Efficacy of Fixed Infrared Thermography for Identification of Subjects with Influenza-Like Illness Christopher M
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Walden University ScholarWorks Harold L. Hodgkinson Award for Outstanding University Awards Dissertation 2011 Efficacy of Fixed Infrared Thermography for Identification of Subjects with Influenza-like Illness Christopher M. Hinnerichs Follow this and additional works at: http://scholarworks.waldenu.edu/hodgkinson This Dissertation is brought to you for free and open access by the University Awards at ScholarWorks. It has been accepted for inclusion in Harold L. Hodgkinson Award for Outstanding Dissertation by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University COLLEGE OF HEALTH SCIENCES This is to certify that the doctoral dissertation by Christopher M. Hinnerichs has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Angela Prehn, Committee Chairperson, Public Health Faculty Dr. German Gonzalez, Committee Member, Public Health Faculty Dr. Cheryl Anderson, University Reviewer, Public Health Faculty Chief Academic Officer David Clinefelter, Ph.D. Walden University 2011 Abstract Efficacy of Fixed Infrared Thermography for Identification of Subjects with Influenza-like Illness by Christopher M. Hinnerichs MS, University of New Mexico, 2006 BA, University of New Mexico, 2004 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Epidemiology Walden University August, 2011 Abstract Due to pandemic threats and the occurrence of biological terrorism, technological advancements are being vetted, developed, and implemented as part of surveillance systems and tools. A potential surveillance tool is infrared thermography (IRT), and its efficacy for screening was the focus of this dissertation. IRT-screened participants’ temperatures were compared to laboratory diagnostics to confirm the presence or absence of influenza-like illness (ILI). An archival dataset of personnel on United States Navy and Marine vessels that were identified as exceeding an ILI threshold limit provided the data for the 320 study participants. Using a guiding thermo-science framework, derived from past IRT studies, the primary research question concerned whether IRT could statistically differentiate between afebrile participants (without ILI) and febrile participants (with ILI) using receiver operating characteristics (ROC). Results showed that IRT could differentiate between febrile and afebrile participants 91% of the time (ROC = 0.91; χ2 = 230.71, p = < 0.01), indicating excellent efficacy in this study setting. In addition, the correlation between oral temperatures and IRT surface temperatures was analyzed by gender. A strong correlation between the two variables for males (r = 0.90, n = 226, p < 0.01) and females (r = 0.87, n = 94, p < 0.01) was shown with little variance between the genders (observed z = 1.12, SE = 0.26). These findings have significant positive social change implications as they could provide senior public health decision makers with informed knowledge of IRTs benefits and limitations for rapid screening of febrile individuals in public settings to impede the transmission of ILI. Efficacy of Fixed Infrared Thermography for Identification of Subjects with Influenza-like Illness by Christopher M. Hinnerichs MS, University of New Mexico, 2006 BA, University of New Mexico, 2004 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Epidemiology Walden University August 2011 UMI Number: 3466834 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMI 3466834 Copyright 2011 by ProQuest LLC. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 - 1346 Dedication I would like to dedicate this dissertation to my family and friends. These amazing individuals have truly been my support throughout these challenging times, celebrated in my victories, and always encouraged me during shortfalls along this academic process. Their prayers, guidance, and motivation instilled and sustained the strength in me to push for this dream to come into fruition. Acknowledgements I am truly grateful to my committee chair, Dr. Angela Prehn, for her judicious responses, eye for detail, and encouragement and for asking the hard questions that strengthened my dissertation and learning process. To my board member Dr. German Gonzalez, I greatly appreciated your clinical insight, depth, and knowledge that bolstered my research while providing me with a reality check when the content ventured outside my epidemiologic lane of proficiency. To my colleague and friend, Dr. Jesse Monestersky, who provided additional clinical and oversight support, linkage to my research population, mentorship, and encouragement along this road – thank you tremendously. In addition, I would like to thank Brenda Crabtree for being my microbiology and laboratory subject matter expert – her explanations of the diagnostic results and recommendations were invaluable. To the Pacific Command Surgeon’s Office, thank you for the dedicated time that allowed me to center on my research, encouragement along the way, and exemplar leadership that I will emulate throughout my career. I would like to acknowledge my parents, Dr. Terry and Cheryle Hinnerichs, for their astute guidance, support, and their own personal achievements that motivated me to never relinquish what I started. To my brother, Todd Hinnerichs, for his humor, inspiration, and successful career path that further inspired me to push the limits and not settle for mediocrity. Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Problem Statement .........................................................................................................4 Nature of the Study ........................................................................................................5 Research Questions and Hypotheses .............................................................................6 Purpose of Study ............................................................................................................7 Conceptual Framework ..................................................................................................8 Definition of Terms........................................................................................................9 Assumptions and Limitations ......................................................................................12 Significance of the Study .............................................................................................12 Summary and Transition ..............................................................................................14 Chapter 2: Literature Review .............................................................................................16 Introduction ..................................................................................................................16 Conceptual Framework ................................................................................................17 Influenza like Illness (ILI) ..........................................................................................19 Surveillance and IRT ...................................................................................................20 Applications of IRT .....................................................................................................21 Causes of Elevated Body Temperature .................................................................22 i IRT and Selection of Febrile Subjects ............................................................................23 Temperature Thresholds for IRT ..........................................................................25 Validity, Accuracy, and Reliability of IRT ..................................................................29 Sensitivity and Specificity ....................................................................................29 Accuracy ...............................................................................................................35 Reliability ..............................................................................................................37 Potential IRT Covariates .......................................................................................37 Thermal Target Zone ...................................................................................................46 Environmental Inferences ............................................................................................48