3/30/2020 Control4 2.5.3 Incorrect Time
This App is needed for configuration of the Control4 C4-KNX-SUAC Split Unit Gateway. The manufacturer of the split unit and the model of the remote are loaded into the ETS application. All SUG/U 1.41 in the project can be processed at the same time. The download into the device is done by normal ETS download. Www.control4.c 7 B 17-09-0 DH INTRODUCTION The Triad 8-Zone Power Amplifer delivers high-performance, reliability, and robust amplification in a compact form factor—providing the perfect solution for distributed audio systems. Low wake-from-standby time and high-resolution audio quality output make this amplifier worthy of any audio solution.
![]() Prothrombin Time and INR
The prothrombin time (PT or protime) is the actual time, measured in seconds, for an anticoagulated sample of plasma or whole blood to clot after it is added to a thromboplastin reagent. Thromboplastin is a mixture of tissue factor and calcium chloride. The PT assesses the coagulation factors of the extrinsic pathway (factors VII, X and V) and the factors in the common pathway (prothrombinase [a complex of activated factor X, activated factor V, and calcium which acts as the substrate for prothrombin], prothrombin, thrombin and fibrinogen). Physicians may request a PT to evaluate a patient:
The prothrombin time may be prolonged by deficiency of a single or multiple coagulation factors (Factor VII, Factor X, Factor V, Factor II or fibrinogen). The prothrombin time may also be prolonged due to the presence of a coagulation inhibitor such as a specific factor inhibitor or the lupus anticoagulant.
Warfarin acts in the liver by inhibiting the synthesis of vitamin K dependent clotting factors, which include factors II, VII, IX and X, and other proteins essential for the clotting process. Warfarin starts working in the liver within 24 hours but the maximum effect of a single dose may not be seen for 2-4 days. If administered on a daily basis, it usually takes 5-10 days for the warfarin level in the patient’s bloodstream to reach a steady state. Due to significant patient variability in response to warfarin therapy, the PT/INR must be closely monitored until a steady state has been reached. Typically, monitoring is performed daily, until several days after the therapeutic range is reached. Warfarin dosage changes may also be required in response to the PT/INR results. However, until the patient reaches a steady state, PT/INR fluctuations are expected. It may take up to one month for a physician to reach an optimal therapeutic level of warfarin for an individual patient.
Medications (such as antibiotics, birth control pills, estrogens, and other hormones) can also affect the action of warfarin in the liver, necessitating the evaluation of the possible effect of the added medication on the PT/INR. Any time a physician changes or adds medication to a patient’s regimen, the PT/INR should be checked to ensure that the patient maintains the proper level of anticoagulation. Alcohol, changes in diet, infections, liver disease, and other illnesses also can alter the patient’s PT/INR. Periodic monitoring, up to once every month, is necessary as long as the patient remains on anticoagulation therapy. More frequent routine monitoring may be required in some patients.
The American College of Chest Physicians and the National Heart Lung and Blood Institute revised their recommendations for intensity of warfarin therapy in 1995. An INR of 2.0 to 3.0 is recommended for all indications except mechanical prosthetic heart valves, for which an INR of 2.5 to 3.5 is recommended.
Recommended Therapeutic Ranges for Oral Anticoagulant Therapy
While the PT is a common test for evaluating the coagulation of the patient, differences in thromboplastin reagents have caused problems when comparing results across laboratories. This lack of comparability is of special concern for patients who may use more than one laboratory for PT testing. This has been due to varying sensitivities of different thromboplastin reagents used in the PT test. The World Health Organization has recommended a scheme for standardization of oral anticoagulant monitoring, based on expressing PT results in terms of an International Normalized Ratio (INR).
Various thromboplastin reagents have different sensitivities to the warfarin-induced reduction in coagulation factor synthesis. Since 1983 the International Normalized Ratio (INR) has been used to standardize PT results for patients on warfarin.The INR is a calculation designed to minimize the variability of PT results due to differences in sensitivity of thromboplastin reagents. With the INR, results from different laboratories utilizing different methodologies can be compared. Even with the INR, however, significant interlaboratory variations in INR results have been reported.
The international sensitivity index (ISI) reflects the sensitivity of the reagent as compared to an international standard. The manufacturer of the thromboplastin reagent determines the ISI by comparing each batch of reagent to a World Health Organization reference plasma and then assigning an ISI value to that lot of reagent. Reagent and instrument specific ISIs reduce the variability in INR results.The INR is calculated from the following formula:
INR = (PT patient / PT normal )ISI
• PT patient is the patient’s PT result expressed in seconds.
• PT normal is the laboratory’s geometric mean value for normal patients expressed in seconds.
Each laboratory must determine the normal range for the patients it serves in order to calculate an accurate INR. To find the normal range, a minimum of 20 unanticoagulated healthy patients evenly distributed between males and females should be tested.Emergency department or pre-op patients should not be used for the normal patient pool, because their blood may contain acute phase reactants that are elevated in times of stress and inflammation and can shorten the normal range.Testing should be completed over a period of several days to include intra-lab variabilities.
The INR result is the patient’s PT result in seconds divided by the geometric mean of PT result of the laboratory’s normal patients, as calculated by each laboratory. The geometric mean is a type of average that is different from the simple arithmetic average. It is calculated by multiplying all the PT results together (in this case, the 20 normal PT results) raised to the reciprocal of the number of results (in this case, 1/20). The geometric mean is used to avoid bias that may be caused by the inclusion of extremely high or low values. A calculator or software program is necessary to calculate geometric mean.
Because of the exponential nature of the equation for calculating the INR result, a lower ISI yields a more accurate result. The College of American Pathologists (CAP) Conference on Laboratory Monitoring of Anticoagulant Therapy held in 1998 recommended that an ISI between 0.9 and 1.7 be used, with the desired range being at the lower range of this scale. The following table illustrates the effect that the ISI can exert on the INR result.
Impact of ISI on INR Results
INR calculations are intended to yield identical INR results when a single specimen is tested by two laboratories; one using a more sensitive thromboplastin (yielding a higher PT result) and the other using a less sensitive thromboplastin (yielding a lower PT result).
It was previously believed that INR precision would be improved by using more sensitive thromboplastins (with lower ISI values). This has been shown to be incorrect. One intrinsic source of error in INR reporting is the fact that any imprecision in the PT measurement is amplified exponentially when the INR is calculated. This imprecision is greater for higher PT and INR values. Other problems contributing to lack of INR reproducibility include differences in sample collection or handling, and inherent biological variation in individuals. All of these limitations in the INR system are illustrated by a study in which parallel INR determinations were performed at three different hospitals within a single community, using split plasma samples from patients on long-term warfarin therapy. When the patient INR’s were classified as therapeutic, sub- or supratherapeutic, interlaboratory discrepancies were observed in 30% of paired samples, with the majority of discrepancies occurring with INR values greater than 3.0.
Laboratories must do extensive comparison studies before switching to a new lot of PT reagent or changing methodology to confirm accuracy of the assigned ISI value. The CAP Coagulation Resource Committee has published a checklist to assist laboratories with prevention of problems with the INR calculation.
One important practical issue related to the imprecision of the INR is the question of warfarin dose adjustment. Random variation of INR values may occur in a patient on stable oral anticoagulant dosage, as a result of both biological and analytic variation. This total random variation has been estimated at ~10%. This data has been used to evaluate whether a change in the INR represents clinically insignificant random variation, or a clinically relevant change requiring warfarin dose adjustment. It has been calculated that in a patient on fixed dose and steady state warfarin, a change in the INR is significant only if it is a change (increase or decrease) of greater than 0.28 times the previous INR value. This is detailed in the accompanying table.
In summary, the INR reporting system is a major improvement over PT values for standardization of oral anticoagulant monitoring, however clinicians should bear in mind that the system is not problem-free, and that apparent discrepancies may arise between different laboratories, and over time within a single patient.
A sensitive thromboplastin reagent for measuring prothrombin times (PT’s) is associated with improved precision in PT testing, as well as a wider therapeutic PT range, resulting in more reliable monitoring of oral anticoagulant therapy, and facilitation of dose adjustment.
There are many variables that can affect the PT/INR result outcome. In fact, preanalytical variables account for up to 64% of all errors in PT/INR testing.One of the most important factors is the anticoagulant used in drawing the blood specimen. The World Health Organization and NCCLS guidelines recommend the use of 3.2% buffered citrate.The evacuated tube must be completely filled (at least 90% full) to maintain the proper anticoagulant-to-blood ratio. It is best to avoid traumatic venipunctures to minimize the release of tissue factor, which can initiate coagulation.Although not critical for coagulation specimens, it is always good practice to release the tourniquet as soon as possible. The blood sample must be centrifuged for sufficient time (10 minutes) to create platelet-poor plasma as the presence of platelets in the specimen can shorten clotting times. Specimens for PT testing may be stored at room temperature and will yield valid results for specimens stored up to 24 hours, provided that the collection tube remains unopened. If testing cannot be performed within this time period, the platelet-poor plasma should be frozen.
Reference range is 11.4-14.2 seconds. Critical value is an INR >5.0 i
Specimen requirement is one light blue top (sodium citrate) tube of blood drawn after a 5 mL red top discard tube.
Sort by: NameDeveloperPriceControl4 Split Unit Gateway by Control4 Corporate
Version 1.0.27
This App is needed for configuration of the Control4 C4-KNX-SUAC Split Unit Gateway. The manufacturer of the split unit and the model of the remote are loaded into the ETS application.
All SUG/U 1.41 in the project can be processed at the same time. The download into the device is done by normal ETS download.
Price
VAT exclusive
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Control4 Update Copy Convert by Control4 Corporate
Version 1.0.85
The app provides a series of useful functions for device configuration (parameters and Group Addresses) in an ETS project.
The functions are:
Update - Changes the application program to a later or earlier version while retaining current configurations. Convert - Transfers / adopts a configuration from an identical or compatible source device. Channel Copy - Copies a channel configuration to other channels on a multi-channel device. Channel Exchange - Exchanges configurations between two channels on a multi-channel device. Import / Export - Saves and reads device configurations as external files.
Price
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Csv Importer by Neuberger Gebäudeautomation GmbH
Version 1.0.0
The Csv Importer (DCA) enables a simple and effective configuration of the KNX TP communication module CM8400 from Neuberger Gebäudeautomation GmbH.
The configuration can be exported or imported into a CSV file. Via the CSV file, the configuration can be synchronised with the AS project in PMC Studio or re-imported in another project. Thus a laborious configuration by hand is spared.
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DALI-Gateway KNX plus by Theben AG
Version 1.1.0.0
Device Configuration App (DCA) for Theben DALI-Gateway KNX plus
Order number: 9070929 Application: DALI-Gateway KNX plus (v2.0) New features: Coloured light control including device type 8 ECGs: Colour temperature (DT-8 Sub-Type TC) XY colour (DT-8 Sub-Type XY) RGB (DT-8 Sub-Type RGBWAF) HSV (DT-8 Sub-Type RGBWAF) RGBW (DT-8 Sub-Type RGBWAF) HSVW (DT-8 Sub-Type RGBWAF)
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DALIControl e64 by IPAS GmbH
Version 1.1.0.0
Device Configuration App (DCA) for IPAS DALIControl e64
Order No.: 4101-145-01 Application: DaliControl e64-01-0310
Coloured light control including device type 8 ECGs:
Colour temperature (DT-8 Sub-Type TC) XY colour (DT-8 Sub-Type XY) RGB (DT-8 Sub-Type RGBWAF) HSV (DT-8 Sub-Type RGBWAF) RGBW (DT-8 Sub-Type RGBWAF) HSVW (DT-8 Sub-Type RGBWAF)
Price
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