Detection of hepatitis E virus genotype 3 in an Algerian mouse (Mus spretus) in Portugal.

Virus monitoring in small mammals is central to the design of epidemiological control strategies for rodent-borne zoonotic viruses. Synanthropic small mammals are versatile and may be potential carriers of several microbial agents. In the present work, a total of 330 fecal samples of small mammals were collected at two sites in the North of Portugal and screened for zoonotic hepatitis E virus (HEV, species Paslahepevirus balayani). Synanthropic small mammal samples (n = 40) were collected in a city park of Porto and belonged to the species Algerian mouse (Mus spretus) (n = 26) and to the greater white-toothed shrew (Crocidura russula) (n = 14). Furthermore, additional samples were collected in the Northeast region of Portugal and included Algerian mouse (n = 48), greater white-toothed shrew (n = 47), wood mouse (Apodemus sylvaticus) (n = 43), southwestern water vole (Arvicola sapidus) (n = 52), Cabrera's vole (Microtus cabrerae) (n = 49) and Lusitanian pine vole (Microtus lusitanicus) (n = 51). A nested RT-PCR targeting a part of open reading frame (ORF) 2 region of the HEV genome was used followed by sequencing and phylogenetic analysis. HEV RNA was detected in one fecal sample (0.3%; 95% confidence interval, CI: 0.01-1.68) from a synanthropic Algerian mouse that was genotyped as HEV-3, subgenotype 3e. This is the first study reporting the detection of HEV-3 in a synanthropic rodent, the Algerian mouse. The identified HEV isolate is probably the outcome of either a spill-over infection from domestic pigs or wild boars, or the result of passive viral transit through the intestinal tract. This finding reinforces the importance in the surveillance of novel potential hosts for HEV with a particular emphasis on synanthropic animals.

Detection and Molecular Characterization of Giardia and Cryptosporidium spp. Circulating in Wild Small Mammals from Portugal.

Cryptosporidium spp. and Giardia spp. are important diarrhea-causing protozoan parasites worldwide that exhibit broad host ranges. Wild small mammals can harbor host-adapted and potentially zoonotic species of both parasites. The aim of this study was to investigate Cryptosporidium spp. and Giardia spp. in wild rodents and shrews in Portugal, focusing on the protist's occurrence and genetic diversity. Molecular screening by PCR at the small subunit (SSU) rRNA gene locus of 290 fecal samples from wood mice (Apodemus sylvaticus), southwestern water voles (Arvicola sapidus), Cabrera's voles (Microtus cabrerae), Lusitanian pine voles (Microtus lusitanicus), Algerian mice (Mus spretus) and greater white-toothed shrews (Crocidura russula) in Northeast Portugal revealed the low occurrence of Cryptosporidium spp. (1%) and high occurrence of Giardia spp. (32.8%). The analysis revealed that "species" was the only significant factor associated with the increasing probability of Giardia spp. infection, with the highest prevalence reported in southwestern water voles and Lusitanian pine voles. Cryptosporidium and Giardia species determination at the SSU rRNA gene locus revealed C. muris and G. microti as the only circulating species, respectively. Subtyping of the glutamate dehydrogenase (gdh) and beta-giardin (bg) genes provided evidence of the high genetic diversity within the G. microti clade. This study suggests that rodent-adapted G. microti occurs to a large extent in cricetid hosts and supports the limited role of wild rodents and shrews as natural sources of human infections in Northeast Portugal regarding the investigated parasites. Moreover, this is the first record of G. microti in southwestern water voles, Lusitanian pine voles, Algerian mice, wood mice and Cabrera's voles and C. muris in Cabrera's voles. Finally, this study improves the database of sequences relevant for the sequence typing of G. microti strains and provides new insights about the epidemiology of Giardia spp. and Cryptosporidium spp. in wild rodents and shrews, two parasite genera of high importance for public and animal health.

Experiences of moral distress in a COVID-19 intensive care unit: A qualitative study of nurses and respiratory therapists in the United States.

The COVID-19 pandemic has placed extraordinary stress on frontline healthcare providers as they encounter significant challenges and risks while caring for patients at the bedside. This study used qualitative research methods to explore nurses and respiratory therapists' experiences providing direct care to COVID-19 patients during the first surge of the pandemic at a large academic medical center in the Northeastern United States. The purpose of this study was to explore their experiences as related to changes in staffing models and to consider needs for additional support. Twenty semi-structured interviews were conducted with sixteen nurses and four respiratory therapists via Zoom or by telephone. Interviews were transcribed verbatim, identifiers were removed, and data was coded and analyzed thematically. Five major themes characterize providers' experiences: a fear of the unknown, concerns about infection, perceived professional unpreparedness, isolation and alienation, and inescapable stress and distress. This manuscript analyzes the relationship between these themes and the concept of moral distress and finds that some, but not all, of the challenges that providers faced during this time align with previous definitions of the concept. This points to the possibility of broadening the conceptual parameters of moral distress to account for providers' experiences of treating patients with novel illnesses while encountering institutional and clinical challenges.

Comparison of two arbitrary cast transfer systems with a kinematic facebow for mounting a maxillary cast on a semiadjustable articulator.

STATEMENT OF PROBLEM: The Kois Dento-Facial Analyzer (KDFA) is used by clinicians to mount maxillary casts and to evaluate and treat patients. Limited information is available for understanding whether the KDFA should be considered as an alternative to an arbitrary facebow. PURPOSE: The purpose of this clinical study was to evaluate and compare maxillary casts mounted by using the KDFA with casts mounted by using the Panadent Pana-Mount Facebow (PMF) and a kinematic axis (KA) facebow. MATERIAL AND METHODS: Fifteen participants were enrolled in the study. Three maxillary impressions were made of each study participant. One cast from each study participant was mounted on an articulator by means of the KDFA, PMF, and KA. A standardized photograph of each mounting was made, and the condylar center-incisor distance and the occlusal and incisal plane angles were measured. A randomized complete block design analysis of variance (RCBD) (α=.05) and post hoc tests (Tukey-Kramer HSD) were used to evaluate the occlusal and incisal plane angles and the condylar center-incisor distance. RESULTS: Compared with the occlusal plane angle (OPA), the KDFA mounted the maxillary cast at an angle that was statistically lower than those of PMF and KA (P<.001). The KDFA and the PMF condylar center-incisor distances were both significantly greater than that of KA (P=.01). No differences were found between the incisal plane angle (IPA) on maxillary casts mounted with the KDFA, KA, or PMF (P=.16). CONCLUSIONS: The KDFA and PMF mounted the maxillary casts in a position that was farther from the axis when compared with the KA mounted casts. The KDFA resulted in a lower articulator OPA compared with both PMF and KA. No difference was found between the IPAs of the KDFA, PMF, and KA.

Encountering the social determinants of health on a COVID-19 ICU: Frontline providers' perspectives on inequality in a time of pandemic.

Efforts to improve health equity may be advanced by understanding health care providers' perceptions of the causes of health inequalities. Drawing on data from in-depth interviews with nurses and registered respiratory therapists (RRTs) who served on intensive care units (ICUs) during the first surge of the pandemic, this paper examines how frontline providers perceive and attribute the unequal impacts of COVID-19. It shows that nurses and RRTs quickly perceived the pandemic's disproportionate burden on Black and Latinx individuals and families. Providers attribute these inequalities to the social determinants of health, and also raise questions about how barriers to healthcare access may have made some patients more vulnerable to the worst consequences of COVID-19. Providers' perceptions of inequality and its consequences on COVID-19 ICUs were emotionally impactful and distressing, suggesting that this is a critical moment for offering clinicians practical strategies for understanding and addressing the persistent structural inequities that cause racial inequalities in health.

Intensive care unit nurses living through COVID-19: A qualitative study.

AIMS: To understand how nurses experience providing care for patients hospitalized with COVID-19 in intensive care units. BACKGROUND: As hospitals adjust staffing patterns to meet the demands of the pandemic, nurses have direct physical contact with ill patients, placing themselves and their families at physical and emotional risk. METHODS: From June to August 2020, semi-structured interviews were conducted. Sixteen nurses caring for COVID-19 patients during the first surge of the pandemic were selected via purposive sampling. Participants worked in ICUs of a quaternary 1,000-bed hospital in the Northeast United States. Interviews were transcribed verbatim, identifiers were removed, and data were coded thematically. RESULTS: Our exploratory study identified four themes that describe the experiences of nurses providing care to patients in COVID-19 ICUs during the first surge: (a) challenges of working with new co-workers and teams, (b) challenges of maintaining existing working relationships, (c) role of nursing leadership in providing information and maintaining morale and (d) the importance of institutional-level acknowledgement of their work. CONCLUSIONS: As the pandemic continues, hospitals should implement nursing staffing models that maintain and strengthen existing relationships to minimize exhaustion and burnout. IMPLICATIONS FOR NURSING MANAGEMENT: To better support nurses, hospital leaders need to account for their experiences caring for COVID-19 patients when making staffing decisions.

A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients.

PURPOSE: Critically ill patients with Coronavirus Disease 2019 (COVID-19) have high rates of line thrombosis. Our objective was to examine the safety and efficacy of a low dose heparinized saline (LDHS) arterial line (a-line) patency protocol in this population. MATERIALS AND METHODS: In this observational cohort study, patients ≥18 years with COVID-19 admitted to an ICU at one institution from March 20-May 25, 2020 were divided into two cohorts. Pre-LDHS patients had an episode of a-line thrombosis between March 20-April 19. Post-LDHS patients had an episode of a-line thrombosis between April 20-May 25 and received an LDHS solution (10 units/h) through their a-line pressure bag. RESULTS: Forty-one patients (pre-LDHS) and 30 patients (post-LDHS) were identified. Baseline characteristics were similar between groups, including age (61 versus 54 years; p = 0.24), median Sequential Organ Failure Assessment score (6 versus 7; p = 0.67) and systemic anticoagulation (47% versus 32%; p = 0.32). Median duration of a-line patency was significantly longer in post-LDHS versus pre-LDHS patients (8.5 versus 2.9 days; p < 0.001). The incidence of bleeding complications was similar between cohorts (13% vs. 10%; p = 0.71). CONCLUSIONS: A LDHS protocol was associated with a clinically significant improvement in a-line patency duration in COVID-19 patients, without increased bleeding risk.

Comparison of the Kois Dento-Facial Analyzer System with an earbow for mounting a maxillary cast.

STATEMENT OF PROBLEM: The Kois Dento-Facial Analyzer System (KDFA) is used by clinicians to mount maxillary casts and evaluate and treat patients. Limited information is available for understanding whether the KDFA should be considered as an alternative to an earbow. PURPOSE: The purpose of this study was to evaluate maxillary casts mounted using the KDFA with casts mounted using Panadent's Pana-Mount Facebow (PMF). Both articulation methods were compared against a lateral cephalometric radiograph. MATERIAL AND METHODS: Fifteen dried human skulls were used. Lateral cephalometric radiographs and 2 maxillary impressions were made of each skull. One cast from each skull was mounted on an articulator by means of the KDFA and the other by using the PMF. A standardized photograph of each articulation was made, and the distance from the articular center to the incisal edge position and the occlusal plane angle were measured. The distance from condylar center to the incisal edge and the occlusal plane angle were measured from cephalometric radiographs. Finally, the 3-dimensional position of each articulation was determined with a Panadent CPI-III. A randomized complete block design analysis of variance (RCBD) and post hoc tests (Tukey-Kramer HSD) (α=.05) were used to evaluate the occlusal plane angle and axis-central incisor distance. A paired 2-sample t test for means (α=.05) was used to compare the X, Y, and Z distance at the right and left condyle. RESULTS: The KDFA and PMF mounted the maxillary cast in a position that was not statistically different from the skull when comparing the occlusal plane angle (P=.165). Both the KDFA and the PMF located the maxillary central incisor edge position in a significantly different position compared with the skull (P=.001) but were not significantly different from each other. The 3-dimensional location of the maxillary casts varied at the condyles by approximately 9 to 10.3 mm. CONCLUSION: The KDFA mounted the maxillary cast in a position that was not statistically different from the PMF when comparing the incisal edge position and the occlusal plane angle. Both the KDFA and the PMF located the maxillary incisal edge position in a significantly different position compared with the anatomic position on dried human skulls.