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With younger vaulters blood pressure pills names buy generic atenolol 100 mg on-line, it may be necessary to heart attack grill quadruple bypass burger purchase atenolol 100 mg line put a bar up on the first day of practice to heart attack 40 cheap atenolol 100mg on-line keep them interested. With older, more mature athletes, it is best to wait two to three weeks before letting them vault at a crossbar. For the intermediate and advanced vaulter, use penetration and pole bend as your guide. Penetration is the distance the vaulter travels forward into the landing area from the takeoff point. If the vaulter swings too deep into the landing area, or if the peak height of the vault occurs more than 24 inches beyond the horizontal standard setting, there is excessive penetration and the vaulter should move to a stiffer pole. Poor penetration occurs when the vaulter fails to swing beyond the front of the pit or the pole fails to come to a vertical position. Twelve- and 13-foot vaulting poles can accommodate a large variety of handgrips for 383 ChapTer 16 Training Pole Vaulters the beginning vaulter. However, the general recommendation for top hand grip range when bending a pole is between is 18 to six inches from the top of the pole. Achieving a "C" position should not be coached, but should be a result of a proper takeoff. Itisnotuncommonforvaulters to require poles rated 10­25 pounds above their body weight. Using the proper grip height is the key to developing efficient, safe vaulting technique. Use the chart below to determine the proper grip height on the pole, takeoff distance from the back of the box, six-stride check mark placement, and six-stride time into the takeoff. For any given grip height, shorter vaulters will take off further out and taller vaulters will be closer. Then, based on the chart, place a check mark next to the runway for the six stride mark. A vaulter who does not achieve the average time for these six strides into the takeoff can expect a vault below the height listed for that time on the chart. A vaulter who runs faster than the average time listed can expect a vault greater than the height listed, given proper vaulting technique. The first check mark can be determined by the vaulter placing the takeoff foot the correct distance from the plant box, turning to face away from the pit and running the number of strides toward the end of the runway that allows him or her to attain maximum controlled running speed. The start marker is placed where the takeoff foot strikes the runway after 10­16 strides. These two marks allow the vaulter to check the accuracy of the start of the approach. A third marker placed six strides from the takeoff point should be used by the coach to check the accuracy and consistency of the approach run. The beginning vaulter should use 10­12 progressively faster strides into the pole plant/takeoff. The vaulter may either count these strides by counting the number of times the takeoff foot strikes the runway (five or six times) or by using visual cues along the side of the runway. Optimum penetration is the result of using the correct grip height for the amount of force transferred toward the pit at takeoff. Poor penetration occurs when the pole fails to reach a vertical position and the vaulter fails to reach the vertical plane of the back of the vault box. Excess penetration (too low a grip height for the amount of force transferred at takeoff) will not allow the vaulter enough time to complete the swing and reach the fully inverted position. If the athlete has a proper takeoff, adjusting grip height up or down approximately four inches will usually correct penetration problems. Methods of Training Of all track and field events, the pole vault requires the greatest range of athletic ability. Training for the pole vault should include running, sprinting, weight training, plyometrics, gymnastics, flexibility exercises, vault-specific drills and, of course, vaulting. In order to develop the strength required for the pole vault, the following points should be noted: · Polevaultersneedtohavegoodstrengthrelativetotheirbodyweight,buttheydo not need to become bodybuilders. Recommended Lower Body Exercises, Without Weights · Hamstringcurlsusinganelasticstrap,eitherfixedorheldbyapartner,ankle weights or weighted shoes.

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In some systems blood pressure watches cheap generic atenolol canada, clinically diagnosed pertussis cases (without laboratory confirmation) are reported pulse pressure different in each arm buy atenolol master card, while other systems focus on laboratory-diagnosed pertussis arrhythmia svt atenolol 50 mg visa. In systems that gather clinically diagnosed pertussis reports, there is potential for overestimating pertussis disease rates. In contrast, other systems that focus on laboratory-confirmed pertussis reports may underestimate true pertussis rates, because substantially less than 100% of clinically suspected pertussis may undergo laboratory testing (163). Underreporting of cases is more likely, and it has been suggested that the true incidence of pertussis is at least three times higher than the official reported rates (164­170). Underreporting is of particular significance with regard to older children and adults, for whom the cough pattern may be atypical. Clinical presentations with atypical cough may result in significant delays in seeking medical consultation (171­173). For the past several decades, routine pertussis immunization has dramatically reduced disease incidence. In the past, pertussis was primarily a disease affecting children less than 6 years old. However, in the past 20 years there has been a change in the epidemiology of pertussis such that adolescent and adult pertussis 452 cmr. Burden of Pertussis in Infants and Toddlers In the vaccine era (from the 1940s to the present), pertussis epidemics have occurred in 3- to 4-year cycles that may have resulted from the cycling of population immunity (188, 189). In the United States, pertussis has become endemic and is currently considered the most common vaccine-preventable disease (190­195). Recent nationwide incidences of pertussis for children less than 6 months, 6 through 11 months, 1 through 6 years, and 7 through 10 years were approximately 160, 40, 22, and 30 per 100,000 population, respectively (196). In 1994 to 1998, 13,800 children less than 2 years old were hospitalized as result of pertussis, whereas in 1999 to 2003, the number of hospitalizations was 17,000 for the same age group (197). In 2003, 19% of total reported pertussis cases (n 11,647) occurred in infants aged less than 1 year (198). In 2010, a total of 25 deaths were reported among infants aged less than 6 months (199). In the United States, from 2012 to 2013, 12 pertussis-associated deaths were reported in infants under 3 months of age, and one child died among children aged 1 through 4 years old (200). From 2013 to 2014, seven deaths in infants under 3 months old and one fatality in children 1 through 4 years old were reported (196). Pertussis outbreaks have occurred in several states and in all regions of the United States (201­206). Additionally, from May 2010 through May 2011, a mixed pertussis and pertussis-like illness outbreak produced 918 cases in Franklin County, Ohio (34). In 2012, Minnesota experienced a large pertussis epidemic in which 4,144 cases were reported (206). Nationwide, during 2012, the total number of reported pertussis cases in all age groups exceeded 48,000, including 20 pertussis-related deaths that occurred primarily in infants aged less than 3 months (207). In the same year (2012), there were 4,918 total cases (including both confirmed and probable cases), with an overall incidence of 11/100,000 residents (203, 208). During this outbreak, 95 infants were diagnosed with pertussis (incidence, 107/ 100,000), including 35 children who required hospitalization (208). In 2013 and 2014, while transmission continued, the number of reported pertussis cases declined to 748 and 565 cases, respectively (202, 208). However, in 2015, the number of pertussis cases reported to the Washington State health department through week 48 exceeded 1,300, compared with 456 reported cases through week 48 in 2014 (202). In Michigan, the number of cases reported from 2010 through 2012 exceeded 3,000, with more than half (n 1,564) of these cases reported in 2010 (204). From 2010 through 2014, pertussis has been widespread throughout the state of California; 26,566 cases were reported, more than 1,700 of the patients were hospitalized, and there were 15 reported fatalities. In 2014, the number of cases reported (n 10,831) was the highest of any single year (201). Among them, 376 people were hospitalized, and 85 (23%) of them required intensive care. Of the 376 hospitalized patients, 227 (60%) were infants less than 4 months of age, and four cases were fatal in infants less than 2 months of age. The cumulative pertussis disease burden in California from 2010 to 2014 underscores the ongoing impact of pertussis. Recently, Canadian public health officials identified an outbreak of pertussis that began in the Mauricie-Central Quebec region during early October 2015 (209).

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These make cytologic screening and colposcopy of the endocervical tissues technically more difficult and less reliable than for the smoother and more accessible squamous epithelium of the ectocervix arrhythmia symptoms order atenolol 50 mg fast delivery. The overall size and shape of the cervical portio blood pressure chart home use best 50mg atenolol, along with numerous other factors such as parity blood pressure of 12080 cheap atenolol 50mg visa, location and severity of disease, will influence choice of management and treatment options. Cold knife conization of the cervix can be associated with subsequent adverse pregnancy outcome in some cases, presumably secondary to shortening of the cervix. Although the determinants of obstetrical cervical competence remain enigmatic, the length of the cervix probably plays a role. In addition, an unusually small or large cervix, or one that is difficult to reach due to anatomic variations, may influence whether any needed treatment will take place in an inpatient versus an outpatient setting. Cervical and vaginal branches of the uterine arteries supply the cervix and upper vagina. There is considerable anatomic variation and anastomoses with vaginal and middle hemorrhoidal arteries. The venous drainage of the cervix parallels the arterial supply, eventually emptying into the hypogastric venous plexus. The primary route of spread of cervical cancers is through the lymphatics of the pelvis. Radical hysterectomy for invasive cancer of the cervix includes removal of as much of the pelvic lymphatics as possible. These attach to the lateral and posterior aspects of the cervix above the vagina and extend laterally and posteriorly to the walls of the bony pelvis. The uterosacral ligaments are the conduits of the main nerve supplying to the cervix, derived from the hypogastric plexus. Instrumentation of the endocervical canal (dilatation and / or curettage) may result in a vasovagal reaction with reflex bradycardia in some patients. The endocervix also has a plentiful supply of sensory nerve endings, while the ectocervix is relatively lacking in these. This allows procedures such as small cervical biopsies and cryotherapy to be well tolerated in most patients without the use of anesthesia. The stroma of the cervix, which accounts for most of its mass and shape, is composed of dense, fibromuscular tissue made up of collagenous connective tissue (smooth muscle and elastic tissue) and ground substance (mucopolysaccharide). Through the stroma course the vascular, lymphatic, and nervous supplies of the cervix. While of great importance to the structure and obstetrical functioning of the cervix, the stroma plays little role in cervical neoplasia. Rather, it is the epithelium of the cervix which gives rise to cervical neoplasia. The cervix is covered by both columnar and stratified non-keratinising squamous epithelia. The squamocolumnar junction, where these two meet, is the most important cytologic and colposcopic landmark, as this is where over 90% of lower genital tract neoplasia arises. This junction is presumed, but not proven, to be the embryologic junction of the Mьllerian and urogenital sinus epithelia. Colposcopically, it appears featureless except for a fine network of vessels which is sometimes visible. The relative opacity and pale pink coloration of the squamous epithelium derives from its multi-layered histology and the location of its supporting vessels below the basement membrane. A full description of the histology and maturation of squamous epithelium can be found in any number of pathology texts and will not be detailed here. Mature squamous epithelium (H&E x 400): Different layers starting at the basement membrane (basal, parabasal, intermediate, superficial) are evident. The maturation and glycogenation of the squamous epithelia of the vagina and cervix are influenced by ovarian hormones. This explains why the squamous epithelium appears atrophic after loss of ovarian function, with pallor and subepithelial point-hemorrhages from increased vulnerability of the underlying vessels. These atrophic changes may be seen, albeit less dramatically, with prolonged exposure to progestins, as with injectable progestin-only contraceptives. It may also show abnormal deposition of keratin in the upper layers of the epithelium. Parakeratosis (H&E x 400): Orange layer of keratin above the superficial squamous epithelial cells. The blue cell layer beneath the keratin indicates the production of keratin granules.

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Most runners arteria epigastrica superficial buy 100mg atenolol otc, lacking experience prehypertension jnc 7 generic 50 mg atenolol with visa, do not have enough confidence or knowledge of pace to blood pressure psi safe 100mg atenolol make the even pace happen; however, when this tactic is learned, it can be extremely successful H. Running for the team versus running as an individual In many track meets distance runners are often called upon to run as many as three or four races in a single meet for the team to be successful. In order to be strong in later events, a distance runner may run slower than his or her best effort in order to score points but conserve energy for efforts later in the meet. Even in these "easier" efforts, athletes need to begin each race with a solid race plan as to how to accomplish the goal. Many inexperienced high school runners may have trouble with this concept and actually expend too much energy in running a race that is different than normal. This is a tactic that needs to be "rehearsed" in preseason meets before a team really needs to use it in a "big meet. Regardless of the methods, the key to an effective training program is detailed planning, the judicious use of rest and recovery, and a gradual increase in training intensity and duration. Steady state training Steady state runs are long runs that should be done at a pace that can be maintained for 40­60 minutes with relative ease. These long, steady run periods of training programs serve as the "base" or "foundation" that is absolutely necessary to allow for longer, more intense training later in the training cycle. It is important coaches not fall into the "more is better" philosophy when dealing with steady state training. While increased volume is certainly helpful, too many miles tends to destroy the snap in the legs and the excitement in the brain; furthermore, there is substantial evidence to indicate that extensive miles run at a young training age can actually reduce the additional capillarization that will occur during heavy training when an athlete reaches physical maturity. Theoretically, regular threshold training will enable the runner to maintain a faster race pace with no greater accumulation of lactic acid. Tempo runs are typically 20­30 minutes at a pace about 20 to 40 seconds per mile slower than 5K race pace, with warmup and cool-down running included before and after the run. The purpose of tempo runs is to train at an intensity level just short of hard pace running. Segmented threshold training is also referred to as tempo repetitions or tempo intervals. This training consists of a series of shorter segment runs, usually lasting 90 seconds to eight minutes, with short recovery periods of one-minute or less in between. A entire tempo interval workout could last as little as 30­40 minutes, including recovery time. Repeated segments of one to six minutes of fast running have been identified by exercise physiologists as ideal repetition training for distance runners. Repetition training is designed to increase running efficiency by decreasing the oxygen cost of running and to help the runner become more pace and rhythm conscious. Repetition training enables a runner to train at V02 max for a cumulative period of time greater than could be sustained in a single race. A total time of 20­25 minutes, not including recovery time, is a good upper limit for a repetition training session. In an interval training session, the objective is to run specific segmented distances repeatedly at a high lactate blood level, so the recovery ratio is 2:1 run to recovery-in other words, the time rested (interval) between running segments is half the time it took to run the previous segment. Interval training should be included more often in the training of 800m and 1600m runners than 3200m runners because those races are 30­50% anaerobic. Research has shown that middle distance runners need to be able to tolerate high levels of lactic acid because it is a byproduct of anaerobic running. Research also shows that middle distance runners must be able to produce high levels of lactic acid because it becomes an energy source in the absence of oxygen via the Krebs cycle. The intensity of interval training should be faster than race pace because its purpose is to produce lactic acid by performing the last portion of each run anaerobically. The duration of each segment run in an interval session is typically 15­90 seconds (100­ 600m). The idea is not to fully recover but to maintain a high level of lactic acid in the blood throughout the workout.