Unrecognized pretransplant and donor‐derived cryptococcal disease in organ transplant recipients.

BACKGROUND: Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known. METHODS: Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively. RESULTS: Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor‐acquired infection. CONCLUSIONS: A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.

The beginnings of expertise for ballads

To study the beginning stages of expertise, 14 students, who were inexperienced with ballads, heard and recalled a series of 5 ballads over the course of 5 weeks. Compared with their first recall of the first ballad, their first recall of the fifth ballad had one and a half times as many words, two times as many rhyming words, and three times as much line structure evident in the written recall protocols. Compared with novices, the 14 beginning experts more often filled in blank spaces in novel ballads with words of the correct number of syllables and more often chose the original stanza of a novel ballad that was paired with a changed version of the stanza. The beginning experts were also able to compose, in 20 min, ballads about two thirds as long as the 10-stanza ballads they learned. Thirty characteristics were identified in the set of the five learned ballads. The ballads composed by the beginning experts used over half of these. The beginning experts also explicitly stated about one quarter of these 30 characteristics, but there was no statistical relationship between the characteristics used and the characteristics stated. Memory expertise is viewed as a pervasive aspect of cognition in which people make use of a variety of regularities in the material to be learned. © 1993 Cognitive Science Society, Inc.