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Regular integral models for Shimura varieties of orthogonal type
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- G. Pappas, I. Zachos
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- Journal:
- Compositio Mathematica / Volume 158 / Issue 4 / April 2022
- Published online by Cambridge University Press:
- 15 June 2022, pp. 831-867
- Print publication:
- April 2022
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We consider Shimura varieties for orthogonal or spin groups acting on hermitian symmetric domains of type IV. We give regular $p$-adic integral models for these varieties over odd primes $p$ at which the level subgroup is the connected stabilizer of a vertex lattice in the orthogonal space. Our construction is obtained by combining results of Kisin and the first author with an explicit presentation and resolution of a corresponding local model.
Quetiapine and Hypothyroidism: A Literature Review
- V. Kontaxakis, D. Karaiskos, B. Havaki-Kontaxaki, D. Skourides, P. Ferentinos, D. Pappa, G. Papadimitriou
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- Journal:
- European Psychiatry / Volume 24 / Issue S1 / January 2009
- Published online by Cambridge University Press:
- 16 April 2020, 24-E1009
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Objective:
Recently, there is an interest on the possible association between quetiapine and hypothyroidism. the aim of this study is to critically review all the reported cases in the international literature.
Methods:A Medline search for all studies dealing with quetiapine induced hypothyroidism was carried out from January 1997 to June 2008.
Results:Published literature on quetiapine's impact on thyroid function consists of 1 double-blind study, 1 observational study, 2 open studies, 3 case reports and data from the product monograph. A study on elderly psychotic patients revealed only small decreases in T4 levels, while another one in adolescents show trends for decrease in T4 and a marked increase in TSH. an observational study of thyroid function in patients treated with quetiapine and other antipsychotics, found a decrease in T4 with no changes in TSH and T3 and another one only slight increases in TSH. in the case reports all patients excibited clinical hypothyroidism. in one case there was a positive history for hypothyroidism, while in another one the patient had experienced lithium induced hypothyroidism in the past. According to quetiapine manufacturer 0.4% of the patients experienced TSH increases with half of them requiring thyroid replacement treatment. in studies, where quetiapine was adjunct to lithium or divalproate, 12% of patients had elevated TSH levels.
Conclusion:We suggest a careful thyroid monitoring for patients initiating quetiapine, since hypothyroidism may emerge and masquerade psychopathologic manifestations. However, there is an open question whether thyroid dysfunction is a permanent or reversible condition.
Can Quetiapine Induced Hypothyroidism be Reversible?
- V. Kontaxakis, D. Karaiskos, B. Havaki-Kontaxaki, D. Skourides, P. Ferentinos, D. Pappa, G. Papadimitriou
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- Journal:
- European Psychiatry / Volume 24 / Issue S1 / January 2009
- Published online by Cambridge University Press:
- 16 April 2020, 24-E1008
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Objective:
Quetiapine induced hypothyroidism is a rare side effect requiring either drug discontinuation or initiation of thyroid replacement therapy. We highlight the potential reversibility of quetiapine induced hypothyroidism in two such cases.
Methods:Two case reports.
Results:Case 1.Quetiapine (200mg/day) was initiated to a psychotic female patient due to exaggeration of positive symptomatology. Although her thyroid function tests (TFTs) upon admission were normal after a month significant decreases in T3 and T4 level and an elevation in TSH was observed. 45 days later the TFT returned to normal, although she remained on quetiapine. Case 2. Quetiapine (300mg/daily) was prescribed to a bipolar male patient due to a mixed affective episode with a very good response. Despite his normal admission TFTs, three weeks later a decrease in total T4 and a marked increase in TSH was observed .45 days later, although no measures were taken, TFTs returned within reference range.
Conclusions:These are the first cases reporting reversibility of quetiapine induced hypothyroidism. TFTs alterations are dose related, relatively slight and linked to a positive history of thyroid abnormality. Our patients did not fulfil any of these criteria. Besides, hypothyroidism resolved although the antipsychotic therapy was continued and no thyroid replacement therapy was given. We suggest a careful thyroid monitoring for patients initiating quetiapine. However, physicians should wait in cases of thyroid dysfunction, since thyroid dysregulation may soon be resolved.
EPA-1594 - Regression Model for Subjective well being in Patients with Diabetes Mellitus
- G. Lyrakos, D. Damigos, E. Chatziaggelaki, A.K. Papazafiropoulou, A. Koutsovasilis, C. Batistaki, S. Bousboulas, S. Pappas, V. Spinaris
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- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Subjective well being (SWB) is really an umbrella term, that includes several different components and these components are somewhat independent, while Diabetes Mellitus (DM) is a chronic condition affected by many biopsychosocial factors.
ObjectivesTo measure the impact of SWB in adult patients with DM
AimsTo explore possible demographic, physical, and psychosocial correlates in SWB.
Methods293 DM patients(115(39.2%) males/178(60.8%) females), in two outpatients’ clinics in Athens-Greece took part in the study. Satisfaction with Life Scale(SWLS) was used for SWB, along with SF12 for health related quality of life Depression Anxiety Stress Scale(DASS), Life Orientation Test(GrLOT-R) for dispositional optimism and a questionnaire about sociodemographic characteristics. Statistical analysis was performed with SPSS 21.
Resultsinternal Almost half of the patients(54.5%) scored below average(<24) in SWLS while 20% were highly satisfied (score 30-35) and 25% satisfied(25-29). No existing differences were present in SWB according to sex(t=1.605-p=NS). Multivariate analysis revealed that depression(beta=-.423), Physical component score (SF12-PCS) (beta=.317), fatigue(beta=.211), income(beta=.186), stress(beta=-.150) and pain intensity (beta=.139), explained 52.9% of the variance in SWB(adjusted R2=.529-p=0.001). Sex, education, marital status, anxiety, Mental Composite Score, HbA1c, insulin therapy, and diabetes complications had a NS effect in the model.
ConclusionsOur results indicates that SWB is affected equally from biological, psychological and societal variables, giving strong evidence to the biopsychosocial model of subjective health and suggests that multidisciplinary treatment with psychological screening should be applied in these patients in order to help and motivate them feel better.
Design optimization of a CFRP–aluminum joint for a bioengineering application
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- G. A. Pappas, J. Botsis
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- Journal:
- Design Science / Volume 5 / 2019
- Published online by Cambridge University Press:
- 16 September 2019, e14
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Lightweight design demands and complexity requirements of modern high-end structures in aerospace, automotive, sports and bioengineering can be successfully covered by a combination of fiber reinforced polymers (FRPs) with metallic components. Conventionally, mechanical locking is favored in integrating multi-material parts, avoiding bonded interfaces. The feasibility of a multi-material carbon FRP–aluminum structural component of a robotic exoskeleton, fabricated in a single step with the FRP directly cured on the aluminum domain, was investigated. To conduct the feasibility analysis, pertinent systematic FE modeling involving cohesive contact was employed to optimize the design, while strength and fracture testing were conducted to define the formed interfaces’ resistance. Sandblasting treatment was also investigated and compared with plain surfaces. The results show that the effect of residual stresses due to curing process governs the created joint’s durability. To reduce their effect, the local compliance of the multi-material components was altered by introducing a compliant layer along with modification of the aluminum domains’ local geometry in a manner that does not compromise the overall structural integrity. The interface stresses of the optimized geometry are a few times lower than the ones estimated for the initial design. The methodology adopted herein delivers some guidelines on treating such problems.
Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience
- Rachael A. Lee, Morgan C. Scully, Bernard C. Camins, Russell L. Griffin, Danielle F. Kunz, Stephen A. Moser, Craig J. Hoesley, Todd P. McCarty, Peter G. Pappas
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 39 / Issue 12 / December 2018
- Published online by Cambridge University Press:
- 09 October 2018, pp. 1419-1424
- Print publication:
- December 2018
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Objective
Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.
DesignRetrospective cohort.
SettingLarge academic medical center.
MethodsWe performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).
ResultsLarge rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).
ConclusionsA stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.
$(G,\unicode[STIX]{x1D707})$-DISPLAYS AND RAPOPORT–ZINK SPACES
- O. Bültel, G. Pappas
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- Journal:
- Journal of the Institute of Mathematics of Jussieu / Volume 19 / Issue 4 / July 2020
- Published online by Cambridge University Press:
- 19 September 2018, pp. 1211-1257
- Print publication:
- July 2020
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Let $(G,\unicode[STIX]{x1D707})$ be a pair of a reductive group $G$ over the $p$-adic integers and a minuscule cocharacter $\unicode[STIX]{x1D707}$ of $G$ defined over an unramified extension. We introduce and study ‘$(G,\unicode[STIX]{x1D707})$-displays’ which generalize Zink’s Witt vector displays. We use these to define certain Rapoport–Zink formal schemes purely group theoretically, i.e. without $p$-divisible groups.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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178 - Blastomycosis
- from Part XXII - Specific organisms: fungi
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- By Peter G. Pappas, University of Alabama
- Edited by David Schlossberg, Temple University, Philadelphia
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 1138-1140
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Summary
Blastomycosis is a systemic pyogranulomatous disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. The disease is endemic to parts of the midwestern and south-central United States and Canada, although blastomycosis has been reported worldwide, including isolated reports from Africa, Asia, and Central and South America. Within the United States and Canada, the disease is concentrated in areas along the Mississippi and Ohio River basins and the Great Lakes. In endemic areas, small point-source outbreaks of blastomycosis have been associated with recreational and occupational activities occurring in wooded areas along waterways. Current evidence indicates that B. dermatitidis exists in warm moist soil enriched by organic debris, including decaying vegetation and wood.
Most infections with B. dermatitidis occur through inhalation of aerosolized spores, although infection through direct inoculation has been reported rarely. Primary infections are usually asymptomatic or may result in a self-limited flu-like illness. Hematogenous dissemination of organisms from the lung can result in extrapulmonary manifestations.
Blastomycosis is usually recognized as a chronic, indolent systemic fungal infection associated with various pulmonary and extrapulmonary manifestations. Pulmonary blastomycosis usually manifests as a chronic pneumonia syndrome characterized by productive cough, chest pain, hemoptysis, weight loss, and low-grade fever. There are no distinguishing radiologic features of pulmonary blastomycosis, although nodular and mass lesions, with or without cavitation, often mimicking other granulomatous diseases or bronchogenic carcinoma are common. Hilar adenopathy and pleural effusions are uncommon. Rarely, diffuse interstitial infiltrates consistent with adult respiratory distress syndrome can occur secondary to blastomycosis.
The role of organic selenium in cadmium toxicity: effects on broiler performance and health status
- A. Al-Waeli, E. Zoidis, A. C. Pappas, N. Demiris, G. Zervas, K. Fegeros
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This work was part of a project designed to assess whether organic selenium (Se) can protect against the toxic effects of cadmium (Cd). A total of 300 1-day-old, as hatched, broilers were randomly distributed in four dietary treatments with five replicate pens per treatment. In T1 treatment, broilers were fed a diet with 0.3 mg/kg added Se, as Se-yeast, without added Cd; in T2, broilers were fed a diet with 0.3 mg/kg Se and 10 mg/kg Cd; in T3, broilers were fed a diet with 0.3 mg/kg Se and 100 mg/kg of Cd; and in T4 treatment broilers were fed a diet with 3 mg/kg Se and 100 mg/kg Cd. The Cd was added to diets T2, T3 and T4 as CdCl2. On the 4th and 6th week, two broilers per replicate pen were killed in order to obtain whole blood, liver, kidney and breast samples. Body mass, feed conversion ratio and mortality were assessed and haematological analyses were performed. Se and Cd levels in tissues were analysed by inductively coupled plasma mass spectrometry. Broilers supplemented with 0.3 mg/kg Se can tolerate low levels of Cd added to the diets, as there were no significant negative effects on the examined performance parameters, whereas addition of excess Cd led to an impairment of broilers’ performance. Mortality of broilers did not differ between the four dietary treatments at any interval point or the whole period. The examined haematological parameters such as haematocrit, total blood protein concentration, and leukocytes types ranged within physiological values, revealing no negative health effects after simultaneous Cd and Se addition. The present study indicated that Se can help against the negative effects of Cd, but cannot counteract all of its negative effects.
Association between Vancomycin-Resistant Enterococci Bacteremia and Ceftriaxone Usage
- James A. McKinnell, Danielle F. Kunz, Eric Chamot, Mukesh Patel, Rhett M. Shirley, Stephen A. Moser, John W. Baddley, Peter G. Pappas, Loren G. Miller
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 33 / Issue 7 / July 2012
- Published online by Cambridge University Press:
- 02 January 2015, pp. 718-724
- Print publication:
- July 2012
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Objective.
Vancomycin-resistant enterococci (VRE) have become a public health concern with implications for patient mortality and costs. Hospital antibiotic usage may impact VRE incidence, but the relationship is poorly understood. Animal investigations suggest that ceftriaxone may be associated with VRE proliferation. We measured antimicrobial usage and VRE bloodstream infection (VRE-BSI) incidence to test our hypothesis that increased ceftriaxone usage would be associated with a higher incidence of VRE-BSI.
Design.Retrospective cohort study.
Setting.University of Alabama at Birmingham Medical Center, a 900-bed urban tertiary care hospital.
Participants.All patients admitted during the study period contributed data.
Methods.We conducted a retrospective analysis of antimicrobial usage and VRE-BSI from 2005 to 2008 (43 months). Antimicrobial usage was quantified as days of therapy (DOTs) per 1,000 patient-days. VRE-BSI incidence was calculated as cases per 1,000 patient-days. Negative binomial regression with adjustment for correlation between consecutive observations was used to measure the association between antimicrobial usage and VRE-BSI incidence at the hospital- and care-unit levels.
Results.VRE-BSI incidence increased from 0.06 to 0.17 infections per 1,000 patient-days. Hospital VRE-BSI incidence was associated with prior-month ceftriaxone DOTs (incidence rate ratio, 1.38 per 10 DOTs; P = .005). After controlling for ceftriaxone, prior-month cephalosporin usage (class) was not predictive of VRE-BSI (P = .70). Similarly, prior-month usage of piperacillin-tazobactam, ceftazidime, cefepime, cefazolin, or vancomycin was not predictive of VRE-BSI when considered individually (P ≥ .4 for all comparisons). The final model suggests that type of intensive care unit was related to VRE-BSI incidence.
Conclusions.Ceftriaxone usage in the prior month, but not cephalosporin (class) or vancomycin usage, was related to VRE-BSI incidence. These findings suggest that an antimicrobial stewardship program that limits ceftriaxone may reduce nosocomial VRE-BSI incidence.
Contributors
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
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- 11 July 2011, pp xv-xxviii
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Epidemiological and clinical aspects of human Brucella suis infection in Polynesia
- G. GUERRIER, J. M. DARONAT, L. MORISSE, J. F. YVON, G. PAPPAS
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- Journal:
- Epidemiology & Infection / Volume 139 / Issue 10 / October 2011
- Published online by Cambridge University Press:
- 21 June 2011, pp. 1621-1625
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High brucellosis seroprevalence rates in domestic swine herds have been reported in Wallis and Futuna Islands and are associated with a significant burden of human infection by Brucella suis, a species that is rarely incriminated in human disease. Between 2003 and 2010, seven patients had a positive blood culture for B. suis biovar 1, 11 symptomatic patients had a positive Rose Bengal test (RBT) and a positive serum agglutination test (SAT) and three asymptomatic cases were found to be positive for RBT, SAT or ELISA IgM (after systematic screening of 52 family members of 15 index cases). Overall, Brucella infection was diagnosed in 21 people, corresponding to a mean annual incidence of 19 cases/100 000 inhabitants. Compared to series of patients infected with other more commonly encountered Brucella spp. such as B. melitensis and B. abortus, clinical presentation and percentage and distribution of complications were similar, apart from a marked observation of significantly increased median alanine aminotransferase levels, 20 times greater than upper normal rates, but not accompanied by any particular hepatic pathology. Wallis and Futuna, where people live in close proximity to animals and where the cultural significance of pig-raising precludes the implementation of adequate veterinary preventive measures, thus represents one of the few known B. suis foci worldwide and allows for evaluation of the peculiarities of this infection.
Partial characterization of the carbohydrates of the eggs (oncospheres) of the tapeworm, Hymenolepis diminuta
- P. W. Pappas, G. M. Durka
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- Journal:
- Parasitology / Volume 110 / Issue 2 / February 1995
- Published online by Cambridge University Press:
- 06 April 2009, pp. 231-239
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The carbohydrate constituents of whole eggs and fractions derived from the eggs of Hymenolepis diminuta were partly characterized. Whole eggs contained 9·6 ng of carbohydrate (phenol-sulphuric acid-positive material) per egg, and 3·6 ng of glucose. Analysis of hydrolysed eggs by HPLC demonstrated the presence of glucose, galactose, glycerol, N-acetylgalactosamine, and 2-deoxyribose. Isolated egg shells and the KOH-stable, ethanol-precipitable fraction (putative glycogen) of eggs contained 26 and 76%, respectively, of the total carbohydrate associated with eggs. Glucose and galactose were present in both of these samples, but only glucose was present in the KOH-stable, ethanol-precipitable fraction isolated from chemically deshelled eggs; thus, the source of the galactose in the KOH-stable, ethanol-precipitable fraction isolated from whole eggs was the egg-shells. These data confirm earlier reports that the shells contain carbohydrate; the data demonstrate further that only two monosaccharides (glucose and galactose) are present in the shells, and that they are present as high molecular weight polymers. The ethanol-soluble fraction of eggs contained 2·5% of the total carbohydrate in eggs, and glucose accounted for < 1% of the ethanol-soluble carbohydrate. Analysis of the ethanol-soluble fraction by HPLC demonstrated that the predominant monosaccharides were glycerol and mannose, with smaller quantities of 2-deoxyribose and 2-deoxyglucose. The absence of a ‘free pool’ of glucose in eggs, and the presence of large amounts of glycerol and mannose, suggest that the pathways of intermediary carbohydrate metabolism in eggs might be very different from those in adult tapeworms.
A study of carbohydrate metabolism in the eggs (oncospheres) of the tapeworm, Hymenolepis diminuta, with special reference to glucose
- P. W. Pappas, G. M. Durka
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- Journal:
- Parasitology / Volume 106 / Issue 2 / February 1993
- Published online by Cambridge University Press:
- 06 April 2009, pp. 201-209
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When incubated in vitro for 24 h, intact eggs, chemically shelled eggs (obtained by treating intact eggs with NaOCl), activated larvae (eggs in which the outer shell and inner envelope were removed), and oncospheres (activated larvae treated with papain to remove the embryophore) absorb and metabolize radioactive glucose. Intact eggs, which are covered by the impermeable shell, absorb only small amounts of exogenous radioactive glucose, while chemically shelled eggs, activated larvae, and oncospheres absorb much larger amounts. Only very small amounts of the exogenous glucose are incorporated into the ethanol-precipitable carbohydrate fraction (which would include glycogen) by any of the preparations of eggs/larvae. However, the glucose is incorporated into higher molecular weight end-products that are liberated into the incubation medium. There is a temporal shift in the ability of activated larvae and oncospheres to metabolize exogenous glucose. Activated larvae and oncospheres absorb but do not metabolize glucose during the first 8 h post-activation. Between 8 and 16 h post-activation, however, virtually all of the absorbed glucose is metabolized into higher molecular weight end-products that are liberated into the incubation media. This temporal shift suggests that activation of oncospheres and cysticercoid morphogenesis are accompanied by distinct changes in carbohydrate metabolism.
Temporal changes in glucose and carbohydrate metabolism in the oncospheres of the cyclophyllidean tapeworm, Hymenolepis diminuta
- P. W. Pappas, G. M. Durka
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- Journal:
- Parasitology / Volume 106 / Issue 3 / April 1993
- Published online by Cambridge University Press:
- 06 April 2009, pp. 317-325
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When incubated in vitro for 24 h, oncospheres of Hymenolepis diminuta absorb and metabolize radioactive glucose. Between 0 and 12 h post-activation, oncospheres absorb glucose, but glucose is neither metabolized into other carbohydrates nor incorporated into the ethanol-precipitable fraction (which would contain glycogen). Between 12 and 24 h post-activation glucose is incorporated into a number of higher molecular weight carbohydrates that are demonstrable in ethanol extracts of the larvae, as well as the incubation media. Furthermore, measurable amounts of radioactivity are incorporated into the ethanol-precipitable carbohydrate fraction of oncospheres. To determine if these temporal changes in carbohydrate metabolism occurred spontaneously following activation, oncospheres were pre-incubated for 12 h (0–12 h post-activation) in the absence or presence of glucose, and then transferred to media containing radioactive glucose for an additional 12 h (12–24 h post-activation). In these latter experiments, glucose absorption and metabolism between 12 and 24 h post-activation were virtually identical to glucose metabolism in oncospheres that were incubated in radioactive glucose for 0–12 h immediately following activation. Thus, these data do not support the hypothesis that the temporal shift in carbohydrate metabolism occurs spontaneously.
Hymenolepis diminuta (Cestoda) liberates an inhibitor of proteolytic enzymes during in vitro incubation
- P. W. Pappas, G. L. Uglem
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- Journal:
- Parasitology / Volume 101 / Issue 3 / December 1990
- Published online by Cambridge University Press:
- 06 April 2009, pp. 455-464
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Hymenolepis diminuta liberated measurable amounts of ‘Lowry-positive material’ (LPM) and protein during incubation for 2 h in vitro. When tapeworms were incubated in the presence of bovine trypsin (BT), or when BT was added to the medium after removing the tapeworms, the enzyme's proteolytic activity was inhibited significantly. Centrifugation of the medium at 30 000 g yielded a pellet composed of tegumental elements, but this fraction did not inhibit BT. The 30 000 g supernatant fraction contained a chemical(s) that inhibited the proteolytic enzymes of the rodent host's intestinal contents (IC). The inhibitor(s) was stable following repeated freeze-thaw cycles, heat labile, and not degraded by BT or IC, and it inhibited the amidase activity of BT in a non-competitive manner.
Local models in the ramified case. III Unitary groups
- Part of
- G. Pappas, M. Rapoport
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- Journal:
- Journal of the Institute of Mathematics of Jussieu / Volume 8 / Issue 3 / July 2009
- Published online by Cambridge University Press:
- 26 March 2009, pp. 507-564
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- July 2009
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We continue our study of the reduction of PEL Shimura varieties with parahoric level structure at primes p at which the group defining the Shimura variety ramifies. We describe ‘good’ p-adic integral models of these Shimura varieties and study their étale local structure. In the present paper we mainly concentrate on the case of unitary groups for a ramified quadratic extension. Some of our results are applications of the theory of twisted affine flag varieties that we developed in a previous paper.
176 - Blastomycosis
- from Part XXII - Specific Organisms – Fungi
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- By Peter G. Pappas, University of Alabama School of Medicine
- Edited by David Schlossberg
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 1215-1218
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Summary
Blastomycosis is a systemic pyogranulomatous disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. The disease is endemic to parts of the midwestern and southcentral United States and Canada, although blastomycosis has been reported worldwide, including isolated reports from Africa and Central and South America. Within the United States and Canada, the disease is concentrated in areas along the Mississippi and Ohio River basins and the Great Lakes. In endemic areas, small point-source outbreaks of blastomycosis have been associated with recreational and occupational activities occurring in wooded areas along waterways. Current evidence indicates that B. dermatitidis exists in warm moist soil enriched by organic debris, including decaying vegetation and wood.
Most infections with B. dermatitidis occur through inhalation of aerosolized spores, although infection through direct inoculation has been reported rarely. Primary infections are usually asymptomatic or may result in a self-limited flulike illness. Hematogenous dissemination of organisms from the lung can result in extrapulmonary manifestations.
Blastomycosis is usually recognized as a chronic, indolent systemic fungal infection associated with various pulmonary and extrapulmonary manifestations. Pulmonary blastomycosis usually manifests as a chronic pneumonia syndrome characterized by productive cough, chest pain, hemoptysis, weight loss, and low-grade fever. There are no distinguishing radiologic features of pulmonary blastomycosis, although one or more fibronodular infiltrates or mass lesions with or without cavitation are common, often mimicking other granulomatous diseases or bronchogenic carcinoma. Hilar adenopathy and pleural effusions are uncommon. Rarely, diffuse pulmonary infiltrates consistent with adult respiratory distress syndrome may occur secondary to blastomycosis.
Comparison of the Use of Administrative Data and an Active System for Surveillance of Invasive Aspergillosis
- Douglas C. Chang, Lauren A. Burwell, G. Marshall Lyon, Peter G. Pappas, Tom M. Chiller, Kathleen A. Wannemuehler, Scott K. Fridkin, Benjamin J. Park
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 29 / Issue 1 / January 2008
- Published online by Cambridge University Press:
- 02 January 2015, pp. 25-30
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- January 2008
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Background.
Administrative data, such as International Classification of Diseases, Ninth Revision (ICD-9) codes, are readily available and are an attractive option for surveillance and quality assessment within a single institution or for interinstitutional comparisons. To understand the usefulness of administrative data for the surveillance of invasive aspergillosis, we compared information obtained from a system based on ICD-9 codes with information obtained from an active, prospective surveillance system, which used more extensive case-finding methods (Transplant Associated Infection Surveillance Network).
Methods.Patients with suspected inyasive aspergillosis were identified by aspergillosis-related ICD-9 codes assigned to hematopoietic stem cell transplant recipients and solid organ transplant recipients at a single hospital from April 1, 2001, through January 31, 2005. Suspected cases were classified as proven or probable invasive aspergillosis by medical record review using standard definitions. We calculated the sensitivity and positive predictive value (PPV) of identifying invasive aspergillosis by individual ICD-9 codes and by combinations of codes.
Results.The sensitivity of code 117.3 was modest (63% [95% confidence interval {CI}, 38%-84%]), as was the PPV (71% [95% CI, 44%-90%]); the sensitivity of code 117.9 was poor (32% [95% CI, 13%-57%]), as was the PPV (15% [95% CI, 6%-31%]). The sensitivity of codes 117.3 and 117.9 combined was 84% (95% CI, 60%-97%); the PPV of the combined codes was 30% (95% CI, 18%-44%). Overall, ICD-9 codes triggered a review of medical records for 64 medical patients, only 16 (25%) of whom had proven or probable invasive aspergillosis.
Conclusions.A surveillance system that involved multiple ICD-9 codes was sufficiently sensitive to identify most cases of invasive aspergillosis; however, the poor PPV of ICD-9 codes means that this approach is not adequate as the sole tool used to classify cases. Screening ICD-9 codes to trigger a medical record review might be a useful method of surveillance for invasive aspergillosis and quality assessment, although more investigation is needed.