Surgical Site Infections In Women And Their Association With Clinical Conditions.

Surgical site infections (SSIs) can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth reflecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs.47457-6

Surgical site infections in women and their association with clinical conditions

Introduction: Surgical site infections (SSIs) can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Methods: Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. Results: The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Conclusions: Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth refl ecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs474457461sem informaçã

Use Of Molecular Epidemiology To Monitor The Nosocomial Dissemination Of Methicillin-resistant Staphylococcus Aureus Un A University Hospital From 1991 To 2001

Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period 1, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.37913451351Fluckiger, U., Widmer, A.F., Epidemiology of methicillin-resistant Staphylococcus aureus (1999) Chemotherapy, 45, pp. 121-134Deplano, A., Schuermans, A., Van Eldere, J., Multicenter evaluation of epidemiological typing of methicillin-resistant Staphylococcus aureus strains by repetitive-element PCR analysis (2000) Journal of Clinical Microbiology, 38, pp. 3527-3533Stranden, A., Frei, R., Widmer, A.F., Molecular typing of methicillin-resistant Staphylococcus aureus: Can PCR replace pulsed-field gel electrophoresis? (2003) Journal of Clinical Microbiology, 41, pp. 3181-3186Wang, J.T., Chen-Chun, Y., Yang, T.L., Chang, C.S., Molecular epidemiology and antimicrobial susceptibility of methicillin-resistant Staphylococcus, aureus in Taiwan (2002) Diagnostic Microbiology and Infectious Disease, 42, pp. 199-203Tambic, A., Power, E.G.M., Talsania, H., Anthony, R.M., French, G.L., Analysis of an outbreak of non phage-typeable methicillin-resistant Staphylococcus aureus by using a randomly amplified polymorphic DNA assay (1997) Journal of Clinical Microbiology, 35, pp. 3092-3097Conterno, L.O., Wey, S.B., Castello, A., Risk factors for mortality in Staphylococcus aureus bacteremia (1998) Infection Control and Hospital Epidemiology, 19, pp. 32-37Pujol, M., Penã, C., Pallares, R., Ayats, J., Arisa, J., Gudiol, F., Risk factors for nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus (1996) European Journal of Clinical Microbiology and Infectious Diseases, 13, pp. 96-102Archer, G.L., Niemeyer, D.M., Origin and evolution of DNA associated with resistance to methicillin in Staphylococci (1998) Trends in Microbiology, 2, pp. 343-347Witte, W., Kresken, M., Braulke, C., Cuny, C., Increasing incidence and widespread dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in central Europe, with special reference to German hospitals (1997) Clinical Microbiology and Infection, 3, pp. 414-422Corso, A., Santos, S.I., Aires de Souza, M., Rossi, A., Lencastre, H., Spread of a methicillin-resistant and multiresistant epidemic clone of Staphylococcus aureus (1998) Journal of Medical Microbiology, 4, pp. 179-184Alfizah, H., Norazah, A., Nordiah, A.J., Lim, V.K., DNA fingerprinting of methicillin-resistant Staphylococcus aureus (MRSA) by pulsed-field gel electrophoresis (PFGE) in a teaching hospital in Malaysia (2002) Medical Journal of Malaysia, 57, pp. 319-328Sola, C., Gribaudo, G., Vindel, A., Patrito, L., Bocco, J.L., Identification of a novel methicillin-resistant Staphylococcus aureus epidemic clone in Cordoba, Argentina, involved in nosocomial infections (2002) Journal of Clinical Microbiology, 40, pp. 1427-1435Melter, O., Aires de Sousa, M., Urbaskova, P., Jakubu, V., Zemlickova, H., Lencastre, H., Update on the major clonal types of methicillin-resistant Staphylococcus aureus in the Czech Republic (2003) Journal of Clinical Microbiology, 41, pp. 4998-5005Sader, H.S., Pignatari, A.C., Hollis, R.J., Jones, R.N., Evaluation of inter-hospital spread of methicillin-resistant Staphylococcus aureus in São Paulo using pulsed-field gel electrophoresis of chromosomal DNA (1994) Infection Control and Hospital Epidemiology, 15, pp. 320-323Santos, F.L., Sader, H., Bortolotto, V.I., Gontijo, F.P.P., Pignatari, A.C., Analysis of the clonal diversity of Staphylococcus aureus methicillin-resistant strains isolated at João Pessoa, State of Paraíba, Brazil (1996) Memórias Do Instituto Oswaldo Cruz, 91, pp. 101-105Moretti-Branchini, M.L., Aplicação de métodos de tipagem molecular na investigação de surtos intra-hospitalares (1998), Livre-docência thesis, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, BrazilPottinger, J.M., Herwaldt, L.A., Peri, T.M., Basics of surveillance: An overview (1999) Infection Control and Hospital Epidemiology, 18, pp. 513-527Loureiro, B.A., De Moraes, B.A., Quadra, M.R.R., Pinheiro, G.S., Suffys, P.N., Asensi, M.D., Molecular epidemiology of methicillin resistant Staphylococcus aureus isolated from newborns in a hospital in Rio de Janeiro, Brazil (2000) Memórias Do Instituto Oswaldo Cruz, 95, pp. 777-782Blanc, D.S., Struelens, M.J., Deplano, A., Hauser, P.M., Petgnat, C., Franioli, P., Epidemiological validation of pulsed-field gel electrophoresis patterns for methicillin-resistant Staphylococcus aureus (2001) Journal of Clinical Microbiology, 39, pp. 3442-3445Tenover, F.C., Gaynes, R.P., The epidemiology of Staphylococcus infection (2000) Gram-Positive Pathogens, , Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA & Rood JL (Editors), American Society for Microbiology, Washington, DC, USASchmitz, F.J.M., Steiert, H.V., Tichy, B., Hofmann, J., Verhoef, H.P., Heinz, K., Köhrer, T., Jones, M.E., Typing of methicillin-resistant Staphylococcus aureus isolates from Düsseldorf by six genotypic methods (1998) Journal of Clinical Microbiology, 47, pp. 341-351Montesianos, I., Salido, E., Delgado, T., Cuervo, M., Sierra, A., Epidemiologic genotyping of methicillin-resistant Staphylococcus aureus by pulsed-field gel electrophoresis at a university hospital and comparison with antibiotyping and protein A and coagulase gene polymorphisms (2002) Journal of Clinical Microbiology, 40, pp. 921-925Tenover, F.C., Arbeit, R.D., Goering, R.V., Mickelsen, P.A., Murray, B.E., Persing, D.H., Swaminathan, B., Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: Criteria for bacterial strain typing (1995) Journal of Clinical Microbiology, 33, pp. 2233-2239Barbier, N., Saulnier, P., Chachaty, E., Dumontier, S., Remont, A., Random amplified polymorphic DNA typing versus pulsed-field gel electrophoresis for epidemiological typing of vancomycin-resistant enterococci (1996) Journal of Clinical Microbiology, 34, pp. 1096-1099Olive, M., Bean, P., Principles and application of methods for DNA-based typing of microbial organisms (1995) Journal of Clinical Microbiology, 37, pp. 1661-1669Fujino, T., Sekiguchi, J.I., Kawana, A., Molecular epidemiology of methicillin-resistant Staphylococcus aureus in a Tokyo hospital in 2002 (2003) Journal of Infectious Diseases, 55, pp. 210-213Tenover, F.C., Arbeit, R.D., Goering, R.V., How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: A review for healthcare epidemiologists (1997) Infection Control and Hospital Epidemiology, 18, pp. 426-439Garner, J.S., Jarvis, W., Emori, T.G., Horan, T.C., Hughes, J.M., CDC definitions for nosocomial infections (1988) American Journal of Infection Control, 16, pp. 128-140Bauer, A.W., Kirby, W.M.M., Sherris, J.C., Turck, M., Antibiotic susceptibility testing by a standardized single disk method (1996) American Journal of Clinical Pathology, 45, pp. 493-496(1999) Performance Standards for Antimicrobial Susceptibility Testing, , National Committee for Clinical Laboratory Standards (NCCLS) Ninth Informational Supplement M100-S9Aires De Sousa, M., Crisostomo, M.I., Santos Sanches, I., Wu, J.S., Fuzhong, J., Tomasz, A., De Lencastre, H., Frequent recovery of a single clonal type of multidrug-resistant Staphylococcus aureus from patients in two hospitals in Taiwan and China (2003) Journal of Clinical Microbiology, 41, pp. 159-163Teixeira, L., Resende, C.A., Ormonde, L.R., Rosenbaum, R., Figueiredo, A.M.S., Lencastre, H., Tomasz, A., Geographic spread of epidemic multiresistant Staphylococcus aureus clone in Brazil (1995) Journal of Clinical Microbiology, 33, pp. 2400-2404Tambic, A., Power, E.G.M., Tambic, T., Snur, I., French, G.L., Epidemiological analysis of methicillin-resistant Staphylococcus aureus in a Zagreb trauma hospital using a randomly amplified polymorphic DNA-typing method (1999) European Journal of Clinical Microbiology and Infectious Diseases, 18, pp. 335-340Miragaia, M., Couto, I., Pereira Sandro, F.F., Molecular characterization of methicillin-resistant Staphylococcus epidermidis: Evidence of geographic dissemination (2002) (2003) Journal of Clinical Microbiology, 40, pp. 430-438Boyce, J.M., Treatment and control of colonization in the prevention of nosocomial infections (1996) Infection Control and Hospital Epidemiology, 17, pp. 256-261Salmenlinna, S., Vuopio-Varkila, J., Recognition of two groups of methicillin-resistant Staphylococcus aureus strains based on epidemiology, antimicrobial susceptibility, hypervariable-region type, and ribotype in Finland (2001) Journal of Clinical Microbiology, 39, pp. 2243-2247El-Din, S.A.S., El-Shafey, E.I., Mohamad, B., El-Hadidy, M.R., El-Din, A.B., El-Hadidy, M.M., Zaghloul, H.A., Methicillin-resistant Staphylococcus, aureus: A problem in the burns unit (2003) Egyptian Journal of Plastic and Reconstructive Surgery, 27, pp. 1-10Walker, J., Borrow, R., Goering, R.V., Egerton, S., Fox, A., Oppenhein, B.A., Subtyping of methicillin-resistant Staphylococcus aureus isolates from the North-West of England: A comparison of standardized pulsed-field gel electrophoresis with bacteriophage typing including an inter-laboratory reproducibility study (1999) Journal of Medical Microbiology, 48, pp. 297-301Waller, T.M.A., Methicillin-resistant Staphylococcus aureus typing methods: Which should be international standard? (2000) Journal of Hospital Infection, 44, pp. 160-172McDougal, L.K., Steward, C.D., Killgore, G.E., Chaitram, J.M., McAllister, S.K., Tenover, F.C., Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: Establishing a national database (2003) Journal of Clinical Microbiology, 41, pp. 5113-512

Designing a Story Database for Use in Automatic Story Generation

In this paper we propose a model for the representation of stories in a story database. The use of such a database will enable computational story generation systems to learn from previous stories and associated user feedback, in order to create believable stories with dramatic plots that invoke an emotional response from users. Some of the distinguishing characteristics of our proposal are the inclusion of what we call ‘narratological concepts’ and user feedback in the story database

"El nen s'ha menjat una aranya": The development of narratives in Catalan speaking children

The production of a well-constructed narrative is the culmination of several years of language acquisition and is an important milestone in children's development. There is no current description of narrative development for Catalan speaking children. This study collected elicited narratives in Catalan from 118 children aged 4;0-10;11. Narratives were scored for macrostructure and microstructure. Narrative scores improved with age with maximum performance for macrostructure by 9 years. Children's ability to use micro-structural components of Catalan is variable with some developments continuing beyond 9 years. The results are discussed in relation to theoretical arguments about universal and specific features of narrative development. We conclude by highlighting the usefulness of the new test for future language assessment of children acquiring Catalan

Use Of Molecular Epidemiology To Monitor The Nosocomial Dissemination Of Methicillin-resistant Staphylococcus Aureus In A University Hospital From 1991 To 2001.

Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period I, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.371345-5

Surgical Site Infections In Women And Their Association With Clinical Conditions

Introduction: Surgical site infections (SSIs) can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Methods: Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. Results: The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Conclusions: Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth refl ecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs.474457461Assistência Segura: Uma Refl exão Teórica Aplicada à Prática (2013) Vigilância e Monitoramento em Serviços de Saúde (GVIMS), , Gerência Geral de Tecnologia em Serviços de Saúde (GGTES). Série Segurança do Paciente e Qualidade em Serviços de Saúde. Brasília (DF)Martins, M.A., França, E., Matos, J.C., Goulart, E.M.A., Post-discharge surveillance of children and adolescents treated for surgical site infections at a university hospital in Belo Horizonte, Minas Gerais State, Brazil (2008) Cad Saude Publica, 24, pp. 1033-1041Ferreira, F.A.P.B., Marin, M.L.G., Strabelli, T.M.V., Carmona, J.C., Ways the anesthesiologist can contribute to the prophylaxis of infection in the surgical patient (2009) Rev Bras Anestesiol, 59, pp. 756-766Garcia, R.B., Delagado, M.L., Kuba, E.B., Cabello, R.R., Chessin, A., Rendón, J.C., Infección del sitio quirúrgico. Experiencia de dos años en el servicio de ginecología y obstetricia del Hospital General de México (2006) Ginecol Obstet Mex, 74, pp. 260-264Gomes, A.E.B., Cavalcante, R.S., Pavan, E.C.P., Freitas, E.S., Fortaleza, C.B., Predictive factors of post-discharge surgical site infections among patients from a teaching hospital (2014) Rev Soc Bras Med Trop, 47, p. 238Assis, D.B., Madalosso, G., Ferreira, A.S., Yassuda, Y.Y., Polachini, Z.M., Surveillance System for Hospital Infections in the State of São Paulo in 2011 (2012) BEPA, 9, pp. 15-23Amorim, M.M.R., Santos, L.C., Guimaraes, V., Risk Factors for Infection after Total Abdominal Hysterectomy (2000) Rev Bras Ginecol Obstet, 22, pp. 443-448Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection (1999) Infec Control and Hosp Epidemiol, 20, pp. 247-278Anderson, D.J., Kaye, S.K., Classen, D., Arias, K.M., Podgorny, K., Burstin, H., Strategies to prevent surgical site infections in acute care hospitals (2008) Infect Control and Hosp Epidemiol, 29, pp. 51-61Lichtenfels, E., Frankini, A.D., Paludo, J., D'azevedo, P.A., Prevalence of bacterial resistance in surgical wound infections in peripheral arterial surgery (2008) J Vasc Bras, 7, pp. 239-247Torres, L.M., (2011) Readmissão por infecção do sítio cirúrgico em um hospital público de Belo Horizonte-MG. 2011, , Dissertação (Mestrado em Enfermagem)-Escola de Enfermagem-Universidade de São Paulo, São PauloSasaki, V.D.M., Romanzini, A.E., Jesus, A.P.M., Carvalho, E., Gomes, J.J., Damiano, V.B., Surgical site infection surveillance in post-hospital discharge after cardiac reconstructive surgery (2011) Texto contexto-enferm, 20, pp. 328-332Oliveira, A.C., Ciosak, S.I., Lorenzo, D., Post-discharge surveillance and ITS impact ON surgical site infection incidence (2007) Rev Esc Enferm USP, 41, pp. 653-659. , São PauloErcole, F.F., Chianca, T.C.M., Duarte Ds Carlos, E.F., Carneiro, M., Surgical site infection in patients submitted to orthopedic surgery: The NNIS risk index and risk prediction (2011) Rev Latino-Am Enfermagem, 19, pp. 269-276Breigeiron, R., (2005) Fatores de risco para infecção de sítio cirúrgico em pacientes submetidos à cirurgia por perfuração esofágica, , Porto Alegre: PUCRS. Dissertação (Mestrado)-Pontifícia Universidade Católica do Rio Grande do Sul. Faculdade de MedicinaFelippe, A.B., (2005) Fatores associados à infecção do sítio cirúrgico após cirurgia para o tratamento do câncer de mama em mulheres usuárias do sistema de drenagem, , [Masters Dissertation]. [Rio de Janeiro]: Universidade Federal do Rio de JaneiroParker, W.H., Broder, M.S., Chang, E., Feskanich, D., Farquhar, C., Liu, Z., Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study (2009) Obstet Gynecol, 113, pp. 1027-1037Sória, H.L.Z., Fagundes, D.J., Sória-Vieira, S., Cavalli, N., Santos, R.C., Hysterectomy and benign gynecological diseases: What has been performed in Medical Residency in Brazil? (2007) Rev Bras Ginecol Obstet, 29, pp. 67-73Batista, T.F., Rodrigues, M.C.S., Surveillance of surgical site infection after hospital discharge in a teaching hospital of the Federal District, Brazil: A retrospective descriptive study in the period 2005 (2012) Epidemiol Serv Saude, 21, pp. 253-264Lake, A.M.G., McPencow, A.M., Dick-Biascoechea, M.A., Martin, D.K., Erekson, E.A., Surgical site infection after hysterectomy (2013) Am J Obstet Gynecol, 209, pp. 490-499Costa, A.A.R., Amorim, M.M.R., Cursino, T., Vaginal hysterectomy versus abdominal hysterectomy in patients without uterine prolapse: A randomized clinical trial (2003) Rev Bras Ginecol Obstet, 25, pp. 169-176Geller, E.J., Vaginal hysterectomy: The original minimally invasive surgery (2014) Minerva Ginecol, 66, pp. 23-33Custovic, A., Zulcic-Nakic, V., Asceric, M., Hadzic, S., Surveillance of intrahospital infections at the clinic for gynaecology and obstetrics (2009) Bosn J Basic Med Sci, 9, pp. 66-70Moraes, C.M., Galvão, C.M., Surgical site infection: Analysis of scientific production in nursing (2006) Rev SOBECC, 11, pp. 22-31Silva, E.C.B.F., Samico, T.M., Cardoso, R.R., Rabelo, M.A., Bezerra, N.A.M., Melo, F.L., Colonization by Staphylococcus aureus among the nursing staff of a teaching hospital in Pernambuco (2012) Rev Esc Enferm USP, 46, pp. 132-137Aguiar, A.P.L., Prado, P.R., Opitz, S.P., Vasconcelos, S.P., Faro, M.C., Factors associated with surgical site infections in a hospital in the western brazilian amazon (2012) Rev SOBECC, 17, pp. 60-70Ledur, P., Almeida, L., Pellanda, L.C., Schaan, D.B., Predictors of infection in post-coronary artery bypass graft surgery (2011) Rev Bras Cir Cardiovasc, 26, pp. 190-196Chen, S., Anderson, M.V., Cheng, W.K., Wongworawat, M.D., Diabetes associated whith increased surgical site infection in spinal arthrodesis (2009) Orthop Relat Res Clin, 467, pp. 1670-1673Gutiérrez, M.G.R., Gabrielloni, M.C., Barbi, T., Areias, V.L., Surgical site infections: Surveillance measures in the early discharge after breast cancer surgery (2004) Rev Bras Cancer, 50, pp. 17-2

Use of molecular epidemiology to monitor the nosocomial dissemination of methicillin-resistant Staphylococcus aureus in a University Hospital from 1991 to 2001

Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period I, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.1345135

Space Mission Architecture Trade off Based on Stakeholder Value

Abstract. One the most difficult aspects of system conceptualization process is to recognize, understand and manage the trade-offs in a way that maximizes the success of the product. This is particularly important for space projects. In this way, a major part of the system engineer's role is to provide information that the system manager can use to make the right decisions. This includes identification of alternative architectures and characterization of those elements in a way that helps managers to find out, among the alternatives, a design that provides a better combination of the various technical areas involved in the design. Space mission architecture consists of a broad system concept which is the most fundamental statement of how the mission will be carried out and satisfy the stakeholders. The architecture development process starts with the stakeholder analysis which enables the identification of the decision drivers, then, the requirements are analysed for elaborationg the system concept. Effectiveness parameters such as performance, cost, risk and schedule are the outcomes of the stakeholder analysis which are labelled as decision drivers to be used in a trade off process to improve the managerial mission decisions. Thus, the proposal presented herein provides a means for innovating the mission design process by identifying drivers through stakeholder analysis and use them in a trade off process to obtain the stakeholder satisfaction with effectiveness parameters