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The main role of the primary care physician is to be aware of the risk factors for development of VAIN and to evaluate patients appropriately. Once abnormal cytology is obtained, the physician should proceed with colposcopy or refer the patient for colposcopic exam by another provider.
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the bound tighter than the information available from the basic possibility assignment permits us to. It is even possible that by choosing the maximum we go below the probability and thus make the bound lower than it can be made. Therefore choosing the maximum operation is obviously not the most pessimistic, but, contrariwise, the most optimistic choice. On the other hand, we could accept the weak upper bound given by the right hand side of the above inequality, i.e. (E) min 1, E ( ) (which actually is the most pessimistic choice), thus seeking refuge in an approach already mentioned in a different context above, namely to redefine a degree of possibility as an upper bound on the probability of the possibility of an event. Although this bound is usually greater than necessary, we can maintain the interpretation that a degree of possibility is an upper bound for the probability of an event. However, for this bound to be useful, there must be very few contexts with more than one possible value, to keep the sum below the cutoff value 1. Clearly, if the cutoff value 1 is reached for too many sets, the measure is useless, since it conveys too little information. This will become clearer in the next chapter where we consider multidimensional possibility distributions. In our opinion this drawback disqualifies this approach, because it practically eliminates the capability of possibility theory to handle situations with imprecise, that is, set-valued information. Nevertheless, there is a (surprisingly simple) way out of this dilemma, which we discuss in the next but one section. It involves a reinterpretation of a degree of possibility for general, non-elementary events while keeping the adopted interpretation for elementary events.
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The majority of VIN lesions will not progress to vulvar carcinoma and some spontaneously regress. A small percentage will develop malignant changes. Patients often have recurrent vulvar dysplasia, though some recurrences may actually be persistent disease. The clinical course is variable based on disease and host factors that are incompletely understood, making this disease dif cult and frustrating for treating physicians. Studies have shown that some lesions will spontaneously regress. Jones and Rowan studied 14 women diagnosed with VIN II-III whose lesions regressed in a median of 9.5 months. The median age of these patients was 19.5 years (range, 15 27 years), and all lesions were multifocal and pigmented. All women who demonstrated regression of their lesion were asymptomatic and quite young as compared to the majority of women diagnosed with VIN II-III (median age, 19.5 vs. 35 years).14 The terms reversible vulvar atypia and bowenoid papulosis were used in the 1970s to describe a variant of VIN II-III seen in young women with multifocal pigmented papular vulvar lesions that often regressed spontaneously. Unfortunately, there have been reports of such lesions progressing to invasive carcinoma. Given that there is no reliable way to predict which lesions will progress, it is advisable that treatment should be offered when VIN II or III is present.15, 16
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TIP: Consider borrowing from your 401(k) if it is permitted, recommends Johnathan Kenter, a pension attorney with New York City law f irm Richards & O Neil. There will be no tax penalty. Many employers allow you to borrow from your 401(k) if you re buying a house for yourself (not a child or other relative). Contact your human resources department or f inancial planner for more information.
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The relationships between S/N, % fluctuations detected at 95% confidence, and image quality are given in Table 15-1. An object image with S/N 10 20 is poor and grainylooking, whereas the appearance of the same object at S/N 100 is good to excellent.
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The mappings between application and transport data representations are called marshalling and unmarshalling.
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