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5 3 4 7 8 9 10 6 Depending on the circumstances, these may include a blood count and erythrocyte sedimentation rate (especially helpful in screening for infection or myeloma); calcium, phosphorus, uric acid, alkaline phosphatase, acid phosphatase, and prostate-speci c antigen (if one suspects metastatic carcinoma of the prostate); a serum protein electrophoresis (myeloma proteins); in special cases, a tuberculin test or serologic test for Brucella; a test for rheumatoid factor; and HLA typing (for ankylosing spondylitis) Radiographs of the lumbar spine (preferably with the patient standing) in the anteroposterior, lateral, and oblique planes are still useful in the routine evaluation of low back pain and sciatica Readily demonstrable in plain lms are narrowing of the intervertebral disc spaces, bony facetal or vertebral overgrowth, displacement of vertebral bodies (spondylolisthesis), and an unsuspected in ltration of bone by cancer.

The notochord is the key anatomic feature. It is a long, narrow structure in the back (noto-) that looks like a thin cord (chord) or rod. The notochord s chief function is supporting and sti ening the body. All chordates have a notochord in their bodies during at least one stage of their development. And it is this notochord that can serve as the basis for development of a full vertebral column or jointed backbone.

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Earth, like the Moon, casts a shadow into space, but Earth s shadow is longer and wider. The full Moon usually misses Earth s shadow, but it sometimes enters the penumbra, and once in while it makes it into the umbra. If the Moon passes into Earth s penumbral shadow, we usually don t notice anything; for a few hours the full Moon might shine a little less brightly than it ought, but that is all. However, if part or all of the Moon moves into Earth s umbral shadow, a lunar eclipse occurs, and anyone on Earth who can view the Moon will see the eclipse. When the Moon first begins to enter Earth s umbral shadow, the darkness takes a bite out of the Moon in much the same way as the Moon obscures the Sun during the beginning of a solar eclipse. The Moon might pass beneath or above the shadow core, so darkness never covers the Moon completely; in these cases we see a partial lunar eclipse. At mideclipse, the Moon seems to either smile or frown depending on which side of the umbra it passes. The diameter of Earth s umbral shadow at the Moon s distance (381,000 kilometers, or 237,000 miles, on average) is several times the diameter of the Moon itself. For this reason, there is a fair chance that the Moon will plunge entirely into the umbra for a time, causing a total lunar eclipse (Fig. 4-12). These happen more often than total solar eclipses occur on Earth. The Moon rarely goes black during totality but exhibits a dim coppery or rusty glow caused by sunlight passing through Earth s

My greatest wish has always been to have a home where I could provide top-notch care for older people who would spend the last years of their lives with me To prepare for this, I became a CNA; I worked in institutions and also as a private duty nurse and saved my money Fortunately, Rod, my husband, who is a doctor, shared my dream and has helped me all along the way We needed his income when we were planning this home because of the start-up expenses, to say nothing of the huge investment needed for furniture and equipment Brenda has someone to help with the housework as well as an aide to look after the residents needs Our inn is a home away from home, where residents are a family unit, living in a caring atmosphere that fosters dignity and independence, the owner said.

We provide services and support in the least restrictive normal living environment possible, because ours is a noninstitutional private home setting where residents come by choice to live The cook prepares all meals, and on his days off, the aide and Brenda cook and serve When the aide is not there, Brenda covers for her Sometimes some of the residents offer to help, which gives them a sense of being needed In addition to running the inn, Brenda finds time to plan activities for the residents, take them to the doctor, the mall, the movies, or a drive into the mountains As if that is not enough, she is also a licensed cosmetologist and can take care of the residents beauty needs As we prepared to leave, we asked Brenda if she had any advice for those interested in starting their own assisted care home.

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