Examination Of Levels Research Articles

Accuracy of colposcopic findings in detecting vaginal intraepithelial neoplasia: a retrospective study.

Malignancies of the vagina are rare, but colposcopy-directed biopsies play a major role in detecting vaginal intraepithelial lesions. Data of accuracy in detecting neoplasia of the vagina are very rare compared to accuracy in detecting cervical neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with clinical findings of the examiner. The accuracy of colposcopy-directed biopsy was compared with the clinical finding in relation to the patient's age and the examiner's level of training. This was done in combination with PAP-smear, HPV-test results, and the history of other malignancies of the lower genital tract. The data were collected between January 2014 and February 2018 at the certified Dysplasia Unit of the University Hospital Erlangen. In total, 253 biopsies from 253 women from the vagina were obtained. The overall accuracy of biopsy in comparison with clinical finding was 52.17% for all entities-benign lesions, low-grade squamous intraepithelial lesions (LSILs), high-grade squamous intraepithelial lesions (HSILs), and vaginal carcinoma. The accuracy for detecting HSIL was 82.46% (47/57), with an underdiagnosis rate of 15.79% and an overdiagnosis rate of 1.79%. With a sensitivity of over 80%, colposcopy-directed biopsy plays an important role in detecting vaginal-HSIL. A highly experienced practitioner is increasing the sensitivity in detecting vaginal-HSIL. Careful examination is required in women with a history of HSIL of the lower genital tract or with simultaneous neoplasia because they are of greater risk of developing vaginal malignancies. The combination of careful clinical work up, PAP-smear, HPV-testing, and colposcopy-guided biopsy is crucial in detecting vaginal-HSIL.

Syarat Objektifitas Dan Subjektifitas Penangguhan Penahanan

Requests for suspension of detention can be granted with conditions that must be met. The requirements that must be met by the applicant for detention suspension are 2 (two) conditions, namely subjective conditions and objective conditions. The subjective condition referred to is the existence of subjective judgments made by the investigator or public prosecutor or judge to assess the reason for the applicant's suspension of detention granted or rejected. Whereas the objective requirement is that there is a guarantee in accordance with Article 31 of the Criminal Procedure Code which states that an authorized official at the examiner's level can suspend detention. This writing uses normative juridical legal research methods (normative research) with descriptive analytical research specifications that use secondary data. The procedure of data collection is in the form of documentation of notes or quotations, search of legal literature, books and others related to the identification of problems both offline and online, which are then analyzed through the content analysis method (centent analysis method) with a focus on the problem of how objective conditions are and the subjectivity of detention suspension in the Criminal Procedure Code (KUHAP) in Indonesia. From the results of the study it is known that the objective and subjective conditions of suspension of detention in Indonesia are suspects must fulfill the conditions specified in the explanation of Article 31 of the Criminal Procedure Code (KUHAP), which is the requirement for reporting, not leaving the house and / or not leaving town the terms of subjectivity include consideration of institutional officials asking for money guarantees and / or guarantees of people. Consideration of objectivity, namely the suspect is not worried about escaping, damaging or removing evidence and will repeat the action. Consideration of subjectivity, namely the suspect is willing to sign and fulfill the terms of detention suspension

The impact of proficiency testing information and error aversions on the weight given to fingerprint evidence.

Fingerprint examiners regularly participate in tests designed to assess their proficiency. These tests provide information relevant to the weight of fingerprint evidence, but no prior research has directly examined how jurors react to proficiency testing information. Using a nationally representative sample of American adults, we examined the impact of proficiency testing information on the weight given to the opinions of fingerprint examiners by mock jurors considering a hypothetical criminal case. The fingerprint examiner's level of performance on a proficiency test (high, medium, low, or very low), but not the type of error committed on the test (false positive identifications, false negative identifications, or a mix of both types of error), affected the weight that jury-eligible adults gave to an examiner's opinion that latent fingerprints recovered from a crime scene matched the defendant's fingerprints, which in turn affected judgments about the defendant's guilt. Jurors who had no information about proficiency gave similar weight to the testimony as jurors exposed to highly proficient examiners, suggesting that jurors assume fingerprint examiners perform at high levels of proficiency unless informed otherwise. We also found that a plurality of Americans deems false acquittals just as aversive as false convictions and a significant minority deems false acquittals more serious. These differences in error aversions predicted differences in evidentiary assessments, suggesting that error aversions of jurors may play an important role in criminal trials.

Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: a retrospective study.

Colposcopy-directed biopsy is a cornerstone method for diagnosing cervical intraepithelial neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with definitive surgery. The accuracy of colposcopy-directed biopsy was compared with the final histology in relation to different types of transformation zone (TZ), the patient's age, and the examiner's level of training. The overall accuracy of biopsy in comparison with definitive surgery was 71.9% for all entities-benign lesions, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions (HSILs), and cervical carcinoma-with an underdiagnosis rate of 11.8% and an overdiagnosis rate of 16.5%. The accuracy for detecting HSIL was 88% (401/455), with an underdiagnosis rate of 10.5% and overdiagnosis rate of 1.3%. The accuracy rates for detecting HSIL in women with TZ1, TZ2, or TZ3 were 92.2, 90.5, and 76.5%, respectively. The accuracy rates for detecting HSIL in the different age groups were 93.1% (age 0-34), 83.6% (age 34-55), and 80% (age 55 or older). A combination of the colposcopic findings, cytology, human papillomavirus testing, and colposcopy-directed biopsy is necessary for the correct diagnosis of HSIL. The accuracy rate depends on the TZ and the patient's age. The examiner's level of training does not have any substantial influence on the accuracy.

Topographic Mapping of Residual Vision by Computer

Many persons with low vision have diseases that damage the retina only in selected areas, which can lead to scotomas (blind spots) in perception. The most frequent of these diseases is age-related macular degeneration (AMD), in which foveal vision is often impaired by a central scotoma that impairs vision of fine detail and causes problems with reading and recognizing faces. One would think that differences between damaged and relatively intact areas should be painfully obvious to those who have AMD. However, as clinical practice and scientific studies have shown, this is often not the case (Safran & Landis, 1996, 1999; Schuchard, 1995). Thus, patients and rehabilitation workers need to know where on the retina or in the visual field vision is still good enough to be usable. Having this information increases the chances for successful rehabilitation, the necessity and feasibility of which have been demonstrated (Backman & Inde, 1979; Nilsson, Frennesson, & Nilsson, 2003; Otto, 1969; Park, 1999). The fact that rehabilitation is possible emphasizes the need for a topographic assessment of remaining vision. In this article, I describe the Macular Mapping Test (MMT) and illustrate with case reports how it can be used in clinical practice to assist in the assessment and rehabilitation of patients with central vision loss. THE IDEAL SOLUTION Topographic assessment is best done by a scanning laser ophthalmoscope (SLO) that shows live images of the retina and the stimulus that is scanned directly onto it. A useful vision assessment in AMD does not need to encompass the entire visual field. It can be restricted to the macula, a central area of 20 degrees diameter, where most preferred retinal loci (PRL) develop (Fletcher & Schuchard, 1997). If small spots of light are flashed onto the retina (microperimetry), the patient indicates which are detected and which are not. For precise placement of stimuli, modern software compensates for involuntary eye movements during testing, so that precise fixation is not necessary (MacKeben & Gofen, 2007). Since SLOs are expensive and rare, they are not available to most vision professionals. WHAT OTHER MEANS ARE AVAILABLE? Conventional perimetry can provide relevant data, but it is time-consuming and requires sophisticated equipment and special expertise. In addition, the resulting intensity thresholds are not needed to find usable remaining vision for rehabilitation. The standard tangent screen test has shortcomings in that it makes it hard to include a discrimination (recognition) paradigm for a better measurement of visual performance. Furthermore, it is difficult to time the appearance and disappearance of a target precisely at defined locations, and the results can vary with the examiner's level of skill and personal habits. The Amsler grid is a subjective test that is sensitive only to drastic changes, but not to those that develop over longer periods. At best, it indicates where damage has been done, but not visual performance. In addition, the normal filling-in mechanism often prevents the detection of scotomas of less than 5 degrees diameter (Ramachandran & Gregory, 1991; Schuchard, 1993). [FIGURE 1 OMITTED] Note that measuring visual acuity alone is insufficient, despite the importance of visual acuity for prescribing optical aids, because it has limited utility in predicting the performance of activities of daily living, like reading (Backman, 2000; Crossland, Culham, & Rubin, 2005) or visually guided mobility (Brown, Brabyn, Welch, Haegerstrom-Portnoy, & Colenbrander, 1986; Hassan, Lovie-Kitchen, & Woods, 2002; Marron & Bailey, 1982) after the loss of central vision. Also note that subsets of the data presented here were published previously (MacKeben & Colenbrander, 2000; MacKeben, Colenbrander, & Gofen, 1999). DESCRIPTION OF THE TEST Procedure Although MMT is not new (MacKeben & Colenbrander, 2000; MacKeben et al. …

Rorschach Comprehensive System Data for a Sample of 100 Adult Nonpatients From the Belgian French-Speaking Community

This article presents normative data for the Rorschach Comprehensive System (CS) on 100 adult nonpatients from the Belgian French-speaking community. We compare our Belgian sample to a French one (Sultan et al., 2004), data of Exner's (Exner & Erdberg, 2005) and a Californian sample (Shaffer, Erdberg, & Haroian, 1999). Each sample's specific characteristics are explored, as well as findings provided by sample-specific comparisons. Exner's data, ultimate normative reference for the CS, differ significantly from the three other samples for many variables. Cultural factors, examiner's level of experience, as well as participants' selection and recruitment, presumably flow into calculated differences between the four samples. Our findings indicate the necessity for constituting normative data for different communities, as well as the indispensability of examiners' familiarity with the CS, in order to provide reliable clinical information.

The role of fetal echocardiography in genetic sonography

Genetic sonography identifies between 60% and 93% of fetuses with trisomy 21. One of the reasons for the variation in sensitivity is because of the under-detection of congenital heart defects. Although congenital heart defects are present in 56% of second trimester fetuses and 44% of newborns with trisomy 21, most studies evaluating second-trimester fetuses at risk for trisomy 21 detect less than 10% of heart malformations. This review discusses an approach that allows the fetal sonographer to incorporate fetal echocardiography, based upon the examiner's level of skill and experience, when evaluating the fetus at risk for trisomy 21. The cardiovascular examination consists of three levels. In the Level I examination only noncardiac markers are evaluated for a detection rate of 60% and false-positive rate of 5.9%. The Level II examination incorporates the four-chamber view with non-cardiac markers. If the examiner can identify atrial and/or ventricular chamber disproportion, then the sensitivity is increased to 75%, with a false-positive rate of 6.4%. The Level III examination utilizes grayscale and color Doppler ultrasound to evaluate the fetal heart. If the examiner can identify ventricular septal defects, atrioventricular septal defects, pericardial effusion, tricuspid regurgitation, and chamber disproportion, then the sensitivity of genetic sonography increases to 91% with a false-positive rate of 14%. This review includes Likelihood Ratios for each of the ultrasound markers so that the examiner can compute the risk for trisomy 21 for an individual patient.

Accuracy of the Preoperative Examination in Zone 5 Wrist Lacerations

Fifty patients were studied to determine the accuracy of the preoperative physical examination in flexor tendon Zone 5 wrist lacerations. Initially, a retrospective review of the charts of 33 patients who were examined by a second- or third-year postgraduate physician was done. An average of three errors per examination was found. Then a prospective study of 17 patients was performed to see if an examiner's level of training in hand surgery influenced the accuracy of the examination. Error rates improved slightly with experience. Ninety-seven examinations were performed in the combined prospective and retrospective studies, and only 13 were completely correct. Nearly 1/2 of all examinations had three or more errors. If a structure had been lacerated, the injury was not detected 33% of the time on the preoperative examination. The size and mechanism of injury of the skin laceration did not correlate with the number of structures that were cut.

Effects of the learning disability label, quality of writing performance, and examiner's level of expertise on the evaluation of written products.

Examiners were directed to score three essays differing in quality and were told that the essays were written by LD or normal students. Half of the examiners received a brief introduction to the scoring procedures; the other half received more intensive training. Labeling effects were successfully attenuated by providing additional training.

Colonic polyp detection: role of roentgenography and colonoscopy.

In order to determine the relative yields of colonoscopic and radiologic examinations of the colon, the following guidelines are suggested: (a) prospective data collection; (b) a standard, effective colon cleansing regimen; (c) colonoscopic and radiologic examiners of comparable expertise; (d) examiners should be unaware of each other's findings; (e) a suitable method for demonstrating false-negative findings and for resolving conflicting findings between the two examinations; and (f) indexing of the study findings as to lesion size, lesion location, quality of colon cleansing, and examiner's level of confidence. The two examinations should be used as complementary diagnostic procedures.