Bias associated with delayed verification in test accuracy studies: accuracy of tests for endometrial hyperplasia may be much higher than we think!

BACKGROUND: To empirically evaluate bias in estimation of accuracy associated with delay in verification of diagnosis among studies evaluating tests for predicting endometrial hyperplasia. METHODS: Systematic reviews of all published research on accuracy of miniature endometrial biopsy and endometr ial ultrasonography for diagnosing endometrial hyperplasia identified 27 test accuracy studies (2,982 subjects). Of these, 16 had immediate histological verification of diagnosis while 11 had verification delayed > 24 hrs after testing. The effect of delay in verification of diagnosis on estimates of accuracy was evaluated using meta-regression with diagnostic odds ratio (dOR) as the accuracy measure. This analysis was adjusted for study quality and type of test (miniature endometrial biopsy or endometrial ultrasound). RESULTS: Compared to studies with immediate verification of diagnosis (dOR 67.2, 95% CI 21.7–208.8), those with delayed verification (dOR 16.2, 95% CI 8.6–30.5) underestimated the diagnostic accuracy by 74% (95% CI 7%–99%; P value = 0.048). CONCLUSION: Among studies of miniature endometrial biopsy and endometrial ultrasound, diagnostic accuracy is considerably underestimated if there is a delay in histological verification of diagnosis

In-between spaces and social interaction: a morphological analysis of Izmir using space syntax

This research tackles the intermediate spaces between buildings and the street, by examining the definition and importance of spatial configuration in relation to urban morphology and social relations. It also analyses how the organisation of in-between space affects social interaction in different urban forms. To understand the complex relations and socio-spatial structure of the city, it is important to use mixed methods. This research utilises various methods to focus on three dissimilar urban morphologies in Izmir, Turkey. Two inner city quarters and one modern housing estate of middle- and high-income groups are compared using space syntax analysis and snapshot observations. These neighbourhoods are selected according to their syntax measures from more integrated to segregated neighbourhoods in the axial analysis. And for a detailed zoomed-in analysis, similar diameter areas are covered for observations. Subsequently, activity patterns are observed at different times of the day, one weekday and one Sunday in three cases. In each neighbourhood, syntactic measures of all selected streets are correlated with these recorded activities. This study reveals that connectivity of streets is important for supplying niches that trigger long-duration activities and social interaction. In modern estates, stationary activities are not correlated strong enough with movement as it is in inner city neighbourhoods. Additionally, in-between spaces increase the frequency of social interaction and co-presence of people particularly in more integrated areas. However, this is only one element in developing sense of community. Further research is needed especially in correlating space syntax with environmental issues, as well as people’s behaviour

The Nature of Landmarks for Real and Electronic Spaces

Landmarks are significant in one’s formation of a cognitive map of both physical environments and electronic information spaces. Landmarks are defined in physical space as having key characteristics that make them recognizable and memorable in the environment. The challenge of defining measurable features of landmarks that can be used in designing and recognizing landmarks in information spaces is explored. By drawing on diverse areas such as urban planning, architecture, cognitive science and hypertext, a coherent definition of a landmark is proposed, which is relevant to both physical and electronic spaces. It is argued that landmarks can be classified in terms of visual, cognitive and structural dimensions, which has implications for how environments can be designed or built in such a way that landmarks will emerge appropriately for unique situations