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Despite that convolutional neural networks (CNNs) have shown high-quality reconstruction for single image dehazing, recovering natural and realistic dehazed results remains a challenging problem due to semantic confusion in the hazy scene. In this article, we show that it is possible to recover textures faithfully by incorporating semantic prior into dehazing network since objects in haze-free images tend to show certain shapes, textures, and colors. We propose a semantic-aware dehazing network (SDNet) in which the semantic prior is taken as a color constraint for dehazing, benefiting the acquisition of a reasonable scene configuration. In addition, we design a densely connected block to capture global and local information for dehazing and semantic prior estimation. To eliminate the unnatural appearance of some objects, we propose to fuse the features from shallow and deep layers adaptively. Experimental results demonstrate that our proposed model performs favorably against the state-of-the-art single image dehazing approaches.

Cyclone Pam swept through the archipelago of Vanuatu on 13-14 March 2015, with wind speeds exceeding those recorded anywhere in the South Pacific since the 1980s. Southern and central parts of the country were particularly affected. Material damage on Tongoa, one of the most afflicted islands, was extensive, but no deaths were reported. During the storm, villagers found shelter in their kitchen, in what is considered locally as a 'lifeboat'. The aftermath was managed and mitigated by international aid organisations. On Tongoa, this included a 'Shelter Cluster' programme, under which villagers were given house rebuilding kits. Elaborating upon extensive ethnographic investigations on site between 2011 and 2018, this paper explores and reveals the ways in which this aid generated confusion among the local population. In a larger context of regular disasters triggered by natural hazards, locals have found endogenous ways of dealing with such extreme climatic events, for the most part without any external assistance.في الفترة من 13 إلى 14 مارس 2015 ، اجتاح إعصار بام أرخبيل منطقة فان واتو بسرعات رياح تجاوزت تلك المسجلة في أي مكان في منطقة جنوب المحيط الهادئ منذ الثمانينيات. وقد تأثرت الأجزاء الجنوبية والوسطى من البلاد بشكل خاص. في تونغوا، إحدى الجزر الأكثر تضررًا، كانت الأضرار المادية جسيمة على الرغم من عدم الإبلاغ عن أي حالة وفاة. خلال العاصفة، وجد القرويون المأوى في مطبخهم، والذي اعتبروه محليًا "قوارب نجاة". تمت إدارة تداعيات الكارثة والتخفيف من حدتها من قبل منظمات الإغاثة الدولية. وشمل ذلك في تونغوا برنامج "مجموعة المأوى" حيث تم تزويد القرويين بمجموعات أدوات إعادة بناء المنازل. بالتفصيل في التحقيقات الإثنوغرافية المكثفة في الموقع التي أجريت بين عامي 2011 و 2018 ، تستكشف هذه المقالة وتكشف الطرق التي تسببت بها هذه المساعدة في حدوث ارتباك بين السكان المحليين. في سياق أكبر من الكوارث العادية التي تسببها الأخطار الطبيعية، وجد السكان المحليون طرقًا داخلية للتعامل مع مثل هذه الأحداث المناخية المتطرفة ، في الجزء الأكبر من دون أي مساعدات خارجية - مما يكشف عن ديناميكية المساعدات الإنسانية الكلمات الدالة: إعصار بام ، كارثة ، مساعدات إنسانية ، إعادة بناء ما بعد الكارثة ، تو نغوا ، فان واتو ، العمارة العامية.2015年3月13日-14日，飓风帕姆席卷瓦努阿图群岛，风速超过了自1980年代以来南太平洋地区任何地方的记录。该国南部和中部地区受到的影响尤其严重。汤戈阿是受灾最为严重的岛屿之一，虽然没有死亡报告，但财产损失很大。暴风雨期间，村民们都躲在厨房里避难，厨房被当地人视为是“救生艇”。国际援助组织为这场灾难提供了善后工作和减灾帮助。这包括一项“避难所助建”计划，向村民提供房屋重建工具包。本文详细阐述了2011年至2018年间，在现场进行的大范围民族学调查，探讨并揭示了这种援助对当地人造成混乱的各种情况。对于周期性的自然灾害，当地人在大多数没有任何外界援助的情况下，已经掌握了一些在处理此类极端气候事件的老办法，这也揭示了人道主义援助的动态 关键词：飓风帕姆，灾难，人道主义援助，灾后重建，汤戈阿，瓦努阿图，乡土建筑.

OBJECTIVE Chiari malformation type 1 (CM-1) and spontaneous intracranial hypotension (SIH) are causes of headache in which cerebellar tonsillar ectopia (TE) may be present. An accurate method for differentiating these conditions on imaging is needed to avoid diagnostic confusion. Here, the authors sought to determine whether objective measurements of midbrain morphology could distinguish CM-1 from SIH on brain MRI. METHODS This is a retrospective case-control series comparing neuroimaging in consecutive adult subjects with CM-1 and SIH. Measurements obtained from brain MRI included previously reported measures of brain sagging: TE, slope of the third ventricular floor (3VF), pontomesencephalic angle (PMA), mamillopontine distance, lateral ventricular angle, internal cerebral vein–vein of Galen angle, and displacement of iter (DOI). Clivus length (CL), an indicator of posterior fossa size, was also measured. Measurements for the CM-1 group were compared to those for the entire SIH population (SIHall) as well as a subgroup of SIH patients with > 5 mm of TE (SIHTE subgroup). RESULTS Highly significant differences were observed between SIHall and CM-1 groups in the following measures: TE (mean ± standard deviation, 3.1 ± 5.7 vs 9.3 ± 3.5 mm), 3VF (−16.8° ± 11.2° vs −2.1° ± 4.6°), PMA (44.8° ± 13.1° vs 62.7° ± 9.8°), DOI (0.2 ± 4.1 vs 3.8 ± 1.6 mm), and CL (38.3 ± 4.5 vs 44.0 ± 3.3 mm; all p < 0.0001). Eight (16%) of 50 SIH subjects had TE > 5 mm; in this subgroup (SIHTE), a cutoff value of < −15° for 3VF and < 45° for PMA perfectly discriminated SIH from CM-1 (sensitivity and specificity = 1.0). DOI showed perfect specificity (1.0) in detecting SIH among both groups. No subjects with SIH had isolated TE without other concurrent findings of midbrain sagging. CONCLUSIONS Measures of midbrain sagging, including cutoff values for 3VF and PMA, discriminate CM-1 from SIH and may help to prevent misdiagnosis and unnecessary surgery.

Face aging has attracted widespread attention in recent years, but most studies are based on the same emotional situation. Is the same person’s aging in different emotional situations the same? To solve the above confusion, this paper proposes a novel face aging model DEF-Net, which consists of two parts: different emotional learnings (Emotion-Net) and face aging (Age-Net). Given a target emotion category, DEF-Net first assists the image from the original dataset to learn the emotion features through Emotion-Net and the generated dataset is used as the inputs of Age-Net. At the same time, multiple loss functions are used to ensure that the crucial information of the original image is not lost. Secondly, Age-Net, which has been pre-trained on the original dataset, began to adopt the generated dataset to learn the aging distribution under different emotions. Designed loss functions are utilized to ensure that the realistic target images generated by Age-Net do not lose the learned emotional characteristics. Finally, extensive experiments are used to verify the performance of DEF-Net. Compared with other state-of-the-art methods: (1) DEF-Net can learn different facial emotions across different datasets and generate corresponding realistic aging images; (2) the results achieved by our DEF-Net are demonstrated to be better than those by the model that performs face aging first and then learns different emotional characteristics.

A 45-year-old female presented to hospital with confusion and visual disturbances. She had undergone a liver transplant 3 years prior for cirrhosis secondary to primary biliary cholangitis. Computed tomography and magnetic resonance imaging of the brain showed features consistent with posterior reversible encephalopathy syndrome. Her medications included tacrolimus, sirolimus, and prednisone. She reported smoking 4 grams of cannabis per day. Following cessation of tacrolimus, the patient’s encephalopathy and visual disturbances resolved. To our knowledge, this case represents the longest time elapsed from liver transplantation to the development of tacrolimus-associated posterior reversible encephalopathy syndrome in the literature. This case highlights the potential danger of cannabis use in transplant recipients who are on immunosuppressants such as tacrolimus. Clinicians should have a high index of suspicion for posterior reversible encephalopathy syndrome in post-transplant patients presenting with altered mental status, even years after liver transplantation, and be familiar with potential interactions between cannabis and immunosuppressants.

Hepatic hemangiomas infrequently exhibit atypical imaging features, which may cause diagnostic confusion with hepatic malignancies and lead to unnecessary surgery. We report a rare case of multilocular cystic hemangioma of the liver mimicking a mucinous cystic neoplasm of the liver in a 48-year-old female, focusing on computed tomography and magnetic resonance imaging features and their differential diagnosis.

The entire world has gotten caught and is now furious that the deadly corona virus is out. All and every person’s life across the globe has stopped. It took millions of lives already. The government of most countries agreed to follow the full lock-down of human activities due to its propensity to a high spread frequency. Therefore, this work of mine would be a accentuating the affectivity of the Aarogya Setu application in spreading realization amongst the masses that self- care in this situation of emergence is the only way not only of saving one’s own life but also of others. It would also effectively highlight that though, the use of virtual platform has benefitted all but its improper utilization can create loads of misunderstanding, confusion and can give rise to some devastating situation.

The identification and classification of plant diseases is of great significance to ecological protection and deep learning methods have made a great of progress in the common plant diseases identification for specific plant. While faced with the same plant disease of other plants, due to the insufficient or low quality training data, current deep learning methods will be difficult to identify the diseases effectively and accurately. Inspired by the advantages of GAN in dataset expansion, we propose the CycleGAN based confusion model in this paper. In this paper, GAN framework is improved by adding noise label and learn together during training stage, which migrates the data of common plant diseases to the plants with insufficient or low quality data. In order to evaluate the quality of the migrated training dataset among different GAN approaches, we introduce the quality indicators of the migration images such as MMD, FID, EMD etc. We compare our model with other GANs model, and the experimental results show that the proposed model obtains better results in the migration process, which make it more effective for the identification of cross species plant diseases.

Background The rate of urinary tract infection (UTI) investigation and treatment in confused older emergency department (ED) patients has not been described in the literature. We aim to describe the pattern of practice in an academic tertiary care ED for this common presentation. Methods A health record review was conducted on 499 adults aged ≥65 presenting to academic EDs with confusion. Exclusion criteria: Glasgow Coma Scale < 13, current treatment for UTI, indwelling catheters, nephrostomy tubes, transfer from another hospital. Outcomes were the prevalence of UTI investigation, diagnosis and antibiotic treatment. Results 64.9% received urine tests, 11.4% were diagnosed with UTI, and 35.2% were prescribed antibiotics. In the subgroup with no urinary symptoms, fever, or other obvious indication for antibiotics, these numbers were 58.2%, 7.6%, and 18.1%, respectively. Patients who had urine tests or received antibiotics were older than those who did not (p values < .01). Patients receiving antibiotics had higher admission rates and 30-day and six-month mortality (OR of 2.9 [2.0–4.3], 4.0 [1.6–11], and 2.8 [1.4–5.8], respectively). Conclusion Older patients presenting to ED with confusion were frequently investigated and treated for UTI, even in the absence of urinary symptoms. Antibiotic treatment was associated with higher hospitalization and mortality.

Objective Lithium is a drug of choice in the treatment of bipolar disorder and refractory depressive disorders. However, previous research suggests lithium has a negative cognitive impact in recovery from electroconvulsive therapy (ECT) and a higher risk of delirium, so patients are often required to stop taking lithium before ECT, despite risk of relapse. We studied the cognitive impact of serum lithium levels in patients undergoing ECT. Methods This was an observational prospective study. Serum lithium levels, thyroid and biochemical parameters were measured prior to each ECT session. Time elapsed from the anesthetic induction to the electrical stimulus and then to the patients’ reorientation was recorded, as well as the motor seizure duration and electroencephalogram (EEG) seizure duration. A statistical analysis using a linear mixed model was run while adjusting for confounding factors. Results Ten participants underwent a total of 86 ECT sessions (41% right unilateral ultrabrief pulse, and 59% bilateral brief pulse). A negative interaction between lithium levels and reorientation time was found among those doing bilateral brief pulse ECT. No association was observed in patients doing unilateral ultrabrief pulse ECT. No significant relationship was observed between lithium and both motor and EEG-assessed seizure duration. Conclusion This study suggests that low to moderate serum lithium levels (< 0.7 mmol/L) might have no harmful cognitive effects in patients under right unilateral ultrabrief pulse and bilateral brief pulse ECT.

Introduction The association between periodontitis and certain systemic diseases is well established; however, there is a distinct lack of research available on its awareness among medical students in the United Kingdom. Aims To determine the awareness of fourth-year undergraduate medical students concerning periodontitis including its risk factors, relationship with systemic health and students' attitudes towards oral diseases and further education. Methods We delivered an online survey via a weekly email news bulletin to 299 fourth-year medical students and received 101 completed responses. Results Medical students were largely aware of the most common features of periodontitis and recognised that systemic diseases may affect the periodontium. There was less awareness of the associations between certain systemic diseases and periodontitis and there appeared to be confusion with tooth decay. Perceived knowledge was generally reported to be poor and most students believed that further teaching would improve their medical practice. Conclusions Increased teaching on periodontitis within the medical curriculum would benefit students. This may be achieved using an integrated teaching approach. Future doctors should graduate with an adequate education on the interdisciplinary links and should be capable of signposting or referring patients early to the appropriate services where indicated to improve patient care.

In view of the various types of fabric defects, and the problems of confusion, density unevenness and small target defects, which are difficult to detect, this paper builds a deep learning defect detection network incorporating an attention mechanism. The data augmentation strategy is used to enrich the number of samples of each defective type, and the enriched samples were extracted by the feature extraction network integrated with the attention mechanism, which can improve the feature extraction ability of confusable defect types and small defect types. Region proposal generation generates a proposal box for extracted features, and adds an online hard example mining strategy to re-learn hard examples to accelerate network convergence. Region feature aggregation maps the proposal box to the feature map to obtain the region of interest. Finally, the defect features are classified and the bounding boxes are regressed. The results show that this algorithm can effectively detect 39 categories of fabric defects with a detection speed of 0.085 s and a detection accuracy of 0.9338.

PurposeMultiple organisations which have attempted to implement lean production/manufacturing/thinking have failed to achieve significant benefits. Practitioners and researchers have identified the barriers that hinder successful implementation. This study first consolidates such lean implementation barriers that are common across all industry sectors. Further, a systemic understanding of lean barriers is attempted by determining causal relationships between barriers and their relative causal strength.Design/methodology/approachBarriers to lean implementation were first identified from extant literature and categorised into broad barrier groups. These barrier groups were classified into four categories as specified by Liker's 4P model of lean–philosophy, people and partnership, processes and problem-solving. Additionally, interrelations between barriers, both within and among these four categories were determined.FindingsThe barriers classified under philosophy were the most critical as it affects the barriers in other groups. Similarly, barriers such as lack of leadership and top management commitment, lack of resources, shortage of lean consultants and trainers, lack of systemic understanding of lean and the need for its implementation, lack of lean expertise and training were found to be the most critical causal barriers.Research limitations/implicationsHighly critical barriers in terms of causality should be addressed with high priority, as effective measures against them may eliminate or reduce the impact of other barriers.Originality/valueThis study addresses the confusion regarding the high number of lean barriers in extant literature by providing a systemic understanding of the same. By exploring the interrelations among barriers, the most important causal barriers and barrier types (4Ps) are identified, the knowledge of which could improve lean implementation success. This is a novel attempt in the domain of lean.

Needleless connectors (NCs) for vascular access have limited needlestick injuries, but complications including occlusion, thrombosis, and infections have increased despite reduced needlestick injuries. These complications relate to the ability of an NC design to limit volume fluctuations that can lead to fluid reflux with potential for microbial contamination. Different NC designs requiring specific usage protocols and training, a lack of clarity in NC function relative to manufacturer-designated categories, and confounding results from a limited number of studies comparing different NCs have resulted in confusion, ultimately leading to complications from undesirable fluid movement within the vascular access. The authors therefore quantified the magnitude of reflux with current commercially available NCs using a venous stimulator. Thirteen blinded NC designs spanning the categories of negative and positive displacement, neutral, and antireflux were tested to quantify fluid movement upon disconnection and reconnection from a representative intravenous pressure (3 NCs per design; 10 trials per NC). Trials for each NC tested followed consistent displacement trends leading to tight error bars. Blinded NCs were then characterized according to their function and compared with their category designation after unblinding. All positive and negative NCs functioned in a manner consistent with their respective category designations. Conversely, all NCs categorized as neutral actually functioned with negative displacement (ie, reflux upon disconnection; 4/5 NCs) or positive displacement (1/5 NCs). Only NCs classified as antireflux functioned as neutral, which was confirmed in a blinded bidirectional flow test. These results suggest that the neutral NC-marketed category may be confusing to users unless the particular NC design has an integrated antireflux component.

Introduction and Objectives Implantable cardiac defibrillator (ICD) has been established as a therapy for malignant ventricular arrhythmias in patients at high risk of suffering them. Some studies suggest a possible relationship between the development of cancer and some prosthetic materials. Likewise, some investigations describe a higher incidence of cancer in patients with an ICD that suggest a potential relationship. Methods Retrospective cohort study of patients that underwent implantation of an ICD in the Complejo Hospitalario de Navarra between 2000 and 2016. The follow-up finished in June 2018. Sociodemographic, comorbidities and oncological data was analysed. Cancer incidence rates were estimated and compared with the general population data and with data of a cohort of patients with reduced LVEF heart failure. Risk of cancer models were adjusted by competitive risk models. Results 497 patients were included, mostly male (89.1%), with a mean age of 59.98 (14.98) years and a proportion of smokers of 67.6% and of ischaemic heart disease of 51.6%. The cancer incidence rate in the sample was 1230.9 per 100.000 person-year. In our study, features associated with cancer were older age, higher tobacco use and ischaemic cardiopathy. Conclusions In our sample of ICD carriers the incidence of cancer is high. This finding mainly seems to be related to tobacco usage and higher age.

Background The imaging features of focal liver lesions (FLLs) are diverse and complex. Diagnosing FLLs with imaging alone remains challenging. We developed and validated an interpretable deep learning model for the classification of seven categories of FLLs on multisequence MRI and compared the differential diagnosis between the proposed model and radiologists. Methods In all, 557 lesions examined by multisequence MRI were utilised in this retrospective study and divided into training–validation (n = 444) and test (n = 113) datasets. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the performance of the model. The accuracy and confusion matrix of the model and individual radiologists were compared. Saliency maps were generated to highlight the activation region based on the model perspective. Results The AUC of the two- and seven-way classifications of the model were 0.969 (95% CI 0.944–0.994) and from 0.919 (95% CI 0.857–0.980) to 0.999 (95% CI 0.996–1.000), respectively. The model accuracy (79.6%) of the seven-way classification was higher than that of the radiology residents (66.4%, p = 0.035) and general radiologists (73.5%, p = 0.346) but lower than that of the academic radiologists (85.4%, p = 0.291). Confusion matrices showed the sources of diagnostic errors for the model and individual radiologists for each disease. Saliency maps detected the activation regions associated with each predicted class. Conclusion This interpretable deep learning model showed high diagnostic performance in the differentiation of FLLs on multisequence MRI. The analysis principle contributing to the predictions can be explained via saliency maps.

Samples of biologic specimens and their derivatives (eg, wet tissues, paraffin-embedded tissue blocks, histology slides, frozen tissues, whole blood, serum/plasma, and urine) are routinely collected during the course of nonclinical toxicity studies. Good Laboratory Practice regulations and/or guidance specify minimum requirements for specimen retention duration, with the caveat that retention of biologic specimens need not extend beyond the duration of sample stability. However, limited availability of published data regarding stability for various purposes following storage of each specimen type has resulted in confusion, uncertainty, and inconsistency as to the appropriate duration for storage of these specimens. To address these issues, a working group of the Society of Toxicologic Pathology Scientific and Regulatory Policy Committee was formed to review published information, regulations, and guidance pertinent to this topic and to summarize the current practices and rationales for retention duration through a survey-based approach. Information regarding experiences reaccessing biologic specimens and performing sample stability investigations was also collected. Based on this combined information, the working group developed several points to consider that may be referenced when developing or revising sample retention practices. [Box: see text]

Infiltration of the optic pathway by germ cell tumors is exceptional and can lead to confusion with glioma or inflammatory conditions. We present the case of a 14-year-old girl with an optic nerve germinoma extending to the hypothalamus and manifesting as panhypopituitarism and visual loss. The patient experienced spontaneous regression of the lesion followed by secondary deterioration requiring treatment. Four other cases of spontaneously regressing intracranial germinoma followed by regrowth have been reported in the literature. This report highlights the importance of clinical and radiologic monitoring of intracranial germinoma, even in the event of initial spontaneous improvement.

Symptoms also included confusion, blank staring, blurred vision, incoordination of the extremities, decreased verbal communication, and holding her left hand in a fist.

Purpose of review This article describes the prerequisites for brain death/death by neurologic criteria (BD/DNC), clinical evaluation for BD/DNC (including apnea testing), use of ancillary testing, and challenges associated with BD/DNC determination in adult and pediatric patients. Recent findings Although death determination should be consistent among physicians and across hospitals, states, and countries to ensure that someone who is declared dead in one place would not be considered alive elsewhere, variability exists in the prerequisites, clinical evaluation, apnea testing, and use of ancillary testing to evaluate for BD/DNC. Confusion also exists about performance of an evaluation for BD/DNC in challenging clinical scenarios, such as for a patient who is on extracorporeal membrane oxygenation or a patient who was treated with therapeutic hypothermia. This prompted the creation of the World Brain Death Project, which published an international consensus statement on BD/DNC that has been endorsed by five world federations and 27 medical societies from across the globe. Summary The World Brain Death Project consensus statement is intended to provide guidance for professional societies and countries to revise or develop their own protocols on BD/DNC, taking into consideration local laws, culture, and resource availability; however, it does not replace local medical standards. To that end, pending publication of an updated guideline on determination of BD/DNC across the lifespan, the currently accepted medical standards for BD/DNC in the United States are the 2010 American Academy of Neurology standard for determination of BD/DNC in adults and the 2011 Society of Critical Care Medicine/American Academy of Pediatrics/Child Neurology Society standard for determination of BD/DNC in infants and children.

Acute respiratory distress syndrome is a common condition among critically ill patients, but remains under-recognized and undertreated. Under-recognition may result from confusion over the clinical inclusion criteria, as well as a misunderstanding of the complex relationship between the clinical syndrome, the variable histopathologic patterns, and the myriad clinical disorders that cause acute respiratory distress syndrome. The identification of the clinical syndrome and determination of the causal diagnosis are both required to optimize patient outcomes. Here we review the definition, discuss pitfalls in recognizing acute respiratory distress syndrome and consider an approach to ascertain specific etiologies of acute respiratory distress syndrome.

Aim Delirium is a common presenting symptom among older patients. Patients who presented with delirium may have a higher morbidity and mortality rate due to older age, other comorbidities, and atypical COVID-19 presentation. Currently, the evidence supporting delirium as one of the predictors of poor outcome of COVID-19 is still insufficient. This study aims to explore the potential association between delirium and poor outcomes from COVID-19. Methods We systematically searched the PubMed and Google Scholar databases using specific keywords related to our aims until January 30th, 2021. All articles published on COVID-19 and delirium were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for case-series studies. Statistical analysis was done using Review Manager 5.4 software. Results Our meta-analysis of 20 studies showed that delirium symptoms on admission was associated with poor outcomes from COVID-19 [OR 2.36 (95% CI 1.80–3.09), p

Background Research indicates that nurse navigators can play key roles in promoting empowerment for patients with cancer through advocacy, educational support, resource navigation, and psychosocial care. Objectives This study attempted to elucidate the efficacy of nurse navigation in patient knowledge, care coordination, and well-being before a breast oncology appointment. Methods Staff provided a nine-question survey to 50 newly referred patients before their initial appointment. After survey completion, patients had the option to participate in an open-ended interview about their experience. Findings A greater proportion of patients with initial nurse navigation than those without felt informed before their appointment and thought that their care was effectively coordinated. Although some patients without nurse navigation experienced delays and confusion in scheduling their appointment, no patients with nurse navigators reported such issues.

Purpose This study aims to investigate how external auditors properly classify the requirements of ISA 701 for key audit matters (KAM) compared with an emphasis of matter or other matters (EOM) in ISA 706 and going concern (GC) in ISAs 706 and 570. Such investigation is important to assess whether the explanatory matters included in ISAs 701, 706 and 570 are appropriate for external auditors so they can properly classify identified audit matters as either KAM, EOM or GC matters and considering the relationship among them. Design/methodology/approach The research used questionnaires sent to a sample of external auditors in five audit firms with international affiliations including two of the Big 4 audit firms. The Z-test for two proportions is conducted to assess whether external auditors were confused when interpreting the explanatory matters included in the ISAs. Findings The research suggests that the current ISA 701 explanations may not adequately help some auditors in their aim of properly identifying all KAM from among the different matters they reach during their audit. When classifying EOM and GC, most of the external auditors misclassified them as KAM. Practical implications This is a timely study. The results have implications for standard setters and regulators through revising the explanations included in the different audit reporting standards including ISA 701 and considering the relationships among them. Originality/value According to the authors’ knowledge, this study is considered among the first that surveyed the appropriateness of the explanations included in ISAs for KAM, EOM, GC and how auditors perceive such explanations when forming their opinion about their clients’ financial statements.

En un mundo en constante cambio, la transformación digital en los emprendimientos se ha vuelto una necesidad imperiosa para la sostenibilidad de los negocios, situación que debe planificarse y aplicarse en el mediano plazo. El objetivo de la presente investigación fue analizar la relación entre las variables transformación digital y emprendedores universitarios del Ecuador, para ello de forma exploratoria se realizó una revisión bibliográfica sobre las variables de interés, lo que permitió fundamentar el marco teórico del estudio, posteriormente y para aterrizar los conceptos al contexto ecuatoriano, se empleó el método Delphi con dos rondas de entrevistas a expertos, lo que a su vez permitió diseñar un cuestionario, el que posteriormente fue aplicado a 384 emprendedores universitarios del Ecuador, para recabar su opinión y percepción sobre la transformación digital y su efecto en la sostenibilidad de sus emprendimientos. Como principal resultado, los encuestados reconocen la importancia de la transformación digital en los emprendimientos, sin embargo, esto no se ve reflejado en las operaciones de sus negocios, lo cual puede deberse a una confusión entre la transformación digital y el solo hecho de usar herramientas tecnológicas de forma aislada en uno o más procesos. Esta ausencia de transformación digital también puede ser atribuida a la falta de: fuentes de financiamiento, conocimiento de herramientas de gestión y estudios a profundidad sobre el mercado.

The novel coronavirus disease (COVID-19) has generated great confusion around the world, affecting people’s lives and producing a large number of deaths. The development of portable and wearable devices is of great importance in several fields such as point-of-care medical applications and environmental monitoring. Wearable devices with an ability to collect various types of physiological records are progressively becoming incorporated into everyday life of people. Physiological indicators are essential health indicators and their monitoring could efficiently enable early discovery of disease. This would also help decrease the number of extra severe health problems, in disease avoidance, and lower the overall public sector health cost. Protective clothing is nowadays a main part of textiles classified as technical or industrial textiles. Protective clothing aims to protect its wearer from the harsh environmental impacts that may result in injury or death. Providing protection for the common population has also been taken seriously considering the anticipated disaster due to virus attacks. This review highlights the properties of the materials that are used in wearable health care device and medical textiles.

Avascular necrosis of the scaphoid, often referred to as Preiser's disease, is little known despite the scaphoid being the second most frequently involved location in avascular pathology of the carpal bones after the lunate (Kienböck's disease). Nonetheless, very few cases have been reported in the medical literature over the last century. Its pathophysiology is not completely elucidated although the unique vascularization of the scaphoid and several risk factors seem to be recurrently incriminated. Two new classifications based on modern imaging have appeared in the last decade and are now considered essential supplements to Herbert and Lanzetta's original radiographic classification. Because of the lack of formal treatment guidelines, a wide range of different treatments have been explored over time, contributing to the confusion around this pathology. Adding to this confusion, are the numerous terms used to designate the condition and lack of knowledge concerning its pathophysiology, risk factors, clinical and radiographic presentation. The aim of this review is therefore to explore and clarify Preiser's disease in terms of history, terminology, pathophysiology, clinical considerations and imaging and to propose a simple updated treatment algorithm based on the results provided by a thorough review of literature (53 publications, 170 patients) since Georg Preiser's original and controversial description in 1910.

This study analyzed the effects of consumer confusion on shopping fatigue and negative purchasing behaviors in an internet shopping environment. Further, the effects of shopping fatigue on negative purchasing behaviors were analyzed. The survey was conducted among consumers in their 20s and 40s in the Seoul metropolitan area who had experience of purchasing fashion products through internet shopping. A total of 392 questionnaire were analysis, with frequency, reliability, factor, correlation, and regression analysis completed using the SPSS statistics program. The results of the study showed that consumer confusion and shopping fatigue in internet shopping environment affected negative purchasing behaviors. First, consumer confusion comprised overload confusion, similarity confusion, and ambiguity confusion. It was found that overload confusion and similarity confusion significantly affected shopping fatigue. Second, shopping fatigue significantly affected negative purchasing behaviors, and an increased level of shopping fatigue result in, increased purchase delay and non-purchase behavior. Third, consumer confusion (overload confusion, similarity confusion, ambiguity confusion) significantly affected purchase delay behavior, while similarity confusion and ambiguity confusion significantly affected non-purchasing behavior. These results will provide useful data for e-CRM and marketing directions of internet companies and will contribute to rational decision-making of internet consumers and improve the quality of consumer life.

Mycosis fungoides (MF) expresses T-cell markers and the alpha-beta T-cell receptor (TCR) complex. Here, we describe a case of MF with dual expression of TCR delta and TCR beta and a case of MF expressing the B-cell marker CD20. Both anomalies were detected after we instituted a broad-spectrum immunostaining panel for cutaneous T-cell lymphomas. These findings suggest anomalous immunophenotypes may be more common in MF than previously appreciated. Histopathologists should be aware of unexpected malleability in the immunophenotype of MF to avoid confusion with other subtypes of cutaneous lymphoma. Further research into the prevalence and significance of CD20 and TCR-delta expression in MF is encouraged.

Study design Level-1 diagnostic study. Objective The purpose of this study was to evaluate the sensitivity and specificity of combined motor and sensory intraoperative neuromonitoring (IONM) for cervical spondylotic myelopathy (CSM). Summary of background data Intraoperative neuromonitoring during spine surgery began with sensory modalities with the goal of reducing neurological complications. Motor monitoring was later added and purported to further increase sensitivity and specificity when used in concert with sensory monitoring. Debate continues, however, as to whether neuromonitoring reliably detects reversible neurologic changes during surgery or simply adds set-up time, cost, or mere medicolegal reassurance. Methods Neuromonitoring data using combined motor and sensory evoked potentials for 540 patients with CSM undergoing anterior or posterior decompressive surgery were collected prospectively. Patients were examined postoperatively to determine the clinical occurrence of new neurologic deficit which correlated with monitoring alerts recorded per established standard criteria. Results The overall incidence of positive IONM alerts was 1.3% (N = 7) all of which were motor alerts. All were false positives as no patient had clinical neurological deterioration post-operatively. The false-positive rate was 1.4% (N = 146) for anterior surgeries and 1.3% (N = 394) for posteriors with no statistical difference between them (P = 1.0, Fisher exact test). There were no false-negative alerts, and all negatives were true negatives (N = 533). The overall sensitivity of detecting a new neurologic deficit was 0%, overall specificity 98.7%. Conclusion Combined motor and sensory neuromonitoring for CSM patients created a confusing choice between the motor or sensory data when in disagreement in 1.3% of surgical patients. Criterion standard clinical examinations confirmed all motor alerts were false positives. Surgical plan was negatively altered by following false motor alerts early on, but disregarded in later cases in favor of sensory data. Neuromonitoring added set-up time and cost, but without clear benefit in this series.Level of Evidence: 4.

Researchers often tend to use the words emotions, feelings, moods, and affect interchangeably, which creates confusion in both conceptual and methodological domains of tourism and hospitality research. However, the insights from neuroscience and psychology demonstrated that there are fundamental differences between these concepts, including their causes, duration, intensity, and outcomes. This research note aims to discuss conceptual and methodological aspects related to using emotions, moods, feelings, and affect, provide comprehensive definitions, and outline opportunities to capture them comprehensively in tourism and hospitality research.

A Woman with Fever, Sore Throat, and Confusion A 63-year-old woman with hypertension was admitted during the Covid-19 pandemic because of fever, headache, sore throat, and confusion. She also repor...

Objective:Retrospective self-report is typically used for diagnosing previous pediatric traumatic brain injury (TBI). A new semi-structured interview instrument (New Mexico Assessment of Pediatric TBI; NewMAP TBI) investigated test–retest reliability for TBI characteristics in both the TBI that qualified for study inclusion and for lifetime history of TBI.Method:One-hundred and eight-four mTBI (aged 8–18), 156 matched healthy controls (HC), and their parents completed the NewMAP TBI within 11 days (subacute; SA) and 4 months (early chronic; EC) of injury, with a subset returning at 1 year (late chronic; LC).Results:The test–retest reliability of common TBI characteristics [loss of consciousness (LOC), post-traumatic amnesia (PTA), retrograde amnesia, confusion/disorientation] and post-concussion symptoms (PCS) were examined across study visits. Aside from PTA, binary reporting (present/absent) for all TBI characteristics exhibited acceptable (≥0.60) test–retest reliability for both Qualifying and Remote TBIs across all three visits. In contrast, reliability for continuous data (exact duration) was generally unacceptable, with LOC and PCS meeting acceptable criteria at only half of the assessments. Transforming continuous self-report ratings into discrete categories based on injury severity resulted in acceptable reliability. Reliability was not strongly affected by the parent completing the NewMAP TBI.Conclusions:Categorical reporting of TBI characteristics in children and adolescents can aid clinicians in retrospectively obtaining reliable estimates of TBI severity up to a year post-injury. However, test–retest reliability is strongly impacted by the initial data distribution, selected statistical methods, and potentially by patient difficulty in distinguishing among conceptually similar medical concepts (i.e., PTA vs. confusion).

In this article we aim to present the main resemblances and differences between accounting the carried out by LLCs and the double entry accounting of NGO regarding inventories. Thus, we will highlight matters regarding the features related to donations received/made, value depreciations and commercial discounts, the recording of goods resulting from dismantling, as well as the accounting treatment of assets with a long production cycle, so that there is no confusion regarding the application of the appropriate accounting treatment.

BackgroundInconclusive results in SARS-CoV-2 molecular assays cause confusion among clinicians and delay appropriate infection prevention and control. In this study, we aimed to characterize the respiratory specimens associated with inconclusive SARS-CoV-2 molecular assay results.MethodsWe re-evaluated inconclusive specimens by 3 additional RT-PCR assays and attempted to detect subgenomic RNA (sgRNA) in these specimens.ResultsAmong follow-up tests from confirmed SARS-CoV-2 cases, 36.3% of the inconclusive results were classified as presumptive positive results (45/124). However, none of the specimens from 36 screening cases was classified as a presumptive positive result. Among 160 inconclusive specimens, sgRNAs were detected in 78 samples (48.8%): 58 were confirmed cases (58/124, 46.8%) and 20 were screening cases (20/36, 55.6%).ConclusionsThe results of our study suggest the recommendation of considering inconclusive results as positive results for confirmed SARS-CoV-2 cases. In screening cases, viral remnants could be partially amplified in PCR assays, and these inconclusive results could be related to previous infections. In addition, sgRNAs were detected in about half of the inconclusive specimens; however, the clinical significance of sgRNA is not yet clear.

In the last two decades, a strong interest on the interosseous membrane (IOM) has developed. The authors present a review of the new concepts regarding the understanding of forearm physiology and pathology, with current trends in the surgical management of these rare and debilitating injuries. Anatomical and biomechanical studies have clarified the anatomy of forearm constrains and their role in forearm longitudinal and transverse stability. The radial pull test, a new intraoperative test, has been developed that might increase the detection on IOM injuries. The forearm is now considered a “functional unit” and, consequently, a new classification has been proposed. Uncommon variants and rare patterns of forearm fracture dislocations have been reported in the literature and could not be classified to those commonly referred to using eponyms (Monteggia, Galeazzi, Essex-Lopresti). The new Artiaco et al. classification includes all injury patterns, thus avoids confusion in the nomenclature, and helps surgeon with detection of lesions and guiding surgical treatment. Based on the new classification and after current literature review, authors propose a management flowchart for treatment of forearm instability injuries.

In this commentary, we examine whether we should reconsider the widespread use of the words ‘cancer prevention’ and replace them with the words ‘cancer risk reduction’. Our recommendation is because ‘risk reduction’ more accurately reflects what we know from cancer research, but more importantly recognizes the confusion and potential harm to patients from the inaccurate use of the words ‘cancer prevention’.

Currently, there is a persisting dispute regarding the renin-angiotensin-aldosterone-system (RAAS) inhibitors' safety of use in COVID-19 pandemics. On one side, RAAS inhibitors appear to determine an overexpression of ACE2, the receptor of SARS-CoV-2. Therefore, they could increase the risk of SARS-CoV-2 infection and its degree of severity. On the other side, the discontinuation of RAAS leads to cardiovascular decompensation and has been discouraged by the major medical societies. Also, large-cohort studies report beneficial or at least neutral effects for the RAAS inhibitors in COVID-19 patients. Worldwide, millions of patients receive RAAS inhibitors for the treatment of hypertension and other important comorbidities. In this context, knowledge of the exact effect of these medications becomes of crucial significance. This paper aims to fill in a gap in the current knowledge and presents a putative mechanism by which RAAS inhibitor administration's beneficial results can be explained better. RAAS inhibitors can be beneficial, as they counteract the excessive detrimental activation of the classical angiotensin-converting enzyme (ACE) axis, decreasing the angiotensin II levels. The angiotensin receptor blockers (ARBs) increase the angiotensin II levels, while the angiotensin-converting enzyme inhibitors (ACEI) increase the angiotensin I levels; these substrates will compete with the SARS-CoV-2 for the ACE2 binding, decreasing the viral infectivity. In addition, following the RAAS inhibitors treatment, the up-regulated ACE2 will cleave these substrates (angiotensin I and II), particularly to angiotensin 1-7 that possesses vasodilator, protective effects.

The term latent tuberculosis (TB) was coined two centuries ago to describe post-mortem tuberculous pathology in the absence of ante-mortem tuberculosis manifestations. However, the meaning of the term has changed with each passing century, engendering confusion. In the early 20th century, with the advent of microbiological assays for live tubercle bacteria, latent TB switched from the host to refer to the bacteria from post-mortem tissues of nontuberculous hosts. Then in the late 20th century, the definition of latent TB infection returned to the host, this time referring to those with immunoreactivity to Mycobacterium tuberculosis antigens. Based on this new definition, latent TB infection is unique among bacterial infectious diseases, in that supportive evidence of the infection state is sought by the absence of the causative bacterium and its clinical manifestations. The use of indirect bedside and laboratory tests to denote infection creates clinical and research confusion, as the tests for immunoreactivity suffer from recognized limitations in sensitivity and specificity. We propose that the concept of latent TB infection be separated from that of tuberculous immunoreactivity in the interest of correct diagnosis and focused treatment, correct formulation and interpretation of research questions and better allocation of programmatic resources for TB elimination. To this end, we suggest new terminology to course-correct our thinking about tuberculous infection (TBI) which is subdivided into tuberculous infection-no disease (TBInd) and the long-accepted term for the disease, tuberculosis (TB).

Aufgrund einer Verwechslung as ein alteres Ehepaar eine Mahlzeit mit Krautern aus ihrem Garten, die Blatter des Blauen Eisenhuts (Aconitum napellus) enthielt. Die Eisenhutpflanzen wuchsen im Garten in der Nahe der Krauter. Beide Patienten entwickelten die typische Symptomatik einer Aconitinvergiftung mit Parasthesien, Hypotonie und Bradykardie. Im Verlauf hatten beide Herzrhythmusstorungen mit ventrikularen Extrasystolen und mussten intensivmedizinisch behandelt werden. Katecholamine wurden bei dem starker betroffenen Ehemann erfolgreich eingesetzt. Bei der toxikologischen Untersuchung des Serums, entnommen 3,5 h nach der Mahlzeit, wurden 1,8 ng/ml bzw. 2,0 ng/ml Aconitin nachgewiesen. Die Patienten konnten nach einem bzw. 2 Tagen in gutem Allgemeinzustand entlassen werden.

The sets of activities performed across all organizational levels can include the opportunities, risks, and uncertainties that may affect goal realization, prompting executives to identify and manage them at different levels within a risk management framework. Risk management requires steps and measures that can be best taken by following the models and standards developed by different researchers and institutes based on extensive experiences and studies. However, the review of these studies and instructions indicated considerable differences and similarities, something which can cause confusion in the selection of the best risk management model to address current needs and organizational conditions. With a thorough review of literature, this paper analyzes the studies, models, and standards of risk management and highlights their differences in definitions and processes. Finally, a solution is offered to select the right model which can properly satisfy the current needs for risk management.

Objectives: To explore and visualize the relationships among multiple symptoms in people living with HIV (PLWH) and compare centrality indices and the density of symptom networks among groups of individuals with different HIV-positive durations. Methods: We conducted a secondary analysis of data from the HIV-related Symptoms Monitoring Survey conducted in China. Networks were constructed among 27 symptoms. Centrality properties, including strength and closeness, and network density were used to describe relationships among symptoms in 5 different HIV-positive duration groups. Results: The findings showed that PLWH with longer HIV-positive durations did not have more severe symptoms; instead, their symptom networks were denser than those of their newly HIV-diagnosed counterparts (F = 27.073, P < 0.001). Fatigue was the most severe and central symptom in PLWH with an HIV-positive duration 10 years. Conclusion: This study demonstrates a need to include an assessment of PLWH symptom networks as an essential component of HIV care. We recommended evaluating cognitive function and cognitive training as essential components of HIV care for long-term survivors, even in younger populations (aged ≤50 years).

Magnetic resonance imaging (MRI) has become the gold standard for the diagnosis of many pathologies. Using MRI in patients with auditory implants can however raise concerns due to mutual interactions between the implant and imaging device, resulting in potential patient risks. Several implant manufacturers have been working towards more MRI safe devices. Older devices are however often labelled for more stringent conditions, possibly creating confusion with patients and professionals. With this myriad of different devices that are implanted in patients for lifetimes of at least 20 years, it is crucial that both patients and professionals have a clear understanding of the safety of their devices. This work aims at providing an exhaustive overview on the MRI safety of active auditory implants. The available industry standards that are followed by manufacturers are outlined and an overview of the latest scientific developments focusing on the last five years is provided. In addition, based on the analysis of the adverse events reported to the Food and Drug Administration (FDA) and in literature within the past ten years, a systematic review of the most commonly occurring issues for patients with auditory implants in the MRI environment is provided. Results indicate that despite the release of more MRI conditional active hearing implants on the market, adverse events still occur. An extensive overview is provided on the MRI safety of active auditory implants, aiming to increase the understanding of the topic for healthcare professionals and contribute to safer scanning conditions for patients. ispartof: Journal of Otology vol:16 issue:3 pages:185-198 ispartof: location:China status: Published online

The article analyzes the management of the influence of organized interests on public policy. The article reveals the concept of organized interests, the essential differences in comparing the concepts of organized interests and interest groups. The article takes the view that organized interests are a more neutral concept that better explains the nature of all actors seeking to influence public policy-making. The author of the article is of the opinion that the concept of interest groups – due to the disagreement of scientists in defining it – causes a lot of confusion when comparing the results of different researches and using the theoretical insights of other scientists. Organized interests interact with other public policy makers to influence policy outcomes. This article analyzes the ways in which organized interests can influence public policy. According to the author of the article, by identifying the ways of influencing public policy, it is possible to envisage ways to manage that influence. The article applies methods of analysis, synthesis, generalization and comparative analysis of scientific literature.

In this paper, we present an experimental study in which an electroencephalogram (EEG) device was used to measure cognitive load in programmers as they attempted to predict the output of C code sni...

A 61-year-old man who was a psychiatric patient and an alcoholic was admitted to hospital after a fall in his bathroom. He showed signs of hemorrhagic shock, and CT scans showed the presence of the right kidney and part of the right retroperitoneum in the right hemithorax, surrounded by liquid. Surgery showed that the right hemidiaphragm was intact and that no intraabdominal viscera prolapsed into thoracic cavity. The bleeding in the right retroperitoneum was evacuated. The surgical report also stated that "the right kidney and ureter were explored and no injuries or active bleeding were found". The patient died the third day after admission. Autopsy revealed a livid swelling covered with parietal pleura in the right half of the thoracic cavity, behind the costophrenic sinus, about 20 × 15x12 cm in size, filled with about 1500 ml of blood, with ectopic right kidney in the right half of the thorax, slightly rotated posteriorly and downwards. The kidney was smaller (80 g in weight), compared to the normally positioned enlarged left kidney (300 g). The right hemidiaphragm was also intact with small Bochdalek's foramen behind the posterior edge, with communication between the right retropleural and retroperitoneal spaces, through which intact elongated right renal artery (15 cm), vein (14 cm) and ureter were passing. The cause of death was hemorrhagic shock due to retroperitoneal bleeding, with coagulation disorder as possible contributing factor. Intrathoracic kidneys may pose many diagnostic and management dilemmas for clinicians and pathologists. Association between a Bochdalek hernia and an intrathoracic renal ectopia is very rare and may be confusing for doctors in different clinical situations.