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Shorter product innovation cycles, high variant products, and demand fluctuation, as well as equipment life cycles and technology life cycles force manufacturing companies to regularly change their manufacturing system. In order to address this challenge, an efficient and structured change management is required. As change causes and factory elements are connected via a complex network of relations and flows, an essential step in change management is the evaluation of considered adjustments with regard to their effects on the current production system. Depending on the context of the application, change impact analysis must process specific inputs and deliver different results. Current approaches, however, each focus only on selected aspects of the versatility of change effects. To address this challenge, this paper presents a modular approach for the individual design of change impact analysis.

To compare a modified pulmonary artery catheter (PAC) and pulse-contour analysis by the PiCCO (Pulsion Medical Systems, Munich, Germany) system for continuous assessment of cardiac output in patients with septic shock. In addition, to assess the relationships between an index of global end-diastolic volume (GEDV) derived by the PiCCO system with traditional PAC-derived indicators of filling: central venous pressure; pulmonary artery occlusion pressure; and right ventricular end-diastolic volume (RVEDV). Prospective cohort study. Surgical intensive care unit of a university hospital. 14 patients with septic shock. None. A significant correlation was found between continuous cardiac output by PAC (CCOPAC) and by pulse-contour analysis (r 2 = 0.714, p

We consider optimal control problems for systems described by stochastic differential equations with delay. We state conditions for certain classes of such systems under which the stochastic control problems become finite-dimensional. These conditions are illustrated with three applications. First, we solve some linear quadratic problems with delay. Then we find the optimal consumption rate in a financial market with delay. Finally, we solve explicitly a deterministic fluid problem with delay which arises from admission control in ATM communication networks.

Ziel dieser Untersuchung war ein Vergleich von Cisatracurium und Pancuronium hinsichtlich Hamodynamik und neuromuskularer Wirkungen bei der Narkoseeinleitung β-blockierter Koronarbypasspatienten (ASA III, gute bis masig eingeschrankte LV-Funktion). Doppelblind prospektive Untersuchung an 60 Patienten: Jeweils 20 Patienten erhielten bei Einleitung einer Sufentanil/Midazolam/Etomidatanasthesie zur Muskelrelaxation Pancuronium 0,1 mg/kg (Gruppe P) oder Cisatracurium (0,1 mg/kg: Gruppe C2; 0,2 mg/kg: Gruppe C4). Die Hamodynamik wurde mittels EKG, invasiver arterieller Druckmessung und pulmonalarteriellem Katheter, die neuromuskulare Ubertragung mittels Elektromyographie gemessen. Die Herzfrequenz fiel signifikant ab in Gruppe C2 von 62,7±9,3 min−1 vor Einleitung auf 50,2±6,8 min−1 3 min nach Einleitung, in Gruppe C4 von 63,8±9,3 auf 54,3±11 min−1, blieb dagegen in Gruppe P (63±19 und 62,4±13,2 min−1) unverandert. Dieser Unterschied blieb signifikant bis 60 min nach Einleitung. Die Anschlagszeit betrug 5,2±3,4 min in Gruppe P, 6,4±2,1 min in Gruppe C2 und 2,9±1,2 min in Gruppe C4. Schlussfolgerung. Bei Narkoseeinleitung koronarchirurgischer Patienten mit hochdosierten Opioiden muss bei Anwendung von Cisatracurium im Gegensatz zu Pancuronium mit dem Auftreten einer interventionsbedurftigen Bradykardie gerechnet werden.

Commercially available semi-continuous cardiac output (SCCO) monitoring systems are based on the pulsed warm thermodilution technique. There is evidence that SCCO fails to correlate with standard intermittent bolus cardiac output (ICO) in clinical situations with thermal instability in the pulmonary artery. Furthermore, ventilation may potentially influence thermodilution measurements by enhanced respiratory variations in pulmonary artery blood temperature and by cyclic changes in venous return. Therefore, we evaluated the correlation, accuracy and precision of SCCO versus ICO measurements before and after extubation.Prospective cohort study.Intensive care unit (ICU) of a university hospital.22 cardiac surgical ICU patients.None.SCCO and ICO data were obtained at nine postoperative time points while the patients were on controlled mechanical ventilation. Further sets of measurements were taken during the weaning phase 20 min before extubation, and 5 min, 20 min and 1 h after extubation. SCCO and ICO measurements yielded 286 data pairs with a range of 1.8-9.9 l/min for SCCO and 1.9-9.8 l/min for ICO. The correlation between SCCO and ICO was highly significant (r = 0.92; p0.01), accompanied by a bias of -0.052 l/min and a precision of 0.56 l/min. Correlation, accuracy and precision were not influenced by the mode of respiration.Our results demonstrate excellent correlation, accuracy and precision between SCCO and ICO measurements in postoperative cardiac surgical ICU patients. We conclude that SCCO monitoring offers a reliable clinical method of cardiac output monitoring in ICU patients following cardiac surgery.