Flag System Research Articles

Manual flagging failed to identify pseudohyperkalemia in acute myeloid leukemia: case report

BackgroundPseudohyperkalemia is well known in acute or chronic lymphocytic leukemia, but it is very rare in acute myeloid leukemia (AML). The lab flagging system for leukocytosis to prevent pseudohyperkalemia may not work.Case presentationA 55 year-old white man with AML was sent to emergency department for transfusion due to severe anemia. Blood test showed severe leukocytosis and elevated potassium. Repeated blood test showed his potassium was even higher. Anti-hyperkalemic medical treatment was given. He was then diagnosed with pseudohyperkalema.InvestigationI was repeatedly reassured that the lab’s manual flagging system for leukocytosis was the key in reaching the correct diagnosis. My persistent inquiries, however, revealed that the flagging system was not functioning in the care of this patient. It was clinicians’ suspicion of pseudohyperkalema that led to the correct diagnosis, although the clinicians’ recommendation of obtaining a heparinized plasma for test did not play a role because all blood samples were already heparinized. The cause of pseudohyperkalemia was pneumatic tube transport. After this incident, our laboratory is investigating the options of using the Laboratory Information System to automatically flag the results and Clinical Laboratory Scientists to make the chemistry team more aware of potentially erroneous potassium results due to pseudohyperkalemia.ConclusionsPseudohyperkalemia associated with leukocytosis still occurs. This is the first case of pneumatic tube transport causing pseudohyperkalemia associated with AML. When significant leukocytosis, thrombocytosis, hyperproteinemia, or hyperlipidemia is present, whole blood should be utilized for potassium measurements and walked to the lab instead of sent by pneumatic tube transport. Even in a lab with a manual flagging system, there is still room to improve by implementing an automatic flagging system.

The Gaia-ESO Survey DR5.1 and Gaia DR3 GSP-Spec: a comparative analysis

Context. The third data release of Gaia, has provided stellar parameters, metallicity [M/H], [α/Fe], individual abundances, broadening parameter from its Radial Velocity Spectrograph (RVS) spectra for about 5.6 million objects thanks to the GSP-Spec module, implemented in the Gaia pipeline. The catalogue also publishes the radial velocity of 33 million sources. In recent years, many spectroscopic surveys with ground-based telescopes have been undertaken, including the public survey Gaia-ESO, designed to be complementary to Gaia, in particular towards faint stars. Aims. We took advantage of the intersections between Gaia RVS and Gaia-ESO to compare their stellar parameters, abundances and radial and rotational velocities. We aimed at verifying the overall agreement between the two datasets, considering the various calibrations and the quality-control flag system suggested for the Gaia GSP-Spec parameters. Methods. For the targets in common between Gaia RVS and Gaia-ESO, we performed several statistical checks on the distributions of their stellar parameters, abundances and velocities of targets in common. For the Gaia surface gravity and metallicity we considered both the uncalibrated and calibrated values. Results. Overall, there is a good agreement between the results of the two surveys. We find an excellent agreement between the Gaia and Gaia-ESO radial velocities given the uncertainties affecting each dataset. Less than 25 out of the ≈2100 Gaia-ESO spectroscopic binaries are flagged as non-single stars by Gaia. For the effective temperature and in the bright regime (G ≤ 11), we found a very good agreement, with an absolute residual difference of about 5 K (±90 K) for the giant stars and of about 17 K (±135 K) for the dwarf stars; in the faint regime (G ≥ 11), we found a worse agreement, with an absolute residual difference of about 107 K (±145 K) for the giant stars and of about 103 K (±258 K) for the dwarf stars. For the surface gravity, the comparison indicates that the calibrated gravity should be preferred to the uncalibrated one. For the metallicity, we observe in both the uncalibrated and calibrated cases a slight trend whereby Gaia overestimates it at low metallicity; for [M/H] and [α/Fe], a marginally better agreement is found using the calibrated Gaia results; finally for the individual abundances (Mg, Si, Ca, Ti, S, Cr, Ni, Ce) our comparison suggests to avoid results with flags indicating low quality (XUncer = 2 or higher). These remarks are in line with the ones formulated by GSP-Spec. We confirm that the Gaia vbroad parameter is loosely correlated with the Gaia-ESO v sin i for slow rotators. Finally, we note that the quality (accuracy, precision) of the GSP-Spec parameters degrades quickly for objects fainter than G ≈ 11 or GRVS ≈ 10. Conclusions. We find that the somewhat imprecise GSP-Spec abundances due to its medium-resolution spectroscopy over a short wavelength window and the faint G regime of the sample under study can be counterbalanced by working with averaged quantities. We extended our comparison to star clusters using averaged abundances, using not only the stars in common, but also the members of clusters in common between the two samples, still finding a very good agreement. Encouraged by this result, we studied some properties of the open-cluster population, using both Gaia-ESO and Gaia clusters: our combined sample traces very well the radial metallicity and [Fe/H] gradients, the age-metallicity relations in different radial regions, and allows us to place the clusters in the thin disc.

IS MY BALANCE DISORDER PATIENT IMPROVING WITH THIS REHABILITATION TREATMENT? RAPID STABILOMETRIC PLATFORM TEST

The aim of the present study is to compare the use and results of a rapid stabilometric platform test with traditional clinical scales to assess the individual clinical evolution of heterogeneous patients with balance disorders during rehabilitation treatment. The 67 participating vertigo patients underwent two assessment sessions, one before starting rehabilitation treatment and one after starting treatment. In each session, six static balance assessment tests with the stabilometric platform were accomplished. Then, the centre of pressure (COP) measured by the device, was processed using the MCQ-Balance method, that transforms the signal into clinical interpretable results. Additionally, in order to compare the results, three medical diagnostic tests were conducted and a methodical flag system to classify their results was proposed. The agreement rises until 85.71% with a contingency coefficient of 0.751 and a Kappa of 0.775. The platform showed a sensitivity of 100% with a specificity of 72.99%. Furthermore, it was not found false negatives in the platform. The stabilometric platform provided valuable assistance in the diagnosis of the evolution of balance pathology, involving less time and uncertainty than traditional tests.

Comparison of concurrent care and traditional hospice at a regional VA.

e24065 Background: While hospice care offers many patients services promoting comfort and quality of life, the traditional hospice model described in Medicare policy presents numerous barriers to utilization. Notably, since hospice pays for all therapies related to a terminal illness, patients are often forced to make a difficult choice to stop disease-directed therapies in order to enroll in hospice. Poor provider understanding of hospice also contributes to the common scenario in which hospice is offered too late to make a meaningful impact for patients and their families. These issues were prominent in the VA population in 2006, when only 5% of eligible Veterans received hospice services. Consequently, the VA Comprehensive End-of-Life Care Initiative in 2009 created the concurrent care hospice model in where Veterans no longer had to stop all disease-directed therapies to enroll. Initial national VA data in lung cancer suggested that concurrent care may be better than traditional hospice by decreasing aggressive treatments, ICU hospitalizations, and medical costs. Our regional VA developed a Hospice Flag system that tagged patients in the electronic medical record who had either a concurrent or traditional hospice enrollment to better inform health care providers. This project investigates how the concurrent care hospice model may help achieve an important Veteran-centered outcome, which is to die in the home setting and improve access to hospice care. Methods: We retrospectively reviewed all Veterans with a hospice flag from October 2017 to July 2021 and cancer as the primary hospice diagnosis. Our primary aim was to establish correlation between hospice type and Veterans’ ultimate location of death with the percentage at home versus institution (e.g. care center, hospital, or hospice house). A secondary measure was median length-of-stay (LOS) in hospice. Results: 317 total Veterans were enrolled in concurrent care hospice (96) and traditional hospice (221) from Oct 2017 to July 2021. 72% of Veterans in concurrent care (69/96) died at home compared to only 57% in traditional hospice (125/221) with the remainder dying in an institution; this result was statistically significant by Chi-square analysis (p = 0.01). Median LOS in hospice was 62 days for concurrent care and 26 days for traditional hospice. Conclusions: This project demonstrates that concurrent care hospice is significantly associated with Veterans being able to die in their own home. Concurrent care was also correlated with longer median LOS in hospice, suggesting greater duration of support services provided to patients and families.

The dilution evaluation as a corrective measure for interference in the white blood cell scattergram in Beckman Coulter DxH 900.

The Beckman Coulter DxH 900 is a haematological analyser capable of counting and sizing blood cells, and obtaining a complete blood cell count (CBC). This analyses different parameters of red blood cells (RBC), platelets and white blood cells/leukocytes. Some automated CBC counters present limitations due to specimen characteristics, abnormal cells or both factors. In the presence of abnormalities, the DxH 900 has a flagging system, warning the laboratory technician that something needs to be verified. In the present work, we evaluated samples from oncologic patients, presenting a population erroneously perceived as being lymphocytes. The most common explanations for this situation are RBC resistant to lysis or serum hyperbilirubinaemia. In an attempt to solve and understand what the cause of this problem might be, we diluted our samples (1:3) and analysed the serum total bilirubin. To identify cells' abnormalities, the samples were also analysed by manual DLC counts. During the study, we also checked the different flags presented by the equipment. The results evidenced that the major interference was due to RBC lysis resistance, corresponding to 94.7% of the cases, while hyperbilirubinaemia was only present in 73.4%. Besides, we determined that some samples with normal bilirubin levels also presented interference, suggesting that hyperbilirubinaemia was not the main cause of the error. The most recurrent flag observed was "High event rate". The dilution solved all of the observed interferences. The results between diluted and manual counts showed a strong correlation, leading us to introduce dilution in our laboratory routine.

Impact of Flagging/Risk Stratification System on Complications in Hospitalist Hip Fracture Co-management: Retrospective Cohort Study.

Hip fractures are associated with high morbidity and mortality, the rates of which can be improved by comprehensive care. To improve hospitalist co-management of hip fractures, we designed and implemented hip fracture template (HFT), a flagging and risk stratification algorithm system. It includes consideration of perioperative management and preventative measures against hip fractures. We examined its effect on morbidity in patients with hip fractures and the factors associated with complications. We conducted a retrospective cohort study of patients who underwent surgery for hip fracture. The primary outcome was the perioperative complication rate, comparing patients managed with and without HFT. Multivariate analysis was adjusted for age, gender, and any significant variables shown in univariate analysis. HFT was used in 121 patients and not used in 147 patients. In univariate analysis, patients were less likely to have complications if HFT was used (19.0% vs. 29.9%, P = 0.047), but there was no difference in length of stay (17days vs. 17days, P = 0.27) or in-hospital-mortality (0.8% vs. 0.7%, P = 1.00) between the groups. In adjusted analysis, patients managed by HFT had lower likelihood of complications (OR 0.55, 95% CI 0.31-0.98). Among patients managed by HFT, those with revised cardiac risk index (RCRI) ≥ 1 were more likely to have complications in both univariate (42.1% vs. 14.7%, P = 0.01) and adjusted analysis (OR 3.37, 95% CI 1.03-10.84). Patients with hip fractures managed with HFT were less likely to have complications, especially those with RCRI ≥ 1, suggesting benefits of using HFT.

Evaluating the Implementation of the Connect for Health Pediatric Weight Management Program

Adoption of primary care interventions to reduce childhood obesity is limited. Progress in reducing obesity prevalence and eliminating disparities can be achieved by implementing effective childhood obesity management interventions in primary care settings. To examine the extent to which implementation strategies supported the uptake of research evidence and implementation of the Connect for Health pediatric weight management program. This quality improvement study took place at 3 geographically and demographically diverse health care organizations with substantially high numbers of children living in low-income communities in Denver, Colorado; Boston, Massachusetts; and Greenville, South Carolina, from November 2019 to April 2022. Participants included pediatric primary care clinicians and staff and families with children aged 2 to 12 years with a body mass index (BMI) in the 85th percentile or higher. Pediatric weight management program with clinician-facing tools (ie, clinical decision support tools) and family-facing tools (ie, educational handouts, text messaging program, community resource guide) along with implementation strategies (ie, training and feedback, technical assistance, virtual learning community, aligning with hospital performance metrics) to support the uptake. Primary outcomes were constructs from the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework examined through parent, clinician, and leadership surveys and electronic health record data to understand the number of children screened and identified, use of the clinical decision support tools, program acceptability, fidelity to the intervention and implementation strategies, and program sustainability. The program screened and identified 18 333 children across 3 organizations (Denver Health, 8480 children [46.3%]; mean [SD] age, 7.97 [3.31] years; 3863 [45.5%] female; Massachusetts General Hospital (MGH), 6190 children [33.8%]; mean [SD] age, 7.49 [3.19] years; 2920 [47.2%] female; Prisma Health, 3663 children [20.0%]; mean [SD] age, 7.33 [3.15] years; 1692 [46.2%] female) as having an elevated BMI. The actionable flagging system was used for 8718 children (48%). The reach was equitable, with 7843 children (92.4%) from Denver Health, 4071 children (65.8%) from MGH, and 1720 children (47%) from Prisma Health being from racially and ethnically minoritized groups. The sites had high fidelity to the program and 6 implementation strategies, with 4 strategies (67%) used consistently at Denver Health, 6 (100%) at MGH, and 5 (83%) at Prisma Health. A high program acceptability was found across the 3 health care organizations; for example, the mean (SD) Acceptability of Intervention Measure score was 3.72 (0.84) at Denver Health, 3.82 (0.86) at MGH, and 4.28 (0.68) at Prisma Health. The implementation strategies were associated with 7091 (39%) uses of the clinical decision support tool. The mean (SD) program sustainability scores were 4.46 (1.61) at Denver Health, 5.63 (1.28) at MGH, and 5.54 (0.92) at Prisma Health. These findings suggest that by understanding what strategies enable the adoption of scalable and implementation-ready programs by other health care organizations, it is feasible to improve the screening, identification, and management of children with overweight or obesity and mitigate existing disparities.

THE EFFECT OF AUDITOR COMPETENCE, PROFESSIONAL SKEPTICISM, RED FLAG, AND INTERNAL CONTROL SYSTEM ON FRAUD DETECTION

Today more and more cases of fraud occur. In each of these cases, there is always an auditor's failure to detect fraud. It makes the fraud going on for a long time before being discovered. Based on this, we intend to research the factors influencing fraud detection. This study aims to determine the effect of auditor competence, professional skepticism, red flags, and internal control systems on fraud detection. The data collection technique in this study used primary data by distributing questionnaires to auditors working at the Public Accounting Firm (KAP) in the DKI Jakarta area using a purposive sampling method. The data analysis method uses a partial least square model using the SmartPLS 3.3 software. The results of this study indicate that auditor competence, red flag, and internal control system variables significantly affect fraud detection. In contrast, the professional skepticism variable has no significant effect on fraud detection.

Familiarity with beach warning flags in the Netherlands

Beach safety flags form an internationally adopted warning system intended to prevent adverse incidents, including drownings. However, little is known about people’s familiarity with these flags. In this study we tested the recognition and understanding of beach warning flags in the Netherlands, a country which welcomes millions of beach visitors every year. A convenience sample (N = 174) of the Dutch population was interviewed using a structured survey which asked for the meaning of eight different flags, the respondents’ confidence in their choice, as well as their intention with regard to entering the water. The results show an overall poor understanding of the meaning of all flags except for the red flags (which indicate high hazard). The level of confidence largely followed the same pattern, with low confidence for most flags except the red ones. Strikingly, the yellow flag (which indicates potential hazard and is meant to discourage bathing) evoked a considerable proportion of opposite associations (i.e., safety), combined with moderately high confidence and intentions to enter the water. More people were in fact inclined to enter the water under a yellow flag than under a red & yellow flag (which indicates a patrolled beach). Direct or indirect experience with danger in the sea did not affect people’s knowledge of the flags but did reduce the intention to enter the water. We conclude that familiarity with the flag system in the Netherlands is wanting and we propose a number of recommendations to improve public understanding.

Beach management policy analysis concerning safety flag systems in Northern Spain

The aim of this paper is to analyse the meaning of beach safety flags and their management along the Northern Spanish coast. There are more than 1000 small beaches, which are often in high demand by tourism during the summer season. To carry out the research, most of main beaches have been visited to observe and analyse the meaning of all the safety flags and their correct use depending on the oceanographic and meteorological conditions. The influence of the beach safety management and regulations on the use of beach safety signage has been also analysed. The results show that safety flag systems differ even between very close beaches where safety management is in the hands of different local governments. Outdated and local legal framework and the absence of an agreed system between the different organizations that provide lifeguarding services seem to be behind this lack of uniformity. A specific guide for beach safety flags and signage within a national safety beach plan agreed by all the autonomic or provincial governments may be a solution.

Performance comparison of quantitative metrics for analysis of in vivo Cherenkov imaging incident detection during radiotherapy.

Examine the responses of multiple image similarity metrics to detect patient positioning errors in radiotherapy observed through Cherenkov imaging, which may be used to optimize automated incident detection. An anthropomorphic phantom mimicking patient vasculature, a biological marker seen in Cherenkov images, was simulated for a breast radiotherapy treatment. The phantom was systematically shifted in each translational direction, and Cherenkov images were captured during treatment delivery at each step. The responses of mutual information (MI) and the γ passing rate (%GP) were compared to that of existing field-shape matching image metrics, the Dice coefficient, and mean distance to conformity (MDC). Patient images containing other incidents were analyzed to verify the best detection algorithm for different incident types. Positional shifts in all directions were registered by both MI and %GP, degrading monotonically as the shifts increased. Shifts in intensity, which may result from erythema or bolus-tissue air gaps, were detected most by %GP. However, neither metric detected beam-shape misalignment, such as that caused by dose to unintended areas, as well as currently employed metrics (Dice and MDC). This study indicates that different radiotherapy incidents may be detected by comparing both inter- and intrafractional Cherenkov images with a corresponding image similarity metric, varying with the type of incident. Future work will involve determining appropriate thresholds per metric for automatic flagging. Classifying different algorithms for the detection of various radiotherapy incidents allows for the development of an automatic flagging system, eliminating the burden of manual review of Cherenkov images.

Do Red-Flagged Clients Exit Social Assistance Earlier than Others? The Case of the Finnish Social Assistance System

We examine an early ‘red flag system’ in the Finnish social assistance system and its efficiency in reducing the length of social assistance spells. We utilise the age-threshold in the policy that requires notifying social services on beneficiaries under twenty-five years of age after four months of social assistance receipt. Using monthly administrative data covering all twenty-three to twenty-six-year-old social assistance beneficiaries in Finland in 2018-2019, we compare the social assistance receipt of those below and above the age-threshold. Our findings show that those who are ‘red flagged’ do not exit social assistance earlier than others. On the contrary, four months after the notification is sent to social services, they are more likely to still have social assistance as their primary source of income compared to the twenty-five to twenty-six-year-old individuals. Our results shed light on the little discussed question on how to combine social work with digitalised and automatised welfare.

Chen–Ruan cohomology and moduli spaces of parabolic bundles over a Riemann surface

Let \((X,\,D)\) be an m-pointed compact Riemann surface of genus at least 2. For each \(x \,\in \, D\), fix full flag and concentrated weight system \(\alpha \). Let \(P \mathcal {M}_{\xi }\) denote the moduli space of semi-stable parabolic vector bundles of rank r and determinant \(\xi \) over X with weight system \(\alpha \), where r is a prime number and \(\xi \) is a holomorphic line bundle over X of degree d which is not a multiple of r. We compute the Chen–Ruan cohomology of the orbifold for the action on \(P \mathcal {M}_{\xi }\) of the group of r-torsion points in \(\mathrm{Pic}^0(X)\).

Analyzing the Influence of Harmonic Parameters on Accuracy Indices When Applying Wavelet Transform

The paper deals with the evaluation of root mean square deviations and maximum absolute relative errors associated to the decomposition followed by recomposition based on Wavelet Packet Transform (WPT) of signals pol-luted with harmonics. Subtrees associated to sets of harmonics presenting practical interest for industrial applications are addressed. The study uses artificial signals generated through the superposition of perfect sinusoids with pairs of harmonics which proved to be related in an almost exclusive manner to pairs of nodes from the bottom level of a WPT tree. 4 parameters had to be considered when determining the maximum and minimum values of errors for each set: the clustered harmonics’ magnitudes and their phase-shifts relative to the component of fundamental frequency. The decomposition/recomposition are time-efficient due to an original system of flags labeling each node from the WPT tree. For each analyzed set of harmonics, 3d graphical representation of minimum and maximum errors along with the associated 3d graphical representation of the phase-shifts are provided. At the same time, per set limits of errors ranges were established and discussed while specific patterns were deduced for the context in which extreme errors appear (phase-shifts and harmonic magnitudes). The results were commented, and conclusions were drawn.

A Global Ocean Oxygen Database and Atlas for Assessing and Predicting Deoxygenation and Ocean Health in the Open and Coastal Ocean

In this paper, we outline the need for a coordinated international effort toward the building of an open-access Global Ocean Oxygen Database and ATlas (GO2DAT) complying with the FAIR principles (Findable, Accessible, Interoperable, and Reusable). GO2DAT will combine data from the coastal and open ocean, as measured by the chemical Winkler titration method or by sensors (e.g., optodes, electrodes) from Eulerian and Lagrangian platforms (e.g., ships, moorings, profiling floats, gliders, ships of opportunities, marine mammals, cabled observatories). GO2DAT will further adopt a community-agreed, fully documented metadata format and a consistent quality control (QC) procedure and quality flagging (QF) system. GO2DAT will serve to support the development of advanced data analysis and biogeochemical models for improving our mapping, understanding and forecasting capabilities for ocean O2 changes and deoxygenation trends. It will offer the opportunity to develop quality-controlled data synthesis products with unprecedented spatial (vertical and horizontal) and temporal (sub-seasonal to multi-decadal) resolution. These products will support model assessment, improvement and evaluation as well as the development of climate and ocean health indicators. They will further support the decision-making processes associated with the emerging blue economy, the conservation of marine resources and their associated ecosystem services and the development of management tools required by a diverse community of users (e.g., environmental agencies, aquaculture, and fishing sectors). A better knowledge base of the spatial and temporal variations of marine O2 will improve our understanding of the ocean O2 budget, and allow better quantification of the Earth’s carbon and heat budgets. With the ever-increasing need to protect and sustainably manage ocean services, GO2DAT will allow scientists to fully harness the increasing volumes of O2 data already delivered by the expanding global ocean observing system and enable smooth incorporation of much higher quantities of data from autonomous platforms in the open ocean and coastal areas into comprehensive data products in the years to come. This paper aims at engaging the community (e.g., scientists, data managers, policy makers, service users) toward the development of GO2DAT within the framework of the UN Global Ocean Oxygen Decade (GOOD) program recently endorsed by IOC-UNESCO. A roadmap toward GO2DAT is proposed highlighting the efforts needed (e.g., in terms of human resources).

Persebaran Penyakit di Kawasan Laut Jawa Abad XIX - XX

This article discussed about the process of diseases spreading along the Java Sea area during the 19th and the early 20th century. This study utilized historical method with an aim to reconstruct past events, especially on the outbreaks happened in the Java Sea area and how the colonial governmnet dealt with the occurrence. The article applied Braudel’s structural theory (1988) to analyze the existence of structures, which were taking a role in the process of diseases spreading. This analysis was supported by the concept of ‘silent barter’, developed by Knapen (1995) as a benchmark to determine factors that caused the spread. The results allowed us to discover that the dynamics of shipping and trading in the Java Sea at that time were part of the whole pandemic situation. There were at least two diseases discussed as the main focus of this article, smallpox and cholera, as these two severely affected the trading and shipping activity. These diseases were carried by the crews of ships escaping the quarantine doctors who carried out medical examination at various ports. Several ports in Java, such as Batavia, Semarang, Cirebon, and Surabaya, had become the epicenters of the outbreak. The government applied a regulation to attached a yellow flag to the ship contaminated by the plague before they entered the port area. The yellow flag functioned as an identifying marker. The regulation was supposed to limit the spread of diseases from the coastal area of Java to the mainland, as well as to gain more attention from other ships and doctors resided near the ports. The yellow flag system made it easier for the government and doctors to handle smallpox and cholera outbreaks, even though there had been some aberrations in economic activities in this area.

A global occurrence database of the Atlantic blue crab Callinectes sapidus

The Atlantic blue crab Callinectes sapidus is a portunid native to the western Atlantic, from New England to Uruguay. The species was introduced in Europe in 1901 where it has become invasive; additionally, a significant northward expansion has been emphasized in its native range. Here we present a harmonized global compilation of C. sapidus occurrences from native and non-native distribution ranges derived from online databases (GBIF, BISON, OBIS, and iNaturalist) as well as from unpublished and published sources. The dataset consists of 40,388 geo-referenced occurrences, 39,824 from native and 564 from non-native ranges, recorded in 53 countries. The implementation of quality controls imposed a severe reduction, in particular from online databases, of the records selected for inclusion in the dataset. In addition, a technical validation procedure was used to flag entries showing identical coordinates but different year of record, in-land occurrences and those located close to the coast. Similarly, a flagging system identified entries outside the known distribution of the species, or associated with unsuccessful introductions.

Identifying the at-risk General Practice trainee: a retrospective cohort meta-analysis of General Practice registrar flagging.

A central principle of programmatic assessment is that the final decision is not a surprise to the learner. To achieve this, assessments must demonstrate predictive and consequential validity, however, to date, research has only focussed on the former. The present study attempts to address this gap by examining the predictive and consequential validity of flagging systems used by Australian General Practice regional training organisations (RTOs) in relation to Fellowship examinations. Informed by unstructured interviews with Senior Medical Educators to understand the flagging system of each RTO, meta-analyses of routinely-collected flagging data were used to examine the predictive validity of flagging at various points in training and exam performance. Additionally, flagging system features identified from the interviews were used to inform exploratory subgroup analyses and meta-regressions to further assess the predictive and consequential validity of these systems. Registrars flagged near the end of their training were two to four times more likely to fail Fellowship exams than their non-flagged counterparts. Regarding flagging system features, having graded (i.e. ordinal) flagging systems was associated with higher accuracy, whilst involving the assigned medical educator in remediation and initiating a formal diagnostic procedure following a flag improved registrars' chances of passing exams. These results demonstrate both predictive and consequential validity of flagging systems. We argue that flagging is most effective when initiated early in training in conjunction with mechanisms to maximise diagnostic accuracy and the quality of remediation programs.

Baseline monitoring of volcanic regions with little recent activity: application of Sentinel-1 InSAR to Turkish volcanoes

Volcanoes have dormancy periods that may last decades to centuries meaning that eruptions at volcanoes with no historical records of eruptions are common. Baseline monitoring to detect the early stages of reawakening is therefore important even in regions with little recent volcanic activity. Satellite techniques, such as InSAR, are ideally suited for routinely surveying large and inaccessible regions, but the large datasets typically require expert interpretation. Here we focus on Turkey where there are 10 Holocene volcanic systems, but no eruptions since 1855 and consequently little ground-based monitoring. We analyse data from the first five years of the European Space Agency Sentinel-1 mission which collects data over Turkey every 6 days on both ascending and descending passes. The high relief edifices of Turkey’s volcanoes cause two challenges: 1) snow cover during the winter months causes a loss of coherence and 2) topographically-correlated atmospheric artefacts could be misinterpreted as deformation. We propose mitigation strategies for both. The raw time series at Hasan Dag volcano shows uplift of ~ 10 cm between September 2017 and July 2018, but atmospheric corrections based on global weather models demonstrate that this is an artefact and reduce the scatter in the data to < 1 cm. We develop two image classification schemes for dealing with the large datasets: one is an easy to follow flowchart designed for non-specialist monitoring staff, and the other is an automated flagging system using a deep learning approach. We apply the deep learning scheme to a dataset of ~ 5000 images over the 10 Turkish volcanoes and find 4 possible signals, all of which are false positives. We conclude that there has been no cm-scale volcano deformation in Turkey in 2015–2020, but further analysis would be required to rule out slower rates of deformation (< 1 cm/yr). This study has demonstrated that InSAR techniques can be used for baseline monitoring in regions with few historical eruptions or little reported deformation.

Lactate and glucose as additional considerations to the plasma sodium level-corrected erythrocyte mean corpuscular volume report when using the Sysmex XE-2100

BackgroundMean corpuscular volume (MCV) can be artefactually inflated, by variation in sodium concentration, on the Sysmex XE-2100. We report that severe hyperglycemia and modest lactic acidemia can also spuriously increase MCV. To catch and correct such inaccurate MCV measurements, we propose to flag them using commonly assayed biomarkers. Materials and MethodsWe examined the relationship between delta MCV (uncorrected MCV minus corrected MCV), plasma osmolality, and levels of plasma glucose, lactate, and sodium in 60 samples from emergency room patients. Based on these biomarkers, we developed and tested a preliminary composite flag system to identify high delta MCV on 105 ER samples. Finally, we evaluated a revised composite flagging system optimized to improve the positive predictive value. ResultsPlasma osmolality, glucose and lactate are each correlated with delta MCV. The revised composite flag system – based on ≥ 5.0 mmol/L of plasma lactate, > 32 mmol/L of glucose, or > 150 mmol/L of sodium – identified twice as many patients with spuriously elevated MCV as the vendor recommended MCHC flagging system. The associated positive predictive value of 31%, while lower than the vendor flagging system (62%), was considered adequate for implementation in our laboratory. ConclusionsWe recommend reporting clinically significant corrected MCVs, based on sample pre-dilution with the Sysmex buffer, when the proposed composite metabolic flag is triggered.