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12 results

  • TB or not TB? Development and validation of a clinical decision support system to inform airborne isolation requirements in the evaluation of suspected tuberculosis

  • Caitlin M. Dugdale, Kimon C. Zachary, Rebecca L. Craig, Alexandra Doms, Lindsay Germaine, Chloe V. Green, Eren Gulbas, Rocio M. Hurtado, Emily P. Hyle, Michelle S. Jerry, Jacob E. Lazarus, Stephen Maxfield, Molly Paras, Katherine Swanson, Erica S. Shenoy
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 46 / Issue 2 / February 2025
    Published online by Cambridge University Press:
    02 January 2025, pp. 120-128
    Print publication:
    February 2025
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  • Background:

    The study objective was to develop and validate a clinical decision support system (CDSS) to guide clinicians through the diagnostic evaluation of hospitalized individuals with suspected pulmonary tuberculosis (TB) in low-prevalence settings.

    Methods:

    The “TBorNotTB” CDSS was developed using a modified Delphi method. The CDSS assigns points based on epidemiologic risk factors, TB history, symptoms, chest imaging, and sputum/bronchoscopy results. Below a set point threshold, airborne isolation precautions are automatically discontinued; otherwise, additional evaluation, including infection control review, is recommended. The model was validated through retrospective application of the CDSS to all individuals hospitalized in the Mass General Brigham system from July 2016 to December 2022 with culture-confirmed pulmonary TB (cases) and equal numbers of age and date of testing-matched controls with three negative respiratory mycobacterial cultures.

    Results:

    104 individuals with TB (cases) and 104 controls were identified. Prior residence in a highly endemic country, positive interferon release assay, weight loss, absence of symptom resolution with treatment for alternative diagnoses, and findings concerning for TB on chest imaging were significant predictors of TB (all P < 0.05). CDSS contents and scoring were refined based on the case–control analysis. The final CDSS demonstrated 100% sensitivity and 27% specificity for TB with an AUC of 0.87.

    Conclusions:

    The TBorNotTB CDSS demonstrated modest specificity and high sensitivity to detect TB even when AFB smears were negative. This CDSS, embedded into the electronic medical record system, could help reduce risks of nosocomial TB transmission, patient-time in airborne isolation, and person-time spent reviewing individuals with suspected TB.

  • COVID-19 passenger screening to reduce travel risk and translocation of disease

  • Lindsay L. Waite, Ahmad Nahhas, Jan Irvahn, Grace Garden, Caroline M. Kerfonta, Elizabeth Killelea, William Ferng, Joshua J. Cummins, Rebecca Mereness, Thomas Austin, Stephen Jones, Nels Olson, Mark Wilson, Benson Isaac, Craig A. Pepper, Iain S. Koolhof, Jason Armstrong
  • Journal:
    Epidemiology & Infection / Volume 152 / 2024
    Published online by Cambridge University Press:
    08 February 2024, e36
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  • Aviation passenger screening has been used worldwide to mitigate the translocation risk of SARS-CoV-2. We present a model that evaluates factors in screening strategies used in air travel and assess their relative sensitivity and importance in identifying infectious passengers. We use adapted Monte Carlo simulations to produce hypothetical disease timelines for the Omicron variant of SARS-CoV-2 for travelling passengers. Screening strategy factors assessed include having one or two RT-PCR and/or antigen tests prior to departure and/or post-arrival, and quarantine length and compliance upon arrival. One or more post-arrival tests and high quarantine compliance were the most important factors in reducing pathogen translocation. Screening that combines quarantine and post-arrival testing can shorten the length of quarantine for travelers, and variability and mean testing sensitivity in post-arrival RT-PCR and antigen tests decrease and increase with the greater time between the first and second post-arrival test, respectively. This study provides insight into the role various screening strategy factors have in preventing the translocation of infectious diseases and a flexible framework adaptable to other existing or emerging diseases. Such findings may help in public health policy and decision-making in present and future evidence-based practices for passenger screening and pandemic preparedness.

  • Psychiatric symptoms in Ground Zero ironworkers in the aftermath of 9/11: prevalence and predictors

  • Craig L. Katz, Stephen Levin, Robin Herbert, Simon Munro, Anand Pandya, Rebecca Smith
  • Journal:
    Psychiatric Bulletin / Volume 33 / Issue 2 / February 2009
    Published online by Cambridge University Press:
    02 January 2018, pp. 49-52
    Print publication:
    February 2009
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  • Aims and Method

    To establish the prevalence of, and risk factors for, psychiatric symptoms in Ground Zero ironworkers. Questionnaires commonly used to screen for psychiatric symptoms were completed by 124 workers.

    Results

    We have established the prevalence of screening positive for symptoms of post-traumatic stress disorder, panic attacks, generalised anxiety, depression and alcohol misuse. Among the risk factors were alcohol misuse, injury to or death of a family member, friend or co-worker at Ground Zero and one or more adverse life events since 9/11.

    Clinical Implications

    Ironworkers at Ground Zero tend to have significant psychiatric symptoms likely to be associated with the traumatic experience of working there during the clean-up operation. Risk factors for psychiatric symptoms were established.

  • 5 - Neurobiology of disaster exposure: fear, anxiety, trauma, and resilience

  • from Part II - Foundations of disaster psychiatry
    • By Rebecca P. Smith, Assistant Clinical Professor World Trade Center Worker and Volunteer Mental Health Screening, Monitoring and Interventions Programs, Craig L. Katz, Assistant Clinical Professor Psychiatry Mount Sinai School of Medicine, Dennis S. Charney, Professor Psychiatry Mount Sinai School of Medicine, Steven M. Southwick, Professor Section of Child Study Center Yale University
  • Edited by Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland, Lars Weisaeth, Universitetet i Oslo, Beverley Raphael, University of Western Sydney
  • Book:
    Textbook of Disaster Psychiatry
    Published online:
    09 August 2009
    Print publication:
    01 November 2007, pp 97-118
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  • Summary

    This chapter reviews the findings of human and animal studies which have characterized normal function in the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, and then briefly describes post-traumatic stress disorder (PTSD)-associated abnormalities seen in each system. Neurobiological models of the structure, function and neurochemistry of the brain have evolved significantly as a result of recent input from findings of neuroimaging studies. In recent years several neurochemicals have been associated with resilience. In humans, neuroimaging studies of PTSD have primarily focused on the amygdala, the hippocampus, medial prefrontal cortex, and anterior cingulate cortex. Multidisciplinary studies that use neurochemical, neuroimaging, genetic, and psychosocial approaches may in the future clarify the complex relationships between genotype, phenotype, and psychobiological responses to stress. Pharmacological intervention aimed at treating early severe symptoms which are known to be predictive of later PTSD, such as excessive arousal, is one possible avenue of study.

  • 21 - The World Trade Center Worker/Volunteer Mental Health Screening Program

  • from Part IV A - New York area
  • Edited by Yuval Neria, Columbia University, New York, Raz Gross, Columbia University, New York, Randall D. Marshall, Columbia University, New York, Ezra S. Susser, Columbia University, New York
  • Foreword by Beverley Raphael
  • Book:
    9/11: Mental Health in the Wake of Terrorist Attacks
    Published online:
    27 October 2009
    Print publication:
    14 September 2006, pp 355-377

  • Summary

    The traumatic exposure

    The dramatic effect of the pictures notwithstanding, the physical and mental effects of being at “Ground Zero” were described by many “Ground Zero workers” as only able to be understood through direct experience of it. The site occupied 16 acres in lower Manhattan, with buildings grouped around a 5-acre central plaza. The site is bounded by Vesey Street on the north, Church Street on the east, Liberty Street on the south, and West Street on the west, about three blocks north of the New York Stock Exchange. The Twin Towers were 110 stories, 1353 feet (412 meters) tall. In total, there were about 10,000,000 square feet of rentable space. About 50,000 people occupied the buildings. There were 43,200 square feet (4020 square meters) – about an acre of rentable space – on each floor. The seven buildings were made up of 95% air by volume, and contained 15 million square feet of space. Commercially, the seven-story mall beneath the World Trade Center (WTC) was America's third most heavily trafficked mall (Tomasky, 2003). In the aftermath of 9/11, the site continues to be an object of much interest, discussion and meaning for droves of visitors.

    Whatever else “Ground Zero” may have been, it was also the workplace for a large number of workers and volunteers. In addition to the firemen and policemen whose volunteer, rescue, and recovery efforts have been chronicled in the media, “Ground Zero” also provided employment for at least 50 other professions, as well as a host of volunteers.