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PubMed1996

Diagnostic accuracy and confusability analyses: an application to the Diagnostic Interview for Genetic Studies.

The dominant, contemporary paradigm for developing and refining diagnoses relies heavily on assessing reliability with kappa coefficients and virtually ignores a core component of psychometric practice: the theory of latent structures. This article describes a psychometric approach to psychiatric nosology that emphasizes the diagnostic accuracy and confusability of diagnostic categories. We apply these methods to the Diagnostic Interview for Genetic Studies (DIGS), a structured psychiatric interview designed by the NIMH Genetics Initiative for genetic studies of schizophrenia and bipolar disorder. Our results show that sensitivity and specificity were excellent for both DSM-III-R and RDC diagnoses of major depression, bipolar disorder, and schizophrenia. In contrast, diagnostic accuracy was substantially lower for subtypes of schizoaffective disorder-especially for the DSM-III-R definitions. Both the bipolar and depressed subtypes of DSM-III-R schizoaffective disorder had excellent specificity but poor sensitivity. The RDC definitions also had excellent specificity but were more sensitive than the DSM-III-R schizoaffective diagnoses. The source of low sensitivity for schizoaffective subtypes differed for the two diagnostic systems. For RDC criteria, the schizoaffective subtypes were frequently confused with one another; they were less frequently confused with other diagnoses. In contrast, the DSM-III-R subtypes were often confused with schizophrenia, but not with each other.

Bipolar Disorder↗
PubMed2005

Confusion approach to porphyrinoid chemistry.

N-confused porphyrin (NCP) is a porphyrin isomer that is different largely from the parent porphyrin, particularly in the physical, chemical, structural, and coordination properties. Introduction of the confused pyrrole into the normal and expanded porphyrins leads to generation of the confused porphyrinoids having rich structural diversity. In this Account, we introduce a series of N-confused porphyrinoids recently synthesized and highlight their properties such as fusion, peripheral N coordination, supramolecular assemblies, anion binding, and singlet-oxygen sensitization.

Anions↗
PubMed2006

Iron complexes of N-confused pyriporphyrin: NMR studies.

Insertion of iron(II) into 6,11,16,21-tetraaryl-3-aza-m-benziporphyrin (N-confused pyriporphyrin, (PyPH)H) yielded the high-spin iron(II) complex, (PyPH)Fe(II)Br. The coordination of iron(II) to the perimeter nitrogen atom of (PyPH)Fe(II)Br resulted in the formation of the diiron species. Oxidation and oxygenation of (PyPH)Fe(II)Br were followed by 1H NMR spectroscopy. The addition of Br2 to the solution of (PyPH)Fe(II)Br in the absence of dioxygen results in a one-electron oxidation yielding the high-spin iron(III) N-confused pyriporphyrin [(PyPH)Fe(III)Br]+ which preserves the side-on interaction between the inverted pyridine ring and metal ion. The reaction of (PyPH)Fe(II)Br with dioxygen ends up with the formation of a five-coordinate species (PyPO)Fe(III)Br] ((PyPOH)H = 3-aza-22-hydroxy-m-benziporphyrin, PyPO = the corresponding dianion) which is formed by oxygenation at the C(22) position. Coordination of a metal ion by 3-aza-22-hydroxy-benziporphyrin imposes a steric constraint on the geometry of the ligand. The halide ligand of (PyPO)Fe(III)Br coordinates on one of the two inequivalent faces of the macrocycle, leading to two distinct species: syn and anti. The (1)H NMR spectra of paramagnetic iron(II) and iron(III) N-confused pyriporphyrin complexes have been examined. The characteristic patterns of pyrrole and pyridine resonances have been found to be diagnostic of the ground electronic state of iron and the donor nature of the C(22)H and N(3) centers. The enormous downfield H(22) paramagnetic shift, determined for the iron(II) N-confused pyriporphyrin, provides a distinct resonance in a peculiar spectroscopic window (350-800 ppm) for a series of axial ligands which can be considered as a diagnostic sign of an agostic Fe(II)...{C(22)-H} interaction. Coordination of the pyridine moiety via the perimeter N(3) atom is reflected unambiguously by the H(2/4) resonance at 201 ppm.

Journal Article↗
PubMed1999

N-Confused Tetraphenylporphyrin and Tetraphenylsapphyrin Formation in One-Flask Syntheses of Tetraphenylporphyrin.

The yields of tetraphenylporphyrin (TPP), N-confused tetraphenylporphyrin (NC-TPP), and tetraphenylsapphyrin (TPS) were examined under diverse conditions in the one-flask room-temperature reaction of pyrrole and benzaldehyde. The conditions examined included TFA and BF(3)-etherate catalysis, acid concentrations, pyrrole and benzaldehyde concentrations, pyrrole:benzaldehyde ratios, the addition of salt, and reaction times. The quantities of TPP, NC-TPP, and TPS were determined by HPLC. The yield of NC-TPP mirrored that of TPP during systematic variation of reaction parameters but was consistently lower (</=7.5%). The rate of NC-TPP formation also resembled that of TPP. Excess pyrrole was not required to form NC-TPP. About 2-fold more NC-TPP was obtained with BF(3)-etherate compared with TFA catalysis. TPS was observed in only a few of the reactions examined. The yield of TPS peaked early and declined well before the maximum yields of TPP and NC-TPP were reached. The highest yield of TPS observed was 1.2%. TPS was produced in higher yields by TFA compared with BF(3)-etherate catalysis. Additional pigments with chromatographic properties spanning the range of TPP and NC-TPP were observed in very low yield but were not characterized. N-confused tetramesitylporphyrin was isolated from the reaction of mesitaldehyde and pyrrole under BF(3)-ethanol cocatalysis. Examination of the Adler reaction of benzaldehyde and pyrrole revealed the presence of NC-TPP and TPS in the filtrate but not in the crystalline TPP material. The substantial chromatographic differences between the porphyrins and N-confused porphyrins make for straightforward isolation of the purified porphyrin devoid of contaminating N-confused porphyrin. These studies indicate that the scope of conditions yielding NC-TPP is extremely broad.

Journal Article↗
PubMed2000

Lawyers' questioning: the effect of confusing questions on witness confidence and accuracy.

The present study investigated the effect on witness confidence and accuracy of confusing questions often used by attorneys in court. Participants viewed a videotaped film and were individually questioned about the incident 1 week later. Half the participants were asked questions using six categories of confusing questions (negatives, double negatives, leading, multiple questions, complex syntax, and complex vocabulary); the remaining half were asked for the same information using simply phrased equivalents. Confusing questions reduced participant-witnesses' accuracy and suppressed confidence-accuracy relationships compared with the condition where simplified alternatives were asked. Witness performance was impaired by the fact that mock-witnesses rarely asked for a confusing question to be explained or qualified their answers. This experiment demonstrates the importance of ensuring that lawyers ask witnesses simple, clear, questions.

Adult↗
PubMed2000

Tori of confusion: binaural localization cues for sources within reach of a listener.

To a first-order approximation, binaural localization cues are ambiguous: many source locations give rise to nearly the same interaural differences. For sources more than a meter away, binaural localization cues are approximately equal for any source on a cone centered on the interaural axis (i.e., the well-known "cone of confusion"). The current paper analyzes simple geometric approximations of a head to gain insight into localization performance for nearby sources. If the head is treated as a rigid, perfect sphere, interaural intensity differences (IIDs) can be broken down into two main components. One component depends on the head shadow and is constant along the cone of confusion (and covaries with the interaural time difference, or ITD). The other component depends only on the relative path lengths from the source to the two ears and is roughly constant for a sphere centered on the interaural axis. This second factor is large enough to be perceptible only when sources are within one or two meters of the listener. Results are not dramatically different if one assumes that the ears are separated by 160 deg along the surface of the sphere (rather than diametrically opposite one another). Thus for nearby sources, binaural information should allow listeners to locate sources within a volume around a circle centered on the interaural axis on a "torus of confusion." The volume of the torus of confusion increases as the source approaches the median plane, degenerating to a volume around the median plane in the limit.

Auditory Perception↗
PubMed2006

Labeling of medicines and patient safety: evaluating methods of reducing drug name confusion.

OBJECTIVE: We report three experiments evaluating the proposal that highlighting sections of drug names using uppercase ("tall man") lettering and/or color may reduce the confusability of similar drug names. BACKGROUND: Medication errors commonly involve drug names that look or sound alike. One potential method of reducing these errors is to highlight sections of names on labels in order to emphasize the differences between similar products. METHOD: In Experiments 1 and 2, participants were timed as they decided whether similar name pairs were the same name or two different names. Experiment 3 was a recognition memory task. RESULTS: Results from Experiments 1 and 2 showed that highlighting sections of words using tall man lettering can make similar names easier to distinguish if participants are aware that this is the purpose of the intervention. Results from Experiment 3 suggested that tall man lettering and/or color does not make names less confusable in memory but that tall man letters may increase attention. CONCLUSION: These findings offer some support for the use of tall man letters in order to reduce errors caused by confusion between drug products with look-alike names. APPLICATION: The use of tall man letters could be applied in a variety of visual presentations of drug names--for example, by manufacturers on packaging, labeling, and computer software, and in pharmacies on shelf labels. Additionally, this paper demonstrates two meaningful behavioral measures that can be used during product design to objectively assess confusability of packaging and labeling.

England↗
PubMed2001

Susceptibility of last instar red flour beetles and confused flour beetles (Coleoptera: Tenebrionidae) to hydroprene.

Last instar larvae of the red flour beetle, Tribolium castaneum (Herbst), and the confused flour beetle, Tribolium confusum Jacquelin du Val, were either exposed for 8-144 h on concrete treated with 1.9 x 10(-3) mg(AI)/per cm2 hydroprene, or continually exposed on concrete treated with 9.8 x 10(-4) to 1.9 x 10(-3) mg[AI]/per cm2 hydroprene. In both tests, larvae were exposed and held at 27 or 32 degrees C and 40, 57, or 75% RH. When larvae were exposed with no food to hydroprene for different time intervals, then transferred to untreated concrete containing flour, consistent effects were produced only at 144 h. At this exposure interval, the percentage of beetles arrested in the larval stage after 3-4 wk was generally greater at 75% RH compared with 40 and 57% RH, but there were no differences between species or temperature. The percentages of dead adult red flour beetles and live adults with morphological deformities were also greatest at 75% RH, and defects were more prevalent in red flour beetles than in confused flour beetles. When larvae were continually exposed to different concentrations of hydroprene on concrete that contained flour, the percentage of arrested larvae, dead adults, and live adults of both species generally increased with concentration. There were more deleterious effects at 75% RH compared with either 40 or 57% RH, and effects were more pronounced in the red flour beetle compared with the confused flour beetle. In both experiments, temperature effects were variable and inconclusive. Results indicate that continual exposure of last instar red flour beetle and confused flour beetle to hydroprene can limit population development, but exposure intervals of >6 d may be required for maximum effectiveness.

Animals↗
PubMed2026

AI-Supported, Integrative Prediction of Postoperative Delirium: Protocol for the CONFUSED Study.

BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication in older surgical patients, characterized by acute cognitive dysfunction and fluctuating levels of consciousness. POD is associated with prolonged hospitalization, long-term cognitive decline, reduced quality of life, and increased mortality. Despite its clinical relevance, the underlying pathophysiological mechanisms remain poorly understood, and reliable biomarkers for early prediction and prevention are lacking. OBJECTIVE: The CONFUSED study aims to identify molecular and clinical predictors of POD by integrating clinical data with proteomic, transcriptomic, and epigenetic analyses. The primary objective is to develop predictive models for POD using multimodal data. Secondary objectives include the identification of delirium-associated genes, proteins, and epigenetic signatures, as well as the exploration of patient subgroups at increased risk for POD. METHODS: CONFUSED is a prospective observational cohort study conducted at a German university hospital. Adult patients undergoing major surgery under general anesthesia will be enrolled until 100 cases of POD have been observed, which is expected to require a total sample size of approximately 200 to 300 patients. Blood samples are collected at 4 predefined time points: before premedication, immediately after surgery, and on postoperative days 2 and 5. Samples undergo comprehensive proteomic profiling, transcriptomic analysis using RNA microarrays, DNA methylation analysis, and genotyping of selected polymorphisms. Clinical data, including demographics, comorbidities, perioperative variables, medications, and delirium assessments using the Confusion Assessment Method (CAM) and CAM for the intensive care unit, are systematically recorded. Statistical analyses include univariate and multivariate methods, as well as machine learning approaches such as random forests and support vector machines, to identify relevant biomarkers and develop predictive models. The study protocol follows STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines and was approved by the responsible ethics committees. RESULTS: The study was registered in the German Clinical Trials Register (DRKS00033854) on March 18, 2024. Recruitment started in January 2024 and is ongoing at the time of manuscript submission. As of now, 135 patients have been enrolled. Sample collection and laboratory analyses are ongoing. Data analysis began in January 2026, with first results anticipated in July 2026. Final data lock is anticipated after the completion of recruitment. CONCLUSIONS: By integrating multimodal molecular data with clinical parameters and applying advanced machine learning techniques, the CONFUSED study aims to improve the prediction and understanding of POD. The results are expected to support the development of personalized preventive strategies and contribute to improved perioperative care for patients at risk of POD.

Humans↗
PubMed1990

Similarity between Fourier transforms of objects predicts their experimental confusions.

Two sets of stimuli were presented tachistoscopically to 4 subjects. On each trial, a single stimulus was presented, and the subject was required to identify the stimulus by verbal response. An exposure duration was chosen such that the subject's identification performance fell within a range from faultless identification to chance guessing. The object-identification data of each subject obtained for all stimulus exposures were pooled to form an object confusion matrix. A model of visual processing based on two-dimensional spatial frequency content (Fourier transforms) was used to predict confusions among stimulus pairs. The model properties that appear to be the most essential are those that allow it (1) to account for the obvious dependence of the Fourier transform on the choice of an origin point; and (2) choose the point of origin for each object separately, irrespective of other objects of the set. The point of origin of the reference frame, in which Fourier transforms are performed, is chosen so as to minimize the low-frequency phase component for each object. A high correlation (up to .96) between confusion matrices and model interobject distances was attained. The results demonstrate that such a distance measure gives a good prediction of object confusability.

Adult↗
PubMed2002

[Direct identification of Retinervus Citri Reticulatae from its confused species by FTIR].

In this paper, direct and accurate identification of Retinervus Citri Reticulatae and its confused species has studied. The IR of Retinervus Citri Reticulatae and its confused species were obtained by Fourier Transform Infrared Spectrum directly. Obvious characteristics for its identification in FTIR were revealed, which can be used to identify Retinervus Citri Reticulatae and its confused Reticulatae and its confused species were directly, fastly and accurately identificated by FTIR.

Drug Contamination↗
PubMed2004

[Direct identification of Ophiogon japonicus (Thunb.)Ker-Gawl. from its confusable varieties by second derivative FTIR spectroscopy combined with statistics].

In order to establish the theory and method for the identification of Ophiogon japonicus (Thunb.)Ker-Gawl. of traditional Chinese herbal medicines and its confusable varieties, second derivative FTIR spectroscopy was used combined with statistics. Samples were collected directly by Fourier Transform Infrared (FTIR) spectra with OMNI-Sampler. Then through converting FTIR spectra of the samples into second derivative spectra by derivative spectra software, Ophiogon japonicus (Thunb.)Ker-Gawl. could be identified from the confusable varieties with statistics. The result shows that the second derivative FTIR of Ophiogon japonicus (Thunb.)Ker-Gawl. and its confusable varieties are different, which differ greatly in 2 000-650 cm(-1) range in second derivative FTIR spectroscopy. The Ophiogon japonicus (Thunb.)Ker-Gawl. and its confusable varieties can be identified by identifying the inner layer parts of the cuticles of samples by second derivative FTIR spectroscopy with statistics directly, rapidly and accurately.

Drugs, Chinese Herbal↗
PubMed2006

[Nipple confusion and breastfeeding: a literature review].

Among the ten steps to successful breastfeeding advocated by the WHO and UNICEF, steps six and nine clearly state that formula supplementation and pacifier use, except when medically necessary, should be avoided. Early formula supplementation may not only interfere with the mother's lactation but also result in nipple confusion on the part of the baby. To avoid nipple confusion, the encouragement of cup feeding and the non-provision of pacifiers or bottles are required nursing practice in baby-friendly hospitals. However, the relationship between nipple confusion and the duration of breastfeeding has not been well examined. The purpose of this paper is to explore the relationships between three methods of feeding (i.e. pacifier, bottle feeding, and cup feeding), nipple confusion, and duration of breastfeeding. A hypothetical framework is proposed to explain these relationships on the basis of a review of the literature.

Bottle Feeding↗
PubMed2004

A randomized controlled trial of a behavior advisory service for hospitalized older patients with confusion.

OBJECTIVE: To determine whether individualized advice on non-pharmacological strategies for hospitalized older patients with confusion and behavioral problems can improve levels of agitation and reduce the use of psychotropic medication. METHOD: Pragmatic randomized controlled trial in two metropolitan teaching hospitals in South Australia. Seventy-one older patients with confusion and a behavioral disturbance were randomly allocated to receive either an assessment and ongoing individualized advice from an extended practice nurse on non-pharmacological strategies or usual care. Usual care included an assessment by a geriatrician. MEASUREMENTS: Primary outcomes were levels of agitation (Pittsburgh Agitation Scale), appropriateness of psychotropic medication prescribing (Medication Appropriateness Index) and levels of psychotropics administered (chlorpromazine and diazepam dose equivalents). Secondary outcomes were length of stay, discharge destination, number of falls, restraint use and satisfaction from nursing staff and next of kin. RESULTS: Levels of agitation were modest at baseline with mean PAS intervention group 3.4 (SD = 0.5) and control group 4.0 (SD = 0.4) and both groups improved over time to 1.7 (SD = 0.4) for the intervention group and 1.8 (SD = 0.3) for the control group on the final day of data collection. Median length of follow-up was nine days. There was no effect of the intervention on levels of agitation, amount and appropriateness of psychotropic medication prescribed and administered, falls, length of stay, discharge destination, restraint use and nursing and next of kin satisfaction. CONCLUSION: A nursing consultation service providing individualized non-pharmacological advice does not improve patient agitation or use of psychotropic medication for older patients with confusion and behavioral problems in an acute hospital.

Aged↗
PubMed2003

Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute, long-term, and community health care environments.

In an article on a previous study involving hospitalized older adults (McCarthy, 2003), it was argued that the theory of situated clinical reasoning explains why nurses often fail to recognize acute confusion. Further, the theory illuminates how nurses' perspectives toward health in aging affect the ways they regard and ultimately deal with older people in this particular clinical situation. The purpose of the current study was to challenge and refine the theory by exploring the influence of different care environments on clinical reasoning related to acute confusion. Following a period of participant observation, a purposive sample of 30 nurses, 10 each from a teaching hospital, a long-term facility, and a home care agency, participated in semistructured interviews. Dimensional analysis provided the methodological framework for data collection and interpretation. The results reinforce prior findings that the ability of nurses to recognize acute confusion and to distinguish it from dementia can be attributed to their personal philosophies about aging. Care environment was identified as a factor that influenced clinical reasoning in limited ways under certain conditions and within certain contexts.

Acute Disease↗
PubMedDate not supplied

Possible mechanisms for reducing memory confusion during sleep.

Confusion readily occurs in memory processes between patterns that overlap substantially. Possible mechanisms are considered that might operate in an automatic manner to reduce such confusion. One such mechanism is the recall of patterns in a distorted way, so that they are enriched with greater activity in distinctive elements of experienced patterns than in overlapping elements. Selective consolidation based on such enriched patterns would reduce confusion in long-term recall and might benefit discrimination learning. It is shown how automatic algorithms could achieve this through a process with two phases. In the first phase, somewhat analogous to slow-wave sleep, it is necessary for the normal tendency of the nervous system to learn correlations of associated activity to be disabled. The second phase must occur while the cells most active in the first phase are relatively inexcitable. Enriched patterns would be generated during this phase through recall, which might be triggered by bursts of activity such as occur in rapid eye movement sleep. Selective consolidation would take place during the second phase. If such processes do occur in the nervous system, it seems likely that they would have evolved to occur during sleep.

Animals↗
PubMed2005

Multidimensional assessment of acute confusion after traumatic brain injury.

OBJECTIVES: To describe the phenomenology of posttraumatic confusional state (PTCS) and to provide preliminary validation of a new procedure, the Confusion Assessment Protocol (CAP), for assessing PTCS. DESIGN: Criterion standard investigation. SETTING: Inpatient traumatic brain injury (TBI) rehabilitation program. PARTICIPANTS: Two consecutive series of patients (n=62, n=93) with TBI admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical diagnosis of delirium based on Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria, classification of posttraumatic amnesia (PTA) based on the Galveston Orientation and Amnesia Test (GOAT), and Disability Rating Scale score at time of rehabilitation hospital discharge. Results Agreement between the diagnosis of PTCS with the CAP and DSM-IV classification of delirium was 87%, and agreement between PTCS and PTA using GOAT criteria was 90%. Patients classified as in PTCS sustained more severe injuries and required longer rehabilitation stays. Confusion status was associated with poorer functional status at rehabilitation discharge. CONCLUSIONS: The CAP is a brief, structured, repeatable measure of multiple neurobehavioral aspects of PTCS. Confusion status as determined by CAP assessment contributed to prediction of outcome at rehabilitation discharge after adjustment for other potential predictors.

Adult↗
PubMedDate not supplied

Caring for the confused geriatric surgical patient.

Postoperative confusion in elderly patients is generally a temporary and reversible condition. The causes and contributing factors are numerous. The number of elderly surgical patients will continue to increase as this age group continues to grow. Our role as nurses is to provide the care that will not only focus on early recognition, assessment, and treatment of postoperative confusion, but will also recognize factors that preoperatively place a patient at increased risk and provide care that will prevent or minimize postoperative confusion.

Aged↗