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The MISS current high-level operation work ow that starts from presurgical consultation, proceeds to pre-operation preparation, intra-operation image, vital signs acquisition and display, and postsurgery documentation, and ends with patient recovery monitoring is shown in Figure 24.13. The work ow can be broken down into three phases: (1) before surgery; (2) during surgery (including the preparation); (3) postsurgery, which will be discussed below. 1. Before surgery (pre-op): Prior to the actual surgical procedure usually the patient presents with a problem and is evaluated by the physician to determine whether MISS is needed and whether it would be helpful to the patient. If this case is true, then a procedure is scheduled. At this stage the surgeon or surgeons in combination with the physician s assistant plan the surgical

(6.60)

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T h e next step is to map out how the key aspects can be enhanced: what needs to be achieved, who would d o it, how much would it cost, what would be the costs of disruption Two areas of questioning are important here: what are the key drivers of revenue and cost in the business, and how will online developments affect these This requires a detailed appraisal of all the activities, online and offline, to be completed, as well as a detailed assessment of the cost of these new enhancements and the likely benefits in ternis of increased market share, increased prices and/or reduced cost. I n considering this, it can often help to approach the business from an entirely new, objective perspective, perhaps even developing a different business model. To this end, business consultants (a much maligned profession!) can add real value, questioning revered tenets of conventional wisdom and providing a dynamic perspective that is flexible, realistic and action oriented.

differences are small (or non-existent) among adolescents and young adults (Bray, 2004). The lower BMI and higher mortality among smokers are partly responsible for the low extreme of the U-shaped relationship between BMI and risk of death ( 9). Conversely, smoking cessation often leads to weight gain. Several large prospective studies have shown that those who stop smoking gain on average 4 5 kg. Weight increase is more pronounced in women, younger subjects, Black people, heavy smokers and those whose initial weight is relatively low; overall, some 20% of those who stop smoking gain 10 kg or more (Bray, 2004). This is due to increased energy intake (especially of sweet and fat-rich foods), together with loss of the catabolic actions of nicotine. Smokers commonly view weight gain as a serious consequence of stopping smoking, and it is probably a major disincentive for many; some young people, especially women, may use smoking as a means to limit weight gain. The bene ts of stopping smoking undoubtedly outweigh any detrimental effects of postcessation weight gain, and on balance, smoking cessation should take priority.

import time as _time def _getnow(): Returns current time tuple return _time.localtime(_time.time()) def time(): Returns current time as string return _time.strftime( %I:%M %p ,_getnow()) def date(): Returns current date as string return _time.strftime( %b %d, %Y ,_getnow())

A; I or II A or B; I or II A; I or II A or B; I or II A or B A or B A, B or C A or B; I or II A or B A or B A or B

Theorem C.8 shows that the first K diagonal elements of * ( ~ + 1 )are larger than or equal to the corresponding diagonal elements of Q(K) if f K + l # 0. If f K + l = 0 ,these diagonal elements are equal. Then, the Fisher scores for the parameters O ( K ) are not correlated with the Fisher score for the parameter OK+l. Furthermore, the (K -t 1)th diagonal element of Q(K+l) is larger than 1/fK+1,K+1 if fK+1 # 0.If f K + l = 0 ,they are equal. This result may be interpreted as follows. Estimating the additional parameter OK+I causes the Cram&-Rao variances for the parameters O ( K ) to increase or, at best, to remain the same. They remain the same if the Fisher score for 6 ~ + 1 not correlated with the is

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