O trabalho busca avaliar, através do estudo configuracional, o desempenho de um bairro construído originalmente a partir da implantação do projeto de um núcleo habitacional, cujo objetivo era erradicar as favelas do centro da cidade. Sua consolidação se dá pela ação de diferentes agentes, entre eles o Estado. Embora os objetivos do projeto original estivessem imbuídos de altos ideais sociais, o tratamento desigual dispensado pelo Estado à áreas justapostas provocou a não-integração sócio-espacial no assentamento. Assim, após 30 anos da sua implantação, é avaliado o desempenho do projeto comparativamente à área real existente. Busca-se verificar, sob o prisma da inter-relação entre espaço urbano e apropriação social, a espacialização da centralidade. É realizado um confronto entre a realidade consolidada e os objetivos implícitos ao planejamento inicial através da utilização do Modelo de Centralidade e à luz de conceitos teóricos inerentes à evolução urbana e à análise configuracional. O bairro é conhecido através dos resultados da aplicação do modelo em cinco diferentes períodos, ao longo de seu desenvolvimento. O confronto dos resultados indica que os espaços reservados, no projeto, ao desenvolvimento da centralidade não atingiram, na situação real, o objetivo esperado. Assim, decisões de planejamento resultaram em espaços de alto custo que não cumpriram a função almejada em termos sociais no espaço urbano real. Tais decisões contribuíram para a falta de integração entre o espaço urbano projetado e os demais, verificados na realidade, ao negarem a importância da estrada enquanto elemento preexistente e elo de ligação entre as diferentes áreas no assentamento e destas com o restante da cidade. Confirmou-se, portanto, a hipótese de que efeitos contraditórios podem ocorrer pela ausência de uma avaliação preliminar da interferência dos atributos espaciais sobre a dimensão social, pois a estrada demonstrou, desde o início, seu potencial de centralidade e desenvolveu-se neste sentido pela ação da população, enquanto as áreas definidas pelo projeto para desenvolver a centralidade, e a decorrente promoção e integração social, não se efetivaram. / This work has aimed at evaluating, through a configurational study, the performance of a suburban district built originally from the implementation of a project for a urban nucleus in the outskirts of Porto Alegre, RS, Brazil, to satisfy housing demands arising from the clearance of slums in the city centre. The consolidation of the district, afterwards, occurs as a result of the action of different agents, including the State. Although the objectives of the original project were imbued with high social ideals, the State, by creating and unequally treating juxtaposed areas, induced the social-spatial disintegration in the settlement. The performance of the project is assessed in comparison with the actual existing area after 30 years from its implementation. Under the prism of the interrelation between urban space and social appropriation, the spatialisation of the centrality is verified. Through the utilization of the Centrality Model and in the light of theoretical concepts inherent to the urban evolution and to the configurational analysis, a confrontation between the consolidated reality and the objectives implicit to the initial planning is then accomplished. The reality is known by examining the results of the model application in five different periods along the district’s development. These results indicate that the spaces reserved, in the project, to the development of the centrality, have not achieved, in the actual situation, the expected centrality. Therefore, project decisions resulted in high cost spaces which have not accomplished the aimed function in social terms. The large disintegration between the planned and the real areas (namely Restinga Nova and Restinga Velha, respectively) has been reinforced by the decision that there should be a few links with the pre-existing main road. This has led to the negation of the pre-existing element and its importance as a connector between the two areas, built along the time, and these two and the remaining urban area. Therefore, it has been confirmed the hypothesis stating that contradictory effects can occur by the absence of a preliminary evaluation of the interference of the spatial attributes on the social dimension. Since the beginning, the road showed its centrality potential and developed towards this direction through the intervention of the population. Whereas the areas built from the project to develop the centrality and the expected deriving social promotion and integration have not been accomplished.

Zoneamentos bioestratigráficos foram elaborados para os depósitos cretáceos de todas as bacias da margem costeira brasileira, excetuando-se a Bacia de Pelotas, cujo conhecimento micropaleontológico é restrito a microfósseis de parede calcária, justificando o levantamento sistemático de dados palinológicos em todas as suas seções. Este trabalho apresenta os resultados da análise palinológica realizada em 37 amostras de calha e 7 amostras de testemunhos de sondagem dos poços BP-01 e BP-02, respectivamente, perfurados na bacia, que revelou associações relativamente diversificadas e abundantes, com significado bioestratigráfico e paleambiental. Um total de 123 táxons de palinomorfos foi identificado, compreendendo 60 táxons de esporomorfos (28 de esporos, 32 de grãos de pólen), algas (60 de Dinophyceae e 3 de Prasinophyceae), incluindo 9 táxons registrados pela primeira vez na margem costeira brasileira; palinoforaminíferos, ovos de copépodes, fungos indeterminados e escolecodontes também foram reconhecidos Em termos bioestratigráficos, as associações do poço BP-02 indicam quatro idades entre o Albiano e o Campaniano, tendo como base os zoneamentos previamente publicados em outras bacias: (i) Albiano (extinção de Oligosphaeridium aff. Complex); Cenomaniano (extinção Endoceratium dettmanniae); (ii) Turoniano (extinção Cribroperidinium cf. edwardsii); (iv) Santoniano (extinção aparente de Anacolosidites sp. A e ocorrência Steevesipollenites aff. nativensis). As amostras do poço BP-01 revelaram uma associação mais jovem, atribuída ao Campaniano, considerando a associação de Trichodinium castanea, Odontochitina porífera e Isabelidinium pellucidum. Considerando a composição das paleofitoprovíncias definidas para a margem atlântica durante o Cretáceo, os depósitos estudados comportam associações diferenciadas, inserindo-se em um contexto de transição, entre as províncias adjacentes reconhecidas a norte e a sul da bacia, com elementos endêmicos (p. ex.: Anacolosidites sp. A), podendo caracterizar uma porção particular da paleoflora sul-americana no intervalo Embora a natureza marinha das amostras seja inquestionável pela presença de dinoflagelados e palinoforaminíferos, altas freqüências relativas de elementos da microflora terrestre são observadas, indicando significativa proximidade do sítio deposicional do continente; além disso, tétrades encontram-se preservadas na maioria dessas amostras. A presença e abundância relativa de determinados gêneros de grãos de pólen em certos intervalos do poço BP-02 (p. ex.: Classopollis, Circulina, Inaperturopollenites) são indicativas de condições paleoclimáticas áridas e quentes. / Biostratigraphic schemes were developed for Cretaceous deposits of all Brazilian coastal margin basins, excluding the Pelotas Basin, whose micropaleontological knowledge is restricted to calcareous microfossils, but palynological data are needed. This work presents results from palynological analysis performed in 37 cuttings samples and 7 core samples derived from the BP-01 and BP-02, respectively, drilled in this basin. Diverse and abundant associations were revealed, wich biostratigraphical and paleoenvironmental significance. 123 palynomorphs taxa were identified, related to 60 sporomorphs (28 spores, 32 pollen grains), algae (60 Dinophyceae and 3 Prasinophyceae), including 9 species unknown for the Brazilian coastal margin basins. Furthermore, palynoforaminifers, copepods eggs, indeterminate fungi and scolecodonts were also recognized. In biostratigraphic terms, associations from the well BP-02 indicate four ages within the Cretaceous, from Albian to Campanian, based on data from other basins: (i) Albian (last appearance of Oligosphaeridium aff. complex); Cenomanian (last appearance of Endoceratium dettmanniae) (ii) Turonian (last appearance of Cribroperidinium cf. edwardsii) (iv); Santonian (apparent extinction of Anacolosidites sp. A and the record of Steevesipollenites aff. nativensis) Well BP-01 samples showed a younger association, attributed to the Campanian, taking into account the associaton of Trichodinium castanea, Odontochitina porífera and Isabelidinium pellucidum. Considering the composition of certain paleophytoprovincias defined for the Atlantic margin during the Cretaceous, studied deposits contain different associations, once is placed into a transition context, between the recognized adjacent provinces at north and at south of the basin. Endemic elements (e.g.: Anacolosidites sp. A) might characterize a particular paleoflora within the South American. Although the marine nature of these deposits be unquestionable, by the presence of dinoflagellates and palynoforaminifers, high relative frequencies of terrestrial microfloristic elements are observed, indicating a significant proximity of the depositional site to the continent; in addition, tetrads are preserved in most of these samples, corroborating this idea. The presence and relative abundance of certain pollen grains genus, in particular from the well BP-02 (eg.: Classopollis, Circulina, Inaperturopollenites) are used as paleoclimatic indicative of arid and hot conditions.

Poucos estudos descrevem adequadamente as características e capacidade produtiva dos ecossistemas campestres do Bioma Pampa associadas a Neossolos Litólicos derivados de basalto. Esse estudo foi desenvolvido sobre um campo natural no município de Santana do Livramento, região da Campanha do RS e objetivou descrever a diversidade florística e estrutural dessa fisionomia campestre e compreender sua dinâmica produtiva associada ao desempenho animal. O levantamento florístico identificou 232 espécies pertencentes a 40 famílias botânicas, com predominância de Poaceae e Asteraceae. Os Índices de Diversidade de Shannon-Wiener e de Equidade de Pielou foram de 3,00 e 0,874, respectivamente. O percentual de solo descoberto e de afloramentos rochosos representou 19,3% da área. A análise multivariada indicou a existência de apenas dois diferentes padrões de vegetação, com alto grau de agregação interna, os quais determinam a variabilidade estrutural do pasto. Um padrão é caracterizado pela presença de espécies de porte mais alto em locais de solos mais profundos e outro padrão com espécies de menor altura e menor massa de forragem associado aos solos mais rasos. O desenvolvimento de novilhas Hereford entre os 15 e 25 meses de idade apenas a campo (Tratamento 1) ou com a utilização estratégica de suplementação proteico ou proteico-energética (Tratamento 2), bem como das características produtivas do pasto, foram avaliados num delineamento de blocos casualizados, com três repetições. Utilizou-se pastoreio contínuo com carga variável para manter uma oferta média de forragem superior a 13% do peso vivo/dia. Os diferentes padrões de fisionomia identificados “a priori” como aberto, fechado, macio e indecorum se caracterizaram por massas de forragem médias de 547, 1552, 3053 e 829 kg/ha de matéria seca, altura média de 3,3, 8,6, 16,5 e 5,5 cm e ocuparam 32, 52, 12 e 4% da área, respectivamente. As taxas de acúmulo de matéria seca do pasto foram de 27; 14; 3 e 17 kg/ha/dia para o verão, outono, inverno e primavera, respectivamente. Bons ganhos médios diários foram obtidos no outono e primavera, mas no inverno o desempenho foi afetado negativamente pela alta percentagem de material morto na forragem. O desempenho médio não diferiu entre os tratamentos, e as novilhas chegaram aos dois anos com um escore de condição corporal de 3,2 e peso médio de 337 kg, permitindo atingir 100% de prenhez. / Few studies had adequately described the characteristics and productive capacity of natural grasslands associated to shallow basaltic soils in Pampa Biome. This study was carried out on natural pasture at Santana do Livramento municipality, in the Campanha region of Rio Grande do Sul, Brazil aiming to describe their floristic and structural diversity and to understand the productivity dynamics associated with animal performance. 232 vegetal species from 40 botanical families were identified in the floristic survey, with predominance of Poaceae and Asteraceae. The Shannon-Wiener Diversity and Equability Pielou Indexes were 3,00 and 0,874, respectively. Bare soil and rock outcrop represents 19,3% of surface area. Multivariate analysis revealed only two different pattern of vegetation, both with high degree of internal aggregation, determining the structural variability of the pasture. One characterized by the presence of tall species and associated with deep soils and the other in the shallow soils and presence of prostrated species. The evaluation of agronomic characteristics of the pasture and the effect of mineral supplementation or not on the development of Hereford heifers during the period between 14 and 25 month of age were tested in a completely randomized block design with three replicates. Continuous grazing with variable stocking rate was used in order to maintain minimal forage allowance of 13% of live weight/day. Different physiognomic patterns identified "a priori" as "open", "closed", "soft" and "indecorum", were characterized respectively by dry matter mass of 547, 1552, 3053 e 829 kg/ha and 3,3, 8,6, 16,5 e 5,5 cm of average high and occupied 32, 52, 12 and 4% of the entire grassland surface. Independent of the vegetation patterns measured accumulation forage rates were 27, 14, 3 and 17 kg/ha of dry matter, in summer, autumn, winter and spring, respectively. Good live weight daily gains were obtained during autumn and spring but the high percentage of dead material in the forage on offer during winter affected negatively the animal performance in this season. Average animal performance was not affected by supplementation treatment and all heifers reached two years age whit a body score condition of 3,2 and 337 kg of average weight that allow to attain 100% of pregnancy.

A análise de minerais pesados para estudos de proveniência é uma das técnicas mais sensíveis atualmente empregadas. As associações dos minerais pesados formam paragêneses, as quais propiciam informações cruciais sobre os tipos de rochas-fonte, não podendo essas serem obtidas por outros meios. O presente estudo tem por objetivo identificar as assembléias de minerais pesados detríticos, bem como determinar as prováveis fontes primárias e a distribuição destas assembléias ao longo da margem emersa da Bacia de Pelotas. Além disso, este trabalho propõe uma análise do sentido da deriva litorânea com base no estudo da variação das concentrações destas assembléias de minerais pesados. Os minerais pesados presentes nas amostras analisadas são: epidotos, apatita, turmalinas, hornblenda, estaurolita, zircão, cianita, granadas, rutilo, piroxênios, actinolita-tremolita, monazita, silimanita e, em menores quantidades, observa-se ainda clorita, andaluzita e titanita, alem de minerais opacos. A maior concentração de minerais pesados ocorre no sul da área em estudo, alcançando o valor máximo de 4,75% , e diminuindo em direção ao norte da Planície Costeira do Rio Grande Sul. A assembléia de minerais pesados no norte da área de estudo tem como rocha fonte importante os basaltos da Formação Serra Geral, que contribuem com minerais mais instáveis, tais como os piroxênios e os anfibólios, enquanto que a assembléia de minerais pesados no litoral sul possui uma maior concentração de minerais metamórficos saturados em alumínio (cianita, silimanita, andaluzita e estaurolita) e granadas, indicando que as rochas fonte destas assembléias são os terrenos metamórficos do Escudo Sul-riograndense e do Escudo Uruguaio. Analisando as concentrações de granadas e de piroxênios, observa-se que a abundância de granadas diminui de sul para norte, enquanto que o percentual de piroxênios diminui de norte para sul. Este fato, aliado à diminuição da concentração da assembléia total de minerais pesados de sul para norte, evidencia que a deriva litorânea nas praias da PCRS se dá de sul para norte. / The heavy mineral analysis for provenance study is one of the most sensitive techniques currently applied. The heavy mineral associations formed parageneses, which provided crucial information about the source rocks types, that can not be obtained through other means.This study aims to identify the detrital heavy mineral assemblages, as well as determine the probable primary sources and the distribution of these assemblages along the onshore margin of the Pelotas Basin. In addition, this paper proposes an analysis of the littoral drift direction based on the study of variation of concentrations of these heavy mineral assemblages. The heavy minerals present in the samples analyzed are epidotes, apatite, tourmaline, hornblende, staurolite, zircon, kyanite, garnets, rutile, pyroxene, actinolite-tremolite, monazite, sillimanite and, in smaller quantities, there is still chlorite, and andalusite titanite, opaque minerals besides.The largest concentration of heavy mineral occurs in the south of the study area, reaching the maximum value of 4.75% and decreasing towards the north of the coastal plain of the Rio Grande Sul. The heavy minerals assemblage in the northern area of study shows how important source rock the basalts of the Serra Geral formation, contributing minerals more unstable, such as pyroxenes and anphiboles, while the heavy mineral assemblage in the southern coast has a greater concentration of metamorphic minerals aluminium saturated (kyanite, staurolite, andalusite and sillimanite) and garnets, indicating that the source rocks of these assemblies are the metamorphic terrains of the Sul-riograndense and Uruguay Shields. By analyzing the concentrations of garnets and pyroxenes, it is observed that the abundance of garnets decreases from south to north, while the percentage of pyroxene decreases from north to south. This fact, coupled with decreased concentration of total heavy mineral assemblage from south to north, shows that the littoral drift on the beaches of the PCRS occurs from south to north.

Introduction: Despite the importance of pharmacokinetic (PK) information for patient management there are low numbers of paediatric PK studies and little guidance available on optimum study design and conduct. Method: Drawing on Implementation Science, a mixed-methods study was conducted, including a scoping review (SR) (PK literature: 1990-2015) and quantitative and qualitative inquiry (stakeholders: lay population, service users and health-care professionals). Aim: to explore the feasibility and acceptability of paediatric PK research. Results: The SR (203 papers) highlighted significant problems with participant recruitment, retention and sampling. Stakeholders (n=240) added insight into these phenomenon, with lack of research staff, additional blood-sampling and appointments highlighted as significant barriers to recruitment and conduct. Facilitators included sensitivity and timeliness of approach, communication, involvement of child/young person (CYP) in decision-making, engagement between research and clinical teams, reassurance of safety, pain minimisation, and avoidance/reduction of burden to the CYP and family. Dedicated research support was viewed as critical to success. Discussion: PK research was viewed as feasible and acceptable by service users and health professionals, even in the context of critical illness. Novel, evidence-based, patient-centred, recommendations for future PK study conduct and design have been generated which are applicable for those designing, approving and implementing PK research.

Ziel dieser retrospektiven, monozentrischen Studie war es, die virale Ätiologie und die klinischen Charakteristika bei hospitalisierten Kindern und Jugendlichen unter 17 Jahren mit ARE an der Universitäts-Kinderklinik Würzburg im Zeitraum Juni 2012 – Juni 2014 zu untersuchen. Die Virusdiagnostik erfolgte dabei aus respiratorischen Sekreten mittels Multiplex-RT-PCR für 18 respiratorische Viren. Es wurden insgesamt 960 Kinder mit ARE und Multiplex-PCR-Testung auf respiratorische Viren in die Untersuchung eingeschlossen. 566 Kinder (59%) waren männlich. Der Altersmedian betrug 1,9 Jahre (IQR 1,0-4,4). Die Patienten befanden sich im Median 3 Tage (IQR 2-5) in stationärer Behandlung. Die häufigsten mit ARE assoziierten Symptome waren Fieber (n=538, 56%), Husten (n=527, 55%) und Nahrungs-/ Trinkverweigerung (n=382, 40%). Bei 52% der Patienten (n=502) lag eine URTI und bei 48% (n=458) eine LRTI vor. Ca. 50% der Kinder (n=481) hatten eine oder mehrere Vorerkrankungen, wobei eine bestehende chronische Lungenerkrankung mit 18% (n=176) und Frühgeburtlichkeit (n=100, 10%) die häufigsten prädisponierenden Faktoren darstellten. 13 Kinder (1,4%) benötigten eine intensivstationäre Betreuung. 460 Kinder (48%) erhielten initial eine antibiotische Therapie. 168 Kinder (18%) benötigten eine Sauerstofftherapie. Zwei Kinder (0,2%) starben bei vorher bestehender Grunderkrankung. Zusammenfassend konnte in dieser Dissertation gezeigt werden, dass hospitalisierte Kinder mit LRTI, mit positivem Virusnachweis oder mit einer viralen Koinfektion wesentlich jünger waren als Kinder mit URTI, negativem Virusnachweis oder viraler Monoinfektion. Zudem wurde vor allem bei Kindern mit hMPV- oder RSV-Nachweis ein schwererer klinischer Verlauf verzeichnet, wobei sich insbesondere hMPV als häufigster Erreger bei Kindern mit viraler Pneumonie herausstellte. Insgesamt spiegeln die Studienergebnisse die hohe Krankheitslast der viral bedingten ARE im Kindesalter wieder, welche trotz vielseitiger Bestrebungen zu konsequenten Hygienemaßnahmen nur begrenzt reduziert werden können. Obwohl eine symptomatische Therapie mehrheitlich zu einer raschen Genese der Kinder führt, wäre der differenziertere und folglich reduzierte Einsatz einer Antibiotikatherapie unter Einbezug einer standardisierten Virusdiagnostik wünschenswert. / In Germany, data on the aetiology, epidemiology and clinical characteristics of virus associated acute respiratory infections (ARI) in children with is limited. In a single-centre tertiary care pediatric hospital, respiratory specimens in children <17 years of age hospitalized with ARI were routinely tested by multiplex-PCR for 21 viral pathogens from July 2012 to June 2014. Clinical data were collected from hospital medical records using a standardized questionnaire. A total of 942 ARI patients (52.2% upper ARI; 47.8% lower ARI) with a median age of 23 months (IQR 12-53) were enrolled. Virus-positive children (n=696, 73.9%) were significantly younger than virus-negative children (n=246, 26,1%) (p<0,001) and lower ARI was diagnosed more frequently (virus-positive children: n=364, 52% vs. virus-negative children n=86, 35%, p<0,001). Children with viral mono-infection (n=499, 71.7% of 696 virus-positive children, median age: 23 (11-49) months) were older than children with viral co-detection (n=197, 28,3%, median age: 19 (11-31) months, p=0,006; 2 viruses: 23.6%, 3 viruses: 3.1%, >3 viruses 1.7%; p=0,006), but presented with similar clinical severity. The viral distribution among viral monoinfections was as follows: rhinovirus (RhV) (34.9% of 499 mono-infections), respiratory syncytial virus (RSV) (14.6%), influenzavirus (IV) A(H1)/A(H3)/B (10.6%), parainfluenzavirus (PIV) 1-4 (8.4%) and adenovirus (AV) (8.0%), human metapneumovirus (hMPV) (7,4%), human coronavirus (hCoV) NL63/OC43/ HKU1/229E (5%), human bocavirus (hBoV) (4,4%), enterovirus (EV) (3,2%) and parechovirus (PV) (0,4%). Clinical severity was highest in children infected with RSV: bronchitis (59%), oxygen therapy (43%), high viral load (81%)) and hMPV: pneumonia (38%). Viral co-detection was not associated with a significant difference concerning the frequency of a specific clinical diagnosis in children infected with RSV, PIV, hCoV, hBoV or hMPV. However, RhV-co-detection was associated with a higher frequency of bronchitis (n=48, 45% vs. n=56 (32%), p=0,042) and respiratory insufficiency (n=28, 26% vs. n=25, 14%, p=0,018). Among the detected respiratory viral pathogens, RhV was the most frequent, whereas RSV and hMPV were associated with higher disease severity in hospitalised children with ARI.

Hintergrund: In den letzten Jahren werden in der virologischen Routinediagnostik herkömmliche Methoden, wie der Immunfluoreszenztest (IFT), zunehmend durch neue molekulare Detektionsmethoden ersetzt. Auf der Suche nach einem für das Kinderklinik-Kollektiv geeigneten alternativen Screeningtest war im Vorfeld das Resplex Panel im Vergleich zum aktuellen Standard (IFT) getestet worden. Die Ergebnisse für ADV und RSV waren dabei deutlich diskrepant. Studiendesign: Zur weiteren Abklärung der diskrepanten Ergebnisse zwischen IFT und Resplex wurden respiratorische Proben aus dem Zeitraum Mai 2004 bis Februar 2008 von Patienten aus Würzburger Kinderkliniken verwendet. Dies umfasste 71 Proben, die im IFT positiv für Adenovirus-Antigen vorgetestet waren, und 68 Proben, die im IFT positiv für RSV-Antigen vorgetestet waren. Für alle Proben lagen Resplex-Ergebnisse vor. Mittels Sequenzierung aus Restmaterial wurden Adenovirus-Typen und RSV-Subtypen bestimmt. IFT-, Resplex- und Typisierungs-Ergebnisse wurden verglichen. Zusätzlich erfolgte eine epidemiologische Auswertung. Ergebnisse: Das Resplex Panel zeigt sich im vorliegenden pädiatrischen Kollektiv zur Detektion von ADV und RSV aufgrund unterschiedlicher Ursachen als ungeeignet: Für ADV ist sein auf zwei Spezies (ADV B und E) beschränktes Spektrum unzureichend, wodurch es die im Kollektiv häufige ADV C-Spezies (43%) nicht erfasst. Für RSV bedürfen die Primer bzw. Sonden einer Überarbeitung, da das Resplex Panel, verglichen mit dem IFT, wesentlich weniger Proben (41%) als RSV-positiv erkennt. Bezüglich der Prävalenz der Typen wurde eine für ADV typische Verteilung in Kinderkollektiven (54% ADV 3, 26% ADV 2, 12% ADV 1) nachgewiesen. Betroffen waren vor allem Kinder im Alter von sechs Monaten bis fünf Jahren. Kinder mit ADV C-Infektionen waren signifikant jünger als Kinder mit ADV B-Infektionen. Für RSV zeigte sich in der respiratorischen Saison 2006/2007 und in den Wintermonaten 1 – 2/2008 eine Dominanz von RSV Subtyp B. Betroffen waren vor allem Kinder im ersten Lebensjahr. Resumé: Die vorliegende Studie bestätigt die unzureichende Detektion von ADV und RSV durch das Resplex Panel, wobei bezüglich ADV ein unzureichendes Spektrum, für RSV unzureichend optimierte Primer und Sonden vermutlich ursächlich sind. Die epidemiologischen Daten stehen mit denen aus anderen Studien an ähnlichen Kollektiven in Einklang. / Background: Over the past years conventional virological diagnostic like the immunofluorescence assay (IFA) has been replaced by molecular diagnostic methods. In this context previously the standard (IFA) had been tested compared to the Resplex panel, a new multiplex PCR, for testing respiratory samples. The results were discrepant for adenovirus and RSV. Study design: In order to identify the reasons for this discrepancy the samples (68 samples for RSV, 71 for Adenovirus) were re-evaluated by further testing (sequencing). Results: The Resplex panel is not suitable as a respiratory screening test in the pediatric collective for the detection of adenovirus and RSV because of different reasons: for adenovirus the spectrum is limited to two of the possible seven species (B and E). That’s why adenovirus species C which is common in the pediatric collective (43%) cannot be detected. For RSV the primers and probes should be improved. The epidemiological data is consistent with other studies concerning similar collectives.

In dieser Dissertation wurden die Häufigkeit und das klinische Erscheinungsbild von Kindern mit schwerer RSV-assoziierten akuten Atemwegserkrankung (ARE) auf pädiatrischen Intensivstationen untersucht. Die Daten stammen aus einer prospektiven multizentrischen Studie zu intensivstationär behandelten viralen ARE bei Kindern, die im Studienzeitraum von Oktober 2010 – September 2013 durchgeführt wurde und an der bayernweit 23 von 30 Kliniken (77%) mit pädiatrischen Intensivstationen teilnahmen. RSV war mit 31% aller Erregernachweise in der Multiplex-PCR und mit 28% aller untersuchten PICU-ARE-Patienten der häufigste virale respiratorische Erreger auf pädiatrischen Intensivstationen. Die Hälfte der Patienten war männlich und das mediane Alter der betroffenen Kinder lag bei 2,5 Monaten mit einem (IQR von 1,5 bis 19,2 Monaten, min. 0,6 Monate alt, max. 193 Monate ~ 16,1 Jahre). Die hohe Bedeutung schwerer RSV-Infektionen im ersten Lebensjahr wurde dadurch belegt, dass 70% aller Patienten Säuglinge waren. Das häufigste Symptom bei Aufnahme auf die Intensivstation war Atemnot (93%). Es folgten an zweiter und dritter Stelle die Symptome Husten (78%) und Trink- und Nahrungsverweigerung (63%). Pathologische röntgenologische Befunde des Thorax wurden bei 85% der Kinder erhoben. In der Schweregradbeurteilung mittels SIC-Score wurden von den behandelnden Ärzten 17% der Kinder bei Aufnahme als lebensbedrohlich erkrankt eingestuft. Die häufigsten Diagnosen bei intensivstationär behandelten Kindern mit RSV-assoziierter ARE waren mit 86% Bronchiolitis, Infektionen der oberen Atemwege (76%) und Pneumonie (58%). Von den erkrankten Kindern hatten 46% mindestens eine Grunderkrankung. Die häufigsten waren Frühgeburtlichkeit (23%), neurologische Vorerkrankungen (17%) und pulmonologische Vorerkrankungen (14%). Die häufigste Behandlungsmaßnahme war die Sauerstoffgabe (88%) für eine mediane Dauer von 4 Tagen (IQR 3-7 Tage). Eine CPAP-Behandlung erhielten 36% (mediane Dauer 3 Tage; IQR 2-5 Tage) und eine mechanische endotracheale Beatmung 14% der Patienten (mediane Dauer 7 Tage; IQR 5-10 Tage). Eine orale oder intravenöse Antibiotikagabe erhielten 80% aller Patienten. Die mediane Verweildauer im Krankenhaus betrug acht Tage (IQR 6 bis 11 Tage), darauf entfielen vier Tage (IQR von 2 bis 7 Tagen) auf die intensivstationäre Betreuung. Von allen Kindern mit RSV-assoziierter ARE konnten 97% das Krankenhaus ohne Krankheitsfolgen verlassen, bei drei (2%) Patienten konnten mögliche Folgeschäden nicht ausgeschlossen werden, und zwei Kinder (1%) mit vorbestehender schwerer Grunderkrankung (eine weibliche Patientin, Alter 1 Jahr mit spinaler Muskelatrophie und progredienter respiratorischer Insuffizienz; sowie ein männlicher Patient, Alter 5 Jahre mit spastischer Tetraparese bei Z.n. Asphyxie und hypoxisch-ischämischer Enzephalopathie) verstarben während des intensivstationären Aufenthalts. Interessanterweise war die stationäre Aufenthaltsdauer von älteren Kindern (> 3-17 Jahre) signifikant länger (2 Tage im Median) als die jüngerer Kinder (≤ 3 Jahre) (p-Wert=0,044). Dies könnte auf eine höhere Prävalenz von Grunderkrankungen bei den älteren Patienten (96% versus 37%; p-Wert=<0,001) zurückzuführen sein. Hier wurden v.a. deutliche Unterschiede bei neurologischen (57% versus 9% p-Wert=<0,001) und pulmonologischen (39% versus 9%; p-Wert=0,001) Grunderkrankungen beobachtet. Eine respiratorische Partialinsuffizienz war ein häufigeres Symptom bei den älteren Kindern (87% versus 58%; p-Wert=0,009), bei denen die Diagnose Pneumonie in der Tendenz (74% versus 56; p=0,113) und ARDS (22% versus 5%; p-Wert=0,013) signifikant häufiger vorkam. Eine Trink- und Nahrungsverweigerung kam, nicht überraschend, bei den jüngeren Kindern häufiger (68% versus 35%; p-Wert=0,004) vor, ebenso die Diagnosen Bronchitis/Bronchiolitis (92% versus 52%; p-Wert=<0,001) und Infektion der oberen Atemwege (80% versus 57%; p-Wert=0,030). Die Inzidenz schwerer RSV-assoziierter ARE bei Kindern auf Intensivstationen lag für die erste Saison bei 31/100.000/Jahr, für die zweite Saison bei 27/100000/Jahr und für die dritte Saison bei 29/100.000/Jahr. In der prospektiven Studie von Forster et al. mussten 1117/100000 aufgrund einer RSV-Infektion hospitalisiert werden [24], eine Inzidenzabschätzung zu intensivstationär behandelten Kindern mit RSV in Deutschland gibt es in dieser Form noch nicht. Bei 24% der Kinder mit RSV-assoziierter ARE konnte parallel in der durchgeführten Multiplex-PCR Untersuchung, die insgesamt 19 virale Erreger nachweisen kann, ein weiterer viraler Erreger nachgewiesen werden. Bei RSV waren 34% Mehrfachinfektionen (30% waren Doppelinfektionen, 4% waren Dreifachinfektionen). Das CoV war mit 9% der häufigste zusätzlich nachgewiesene Erreger, darauf folgten RV mit 7% und hBoV mit 4%. Kinder mit viraler Mehrfachinfektion waren im Median 4,4 Monate älter als Kinder mit RSV-Monoinfektion (p-Wert=0,030). Die Symptome Atemnot (97% versus 83%; p-Wert=0,017) und Trink- und Nahrungsverweigerung (73% versus 42%; p-Wert=0,003) kamen bei Kindern mit RSV-Monoinfektion häufiger vor. Bezüglich des Schweregrades der Erkrankung gab es keinen Unterschied zwischen Kindern mit Mono- oder Mehrfachinfektion. Neurologische Vorerkrankungen waren jedoch häufiger bei Kindern mit viralen Mehrfachinfektionen (31% versus 9%; p-Wert=0,005) Prädisponierende Faktoren/chronische Vorerkrankungen kamen bei den viralen Mehrfachinfektionen häufiger vor (61% versus 31%; p-Wert=0,004). Insgesamt waren virale Mehrfachinfektionen mit einem Drittel aller RSV-ARE häufig. Die vorliegende Dissertation bestätigt die Bedeutung von RSV als häufigen Erreger akuter respiratorischer Infektionen der Winter- und Frühlingsmonate in Deutschland und als häufige Ursache für Hospitalisationen, v.a. im frühen Kindesalter. In dieser Dissertation konnte die besondere Bedeutung von RSV als Ursache für intensivstationär behandlungspflichtige Atemwegserkrankungen im Kindesalter hervorgehoben werden. Es ist bemerkenswert, dass RSV mit fast 30% der häufigste Erreger bei Kindern mit respiratorischen Infektionen auf Intensivstationen war, die Letalität mit einem Prozent jedoch vergleichsweise gering war. Bei fast einem Viertel aller Patienten wurde zusätzlich zu RSV mindestens ein weiterer viraler Erreger nachgewiesen. In weiteren Untersuchungen ist zu klären, ob die parallel nachgewiesenen Erreger gemeinsam pathophysiologisch an der untersuchten schweren Atemwegserkrankung beteiligt sind oder ob sich bei Kleinkindern noch über zuvor abgelaufene virale Infektionserkrankungen Virus-DNA nachweisen lässt, die dann im Rahmen der nächsten Erkrankung weiterhin nachweisbar ist. Die derzeitig verfügbare passive Immunisierung mit einem monoklonalen Antikörper kommt aufgrund der begrenzten Wirksamkeit und der hohen Kosten nur für eine kleine Zahl an Hochrisikopatienten in Frage. Ein geeigneter, möglichst im frühen Säuglingsalter zu applizierender aktiver Impfstoff gegen RSV oder eine maternale Impfung in der Schwangerschaft könnten theoretisch die RSV-Morbidität insgesamt und insbesondere auch die Zahl schwerer RSV-assoziierter ARE senken. / In this study the frequency and clinical appearance of children with severe RSV-associated acute respiratory tract infection in pediatric intensive care units (PICU) were investigated. The data originated from a prospective multicentre study with children who were treated because of viral infection of the respiratory tract. The study timeframe of the survey was from October 2010 to September 2013. Twenty-three of 30 hospitals (77%) with a PICU in Bavaria, Germany participated. The means of detection was a Multiplex-PCR. From all positive viral detections RSV was the most common (31%). Half of all patients were male and the median age was 2.5 months (IQR 1.5 – 19.2 months, maximum age 16.1 years, minimum age 0.6 month). The most common symptom was dyspnea (93%), the second and third most comomon were coughing (78%) and refusal to eat or drink (63%). Pathological radiologic findings were described in 85% of the patients. When the children were admitted to the PICU a severity classification was performed. From all the children, 17% were graded as having a life-threatening condition. The most common diagnosis in the PICU was bronchitis/bronchiolitis (86%), also common were infection of the upper airways (76%) and pneumonia (58%). An underlying chronic condition was seen in 46% of the treated children. The most common was preterm birth (23%). Other described conditions were chronic neurological disorders (17%) and pulmonary disorders (14%). The most frequently used therapy was application of oxygen (88%; median duration of application 4 days; IQR 3-7). A CPAP-therapy was used in 36% of the cases with a median duration of 3 days (IQR 2-5), 14% of the children received a mechanical ventilation (median time of application 7 days; IQR 5-10 days). An oral or intravenous antibiotic therapy was carried out in 80% of the treated children. The median time of hospital stay was 8 days (IQR 6-11), the median time of treatment in the PICU was 4 days (2-7). From all children treated because of a RSV-associated infection, 97% left the hospital without sequelae at the time of discharge. In two cases potential sequelae could not be excluded. Overall two children died due to a RSV-infection. One child with spinal muscular atrophy died because of a progressive respiratory failure, the other child had a spastic tetraparesis and died due to an ARDS. Interestingly, the duration of hospital stay of older children was significantly longer (p-value=0,044). This could be attributed to the higher prevalence of chronic underlying conditions in the population of the older children (96% vs. 37%; p-value=<0,001). Hypoxaemia was a symptom associated with the older children (87% vs. 58%, p-value=0,009), as were the diagnoses pneumonia (74% vs. 56%, p-value=0,113) and acute respiratory distress syndrome (ARDS) (22% vs. 5%, p-value=0,013). The younger children were more often associated with refusal of drinking and eating (68% vs. 35%, p-value=0,004), as well as bronchitis/bronchiolitis (92% vs. 52%, p-value=<0,001) and infection of the upper airways (80% vs. 57%, p-value=0,030). The incidence of severe RSV-associated respiratory tract infections of children treated in a PICU was 31/100000/year for the first season. In the second season the incidence was 27/100000/year and in the third season it was 29/100000/year. In 34% of the children tested via Multiplex-PCR another viral pathogen could be detected (30% were double infections, 4% were triple-infections). The human coronavirus (9%) was the most frequently detected virus together with RSV. Other viral coinfections were rhinovirus (7%) and human bocavirus (4%). Children with a viral coinfection were older than children with viral monoinfection (p-value=0,030). The symptoms dyspnoae (97% vs. 83%, p-value=0,017), as well as refusal of drinking and eating (73% vs. 42%, p-value=0,003) were more often associated with viral monoinfection. Chronic underlying conditions were more often described in children with a viral coinfetion (61% vs. 31%, p-value=0,004). This study confirms the impact of RSV as a common pathogen for acute respiratory infections in winter and early spring in Germany. It showed that particularly the young children had to be treated in the PICU. Although RSV was the most common pathogen (30% of all detected pathogens), the lethality rate was low in comparison. In nearly one quarter of the cases another viral pathogen was detected together with RSV. There is a need to clarify if the simultaneous detection of two or more pathogens equals a concurrent disease or just shows a reverberation of a prior infection.

<p>For multispectral Remote Sensing (RS) image analysis, a big problem is that original dataalways include Clouds-Interference (CI). Especially in the bad weather conditions, the CI is evidentin RS image. So during the pre-processing of RS image, the CI should be reduced as much aspossible. In this paper, reducing CI is researched as the central problem, so that much Ground-Objects Feature (GOF) can be obtained. An analysis about the clouds reflection in differentSpectral-Bands (SBs) was done based on optical theory and early researches. Moreover, therelationships between clouds reflection and ground-objects reflection are presented to understandwhat the Digital Number (DN) represented in each SB, and to reduce the impact of CI the Same DNSpectral Matching Method (SDN-SMM) based on the multispectral application is applied. Finally,two cases are tested using Matlab Programme to indicate the rationality and practicability of SDNSMM.About SDN-SMM, some advantages and disadvantages are concluded through discussion onfinal results. The method can be used in any kind of multispectral sensors image with simplecalculation, while, the original data of clouds-free region will not be changed. However, the qualityof CI reduction depends on the precision of clouds identification and the SB which is used forspectral position relationship creating. In the end of this paper, the improvement is also presentedfor the future work.</p>

For multispectral Remote Sensing (RS) image analysis, a big problem is that original dataalways include Clouds-Interference (CI). Especially in the bad weather conditions, the CI is evidentin RS image. So during the pre-processing of RS image, the CI should be reduced as much aspossible. In this paper, reducing CI is researched as the central problem, so that much Ground-Objects Feature (GOF) can be obtained. An analysis about the clouds reflection in differentSpectral-Bands (SBs) was done based on optical theory and early researches. Moreover, therelationships between clouds reflection and ground-objects reflection are presented to understandwhat the Digital Number (DN) represented in each SB, and to reduce the impact of CI the Same DNSpectral Matching Method (SDN-SMM) based on the multispectral application is applied. Finally,two cases are tested using Matlab Programme to indicate the rationality and practicability of SDNSMM.About SDN-SMM, some advantages and disadvantages are concluded through discussion onfinal results. The method can be used in any kind of multispectral sensors image with simplecalculation, while, the original data of clouds-free region will not be changed. However, the qualityof CI reduction depends on the precision of clouds identification and the SB which is used forspectral position relationship creating. In the end of this paper, the improvement is also presentedfor the future work.