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Advancing age; multiparity (vaginal delivery route); obesity; history of pelvic surgery (particularly hysterectomy); increased intraabdominal pressure (i.e., chronic straining during constipation, chronic coughing (COPD), heavy lifting); postpartum muscle weakness (i.e., levator ani); loss of innervation; connective tissue disorders; tumor/masses; genetic predisposition Many women are asymptomatic and are found to have prolapse on exam. The most specific complaint for POP is when the woman can see or feel a bulge of tissue that protrudes to or past the vaginal opening. Patients sometimes describe this as a pressure or heaviness. This may be relieved by lying down, may be less noticeable in the morning and worsen later in the day because of extended exertion or standing Other symptoms include: stress incontinence, urinary frequency or hesitancy, feeling of incomplete emptying of the bladder, defecatory symptoms, coital laxity It is based upon the findings of physical examination. The patient should be examined in both upright and recumbent (dorsal lithotomy) positions and each area of vaginal anatomy should be described separately While there are several different classifications, currently the two most commonly used are: (1) The Pelvic Organ Prolapse Quantification (POPQ) system (2) The Baden Walker system
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Downloaded from Digital Engineering Library @ McGraw-Hill (www.digitalengineeringlibrary.com) Copyright 2004 The McGraw-Hill Companies. All rights reserved. Any use is subject to the Terms of Use as given at the website.
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Downloaded from Digital Engineering Library @ McGraw-Hill (www.digitalengineeringlibrary.com) Copyright 2004 The McGraw-Hill Companies. All rights reserved. Any use is subject to the Terms of Use as given at the website.
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NOTE We ll talk about some security issues later in this chapter.
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The main function of LMI is to allow the Frame Relay DTE and DCE to exchange status information about the VCs and themselves. To implement this function, the Frame Relay DTE sends an LMI status enquiry (query) message periodically to the attached Frame Relay DCE. Assuming that the DCE is turned on and the DCE is configured with the same LMI type, the DCE responds with a status reply message. These messages serve as a keepalive function, allowing the two devices to determine each other s state. Basically, the DTE is asking the switch are you there and the switch responds yes, I am. By default, only the DTE originates these keepalives and only the DCE responds. After so many status enquiries, the Frame Relay DTE generates a special query message called a full status update. In this message, the DTE is asking the DCE for a full status update of all information that is related to the DTE. This includes such information as all of the VCs connected to the DTE, their addresses (DLCIs), their configurations (CIR, BC, and BE), and their statuses. For example, let s assume that Site 1 from Figure 26-4 has a PVC to all other remote sites and that it sends a full status update message to its connected DCE. The DCE responds with the following PVC information: Site 1 Site 2, Site 1 Site 3, and Site 1 Site 4. Notice that the DCE switch does not respond with these VCs: Site 2 Site 3, Site 3 Site 4, and Site 2 Site 4, since these VCs are not local to this DTE.
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The BD format has been designed for the seamless user experience by defining an independent interactive graphics plane that overlays the video. This graphics plane can be controlled by authoring and can be filled with popup graphics of all sorts, including those nec-
If you want to control which gateways and call agents interact with each other in setting up the connections between phones, reference a layer 7 MGCP policy map in your inspect mgcp command.
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23:
No intervention Follow-up Histopathologic diagnosis
First Line Baseline Choose First Line Baseline to have CorelDRAW use the baseline of the first line of text as a reference for the alignment action. Last Line Baseline Choose this option to have CorelDRAW use the baseline of the last line of text as a reference for the alignment action.
TLFeBOOK
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Figure 6.2 Pennsylvania s 4-axle (ML-80) truck.
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