This research presents a new multivariate statistical approach to downscale hydroclimatic variables associated with global climate signals, from low-resolution Global Climate Models (GCMs) to high-resolution grids that are appropriate for regional and local hydrologic analysis. The approach uses Principal Component Analysis (PCA) and Multichannel Singular Spectrum Analysis (MSSA) to: 1) evaluate significant variation modes among global climate signals and spatially distributed hydroclimatic variables within certain spatial domain; 2) downscale the GCMs' projections of the hydroclimatic variables using these significant modes of variation and 3) extend the results to other correlated variables in the space domain. The approach is applied to the Colorado River Basin to determine common oscillations among observed precipitation and temperature patterns in the basin and the global climate signals El Nino Southern Oscillation (ENSO) and Pacific Decadal Oscillation (PDO). These common oscillations serve as a basis to perform the downscaling of ENSO-related precipitation and temperature projections from GCMs, using a new gap-filling algorithm based on MSSA. The analysis of spatial and temporal correlations between observed precipitation, temperature and vegetation activity (represented by the Normalized Difference Vegetation Index, NDVI) is used to extend the downscaling of precipitation to vegetation responses in ten ecoregions within the basin. Results show significant common oscillations of five and 15-year between ENSO, PDO and annual precipitation in the basin, with wetter years during common ENSO and PDO positive phases and dryer years during common negative phases. Precipitation also shows an increase in variability in the last 20 years of record. Highly correlated responses between seasonally detrended NDVI and precipitation were also identified in each ecoregion, with distinctive delays in vegetation response ranging from one month in the southern deserts (in the fringe of the monsoon precipitation regime), to two months in the mid latitudes and three months to the north, affected by seasonal precipitation. These results were used to downscale precipitation and temperature from two GCMs that perform well in the basin and have a distinctive ENSO-like signal (MPI-ECHAM5 and UKMO-HADCM3) and to extend the downscaling to estimate vegetation responses based on their significant correlations with precipitation.

Systemische Infektionen mit S. aureus (MSSA und MRSA) und Infektionen des Gefäßzugangs bei HD-Patienten sind eine der wichtigsten Ursachen für Morbidität und Mortalität in dieser speziellen Population. Infektionsrisikos stellen die zunehmende Verwendung von Fremdkörpern, wie Katheter und Graft als Gefäßzugänge, sowie die intensivmedizinische Behandlung bei älteren und multimorbiden Patienten dar. Unter den bakteriell bedingten Infektionen bleiben Staphylokokken der am häufigsten nachgewiesene Stamm. Mit dem zunehmenden Gebrauch von Vancomycin zur Behandlung von MSSA-Infektionen hat das Vorkommen von MRSA zugenommen. Dies macht die Entwicklung von alternativen Antibiotikaregimen nötig, die eine Selektion von MRSA-Spezies verhindern. Unter dieser Überlegung wurde auf die Behandlung mit Vancomycin bei Zugangs-bezogenen Infektionen verzichtet. Es wurde im Jahr 2000 durch ein Standardregime bestehend aus Flucloxacillin und Rifampicin ersetzt. Mithilfe eines Screeningprogramms wurde nach MSSA- (n=88) und MRSA- (n=1) Kolonisationen gesucht. Dies gelang mit Hilfe von Querschnitts-Screenings und Indikations-Screeninguntersuchungen bei Aufnahme über den Zeitraum von 2000 bis 2010. Eine Besiedlung mit MRSA wurde bei nur einem Patienten während des 10-Jahres-Screenings registriert. Die gefundenen MSSA-Kolonisationen bei HD-Patienten beeinflussten die Morbidität und Mortalität nicht. Die Anzahl an HD-Patienten mit MSSA-Kolonisation nahm während des Beobachtungszeitraums von zehn Jahren ab Behandlungen mit dem Vancomycin-freien Regime waren generell erfolgreich und resultierten in einem Rückgang der klinischen und laborativen Infektionsmarker und/oder negativen Blutkulturen. Es konnte gezeigt werden, dass mit dem Gebrauch von vancomycinfreien Antibiotikaregimen ein erfolgreiches Management von Staphylokokkus-assoziierten Zugangsinfektionen bei HD-Patienten möglich ist.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-23T14:45:23Z No. of bitstreams: 2 Dissertação - Lorrane Souza Neves - 2016.pdf: 2835676 bytes, checksum: 7a1084f234c75094d7359ec814edb8b2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-23T14:45:48Z (GMT) No. of bitstreams: 2 Dissertação - Lorrane Souza Neves - 2016.pdf: 2835676 bytes, checksum: 7a1084f234c75094d7359ec814edb8b2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-23T14:45:48Z (GMT). No. of bitstreams: 2 Dissertação - Lorrane Souza Neves - 2016.pdf: 2835676 bytes, checksum: 7a1084f234c75094d7359ec814edb8b2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-07-15 / Staphylococcus aureus is an important agent of health care and community infections. Environmental surfaces, especially those in frequent contact with the hands, can serve as reservoirs of microorganisms, working as fomites in microbial spread. In the public transportation system, contact surfaces with hands can act as transmission vehicles, assisting the dispersion of S. aureus in the community. The aim of this study was to determine the prevalence of S. aureus and methicillin resistant S. aureus (MRSA) in buses, terminals and platforms of a larger route of the public transportation system in the city of Goiânia-GO, to determine the susceptibility and virulence profiles and assess the genetic similarity among S. aureus isolates. We collected 852 swabs fromhandrails of buses and ratchets of platforms and terminals that compose the East-West line. The isolation of staphylococci was done by standard techniques and species identification by detection of the femA gene. S. aureus identified were submitted to antimicrobial susceptibility testing, conventional PCR for detection of mecA and lukS-Fgenes, multiplex PCR to detect virulence factors genes, SCCmec typing and PFGE to assess the genetic similarity among strains. The contamination prevalence of handrails and ratchets by S. aureus was 17.7% (151/852). MRSA was detected in 0,5% of samples. The phenotype known as iMLSB was detected in 41.0% (62/151) of the isolates. Several virulence profiles were detected in 43 (28.5%)isolates, PFGE analysis revealed extensive genetic diversity of circulating strains, including MRSA strains similar to USA300 and USA800. The results suggest that S. aureus and MRSA strains, showing different susceptibility and virulence profiles are circulating in the community. They may be transmitted between individuals through fomites, putting the user population of the service at risk. / Staphylococcus aureus é um importante agente de infecções relacionadas com a assistência à saúde e à comunidade. As superfícies ambientais, especialmente as que estão em frequente contato com as mãos, podem atuar como reservatórios de microorganismos, funcionando como fômites na disseminação microbiana. No sistema de transporte coletivo, superfícies de contato com as mãos podem operar como veículos de transmissão, auxiliando na dispersão de S. aureus na comunidade. O objetivo do estudo foi determinar a prevalência de S. aureus e S. aureus resistente a meticilina (MRSA) em ônibus, terminais e plataformas da maior linha de carregamento do sistema de transporte público do município de Goiânia-GO, analisar o perfil de suscetibilidade e de virulência e avaliar a similaridade genética entre os S. aureus isolados. Foram coletados 852 swabs das barras fixas verticais e horizontais dos 90 ônibus circulantes na linha Leste-Oeste, além das catracas de todas as plataformas e terminais ao longo da linha. O isolamento de estafilococos foi realizado por técnicas padronizadas e a identificação da espécie, pela detecção do gene femA. Os S. aureus identificados foram submetidos a testes de suscetibilidade a antimicrobianos, PCR convencional para detecção dos genes Meca e lukS-F, multiplex PCR para detecção de genes para fatores de virulência, tipagem de SCCmec e PFGE. A prevalência de contaminação das barras fixas e das catracas por S. aureus foi de 17,7% (151/852). MRSA foi detectado em 0,5% das amostras. O fenótipo conhecido como iMLSB foi detectado em 41,0% (62/151) dos isolados. Vários perfis de virulência foram detectados em 43 isolados (28,5%). A análise de PFGE revelou grande diversidade genética de cepas circulantes, inclusive MRSA semelhante ao USA300 e outro ao USA800. Os resultados sugerem que os S. aureus e MRSA, possuindo perfis de suscetibilidade e virulência diferenciados, estão inseridos na comunidade, podendo ser transmitidos entre indivíduos por intermédio de fômites, colocando a população usuária do serviço em risco.

Um dos principais objetivos da análise de componentes principais consiste em reduzir o número de variáveis observadas em um conjunto de variáveis não correlacionadas, fornecendo ao pesquisador subsídios para entender a variabilidade e a estrutura de correlação dos dados observados com uma menor quantidade de variáveis não correlacionadas chamadas de componentes principais. A técnica é muito simples e amplamente utilizada em diversos estudos de diferentes áreas. Para construção, medimos a relação linear entre as variáveis observadas pela matriz de covariância ou pela matriz de correlação. Entretanto, as matrizes de covariância e de correlação podem deixar de capturar importante informações para dados correlacionados sequencialmente no tempo, autocorrelacionados, desperdiçando parte importante dos dados para interpretação das componentes. Neste trabalho, estudamos a técnica de análise de componentes principais que torna possível a interpretação ou análise da estrutura de autocorrelação dos dados observados. Para isso, exploramos a técnica de análise de componentes principais para o domínio da frequência que fornece para dados autocorrelacionados um resultado mais específico e detalhado do que a técnica de componentes principais clássica. Pelos métodos SSA (Singular Spectrum Analysis) e MSSA (Multichannel Singular Spectrum Analysis), a análise de componentes principais é baseada na correlação no tempo e entre as diferentes variáveis observadas. Essas técnicas são muito utilizadas para dados atmosféricos na identificação de padrões, tais como tendência e periodicidade. / The main objective of principal component analysis (PCA) is to reduce the number of variables in a small uncorrelated data sets, providing support and helping researcher understand the variation present in all the original variables with small uncorrelated amount of variables, called components. The principal components analysis is very simple and frequently used in several areas. For its construction, the components are calculated through covariance matrix. However, the covariance matrix does not capture the autocorrelation information, wasting important information about data sets. In this research, we present some techniques related to principal component analysis, considering autocorrelation information. However, we explore the principal component analysis in the domain frequency, providing more accurate and detailed results than classical component analysis time series case. In subsequent method SSA (Singular Spectrum Analysis) and MSSA (Multichannel Singular Spectrum Analysis), we study the principal component analysis considering relationship between locations and time points. These techniques are broadly used for atmospheric data sets to identify important characteristics and patterns, such as tendency and periodicity.

Um dos principais objetivos da análise de componentes principais consiste em reduzir o número de variáveis observadas em um conjunto de variáveis não correlacionadas, fornecendo ao pesquisador subsídios para entender a variabilidade e a estrutura de correlação dos dados observados com uma menor quantidade de variáveis não correlacionadas chamadas de componentes principais. A técnica é muito simples e amplamente utilizada em diversos estudos de diferentes áreas. Para construção, medimos a relação linear entre as variáveis observadas pela matriz de covariância ou pela matriz de correlação. Entretanto, as matrizes de covariância e de correlação podem deixar de capturar importante informações para dados correlacionados sequencialmente no tempo, autocorrelacionados, desperdiçando parte importante dos dados para interpretação das componentes. Neste trabalho, estudamos a técnica de análise de componentes principais que torna possível a interpretação ou análise da estrutura de autocorrelação dos dados observados. Para isso, exploramos a técnica de análise de componentes principais para o domínio da frequência que fornece para dados autocorrelacionados um resultado mais específico e detalhado do que a técnica de componentes principais clássica. Pelos métodos SSA (Singular Spectrum Analysis) e MSSA (Multichannel Singular Spectrum Analysis), a análise de componentes principais é baseada na correlação no tempo e entre as diferentes variáveis observadas. Essas técnicas são muito utilizadas para dados atmosféricos na identificação de padrões, tais como tendência e periodicidade. / The main objective of principal component analysis (PCA) is to reduce the number of variables in a small uncorrelated data sets, providing support and helping researcher understand the variation present in all the original variables with small uncorrelated amount of variables, called components. The principal components analysis is very simple and frequently used in several areas. For its construction, the components are calculated through covariance matrix. However, the covariance matrix does not capture the autocorrelation information, wasting important information about data sets. In this research, we present some techniques related to principal component analysis, considering autocorrelation information. However, we explore the principal component analysis in the domain frequency, providing more accurate and detailed results than classical component analysis time series case. In subsequent method SSA (Singular Spectrum Analysis) and MSSA (Multichannel Singular Spectrum Analysis), we study the principal component analysis considering relationship between locations and time points. These techniques are broadly used for atmospheric data sets to identify important characteristics and patterns, such as tendency and periodicity.

Systemische Infektionen mit S. aureus (MSSA und MRSA) und Infektionen des Gefäßzugangs bei HD-Patienten sind eine der wichtigsten Ursachen für Morbidität und Mortalität in dieser speziellen Population. Infektionsrisikos stellen die zunehmende Verwendung von Fremdkörpern, wie Katheter und Graft als Gefäßzugänge, sowie die intensivmedizinische Behandlung bei älteren und multimorbiden Patienten dar. Unter den bakteriell bedingten Infektionen bleiben Staphylokokken der am häufigsten nachgewiesene Stamm. Mit dem zunehmenden Gebrauch von Vancomycin zur Behandlung von MSSA-Infektionen hat das Vorkommen von MRSA zugenommen. Dies macht die Entwicklung von alternativen Antibiotikaregimen nötig, die eine Selektion von MRSA-Spezies verhindern. Unter dieser Überlegung wurde auf die Behandlung mit Vancomycin bei Zugangs-bezogenen Infektionen verzichtet. Es wurde im Jahr 2000 durch ein Standardregime bestehend aus Flucloxacillin und Rifampicin ersetzt. Mithilfe eines Screeningprogramms wurde nach MSSA- (n=88) und MRSA- (n=1) Kolonisationen gesucht. Dies gelang mit Hilfe von Querschnitts-Screenings und Indikations-Screeninguntersuchungen bei Aufnahme über den Zeitraum von 2000 bis 2010. Eine Besiedlung mit MRSA wurde bei nur einem Patienten während des 10-Jahres-Screenings registriert. Die gefundenen MSSA-Kolonisationen bei HD-Patienten beeinflussten die Morbidität und Mortalität nicht. Die Anzahl an HD-Patienten mit MSSA-Kolonisation nahm während des Beobachtungszeitraums von zehn Jahren ab Behandlungen mit dem Vancomycin-freien Regime waren generell erfolgreich und resultierten in einem Rückgang der klinischen und laborativen Infektionsmarker und/oder negativen Blutkulturen. Es konnte gezeigt werden, dass mit dem Gebrauch von vancomycinfreien Antibiotikaregimen ein erfolgreiches Management von Staphylokokkus-assoziierten Zugangsinfektionen bei HD-Patienten möglich ist.

Background: The proportion of nosocomial Staphylococcus infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has increased from 22% in 1995 to 63% in 2004. Blood stream infections, more commonly referred to as bacteremias, represented the majority (75.5%) of hospital-onset MRSA cases. The economic impact of Staphylococcus aureus bacteremia merits investigation. Methods: This was a retrospective cohort analysis within Cerner HealthFacts data warehouse. Eligible patients were those who had Staphylococcus aureus bacteremia and were discharged between January 1, 2000, and December 31, 2006. Inclusion criteria include age > 18 years old and onset of infection > 48 hours post admission. The crude association was measured by subtracting the total mean hospital charge for MSSA bacteremia from the MRSA charge. A generalized linear model using a gamma distribution and log link were used to determine the adjusted hospital charge and post-infection length of stay for the MRSA and MSSA groups. Path analysis was used to describe the relationships between infection susceptibility status, LOS and total hospital charge. Results: During the study period, 930 patients meet all the inclusion and exclusion criteria. The overall total hospital charge was $111,636 (MRSA = $121,713, MSSA = $97,307.) The crude difference in mean charge was $24,406. The multivariable model included predicted a MRSA patient would have an increased total charge of $22,889. MRSA had a higher total charge but when patients were more severely ill, MRSA charges decreased while MSSA charges increased. The second multivariable model predicted a MRSA patient would have an increased post-infection LOS of 1.3 days. However, the magnitude of increased post-infection LOS based on pre-infection LOS was different for MRSA and MSSA patients. The path analysis model indicated the direct and indirect effects of susceptibility status on both post-infection LOS and total charge were relatively small. Conclusion: This investigation was the first large multi-center investigation to examine the economic impact of MRSA and MSSA bacteremia. MRSA was associated with a higher total charge and longer post-infection LOS than MSSA patients. The path analysis model analyzed suggests the actually role of infection susceptibility status on post-infection LOS and total charge was minor.

Background: Catheter-associated bloodstream infections have been extensively studied in Intensive Care Unit Patients. However, less is known about the effect these infections have on non-ICU patients. This study attempted to elucidate the nature of the problem effecting non-ICU patients through descriptive analysis. Methods: Data were collected for all non-ICU patients with Staphylococcus aureus (S. aureus) infections at Grady Memorial Hospital in 2006. Demographic and hospitalization information was collected. The hospital epidemiologist responsible for surveillance of infection control programs determined outcomes attributable to the S. aureus infections. Data were entered into an Excel spreadsheet and then imported into EpiInfo 2007. Results: There were 91 S. aureus bloodstream infections documented, 38 infections in non-ICU patients and 52 infections in ICU patients. The descriptive information we accumulated offered potentially important different points between patients with MSSA and MRSA. We found more MRSA infection than MSSA infection in both the non-ICU and ICU patients. Additionally, in both groups those with MRSA infection had a length of stay at least twice as long as patients with MSSA, longer time from admission to positive blood culture, and longer time from positive blood culture to discharge. The most common type of morbidity found was sepsis, which was also the most common morbidity found in those who died. Conclusions: Our hypothesis that non-ICU patients would have increased morbidity and mortality directly attributable to the CA-BSI with S. aureus was proven to be false. Although still an issue, the morbidity and mortality was not as different as we thought it would be. While our hypothesis was proven false, this research provides information that would be well served through further studies.

Methicillin-resistant Staphylococcus aureus (MRSA) is a variant of the more common Methicillin-Susceptible Staphylococcus aureus (MSSA), an opportunistic pathogen a portion of the human population carries as normal bacterial flora. When an outbreak of MRSA occurs, it is often important to determine if and how these strains are related to each other. In this report two different types of epidemiological methods were combined (namely Multi-Locus Sequence Typing and staphylococcal protein A-typing), in order to reduce workload, costs and time. A panel of resistance and virulence markers was also added to gather as much information about the culture as possible in a single analysis. To test the viability of the method extracted DNA and heat-treated bacterial cultures of both MRSA and MSSA were amplified with a curated panel of primers. These products were later sequenced with Nanopore’s MinION using the Flongle flow-cell. The method showed promise and worked as intended regarding the staphylococcal protein A-typing and the panel of resistance and virulence markers. However, the Multi-Locus Sequence Typing did still require optimization in order to be used clinically. In summary the project can be viewed as a success since it succeeded in being more time, cost and work efficient than many of its predecessors, when the problems with the Multi-Locus Sequence Typing are solved.

No description available.