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Women of childbearing age are most at risk for cervical neoplasia. Of the 4 million women who become pregnant each year in the United States, it is estimated that between 2% and 7% will have abnormal cervical cytology on a Pap smear. Cervical cancer screening guidelines are no different for pregnant women. Likewise, an abnormal Pap smear in pregnancy should be evaluated with colposcopy under the same circumstances as in a non-pregnant patient. The only exception is that colposcopy can be postponed until postpartum for LSIL or less, although it is preferred at the time of diagnosis in a nonadolescent. Multiple factors make colposcopy during pregnancy more dif cult, including increased pelvic congestion, vaginal wall laxity, and an enlarged cervix. Just as in a non-pregnant state, an adequate colposcopy with visualization of the transformation zone is ideal. Providers may be wary to perform the necessary evaluation of cervical neoplasia during pregnancy because of the concern of bleeding and complications. However, there is good evidence that cervical biopsy is safe during pregnancy. A biopsy should be performed in any patient for whom CIN 2, CIN 3, or invasive cancer is suspected. Endocervical curettage should be avoided as the risk to pregnancy is unknown. In the face of atypical glandular cells, colposcopy with cervical biopsy can be performed, but endocervical curettage and endometrial biopsy are contraindicated. Similar to a non-pregnant patient, CIN1 can be followed by observation with cytology at the 6-week postpartum visit. Progression of CIN 2 or CIN 3 to invasive cancer is unlikely during pregnancy. Repeat colposcopy later in pregnancy can be performed to exclude this possibility, with biopsy only if the lesion appears worse. Otherwise, treatment of high-grade dysplasia should be postponed until postpartum.21

For many years, however, automatic handover between competing operators in the same country was not implemented anywhere, since the operators resisted the idea of accepting subscribers from a competitor (Lately, an agreement has been worked out in Germany between the T-Mobil network and Viag Interkom for national roaming between the networks without any pressure from the regulator) In comparison, handover agreements between companies in different countries, ie in a non-competitive situation, have normally caused very little dif culty, although the national and the international roaming features are technically quite similar..

C H A P T E R 5 . G R A N D B A H A M A ( F R E E P O R T / L U C AYA )

So far in this chapter we have looked at the automated processes involved in integrating many of the eBusiness activities, but we have not said much about the processes that depend on the involvement of people within the organisation. Certainly, computing processes are being joined up to avoid the need for any more human intervention than is necessary. This is not just to save on wages. Every time we require an operator to re-key data into a system, we introduce a signi cant failure cost owing to errors. (For instance, it has been reported that between 20% and 40% of all spreadsheets contain errors [57].) However, we cannot dispense with people altogether. In fact, human beings, in the right place, with the right skills, are the most valuable resource of most companies. Critical negotiations are still conducted between people, not machines, and there is no serious prospect of this changing in the foreseeable future, even allowing for rapid development in arti cial trading agents (page 354) for non-critical tasks. Therefore, particularly for intrabusiness and interbusiness activities, we require to create person-to-person environments that build trust and continue to support interpersonal operations throughout their life-cycle. A common model of collaborative work emphasises the need to consider it in terms of three distinct, but inter-related activities (Figure 1.29) processes, teams and individual activities.

1. Han Van Der Zee, Paul Laagland, Bas Hafkenscheid, and Leonie Geersing (Nolan Norton Institute), Architectuur als Managementinstrument: Multi Client Study [Architecture as a Management Instrument: A Multiclient Study] (The Hague: Ten Hagen & Stam, 2000). 2. Tim Westbrock, Architecture Process Maturity Revisited and Revised (Meta Group, May 2004); www.eacommunity.com/articles.

where f is the random grain boundary angle with respect to the longitudinal centerline of the metallization line for each grain boundary on either side of each node and is another random angle selected for each grain boundary on either side of the node used to calculate a mobility factor for mass transfer along the grain boundary [135]. The divergence of the metal ion ux at the node k; l can now be calculated from ! ND Df k; l rU r Ja k; l D50 kT 5:3:11