Epidemiology of tuberculosis among healthcare personnel in New York City.

We have updated the epidemiology of tuberculosis (TB) among healthcare personnel (HCP) in New York City (NYC), USA, during a period of declining TB burden. Using routinely collected Health Department data for NYC TB cases from 2001 to 2014, we conducted a retrospective descriptive analysis. values were calculated using Pearson's χ² or Fisher's exact test for categorical data; Wilcoxon rank-sum test was used to compare medians.

Preclinical Validation of a Novel Device Designed to Reduce Biofilms on Percutaneous Osseointegrated Abutments.

Aim: To assess the efficacy of a prototype cleaning device in removing biofilm from skin-penetrating abutments.

Background: Adverse skin reactions around percutaneous osseointegrated implants have been linked to poor hygiene and infection. A cleaning device made from open-cell polyfoam has been developed to facilitate manual cleaning of abutments by the patient.

Factors Associated With Sputum Culture-Negative vs Culture-Positive Diagnosis of Pulmonary Tuberculosis.

Importance: Recognition of active tuberculosis (TB) in its earliest stages could reduce morbidity and prevent advancement to transmissible disease. Little is published about the occurrence and presentation of sputum culture-negative pulmonary TB (PTB), an early paucibacillary but often underrecognized disease state.

Objective: To assess differences between culture-negative and culture-positive PTB regarding occurrence, clinical presentation, radiographic findings, demographics, and comorbidities.

Long-term Mortality of Patients With Tuberculous Meningitis in New York City: A Cohort Study.

Background: Tuberculous meningitis (TBM) is the most devastating clinical presentation of infection with Mycobacterium tuberculosis; delayed initiation of effective antituberculosis therapy is associated with poor treatment outcomes. Our objective was to determine the relationship between drug resistance and 10-year mortality among patients with TBM.

Methods: We conducted a retrospective cohort study of 324 patients with culture-confirmed TBM, susceptibility results reported for isoniazid and rifampin, and initiation of at least 2 antituberculosis drugs, reported to the tuberculosis registry in New York City between 1 January 1992 and 31 December 2001.

Exploring genotype concordance in epidemiologically linked cases of tuberculosis in New York City.

Comparing genotype results of tuberculosis (TB) isolates from individuals diagnosed with TB can support or refute transmission; however, these conclusions are based upon the criteria used to define a genotype match. We used a genotype-match definition which allowed for variation in IS6110 restriction fragment length polymorphism (RFLP) to support transmission between epidemiologically linked persons. Contacts of individuals with infectious TB (index cases) diagnosed in New York City from 1997 to 2003 who subsequently developed TB (contact cases) from 1997 to 2007 were identified.

Increasing the efficiency and yield of a tuberculosis contact investigation through electronic data systems matching.

Background: Electronic health data may improve the timeliness and accuracy of resource-intense contact investigations (CIs) in healthcare settings.

Methods: In September 2013, we initiated a CI around a healthcare worker (HCW) with infectious tuberculosis (TB) who worked in a maternity ward. Two sources of electronic health data were employed: hospital-based electronic medical records (EMRs), to identify patients exposed to the HCW, and an electronic immunization registry, to obtain contact information for exposed infants and their providers at two points during follow-up.

Contact Investigations Around Mycobacterium tuberculosis Patients Without Positive Respiratory Culture.

Objective: To evaluate the yield and effectiveness of contact investigations conducted around potentially infectious tuberculosis (TB) patients with no positive respiratory culture for Mycobacterium tuberculosis in New York City (NYC).

Design: All TB patients without a positive respiratory culture from 2003 to 2012 were extracted from the NYC TB registry, and all patients eligible for contact investigation and their contacts were evaluated. Patients without a positive respiratory culture were defined as eligible for contact investigation if they had a respiratory nucleic acid amplification result positive for M tuberculosis, a cavitary chest radiograph, or a positive respiratory acid-fast bacilli smear.

Confirming Mycobacterium tuberculosis transmission from a cadaver to an embalmer using molecular epidemiology.

Genotyping results and epidemiologic investigation were used to confirm tuberculosis transmission from a cadaver to an embalmer. This investigation highlights the utility of genotyping in identifying unsuspected epidemiologic links and unusual transmission settings. In addition, the investigation provides additional evidence for the occupational risk of tuberculosis among funeral service workers and indicates a need for education about tuberculosis risk and the importance of adhering to appropriate infection control measures among funeral service workers.

A ten-year review of soft tissue reactions around percutaneous titanium implants for auricular prosthesis.

Objectives/hypothesis: Soft tissue reactions around abutments are the most common complications of percutaneous osseointegrated implants. The main objective of this study was to review our series of osseointegrated implants, evaluate the degree of adverse skin reactions around the auricular abutments, and compare with skin reactions in the pediatric bone-anchored hearing aid (BAHA) population. The reason for comparing these two groups was the difference in abutment shape and position in skin with different characteristics.

Moxifloxacin Prophylaxis against MDR TB, New York, New York, USA.

Contacts of persons infected with multidrug-resistant tuberculosis (MDR TB) have few prophylaxis options. Of 50 contacts of HIV- and MDR TB-positive persons who were treated with moxifloxacin, 30 completed treatment and 3 discontinued treatment because of gastrointestinal symptoms. Moxifloxacin was generally well-tolerated; further research of its efficacy against MDR TB is needed.

Feasibility study of a hand guided robotic drill for cochleostomy.

The concept of a hand guided robotic drill has been inspired by an automated, arm supported robotic drill recently applied in clinical practice to produce cochleostomies without penetrating the endosteum ready for inserting cochlear electrodes. The smart tactile sensing scheme within the drill enables precise control of the state of interaction between tissues and tools in real-time. This paper reports development studies of the hand guided robotic drill where the same consistent outcomes, augmentation of surgeon control and skill, and similar reduction of induced disturbances on the hearing organ are achieved.

Mechatronic feasibility of minimally invasive, atraumatic cochleostomy.

Robotic assistance in the context of lateral skull base surgery, particularly during cochlear implantation procedures, has been the subject of considerable research over the last decade. The use of robotics during these procedures has the potential to provide significant benefits to the patient by reducing invasiveness when gaining access to the cochlea, as well as reducing intracochlear trauma when performing a cochleostomy. Presented herein is preliminary work on the combination of two robotic systems for reducing invasiveness and trauma in cochlear implantation procedures.

Comparison on intracochlear disturbances between drilling a manual and robotic cochleostomy.

During cochlear implantation, hearing preservation is a concern. Minimizing disturbances to the cochlea and protection of the underlying endosteal membrane during the formation of a cochleostomy are considered important factors. The robotic micro-drill system tested in this article is the first example of an autonomous surgical drill successfully producing a cochleostomy, which keeps the underlying endosteal membrane intact.

Perioperative considerations for children undergoing bone anchored hearing device surgery: an observational study.

The objective of the study was to identify important factors in the perioperative management of children undergoing bone anchored hearing device (BAHD) surgery in a paediatric tertiary centre. We also aim to compare current practice and identify any changes in practice with the previous study carried out in the same paediatric tertiary centre in 2000. Children undergoing BAHD surgery between January 2008 and January 2011 were identified on a departmental database.

Using QuantiFERON-TB Gold In-Tube for field-based tuberculosis contact investigations in congregate settings.

Contact investigations are crucial to controlling tuberculosis in the United States. In these investigations, the tuberculin skin test has been the primary test to detect tuberculosis infection. Interferon-γ release assays, such as the QuantiFERON-TB Gold In-Tube test, were recently introduced and are intended to address limitations of the tuberculin skin test.

Quality-of-life outcomes after bone-anchored hearing device surgery in children with single-sided sensorineural deafness.

Objective: To report our experience in a series of children with single-sided sensorineural deafness where a bone-anchored hearing device (BAHD) was used for auditory rehabilitation.

Study Design: Retrospective case review.

Setting: Tertiary referral centre.

Robustness analysis of a smart surgical drill for cochleostomy.

Background: There is a need for sensor-guided robotic devices that discriminate working conditions and media, and control interaction of tool-points with respect to tissues. At the micro-surgical scale the need is to control exact penetration through flexible tissues and to control relative motion with respect to moving or deforming tissue targets and interfaces.

Methods: This paper describes a smart surgical drill that is able to control interaction with respect to the flexing tissue to avoid penetration or to control the extent of protrusion with respect to the position of the flexible tissue interface under drilling.

Do 'passive' medical titanium surfaces deteriorate in service in the absence of wear?

Globally, more than 1000 tonnes of titanium (Ti) is implanted into patients in the form of biomedical devices on an annual basis. Ti is perceived to be 'biocompatible' owing to the presence of a robust passive oxide film (approx. 4 nm thick) at the metal surface.

Delay in diagnosis leading to nosocomial transmission of tuberculosis at a New York City health care facility.

Background: Demographic changes have increased the number of elderly individuals for whom age-related immunosenescence may increase latent tuberculosis (TB) infection (LTBI) activation risk. As TB rates decline, maintaining clinical suspicion for TB is challenging. Timely identification, isolation, and treatment of infectious patients are especially important in settings with vulnerable individuals.

Active case finding and prevention of tuberculosis among a cohort of contacts exposed to infectious tuberculosis cases in New York City.

Background: Tuberculosis contact investigation identifies individuals who may be recently infected with tuberculosis and are thus at increased risk for disease. Contacts with latent tuberculosis infection (LTBI) are offered chemoprophylaxis to prevent active disease; however, the effectiveness of this intervention is unclear as treatment completion is generally low.

Methods: A retrospective cohort study of 30 561 contacts identified during investigation of 5182 cases of tuberculosis diagnosed in New York City, 1997-2003, was performed.

A smart micro-drill for cochleostomy formation: a comparison of cochlear disturbances with manual drilling and a human trial.

Background: Cochleostomy formation is a key stage of the cochlear implantation procedure. Minimizing the trauma sustained by the cochlea during this step is thought to be a critical feature in hearing preservation cochlear implantation. The aim of this paper is firstly, to assess the cochlea disturbances during manual and robotic cochleostomy formation.

Cost-effectiveness analysis of the bone-anchored hearing device.

Objective: To establish the cost-effectiveness of a bone-anchored hearing device (BAHD). To date, there has not been any formal economic analysis of this treatment.

Study Design: A prospective cohort case-control analysis.

Biofilm formation on bone-anchored hearing aids.

Objective: To investigate microbiological biofilm contamination of retrieved bone-anchored hearing aids.

Materials And Methods: Nine failed, retrieved bone-anchored hearing aids and 16 internal screws were examined by scanning electron microscopy. A fixture from a failing implant, which had been removed and disassembled under aseptic conditions, was cultured.