The silence of mitotic figures

A career in medicine is guided by the patients you treat and those who have taught you to treat these individuals. Communication is of utmost importance in all aspects of healthcare. However, there are times when communication can be difficult. This story takes you through a physician’s experience that led to a career in women’s healthcare, reflecting on the silence that prevailed as her journey began. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this len

Modification of the Ingram bicycle seat stool for the treatment of vaginal agenesis and stenosis

The use of nonsurgical techniques for the creation of a neovagina for vaginal agenesis and stenosis has been successful for many patients and is currently recommended as first‐line therapy. The Ingram bicycle seat stool technique, a nonsurgical approach, has largely replaced the surgical McIndoe technique as the method of choice for vaginal dilation. It provides an easy and comfortable way for patients to engage in dilation. However, the Ingram bicycle seat stool is not height adjustable. We have created a bicycle seat stool that is height adjustable and will likely provide patients with an improved, more comfortable, and individualized method of dilation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135330/1/ijgo301.pd

Home Study Course: Spring 2001

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72408/1/j.1526-0976.2001.005002105.x.pd

Methodology for the strategy-oriented distribution of decision autonomy in global production networks

Multinational companies deal with production processes in various countries by operating global production networks. These production processes are allocated to production plants with different levels of autonomy regarding strategic and operative decisions. Typically, each plant and the whole network are managed by one or more network managers who have to deal with a decision overload in their daily business. 50% of their decisions are made in less than 9 minutes and only a small amount of decision tasks are dealt with for more than one hour. To reduce this dilemma, it was found that the distribution of decision autonomy can be enhanced. It depends on the company’s strategy and complexity dimensions in global production networks. However, so far there is little evidence on how to better distribute decision autonomy in global production networks in detail. Furthermore, it is not transparent at what level of cetralism a global production network should be managed without cutting the capabilities of production plants. This paper presents a methodology, which examines relevant strategy dimensions and derives guidance on how to distribute decisions in global production networks. First, the network and production strategies of global production networks are classified. Second, relevant complexity dimensions and decisions are introduced. Third, the influence of the distribution of decision autonomy on strategy dimensions is quantified by an impact model. Furthermore, the effect of complexity on the distribution of decision autonomy is quantified by an impact model. Here, the integration of empirical data was used to validate the different influences. Finally, the ideal distribution of decision autonomy for specific production plants in the global production network is derived. The methodology is applied in an industrial use case to prove its practical impact

Multimodal Vulvar and Peripheral Sensitivity Among Women With Vulvodynia: A Case–Control Study

OBJECTIVE: To assess differences in vulvar and peripheral sensitivity between women with and without vulvodynia. METHODS: Women with vulvodynia (n = 41) and age-matched controls (n = 43) seen in the outpatient setting were evaluated via surveys, clinical examination, and multimodal sensory testing (pressure, heat, cold, vibration, and electrical stimulation). The relationships between sensitivity to various sensory modalities and case/control status, as well as by vulvodynia subgroups, were assessed using logistic regression. RESULTS: Women with vulvodynia were more sensitive to pressure and to electrical stimuli than were control women at the vulva (median, 22 vs 230 g and 0.495 vs 0.769 mA, respectively; P 0.025). Those reporting spontaneous pain versus provoked pain had greater pressure sensitivity to the thumb (median, 1850 vs 2690 g; P = 0.020) and greater electrical sensitivity at the introitus (0.450 vs 0.608 mA; P = 0.011), and those with primary versus secondary vulvodynia had substantially greater pressure sensitivity to the thumb (median, 2438 vs 3125 g, P = 0.004). However, having localized versus generalized vulvodynia was not associated with differences in pressure or electrical sensitivity. CONCLUSIONS: Sensitivities to pressure and electrical stimuli are greater among vulvodynia cases than among controls and support 2 previously defined subgroups-those reporting spontaneous pain versus those whose pain only occurred when provoked, and those with primary versus secondary vulvodynia