Epidemiologic and Genomic Evidence for Zoonotic Transmission of SARS-CoV-2 among People and Animals on a Michigan Mink Farm, United States, 2020.

Farmed mink are one of few animals in which infection with SARS-CoV-2 has resulted in sustained transmission among a population and spillback from mink to people. In September 2020, mink on a Michigan farm exhibited increased morbidity and mortality rates due to confirmed SARS-CoV-2 infection. We conducted an epidemiologic investigation to identify the source of initial mink exposure, assess the degree of spread within the facility's overall mink population, and evaluate the risk of further viral spread on the farm and in surrounding wildlife habitats. Three farm employees reported symptoms consistent with COVID-19 the same day that increased mortality rates were observed among the mink herd. One of these individuals, and another asymptomatic employee, tested positive for SARS-CoV-2 by real-time reverse transcription PCR (RT-qPCR) 9 days later. All but one mink sampled on the farm were positive for SARS-CoV-2 based on nucleic acid detection from at least one oral, nasal, or rectal swab tested by RT-qPCR (99%). Sequence analysis showed high degrees of similarity between sequences from mink and the two positive farm employees. Epidemiologic and genomic data, including the presence of F486L and N501T mutations believed to arise through mink adaptation, support the hypothesis that the two employees with SARS-CoV-2 nucleic acid detection contracted COVID-19 from mink. However, the specific source of virus introduction onto the farm was not identified. Three companion animals living with mink farm employees and 31 wild animals of six species sampled in the surrounding area were negative for SARS-CoV-2 by RT-qPCR. Results from this investigation support the necessity of a One Health approach to manage the zoonotic spread of SARS-CoV-2 and underscores the critical need for multifaceted public health approaches to prevent the introduction and spread of respiratory viruses on mink farms.

Trajectories in Turmoil: A Case Study of Engineering Students' Reactions to Disruptions in Their Community of Practice.

Introduction: The COVID-19 pandemic brought unprecedented challenges to universities when instruction had to shift entirely online. Universities were quick to survey their students about those challenges, and education researchers are now focused on building more effective online experiences based on student feedback. About the case: The loss of in-person instruction was difficult for engineering students in practice-based courses as they lost the courses' hands-on aspect, which is essential for reinforcing theoretical concepts. They also lost the support provided through daily interactions with their peers and instructors. Situating the case: Students in a required four-course practice-based mechanical engineering sequence shared their perspectives via reflective portfolio essays on how shifting to online instruction affected their ability to participate in their learning communities and negotiate meaningful learning experiences. Methods/approach: Through thematic analysis of the reflective essays, we applied the lens of communities of practice to put the students' responses into context. Results/discussion: The students' concerns varied depending on their position in the course sequence and the course; however, most students felt that the loss of in-person interaction was most detrimental and disruptive in the transition to online instruction and yielded communication and teaming issues. Implications and conclusions: Five implications arose from the results of this study, including recognizing the unique challenges of online learning in practice-based courses, instructing students in virtual communication tools, exercising empathy, being mindful of cognitive load, and researching self-directed learners in online environments. In addition, faculty should consider the importance of students' communities of practice and build opportunities to maintain and strengthen the bonds of those communities within their courses, both online and face to face. They should also add more opportunities for virtual interaction early in the curriculum to build digital communication skills, which will undoubtedly be required in their careers.

Implementing the New ANA Standard 8: Culturally Congruent Practice

The American Nurses Association (ANA) is responsible for the contract between society and the nursing profession, including the nursing scope and standards of practice. In 2015, an ANA workgroup produced Nursing: Scope and Standards of Practice, 3rd Ed during a time of social change and an increase of culturally and ethnically diverse consumers. Subsequently, a subset of workgroup members and an invited transcultural nursing expert led to the creation of the new Standard 8: Culturally Congruent Practice, describing nursing care that is in agreement with the preferred values, beliefs, worldview, and practices of the healthcare consumer. This article records the history of the revised scope and standards and new Standard 8, the reasoning behind this standard and its impact on nursing practice, education, and research. The article also guides nurses in the application of Standard 8 to nursing practice and offers discussion about implementing culturally congruent practice through the nursing process. We also discuss cultural congruence for the graduate-prepared nurse; offer brief comments related to evaluation of culturally congruent practice using Standard 8 and future research; and conclude with a call to action.

Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings.

The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs. Although nurses applaud the EHR, they also indicate dissatisfaction with its design and cumbersome electronic processes. This article describes the views of nurses shared by members of the Nursing Practice Committee of the Missouri Nurses Association; it encourages nurses to share their EHR concerns with Information Technology (IT) staff and vendors and to take their place at the table when nursing-related IT decisions are made. In this article, we describe the experiential-reflective reasoning and action model used to understand staff nurses' perspectives, share committee reflections and recommendations for improving both documentation and documentation technology, and conclude by encouraging nurses to develop their documentation and informatics skills. Nursing issues include medication safety, documentation and standards of practice, and EHR efficiency. IT concerns include interoperability, vendors, innovation, nursing voice, education, and collaboration.

A novel precision-engineered microfiltration device for capture and characterisation of bladder cancer cells in urine.

BACKGROUND: Sensitivity of standard urine cytology for detecting urothelial carcinoma of the bladder (UCB) is low, attributable largely to its inability to process entire samples, paucicellularity and presence of background cells. OBJECTIVE: Evaluate performance and practical applicability of a novel portable microfiltration device for capture, enumeration and characterisation of exfoliated tumour cells in urine, and compare it with standard urine cytology for UCB detection. METHODS: A total of 54 urine and bladder wash samples from patients undergoing surveillance for UCB were prospectively evaluated by standard and microfilter-based urine cytology. Head-to-head comparison of quality and performance metrics, and cost effectiveness was conducted for both methodologies. RESULTS: Five samples were paucicellular by standard cytology; no samples processed by microfilter cytology were paucicellular. Standard cytology had 33.3% more samples with background cells that limited evaluation (p<0.001). Microfilter cytology was more concordant (κ=50.4%) than standard cytology (κ=33.5%) with true UCB diagnosis. Sensitivity, specificity and accuracy were higher for microfilter cytology compared to standard cytology (53.3%/100%/79.2% versus 40%/95.8%/69.9%, respectively). Microfilter-captured cells were amenable to downstream on-chip molecular analyses. A 40 ml sample was processed in under 4 min by microfilter cytology compared to 5.5 min by standard cytology. Median microfilter cytology processing and set-up costs were approximately 63% cheaper and 80 times lower than standard cytology, respectively. CONCLUSIONS: The microfiltration device represents a novel non-invasive UCB detection system that is economical, rapid, versatile and has potentially better quality and performance metrics than routine urine cytology, the current standard-of-care.

Gradually Guiding Nursing Students through Their Capstone Course: Registered Nurse Preceptors Share Their Experiences.

Professional precepted immersion courses (capstone) have become the standard as a means to prepare senior nursing students to enter the workforce. Preceptors have a significant role in developing the student nurse, yet exactly how to prepare preceptors for this role has been an ongoing discussion. This qualitative inquiry explored the educational needs of clinical registered nurse (RN) preceptors who work directly with senior nursing students in a professional precepted immersion (capstone) course. A descriptive qualitative design was used to examine preceptors responses to a prepared set of questions about their educational needs. Results showed that preceptors have three distinct sets of learning needs: the need to know the expectations of their role, wanting to know how best to role model for the student, and knowing how to socialize the student into the profession of nursing. Overall, preceptors communicated their desire and commitment to doing the best job possible. They also clearly stated their expectation of faculty to have a physical presence on the nursing unit that included being proactive in resolving mismatches and exposing the student to the roles of provider of care, leader and manager of care, and member of profession.

Managing adverse effects of hormonal contraceptives.

Adverse effects of hormonal contraceptives usually diminish with continued use of the same method. Often, physi- cians only need to reassure patients that these symptoms will likely resolve within three to five months. Long-acting injectable depot medroxyprogesterone acetate is the only hormonal contraceptive that is consistently associated with weight gain; other hormonal methods are unlikely to increase weight independent of lifestyle choices. Switching com- bined oral contraceptives is not effective in treating headaches, nor is the use of multivitamins or diuretics. There are no significant differences among various combined oral contraceptives in terms of breast tenderness, mood changes, and nausea. Breakthrough bleeding is common in the first months of combined oral contraceptive use. If significant abnormal bleeding persists beyond three months, other methods can be considered, and the patient may need to be evaluated for other causes. Studies of adverse sexual effects in women using hormonal contraceptives are inconsistent, and the pharmacologic basis for these symptoms is unclear. If acne develops or worsens with progestin-only contra- ceptives, the patient should be switched to a combination method if she is medically eligible. There is insufficient evidence of any effect of hormonal contraceptives on breast milk quantity and quality. Patient education should be encouraged to decrease the chance of unanticipated adverse effects. Women can also be assessed for medical eligibility before and during the use of hormonal contraceptives.

Cytomegalovirus infection in patients with active inflammatory bowel disease.

BACKGROUND: The reported prevalence of cytomegalovirus (CMV) infection with active inflammatory bowel disease (IBD) is highly variable, and whether CMV negatively impacts the clinical course is controversial. AIMS: The aim of this study was to determine the prevalence of CMV in patients with active ulcerative colitis (UC) or Crohn's disease (CD) and compare the course of disease in patients with and without CMV. METHODS: Consecutive patients with acute exacerbations of active IBD colitis had immunohistochemistry staining for CMV antigen performed on archived specimens. Clinical features were retrospectively reviewed. RESULTS: Twelve (10%) of 122 UC patients had CMV, and 0/20 patients with CD had CMV. Of 12 UC patients with CMV infection, seven were not taking steroids or immunosuppressives at their index flare. UC patients with CMV were more likely to have leukocytosis (OR = 5.3, 95% CI 1.5-18.2), require hospitalization (OR = 4.9, 95% CI 1.2-19.0), and be hospitalized > or =7 days (OR = 5.0, 95% CI 1.6-21.3) compared to patients without CMV. Of 12 UC patients with CMV, ten (83%) were treated for their index flare with steroids or 6-mercaptopurine. Only one patient (8%) was treated for CMV infection which occurred 14 months after index endoscopy. Over the 6 months after the index flare, UC patients with CMV had a higher frequency of IBD-related hospitalizations compared to patients without CMV (50 vs. 24%, P = 0.021), but none required surgery or died. CONCLUSIONS: The prevalence of CMV with active UC was 10%. Although CMV infection may be a marker of disease severity, our results suggest it does not cause severe morbidity or mortality in a general population of patients with a UC flare.

Clinical significance of atypical glandular cells in conventional pap smears in a large, high-risk U.S. west coast minority population.

OBJECTIVE: To determine the incidence of clinically significant lesions on subsequent histologic follow-up in high-risk, predominantly minority patients with atypical glandular cells (AGC). STUDY DESIGN: A retrospective study was done on conventional Pap smears diagnosed as AGC of endocervical origin (AGC-EC), AGC of endometrial origin (AGC-EM) and AGC not otherwise specified (AGC-NOS) between January 1, 2003, and December 31, 2005. Histologic diagnoses were correlated with cytologic diagnoses. RESULT: Confirmed AGC cases were divided into 4 categories: 187 AGC-NOS, 169 AGC-EC, 68 AGC and atypical squamous cells of undetermined significance (ASCUS) and 36 AGC-EM. A total of 105 patients (22.8%) had significant precancerous (cervical intraepithelial neoplasia [CIN] 2/3, adenocarcinoma in situ [AIS]) or malignant (carcinoma) histologic outcomes. CIN 2/3 was the most common significant histologic outcome in women with AGC and ASCUS and patients <35 years with AGC. Endometrial neoplasia was the most common significant outcome in women with AGC-NOS and AGC-EM Pap results and in AGC patients > or =35. In women with AGC-EC Pap results, glandular cervical neoplasia occurred in 8.3% and CIN 2/3 in 5.9% offollow-up biopsies. CONCLUSION: AGC subtype and age significantly affect the probability of precancerous and malignant follow-up findings and anatomic site of neoplastic lesions. Access to newer screening technologies such as high-risk HPVDNA testing and liquid-based cytology will likely benefit such high-risk populations.