The increasing competitive pressures and dynamic user preferences have resulted in a fast-paced and uncertain business environment. In the face of these circumstances, organizations are looking into alternatives to incorporate flexibility to become more adaptive and responsive to change. In this line, co-working, typically associated with freelancers, entrepreneurs, and startups, has become a particularly interesting alternative in the market that has caught the attention of corporate occupiers. Therefore, the aim of this paper is to identify co-working strategies that can be implemented as part of the corporate real estate portfolio, in alignment with the flexibility demands of the organization. This nascent research topic is studied through 5 qualitative case studies including in-depth, semi-structured interviews with corporate real estate managers and related case documentation. The results evidence the different motivations that the organizations have when incorporating co-working in their property portfolio. As seen across the cases, organizations in different stages of maturity are implementing co-working as the main office location or as a temporary or complementary space solution, through six different strategies: (1) Swing Space, (2) Expansion Space, (3) Core and Flex, (4) Touchdown Space, (5) Testing Market, and (6) Temporary Projects and Staff. This research evidences that each strategy plays a specific role in the corporate real estate portfolio and implies different sources of flexibility that support the physical, functional, and financial flexibility demands of the organization.
INTRODUCTION:
Hysteroscopy allows direct visualization of the uterine cavity. Traditionally, in office hysteroscopy is performed using a speculum and tenaculum to hold the cervix. However, the emergence of smaller diameter hysteroscopes along with the vaginoscopy no touch technique without the need of speculum or tenaculum has contributed for the procedure to be done in the office setting without the use of analgesia. This study reviews our experience of in office hysteroscopy using the vaginoscopy "no touch" approach.
METHODS:
Retrospective chart review of 22 in office hysteroscopies performed without analgesia using the vaginoscopy “No touch” technique from June 1, 2017 to January 31, 2018. Patients received 200 mcg of oral Misoprostol 30 minutes before the procedure. Data gathered included age, body mass index, prior vaginal deliveries, and pain during the procedure. Success was measured as the ability to enter the endometrial cavity and perform the expected procedure.
RESULTS:
The median age 45 SD ±10.0 and BMI of 26.9 SD ±4.4. Hysteroscopic indications were: 2 (9.1%) postmenopausal bleeding, 5 (22.7%) retained IUD, 7 (31.8%) for suspected polyp, 8 (36.4%) for abnormal uterine bleeding. Of the 22 procedures, 18 were successful completed (80%). The median pain on VAS scale reported immediately after the procedure was 3.8 SD ±0.8 All four of the unsuccessful procedures were in postmenopausal females, two of which due to severe cervical stenosis. There were no complications.
CONCLUSION:
In office hysteroscopies using the vaginoscopy “no touch” technique is a feasible and safe procedure. We recommend adopting this innovative, painless technique.
BACKGROUND: Dysautonomia is thought to affect up to 1% of teenagers and is associated with significant impairments in quality of life (QoL). There are limited therapeutic options for physicians managing adolescents with dysautonomia. Typically, advice is given about fluid and salt balance, as well as physical counter pressure movements. In this pilot study, we sought to determine whether adolescents with dysautonomia improve their QoL following a prescribed body weight resistance training program. METHODS: Participants were referred with symptoms of dysautonomia and underwent a full cardiac assessment including an exercise test. QoL questionnaires (Peds QL) were completed by participants and their parents prior to starting the home-based exercise program. Exercises consisted of: squats, squat holds, lunges, planks, hip bridges, and step ups. Participants were asked to perform 3 sets of 15 repetitions, 5 days per week. Isometric exercises were held longer over the course of the program. Participants were asked to keep a log of the days they completed the exercises as well as their symptoms. Contact was made over the course of the program to ensure compliance and to ensure that the family felt supported. After 8-weeks, participants returned for a repeat exercise test and QoL questionnaires. RESULTS: We enrolled 11 participants, 7 completed the study protocol (Age: 15.1 yrs (13.1-15.5); Height: 164 cm (157-181); Weight: 59.0 kg (51.6-68.0)). Two were excluded due to other medical issues, one did not complete the exercise program, and one was lost to follow-up. All participants completed the exercises at least 3 times per week, up to the prescribed 5 days per week. QoL scores were significantly higher in the participants post intervention [41.67 (32.61-80.43) vs 72.21 (40.22-95.65); p¼0.027]. Parent proxy reports for the QoL of their teens also improved [45.0 (28.26-79.34) vs 73.8 (41.3-100.0); p¼0.046]. The Cohen's d¼0.85 suggests a large clinically relevant effect size. There was no significant change in treadmill time [600 seconds (300-779) vs 591 (480-840); p¼0.138]. CONCLUSION: This is the first study to demonstrate that an 8week body weight resistance training program can improve QoL in adolescents with dysautonomia.
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