Missed Critical Value Callbacks Due to Middleware Flaws

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S25-S26
Author(s):  
Ghaith Altawallbeh ◽  
Christine Senn ◽  
Michael Rapp ◽  
Amy B Karger
Keyword(s):  
Visual Cues ◽  
Critical Value ◽  
Critical Values ◽  
Numerical Code ◽  
Failure Rates ◽  
University Hospitals ◽  
Display Change ◽  
Laboratory Staff ◽  
Affected Relative ◽  
Hematology Analyzer

Abstract A provider notified the laboratory of a missed sodium critical value notification on a patient; during further investigation, it was noted that the laboratory had missed a second sodium critical value notification several hours later on the same patient. The two missed critical callbacks occurred on different shifts with different technologists, pointing to a systematic issue. A thorough investigation was undertaken involving review of critical callback procedures, staff interviews, and retrospective data review to determine the etiology. It was confirmed that the middleware, Siemens Centralink, had captured and displayed the critical values for review. The Centralink display highlights rows with critical results in red for easy visual identification by the laboratory technologist, and a numerical code of “8” appears in the Normal Severity (NS) column as an additional cue. Upon discussion with involved laboratory staff, a supervisor noted that sodium consistently appears in the top row of the Siemens Centralink result screen when held for review. Our Siemens Centralink display was noted to have a blue bar that by default appears in the top row and was noted to obscure the red highlight and NS Flag that provides a visual cue to staff that it is a critical value. Therefore, we hypothesized that the sodium critical values were missed due to being obscured by the default blue bar, and hypothesized that they could be preferentially affected relative to other analytes due to sodium’s default position in the top row when displayed. To investigate further, we pulled retrospective critical value callback data from our university hospitals for 2018. Our overall critical callback failure rates were ~2.0%. When broken down by individual analyte, we found that 7.2% of sodium critical values were not called back to providers, whereas only 1.0% of potassium critical values were missed. Additionally, critical callback failure rates for hemoglobin were 0.1%; our hematology analyzer has a hard stop for all critical values, whereas the chemistry analyzer does not. In conclusion, we discovered that the default display on our Siemens Centralink middleware screen places a blue bar in the top row that obscures the visual cues associated with a critical value. Because sodium results are placed in the top row on the display screen, missed sodium critical callbacks occurred seven times more often than missed potassium callbacks. To remedy the issue, a blank row has been added to the display as the top row so that no clinical data are obscured by the default blue bar. Additionally, the very low critical callback failure rate on the hematology analyzer points to a need for a hard stop on the chemistry analyzer. We will prospectively monitor critical callback data for sodium to determine whether the display change improves sodium callback rates.

scholarly journals Role of thermal field in entanglement harvesting between two accelerated Unruh-DeWitt detectors

2021 ◽  
Vol 2021 (7) ◽  
Author(s):  
Dipankar Barman ◽  
Subhajit Barman ◽  
Bibhas Ranjan Majhi
Keyword(s):  
Mutual Information ◽  
Critical Point ◽  
Thermal Field ◽  
Narrow Range ◽  
Critical Value ◽  
Critical Values ◽  
Parallel Motion ◽  
Field Temperature ◽  
The Right

Abstract We investigate the effects of field temperature T(f) on the entanglement harvesting between two uniformly accelerated detectors. For their parallel motion, the thermal nature of fields does not produce any entanglement, and therefore, the outcome is the same as the non-thermal situation. On the contrary, T(f) affects entanglement harvesting when the detectors are in anti-parallel motion, i.e., when detectors A and B are in the right and left Rindler wedges, respectively. While for T(f) = 0 entanglement harvesting is possible for all values of A’s acceleration aA, in the presence of temperature, it is possible only within a narrow range of aA. In (1 + 1) dimensions, the range starts from specific values and extends to infinity, and as we increase T(f), the minimum required value of aA for entanglement harvesting increases. Moreover, above a critical value aA = ac harvesting increases as we increase T(f), which is just opposite to the accelerations below it. There are several critical values in (1 + 3) dimensions when they are in different accelerations. Contrary to the single range in (1 + 1) dimensions, here harvesting is possible within several discrete ranges of aA. Interestingly, for equal accelerations, one has a single critical point, with nature quite similar to (1 + 1) dimensional results. We also discuss the dependence of mutual information among these detectors on aA and T(f).

scholarly journals Impact of humidity biases on light precipitation occurrence: observations versus simulations

2018 ◽  
Author(s):  
Sophie Bastin ◽  
Philippe Drobinski ◽  
Marjolaine Chiriaco ◽  
Olivier Bock ◽  
Romain Roehrig ◽  
...  
Keyword(s):  
Land Surface ◽  
Climate Models ◽  
Regional Climate ◽  
Strong Dependence ◽  
Mediterranean Area ◽  
Critical Value ◽  
Critical Values ◽  
Frequency Of Occurrence ◽  
The Impact ◽  
Light Precipitation

Abstract. This work uses a network of GPS stations over Europe from which a homogenised integrated water vapor (IWV) dataset has been retrieved, completed with colocated temperature and precipitation measurements over specific stations to i) estimate the biases of six regional climate models over Europe in terms of humidity; ii) understand their origins; iii) and finally assess the impact of these biases on the frequency of occurrence of precipitation. The evaluated simulations have been performed in the framework of HYMEX/Med-CORDEX programs and cover the Mediterranean area and part of Europe at horizontal resolutions of 50 to 12 km. The analysis shows that models tend to overestimate the low values of IWV and the use of the nudging technique reduces the differences between GPS and simulated IWV. Results suggest that physics of models mostly explain the mean biases, while dynamics affects the variability. The land surface/atmosphere exchanges affect the estimation of IWV over most part of Europe, especially in summer. The limitations of the models to represent these processes explain part of their baises in IWV. However, models correctly simulate the dependance between IWV and temperature, and specifically the deviation that this relationship experiences regarding the Clausius-Clapeyron law after a critical value of temperature (Tbreak). The high spatial variability of Tbreak indicates that it has a strong dependence on local processes which drive the local humidity sources. This explains why the maximum values of IWV are not necessarely observed over warmer area, that are often dry area. Finally, it is shown over SIRTA observatory (near Paris) that the frequency of occurrence of light precipitation is strongly conditioned by the biases in IWV and by the precision of the models to reproduce the distribution of IWV as a function of the temperature. The results of the models indicate that a similar dependence occurs in other areas of Europe, especially where precipitation has a predominantly convective character. According to the observations, for each range of temperature, there is a critical value of IWV from which precipitation picks up. The critical values and the probability to exceed them are simulated with a bias that depends on the model. Those models which present too often light precipitation generally show lower critical values and higher probability to exceed them.

Buckling of Oblique Plates with Clamped Edges Under Uniform Shear

1954 ◽  
Vol 5 (1) ◽  
pp. 39-51 ◽  
Author(s):  
W. H. Wittrick
Keyword(s):  
Pure Shear ◽  
Ritz Method ◽  
Critical Value ◽  
Critical Values ◽  
Reverse Direction ◽  
Buckling Mode ◽  
Determinantal Equation ◽  
Uniform System ◽  
Uniform Shear ◽  
Satisfactory Method

SummaryIn a previous paper the author derived, by the Rayleigh-Ritz method, a determinantal equation for obtaining the critical magnitude of any uniform system of edge stress applied to a clamped oblique plate. In the present paper this equation is used to derive values for the buckling stresses of clamped oblique plates subjected to pure shear along and perpendicular to two edges of the plate.As would be expected, it is found that reversal of the direction of the shear produces a change in the critical value. The lower value occurs when the shear is tending to increase the obliquity of the plate and critical values corresponding to this direction are calculated for 45° oblique plates with side ratios varying between 3/5 and 5/3. The critical values obtained for the reverse direction were obviously very inaccurate, due to the inadequacy of the series which was used to represent the buckling mode. As yet no satisfactory method has been found for overcoming this difficulty.

Wechsler Intelligence Scale for Children–Fifth Edition Ancillary and Complementary Index Critical Values and Base Rates for the Normative Sample

2019 ◽  
Vol 38 (5) ◽  
pp. 539-550
Author(s):  
Ash Puttaswamy ◽  
Anjelica Barone ◽  
Kathleen D. Viezel ◽  
John O. Willis ◽  
Ron Dumont
Keyword(s):  
Critical Value ◽  
Base Rate ◽  
Critical Values ◽  
Intelligence Scale ◽  
Storage And Retrieval ◽  
General Ability ◽  
Base Rates ◽  
Rate Information ◽  
Ability Index ◽  
And Storage

An area of particular importance when examining index scores on the Wechsler Intelligence Scale for Children–Fifth Edition (WISC-V) is the utilization and interpretation of critical values and base rates associated with differences between an individual’s subtest scaled score and the individual’s mean scaled score for an index. For the WISC-V, critical value and base rate information is provided for the core subtests contained within each of the primary indices. However, critical value and base rate information is not provided by the test publisher for subtests within the Quantitative Reasoning Index (QRI), Auditory Working Memory Index (AWMI), Nonverbal Index (NVI), General Ability Index (GAI), Cognitive Proficiency Index (CPI), Naming Speed Index (NSI), Symbol Translation Index (STI), and Storage and Retrieval Index (SRI). This study investigates and provides critical values and base rates for performance on the QRI, AWMI, NVI, GAI, CPI, NSI, STI, and SRI.

scholarly journals Measurement of renal function in kidney donors using serum cystatin C and β2-microglobulin

2003 ◽  
Vol 40 (6) ◽  
pp. 656-658 ◽  
Author(s):  
George T John ◽  
Jude Joseph Fleming ◽  
Girish S Talaulikar ◽  
R Selvakumar ◽  
Paaulose P Thomas ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Critical Value ◽  
Critical Values ◽  
Published Data ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Kidney Donors ◽  
Reduced Renal Function

Background: The usefulness of serum cystatin C and serum β2-microglobulin (B2M) as markers of glomerular filtration rate (GFR) were compared in kidney donors before and after nephrectomy. Methods: Blood samples were taken from 28 donors (15 women and 13 men) for serum creatinine, urea, cystatin C and B2M estimation a median of 7 days before and 10 days after nephrectomy. Results: Estimated GFR decreased from a median of 86.2 mL/min/1.73 m2 to 60.3 mL/min/1.73 m2, a median decrease of 28.6%. Serum creatinine increased by 40% and urea by 30.4%; serum cystatin C increased by 31.2% and serum B2M increased by 65.6%. Using published data on biological variation, critical values were calculated. An increase in serum creatinine above 18 µmol/L detected the decline in renal function in 26/28 (92.9%) subjects. Increases in serum B2M greater than a critical value of 0.94 mg/L detected 24/28 (85.7%) of these subjects, but the critical value of 0.59 mg/L for cystatin C detected only 8/28 (28.6%). Conclusion: Using critical values, serial measurement of serum creatinine was better than serum B2M in detecting reduced renal function. Because of its large intraindividual variation, serial serum cystatin C estimation was very poor in detecting reduced renal function.

Degradation Reliability Assessment Using Severe Critical Values

1998 ◽  
Vol 05 (01) ◽  
pp. 85-95 ◽  
Author(s):  
Kai Yang ◽  
Guangbin Yang
Keyword(s):  
Failure Analysis ◽  
Performance Characteristic ◽  
Reliability Assessment ◽  
Method Comparison ◽  
Cost Effective ◽  
Critical Value ◽  
Critical Values ◽  
Time To Failure ◽  
The Relationship ◽  
Over Time

For some products that degrade over time, failure is defined in terms of a specified critical value of performance characteristic. The life of such a product depends on the specified critical value. The more severe the critical value, the shorter the life would be, and vice versa. This paper presents a method of accelerating life by using severe critical values. The method, based on degradation measurements, provides estimates of the relationship between life and critical value and reliability. An example is given to illustrate the application of the proposed method. Comparison between the method and traditional time-to-failure analysis shows that the proposed method is more efficient and cost-effective.

Application of PDCA-Cycle on the Management of Critical Values Reporting

2013 ◽  
Vol 712-715 ◽  
pp. 3203-3206
Author(s):  
Hong Wang ◽  
Ying Chang ◽  
Wen Sheng Che
Keyword(s):  
Statistical Analysis ◽  
Quality Management ◽  
Critical Value ◽  
Reporting Rate ◽  
Critical Values ◽  
Medical Field ◽  
Field Methods ◽  
Pdca Cycle ◽  
Value Reporting ◽  
Staff Number

Objective: Through the PDCA (Plan-Do-Check-Act, also called quality loop) cycle in the management of Critical Value Reporting, and then the discussion on the values of their application in the medical field. Methods: Data were divided into two groups (January to March in 2012 as before the implementation of PDCA-cycle and August to October as after the implementation of PDCA-cycle). Statistical analysis was applied for these two groups. Results: After the application of PDCA-cycle, the executing rate of critical values reporting increased from 38.2% to 96.4 % (P=0.000). The percentage of reporting time, repeat critical values reporting, reporters name and staff number, receivers name and staff number rised from 96.4%, 83.6%, 83.6%, 69.1% to 100.0%, 98.8%, 98.8%, 99.8%, respectively (P=0.000). Meanwhile, critical values reporting rate of Laboratory and Radiology also increased from 47.9%, 30.6% to 96.5%, 96.3% (P=0.000). Conclusion: This study suggested that the PDCA-cycle is an important tool for quality management, and it can effectively improve the executions of critical values reporting.

Modelling oxygen transport in soil with plant root and microbial oxygen consumption: depth of oxygen penetration

Soil Research ◽  
2013 ◽  
Vol 51 (6) ◽  
pp. 539 ◽  
Author(s):  
F. J. Cook ◽  
J. H. Knight ◽  
F. M. Kelliher
Keyword(s):  
Diffusion Coefficient ◽  
Redox Potential ◽  
Water Content ◽  
Soil Water ◽  
Soil Water Content ◽  
Oxygen Concentration ◽  
Oxygen Diffusion ◽  
Plant Root ◽  
Critical Value ◽  
Critical Values

A set of equations governing oxygen diffusion and consumption in soils has been developed to include microbial and plant-root sinks. The dependent variable is the transformed oxygen concentration, which is the difference between the gaseous concentration and a scaled value of the aqueous oxygen concentration at the root–soil interface. The results show how, as the air-filled porosity decreases, the reduced oxygen flux causes the depth of extinction to decrease. The results also show how the depth of extinction at a particular value of soil water content decreases with increasing temperature, due to increased microbial respiration. The critical value of water content at which the oxygen concentration goes to extinction at a finite depth was compared with alternative calculations with only a microbial sink. By ignoring the feedback of oxygen concentration on root uptake, the alternative calculations yielded substantially higher critical values of water content at all temperatures. Two soil oxygen diffusion coefficient functions from the literature were compared and shown to give significantly different critical values of water content for fine-textured soils, one more realistic than the other. A single relationship between the extinction depth and the ratio of the water content to the critical value was shown to apply for all temperatures and soil textures. The oxygen profiles were used along with a function relating redox potential to oxygen concentration to generate redox potential profiles. This application of the model could be useful in explaining soil biochemical processes in soils. For one such process, denitrification, the depth at which a critical oxygen concentration is reached was calculated as a function of the air-filled porosity and temperature of the soil. The implications of the critical value of soil water content in terms of water-filled pore space and matric potential are discussed in relation to the diffusion coefficient functions and recent literature.

Milk acetone concentration as an indicator of hyperketonaemia in dairy cows: the critical value revised

1996 ◽  
Vol 63 (2) ◽  
pp. 183-188 ◽  
Author(s):  
A. H. Gustafsson ◽  
U. Emanuelson
Keyword(s):  
Dairy Cows ◽  
Milk Yield ◽  
Critical Value ◽  
Critical Values ◽  
Reproductive Efficiency ◽  
Early Lactation ◽  
Acetone Concentration ◽  
Daily Milk Yield ◽  
Daily Milk

AbstractAcetone concentration in milk is correlated with subclinical and clinical ketosis and also with milk yield and reproductive efficiency. The purpose of this study was to assess a threshold of milk acetone at which cows tend to be adversely affected. The critical values were estimated on data from 11690 lactations where the change in daily milk yield from weeks 1 to 2 to weeks 5 to 6 of lactation was evaluated in relation to different milk acetone concentrations. Daily milk yield tended to be reduced in cows with acetone concentrations between 0·7 and 1·4 mmol/l, but responses were not entirely consistent. At concentrations >l·4 mmol/l, daily milk yield was clearly reduced. Long-term milk yield (day 0 to 100 and day 0 to 200) was about 190 kg of 40 g/kg fat-corrected milk (FCM) less in cows with acetone concentrations >l·4 vis-à-vis <0·7 mmol/l. Reproductive efficiency was also impaired in cows with acetone concentrations >l·4 mmol/l; 4·9 days longer interval from calving to first service (first parity and parity 2+ cows) and 5·7 times a greater risk of cystic ovaries (parity 1), compared with cows with milk acetone <0·7 mmol/l. However, no significant effects on long-term milk yield or on reproductive efficiency were found in cows with acetone concentrations 0·7 to 1·4 vis-à-vis <0·7 mmol/l. The results suggest that 1·4 mmol/l acetone in milk may be used as the most important critical value, as higher concentrations are detrimental to productivity. The interval 0·7 to 1·4 mmol acetone per I milk may be used as a warning class, since early lactation yield may be reduced.

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