Lipemia: causes, interference mechanisms, detection and management

In the clinical laboratory setting, interferences can be a significant source of laboratory errors with potential to cause serious harm for the patient. After hemolysis, lipemia is the most frequent endogenous interference that can influence results of various laboratory methods by several mechanisms. The most common preanalytical cause of lipemic samples is inadequate time of blood sampling after the meal or parenteral administration of synthetic lipid emulsions. Although the best way of detecting the degree of lipemia is measuring lipemic index on analytical platforms, laboratory experts should be aware of its problems, like false positive results and lack of standardization between manufacturers. Unlike for other interferences, lipemia can be removed and measurement can be done in a clear sample. However, a protocol for removing lipids from the sample has to be chosen carefully, since it is dependent on the analytes that have to be determined. Investigation of lipemia interference is an obligation of manufacturers of laboratory reagents; however, several literature findings report lack of verification of the declared data. Moreover, the acceptance criteria currently used by the most manufacturers are not based on biological variation and need to be revised. Written procedures for detection of lipemia, removing lipemia interference and reporting results from lipemic samples should be available to laboratory staff in order to standardize the procedure, reduce errors and increase patient safety

Design of the Overpass above Highway : Undergraduate Thesis

U radu je prikazana projekt tipskog nadvožnjaka preko autoceste. Nadvožnjak se sastoji od dva jednaka raspona (19 m) te ima stup u pojasu razdvajanja projektiran tako da se širi od dna prema vrhu. Niveleta nadvožnjaka je oko 8.8 m iznad nivelete autoceste tako da ima dosta prostora za slobodni profil ispod nadvožnjaka. Projekt sadrži proračun glavnih nosača, karakteristične građevinske nacrte i tehnički opis.This paper presents the design of the overpass above higway. The structure is consist of two equal spans (19 m) and has a column in the separation zone designed as it gets wider from the bottom up. Elevation of the overpass is 8.8 meters above highway elevation giving enough space for traffic beneath the overpass. The work includes the calculation of the main span girders, characteristic construction plans as well as tehnical description of the construction

MENADŽERSKE VJEŠTINE U KONTEKSTU RJEŠAVANJA PROBLEMA U PODUZEĆU NAFTNI TERMINALI FEDERACIJE D.O.O. : Završni rad

Rješavanje problema predstavlja jedan od ključnih faktora menadžerske efikasnosti koji povlači za sobom i pitanje kvalitete vještina koje menadžeri posjeduju i koje koriste prilikom rješavanja problema. Međutim, rješavanje problema ne možemo promatrati s aspekta isključivo samo jedne vještine i s aspekta sličnih situacija. Suvremena se ekonomska teorija i praksa bavi tim pitanjima te su provedena brojna istraživanja na tu temu. S namjeromispitivanja kvalitete menadžerskih vještina kod djelatnika poduzeća Naftni terminali d.o.o. provedeno je istraživanja čiji su rezultati ukazali na veliku važnost povratne informacije, učinkovite komunikacije i slušanja prilikom rješavanja problema.Problem solving is one of the key managerial efficiency factors, which entails the question of the quality of skills that managers have and which they use when solving problems. However, solving problems cannot be observed from the aspect of just one skill and from the aspect of similar situations. Contemporary economic theory and practice deals with these issues and numerous researches on this topic have been carried out. With the aim of testing the quality of management skills at the employees of the company Naftni terminali d.o.o. a research has been carried out, whose results pointed out the great importance of feedback, effective communication and listening during problem solving

Dipeptidyl peptidase-4 activity is associated with urine albumin excretion in type 1 diabetes

AIMS: The inability of kidneys to prevent urinary protein leakage represents the earliest sign of renal damage in diabetic kidney disease (DKD). Recent data suggest the possible nephroprotective role of the dipeptidyl peptidase-4 (DPP-4) inhibitors. We aimed to investigate whether serum DPP-4 activity is associated with urine albumin excretion (UAE) in patients with type 1 diabetes (type 1 DM). ----- METHODS: DPP-4 activity and UAE measurement were performed in 113 patients with type 1 DM and glomerular filtration rate (GFR) within normal range. They were divided into three groups according to UAE tertiles. ----- RESULTS: Worse lipid profile and higher waist circumference were observed in the group with highest DPP-4 activity. Patients within lowest UAE tertile group had lowest DPP-4 activity value (p<0.001) compared to group within second and third tertile of UAE. DPP-4 activity correlated with systolic blood pressure (ρ=0.142; p=0.001), HbA1c (ρ=0.133; p=0.013) and UAE (ρ=0.349; p<0.001). In the linear regression analysis when DPP-4 activity was adjusted for age, gender, disease duration, HbA1c, waist circumference, the use of ACEI and hypolipemic agents the association remained significant; UAE increased for 8.136mg/24h by each increase of DPP-4 activity of 1U/L (p<0.008). ----- CONCLUSION: Our results indicate that serum DPP-4 activity is associated with albuminuria in type 1 diabetes. This arises the question whether the use of DPP-4 inhibitors might serve as an additional therapeutic strategy to prevent proteinuria in patients with DKD

Hemolysis detection and management of hemolyzed specimens

Assay interferences have long been underestimated and unfortunately too often undetected in the daily clinical laboratory practice. The extra-analytical phase of the laboratory testing process has been recognized as the major source of laboratory errors over the past decade. Preanalytical errors are most common errors within the total testing process and hemolysis is recognized as one of the most prevalent preanalytical errors and surely the most prevalent interference in clinical laboratory testing. Visual detection of hemolysis is arbitrary and therefore mostly unreliable since it may over- and underestimate the actual prevalence of hemolyzed serum specimens (i.e., trained observers are unable to accurately rank the degree of interference in serum). Elevated concentration of bilirubin may further impair the ability to detect hemolysis by visual inspection and therefore lead to serious underestimation of hemolysis in neonatal samples where elevated bilirubin concentration is commonplace. The recent advances in laboratory technology have lead to an increasing trend in the automation of various preanalytical processes into large preanalytical modules. Such modules as well as novel automated laboratory analyzers offer the automated detection of serum indices. This is advantageous due to the increased reproducibility and the improvement in detection of mildly hemolyzed specimens (serum hemoglobin < 0.6 g/L). These platforms commonly use the semiquantitative spectrophotometric measurement and grade interfering substances into several categories. However, various analytical platforms may have different decision thresholds for various serum indices. Moreover, different systems might be different in their assay parameters and the degree of the interference of the specific interfering substance. Therefore, more efforts should be focused to standardize the mean of reporting the hemolysis index, especially when this important parameter is used for obtaining meaningful information on the quality of sample collection throughout collection centers and wards. Hemolysis is still one of the biggest challenges to the laboratory specialists. In case of hemolysis, laboratory personnel should always ask for new sample(s). In case new sample(s) can not be obtained, it is the responsibility of the laboratory specialist to communicate the problem with the physician responsible for the patient and seek for the solution to the best of the patient care

MENADŽERSKE VJEŠTINE U KONTEKSTU RJEŠAVANJA PROBLEMA U PODUZEĆU NAFTNI TERMINALI FEDERACIJE D.O.O. : Završni rad

Rješavanje problema predstavlja jedan od ključnih faktora menadžerske efikasnosti koji povlači za sobom i pitanje kvalitete vještina koje menadžeri posjeduju i koje koriste prilikom rješavanja problema. Međutim, rješavanje problema ne možemo promatrati s aspekta isključivo samo jedne vještine i s aspekta sličnih situacija. Suvremena se ekonomska teorija i praksa bavi tim pitanjima te su provedena brojna istraživanja na tu temu. S namjeromispitivanja kvalitete menadžerskih vještina kod djelatnika poduzeća Naftni terminali d.o.o. provedeno je istraživanja čiji su rezultati ukazali na veliku važnost povratne informacije, učinkovite komunikacije i slušanja prilikom rješavanja problema.Problem solving is one of the key managerial efficiency factors, which entails the question of the quality of skills that managers have and which they use when solving problems. However, solving problems cannot be observed from the aspect of just one skill and from the aspect of similar situations. Contemporary economic theory and practice deals with these issues and numerous researches on this topic have been carried out. With the aim of testing the quality of management skills at the employees of the company Naftni terminali d.o.o. a research has been carried out, whose results pointed out the great importance of feedback, effective communication and listening during problem solving

PROCES ODLUČIVANJA O KUPNJI NA TRŽIŠTU VELIKIH KUĆANSKIH APARATA : Završni rad

Ponašanje potrošača dinamičan je proces pod utjecajem velikog broja osobnih, društvenih i psiholoških čimbenika. Prilikom kupnje, kupac prolazi kroz pet faza procesa donošenja odluke- započinje spoznajom potrebe, a završava poslijekupovnim ponašanjem. Tržište hladnjaka dinamično se razvija prateći tehnološki razvoj i postojeće trendove. Uspjeh tvrtke na tom tržištu ovisi o razumijevanju potreba potrošača, omjeru cijene i kvalitete, aktivnoj interakciji sa kupcima u obliku poslijeprodajnih usluga, istraživanja zadovoljstva i sl.Consumer behaviour is dynamic process influenced by a numerous number of personal, social and psychological factors. While buying a product, consumers goes though five stages of decession making process- it begins with understanding a problem, and ends with after- sales behaviour. Refrigerators market dynamically develops with technological advancement and existing trends. The company's performance on the market is dependent on consumer understanding, cost and quality ratio, active consumer- side interaction, satisfication surveys, etc

MENADŽERSKE VJEŠTINE U KONTEKSTU RJEŠAVANJA PROBLEMA U PODUZEĆU NAFTNI TERMINALI FEDERACIJE D.O.O. : Završni rad

Rješavanje problema predstavlja jedan od ključnih faktora menadžerske efikasnosti koji povlači za sobom i pitanje kvalitete vještina koje menadžeri posjeduju i koje koriste prilikom rješavanja problema. Međutim, rješavanje problema ne možemo promatrati s aspekta isključivo samo jedne vještine i s aspekta sličnih situacija. Suvremena se ekonomska teorija i praksa bavi tim pitanjima te su provedena brojna istraživanja na tu temu. S namjeromispitivanja kvalitete menadžerskih vještina kod djelatnika poduzeća Naftni terminali d.o.o. provedeno je istraživanja čiji su rezultati ukazali na veliku važnost povratne informacije, učinkovite komunikacije i slušanja prilikom rješavanja problema.Problem solving is one of the key managerial efficiency factors, which entails the question of the quality of skills that managers have and which they use when solving problems. However, solving problems cannot be observed from the aspect of just one skill and from the aspect of similar situations. Contemporary economic theory and practice deals with these issues and numerous researches on this topic have been carried out. With the aim of testing the quality of management skills at the employees of the company Naftni terminali d.o.o. a research has been carried out, whose results pointed out the great importance of feedback, effective communication and listening during problem solving

Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots

Introduction: The aim of this paper is to present results of first two years of preanalytical external quality assessment (EQA) in Croatia. Materials and methods: This paper summarizes results from 6 rounds of preanalytical EQA during 2014-2016 in 161-175 Croatian laboratories (number ranged between cycles). EQA was designed as an online survey of the compliance with National recommendations for phlebotomy (NRP). Forty-seven questions in 5 categories are analyzed (materials and equipment, patient identification, patient preparation, sampling and storage). Additionally, preanalytical cases are presented. Overall performance scores (Question score (Qscore) for compliance with NRP and Case score (Cscore) for preanalytical cases) are calculated for each question/case as a proportion of laboratories with satisfactory procedure (x 100). Qscores and Cscores ? 70 were classified as acceptable (maximal score = 100). Results: In investigation of compliance with NRP, acceptable Qscores were obtained for 34/47 questions. The lowest scores were observed for the availability of sterile disposable tourniquets (Qscore = 15) and safe-sharp needles (Qscore = 34), obtaining patients address as an identifier (Qscore = 21), using glycolysis inhibitor tubes for glucose concentration measurement (Qscore = 21) and verification of manufacturers declarations on temperature and time of storage (Qscore = 31). There was no statistically significant difference in overall Qscore according to different categories of phlebotomy procedures (P = 0.284). The results of preanalytical cases showed acceptable Cscore values for all cases (89-96). Conclusion: First two years of preanalytical EQA showed good compliance with the NRP and excellent expertise in resolving complex preanalytical issues. Major critical spots are lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes