles, the garments are shown hanging between two wooden poles, as if on a clothesline, connected to a small architectural structure, which Furst indicates is a steam bath. The Mixtec steam bath is one of several "place signs" associated with water that designate where ceremonies are to be performed. Maya washing of the flowers ceremonies often take place at sacred springs that have been designated as locations for the ritual washing of the garments and religious objects of the saints. In the Codex Vindobonensis, along with depictions of ritual objects and textiles, men are shown wrapping ropes around (wooden? Currently, as in the past, cargo boxes are an important aspect of the highland Maya ceremony, as the textiles and ritual objects for the saints are carried in boxes to the sacred spring, then back again to the church. The boxes function as containers while the textiles and objects are being counted during the ceremony; the depiction of wooden boxes in the Mixtec codex may also suggest the ritual counting of objects. The codex also shows pairs of men holding ropes stretched out between them, perhaps in a ritual act of making a clothesline. In the Maya ceremony, great lengths of ropes for clotheslines are ritually placed onto numerous wooden poles. In the codex, the depiction of boxes of ritual textiles and objects also functioned to designate sacred spaces. The ritual participants Codex Vindobonensis, depicting ceremonial objects, as well as men holding a rope between them and a man wrapping a rope around a box. As in the present-day Maya ceremony, the depiction of boxes in the late Postclassic Mixtec codex may indicate that sacred objects had been stored in boxes during periods between ceremonies as well. The acquisition of land and/or the designation of sacred spaces are metaphorically demonstrated through the depiction of men tying ropes around boxes. Interestingly enough, the sacred space where the chuc nlchim ceremony takes place is designated by rope clotheslines held on poles within that space. Usually the mayordomos sit within the confines set forth by the rope clotheslines and the textiles that are hanging on them. Furthermore, traditionally, when Maya women wash everyday clothing next to a river or washbasin, they allow their everyday clothing to dry flat on the ground or on top of small bushes, rather than setting up any sort of clothesline system. Both the Mixtec Codex Vindobonensis and the present-day Maya washing of the flowers ceremony indicate that ceremonial textiles and religious objects-whether worn by people impersonating gods within a ceremony, by the depictions of gods, by Catholic effigies of saints, or by people who attend the saints within a ceremony-are ritually prepared, honored, and used in order to initiate a ceremonial transformation of the earthly realm into the spiritual realm. Further investigation of current ethnological accounts of these types of Mesoamerican ceremonies, and of Mesoamerican codices, when combined with sixteenth-century Spanish descriptions, may indicate that many ceremonies that utilize ceremonial textiles to penetrate the sacred world are interpretations of ancient Mesoamerican ceremonial practices that have continued to take place within certain areas at least since the late Postclassic period. While more ethnological data about this particular ceremony need to be gathered for the Oaxaca region, it would not be surprising to find that rituals similar to the Maya washing of the flowers ceremony continue to exist within some churches of the indigenous people of Oaxaca. The universal Mesoamerican use of the word flower in association with textiles -albeit in different Mesoamerican languages - symbolically refers to fertility, beauty and divinity, life, and the Full view and detail of a colonial embroidered sampler from Oaxaca.

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Botulinum toxin treatment of sialorrhoea: comparing different therapeutic preparations arrhythmia yahoo answers buy coreg once a day. Cross References Bulbar palsy; Parkinsonism Sighing Occasional deep involuntary sighs may occur in multiple system atrophy heart attack sam coreg 12.5 mg sale. Sighing is also a feature heart attack vs angina 12.5mg coreg overnight delivery, along with yawning blood pressure medication chronic cough order coreg 25 mg with visa, of the early (diencephalic) stage of central herniation of the brainstem with an otherwise normal respiratory pattern. Recognition of single objects is preserved; this is likened to having a fragment or island of clear vision which may shift from region to region. Two types of simultanagnosia are described: · Dorsal: An attentional limitation preventing more than one object being seen at a time; although superficially similar to apperceptive visual agnosia, with which it has sometimes been classified, patients with dorsal simultanagnosia can recognize objects quickly and accurately, but unattended objects are not seen. There may be inability to localize stimuli even when they are seen, manifest as visual disorientation. Ventral: A limitation in the number of objects which can be recognized in unit time, i. Ventral simultanagnosia is most evident during reading which is severely impaired and empirically this may be the same impairment as seen in pure alexia; otherwise deficits may not be evident, unlike dorsal simultanagnosia. This is thought to reflect damage to otolith-ocular pathways or vestibulo-ocular pathways. Skew deviation has been associated with posterior fossa lesions, from midbrain to medulla. Ipsiversive skew deviation (ipsilateral eye lowermost) has been associated with caudal pontomedullary lesions, whereas contraversive skew (contralateral eye lowermost) occurs with rostral pontomesencephalic lesions, indicating that skew type has localizing value. Skew deviation with ocular torsion: a vestibular brainstem sign of topographic diagnostic value. Dysarthria, facial paresis, hemiparesis with or without hemihypoaesthesia, and excessive laughing with or without crying were common accompanying features in one series. Smile­wink phenomenon: aggravated narrowing of palpebral fissure by smiling after lenticulocapsular stroke. Sensory nasal trigeminal afferents run to a putative sneeze centre, localized to the brainstem based on lesions causing loss of sneezing following lateral medullary syndrome and medullary neoplasm. Integration of inputs in this centre reaches a threshold at which point an expiratory phase occurs with exhalation, forced eye closure, and contraction of respiratory musculature. Cross Reference Lateral medullary syndrome Snoring Reduced muscle tone in the upper airway during sleep leads to increased resistance to the flow of air, and partial obstruction often results in loud snoring. Obstructive sleep apnoea­hypopnoea syndrome presenting in the neurology clinic: a prospective 5-year study. Cross Reference Hypersomnolence Snouting, Snout Reflex Sometimes used interchangeably with pout reflex, this term should probably be reserved for the puckering or pouting of the lips induced by constant pressure over the philtrum, rather than the phasic response to a tap over the muscle with finger or tendon hammer. Cross References Frontal release signs; Pout reflex; Primitive reflexes Somatoparaphrenia Ascription of hemiplegic limb(s) to another person. For example, flexor spasms in patients paraplegic due to upper motor neurone lesions are sudden contractions of the flexor musculature, particularly of the legs, either spontaneous or triggered by light touch. Spasm may also refer to a tetanic muscle contraction (tetany), as seen in hypocalcaemic states. Infantile seizures consisting of brief flexion of the trunk and limbs (emposthotonos, salaam or jack-knife seizures) may be known as spasms. This is usually a benign idiopathic condition, but the diagnosis should prompt consideration of an optic pathway tumour. Spasmus nutans-like nystagmus is often associated with underlying ocular, intracranial, or systemic abnormalities. The excessive resistance evident at the extremes of joint displacement may suddenly give way, a phenomenon known as clasp-knife (or, confusingly, clasp-knife rigidity). The amount and pattern of spasticity depends on the location of the lesion and tends to be greater with spinal cord than cortical lesions. Scales to quantitate spasticity are available (Ashworth, modified Ashworth, pendulum test of Wartenberg) but have shortcomings. Spasticity may also vary in distribution: for lesions above the spinal cord it typically affects the arm flexors and the leg extensors to a greater extent (hemiparetic posture).

Migraine headache is preceded by focal neurologic symptoms blood pressure top number high cheap 6.25mg coreg with mastercard, termed "aura hypertension images best 25mg coreg," in up to 30% of patients blood pressure chart 18 year old discount coreg 25mg on line. Aura is typically characterized by any combination of visual arrhythmia electrolyte imbalance discount 6.25 mg coreg, hemisensory, or language abnormalities, with each symptom developing over at least 5 minutes and lasting a maximum of 60 minutes. The most common aura is visual, consisting of a flashing light or an enlarging blind spot rimmed with a shimmering edge or jagged lines in the peripheral vision. Common nonvisual auras include spreading unilateral numbness or tingling affecting the face and arms and disturbed thinking or speech. The associated headache usually occurs within 1 hour, but auras do not always progress to head pain. Use of the 5 criteria most predictive of migraine resulted in 95% sensitivity and 78% specificity. The presence of 3 of these 5 criteria is predictive of migraine and 4 of 5 is highly predictive (1). Tension-type headache is a "featureless" headache, lacking the characteristic symptoms that define migraine. The nonpulsating pressing or tightening quality is described by patients as a "band-like" constriction around their head. There is no aggravation of headache by routine physical activity and no association with nausea or vomiting (although anorexia may occur). However, extensive variability in the clinical expressions of migraine often leads to misdiagnosis of tension headache in the presence of steady bilateral pain or sinus headache, when the discomfort is a frontal or facial pressure. What clinical features suggest that the cause of headache may be more serious than migraine? More serious causes of headache (Table 1) must always be considered because certain conditions that sometimes cause headache, such as aneurysm or giant cell arteritis (temporal arteritis), are so serious that delayed diagnosis or treatment could cause death or permanent impairment (see the Box: Symptoms Suggesting Serious Secondary Causes of Head-ache). Aspects of the history International Headache Society Criteria for Migraine Diagnosis Without aura A. Headache with at least 2 of the following characteristics: · Unilateral location · Pulsating quality · Moderate or severe pain intensity · Aggravation by or causing avoidance of routine physical activity. During heacache, occurrence of at least one of following symptoms: · Nausea and/or vomiting · Photophobia and phonophobia E. Aura consisting of visual, sensory, and/or speech/ language symptoms, each fully reversible, but no motor weakness or brainstem symptoms. At least 2 of the following characteristics: · At least 1 aura symptom spreads gradually over 5 or more minutes, and/or 2 or more symptoms occur in succession · Each individual aura symptom lasts 5­60 minutes · At least 1 aura symptom is unilateral · the aura is accompanied, or followed within 60 minutes, by headache D. The International Classification of Headache Disorders: 3rd edition (beta version). Evidence-based guidelines for migraine headache: neuroimaging in patients with nonacute headache. Onset of migraine after age 50 years is unusual, and the likelihood of secondary causes is greater. A cohort study of patients with giant cell arteritis revealed that headache was the predominant symptom in 65%­80% of patients (3). What is the role of diagnostic testing, including imaging studies and electroencephalogram, in patients with suspected migraine? Neuroimaging is not usually warranted for migraine and is unlikely to reveal an abnormality in patients with a normal neurologic examination. A meta-analysis of studies of migraine patients and a normal neurologic examination found a rate of significant intracranial lesions of 0. The main purpose of the examination is to assure both physician and patient that there is no underlying sinister pathology causing the headache, and patients can be reassured if the findings are "normal" (see the Box: Signs Suggesting Serious Secondary Causes of Headache). In patients seen in a specialist clinic, fewer than 1% have headaches secondary to intracranial disease, and all of such patients have signs attributable to the intracranial process. Particular attention should be paid to the cranial nerves, tendon reflexes, and optic discs. Pulse and blood pressure should be measured, and auscultation for cardiac abnormalities and bruits should be done first and are particularly important if vasoconstrictor drugs, such as ergotamine or triptans, are being considered.

En 1977 se celebrу la Conferencia Intergubernamental de Tbilisi en la cual se redactу el Tratado de Educaciуn Ambiental pulse pressure pregnancy best buy coreg, estableciendo asн las bases de este movimiento (Dpto blood pressure ideal discount 12.5mg coreg mastercard. Luego blood pressure empty chart generic coreg 6.25mg on line, en 1992 pulse pressure nursing buy coreg in united states online, en Rнo de Janeiro, se lleva a cabo la Segunda Conferencia de las Naciones Unidas sobre el Medio Ambiente y Desarrollo donde se insiste en la necesidad de incorporar la educaciуn ambiental en todas las naciones. Igualmente, en esta conferencia se crearon dos documentos que establecieron las estrategias para el desarrollo sostenible en el mundo: 1) La Agenda 21, capнtulo 36 presenta el tema de la educaciуn y comunicaciуn ambiental y 2) El Tratado de Educaciуn Ambiental para Sociedades Sustentables y Responsabilidad Global. Para resolver estos conflictos se tiene que mejorar el conocimiento ambiental utilizando todos los recursos disponibles e integrando distintas disciplinas. La incorporaciуn de programas de educaciуn ambiental en las escuelas son un mйtodo de enseсanza informal que permite que los estudiantes desarrollen todas estas destrezas. Una de las estrategias que se presenta como alternativa para integrar la educaciуn ambiental en las escuelas es, precisamente, enfocarse en establecer alianzas entre modelos de educaciуn formal e informal (Knapp 2000). Esto es porque la implementaciуn efectiva de la educaciуn ambiental no se puede lograr solo; es necesario unir esfuerzos de educaciуn ambiental formal e informal. Este tipo de alianza proveerб a los educadores con personas recurso que cuenten con la experiencia y el entrenamiento adecuado. Ademбs, recursos como las organizaciones no-gubernamentales tambiйn pueden proveer capacitaciуn en el puesto de trabajo para los educadores y asн lograr una mejor diseminaciуn de la educaciуn ambiental. La organizaciуn tambiйn ha publicado varios estudios, incluyendo uno sobre el efecto del desarrollo urbano en las temperaturas de Puerto Rico y otro de clasificaciуn de municipios por nivel de sustentabilidad (Torres Valcбrcel et al. Ademбs de educar acerca de la sustentabilidad y la protecciуn ambiental, este programa busca modificar actitudes y conducta, motivar a los participantes a tomar acciуn desde la escuela teniendo un movimiento de base (Grassroots) y busca que el individuo influya a la comunidad. Al mismo tiempo, cuentan con el apoyo de una organizaciуn sin fines de lucro y reciben el respaldo de la comunidad. Las escuelas no pueden actuar solas para alcanzar todas las metas acadйmicas y es necesario comprender que hay una amplia gama de experiencias de aprendizaje cientнfico que pueden mejorar la educaciуn. Sin embargo, existen muy pocas investigaciones que reflejen los resultados de la educaciуn en ambientes informales y mucho menos en cуmo los programas educativos informales con un enfoque ambiental pueden tener un efecto en el desempeсo acadйmico de los estudiantes. Aunque ya existen algunos estudios relacionados al efecto de la educaciуn ambiental en el aprovechamiento acadйmico de los estudiantes, este tipo de investigaciуn sigue estando escasamente estudiada, especialmente en Puerto Rico. Asimismo sucede con investigaciones acerca del efecto de la educaciуn informal en el aprovechamiento acadйmico. Por ende, existe una necesidad de realizar mбs estudios cuantitativos y cualitativos que demuestren la efectividad de la educaciуn ambiental y su efecto positivo en el aprovechamiento acadйmico. Esta investigaciуn pretende examinar si hay una correlaciуn entre la educaciуn ambiental, mediante un programa de educaciуn informal, y un mayor aprovechamiento acadйmico de voluntario y flexible ya que se ajusta a la disposiciуn y disponibilidad de recursos en cada escuela. Tambiйn es un programa que sirve como herramienta y fuente de apoyo para trabajar por la sustentabilidad. El National Research Council indica que los ambientes informales de aprendizaje pueden ser medios importantes para aprender sobre diversas materias y juegan un rol especial impulsando el aprendizaje de las ciencias, especialmente los programas fuera de horarios regulares de clases. Tambiйn indica que los programas de enseсanza de ciencias toman lugar en escuelas y organizaciones basadas en la comunidad que son ricas en ciencias y que incluyen actividades que son apoyadas por la organizaciуn, la comunidad u otros, o que son organizadas por ellos mismos. Tambiйn cuentan con una variedad de participantes que incluyen maestros, miembros de la comunidad, familiares, grupos estudiantiles, entre otros. Muchos investigadores entienden que la educaciуn ambiental no solamente lleva a adquirir conocimiento ambiental, sino que tambiйn ayuda a mejorar la conducta ambiental (Disinger 1982, Marcinowski 1987, Sia 1984, Zelezny 1999, citados en Bartosh 2003). Ademбs, de acuerdo a Disinger, se espera que la educaciуn ambiental en lugares no tradicionales e informales sea mбs efectiva que los programas tradicionales del salуn para cambiar la conducta ambiental (citado en Bartosh 2003). Ademбs, el estudio analнtico realizado por el National Research Council indica que la educaciуn informal tambiйn contribuye significativamente en el desempeсo del aprendizaje de las ciencias. Por consiguiente, nuestro objetivo es identificar si participar en un programa de educaciуn ambiental informal tambiйn tiene un efecto positivo en el desempeсo acadйmico de los estudiantes en escuelas pъblicas de Puerto Rico. Bartosh (2003) estudiу si los programas de educaciуn ambiental pueden mejorar el conocimiento y las destrezas de los estudiantes en otras materias que no estбn relacionadas con la educaciуn ambiental, como por ejemplo, las matemбticas, escritura, lectura y escuchar. Para medir el aprovechamiento acadйmico utilizу los resultados de dos pruebas estandarizadas que ofrece el estado y los comparу entre escuelas con educaciуn ambiental y escuelas "tradicionales". Asimismo, utilizу unas rъbricas previamente establecidas para determinar 31 el nivel y alcance de la implementaciуn e integraciуn de la educaciуn ambiental en las escuelas.

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