19 results
Effectiveness of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening for Reduction of Vancomycin Use for Pneumonia
- Shannon Snellgrove, Matthew Brown, Seth Edwards, Sixto Leal, Allen Bryan, Peter Pappas, Rachael Lee
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s470-s471
- Print publication:
- October 2020
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Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been a well-established risk for developing MRSA pneumonia. In previous studies, the MRSA nasal screening test has shown an excellent negative predictive value (NPV) for MRSA pneumonia in patients without exclusion criteria such as mechanical ventilation, hemodynamic instability, cavitary lesions, and underlying pulmonary disease. MRSA nasal screening can be used as a stewardship tool to de-escalate broad antibiotic coverage, such as vancomycin. Objective: The purpose of this study was to determine whether implementation of a MRSA nasal screening questionnaire improves de-escalation of vancomycin for patients with pneumonia. Methods: A retrospective review was performed on 250 patients from October 2018 to January 2019 who received MRSA nasal screening due to their prescriber choosing only “respiratory” on the vancomycin dosing consult form. Data obtained included demographics and clinical outcomes. Statistical analyses were performed, and P < .05 was considered significant. Results: Of the 250 patients screened, only 19 patients (8%) were positive for MRSA. Moreover, 40% of patients met exclusion criteria. In 149 patients without exclusion criteria, the MRSA nasal swab had a 98% NPV. Although not statistically significant, vancomycin days of therapy (DOT) based on MRSA nasal swab result was 1 day shorter in those with negative swabs (3.49 days negative vs 4.58 days positive; P = .22). Vancomycin DOT was significantly reduced in pneumonia patients without exclusion criteria (3.17 days “no” vs 4.17 days “yes”; P = .037). Conclusions: The implementation of an electronic MRSA nasal screening questionnaire resulted in reduced vancomycin DOT in pneumonia patients at UAB Hospital. The MRSA nasal swab is an effective screening tool for antibiotic de-escalation based on its 98% NPV for MRSA pneumonia if utilized in the correct patient population.
Funding: None
Disclosures: Rachael Anne Lee reports a speaker honoraria from Prime Education, LLC.
Individualized lightweight structures for biomedical applications using additive manufacturing and carbon fiber patched composites
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- Ralph Kussmaul, Manuel Biedermann, Georgios A. Pappas, Jónas Grétar Jónasson, Peter Winiger, Markus Zogg, Daniel-Alexander Türk, Mirko Meboldt, Paolo Ermanni
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- Journal:
- Design Science / Volume 5 / 2019
- Published online by Cambridge University Press:
- 24 October 2019, e20
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Combining additive manufacturing (AM) with carbon fiber reinforced polymer patched composites unlocks potentials in the design of individualized, lightweight biomedical structures. Arising design opportunities are geometrical individualization of structures using the design freedom of AM and the patient-individual design of the load-bearing components employing carbon fiber patch placement. To date, however, full exploitation of these opportunities is a complex recurring task, which requires a high amount of knowledge and engineering effort for design, optimization, and manufacturing. The goal of this study is to make this complexity manageable by introducing a suitable manufacturing strategy for individualized lightweight structures and by developing a digitized end-to-end design process chain, which provides a high degree of task automation. The approach to achieve full individualization uses a parametric model of the structure which is adapted to patients’ 3D scans. Moreover, patient data is used to define individual load cases and perform structural optimization. The potentials of the approach are demonstrated on an exoskeleton hip structure. A significant reduction of weight compared to a standard design suggests that the design and manufacturing chain is promising for the realization of individualized high-performance structures.
Treatment-resistant and Multi-therapy resistant criteria for bipolar depression: A consensus definition – CORRIGENDUM
- Diego Hidalgo-Mazzei, Michael Berk, Andrea Cipriani, Anthony J. Cleare, Arianna Di Florio, Daniel Dietch, John R. Geddes, Guy M. Goodwin, Heinz Grunze, Joseph F. Hayes, Ian Jones, Siegfried Kasper, Karine Macritchie, R. Hamish McAllister-Williams, Richard Morriss, Sam Nayrouz, Sofia Pappa, Jair C. Soares, Daniel J. Smith, Trisha Suppes, Peter Talbot, Eduard Vieta, Stuart Watson, Lakshmi N. Yatham, Allan H. Young, Paul R. A. Stokes
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- Journal:
- The British Journal of Psychiatry / Volume 214 / Issue 5 / May 2019
- Published online by Cambridge University Press:
- 28 February 2019, p. 309
- Print publication:
- May 2019
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Treatment-resistant and multi-therapy-resistant criteria for bipolar depression: consensus definition
- Diego Hidalgo-Mazzei, Michael Berk, Andrea Cipriani, Anthony J. Cleare, Arianna Di Florio, Daniel Dietch, John R. Geddes, Guy M. Goodwin, Heinz Grunze, Joseph F. Hayes, Ian Jones, Siegfried Kasper, Karine Macritchie, R. Hamish McAllister-Williams, Richard Morriss, Sam Nayrouz, Sofia Pappa, Jair C. Soares, Daniel J. Smith, Trisha Suppes, Peter Talbot, Eduard Vieta, Stuart Watson, Lakshmi N. Yatham, Allan H. Young, Paul R. A. Stokes
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- Journal:
- The British Journal of Psychiatry / Volume 214 / Issue 1 / January 2019
- Published online by Cambridge University Press:
- 06 December 2018, pp. 27-35
- Print publication:
- January 2019
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Background
Most people with bipolar disorder spend a significant percentage of their lifetime experiencing either subsyndromal depressive symptoms or major depressive episodes, which contribute greatly to the high levels of disability and mortality associated with the disorder. Despite the importance of bipolar depression, there are only a small number of recognised treatment options available. Consecutive treatment failures can quickly exhaust these options leading to treatment-resistant bipolar depression (TRBD). Remarkably few studies have evaluated TRBD and those available lack a comprehensive definition of multi-therapy-resistant bipolar depression (MTRBD).
AimsTo reach consensus regarding threshold definitions criteria for TRBD and MTRBD.
MethodBased on the evidence of standard treatments available in the latest bipolar disorder treatment guidelines, TRBD and MTRBD criteria were agreed by a representative panel of bipolar disorder experts using a modified Delphi method.
ResultsTRBD criteria in bipolar depression was defined as failure to reach sustained symptomatic remission for 8 consecutive weeks after two different treatment trials, at adequate therapeutic doses, with at least two recommended monotherapy treatments or at least one monotherapy treatment and another combination treatment. MTRBD included the same initial definition as TRBD, with the addition of failure of at least one trial with an antidepressant, a psychological treatment and a course of electroconvulsive therapy.
ConclusionsThe proposed TRBD and MTRBD criteria may provide an important signpost to help clinicians, researchers and stakeholders in judging how and when to consider new non-standard treatments. However, some challenging diagnostic and therapeutic issues were identified in the consensus process that need further evaluation and research.
Declaration of interestIn the past 3 years, M.B. has received grant/research support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF, NHMRC, Beyond Blue, Rotary Health, Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Meat and Livestock Board, Organon, Novartis, Mayne Pharma, Servier, Woolworths, Avant and the Harry Windsor Foundation, has been a speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eli Lilly, Grunbiotics, Glaxo SmithKline, Janssen Cilag, LivaNova, Lundbeck, Merck, Mylan, Otsuka, Pfizer and Servier. A.J.C. has in the past 3 years received honoraria for speaking from Astra Zeneca and Lundbeck, honoraria for consulting from Allergan, Janssen, Lundbeck and LivaNova and research grant support from Lundbeck. G.M.G. holds shares in P1Vital and has served as consultant, advisor or CME speaker for Allergan, Angelini, Compass pathways, MSD, Lundbeck, Otsuka, Takeda, Medscape, Minervra, P1Vital, Pfizer, Servier, Shire and Sun Pharma. J.G. has received research funding from National Institute for Health Research, Medical Research Council, Stanley Medical Research Institute and Wellcome. H.G. received grants/research support, consulting fees or honoraria from Gedeon Richter, Genericon, Janssen Cilag, Lundbeck, Otsuka, Pfizer and Servier. R.H.M.-W. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending advisory boards) from various pharmaceutical companies including Astra Zeneca, Cyberonics, Eli Lilly, Janssen, Liva Nova, Lundbeck, MyTomorrows, Otsuka, Pfizer, Roche, Servier, SPIMACO and Sunovion. R.M. has received research support from Big White Wall, Electromedical Products, Johnson and Johnson, Magstim and P1Vital. S.N. received honoraria from Lundbeck, Jensen and Otsuka. J.C.S. has received funds for research from Alkermes, Pfizer, Allergan, J&J, BMS and been a speaker or consultant for Astellas, Abbott, Sunovion, Sanofi. S.W has, within the past 3 years, attended advisory boards for Sunovion and LivaNova and has undertaken paid lectures for Lundbeck. D.J.S. has received honoraria from Lundbeck. T.S. has reported grants from Pathway Genomics, Stanley Medical Research Institute and Palo Alto Health Sciences; consulting fees from Sunovion Pharamaceuticals Inc.; honoraria from Medscape Education, Global Medical Education and CMEology; and royalties from Jones and Bartlett, UpToDate and Hogrefe Publishing. S.P. has served as a consultant or speaker for Janssen, and Sunovion. P.T. has received consultancy fees as an advisory board member from the following companies: Galen Limited, Sunovion Pharmaceuticals Europe Ltd, myTomorrows and LivaNova. E.V. received grants/ research support, consulting fees or honoraria from Abbott, AB-Biotics, Allergan, Angelini, Dainippon Sumitomo, Ferrer, Gedeon Richter, Janssen, Lundbeck, Otsuka and Sunovion. L.N.Y. has received grants/research support, consulting fees or honoraria from Allergan, Alkermes, Dainippon Sumitomo, Janssen, Lundbeck, Otsuka, Sanofi, Servier, Sunovion, Teva and Valeant. A.H.Y. has undertaken paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders and LivaNova. He has also previously received funding for investigator-initiated studies from AstraZeneca, Eli Lilly, Lundbeck and Wyeth. P.R.A.S. has received research funding support from Corcept Therapeutics Inc. Corcept Therapeutics Inc fully funded attendance at their internal conference in California USA and all related expenses. He has received grant funding from the Medical Research Council UK for a collaborative study with Janssen Research and Development LLC. Janssen Research and Development LLC are providing non-financial contributions to support this study. P.R.A.S. has received a presentation fee from Indivior and an advisory board fee from LivaNova.
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.
WHAT ARE USER PERSPECTIVES OF EXOSKELETON TECHNOLOGY? A LITERATURE REVIEW
- Part of
- Deborah Hill, Catherine Sarah Holloway, Dafne Zuleima Morgado Ramirez, Peter Smitham, Yannis Pappas
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue 2 / 2017
- Published online by Cambridge University Press:
- 29 August 2017, pp. 160-167
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Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology.
Methods: A systematic literature search was conducted across several healthcare related online databases.
Results: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users’ expectations and experiences of device use; another reported perspectives on potential rather than actual device use, ranking design features in order of perceived importance; and the other reported ratings of ease of device use in training.
Conclusions: The heterogeneity of studies included within this review, leave the authors unable to suggest consensus as to user perspectives of exoskeleton technology. However, it is apparent that users are able to suggest priorities for exoskeleton design and that users’ perspectives of exoskeleton technology might change in response to experience of use. The authors, therefore, suggest that exoskeleton design should be an iterative process, whereby user perspectives are sought, incorporated and refined by tangible experience, to ensure that devices developed are acceptable to and usable by the populations they seek to re-enable.
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.
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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Partial purification and characterization of a soluble acid phosphatase from the tapeworm, Hymenolepis diminuta
- Michael J. Bumbulis, Peter W. Pappas
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- Journal:
- Journal of Helminthology / Volume 65 / Issue 2 / June 1991
- Published online by Cambridge University Press:
- 05 June 2009, pp. 103-110
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An acid phosphatase activity (APA; EC 3.1.3.2) was demonstrated in homogenates of adult Hymenolepis diminuta. The APA was soluble based on the observation that it did not sediment at 130 000 g. APA was partially purified using a combination of differential centrifugation, ammonium sulphate precipitation, chloroform extraction, and gel and fast-protein-liquid-chromatography. This combination of techniques resulted in a preparation with a specific activity approximately 500 times greater than the crude enzyme preparation. The temperature and pH optima of the partially purified APA were 44°C and pH 5·0. The enzyme appeared to be a monomer with a molecular weight of approximately 62 000. APA had a higher affinity for a greater activity towards aromatic than aliphatic phosphoesters and phosphoryl transferase activity was demonstrable using 1-butanol and ethylene glycol as acceptors. APA was inhibited significantly by sodium dodecyl sulphate, fluoride, molybdate and tartrate, but CuSO4 and Fast Garnet GBC were poor inhibitors. The precise cellular localization and function of this enzyme remains unknown since it possesses characteristics of both cytoplasmic and lysosomal APA's of other organisms.
Surface aminopeptidase in Moniliformis dubius and its relation to amino acid uptake
- Gray L. Uglem, Peter W. Pappas, Clark P. Read
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- Journal:
- Parasitology / Volume 67 / Issue 2 / October 1973
- Published online by Cambridge University Press:
- 06 April 2009, pp. 185-195
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Surface aminopeptidase (APase) in the acanthocephalan, Moniliformis dubius, was studied using leucylleucine, leucylglycylglycine, glycylglycine, alanylalanine, tri-alanine and tetra-alanine as substrates. In the presence of intact worms all peptides, except glycylglycine, were hydrolysed liberating amino acids and/or peptide subunits into the incubation medium. In 5 min incubations with 5mM leucylleucine, 93% of the liberated leucine was absorbed by the worms indicating a kinetic advantage for absorption of the leucine. In media with leucylleucine plus 10 mM methionine as an inhibitor of leucine uptake, the liberated leucine was not absorbed by the worms, but accumulated in the incubation medium. The inhibitory effects of leucylleucine and alanylalanine (or products of hydrolysis) on the uptake of 0·1 mM [14C]leucine in 2 min incubations were examined. Inhibition of [14C]leucine uptake by these peptides was non-linear up to 5 mM inhibitor concentration. Concentrations of either peptide greater than 5 mM did not produce further inhibition. A significant portion of [14C]leucine transport was not inhibited by these peptides. Inclusion of 0·5 mM Pb2+, an APase inhibitor, blocked the inhibition of [14C]leucine uptake by leucylleucine indicating that the inhibition is caused by the liberated leucine alone, and that interaction of the intact dipeptide and the leucine transport system is negligible. It is concluded that the surface membrane of adult worms has APase which can hydrolyse peptides in the ambient medium. The spatial arrangement of the APase and the leucine transport system is such that the hydrolysis of a peptide confers a kinetic advantage for absorption of the liberated amino acids. Encysted or mechanically excysted cystacanth larvae from the haemocoele of the cockroach showed no APase activity. Activation of the APase required a 30 min treatment in lipase, [Na+]taurocholate or other surface active agents. Since the APase in adult worms was unaffected by washing, the data strongly suggest that this enzyme is of parasitic origin.
Permeability and membrane transport in the larva of Taenia crassiceps*
- Peter W. Pappas, Clark P. Read
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- Journal:
- Parasitology / Volume 66 / Issue 1 / February 1973
- Published online by Cambridge University Press:
- 06 April 2009, pp. 33-42
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The free pool amino acids of Taenia crassiceps metacestodes (advanced larvae) were analyzed quantitatively. In addition, the uptake of L-glutamic acid, L-proline, L-phenylalanine, L-lysine, and L-methionine was studied. Proline and glutamic acid absorption followed straight-line kinetics with respect to substrate concentration, and were not inhibited by their own molecular species. Lysine, phenylalanine and methionine were found to enter larvae by a combination of diffusion and mediated processes. Lysine absorption was inhibited only by lysine, arginine and ornithine. Phenylalanine and methionine uptake was not inhibited by lysine or arginine, but was inhibited by several other amino acids. The data suggested the presence of a basic amino acid transport locus and two distinct transport loci for methionine absorption. In addition, both immature and advanced larvae were found to be impermeable to [14C]inulin (M.W. ca. 5000). These results are discussed and compared with the results of earlier investigations of protein and amino acid absorption by T. crassiceps larvae.
The influx of purines and pyrimidines across the brush border of Hymenolepis diminuta*
- Peter W. Pappas, Gary L. Uglem, Clark P. Read
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- Journal:
- Parasitology / Volume 66 / Issue 3 / June 1973
- Published online by Cambridge University Press:
- 06 April 2009, pp. 525-538
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The kinetics of uracil, thymine, 5-bromouracil, hypoxanthine, guanine and adenine uptake by Hymenolepis diminuta were studied using shortterm (2 min) incubations. The effects of other purines and pyrimidines on the uptake of these compounds was determined. The data suggest that the purine-pyrimidine transport system of H. diminuta contains at least three distinct transport loci and that two of these loci contain multiple substrate binding sites. The three loci are characterized as follows: (1) A thymine-uracil locus which is responsible for the absorption of thymine and uracil via allosteric mechanisms and, therefore, apparently contains two binding sites for these pyrimidines. Adenine and hypoxanthine are non-productively bound to this locus; purine and 6-methyluracil are also bound to this locus, but it is unknown if binding is productive. (2) A locus which transports hypoxanthine (denoted as hypoxanthine locus no. 1), guanine, and adenine. The latter purine is apparently transported by an allosteric mechanism and, therefore, this locus apparently contains two adenine binding sites. Uracil and 5-bromouracil also bind to this locus, however, the nature of binding is uncertain. (3) A second hypoxanthine locus (hypoxanthine locus no. 2) can also be demonstrated which nonproductively binds adenine. Purine is also bound to this locus, but it is unknown if this binding is productive.
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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- Clinical Infectious Disease
- Published online:
- 05 March 2013
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- 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
- Print publication:
- 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.
Design and Methodology of the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR-ICU) Trial
- W. Charles Huskins, Naomi P. O'Grady, Matthew Samore, Dennis Wallace, Donald A. Goldmann, Peter G. Pappas
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 28 / Issue 2 / February 2007
- Published online by Cambridge University Press:
- 02 January 2015, pp. 245-246
- Print publication:
- February 2007
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Parasitology by J. Chernin. Taylor & Francis, London, UK, 2000, pp. 139. ISBN 0 7484 0817 7. Price £13.99
- PETER W. PAPPAS
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- Journal:
- Parasitology / Volume 122 / Issue 1 / January 2001
- Published online by Cambridge University Press:
- 15 January 2002, pp. 121-123
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A note on the isomorphism problem for SK[G]
- Zoé Chatzidakis, Peter Pappas
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- Journal:
- The Journal of Symbolic Logic / Volume 66 / Issue 3 / September 2001
- Published online by Cambridge University Press:
- 12 March 2014, pp. 1117-1120
- Print publication:
- September 2001
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Let G be an infinite abelian p-group and let K be a field of characteristic ≠ p. Let K[G] be the set of all sums Σg∈Gagg where the ag are in K, and all but finitely many ag are 0. Then K[G] is a K-algebra, with multiplication induced by the group multiplication on G.
If G is countable, then the isomorphism type of K[G] has been completely described by S. D. Berman [1]. If G is a direct sum of countable groups, one can also describe K[G], as K[⊕iGi] ≃ ⊗iK[Gi]. If K contains all pn-th roots of unity, then K[G] is isomorphic to the ring of continuous functions from a Boolean space X to the field K with the discrete topology. In that case, the group UK[G] of invertible elements of K[G] is isomorphic to the direct sum of ∣G∣ copies of K×. More generally, if K is of the second kind with respect to p (see below for the definition), the group UK[G] has a simple description.
Consider the subgroup SK[G] of elements Σgagg which have order a power of p and such that Σg ag = 1. This group is of course much simpler than UK[G]. Classifying SK[G] up to isomorphism reduces to the case where G has no element of infinite height, see [7]. If G is a direct sum of cyclic groups then the isomorphism type of SK[G] has been completely determined, in [2, 3, 7, 8]. The aim of this note is to show that a similar result is in general not possible for uncountable G. We use an invariant Γ associated to abelian groups, and for any regular uncountable cardinal κ, exhibit 2κ groups G for which Γ(G) = Γ(SK[G]) are pairwise distinct. Our work is based on a construction of Shelah [9], who constructed 2κ non-isomorphic abelian p-groups of cardinality κ for κ an uncountable regular cardinal.