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The densities and hazard functions for both passages, 1 3 and 1 4, and the overall time to absorption are presented in Figure 7.24. PH models are also used to model absorption times for situations involving arbitrary initial states. Flowgraph models can be used in the same context but allow the use of arbitrary waiting time distributions with ease. Often, we are interested in the time to absorption starting in a state other than the initial state. For example, in the HIV progression example of Section 7.2, a patient diagnosed with AIDS may already be experiencing pre-AIDS symptoms. In that case, the relevant quantities of interest would be the waiting times to full-blown AIDS or death (i.e., the waiting times 3 4 or 3 5 in the owgraph of Figure 7.2). Similar quantities can be computed for the retinopathy owgraph of Figure 7.4. The next example considers computing such quantities for a birth and death process over states 1, 2, . . . , 6 with an absorbing end state, 6. Example 7.3: Birth and Death Process. Figure 7.25 presents a owgraph model for a birth and death process with an absorbing end state, 6. We use this to demonstrate the effect of starting in arbitrary initial states. For illustration of PH

This includes her name, company, address, preferences, and pro le Other parameters such as her job title, skills, responsibilities, agenda, and tasks may also be included The type of service that she has subscribed to, along with her user certi cate, passwords, and service usage summary are also relevant Location Context This information relates to the location of the user It may specify whether the user is at home, in her of ce, in the hospital, or on the road (coverage area) It may also contain information regarding the type of network.

accurate evidence. Then we could examine the integration of the parts into the whole. Additionally, and/or alternatively, we might develop ways in which the criminal justice system receives feedback. Without feedback an organisation, or system, cannot learn or develop organically. It does not make provision for automatic adaptation, change and improvement (Flood and Jackson, 1991). Indeed, without this provision, its adherents are liable to perceive criticism and examples of error as challenges from the outside. It increasingly becomes a closed system with regard to, and separate from, the rest of the world. If we were to adopt this perspective then we might begin an audit of the quality of the parts of the system. Although we still have dif cult, and basic, decisions to face about what are the goals of our legal system.

What do we want to achieve How should we achieve this (perhaps most importantly) How can we measure success

There is no uniform consensus as to whether tocolytics should be used pre- or postoperatively in the management of the adnexal mass during pregnancy to prevent preterm labor. The largest known risk factor for preterm labor in this patient population is the potential need for emergent surgery, which is only preventable by scheduling an elective removal of the mass. Consultation with a maternal fetal medicine specialist at the institution where the surgery is performed may be considered preoperatively to discuss this issue. In general, though, tocolytics in the second trimester of pregnancy are not routinely used because of the issue of fetal viability. Other general precautions that might reduce the risk of premature labor include: r Positioning on the OR table in a right lateral decubitus position to avoid compression of the vena cava and maternal hypotension r General inhalational anesthesia for both laparoscopy and laparotomy r Minimizing manipulation of the uterus r If surgery occurs in third trimester, providing an adequate incision to obtain easy exposure to the mass r Avoiding air drying of the uterine serosa (apply saline periodically) r Fetal heart rate monitoring beginning in the postoperative recovery unit

Outplacement services Severance packages Accumulated pay, bonus, vacation or sick time Exit incentive bonuses, if offered Use the helpful worksheet in Sidebar 143, developed by N Frederic Crandall and Marc J Wallace, Jr,4 to determine the short-term benefits and longterm costs of a workforce reduction initiative Not to be overlooked in any downsizing initiative are the costs associated with hiring or rehiring employees when the company s financial picture improves The true cost of turnover is a significant expense, particularly when the incentives that make across-the-board job cuts effective also remove valuable, talented employees in the process Part of the cost-benefit analysis of a proposed workforce reduction should be an estimate of the total costs associated with losing people that you will subsequently replace By some estimates, the true cost of turnover can be as high as $250,000 for one position.