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Testing for mycobacterial lipoarabinomannan (LAM) in urine is a practical but insensitive alternative to sputum testing to diagnose tuberculosis (TB) in people with HIV (PWH). We evaluated urine LAM testing conducted in parallel with tests for Mycobacterium tuberculosis DNA in oral swabs. In a cohort of 131 South Africans (92% with HIV), combined urine LAM and oral swab testing was significantly more sensitive than either sample tested alone (57% vs. 35% and 39%, respectively), and 97% specific, compared to reference sputum testing (TB culture and Xpert Ultra). Complementary non-sputum sample testing increased sensitivity of TB diagnosis, without sacrificing specificity.

Patient-Collected Swabs for SARS-CoV-2 Testing Tongue, nasal, and mid-turbinate swabs to detect SARS-CoV-2 were collected by 530 outpatients before a health care worker collected nasopharyngeal swa...

Oral swab analysis (OSA) has been shown to detectMycobacterium tuberculosis(MTB) DNA in patients with pulmonary tuberculosis (TB). In previous analyses, qPCR testing of swab samples collected from tongue dorsa was up to 93% sensitive relative to sputum GeneXpert, when 2 swabs per patient were tested. The present study modified sample collection methods to increase sample biomass and characterized the viability of bacilli present in tongue swabs. A qPCR targeting conserved bacterial ribosomal rRNA gene (rDNA) sequences was used to quantify bacterial biomass in samples. There was no detectable reduction in total bacterial rDNA signal over the course of 10 rapidly repeated tongue samplings, indicating that swabs collect only a small portion of the biomass available for testing. Copan FLOQSwabs collected ~2-fold more biomass than Puritan PurFlock swabs, the best brand used previously (p = 0.006). FLOQSwabs were therefore evaluated in patients with possible TB in Uganda. A FLOQSwab was collected from each patient upon enrollment (Day 1) and, in a subset of sputum GeneXpert Ultra-positive patients, a second swab was collected on the following day (Day 2). Swabs were tested for MTB DNA by manual IS6110-targeted qPCR. Relative to sputum GeneXpert Ultra, single-swab sensitivity was 88% (44/50) on Day 1 and 94.4% (17/18) on Day 2. Specificity was 79.2% (42/53). Among an expanded sample of Ugandan patients, 62% (87/141) had colony-forming bacilli in their tongue dorsum swab samples. These findings will help guide further development of this promising TB screening method.

In schizophrenia patients, one of the most commonly studied deficits of social cognition is emotion processing (EP), which has documented links to facial recognition (FR). But, how are deficits in facial recognition linked to emotion processing deficits? Can neurocognitive and symptom correlates of FR and EP help differentiate the unique contribution of FR to the domain of social cognition?A meta-analysis of 102 studies (combined n=4826) in schizophrenia patients was conducted to determine the magnitude and pattern of relationships between facial recognition, emotion processing, neurocognition, and type of symptom.Meta-analytic results indicated that facial recognition and emotion processing are strongly interrelated (r=.51). In addition, the relationship between FR and EP through voice prosody (r=.58) is as strong as the relationship between FR and EP based on facial stimuli (r=.53). Further, the relationship between emotion recognition, neurocognition, and symptoms is independent of the emotion processing modality - facial stimuli and voice prosody.The association between FR and EP that occurs through voice prosody suggests that FR is a fundamental cognitive process. The observed links between FR and EP might be due to bottom-up associations between neurocognition and EP, and not simply because most emotion recognition tasks use visual facial stimuli. In addition, links with symptoms, especially negative symptoms and disorganization, suggest possible symptom mechanisms that contribute to FR and EP deficits.

To obtain Food and Drug Administration approval for the treatment of cognitive impairments associated with schizophrenia, a drug will need to demonstrate benefits beyond those that may be documented on objective cognitive tests. Interview-based measures of cognition such as the Cognitive Assessment Interview (CAI) are candidate coprimary outcome measures.Psychiatrically stable schizophrenia outpatients (n=150) were studied using the CAI to obtain information about cognitive functioning from both the patient and an informant. Patients also received objective assessments of neurocognition, functional capacity, functional outcome, and symptoms, at baseline and 1 month later.The CAI had good internal consistency (Cronbach's alpha=.92) and good test-retest reliability (r=.83). The CAI was moderately correlated with objective neurocognitive test scores (r's=-.39 to -.41) and moderately correlated with social functioning (r=-.38), work functioning (r=-.48), and overall functional outcome (r=-.49). The correlations of CAI scores with external validity indicators did not differ significantly by source of information (patient alone ratings were valid). Overall functional outcome correlated more strongly with patient CAI scores (r=-.50) than with objective neurocognitive test scores (r=.29) or functional capacity (r=.29).Field testing of the CAI produced reliable ratings of cognitive functioning that were correlated with functional outcome. Patient ratings alone yielded scores with reliability and validity values appropriate for use in clinical trials. The CAI appears to provide useful complementary information and possesses practical advantages for rating cognitive functioning including an interview-based method of administration, brief assessment time (15 min for the patient assessment), little or no practice effects, and ease of scoring.

Background Although in the early course of schizophrenia relapse prevention is of paramount importance, there is an increasing emphasis on establishing and maintaining sustained periods of symptom remission. Recovery in the early course of illness is also possible, although the rates of recovery are lower than for symptom remission. Symptom remission and recovery rates vary considerably across recent-onset schizophrenia studies because of a lack of consistency in treatment interventions and in applying operational outcome criteria. Method Patients who were within two years of their first psychotic episode (N = 77) that were treated with continuous antipsychotic medication in conjunction with psychosocial interventions (without targeted work rehabilitation) were assessed during the first outpatient year after hospital discharge. Published operational criteria were used to classify symptom remission and recovery. Results The rate of full symptom remission maintained for 6 months was 36%, while the rate of recovery for 6 months was 10%. When the same criteria were applied for a continuous period of one year, 22% of patients were found to achieve symptom remission but only 1% of patients met recovery criteria. Using multivariate prediction, the WAIS Comprehension score was a significant predictor of 6 months of good functional outcome. Conclusions Although some schizophrenia patients can achieve both symptom remission and recovery in the early course of illness, the overall rate of symptom remission during the first post-hospitalization year is much higher than the rate of recovery. This suggests that interventions targeting work and social functioning are likely necessary to raise the chances of recovery. Cognitive factors can be predictive of good functional outcome even in the early course of schizophrenia.

Background: The existence of deficits in several social cognitive domains has been established in schizophrenia, and those impairments are known to be a significant determinant of functional outcome. Both symptoms and neurocognition have been linked to social cognitive deficits, but the nature and the relative strength of these relationships have not been established. Methods: A meta-analysis of 154 studies (combined N = 7175) was conducted to determine the magnitude of the relationships between 3 symptom domains (reality distortion, disorganization, and negative symptoms) and 6 Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains of neurocognition with 4 domains of social cognition. Analyses were conducted to determine whether the strength of these relationships differed depending on the symptom type or neurocognitive domain under investigation. Results: The correlations between reality distortion and the domains of social cognition ranged from near zero to moderate (r’s range from −.07 to −.22), as compared with the moderate association for disorganization (r’s range from −.22 to −.32) and negative symptoms (r’s range from −.20 to −.26). For each of the neurocognitive domains, the relationships to social cognitive domains were mostly moderate (r’s range from .17 to .37), with no one neurocognitive domain being prominent. Conclusions: The effect sizes of the correlations between disorganization and negative symptoms with social cognition were relatively larger and more consistent than reality distortion. The relationship between social cognition and 6 MATRICS domains of neurocognition were mostly moderate and relatively consistent. When considering disorganization and negative symptoms, the relationship to social cognitive processes was relatively as strong as for neurocognition.

The authors undertook a study of Denver, Colorado, police department officers to measure their risk of exposure to blood and human immunodeficiency virus (HIV) by type of work assignment and to document how exposures occurred. From December 1989 through March 1991, 137 officers reported an exposure to either blood or saliva, and 42 exposures to blood were independently documented. The overall rate of exposure to HIV-infected blood for medium and high risk assignments was 0.10 per 10,000 person-days. Thirty-two source persons underwent voluntary testing for HIV antibodies, and five (15.6%) were seropositive. Two thirds of the 42 blood exposures occurred in circumstances in which 1) there was little or no time for the officer to put on protective gloves and clothing because the officer was restraining or being assaulted by a suspect or 2) gloves would have not been protective because of penetration by needles. The authors conclude that Denver police officers rarely have percutaneous or mucosal exposures to blood, but when they do, the risk of exposure to HIV-infected blood is quite high. A health department can provide to police officers a number of services: evaluation of an incident involving contact with blood or body fluids to determine whether there was potential for disease transmission; information about modes of transmission and prevention of bloodborne diseases; serologic testing of source persons; HIV counseling for exposed officers and source persons; documentation for worker's compensation claims; and consultation regarding the use of zidovudine for postexposure prophylaxis.

Objective. —To assess the presence of antibody to hepatitis B surface antigen (anti-HBs) at postvaccination testing in Minnesota health care workers receiving recombinant hepatitis B vaccines, and to identify risk factors for lacking anti-HBs following hepatitis B vaccination. Design. —Retrospective cohort study. Setting. —Ten acute care hospitals in Minnesota. Participants. —A total of 595 health care workers who had received hepatitis B vaccine (Recombivax HB or Engerix-B) between June 1987 and December 1991 and who underwent postvaccination testing for anti-HBs within 6 months after receiving the third dose of vaccine. Main Outcome Measure. —Presence or absence of anti-HBs following hepatitis B vaccination. Results. —Five variables were independently associated with lacking anti-HBs by multivariate analysis: vaccine brand, smoking status, gender, age, and body mass index. Stratifying by vaccine brand demonstrated that age (P=.01), body mass index (P Conclusions. —Results indicate that certain populations of health care workers are at increased risk of not responding to hepatitis B vaccination. Further studies evaluating immunogenicity of currently available recombinant hepatitis B vaccines in persons at high risk for primary vaccine failure are needed. (JAMA. 1993;270:2935-2939)

Objective. —To determine the incidence of recognized outbreaks of Campylobacter enteritis associated with drinking raw milk during youth activities. Design. —Retrospective survey of 51 state and territorial health departments. Setting. —The 50 United States and the Territory of Puerto Rico. Populations. —Persons in preschool through college. Measurement. —Information was obtained for all Campylobacter outbreaks associated with consumption of raw milk during youth activities from 1981 through 1990 that were investigated by state and territorial health departments. Results.—Twenty outbreaks were identified in 11 states. Four hundred fifty-eight outbreak-associated cases occurred among 1013 persons who drank raw milk, with an overall attack rate of 45%. At least one outbreak was reported for each year of the 10-year period. Fourteen outbreaks (70%) occurred among children in kindergarten through third grade, compared with one outbreak (5%) among fourth through sixth graders. The remaining five outbreaks (25%) occurred in mixed groups of children and teenagers. Only nine (60%) of 15 outbreaks identified from 1981 through 1988 were reported to the Campylobacter national surveillance system maintained by the Centers for Disease Control and Prevention. Conclusion. —Drinking raw milk on school field trips or other youth activities continues despite the occurrence of multiple Campylobacter outbreaks documented from this practice. Such illnesses can be prevented by educating dairy farmers and officials of schools and youth organizations about the hazards of drinking raw milk. Public health organizations need to develop and implement such educational programs. ( JAMA . 1992;268:3228-3230)