Mallipohjainen järjestelmäintegraatio tuotannonohjausjärjestelmille

Application integration becomes more complex as software becomes more advanced. This thesis investigates the applicability of model-driven application integration methods to the software integration of manufacturing execution systems (MES). The goal was to create a code generator that uses models to generate a working program that transfers data from a MES to another information system. The focus of the implementation was on generality. First, past research of MES was reviewed, the means to integrate it with other information systems were investigated, and the international standard ISA-95 and B2MML as well as model-driven engineering (MDE) were revised. Next, requirements were defined for the system. The requirements were divided into user and developer requirements. A suitable design for a code generator was introduced and, after that, implemented and experimented. The experiment was conducted by reading production data from the database of MES-like Delfoi Planner and then transforming that data to B2MML-styled XML-schema. The experiment verified that the code generator functioned as intended. However, compared to a manually created program, the generated code was longer and less efficient. It should also be considered that adopting MDE methods takes time. Therefore, for MDE to be better than traditional programming, the code generator has to be used multiple times in order to achieve the benefits and the systems cannot be too time-critical either. Based on the findings, it can be said, that model-driven application integration methods can be used to integrate MESs, but there are restrictions.Järjestelmäintegraatio vaikeutuu ohjelmien monimutkaistuessa. Tässä työssä tutkitaan mallipohjaisten järjestelmäintegraatiometodien soveltuvuutta tuotannonohjausjärjestelmille (MES). Tavoitteena oli muodostaa koodigeneraattori, joka käyttää malleja luodakseen toimivan ohjelman, joka siirtää tietoa MES-järjestelmästä johonkin toiseen tietojärjestelmään. Toteutuksessa keskityttiin yleistettävyyteen. Aluksi työssä käytiin läpi aikaisempaa tutkimusta MES-järjestelmistä ja mahdollisuuksista integroida niitä toisiin informaatiojärjestelmiin. Lisäksi otettiiin selvää kansainvälisestä ISA-95 standardista ja B2MML:sta sekä mallipohjaisesta tekniikasta (MDE). Tämän jälkeen järjestelmälle määriteltiin vaatimukset, jotka jaettiin käyttäjän ja kehittäjän vaatimuksiin. Koodigeneraattorista tehtiin ehdot täyttävä suunnitelma, joka toteutettiin ja jolla suoritettiin kokeita. Koe toteutettiin lukemalla tuotantodataa MES:n kaltaisen Delfoi Plannerin tietokannasta, jonka jälkeen data muutettiin B2MML tyyliä noudattavaan XML-schema muotoon. Kokeet osoittivat, että koodigeneraattori toimi kuten toivottiin. Kuitenkin havaittiin, että verrattuna manuaalisesti toteutettuun ohjelmaan, luotu ohjelma ei ollut yhtä tehokas ja lisäksi se oli pidempi. Huomattiin myös, että MDE-metodien käyttöönotto vie paljon aikaa. Jotta MDE olisi perinteistä ohjelmointia parempi vaihtoehto, sitä pitäisi käyttää useita kertoja ja sillä luotu järjestelmä ei saisi olla liian aikariippuvainen. Havaintojen perusteella voidaan sanoa, että mallipohjaisia järjestelmäintegraatiometodeja voidaan käyttää MES-järjestelmien integrointiin, mutta sille on rajoituksia

Impact of cardiac surgery and neurosurgery patients on variation in severity-adjusted resource use in intensive care units

Publisher Copyright: © 2022Purpose: The resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use. Methods: Secondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015–2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery. Results: Cardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15–19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased. Conclusions: Cardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.Peer reviewe

Variation in Severity-Adjusted Resource use and Outcome for Neurosurgical Emergencies in the Intensive Care Unit.

BACKGROUND The correlation between the standardized resource use ratio (SRUR) and standardized hospital mortality ratio (SMR) for neurosurgical emergencies is not known. We studied SRUR and SMR and the factors affecting these in patients with traumatic brain injury (TBI), nontraumatic intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). METHODS We extracted data of patients treated in six university hospitals in three countries (2015-2017). Resource use was measured as SRUR based on purchasing power parity-adjusted direct costs and either intensive care unit (ICU) length of stay (costSRURlength of stay) or daily Therapeutic Intervention Scoring System scores (costSRURTherapeutic Intervention Scoring System). Five a priori defined variables reflecting differences in structure and organization between the ICUs were used as explanatory variables in bivariable models, separately for the included neurosurgical diseases. RESULTS Out of 28,363 emergency patients treated in six ICUs, 6,162 patients (22%) were admitted with a neurosurgical emergency (41% nontraumatic ICH, 23% SAH, 13% multitrauma TBI, and 23% isolated TBI). The mean costs for neurosurgical admissions were higher than for nonneurosurgical admissions, and the neurosurgical admissions corresponded to 23.6-26.0% of all direct costs related to ICU emergency admissions. A higher physician-to-bed ratio was associated with lower SMRs in the nonneurosurgical admissions but not in the neurosurgical admissions. In patients with nontraumatic ICH, lower costSRURs were associated with higher SMRs. In the bivariable models, independent organization of an ICU was associated with lower costSRURs in patients with nontraumatic ICH and isolated/multitrauma TBI but with higher SMRs in patients with nontraumatic ICH. A higher physician-to-bed ratio was associated with higher costSRURs for patients with SAH. Larger units had higher SMRs for patients with nontraumatic ICH and isolated TBI. None of the ICU-related factors were associated with costSRURs in nonneurosurgical emergency admissions. CONCLUSIONS Neurosurgical emergencies constitute a major proportion of all emergency ICU admissions. A lower SRUR was associated with higher SMR in patients with nontraumatic ICH but not for the other diagnoses. Different organizational and structural factors seemed to affect resource use for the neurosurgical patients compared with nonneurosurgical patients. This emphasizes the importance of case-mix adjustment when benchmarking resource use and outcomes

Mortality prediction in intensive care units including premorbid functional status improved performance and internal validity

Objective: Prognostic models are key for benchmarking intensive care units (ICUs). They require up-to-date predictors and should report transportability properties for reliable predictions. We developed and validated an in-hospital mortality risk prediction model to facilitate benchmarking, quality assurance, and health economics evaluation. Study Design and Setting: We retrieved data from the database of an international (Finland, Estonia, Switzerland) multicenter ICU cohort study from 2015 to 2017. We used a hierarchical logistic regression model that included age, a modified Simplified Acute Physiology Score-II, admission type, premorbid functional status, and diagnosis as grouping variable. We used pooled and meta-analytic cross-validation approaches to assess temporal and geographical transportability. Results: We included 61,224 patients treated in the ICU (hospital mortality 10.6%). The developed prediction model had an area under the receiver operating characteristic curve 0.886, 95% confidence interval (CI) 0.882-0.890; a calibration slope 1.01, 95% CI (0.99-1.03); a mean calibration -0.004, 95% CI (-0.035 to 0.027). Although the model showed very good internal validity and geographic discrimination transportability, we found substantial heterogeneity of performance measures between ICUs (I-squared: 53.4-84.7%). Conclusion: A novel framework evaluating the performance of our prediction model provided key information to judge the validity of our model and its adaptation for future use. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ( http:// creativecommons.org/ licenses/ by/ 4.0/ )Peer reviewe

Variation in severity-adjusted resource use and outcome in intensive care units

Purpose Intensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure. Methods Data of 207,131 patients treated in 2008-2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015-2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015-2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models. Results SMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5-5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR. Conclusion The wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.Peer reviewe

Acute hormonal findings after aneurysmal subarachnoid hemorrhage - report from a single center

Purpose: The aim was to assess anterior pituitary hormone levels during the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and analyze the possible association with the clinical condition and outcome. Material and methods: Forty patients with aSAH whose aneurysm was secured by endovascular coiling were enrolled. Basal secretions of cortisol, testosterone, luteinizing hormone (LH), prolactin (PRL), and sex hormone binding globulin (SHBG) levels were measured up to 14 days after the incident. Results: The main finding was that hypocortisolism was rare whereas testosterone deficiency was common in male patients. Furthermore, various other hormone deviations were frequent and there was wide interindividual variability. We found no association between delayed cerebral ischemia (DCI), outcome of the patients or aneurysm location, and hormone abnormalities, while both Hunt & Hess and Fisher grade were associated with low PRL levels. Hunt & Hess 5 was associated with low PRL concentration when compared to grades 1 (OR = 4.81, 95% CI 1.15-20.14, p = 0.03), 3 (OR 7.73, 95% CI 1.33-45.01, p = 0.02), and 4 (OR = 6.86 95% CI 1.28-26.83, p = 0.02). Fisher grade 4 was associated with low PRL concentration when compared to grades 3 (OR 3.37, 95% CI 1.06-10.73, p = 0.03) and 2 (OR 9.71, 95% CI 1.22-77.10, p = 0.04). Conclusion: Deviations from normal and huge interindividual differences are common in hormone levels during the acute phase of aSAH. Routine assessment of anterior pituitary function in the acute phase of aSAH is not warranted. During the follow-up in the outpatient clinic, hormone concentrations were not measured, which would have brought a more long-term perspective into our findings.Peer reviewe

Cerebral autoregulation after aneurysmal subarachnoid haemorrhage. A preliminary study comparing dexmedetomidine to propofol and/or midazolam

Abstract Background Cerebral autoregulation is often impaired after aneurysmal subarachnoid haemorrhage (aSAH). Dexmedetomidine is being increasingly used, but its effects on cerebral autoregulation in patients with aSAH have not been studied before. Dexmedetomidine could be a useful sedative in patients with aSAH as it enables neurological assessment during the infusion. The aim of this preliminary study was to compare the effects of dexmedetomidine on dynamic and static cerebral autoregulation with propofol and/or midazolam in patients with aSAH. Methods Ten patients were recruited. Dynamic and static cerebral autoregulation were assessed using transcranial Doppler ultrasound during propofol and/or midazolam infusion and then during three increasing doses of dexmedetomidine infusion (0.7, 1.0 and 1.4 µg/kg/h). Transient hyperaemic response ratio (THRR) and strength of autoregulation (SA) were calculated to assess dynamic cerebral autoregulation. Static rate of autoregulation (sRoR)% was calculated by using noradrenaline infusion to increase the mean arterial pressure 20 mmHg above the baseline. Results Data from 9 patients were analysed. Compared to baseline, we found no statistically significant changes in THRR or sROR%. THRR was (mean±SD) 1.20 ±0.14, 1.17±0.13(p=0.93), 1.14±0.09 (p=0.72) and 1.19±0.18 (p=1.0) and sROR% was 150.89±84.37, 75.22±27.75 (p=0.08), 128.25±58.35 (p=0.84) and 104.82±36.92 (p=0.42) at baseline and during 0.7, 1.0 and 1.4 µg/kg/h dexmedetomidine infusion, respectively. Dynamic SA was significantly reduced after 1.0 µg/kg/h dexmedetomidine (p=0.02). Conclusions Compared to propofol and/or midazolam, dexmedetomidine did not alter static cerebral autoregulation in aSAH patients, whereas a significant change was observed in dynamic SA. Further and larger studies with dexmedetomidine in aSAH patients are warranted.Peer reviewe

PELAKSANAAN PENYIDIKAN TINDAK PIDANA CUKAI ROKOK OLEH SATUAN RESERSE KRIMINAL POLRES SOLOK

Tindak pidana merupakan gejala sosial yang akan dihadapi masyarakat bahkan negara. Salah satunya adalah tindak pidana cukai yaitu penyelewengan cukai. Mengenai tindak pidana Cukai ini telah diatur dalam Undang-Undang Nomor 39 Tahun 2007 tentang Cukai. Pada Pasal 1 Undang-Undang Nomor 39 tahun 2007 pengertian cukai adalah “pungutan Negara yang dikenakan terhadap barang-barang tertentu yang mempunyai sifat atau karakteristik yang ditetapkan dalam undang-undang ini”.Dalam hal ini cukai merupakan suatu pendapatan negara yang cukup besar dalam pembangunan nasional yang mana dalam pelanggarannya sangat merugikan negara. Untuk itu perlu adanya penanggulangan terhadap tindak pidana cukai yang dilakukan oleh penegak hukum yaitu dari pihak kepolisian sehingga terciptanya pembangunan nasional yang lancar. Permasalahan yang dibahas dalam Skripsi ini adalah (a) pelaksanaan penyidikan tindak pidana cukairokok, (b) kendala – kendala yang dihadapi oleh penyidik dalam pelaksanaan penyidikan tindak pidana cukai rokok dan (c) upaya yang dilakukan oleh penyidik dalam mengatasi kendala – kendala dalam pelaksanaan penyidikan tindak pidana cukai rokok oleh Satreskrim Polres Solok. Penelitian ini merupakan penelitian yang bersifat deskriptif, yaitu suatu penelitian yang menggambarkan atau menjelaskan dan memaparkan hasil dari penelitian secara deskriptif. Metode pendekatan yang digunakan dalam penelitian ini adalah metode pendekatan secara yudiris sosiologis. Sumber data adalah data primer dan data sekunder yang diperoleh dilapangan.Upaya – upaya yang dilakukan penyidik dalam mengatasi kendala – kendala yang dihadapi dalam penyidikan tindak pidana cukai rokok oleh Satreskrim Polres Solok, (a) pelatihan khusus bagi penyidik dalam menghadapi kasus tindak pidana cukai rokok. (b) memberikan penghargaan dan memberikan perlindungan hukum terhadap saksi yang terlibat dalam penyidikan tindak pidana cukai rokok. Kata kunci: Penyelewengan Cukai Roko

Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study

Repetitive transcranial magnetic stimulation (rTMS) has shown variable effect on tinnitus. A prospective, randomized 6-month follow-up study on parallel groups was conducted to compare the effects of neuronavigated rTMS to non-navigated rTMS in chronic tinnitus. Forty patients (20 men, 20 women), mean age of 52.9 years (standard deviation [SD] = 11.7), with a mean tinnitus duration of 5.8 years (SD = 3.2) and a mean tinnitus intensity of 62.2/100 (SD = 12.8) on Visual Analog Scale (VAS 0–100) participated. Patients received 10 sessions of 1-Hz rTMS to the left temporal area overlying auditory cortex with or without neuronavigation. The main outcome measures were VAS scores for tinnitus intensity, annoyance, and distress, and Tinnitus Handicap Inventory (THI) immediately and at 1, 3, and 6 months after treatment. The mean tinnitus intensity (hierarchical linear mixed model: F3 = 7.34, p = .0006), annoyance (F3 = 4.45, p = .0093), distress (F3 = 5.04, p = .0051), and THI scores (F4 = 17.30, p F3 = 2.96, p = .0451) favoring the non-navigated rTMS. Reduction in THI scores persisted for up to 6 months in both groups. Cohen’s d for tinnitus intensity ranged between 0.33 and 0.47 in navigated rTMS and between 0.55 and 1.07 in non-navigated rTMS. The responder rates for VAS or THI ranged between 35% and 85% with no differences between groups (p = .054–1.0). In conclusion, rTMS was effective for chronic tinnitus, but the method of coil localization was not a critical factor for the treatment outcome.</p