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With the advent of information and communication technologies, e-mail is one of the prime tools for communication. Almost everyone uses emails for business communications as well as for sharing personal information. E-mail is vulnerable against cybercrimes. This chapter focuses on the basic concepts of web forensics and then provides an insight about the e-mailing policies, email architecture, and existing investigation techniques used by forensic investigators. Most of the organizations implement some standard e-mailing policies; however, it is not sufficient to handle and prevent the digital crimes. We need to monitor and investigate emails for proper check. This chapter discusses some prominent tools and techniques through which forensic experts can gather and analyze data about suspected email accounts for investigation and produce evidence in the court of law.

Numerical analyses have been carried out to investigate the effect of geometrical and operating parameters on heat and fluid flow of Cu–Al2O3/water Hybrid nanofluid inside annuli. The simulations are performed over a range of aspect ratio (200–500), orientation angle (30–90°), heat flux (2500W/m2-10,000W/m2), and volume fraction of nanoparticles (0–0.045) as controllable parameters. As a novelty, the study is further extended through Multi-response optimization using an entropy-based Range of Value (ROV) method to obtain optimum values of controllable parameters. The four output responses viz. heat transfer coefficient (h), Nusselt number (Nu), rate of mass flow (ṁ), and Reynolds number (Re) were computed and recorded using Taguchi's L16 orthogonal array. The obtained results illustrate that the heat transfer coefficient and mass flow rate increases with aspect ratio, inclination, heat flux, and nanoparticle concentration. The optimum grouping of the controllable factors which maximizes output responses are A4B4C4D4 (i.e.: Aspect ratio = 500, inclination = 90°, Heat flux = 10,000W/m2 and volume fraction of nanoparticles = 0.045). It is also inferred that the inclination has the maximum influence on the multi-performance characteristics followed by heat flux, aspect ratio, and volume fraction.

Objectives: To evaluate the incidence, risk factors, patient characteristics, and outcomes Trichosporon spp bloodstream infections in immunocompromised patients. Methods: This was a single centre retrospective study. Patients older than 18 years of age with Trichosporon spp bloodstream infections from 2004 to 2017 were reviewed. Data were extracted from the electronic medical records and the microbiology database and then analyzed. Results: Eight patients with Trichosporon spp bloodstream infections were included; 7 had hematological malignancies and 1 had ulcerative colitis but had undergone immunosuppressive therapy. A mean of 0.41 episodes per year were noted, but in 2017, 3 episodes were observed – more than a sevenfold increase over the mean. T. asahii was the most common isolate, seen in 7/9 isolates in 8 patients. Three episodes were labelled as primary fungemia (37.5%) and five (62.5%) were line-related. Previous use of steroids, broad-spectrum antibiotics, and neutropenia were found to be common co-existent factors in our patients. The mean treatment duration was 22.9 days and the response rate was 50% with a 30-day mortality rate of 50%. Conclusions: We observed a sixfold increase in the incidence of Trichosporon spp bloodstream infection in the final year of our study. These patients were predisposed to this infection due to their immunosuppressed state. Concerns about Trichosporon fungemia in such patients may impact the choice of antifungal therapy.

Infections in solid organ transplant recipients are complex and heterogeneous. This article reviews the clinical syndromes that will likely be encountered in the intensive care unit and helps to guide in the therapy and management of these patients.

BACKGROUND: Invasive aspergillosis (IA) is a frequent complication in lung transplant recipients (LTRs). Clinical risk factors for IA have not been fully characterized, especially in the era of extensive anti-fungal prophylaxis. The primary objective of this study was to evaluate the clinical risk factors associated with IA in LTRs. The secondary objective was to assess the mortality in LTRs who had at least 1 episode of IA compared with LTRs who never had experienced IA.METHODS: We conducted an international, multicenter, retrospective cohort study of 900 consecutive adults who received lung transplants between 2005 and 2008 with 4years of follow-up. Risk factors associated with IA were identified using univariate and multiple regression Cox proportional hazards models.RESULTS: Anti-fungal prophylaxis was administered to 61.7% (555 of 900) of patients, and 79 patients developed 115 episodes of IA. The rate to development of the first episode was 29.6 per 1,000 person-years. Aspergillus fumigatus was the most common species isolated (63% [72 of 115 episodes]). Through multivariate analysis, significant risk factors identified for IA development were single lung transplant (hazard ratio, 1.84; 95% confidence interval, 1.09-3.10; p = 0.02,) and colonization with Aspergillus at 1 year post-transplantation (hazard ratio, 2.11; 95% confidence interval, 1.28-3.49; p = 0.003,). Cystic fibrosis, pre-transplant colonization with Aspergillus spp, and use of anti-fungal prophylaxis were not significantly associated with the development of IA. Time-dependent analysis showed IA was associated with higher mortality rates.CONCLUSION: Incidence of IA remains high in LTRs. Single-lung transplant and airway colonization with Aspergillus spp. within 1 year post-transplant were significantly associated with IA.

In the present work, we have successfully synthesized graphene oxide (GO) and reduced graphene oxide/magnetite (Gr@Fe 3 O 4 ) nanocomposite (NC) via modified Hummers method and co-precipitation process respectively. Microstructural and physico-chemical properties were investigated through various analytical techniques. XRD and FTIR data analyses revealed highly pure nature of the samples without any other impurity phases. Electron microscopy (SEM/TEM) images of the nanocomposite clearly exhibit uniform and well disperse spherical nanoparticles (NPs) of Fe 3 O 4 over the surface of the graphene sheets. UV-visible absorption spectroscopy indicates a red shift of the absorption band of Gr@Fe 3 O 4 NC as compared to Fe 3 O 4 NPs that suggests π - π noncovalent electrostatic interaction between the magnetic NPs and the graphene surface. The magnetic dispersibility of the NC was also explored using an external magnetic field produced by the simple bar magnets. The results affirm a higher magnetic dispersibility nature of the Gr@Fe 3 O 4 NC than the graphene oxide and Fe 3 O 4 NPs. These behaviour of the NC can be ascribed to synergistic structural and functional effect of Fe 3 O 4 nanoparticles conjugate with graphene sheet.

Background Necrotising enterocolitis (NEC) is a significant cause of infant morbidity and mortality, disproportionately affecting those of extreme prematurity and/or very low birth weight. A number of risk factors have been identified, including an association between the use of antibiotics, and the subsequent development of NEC. Aim This review sought to address whether the choice of antibiotic(s) used to treat infants with suspected late-onset sepsis (LOS) influences the risk of developing NEC. Methods A systematic review was performed across Web of Knowledge, Cochrane Library, Ovid Medline, EMBASE and CINAHL databases, up to February 2018, assessing the primary outcome of NEC occurrence, as extracted directly from the published articles. Studies were included if they were randomised control trials (or featured adequate adjustment for confounders); included clear criteria for defining LOS/NEC; and assessed occurrence of NEC in premature infants treated for LOS with intravenous antibiotics. Studies were excluded if non-original, not exclusively featuring premature infants, or where treatment was given for early-onset sepsis only. Findings 2291 titles and abstracts were identified, of which one study (81 subjects) was suitable for analysis, following screening against eligibility criteria. This suggested a decreased risk of developing definite NEC following treatment with a vancomycin/aztreonam combination, versus a vancomycin/gentamicin regimen (OR = 0·08, 95%CI = 0·00–1·45). Conclusion This systematic review identified one study where the occurrence of NEC was reported in the context of comparing different antibiotic regimens for late onset sepsis and highlights that the type of antibiotic used to treat LOS in preterm infants might be a determinant of the risk of developing NEC. Although it is known that different antibiotic combinations impact the enteric microbiome and that antibiotic exposure is a risk factor for NEC, there is a paucity of well-designed studies that look at the relationship between NEC risk and specific antibiotic exposures.

The current research work focuses on the preparation of nanocrystalline GdFe 1−x Mn x O 3 ( 0 ≤ x ≤ 0 . 3 ) samples via solid state reaction route to explore their microstructural, thermal and optical properties in detail. Scaning electron microscopy (SEM)/Transmission electron microscopy (TEM) results revealed coarse surface and highly agglomerated form of the particles in nanoscale region with increasing particle size on Mn substitution. Elemental composition and homogeneity of the ions were ensured from energy dispersive x-ray (EDX) and SEM-EDX analyses respectively. Fourier transform infrared (FTIR) spectra reflected characteristic peak of Fe–O band at ∼ 559 cm −1 for GdFeO 3 sample and shifted to 579 cm −1 by the substitution of Mn ions, signify the octahedral FeO 6 group of perovskite structure. The variation in heat flow and specific heat at constant pressure ( C p ) with the increase in temperature were monitored through differential thermal analysis (DTA) technique. An anomaly in the specific heat near the Neel temperature (565 K) of GdFeO 3 has been observed. This peak further shifts towards the lower temperature on Mn doping. Moreover, Mn substitution in GdFeO 3 reduces the values of C p . UV–visible absorption spectra exhibited two noticeable bands in the ultraviolet region and the band gap was found to decrease with the increase in Mn content as estimated by employing Tauc’s relation. However, Urbach energy calculated using absorption coefficient enhances. These results demonstrate that the physical properties of GaFeO 3 system could be tuned by the appropriate substitution of Mn for real applications.

Experimental analysis and numerical simulation of transient natural convection flow of distilled water in a high aspect ratio narrow vertical annulus are presented. For the numerical simulation, a CFD model is developed which is solved using ANSYS Fluent and validated with the previous available data. The experimental analysis and numerical simulation have been performed for a heat input range of 300 W–1800 W. The annulus internal diameter is 38 mm and external diameter is 45 mm that results in the annular gap of 3.5 mm while the aspect ratio is 352 and radius ratio is 1.184. The objective of the present work is to develop a CFD model for the prediction of dynamic behaviour of natural convection in a vertical annulus and validate it with experiments. The transient period seems to increase gradually with annulus height. With an increase in heat input, a drop in the transient period is observed. The transient period is predicted fairly well by the computational model. The novelty of the present work is that a very simple CFD model is developed for transient natural convection in a high aspect ratio vertical annulus that can be used in the design of control system for cooling of nuclear reactor cores.

Background The optimal strategy for prevention of invasive fungal infections in lung transplant recipients remains undetermined. We studied strategies based on bronchoalveolar lavage fungal culture and galactomannan for prevention of invasive aspergillosis in lung transplant recipients. Methods Consecutive lung transplant recipients were evaluated during the period January 2010 to September 2014. Rates of invasive aspergillosis and all-cause mortality were recorded at 1 year. Criteria established by the International Society for Heart and Lung Transplantation were used to define invasive fungal infections . Multivariate Cox regression analyses were performed to assess the outcomes of mortality and invasive aspergillosis. Results A total of 519 lung transplant recipients with 3,077 bronchoscopies were included in our study. The cumulative incidence of fungal infections was 14% (75 of 519). Of these patients, 10.6% (54 of 519) developed Aspergillus -related clinical syndromes. Using multivariate analysis , pre-emptive therapy was associated with significantly lower rates of invasive aspergillosis at 1 year post-transplantation compared with no pre-emptive therapy (hazard ratio [HR] 0.23, 95% confidence interval [CI] 0.09 to 0.58). Pre-emptive therapy and invasive aspergillosis had similar mortality rates compared with no invasive aspergillosis, or negative culture and galactomannan at 1 year (HR 0.54, 95% CI 0.23 to 1.28; and HR 0.99, 95% CI 0.44 to 2.25, respectively). During follow-up, 50% (259 of 519) of patients were negative for galactomannan and Aspergillus culture in bronchoalveolar lavage, and did not receive anti-fungal treatment . Only 2 patients developed invasive aspergillosis in this cohort. Conclusions Our study suggests that use of bronchoalveolar lavage culture and a galactomannan-directed pre-emptive approach significantly decreased the risk of invasive aspergillosis, allowing a 50% reduction in anti-fungal exposure compared with a universal prophylaxis approach, without affecting mortality at 1 year.

Numerical and experimental analysis of natural convection subcooled boiling flow in a high aspect ratio narrow vertical annulus operating at atmospheric pressure is carried out. The computational m...

In the present work, nanocrystalline samples of Ti1−xCrxO2 (x = 0, 0.02, 0.04, 0.06 and 0.08) were synthesized in anatase phase through simple and cost effective acid modified sol gel method. The influence of Cr doping on thermal, microstructural, electrical and magnetic properties was investigated in TiO2 host matrix. The surface morphology has revealed less agglomeration and considerable reduction in particle size in case of Cr doped TiO2 as compared to undoped TiO2 nanoparticles (NPs). Energy dispersive x-ray spectroscopy (EDS), Raman and X-ray photoelectron spectroscopy (XPS) established high purity, appropriate stoichiometry and oxidation states of the compositions. The dielectric properties of the nanoparticles were altered by the doping concentration, applied frequency as well as temperature variation. The variation in dielectric constant (e′), dielectric loss (δ) and ac conductivity as a function of frequency and temperature at different doping concentration of Cr were interpreted in the light of Maxwell Wagner theory, space charge polarization mechanism and drift mobility of charge carriers. Both undoped and Cr doped TiO2 samples exhibit room temperature ferromagnetism (RTFM) that remarkably influenced by means of the Cr content. The significant enhancement in the magnetization was observed at 4% Cr doping. However, decrease in magnetization for higher doping signify antiferromagnetic interactions between Cr ions or superexchange mechanism. These results reveal that the oxygen vacancies play a crucial role to initiate the RTFM. Therefore, the present investigation suggests the potential applications of Cr doped TiO2 nanoparticles for spintronics application.

Ureteral stents are routinely used in renal transplant and are associated with reduced urological complications but increased urinary tract infections (UTIs). There is no agreement on the preferred time to removal of stents after transplantation. We performed a systematic review and meta-analysis of all randomized controlled trials (RCTs) comparing stent duration of =14 days. Electronic databases were searched to identify RCTs that compared early vs late stent removal. Primary outcome was urinary tract infections. Secondary outcomes included various urological complications. No significant difference in UTI rates was demonstrated between short and long stent duration (relative risk (RR) 0.85, 95% confidence interval (CI) 0.44-1.64), with significant heterogeneity (I2 = 86%). Sensitivity analysis evaluating studies with low risk of bias for allocation concealment demonstrated statistically significant lower rates of UTI with short stent duration (RR 0.48, 95% CI 0.32-0.71) with no heterogeneity. No significant difference was demonstrated for the outcome of major urological complications (RR 0.72, 95% CI 0.50-1.05), without heterogeneity. Ureteral stenosis rates were significantly lower in the short duration arm (RR 0.42, 95% CI 0.18-0.98). Early removal of ureteral stents after renal transplant may be associated with reduced rates of UTI and ureteral stenosis. Additional RCTs are needed.

We have synthesized SmFe 1-x Mn x O 3 (x = 0.0, 0.1, 0.2 and 0.3) by solid state reaction route in order to understand their structural, morphological and dielectric properties. X-ray diffraction (XRD) patterns confirm single phase nature and the orthorhombic crystal symmetry of our samples. The lattice parameters are determined from the PowderX software, and are found to decrease with increase in Mn concentration. Williamson-Hall-plots are used to investigate physical parameters such as strain, stress, and energy density using different models namely, uniform deformation model (UDM), uniform deformation stress model (UDSM) and uniform deformation energy density model (UDEDM). The strain, stress, energy density and crystallite size increase as the concentration of Mn increases.

Candida spp. are common colonizers of the oral mucosa and respiratory tract in lung transplant recipients. Although thought to be non-pathogenic in most cases, donor derived infections related to Candida spp. have been described. Among the manifestations of invasive candidiasis, chronic meningitis is one of the rarest and one of the most challenging to diagnose, due to the indolence of the disease and the low yield of the CSF cultures. It is associated with severe morbidity and a high mortality. Fungal PCR and BD glucan assays can be assistance in its diagnosis, although these tests are not widely available. We report a case of a possible donor derived Candida dubliniensis infection in a lung transplant recipient, who initially presented with empyema that was treated successfully, but subsequently developed chronic meningitis. Diagnosis was delayed due to the low yield of CSF cultures, and was confirmed with fungal PCR and BD glucan assay. Keywords: Candida meningitis, Chronic meningitis, Candida dubliniensis, Lung transplant, Immunocompromised

This work focuses on the detailed crystal structures and optical and dielectric properties of sol-gel derived Ni doped YbCrO3 composites. The orthorhombic crystal configuration with Pbnm space group of the as-synthesized samples was confirmed using X-ray diffraction measurements. The obtained values for the reliability factors confirm the excellent agreement between the observed and calculated patterns. The average crystallite sizes of the doped samples determined from the Scherrer equation and Williamson–Hall analysis were found to be smaller when compared to the pristine sample. Scanning electron microscopy (SEM) images reveal the slightly elongated spherical shape particles with enhanced agglomeration in the case of the doped samples. The optical band gap of the doped samples decreases, whereas the Urbach energy shows an opposite trend. Significant changes were observed in the dielectric properties and ac conductivity of the doped samples when compared to the pristine sample. The relaxation phenomenon is observed using impedance spectroscopy measurements and the shift in the relaxation peak towards higher frequencies upon increasing the Ni content suggest the lower relaxation time in the doped samples. The results indicate that the optical and dielectric properties of YbCrO3 are enhanced upon Ni doping.

This systematic study aims to provide an extensive review of the experimental and numerical studies conducted on natural convection heat transfer and fluid flow in a vertical annulus. Natural convection in vertical annular geometry has wide applications, such as in the design of the nuclear reactor, electronic equipment cooling, insulation of aircraft cabin, and control of heating and ventilation in building design, etc. Parameters with significant impact on the design and performance are discussed in detail. This includes viz. the effect of operating and geometrical parameters, the effect of cylinder rotation, the effect of magnetic field, effects of using porous media, effects of discrete heating, conjugate analysis, boiling flow, use of Nano-fluids and some miscellaneous. Furthermore, the study highlights weak points and important research gaps such as the lack of experimental studies, 3D studies, etc. Following this, some directions for future research to address these research gaps are provided.

This paper reports the thermal, microstructural, dielectric and magnetic properties of La0.75Sr0.25Fe0.65Ni0.35O3 nanoparticles (NPs) synthesized via reverse micelle technique. The thermogravimetric analysis of as-prepared NPs confirmed a good thermal stability of the sample. Powder x-ray diffraction data analyzed with a Rietveld refinement technique revealed single-phase and orthorhombic distorted perovskite crystal structure of the NPs having Pbnm space group. The transmission electron microscopy images show the crystalline nature and formation of nanostructures with a fairly uniform distribution of particles throughout the sample. Temperature-dependent dielectric properties of the NPs in accordance with the Kramers–Kronig transformation (KKT) model, universal dielectric response model and jump relaxation model have been discussed. Electrode or interface polarization is likely the cause of the observed dielectric behavior. Due to grain boundaries and Schottky barriers of the metallic electrodes of semiconductors, the depletion region is observed, which gives rise to Maxwell–Wagner relaxation and hence high dielectric constants. Magnetic studies revealed the ferromagnetic nature of the prepared NPs upon Sr and Ni doping in LaFeO3 perovskite at room temperature. Therefore, these NPs could be a potential candidate as electrode material in solid oxide fuel cells.

Background: Novel chemotherapeutic agents such as bortezomib and concomitant high-dose chemotherapy followed by autologous hematopoietic stem cell transplant (a-HSCT) for the treatment of multiple myeloma (MM) have increased the risk of recurrent cytomegalovirus (CMV) infection. Few studies have assessed the risk factors for CMV infection in this population. Methods: This retrospective single-centre study reviewed the incidence of, risk factors for, and treatment of CMV infection in patients with MM undergoing a-HSCT between June 2012 and May 2014. Results: Of 354 individuals who underwent a-HSCT during the study period, 242 were CMV seropositive, but 53 seropositive patients were excluded because of missing CMV viral load assessments. Of the 189 patients included in the analysis, 27 (14.3%) had a total of 28 significant CMV infections (defined by a PCR threshold >137 IU). CMV infections occurred within 3 weeks of a-HSCT. Of the patients with CMV infections, 33.3% (9/27) were symptomatic with fever. Therapy for CMV infection, however, was administered in 55.5% (15/27). Multivariate analysis identified 2 risk factors for CMV infection: baseline CMV viral load (OR 1.12, 95% CI 1.03 to 1.22; p=0.01) and receipt of a tandem a-HSCT within 6 months (HR 3.59, 95% CI 1.26 to 9.94; p=0.02). Conclusions: Further prospective studies with CMV viral load monitoring targeting patients at risk for CMV infection are needed to assess the risk, cost-effectiveness of monitoring, and benefit of pre-emptive therapy for prevention of CMV infection in such patients.

Symptomatic cytomegalovirus (CMV) disease has been the standard endpoint for clinical trials in organ transplant recipients. Viral load may be a more relevant endpoint due to low frequency of disease. We performed a meta-analysis and systematic review of the literature. We found several lines of evidence to support the validity of viral load as an appropriate surrogate end-point, including the following: (1) viral loads in CMV disease are significantly greater than in asymptomatic viremia (odds ratio, 9.3 95% confidence interval, 4.6-19.3); (2) kinetics of viral replication are strongly associated with progression to disease; (3) pooled incidence of CMV viremia and disease is significantly lower during prophylaxis compared with the full patient follow-up period (viremia incidence: 3.2% vs 34.3%; P < .001) (disease incidence: 1.1% vs 13.0%; P < .001); (4) treatment of viremia prevented disease; and (5) viral load decline correlated with symptom resolution. Based on the analysis, we conclude that CMV load is an appropriate surrogate endpoint for CMV trials in organ transplant recipients.

Background Invasive aspergillosis is the most common invasive fungal infection in lung transplant recipients. The use of galactomannan testing in bronchoalveolar lavage (BAL) fluid has improved diagnosis of invasive aspergillosis; however, false-positive results can lead to overdiagnosis and unnecessary treatment. The use of proinflammatory markers such as pentraxin 3 (PTX3) may help differentiate between Aspergillus colonization and disease. Methods BAL PTX3 concentrations were measured by enzyme-linked immunosorbent assay in 151 lung transplant recipients and 9 healthy control subjects. Patients were characterized as having Aspergillus colonization or invasive disease according to International Society of Heart and Lung Transplantation criteria. Concomitant PTX3values were compared using Mann-Whitney U and Kruskal-Wallis tests. Results We analyzed 322 BAL stored samples and identified 15 invasive aspergillosis events, 38 Aspergillus colonizations, and 17 positive galactomannan with negative Aspergillus cultures. Median BAL PTX3 level was significantly higher in patients with invasive aspergillosis compared with patients with Aspergillus colonization and healthy control subjects (439.20 pg/ml [interquartile range (IQR) 168.18–778.90], 68.93 pg/ml [IQR 13.67–156.74], and 13.67 pg/ml [IQR 13.67–121.18]; p 319 pg/ml with positive galactomannan and patients with BAL PTX3 value >312 pg/ml with positive Aspergillus culture were 4.5 and 5.5 times more likely to have invasive pulmonary aspergillosis, respectively. Conclusions Our study shows that PTX3 measurements in BAL samples were significantly higher among patients with invasive aspergillosis and may help to identify patients with Aspergillus colonization and false-positive galactomannan in BAL samples.

Solid organ transplantation (SOT) outcomes have continued to improve, although long-term use of immunosuppressants can lead to complications such as diabetes, compromising post-transplant outcomes. In this study, we have characterized the intestinal microbiome (IM) composition at the metagenomic level in the context of hyperglycemia induced by immunosuppressants. Sprague-Dawley rats were subjected to doses of tacrolimus and sirolimus that reliably induce hyperglycemia and an insulin-resistant state. Subsequent exposure to probiotics resulted in reversal of hyperglycemia. 16S rRNA and metagenomic sequencing of stool were done to identify the bacterial genes and pathways enriched in immunosuppression. Bacterial diversity was significantly decreased in sirolimus-treated rats, with 9 taxa significantly less present in both immunosuppression groups: Roseburia, Oscillospira, Mollicutes, Rothia, Micrococcaceae, Actinomycetales and Staphylococcus. Following probiotics, these changes were reversed to baseline. At the metagenomic level, the balance of metabolism was shifted towards the catabolic side with an increase of genes involved in sucrose degradation, similar to diabetes. Conversely, the control rats had greater abundance of anabolic processes and genes involved in starch degradation. Immunosuppression leads to a more catabolic microbial profile, which may influence development of diabetes after SOT. Modulation of the microbiome with probiotics may help in minimizing adverse long-term effects of immunosuppression.

OBJECTIVETo evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections.DESIGNProspective observational cohort study.SETTINGSingle transplant center in Canada.PATIENTSPatients who underwent liver transplantation between February 2011 and August 2014.METHODSMultivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients.RESULTSWe enrolled 250 liver transplant recipients. The recipients’ median age at the time of transplantation was 56 years (range, 19–70 years), and 166 patients (66.4%) were male. Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85–8.13; PP=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin.CONCLUSIONSOrgan-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted.Infect Control Hosp Epidemiol 2017;38:1084–1090

Aspergillus spp. cause serious invasive lung infections, and Aspergillus fumigatus is the most commonly encountered clinically significant species. Voriconazole is considered to be the drug of choice for treating A. fumigatus infections; however, rising resistance rates have been reported. We evaluated a matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS)-based method for the differentiation between wild-type and non-wild-type isolates of 20 Aspergillus spp. (including 2 isolates of Aspergillus ustus and 1 of Aspergillus calidoustus that were used as controls due their intrinsic low azole susceptibility with respect to the in vitro response to voriconazole). At 30 and 48 h of incubation, there was complete agreement between Cyp51A sequence analysis, broth microdilution, and MALDI-TOF MS classification of isolates as wild type or non-wild type. In this proof-of-concept study, we demonstrated that MALDI-TOF MS can be used to accurately detect A. fumigatus strains with reduced voriconazole susceptibility. However, rather than proving to be a rapid and simple method for antifungal susceptibility testing, this particular MS-based method showed no benefit over conventional testing methods.

Although initial therapy for cytomegalovirus (CMV) is usually successful, a significant subset of patients may have recurrent viremia. However, the epidemiology and risk factors for recurrence have not been fully defined, as well as the utility of prolonged antivirals after initial clearance.Solid organ transplant patients with first episode of CMV disease or asymptomatic viremia (≥1000 IU/mL) requiring treatment were identified by chart review. Clinical and virologic data were collected. The primary outcome was recurrence of CMV viremia or disease within 6 months of treatment discontinuation.The first episode of CMV viremia requiring antiviral therapy was assessed in 282 patients (147 CMV disease and 135 asymptomatic viremia). Cytomegalovirus occurred at 5.6 (0.63-27.7) months posttransplant. Recurrent CMV occurred in 30.5% patients at a median of 51 (0-160) days after discontinuation of therapy. Factors predictive of recurrence were treatment phase viral kinetics (P = 0.005), lung transplant (P = 0.002), CMV donor (D)+/recipient (R)- serostatus(P = 0.04) and recent acute rejection(P = 0.02). Prolonged antiviral therapy was given to 226 (80.1%) of 282 patients. Recurrence occurred in 73 (32.3%) of 226 patients that received prolonged antivirals versus 13 (23.2%) of 56 in those with no prolonged antivirals (P = 0.19).Recurrent CMV occurs in a significant percentage of patients after treatment of the first episode of CMV viremia/disease. CMV D+/R- serostatus, lung transplant, and treatment phase viral kinetics were significant predictors of recurrence. Continuation of prolonged antivirals beyond initial clearance was not associated with a reduced risk of recurrence.

When designing clinical trials it is important to involve members of the public, who can provide a view on what may encourage or prevent people participating and on what matters to them. This is known as Public and Patient Involvement (PPI). People from minority ethnic groups are often less likely to take part in clinical trials, but it is important to ensure they are able to participate fully so that health research and its findings are relevant to a wide population. We are preparing to conduct a randomised controlled trial (RCT) to test whether taking probiotic capsules can play a role in preventing preterm birth. Women from some minority ethnic groups, for example women from West Africa, and those who are from low-income groups are more likely to suffer preterm births. Preterm birth can lead to extra costs to health services and psychosocial costs for families. In this article we describe how we engaged women in discussion about the design of the planned trial, and how we aim to use our findings to ensure the trial is workable and beneficial to women, as well as to further engage service users in the future development of the trial. Four socially and ethnically diverse groups of women in East London took part in discussions about the trial and contributed their ideas and concerns. These discussions have helped to inform and improve the design of a small practice or ‘pilot’ trial to test the recruitment in a ‘real life’ setting, as well as encourage further PPI involvement for the future full-scale trial. Background Patient and public involvement (PPI) is an important tool in approaching research challenges. However, involvement of socially and ethnically diverse populations remains limited and practitioners need effective methods of involving a broad section of the population in planning and designing research. Methods In preparation for the development of a pilot randomised controlled trial (RCT) on the use of probiotics to prevent preterm birth, we conducted a public consultation exercise in a socially disadvantaged and ethnically diverse community. The consultation aimed to meet and engage local service users in considering the acceptability of the proposed protocol, and to encourage their participation in future and ongoing patient and public involvement activities. Four discussion groups were held in the community with mothers of young children within the proposed trial region, using an inclusive approach that incorporated a modified version of the Nominal Group Technique (NGT). Bringing the consultation to the community supported the involvement of often seldom-heard participants, such as those from minority ethnic groups. Results The women involved expressed a number of concerns about the proposed protocol, including adherence to the probiotic supplement regimen and randomisation. The proposal for the RCT in itself was perceived as confirmation that probiotic supplements had potentially beneficial effects, but also that they had potentially harmful side-effects. The complexity of the women’s responses provided greater insights into the challenges of even quite simple trial designs and enabled the research team to take these concerns into account while planning the pilot trial. Conclusions The use of the NGT method allowed for a consultation of a population traditionally less likely to participate in medical research. A carefully facilitated PPI exercise can allow members to express unanticipated concerns that may not have been elicited by a survey method. Findings from such exercises can be utilised to improve clinical trial design, provide insight into the feasibility of trials, and enable engagement of often excluded population groups.

The role of antiviral prophylaxis for the prevention of posttransplant lymphoproliferative disease (PTLD) remains controversial for solid organ transplantation (SOT) recipients who are seronegative for Epstein-Barr virus (EBV) but who received organs from seropositive donors. We performed a systematic review and meta-analysis to address this issue. Two independent assessors extracted data from studies after determining patient eligibility and completing quality assessments. Overall, 31 studies were identified and included in the quantitative synthesis. Nine studies were included in the direct comparisons (total 2366 participants), and 22 were included in the indirect analysis. There was no significant difference in the rate of EBV-associated PTLD in SOT recipients among those who received prophylaxis (acyclovir, valacyclovir, ganciclovir, valganciclovir) compared with those who did not receive prophylaxis (nine studies; risk ratio 0.95, 95% confidence interval 0.58-1.54). No significant differences were noted across all types of organ transplants, age groups, or antiviral use as prophylaxis or preemptive therapy. There was no significant heterogeneity in the effect of antiviral prophylaxis on the incidence of PTLD. In conclusion, the use of antiviral prophylaxis in high-risk EBV-naive patients has no effect on the incidence of PTLD in SOT recipients.

Experimental studies on natural convection boiling of water in an internally heated narrow vertical annulus, with the liquid circulating through a cold leg forming a closed-loop thermo-siphon, have been carried out. The radius and aspect ratios of the annulus are 1.184 and 352, respectively. The experimental data, which consist of wall and liquid temperatures, liquid and vapor flow rates, and differential pressure across the test section, are recorded on a data logging system. The experiments have been performed for a constant heat flux of 15–35 kW/m2 from the startup period until the steady state to study the transient behavior of the system. The boiling and non-boiling zones in the annulus have been identified and presented graphically through the liquid and wall temperatures for the steady state. They have been also verified through the visual photographs of the flow patterns in the annulus. The flow is found to be oscillatory in nature with no particular trend. Although the experimental data s...

DNS has been carried out for Rayleigh-Benard convection for two-dimensional flow in a shear enclosure at fixed Reynolds number of 10,000 and Richardson numbers 0, 25, 50, 75, 87.5, while Prandtl number was fixed as 7.0. The key effect observed was that (apart from the basic vortical flow in an enclosure due to the shearing effects) there was simultaneous induction of buoyancy driven flow in an enclosure due to the convection of heat in the flow. For the cases with low and moderate Richardson number the resulting flow was found to be unperturbed, steady and laminar with an original vortical flow unaltered while for cases with high Richardson numbers the resulting flow was found to be unstable and chaotic in nature that attains a quasi-steady state after a certain period of time with strong bifurcations.

BACKGROUND Scedosporium species and Lomentospora prolificans (S/L) are the second most common causes of invasive mold infections following Aspergillus in lung transplant recipients. METHODS We assessed the current practices on management of S/L colonization/infection of the lower respiratory tract before and after lung transplantation in a large number of lung transplant centers through an international practice survey from October 2016 to March 2017. RESULTS A total of 51 respondents from 45 lung transplant centers (17 countries, 4 continents) answered the survey (response rate 58%). S/L colonization was estimated to be detected in candidates by 48% of centers. Only 18% of the centers used a specific medium to detect S/L colonization. Scedosporium spp. colonization was a contraindication to transplantation in 10% of centers whereas L prolificans was a contraindication in 31%; 22% of centers declared having had 1-5 recipients infected with S/L in the past 5 years. CONCLUSIONS This survey gives an overview of the current practices regarding S/L colonization and infection in lung transplant centers worldwide and underscores the need of S/L culture procedure standardization before implementing prospective studies.

The structural and optical properties of nanocrystalline LaFe1−xZnxO3 (0 ≤ x ≤ 0.3) samples, synthesized through sol–gel auto-combustion technique, have been studied. Transmission electron microscopy concomitant with Williamson–Hall analysis elucidates the nanocrystalline nature of the samples. High-resolution transmission electron microscopy in combination with selected area electron diffraction patterns reveals the interplanar spacing and poly-crystalline nature of samples, respectively. LFO being charge transfer insulator, its direct optical bandgap corresponding to O2p band, and the unoccupied Fe-3d band is determined. The red shift in bandgap is found with the increase in Zn doping and may be attributed to the formation of localized energy levels near the conduction band and also to the change in crystal field with the creation of oxygen vacancies. Higher order transition energy corresponding to multiple transitions has also been determined and is found to decrease with Zn doping. Urbach tail which measures the disorder in the system has been found in the pristine and doped samples and is found to increase with zinc doping. Optical constants including complex refractive index and optical conductivity have been determined from the reflectance data. The pristine sample has a refractive index of maximum value 3 which decreases with Zn doping making the sample more transparent and hence conductive. Zn doping enhances the conductivity of the pristine sample by creating the charge imbalance and thereby promoting the hopping motion of charge carriers, making the sample more transparent in the optical region.

INTRODUCTION The significance of granuloma in explanted lungs of lung transplant recipients (LTR) on the development of post-transplant mycobacterial infection is unclear. METHODS A retrospective review comparing LTRs and heart-lung transplant (H-LTR) recipients with granuloma in the explanted lungs between 2000 and 2012 (excluding those LTRs with granuloma due to sarcoidosis) and LTRs or H-LTRs without granuloma. Patients were followed for 2 years post-transplant. RESULTS A total of 144 LTRs and 4 H-LTRs with granulomas (75 necrotizing and 73 non-necrotizing) and a comparator cohort of 144 LTRs and 4 H-LTRs without granuloma were analyzed. In LTRs with granulomas, identification of infectious organisms was more common by histopathology (35 AFB and 22 fungal) compared to cultures (six NTM and seven fungal) taken around time of the transplant. LTRs with granulomas were more likely to have pre-transplant non-tuberculous mycobacteria (NTM) infection compared to LTRs without granuloma; P

Reducing the burden of visual morbidity from retinopathy of prematurity (ROP) begins with primary prevention, and improvements in neonatal care with a positive impact on ROP are possible in all settings. Strategies range from rigorous adoption of inexpensive evidence-based protocols, for example on temperature control, prevention of sepsis and support for breast-milk feeding, through to comprehensive quality improvement programmes, and fostering team work and camaraderie. Oxygen monitoring is essential for very preterm infants receiving supplementary oxygen. The Neonatal Oxygenation Prospective Meta-analysis (NeOProM) collaboration has reported analysis of five trials of oxygen saturation (SpO2) targeting in very preterm infants and shown that a SpO2 target of 85-89% compared to 91-95% was associated with increased mortality (on average 28 extra deaths for every 1000 infants treated). Adopting a SpO2 target higher than 85-89% might increase the risk of ROP for some infants, highlighting the importance of pursuing all other means of prevention.

Cytomegalovirus (CMV) infection and development of CMV drug resistance can cause significant morbidity and mortality in patients with lung transplantation (LTX). We investigated the incidence of CMV drug resistance in adult patients with LTX and characterized this patient group and its outcomes.We analyzed a single-center retrospective cohort of 735 patients who received LTX between January 2012 and October 2017. We assessed the incidences of CMV UL97 and UL54 genotyping for clinically suspected drug resistance and confirmed drug resistance. Case-matched controls (3 control patients for each resistant patient) were identified by matching for CMV serological status, development of CMV disease or significant viremia (≥3,000 IU/ml), and transplantation date.The incidence of drug-resistant CMV was 1.98% (11/556) in donor and/or recipient CMV-positive patients and 4.7% (7/150) in donor-positive/recipient-negative patients. Altogether, 27 patients were tested for drug resistance, and 11 strains were resistant, 8 sensitive, and 8 inconclusive. No differences in immunosuppression, acute rejection, or pre-transplant sensitization were seen between case-matched groups. The peak CMV viral load and mean duration of viremia were significantly higher in the resistant group (324,000 vs. 117,000 mean IU/ml, p = 0.048 and 140 vs. 55 days, p0.001, respectively). The resistant group had increased overall mortality after onset of viremia compared with controls (3-year mortality 70% vs. 30%; p = 0.01).Drug-resistant CMV infection is rare, but patients who develop it have decreased overall survival. Peak CMV viral load and duration of CMV viremia were associated with development of resistant CMV infection.

BACKGROUND Low-level CMV DNAemia is common and in the absence of treatment may either progress to higher viral loads that require therapy, or may spontaneously resolve. The clinical predictors of progression and spontaneous viral clearance are not well defined. METHODS We performed a retrospective cohort study of organ transplant recipients who had untreated low-level CMV DNAemia (

These updated AST-IDCOP guidelines provide information on epidemiology, diagnosis, and management of Aspergillus after organ transplantation. Aspergillus is the most common invasive mold infection in solid-organ transplant (SOT) recipients, and it is the most common invasive fungal infection among lung transplant recipients. Time from transplant to diagnosis of invasive aspergillosis (IA) is variable, but most cases present within the first year post-transplant, with shortest time to onset among liver and heart transplant recipients. The overall 12-week mortality of IA in SOT exceeds 20%; prognosis is worse among those with central nervous system involvement or disseminated disease. Bronchoalveolar lavage galactomannan is preferred for the diagnosis of IA in lung and non-lung transplant recipients, in combination with other diagnostic modalities (eg, chest CT scan, culture). Voriconazole remains the drug of choice to treat IA, with isavuconazole and lipid formulations of amphotericin B regarded as alternative agents. The role of combination antifungals for primary therapy of IA remains controversial. Either universal prophylaxis or preemptive therapy is recommended in lung transplant recipients, whereas targeted prophylaxis is favored in liver and heart transplant recipients. In these guidelines, we also discuss newer antifungals and diagnostic tests, antifungal susceptibility testing, and special patient populations.

Acute cellular rejection (ACR) is a significant risk factor for chronic lung allograft dysfunction (CLAD). Although clinically manifest and higher grade (≥A2) ACR is generally treated with augmented immunosuppression, management of minimal (grade A1) ACR remains controversial. In our program, patients with subclinical and spirometrically stable A1 rejection (StA1R) are routinely not treated with augmented immunosuppression. We hypothesized that an untreated first StA1R does not increase the risk of CLAD or death compared to episodes of spirometrically stable no ACR (StNAR). The cohort was drawn from all consecutive adult, first, bilateral lung transplantations performed between 1999 and 2017. Biopsies obtained in the first-year posttransplant were paired with (forced expiratory volume in 1 second FEV1 ). The first occurrence of StA1R was compared to a time-matched StNAR. The risk of CLAD or death was assessed using univariable and multivariable Cox proportional hazards models. The analyses demonstrated no significant difference in risk of CLAD or death in patients with a first StA1R compared to StNAR. This largest study to date shows that, in clinically stable patients, an untreated first A1 ACR in the first-year posttransplant is not significantly associated with an increased risk for CLAD or death. Watchful-waiting approach may be an acceptable tactic for stable A1 episodes in lung transplant recipients.

The pure and (Nd, Ni) co-doped BFO (Bi0.9Nd0.1Fe0.9Ni0.1O3) nanoparticles have been synthesized using the sol-gel combustion method. The phase purity and crystal structure of the samples are confirmed by the x-ray diffraction pattern. Rietveld refinement analysis is performed to calculate the lattice parameters, bond lengths, and bond angles. The crystal structure of the samples is found to be rhombohedral distorted perovskite structure with space group R3c. The crystallite size is calculated using both Scherrer’s relation and Williamson Hall approach and is found to increase with doping. FTIR studies reveal absorptions peaks at 547 cm−1 and 429 cm−1 respectively. These are the characteristic peaks of the FeO6 octahedra and hence confirm the formation of the BFO phase. The reflectance spectra show a peak at 305 nm in UV region and is transparent to the material in the visible region. The optical band gap has been estimated by using the Tauc’s relation and is found to be 2.92 eV for pure and 2.99 eV for (Nd, Ni) co-doped BFO.

Invasive fungal infections remain a major issue in solid organ transplantation (SOT). The incidence and type of fungal infection vary among organ groups. While invasive candidiasis is the most frequent fungal infections in all SOT, invasive mold infections (IMIs) present as a predominant type of invasive fungal infections in lung transplantation. In lung transplantation, a major challenge is to distinguish invasive infection from colonization of airways. Among other SOT recipients, liver transplant recipients show some specific features of IMI with more frequent disseminated disease. The main mold involved in invasive diseases in SOT recipients is Aspergillus spp. The treatment of choice of IA is voriconazole. Side effects such as liver toxicity and skin toxicity, particularly frequent in SOT recipients, should be kept in mind. Prophylactic strategies vary among organ groups, according to the incidence of mold infection, local epidemiology, and possible side effects of the antifungal drugs. However, modalities and efficacy of prophylactic measures are still debated.

As people around the world are spending increasing amounts of time online, the question of how online experiences are linked to health and wellbeing is essential. Depression has become a public health concern around the world. Traditional methods for detecting depression rely on self-report techniques, which suffer from inefficient data collection and processing. Research shows that symptoms linked to mental illness are detectable on social media like Twitter, Facebook, and web forums, and automatic methods are more and more able to locate inactivity and other mental disease. The pattern of social media usage can be very helpful to predict the mental state of a user. This chapter also presents how activities on Facebook are associated with the depressive states of users. Based on online logs, we can predict the mental state of users.

The nanocrystalline samples of NdFeO3(NFO) and NdFe0.7 Zn0.3O3(NFZO) synthesized by sol-gel combustion route have been investigated for their structural, morphological and optical properties. XRD patterns with Rietveld refinement reveal the orthorhombic structure of the samples with Pbnm space group. The calculated values of tolerance factor indicatetowards enhanced distortion with Zn doping. Fe-O-Fe bond angle and the Fe-O bond length are found to decrease with Zn doping. Williamson-Hall analysis is used to determine the average crystallite size and the lattice strain of the samples. FTIR spectroscopy discloses the stretching vibration (v1mode) for Fe-O band, bending vibration (v2 mode) for O-Fe-O band and the contribution of Nd3+ ions, that confirm the formation of the samples. SEM images demonstrate the clearly distinguished nanosized particles for both the samples. The energy band gap of the NdFeO3 sample decreases with Zn doping from 3.12 eV to 2.86 eV.

La0.9Bi0.1Cr1-xMnxO3 (0≤x≤0.3) samples have been prepared using the sol-gel process. These samples have been analyzed for their structural and dielectric properties. X-ray diffraction patterns affirm that the samples have the orthorhombic crystal symmetry with Pnma space group. Crystallite size is calculated by employing the Williamson-Hall analysis and is found to decrease with the increase in Mndoping. FTIR spectrajustify the formation of La0.9Bi0.1Cr1-xMnxO3 (0≤x≤0.3). Dielectric constant increases with the increase in Mn concentration and is found to have colossal values. Impedance analysis using Nyquist plots reveal that the non-Debye type of relaxation of the grains is responsible for the conduction process in these samples.

All aspects of big data need to be thoroughly investigated, with emphasis on e-governance, needs, challenges and its framework. This chapters recognizes that e-governance needs big data to be reliable, fast and efficient. Another principle is that the trust of a citizen is the main concern. The extraction of meaningful data from large variety of data is a critical issue in big data hence new approaches must be developed. This chapter basically discusses the key concepts of veracity in big data on e-governance. Its main aim is to provide the comprehensive overview big data in e-governance. E-government is still struggling to move advanced level of development. Current e-government applications handle only structured data and sharing between the applications is also difficult.

In the present study, we report on the structure, infrared spectroscopy, and defect energy of the NdFe1-xMnxO3 (x=0.0, 0.1 and 0.2). Structure, bond length, and bond angle of the synthesized samples have been analyzed by Rietveld refinement, that also confirms the single phase structure with Pbnm space group. FTIR spectra reveal the presence of Nd-O-Fe and Nd-O-Mn bonds and further strengthen the fact of successful preparation of the samples. The shifting of the strong absorption peak at 794 cm-1 towards lower wavenumber with doping is in agreement with x-ray diffraction results. Urbach energy of the NdFeO3 is found to be 0.92 eV and that increases with the increase in Mn content due to the formation of localized band states in between valance and conduction bands.

Purpose Bronchiolitis obliterans syndrome (BOS), restrictive allograft syndrome (RAS), and mixed are major phenotypes of CLAD. In previous, older studies, CMV viremia has been associated with reduced survival. We hypothesized that, in a more modern era of CMV prophylaxis, CMV viremia would remain associated with death, but also represent a risk factor for CLAD and specifically RAS/mixed phenotype. Methods This is a retrospective cohort study of all consecutive adult, first, bilateral-/single-lung transplants performed 2010-2016 who had ≥4 pulmonary function tests and ≥1 CMV-PCR measurement. CMV-PCR levels were divided into 3 categories: undetectable, Results Of 645 patients, 257 developed CLAD (143 BOS, 44 RAS/mixed, 66 undefined/unclassified) and 388 were CLAD-free at last follow-up. In univariate analysis, CMV-PCR≥1000 IU/mL was a significant risk factor for CLAD (HR 1.33, p=0.05). In multivariate analysis, CMV-PCR was not a significant risk factor for CLAD, whereas CMV serostatus mismatch was (Table). CMV-PCR was not a significant risk factor for RAS/mixed (CMV-PCR Conclusion CMV viremia was significantly associated with death/re-transplantation. Conversely, CMV viremia was not strongly associated with CLAD or RAS/mixed, while CMV serostatus mismatch was. CMV serostatus mismatch may have an impact on CLAD through mechanisms independent of viremia. In light of these paradoxical results, we are further assessing the relationship between immunosuppression, immune function, and CMV.