Epidemiology of Cryptococcosis and Cryptococcal Meningitis in a large retrospective cohort of patients after solid organ transplantation

Abstract Background Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients. There are no nationally representative data describing the incidence, risk factors, and outcomes of cryptococcosis after SOT. Methods We assembled a large cohort of adult SOT recipients using Classification of Diseases, Ninth Revision, Clinical Modification billing data from Healthcare Cost and Utilization Project State Inpatient Databases of Florida (2006–2012), New York (2006–2011), and California (2004–2010). Demographics, comorbidities, death, and cryptococcal infections coded during hospitalization were identified. Results A total of 42634 adults with SOT were identified during the study period. Cryptococcal disease was identified in 0.37% (n = 158), 44% of which had meningitis (n = 69). Median time to diagnosis of cryptococcosis was 464 days (range, 4–2393). The median time to onset of cryptococcosis was earlier for lung (191 days; range, 7.5–1816), heart (195 days; range, 4–1061), and liver (200 days; range, 4–1581) compared with kidney transplant recipients (616 days; range, 12–2393; P &amp;lt; .001, log rank test). Very early-onset disease (&amp;lt;30 days after transplantation) more frequently occurred in liver and lung transplant recipients. Lung transplant recipients had the highest risk of cryptococcosis (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.21–3.60). Cryptococcosis was associated with death (HR, 2.29; 95% CI, 1.68–3.11), after adjusting for age, type of SOT, and other comorbidities. Conclusions Cryptococcosis is rare after SOT, but it is associated with significantly increased risk of death. Lung transplant recipients are at highest risk for cryptococcosis among SOTs. Nonkidney transplants have earlier onset of cryptococcosis and higher risk of death compared with kidney transplant recipients. </jats:sec

The value of banking relationships during a financial crisis: evidence from failures of Japanese banks

In this paper, we provide evidence on the value of banking relationships by examining the stock market valuation impact of three large bank failures in Japan in 1997 and 1998 on their clients and the clients of surviving banks. Bank failures are theorized to have adverse consequences for other firms in general and for customers of the failed institutions in particular. Firms that are customers of the failed institution may be adversely affected because they may lose an ongoing source of funding and need to incur the expense of search and providing financial and other information about themselves to new lenders. Firms that are not customers of the failed bank may be adversely affected because the failure may signal existing but yet unrecognized problems at other banks, ignite problems at other banks through spillover or contagion, or foretell adverse economic conditions for the economy in the region or nationwide. ; Unlike previous studies of this type, we examine the impact of bank failure announcements on the market valuation not only of the client firms of the failed banks but on all firms including the clients of surviving banks. We find that, as in previous studies, the market value of customers of the failed banks is adversely affected at the date of the failure announcements. Firms that have greater access to alternative sources of funding experience a less severe adverse impact from bank failure announcements. Similarly, clients of banks that are more profitable, better capitalized, and have lower loan loss reserves suffer less from the failure announcements. However, we also find that these effects are not significantly different from the effects experienced by all firms in the economy. That is, the bank failures represent "bad news" for all firms in the economy, not just for the customers of the failed banks.

The value of banking relationships during a financial crisis: evidence from failures of Japanese banks

In this paper, we provide evidence on the value of banking relationships by examining the stock market valuation impact of three large bank failures in Japan in 1997 and 1998 on their clients and the clients of surviving banks. Bank failures are theorized to have adverse consequences for other firms in general, and for customers of the failed institutions in particular. Firms that are customers of the failed institution may be adversely affected because, among other things, they may lose an ongoing source of funding and need to incur the expense of search and providing financial and other information about themselves to new lenders. Hence, severance of banking ties due to a bank failure can have adverse consequences for the clients of the failed bank. In addition, firms that are not customers of the failed bank may be adversely affected because the failure may signal existing but yet unrecognized problems at other banks, ignite problems at other banks through spillover or contagion, or foretell adverse economic conditions for the economy in the region or nationwide. ; Unlike previous studies of this type, we examine not only the impact of bank failure announcements on the market valuation of the client firms of the failed banks, but the impact of the announcements on all firms including the clients of surviving banks. By also examining the stock valuation of the failure announcements for firms that did not have relationships with the failed institutions, we can identify any differences in the effects on clients and non-clients of the failed banks. This is particularly important when the distress or failure announcements occur in the midst of an on-going financial crisis, and therefore, can have strong implications for the viability of surviving banks and their relationships with client firms. ; We find that, as in previous studies, the market value of customers of the failed banks is adversely affected at the date of the failure announcements. In addition, the effects are related to the financial characteristics of the client firms and their primary banks. Firms that have greater access to alternative sources of funding experience a less severe adverse impact from bank failure announcements. Similarly, clients of banks that are more profitable, better capitalized, and have lower loan loss reserves suffer less from the failure announcements. However, we also find that these effects are not significantly different from the effects experienced by all firms in the economy. That is, the bank failures represent "bad news" for all firms in the economy, not just for the customers of the failed banks.Financial crises - Japan ; Bank failures

Investigating the Urban Heat Island Effect with a Collaborative Inquiry Project

Modification of the earth\u27s surface through urbanization can have a dramatic impact on local climate. A phenomenon known as the Urban Heat Island (UHI) effect, which is a measure of the near-surface air temperature contrast between urbanized and adjoining rural areas, can be evaluated with readily available instruments. Students in an undergraduate general education science course study this phenomenon in the Portland, Oregon area through a collaborative research project. This inquiry project includes background content and literature review, preliminary studies, development of research questions, experimental design and implementation, data analysis and report writing. This project successfully enables students to collaboratively generate a data set that is amenable to sophisticated and interesting analysis and provides an opportunity to study a phenomenon in their local environment

Transport pathways of polychlorinated biphenyls in Atlantic water

The distribution of polychlorinated biphenyls (PCBs) in the surface waters of the Atlantic shows concentration maxima in latitudes of high net precipitation and a minimum in the midlatitudes. Very low PCB concentrations are found in the South Atlantic. Since the nonvolatile inorganic radionuclide distribution in the Atlantic shows no dependence on precipitation patterns, codistillation with evaporating water must be a major factor in determining the distribution of PCBs...

From quantum to classical instability in relativistic stars

It has been shown that gravitational fields produced by realistic classical-matter distributions can force quantum vacuum fluctuations of some nonminimally coupled free scalar fields to undergo a phase of exponential growth. The consequences of this unstable phase to the background spacetime have not been addressed so far due to known difficulties concerning backreaction in semiclassical gravity. It seems reasonable to believe, however, that the quantum fluctuations will "classicalize" when they become large enough, after which backreaction can be treated in the general-relativistic context. Here we investigate the emergence of a classical regime out of the quantum field evolution during the unstable phase. By studying the appearance of classical correlations and loss of quantum coherence, we show that by the time backreaction becomes important the system already behaves classically. Consequently, the gravity-induced instability leads naturally to initial conditions for the eventual classical description of the backreaction. Our results give support to previous analyses which treat classically the instability of scalar fields in the spacetime of relativistic stars, regardless whether the instability is triggered by classical or quantum perturbations.Comment: 16 pages. Minor changes to match the published versio