Cause Of Confusion Research Articles

Globalisation, money, taxes – past and present

The article is devoted to changes that have taken place in the world economy and in the econo- mics, starting with the Great Depression of the 1930s to the contemporary Global Crisis. The author pays special attention to the phenomenon of free movement of capital across borders, which lead to weakening of the importance and role of the state.

A case of confusion: paraneoplastic encephalomyelitis in an elderly patient suspected of having urinary tract infection-associated delirium

Acute confusion is a common symptom of physical illness in the older patient. In the majority, it is transient and resolves on treatment of precipitants. In a subset of patients,...

The elastic theory of shells using geometric algebra.

We present a novel derivation of the elastic theory of shells. We use the language of geometric algebra, which allows us to express the fundamental laws in component-free form, thus aiding physical interpretation. It also provides the tools to express equations in an arbitrary coordinate system, which enhances their usefulness. The role of moments and angular velocity, and the apparent use by previous authors of an unphysical angular velocity, has been clarified through the use of a bivector representation. In the linearized theory, clarification of previous coordinate conventions which have been the cause of confusion is provided, and the introduction of prior strain into the linearized theory of shells is made possible.

Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessments and interventions for this group of patients receiving palliative and supportive care. Recommendations • Palliative and supportive care must be multidisciplinary. (G) • All core team members should have training in advanced communication skills. (G) • Palliative surgery should be considered in selected cases. (R) • Hypofractionated or short course radiotherapy should be considered for local pain control and for painful bony metastases. (R) • All palliative patients should have a functional endoscopic evaluation of swallowing (FEES) assessment of swallow to assess for risk of aspiration. (G) • Pain relief should be based on the World Health Organization pain ladder. (R) • Specialist pain management service involvement should be considered early for those with refractory pain. (G) • Constipation should be avoided by the judicious use of prophylactic laxatives and the correction of systemic causes such as dehydration, hypercalcaemia and hypothyroidism. (G) • Organic causes of confusion should be identified and corrected where appropriate, failing this, treatment with benzodiazepines or antipsychotics should be considered. (G) • Patients with symptoms suggestive of spinal metastases or metastatic cord compression must be managed in accordance with the National Institute for Health and Care Excellence guidance. (R) • Cardiopulmonary resuscitation is inappropriate in the palliative dying patient. (R) • 'Do not attempt cardiopulmonary resuscitation' orders should be completed and discussed with the patient and/or the family unless good reasons exist not to do so where appropriate. This is absolutely necessary when a patient's care is to be managed at home. (G).

Pragmatic medicine in solid cancer: a translational alternative to precision medicine.

The precision medicine (PM) initiative is a response to the dismal outlook in solid cancer. Despite heterogeneity, common mechanistic denominators may exist across the spectrum of solid cancer. A shift from conventional research and development (R&D) toward PM will require conceptual and structural change. As individuals and as a society, we welcome innovation, but question change. We ask: In solid cancer, does PM identify and address the causes of prior failures, and, if so, are the proposed solutions feasible? And, when may we expect safer, more effective and affordable drugs in the clinic? Considerations that prompt a pragmatic rethink include a failure analysis of translational R&D in solid cancer suggesting that trials and regulations need to be aligned with the natural history of the disease. In successful therapeutic interventions in chronic, complex disease, surrogate markers and endpoints should be consistent with the Prentice’s criteria. In solid cancer, drug induced tumor shrinkage, is a drug effect and not a disease response; tumor shrinkage does not reflect nor predict interruption of the disease. Overall, we support a pragmatic, multidisciplinary, and collaborative R&D, and suggest that direction be set by clinical need and utility, and by questions, not answers. PM will prove worthwhile if it could improve clinical outcomes. The lag in therapeutics relative to diagnostics is a cause for confusion. Overdiagnosis adds to fear and harm, especially in the absence of effective interventions. A revised initiative that prioritizes metastasis research could replicate the successful HIV/AIDS model in solid cancer. A pragmatic approach may further translational efforts toward meaningfully effective, generally available, and affordable solutions.

Intersexuality: On Secret Bodies and Secrecy

ABSTRACTThe article problematizes the treatment of intersex as a secret within the medical and family systems. Under the biosocial assumption that the “intersexual” body is pathological and requiring immediate surgical and hormonal regulation, intersex individuals are made to undergo a process of transforsexation, that is, the violent production of a normative masculinity or femininity by means of invasive clinical practices. In this process absolute secrecy serves as a central factor for the success of normalization. We argue that not only does “the secret” of intersex bodies become an active factor in the normalization of sex but also paradoxically it is counteracted by the body, which does not “speak” the language of “the secret” and continues to reproduce new forms of intersex combinations in response to ongoing medical intervention. Our analysis is based on case histories told by 6 mothers of intersex children and by 11 intersex adults, stories in which secrecy has been an essential theme in the process of transforsexation imposed by doctors and followed by the parents. Secrecy, even more than the surgery itself, was, in the experience of intersex adults, a great cause of confusion, anger, mistrust, and criticism. Because of secrecy, intersex children are thus deprived of a language to name their experience or interpret the sense of their body.

Teaching of chemical bonding: a study of Swedish and South African students' conceptions of bonding

Almost 700 Swedish and South African students from the upper secondary school and first-term chemistry university level responded to our survey on concepts of chemical bonding. The national secondary school curricula and most common textbooks for both countries were also surveyed and compared for their content on chemical bonding. Notable differences between the countries were found in textbooks and in the curriculum regarding the topics of ionic bonding, bond energetics and use of the VSEPR model, the latter being absent in the Swedish curriculum and ionic bonding not explicitly mentioned in the South African curriculum. To some extent these differences are reflected in the students’ responses to the survey. It is also clear that university teachers in both countries must prepare effective counter-measures against deep rooted misunderstandings. For the upper secondary school level it is suggested that the bond energetics and exothermic and endothermic reactions be clearly and carefully presented and separated as the study indicates that mixing of these two concepts is a major cause of confusion.

Pre-renal or pre-tubular?

Acute kidney injury (AKI) is one of the most common clinical encounters during nephrology inpatient rounds. Over time, I have seen that, the terms renal, pre-renal, and even post-renal, are causing more confusion than help, when discussing the anatomopathophysiology of AKI to students and even other health care providers. It is hard to convince a non-nephrologist that the many urinary indices, including fractional excretion of sodium (FeNa) look pre-renal in pure glomerular disease: after all glomeruli are the pillars of main “renal function”, i.e. glomerular filtration rate (GFR). On the other hand, measurements of urinary sodium and creatinine to calculate FeNa are frequently ordered in any AKI when mostly they do not add any to the management. With underlying advanced chronic kidney disease (CKD), FeNa is naturally increased and the validity of the usual indices used to differentiate pre-renal from renal is much reduced. Unfortunately, too much of emphasis is given to FeNa calculation in advanced CKD patients, and frequently no important implication can be made of the calculated value. Frequently in non-oliguric states, FeNa is not needed, as in the absence of diuretics and sodium loosing renal conditions, lack of oliguria per se, would argue more against pre-renal condition than any value that FeNa can imply. A major cause of confusion is that FeNa is essentially an index of function of renal tubules, and not the GFR, which we define “renal function” with it. With many subtypes of AKI including, pure volume depletion and pure glomerular disease, GFR is decreased, but tubular function of reabsorbing sodium can remain fairly intact in those conditions. In fact, both simple urinary indices (including urinary sodium, creatinine, osmolality), and derived indices (including excreted fraction of the filtered sodium –FeNa – and renal failure index) that have long been used to differentiate acute tubular necrosis from non-renal conditions (1-5) are meant to determine integrity of “tubular” function. The terminology of renal, pre-renal, and post-renal is much older than the use of these indices. These indices are chosen to differentiate normal versus abnormal renal tubular handling of sodium. Using the current terminology, it is not surprising that renal arterial as well as glomerular disease (1) without significant involvement of the tubular system have urinary indices compatible with that of pre-renal condition. A better terminology for pathoanatomophysiologic classification seems to emphasize the tubular versus non-tubular nature of renal failure. Using this terminology, obviously the classical acute tubular injury causing acute renal failure will be considered tubular. Glomerular and renal vascular, as well as conditions associated with low effective intra-arterial volume, will all be properly considered pre-tubular. Early obstructive conditions, inside or outside kidney, without damaging tubular system and tubular handling of sodium, would properly be considered post-tubular in this setting. Several limitations still apply to even proper use of FeNa. Tubular injury is a common consequence of both pre-tubular and post-tubular conditions and mixed features in the continuum of injury are not uncommon. Also, in chronic renal insufficiency, with reduced GFR and creatinine clearance, to maintain sodium homeostasis, the FeNa is increased. It should remembered that, the classic way to teach FeNa, usually teaches the formula of UNa × PCr/PNa × UCr, without describing where it comes from. To start a mathematical equation, first the understanding of its original non-simplified formula is needed. In this case FeNa implies the fraction of excreted sodium (sodium clearance) per measure of GFR (creatinine clearance). It also has the core implication as to why, for example, with reduced creatinine clearance, FeNa should increase so that sodium clearance stays constant. Thus, calculated FeNa is equal to sodium clearance/creatinine clearance. To maintain the sodium clearance stable under steady states, the product of creatinine clearance and FeNa should stay constant (Figure 1). This means that with decreased but stable creatinine clearance, FeNa should be increased under steady states. Thus, baseline FeNa is usually more than 1.0 in chronic renal insufficiency, which is again indicative of deranged, though compensatory, overall tubular function. Therefore, in most original studies evaluating the validity of FeNa, chronic renal insufficiency patients have been excluded (1-3). The amount of sodium intake also directly affects its clearance and FeNa. Figure 1 All of these limitations should be considered when using FeNa for evaluation of renal failure.

Long memory and regime switching: A simulation study on the Markov regime-switching ARFIMA model

Abstract Recent research argues that if the cause of confusion between long memory and regime switching were properly controlled for, they could be effectively distinguished. Motivated by this idea, our study aims to distinguish between them of financial series. We firstly model long memory and regime switching via the Autoregressive Fractionally Integrated Moving Average (ARFIMA) and Markov Regime-Switching (MRS) models, respectively. Their finite-sample properties and the confusion are investigated via simulations. To control for the cause of this confusion, we propose the MRS–ARFIMA model. A Monte Carlo study shows that this framework can effectively distinguish between the pure ARFIMA and pure MRS processes. Furthermore, MRS–ARFIMA outperforms the ordinary ARFIMA model for data simulated from the MRS–ARFIMA process. Finally, empirical studies of hourly and five-minute Garman–Klass and realized volatility of the FTSE index is conducted to demonstrate the advantages and usefulness of the proposed MRS–ARFIMA framework compared with the ARFIMA and MRS models in practice.

People-friendly lighting controls – User performance and feedback on different interfaces

This study aimed to investigate user reactions to lighting controls and to develop guidance on achieving people-friendly user interfaces. An experimental study was conducted in the Building Research Establishment (BRE) lighting laboratory. A total of 24 participants were brought in and asked to control the lighting in a room in various ways. Their success and any causes of confusion or failure were noted; a questionnaire was completed for each participant. In general, participants preferred simple and familiar control types, although they did appreciate being able to change the lighting colour. Controls needed to respond quickly and give visual feedback to the user. Users preferred slide dimmers which allowed them to set their preferred level. Pre-set levels or ‘scenes’ were less popular. Lighting controls needed to be recognisable to avoid unnecessary detail and duplication.

An attachment-based description of the medial collateral and spring ligament complexes.

Anatomy of the medial collateral and spring ligament complexes has been the cause of confusion. The anatomic description is highly dependent on the source studied and little agreement exists between texts. In addition, inconsistent nomenclature has been used to describe the components. This study attempted to clarify confusion through the creation of a 3D ligament map using attachment-based dissection. Nine fresh foot and ankle specimens were observed. The medial collateral ligament and spring ligament complexes were dissected using their attachment sites as a guide to define individual components. Each component's perimeter and thickness was measured and each bony attachment was mapped using a microscribe 3D digitizer. Five components were identified contributing to the ligament complexes of interest: the tibiocalcaneonavicular, superficial posterior tibiotalar, deep posterior tibiotalar, deep anterior tibiotalar, and inferoplantar longitudinal ligaments. The largest component by total attachment area was the tibiocalcaneonavicular ligament followed by the deep posterior tibiotalar ligament. The largest ligament surface area of attachment to the tibia and talus was the deep posterior tibiotalar ligament. The largest attachment to the navicular and calcaneus was the tibiocalcaneonavicular ligament, which appeared to function in holding these bones in proximity while supporting the head of the talus. By defining complex components by their attachment sites, a novel, more functional and reproducible description of the medial collateral and spring ligament complexes was created. The linear measurements and 3D maps may prove useful when attempting more anatomically accurate reconstructions.

Comment on: Endometrial cancer occurrence five years after breast cancer in BRCA2 mutation patient.

We read with great interest the article by Oh et al. [1]. First of all, BRCA2 mutation of the present case is unclassified variants (UVs). The results of the BRCA1/2 genetic test is divided into mutations detected, not-detected and UVs mutations. UVs are referred to the ambiguous clinical significance and include: 1) missense mutations or small in-frame deletions whose effect on the protein structure cannot be immediately inferred; 2) variants, both exonic and intronic, that may potentially affect pre-mRNA splicing, but for which no direct evidence is available; and 3) variants in regulatory sequences. Their effect on cancer risk cannot be established through case-control association studies [2]. Clinical significance of UVs is listed as unknown in the Breast Cancer Information Core (BIC) database in most cases. The unclassified variants (c.1889C>T) of the present case is also listed as unknown in the BIC [3]. In order to clarify the meaning of this UV requires further studies, such as co-segregation test with family members or functional study. Therefore, it is hard to be determined the UV in the case as pathogenic mutation at this point. In short, a female patient with family history of gastric cancer, which has affected by breast cancer and endometrial cancer sequentially, was discovered to have the BRCA2 UV mutation after BRCA genetic test. It is hard to conclude that the breast and endometrial cancers caused by this UV mutation. Premature conclusion the UV as pathogenic or deleterious mutation may lead to a confusion to doctors, patient and patient's families. How will manage the unaffected carrier in the family of the present case and how will counsel these to the carriers? Consider some aspects to present case. Whether other risk factors contributed to endometrial cancer of the patient, such as high body mass index (not mentioned in the article), breast cancer history and hormone therapy after mastectomy (letrozole not tamoxifen in the case). As mentioned earlier in the article, the lifetime risk of endometrial carcinoma is not associated with BRCA mutation [4]. The other point to consider is pathologically to review the specimen, especially the fallopian tubes and ovaries to discriminate synchronous malignancies. Once the cause of confusion as above in this article is from what it might have been misunderstood the interpretation of the UV. I will introduce one case in our institution. A 42-yearold, early-staged, endometrioid cell type, ovarian cancer patient had BRCA2 UV (8665_8667delGGA) at BRCA genetic test. This UV was found to be a pathogenic mutation after co-segregation test in her sister with breast cancer history. And her sister is now managed according to the NCCN guidelines considering as unaffected BRCA carrier. For patients and their families, it will be careful to draw pedigree, genetic counseling, genetic test and risks management.

Magnification to avoid medication errors.

Medication errors are the most common errors harming at least 1.5 million people every year.[1,2] Medication errors were estimated to account for 7000 deaths in the USA in 1993.[3] The reasons for misidentification of a drug can be - look alike/sound alike drugs, syringe swap, confusing, inaccurate, or incomplete drug labels, small print, damaged labels, poor background colour, etc.[2] Cognitive impairment with small prints increases with age. Forty percent of young adults and 96% of older adults reported need for glasses. With this in mind, we decided to study the accuracy of drug label identification by staff in operating theatres and Intensive Care Units (ICU).

The Ethics of Democratic Deceit

AbstractDeception presents a distinctive ethical problem for democratic politicians. This is because there seem in certain situations to be compelling democratic reasons for politicians both to deceive and not to deceive the public. Some philosophers have sought to negotiate this tension by appeal to moral principle, but such efforts may misrepresent the felt ambivalence surrounding dilemmas of public office. A different approach appeals to the moral character of politicians, and to the variety of forms of manipulative communication at their disposal. The public is usually more indulgent of politicians who ‘spin’ the truth than of those who tell bare‐faced lies, but this could be a mistake. Spin expresses disdain for the democratic value of truthfulness, and so democratic ‘spin‐doctors’ ought to trouble us more than they typically do. The cause of confusion here may reside in the failure to appreciate the distinctiveness of public morality, and in the misguided application of private standards of behaviour to a public context in which they are out of place.

A very original case of a mini accessory liver lobe with its own gallbladder

Anatomic variation of the hepatobiliary system is often related to the biliary tract and vascular supply of the liver. We present here one of the smallest accessory hepatobiliary system. The case of a 30-year-old male who was a living liver donor is presented. During the dissection of the portal hilum, 1.5 cm of accessory liver (AL) tissue was noted below the left lobe of the liver. This AL tissue had a gallbladder of 1.5 cm and which had a cystic duct opening to the bile duct of the accessory liver. The AL bile duct opened to the left bile duct of the liver. The arterial and portal supply of the AL came from the left artery and left portal vein of the liver. The accessory gallbladder also had a cystic artery coming from the arterial branch of the AL. It was noted that the hepatic vein of the AL opened directly to left lobe tissue. The hepatobiliary system has many anatomic variations, but this case is rare and original in the literature in that it may be a cause of confusion and even a false diagnosis.

Can we distinguish regime switching from long memory? A simulation evidence

It is well known that long memory can be caused by regime switching and is easily confused with it. However, recent study suggests that if the cause of confusion was properly controlled for, long memory and regime switching could be distinguished. Motivated by this idea, our study aims to distinguish regime switching from long memory for the financial time series. In this article, we model long memory and regime switching via the ARFIMA and Markov regime-switching (MRS) frameworks, respectively. A theoretical proof is provided to show that the time-varying smoothing probability series can induce the presence of significant long memory in the regime-switching process. We then propose a two-stage two-state-ARFIMA (2S-ARFIMA) model to control for the effect of the smoothing probability and use a simulation study to demonstrate that it can effectively distinguish the pure MRS process from the pure ARFIMA process.

Marchiafava Bignami Disease; an uncommon cause of confusion in a long-term alcohol abuser

The Galle Medical Journal is published by the Galle Medical Association. The journal is published quarterly in March, June, September and December each year. The submissions are accepted throughout the year. The aims of the Journal are to foster co-operation among the medical fraternity and to be a forum to make literary contributions, share experiences encountered in medical practice, update their knowledge and have debates on topics related to all aspects of medicine.

Reproducibility of the ATS/ERS classification of idiopathic interstitial pneumonias

Histopathological diagnosis of interstitial pneumonia (IP) requires experiences and is often challenging for general surgical pathologists. In its context, accurate recognition of histopathological usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) patterns along with separation of idiopathic IPs from ones associated with hypersensitivity pneumonia and systemic connective tissue disease are the critical points. Several reports had indicated insufficient interobserver agreement of IP diagnosis, and we also have investigated the interobserver agreement of chronic interstitial pneumonia in various conditions showing that reproducibility of pathological judgment of above points was not greatest. To improve the reproducibility of diagnosis, recent publication of IPF guidelines set criteria of pathological UIP. It indeed helps pathologists to evaluate definite UIP pattern and works well for pulmonary pathologists, however, it still have some confusions and difficulties to the general surgical pathologists. In the course, summary of interobserver agreement along with our own data among pulmonary and general pathologists before and after the new guidelines will be shown. I will also share possible causes of confusion with audience and suggest a few tips for the improved histological assessment.

An analysis of firefighter personal safety alarm effectiveness on the fire ground

For firefighters in the line of duty, the last line of defense and chance for rescue oftentimes relies on the effectiveness of their Personal Alert Safety System (PASS) devices. When activated, a PASS device emits an alarm signal to notify others that a firefighter is in distress. However, there have been notable instances where PASS devices have confused rescue personnel or created a more hazardous situation, for instance, when noise interference originating from other objects is involved. This research compiles data from various sources, for example, firefighter near miss reports and National Institute for Occupational Safety and Health (NIOSH) fatality reports, regarding PASS device effectiveness. The research will investigate the causes of confusion and danger as well as take a look at the situations where the device achieved its goal and was able to save a life. The implications of discovering how interfering noises can render PASS devices ineffective could save several lives in the future and ultimately lead to increased firefighter safety.

7th International Symposium on Enabling Technologies for Life Sciences (ETP)

7^th International Symposium on Enabling Technologies for Life Sciences (ETP)