Cause Of Confusion Research Articles

2211 Improving the proportion of patients > 65 years presenting with delirium who have appropriate bloods checked within 12 hours

Abstract Introduction Early identification and management of all contributory factors is vital in the management of delirium. Delay in investigation can lead to morbidity, mortality, longer length of stay or inappropriate discharge from hospital. We carried out a Quality Improvement project looking to ensure all patients with delirium had appropriate blood tests taken in the Emergency Department (ED). Methods For the first cycle, 25 patients >65 years admitted through ED in December 2022 and January 2023 with delirium were identified based on medical clerking and post take ward round diagnosis. Patients who had a cause for confusion which was clearly known, for example sepsis, were excluded. Data analysis revealed the percentage of patients who had their calcium and CRP bloods checked within 12 hours of admission was only 20% and 76%, respectively. We introduced a simple change: adding bone profile and CRP to the ‘confusion button’ on the ICE electronic requesting and reporting system. A second cycle of data collection was completed for a further 25 patients admitted with delirium between June and July 2023 to measure the effectiveness of the implemented change. Results From our initial analysis, only 20% of patients aged >65 years presenting with delirium had their calcium and 76% of patients had their CRP checked within 12 hours of admission. Following our intervention, we found that 88% of patients had their calcium and 96% of patients had their CRP checked within 12 hours of admission. Conclusion The amendment of the ‘confusion screen’ button, on the ICE requesting system in the hospital, resulted in a significant increase in the number of patents having appropriate blood tests within 12 hours of admission.

Practice Briefing: The implications of a move towards explicit discounted cash flow (DCF) models for property investment valuations

PurposeThe primary purpose of this Practice Briefing is to examine the implications of the recommendations of the Royal Institution of Chartered Surveyors (RICS) Review of Investment Valuations to shift towards (explicit) discounted cash flow (DCF) valuations on valuers, clients, risk management and market data.Design/methodology/approachThis Practice Briefing will develop a conceptual framework to articulate the impact of the shift towards explicit modelling assumptions in valuations. A comparative analysis is conducted to contrast traditional valuation approaches with an explicit DCF approach.FindingsThe proposed shift to DCF valuations in the real estate industry carries both subtle and profound implications. While on the surface, the move appears to bring minimal change since current valuations are already DCF-based, a deeper exploration reveals a potential transformation to the understanding, analysis and measurement of pricing and risks in commercial real estate.Practical implicationsThe traditional techniques adopted in valuations have become pervasive in the industry, hindering more sophisticated modelling and analysis of individual assets and portfolios. Explicitly modelling assumptions in both the initial years of cash flow and perpetuity calculations would unveil fundamental relationships and rationales that have previously been buried within, and perhaps ignored by, an All Risks Yield (ARY).Originality/valueThis briefing identifies the cause of confusion when interpreting ARY differentials on implied target returns and risk and demonstrates how a change to explicit assumptions, such as growth and letting periods, would enhance transparency, enabling more informed client–valuer discussions, which in-turn will boost confidence in valuation accuracy, lead to more sophisticated asset modelling, market data, forecasting and market analysis.

Unusual cause of confusion

Unusual cause of confusion

Opinion of Hadith Scholars on The Understanding of Hadith by Extremists

More than 120 Muslim scholars around the world have rejected Al-Baghdadi's caliphate and condemned atrocities committed by ISIS through one open letter distributed at the end of September 2014. The scholars decided that the concept of the Islamic caliphate is not valid. The article seeks to uncover and deal with hadith concerns misinterpreted by ISIS and addressed by hadith scholars’ views. This article uses library research techniques to gather a variety of ideas, facts, research findings, and expert opinions along with pertinent analysis. Among the causes of confusion and misunderstanding of hadith amongst Muslim is the development of technology, which allows people to obtain and interpret information about hadith without consulting religious experts, using logic of reason in interpreting the hadith, understanding the hadith without considering maqasid, misunderstanding of the contextual approach, and others. The results of this writing are expected to assist Muslim community in understanding the hadiths of the Prophet SAW well without any confusion that can distort their belief and practice.

Does the Available Literature about Hyperhomocysteinemia Cause Confusion to Clinicians?

Background—Aim: Hyperhomocysteinemia (HHcy) (typically defined as serum total homocysteine/tHcy levels >15 μmol/L) has been associated with more than 100 diseases, syndromes, or outcomes. However, the current literature about the testing for or the treatment of HHcy causes confusion to clinicians. The aim of this study was to present and comment on the main causes of this confusion. Discussion: The main causes of the above confusion are the important limitations of clinical trials related to the management of HHcy, the false impression that measurement of serum tHcy levels is not useful generally in clinical practice, the inability of modern diet (poor in folate and rich in methionine) to reduce the serum tHcy levels, and, finally, the consequent exclusion of identifying individuals with genetic causes of HHcy, as MTHFR C677T gene mutation. Conclusion: The recommendations about the testing for or the treatment of HHcy must be clarified.

Practical approaches to the detection of macrotroponin.

Macrotroponin is increasingly recognised as a cause of confusion in interpreting high-sensitivity cardiac troponin (hs-cTnI) results. In this study, we sought to evaluate two practical approaches to detecting macrotroponin. These two approaches are PEG precipitation and SVM (support vector machine) analysis to classify discrepancies between hs-cTn assays. Residual serum and heparin plasma specimens (n = 483) with initially elevated hs-cTnI from hospital and community laboratories were retested on multiple hs-cTn platforms before and after PEG precipitation and Protein A immunoglobulin depletion. SVM analysis was conducted to identify a linear equation that best discriminated specimens with macrotroponin using a combination of results from two different hs-cTn assays. The diagnostic performance of PEG precipitation was carried out using Protein A immunoglobulin depletion as the reference comparator. When a cutoff residual activity after PEG precipitation of ≤ 20% was used, this threshold carried a high specificity of 92% (confidence interval 83-98%; n = 189) using the Siemens hs-cTnI Vista assay and 95% specificity (86%-98%; n = 242) using the Abbott hs-cTnI Architect assay. SVM analysis generated a linear equation identifying macrotroponin specimens from results obtained on two hs-cTn assays. This approach can be highly specific, comparable to PEG precipitation when certain assay combinations and concentrations are used. We describe and identify practical alternatives to detecting macrotroponin. These approaches can be optimised for high specificity, reducing the need for more complex laboratory methods.

Modeling Long Memory and Regime Switching with an MRS-FIEGARCH Model: A Simulation Study

Recent research suggests that long memory can be caused by regime switching and is easily confused with it. However, if the causes of confusion were properly controlled, they could be distinguished. Motivated by this idea, our study aims to distinguish between the long memory and regime switching of financial volatility. We firstly modeled the long memory and regime switching of volatility using the Fractionally Integrated Exponential GARCH (FIEGARCH) and Markov Regime-Switching EGARCH (MRS-EGARCH) frameworks, respectively, and performed a simulation study on their finite-sample properties when innovations followed a non-normal distribution. Subsequently, we demonstrated the confusion between the FIEGARCH and MRS-EGARCH processes using simulations. A recent study theoretically proved that the time-varying smoothing probability series can induce the presence of significant long memory in the regime-switching process. To control for its effect, the two-stage two-state FIEGARCH and MRS-FIEGARCH frameworks are proposed. The Monte Carlo studies showed that both frameworks can effectively distinguish between the pure FIEGARCH and pure MRS-EGARCH processes. When the MRS-FIEGARCH model was further employed to fit series generated with the MRS-FIEGARCH process, it outperformed the ordinary FIEGARCH model. Finally, an empirical study of NASDAQ index return was conducted to demonstrate that our MRS-FIEGARCH model can provide potentially more reliable long-memory estimates, identify the volatility states and outperform both the FIEGARCH and MRS-EGARCH models.

Sense in sensitivity: difference in the meaning of photoperiod insensitivity between wheat and barley.

The description of long photoperiod sensitivity in wheat and barley is a cause of confusion for researchers working with these crops, usually accustomed to free exchange of physiological and genetic knowledge of such similar crops. Indeed, wheat and barley scientists customarily quote studies of either crop species when researching one of them. Among their numerous similarities, the main gene controlling the long photoperiod sensitivity is the same in both crops (PPD1; PPD-H1 in barley and PPD-D1 in hexaploid wheat). However, the photoperiod responses are different: (i) the main dominant allele inducing shorter time to anthesis is the insensitive allele in wheat (Ppd-D1a) but the sensitive allele in barley (Ppd-H1) (i.e. sensitivity to photoperiod produces opposite effects on time to heading in wheat and barley); (ii) the main 'insensitive' allele in wheat, Ppd-D1a, does confer insensitivity, whilst that of barley reduces the sensitivity but still responds to photoperiod. The different behaviour of PPD1 genes in wheat and barley is put in a common framework based on the similarities and differences of the molecular bases of their mutations, which include polymorphism at gene expression levels, copy number variation, and sequence of coding regions. This common perspective sheds light on a source of confusion for cereal researchers, and prompts us to recommend accounting for the photoperiod sensitivity status of the plant materials when conducting research on genetic control of phenology. Finally, we provide advice to facilitate the management of natural PPD1 diversity in breeding programmes and suggest targets for further modification through gene editing, based on mutual knowledge on the two crops.

물질의 상태 분류에 대한 과학교사와 머신러닝 모델의 분류 결과의 비교 분석

Objectives This study compares and analyzes state classification results of matter between developed machine learning model and research participants who are elementary and middle school science teachers, identifies the cause of the situation in which classification results are inconsistent. And based on the results, we tried to find educational implications that can help learn state classification of matter.
 Methods For 31 elementary and middle school science teachers enrolled in the Graduate School of Education at the College of Education located in the central region, matter classification activities were performed and a decision tree algorithm was applied to the machine learning model. And the effectiveness of the program was confirmed through model performance evaluation such as accuracy, F1-score, precision, recall.
 Results The classification accuracy of developed machine learning model for classifying state of matter was 0.820, the F1-score was 0.820, the precision was 0.826 and the recall was 0.820. In addition, the degree of discrepancy between the classification results of science teachers and the classification results of the decision tree algorithm was larger in heterogeneous mixtures than in pure matters or homogeneous mixtures. This discrepancy was analyzed as a phenomenon that occurs because science teachers do not consistently apply the classification criteria from the macroscopic and microscopic perspectives or do have the concept that a specific matter is a specific state in advance when classifying the state of matter. Based on the results of these studies, the cause of confusion revealed in the process of classifying the state of matter pointed out in previous studies was found.
 Conclusions Based on the research results, it was possible to find the cause of confusion revealed in the process of classifying the state of matter of students pointed out in previous studies, and since machine learning can be an effective tool for diagnosing learning conditions, it is suggested that teacher training is needed to utilize it.

THE NEED OF INTERRELIGIOUS DIALOGUE IN 21ST CENTURY

Since the beginning of the universe, religion is a key element of the society across the globe because religion is the collective forces that binds and provide the satisfied explanations regarding the metaphysical queries and force to the members of society. Therefore, it has played the crucial role in the nourishment and development of the core religions. In fact, despite of the universality or relativity between religions the diversity of religious principles, faith, practices and other cultural elements are manifested in numerous states or nations which is one of the significant factor of spreading the religious bigotry sectarianism sentiments among the masses of the society. Even in contemporary modern and advanced era, it is distressing that people are still conflicting with each other on religious basis. The people are being killed; divided and their holy places are occupied and tear down just because of the religious differences and practices. In this context, if we talk about Pakistan so it is the sacred state with religious and cultural diversity. In spite of this the sectarian and religious beliefs, practices, and teaching of other sects and religion is not acceptable at any level in our society which, led hazardous and anarchy situations in the society because in Pakistan sectarianism is being promoted by the political and religious authorities in order to established their political regime and authenticity. Unfortunately, the imam or religious scholars could not play their significant and effective role in condemning such religious violence and exploitations and took part in stressing and promoting the violent behavior by teaching the narrow point of view and brainwashing of their students and followers. The diverse religious beliefs, principles and practices are really a cause of confusion, disorganization and alienation among the masses regarding adherent which belief, principle and traditions. In such hazardous situation there is need of the interreligious dialogue to protect the humanity and to comprehend the diverse religions and their belief structure as well. In this article researcher will yield a brief historical background and introduction of the interreligious discourse, after that author will talk about the need and significance of interreligious dialogue in 21st century. The content will be helpful to understand the discourse between world’s core religions and will be beneficial to eliminate the biasness and misinterpretation regarding the other religious beliefs and practices. Here it is significant to understand the benefits of this discourse such as inception of fairness and world harmony, to escape communities from disintegration, the safety of human rights and the ethical values of diverse religions across the world

Is Distributional Justice Equivalent to Prosocial Sharing in Children's Cognition?

Distribution and sharing are social preference behaviors supported and shaped by selection pressures, which express individuals’ concern for the welfare of others. Distributive behavior results in distributive justice, which is at the core of moral justice. Sharing is a feature of the prosocial realm. The connotations of distribution and sharing are different, so the principles, research paradigms, and social functions of the two are also different. Three potential causes of confusion between the two in the current research on distribution and sharing are discussed. First, they share common factors in terms of individual cognition, situation, and social factors. Second, although they are conceptually different, prosocial sharing and distribution fairness sensitivity are mutually predictive in individual infants. Similarly, neural differences in preschoolers’ perception of distribution fairness predict their subsequent sharing generosity. Finally, similar activation regions are relevant to distribution and sharing situations that need behavioral control on a neural basis.

The Reason for Confusion or Confusion in the Book "Sharh Al-Mamluki in the Interpretation of Ibn Yaish"

The phenomenon of the cause is one of the important phenomena in the language, and on its basis many scholars relied on the interpretation of some grammatical and morphological issues, so we discussed in the research one of the types of morphological defects, which is the cause of confusion or ambiguity, according to a distinguished scholar of Arabic, Ibn Yaish, in His book: Sharh Al-Maluki fi Al-Tasrif, to show the extent of the effect of this reason on some morphological rulings, and from God is success

Typical absence status epilepticus in older people: syndromic delineation.

Objective We describe the clinical, electroencephalograph^ and neuroimaging findings of older patients with typical absence status epilepticus (ASE). Methods This investigation was a retrospective analysis of prospectively collected consecutive patients between January 2011 and October 2021. All patients ≥60 years with impairment of awareness and continuous generalized, rhythmic, synchronous and symmetric epileptiform discharges and normal background on video-electroencephalogram (vEEG) were included. Results Six patients were identified with a diagnosis of typical ASE. The mean age was 67 years. Five could be classified as idiopathic generalized epilepsy (IGE) though two had been erroneously categorized as cryptogenic focal epilepsy (FE). In one, the episode of ASE was thought to represent the beginning of late-onset IGE (de novo late-onset typical ASE). In all cases, ASE was controlled within the first 24 hours. Significance Typical ASE is a rare cause of confusion in the elderly population requiring urgent vEEG evaluation. It most frequently represents reactivation of a previous IGE, in effect related to patients with epilepsy with onset in childhood or adolescence, not previously diagnosed or treated, representing rather the debut of (de novo) late-onset IGE.

Three Perspectives on Changing Gender Stereotypes

Changing gender stereotypes is an essential topic among researchers since the 1970s. The debate on this subject continues in the twenty-first century. Some researchers argue that gender stereotypes have not changed, since it is supported by some solid theoretical foundations and its inherent nature of social interpretation. Moreover, there are gaps in the existing literature, regarding who gets the relative advantage on gender stereotype change and the different outcomes of changing gender stereotypes. Hence, this article reviews the changing gender stereotypes in three perspectives: whether it is prevalent in the whole contemporary world, who gets the relative advantage in gender stereotype change and the realities reflected by the outcomes of changing gender stereotypes. Before these three perspectives, we provide a comprehensive understanding of the definitions, origins and components of changing gender stereotypes. The lack of which may have been an underlying cause of confusion about the concept and its realities. Therefore, this article seeks to evaluate the changing gender stereotypes to provide insights into changing gender stereotypes in the contemporary world, the realities of changing gender stereotypes and directions for future researchers.

CT perfusion in acute confusional migraine

Acute confusional migraine (ACM) is a rare migraine variant characterized by headache associated with altered mental status and speech difficulties. A 50-year-old headache-suffer male was admitted to our Hospital due to severe headache, vomiting, confusion, agitation, disinhibition and dysphasia. He performed brain CT, CTA and CTP which showed hypoperfusion in the left temporal lobe without an ischemic core. All these symptoms completely resolved the following day, with residual amnesia for the episode. Laboratory blood test and cerebrospinal fluid analysis were normal. Brain MRI showed a puntiform hyperintensity on DWI in left parietal lobe, not confirmed on follow-up MRI. Baseline EEG showed diffuse left-side dominant slow waves, with subsequent improvement. ACM is a rare migraine variant and often a challenge for clinicians to diagnose appropriately, also because there are no classification criteria. It is an exclusion diagnosis and some dangerous causes of confusion (e.g., epilepsy, ischemia, hemorrhage, neoplasm and encephalitis) should be ruled out. Data from previous published reports showed that ACM is characterized by decreased cerebral blood flow in the left splenium region and medial temporal lobe on SPECT scans. In our patient we found hypoperfusion on the left temporal lobe without an ischemic core on brain CTP. The more widespread use of brain CTP in an acute setting together with clinical course and blood and CSF results could help physicians to raise the doubt of this rare clinical entity avoiding misdiagnosis or excessive diagnostic testing.

Implementation of Knowledge based Collaborative Filtering and Machine Learning for E-Commerce Recommendation System

This is the era of I-way. The development of high-speed computing and huge storage devices change the working culture of human. It affects the traditional business processes and shifted towards online business. It creates huge problems like overload and irrelevant information which are the causes of confusion both customers as well as enterprise. Recommendation system solves these problems. Design and development of efficient system is one of the key areas of the recent researchers. Collaborative filtering (CF) and content-based filtering algorithms are widely used in the implementation of such system. Collaborative used user’s features while content-based used item’s features. Most of the CFs are rating or review based processed homogeneous information. In this paper we proposed knowledge-based collaborative filtering algorithm for large data set that uses various activities done by users during interaction of item through E-commerce web site like clicks, select and purchase. The performance of the system is compared with the base models using real time Amazon E-commerce dataset using precession, recall and NDCG evaluation parameters in various combinations of activities performed by users on items.

Nietzsche and our discourses on identity

Through his views on perspectivism and the will to power, Nietzsche indirectly influences many current discourses on identity. This article places these themes in the broader context of Nietzsche’s thought. Firstly, it is indicated how difficult it is to speak of someone’s identity by showing how many ‘Nietzsches’ appear in his writings, notebooks and letters and the accounts of his contemporaries. Such comparative readings, although they may cast new light on Nietzsche’s philosophy, are rare in Nietzsche scholarship. Next, his views on identity are briefly explored, paying attention to his rejection of the centred subject, equality and morality and his view on hierarchy, creativity and power struggles. Finally, it is argued that Nietzsche confronts our discourses on identity with challenges regarding the ubiquity of power struggles, the role of ressentiment, the possibility of communication across boundaries, the importance of the individual and the problem of affirmation.Contribution: Discourses on identity, although fashionable, are often confusing. Instead of offering solutions, this article uses Nietzsche’s life and philosophy to identify some causes of confusion and indicates where crucial decisions regarding our presuppositions have to be taken. Its aim was not to produce knowledge but, in line with Nietzsche’s practice, to ‘produce ignorance’, to question the terms we use confidently, without fully considering their meaning or implications.

The importance of reference frame for pressure at the liquid–vapour interface

ABSTRACT The local pressure tensor is non-unique, a fact which has generated confusion and debate in the 70 years since the seminal work by Irving Kirkwood. This non-uniqueness is normally attributed to the interaction path between molecules, especially in the interfacial-science community. In this work, we reframe this discussion of non-uniqueness in terms of the location, or reference frame, used to measure the pressure. By using a general mathematical description of the liquid–vapour interface, we obtain a reference frame that moves with the interface through time, providing new insight into the pressure. We compare this instantaneous moving reference frame with the fixed Eulerian one. Through this process, we show the requirement that normal pressure balance at the moving surface is satisfied by surface fluxes; however, an additional corrective term based on surface curvature is required for the average pressure in a volume. We make the case that a focus on the path of integration is the cause of confusion in the literature. Using an explicit reference frame with a more general derivation of pressure clarifies some of the issues of uniqueness, providing a pressure tensor which is defined at any instant in time and valid away from thermodynamic equilibrium.

Analyse, evaluate, review, synthesise, and argue: why teacher-assessors’ interpretations of command words matter

ABSTRACT Background Secondary school teachers sometimes teach and assess material outside their specialisms for reasons including staff shortages or the growing popularity of the interdisciplinary courses. We hypothesised that teacher-assessors with different subject specialisms may differ in their interpretations of frequently used words in teaching and assessment, such as ‘analyse’ and ‘evaluate’. Differing interpretations of these seemingly generic command words are worthy of investigation because they may have implications for the clarity and success of teaching and assessment. Purpose The aim of this small-scale study was to identify and analyse teacher-assessors’ interpretative differences of command words commonly used in teaching and assessment in order to draw out implications for students’ learning and assessment outcomes. Method Written definitions for five common command words (analyse, evaluate, review, synthesise and argue) were obtained from six published sources and also from nine experienced teacher-assessors in England covering seven subjects. A directed qualitative content analysis was conducted, entailing comparisons across individual definitions and across the humanities and sciences. Findings For all five command words, definitions were found to vary in both conceptual complexity and subject specificity, sometimes within the same subject. Fundamentally different concepts were identified for ‘review’ (which may or may not entail making a judgement about material) and ‘argue’ (which may or may not focus on reasoning). This could be an important cause of confusion for some students and may limit the depth of teaching and understanding for others. Furthermore, such differences could reduce agreement among assessors and undermine the appropriateness of the inferences drawn from the outcomes of assessments. Conclusion This small-scale investigation highlights the importance of building shared understandings of assessment criteria. Although assessor standardisation is the norm and occurs via formal procedures within large examination boards, the emphasis on it may be considerably weaker in less regulated teacher-assessor contexts. Further research could usefully focus on training and support the needs of non-specialist teachers and interdisciplinary course developers, strengthening communities of practice.

A Confusing General Term andldquo;Frailtyandrdquo; Should be Organized in Relation with Friedandrsquo;s Criteria for Frailty, Locomotive Syndrome, Musculoskeletal Ambulation Disability Symptom Complex, and Sarcopenia, as Avoiding Fall into andldquo;Word Playandrdquo;

In this review, we organize confusing concepts of frailty, locomotive syndrome, Musculoskeletal Ambulation Disability Symptom (MADS) Complex, and sarcopenia, as avoiding fall into “word play.” The concept of Clinical Dementia Rating may be useful for understanding mixed situations. Clinical conditions differ during the process of lesion development in the brain among patients with Alzheimer disease, and that the idea of biaxial thinking for “disease” and “condition” is required. Regarding frailty, a mix of “disease” and “condition” in criteria may be a cause of confusion, and this may be an important idea in daily clinical practice. Since frailty has been identified as a reason for fall in many academic studies, of which 70% used Fried’s criteria, it is clear that frailty reflects decreased motor function. This suggests a relationship between frailty and fall.