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Nardell, Edward

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Nardell

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Nardell, Edward
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    Influence of Bioaerosol Source Location and Ceiling Fan Direction on Eggcrate Upper-room Ultraviolet Germicidal Irradiation
    (2015) Rahman, Sumayah F.; Rudnick, Stephen; Milonova, Sonya; McDevitt, James; Nardell, Edward
    Background: Eggcrate upper-room ultraviolet germicidal irradiation (UVGI), an engineering control method for reducing the airborne transmission of infectious diseases, was recently developed as an alternative to conventional upper-room UVGI using conventional louvered fixtures. A UV screen, which is composed of open-cell eggcrate panels supported in a frame designed for a conventional suspended ceiling, was used to minimize UV radiation in the lower room. A ceiling fan, which was blowing upward directly above the microbiological source, provided vertical air exchange between the upper and lower room. This system has been shown to be significantly more effective than conventional upper-room UVGI. Study Design In the present study, the microbiological source location and the airflow direction due to the ceiling fan were varied in order to evaluate their impact on germicidal efficacy. Results: The test results clearly showed that placing an aerosol source directly underneath an upward blowing ceiling fan produces the maximum efficacy. Conclusions: The likely explanation for this outcome is that the fan sucks the microorganisms emitted by the source into the UV beam before being mixed with the air in the room. This is somewhat analogous to local exhaust ventilation in which the contaminant is removed prior to being mixed with the air in the room. Thus, when possible, the ceiling fan should be blowing upward and directly above the source. However, for experimental testing, the source location should be varied in order to access the range of germicidal efficacies that can be expected.
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    Influenza and Ultraviolet Germicidal Irradiation
    (BioMed Central, 2008) Radonovich, Lewis J.; Martinello, Richard A.; Hodgson, Michael; Milton, Donald; Nardell, Edward
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    Estimated Costs of False Laboratory Diagnoses of Tuberculosis in Three Patients
    (Centers for Disease Control and Prevention, 2002) Northrup, Jill M.; Sharnprapai, Sharon; Etkind, Sue; Driscoll, Jeffrey; McGarry, Michael; Taber, Harry W.; Elvin, Paul; Qualls, Noreen L.; Braden, Christopher R.; Miller, Ann; Nardell, Edward
    We estimated direct medical and nonmedical costs associated with a false diagnosis of tuberculosis (TB) caused by laboratory cross-contamination of Mycobacterium tuberculosis cultures in Massachusetts in 1998 and 1999. For three patients who received misdiagnoses of active TB disease on the basis of laboratory cross-contamination, the costs totaled U.S.$32,618. Of the total, 97% was attributed to the public sector (local and state health departments, public health hospital and laboratory, and county and state correctional facilities); 3% to the private sector (physicians, hospitals, and laboratories); and <1% to the patient. Hospitalizations and inpatient tests, procedures, and TB medications accounted for 69% of costs, and outpatient TB medications accounted for 18%. The average cost per patient was $10,873 (range, $1,033-$21,306). Reducing laboratory cross-contamination and quickly identifying patients with cross-contaminated cultures can prevent unnecessary and potentially dangerous treatment regimens and anguish for the patient and financial burden to the health-care system.
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    Genotyping Analyses of Tuberculosis Cases in U.S.- and Foreign-Born Massachusetts Residents
    (Centers for Disease Control and Prevention, 2002) Sharnprapai, Sharon; Miller, Ann; Suruki, Robert; Corkren, Edward; Etkind, Sue; Driscoll, Jeffrey; McGarry, Michael; Nardell, Edward
    We used molecular genotyping to further understand the epidemiology and transmission patterns of tuberculosis (TB) in Massachusetts. The study population included 983 TB patients whose cases were verified by the Massachusetts Department of Public Health between July 1, 1996, and December 31, 2000, and for whom genotyping results and information on country of origin were available. Two hundred seventy-two (28%) of TB patients were in genetic clusters, and isolates from U.S-born were twice as likely to cluster as those of foreign-born (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.69, 3.12). Our results suggest that restriction fragment length polymorphism analysis has limited capacity to differentiate TB strains when the isolate contains six or fewer copies of IS6110, even with spoligotyping. Clusters of TB patients with more than six copies of IS6110 were more likely to have epidemiologic connections than were clusters of TB patients with isolates with few copies of IS6110 (OR 8.01, 95%; CI 3.45,18.93).
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    Impact of Genotyping of Mycobacterium Tuberculosis on Public Health Practice in Massachusetts
    (Centers for Disease Control and Prevention, 2002) Miller, Ann; Sharnprapai, Sharon; Suruki, Robert; Corkren, Edward; Nardell, Edward; Driscoll, Jeffrey R.; McGarry, Michael; Taber, Harry; Etkind, Sue
    Massachusetts was one of seven sentinel surveillance sites in the National Tuberculosis Genotyping and Surveillance Network. From 1996 through 2000, isolates from new patients with tuberculosis (TB) underwent genotyping. We describe the impact that genotyping had on public health practice in Massachusetts and some limitations of the technique. Through genotyping, we explored the dynamics of TB outbreaks, investigated laboratory cross-contamination, and identified Mycobacterium tuberculosis strains, transmission sites, and accurate epidemiologic links. Genotyping should be used with epidemiologic follow-up to identify how resources can best be allocated to investigate genotypic findings.