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Although the abruptness with which the stroke develops and the lack of prodromal symptoms point strongly to embolism, the diagnosis is based on the total clinical picture As already emphasized, the presence of atrial brillation, a history of myocardial infarction (recent or in the preceding months), cardiac valvular disease or a prosthetic valve, or the occurrence of embolism to other vascular territories of the brain or to other regions of the body all support the diagnosis of embolism This diagnosis always merits careful consideration in young persons, in whom atherosclerosis is unlikely In instances in which the cause of embolisms cannot be ascertained, the practice is nevertheless to class them as thromboembolic.

3. Buy a book or two in the format or subject closest to what you have in mind from either a bookstore or a mail-order company such as Classic Motorbooks. Classic Motorbooks parent company, Motorbooks International, is a book publisher as well as a marketer. Automotive books are for a specialized market. Since they are not blockbuster sellers, they wouldn t interest a literary agent. This is just as well, since the agent takes a 10 to 15 percent commission. Payment is usually by royalties, which are anywhere from about 3 to 8 percent of the cover price or wholesale (net) price and are based on copies sold. Advances money paid to you against eventual royalty sales will not be large sums. Don t expect the publisher to bankroll your manuscript preparation time or photography costs. When you ve had your proposal accepted, you will be asked to sign a contract setting forth the publisher s terms. It indicates whether you are to supply photos and if you ll be paid extra for them. The royalty terms, book length, and manuscript due date are also written out. These terms are somewhat negotiable but only before you sign the contract. Although you probably won t get rich, you ll have the joy of seeing your baby arrive, its words and pictures tucked between covers, anywhere from nine months to two years after you finish writing the book.

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Laboratory Findings Not infrequently the rst sign of myocardial infarction is the occurrence of cerebral embolism; therefore it is advisable that an ECG and echocardiogram be obtained in all patients with stroke of uncertain origin, particularly since about 20 percent of myocardial infarctions are of the silent variety; if the ECG does not yield relevant information, prolonged study of heart rhythm with Holter monitoring should be undertaken Also, as indicated earlier, it is advisable in the elderly or in patients with severe atherosclerosis to image the aortic arch with ultrasound or MRA, looking for plaques greater than 4 mm in thickness (Amarenco et al).

As a final step,we can computevaluesfor the analyticalderivativeat a finer levelof resolution to includeon the plot for comparison. r - ' >X a = O :. C l : . E ; . > - i . ' a = 2 5 4 0 0 * x a + 3 * 5 7 5 * x . a . ^ 24 * 9 0 0 * r , r . ^ 3 + 5 * 4 O O * x a^ 4 ; A plot of the nurnerical and analytical estimates be generated can with >> plot (xm,d,'o',):a,ya) in As displayed Fig. 19.8,the results lavorablyfor this case. compare Note that asidefrom evaluatingderivatives,the dif f function comesin handyasa progranming tool fbr testingcertaincharacteristics vectors.For example, following of the statement displaysan error nlessage and terminates M-file if it determines a vector an that :i has unequal spacing:

a week, with no days off, and very few excuses accepted. Lombardi sustained this grueling schedule in part because there really was that much work to be done. He was not one to make up busywork just for the show of it. (The fact that he was also general manager, as well as coach, made his own workload particularly heavy.) But he was also making a point for the benefit of his players. They all saw him put in more effort than they did, every day of every week. So they were moved to put in a little extra effort on Sundays, just to balance things out a bit.

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