Orthopoxvirus Testing Challenges for Persons in Populations at Low Risk or Without Known Epidemiologic Link to Monkeypox - United States, 2022.

Since May 2022, approximately 20,000 cases of monkeypox have been identified in the United States, part of a global outbreak occurring in approximately 90 countries and currently affecting primarily gay, bisexual, and other men who have sex with men (MSM) (1). Monkeypox virus (MPXV) spreads from person to person through close, prolonged contact; a small number of cases have occurred in populations who are not MSM (e.g., women and children), and testing is recommended for persons who meet the suspected case definition* (1). CDC previously developed five real-time polymerase chain reaction (PCR) assays for detection of orthopoxviruses from lesion specimens (2,3). CDC was granted 510(k) clearance for the nonvariola-orthopoxvirus (NVO)-specific PCR assay by the Food and Drug Administration. This assay was implemented within the Laboratory Response Network (LRN) in the early 2000s and became critical for early detection of MPXV and implementation of public health action in previous travel-associated cases as well as during the current outbreak (4-7). PCR assays (NVO and other Orthopoxvirus laboratory developed tests [LDT]) represent the primary tool for monkeypox diagnosis. These tests are highly sensitive, and cross-contamination from other MPXV specimens being processed, tested, or both alongside negative specimens can occasionally lead to false-positive results. This report describes three patients who had atypical rashes and no epidemiologic link to a monkeypox case or known risk factors; these persons received diagnoses of monkeypox based on late cycle threshold (Ct) values ≥34, which were false-positive test results. The initial diagnoses were followed by administration of antiviral treatment (i.e., tecovirimat) and JYNNEOS vaccine postexposure prophylaxis (PEP) to patients' close contacts. After receiving subsequent testing, none of the three patients was confirmed to have monkeypox. Knowledge gained from these and other cases resulted in changes to CDC guidance. When testing for monkeypox in specimens from patients without an epidemiologic link or risk factors or who do not meet clinical criteria (or where these are unknown), laboratory scientists should reextract and retest specimens with late Ct values (based on this report, Ct ≥34 is recommended) (8). CDC can be consulted for complex cases including those that appear atypical or questionable cases and can perform additional viral species- and clade-specific PCR testing and antiorthopoxvirus serologic testing.

Crianças em situação de imigração na escola pública: percepções de docentes / Immigrant children in public school: perceptions of teachers / Scolarisation à lécole publique denfants en situation dimmigration: perception des enseignants / Niños inmigrantes en la escuela pública: percepciones del profesorado

Resumo Este artigo apresenta uma pesquisa qualitativa sobre as percepções de docentes a respeito de crianças em situação de imigração ou de refúgio na escola pública, baseada na perspectiva crítica de educação intercultural e na concepção histórico-cultural. Foram realizadas entrevistas entre 2018 e 2019 com dez professores do Ensino Fundamental I de uma escola municipal de Duque de Caxias, Rio de Janeiro, com mais de doze anos de experiência na educação básica e que tiveram, em suas turmas, crianças congolesas ou angolanas. Identificamos que a presença de crianças em situação de imigração, que inicialmente se poderia constituir em um elemento dificultador para o processo de ensino-aprendizagem, tem sido um motor para novas reflexões sobre diferenças, desigualdades, preconceitos e discriminação no espaço escolar.

Abstract This article presents a qualitative study on the perceptions of teachers about immigrant or refugee children in public schools. It is based on the critical perspective of intercultural education and in the historical-cultural concept. Interviews were conducted between 2018 and 2019 with ten teachers of the first five years in a municipal elementary school in Duque de Caxias, Rio de Janeiro. All the teachers have over twelve years of experience in basic education, and had Congolese or Angolan children in their classes. We identified that the presence of immigrant children, which could initially be a difficult element for the teaching-learning process, has motivated new reflections on differences, inequalities, prejudices and discrimination in schools.

Résumé Cet article présente une recherche qualitative sur les perceptions des enseignants concernant des enfants en situation d'immigration ou de réfuge, ancrée sur la perspective critique de l'éducation interculturelle et la conception historico-culturelle. Des entretiens ont été menés entre 2018 et 2019 auprès de dix enseignants de l'Enseignement élementaire d'une école comunale de Duque de Caxias, Rio de Janeiro, ces enseignants avec douze ans et plus d'expérience avaient dans leurs classes des enfants congolais ou angolais. Nous avons constaté que la présence d'enfants en situation d'immigration qui, au départ, aurait pu rendre difficile le processus d'enseignement-apprentissage est plutôt un moteur de nouvelles réflexions sur les différences, les inégalités, les préjugés et la discrimination dans l'espace scolaire.

Resumen Este artículo presenta una investigación cualitativa sobre las percepciones de docentes sobre los niños inmigrantes o refugiados en las escuelas públicas, basada en la perspectiva crítica de la educación intercultural y la concepción histórico-cultural. Las entrevistas se realizaron entre 2018 y 2019 con diez profesores del primer ciclo de enseñanza primaria, de una escuela municipal en Duque de Caxias, Río de Janeiro, con más de doce años de experiencia en educación básica y que tenían niños congoleños o angoleños en sus clases. Identificamos que la presencia de niños inmigrantes, que inicialmente podría ser un elemento obstaculizador para el proceso de enseñanza-aprendizaje, ha sido un motor para nuevas reflexiones sobre diferencias, desigualdades, prejuicios y discriminación en el espacio escolar.

Interrater and intrarater reliability and minimal detectable change of the Wisconsin Gait Scale when used to examine videotaped gait in individuals post-stroke.

BACKGROUND: Often, interventions targeting the kinematic and temporal and spatial changes in gait commonly seen after a stroke are based on observations of walking. Having the capacity to objectively identify such changes and track improvements over time using reliable and valid measures is important. The Wisconsin Gait Scale (WGS), which is comprised of 14 items, was developed specifically to examine and document gait changes occurring after a stroke. The purpose of the study was to explore the interrater and intrarater reliability and minimal detectable change (MDC) of the WGS when used by physical therapists to examine gait in adults post-stroke. METHODS: Fourteen physical therapists from 3 different acute inpatient rehabilitation centers rated videotapes of the gait of 6 adults post-stroke using the WGS. To minimize subject variability from fatigue, videotapes created by using 4 cameras provided right and left lateral, anterior, and posterior views of walking on a level surface. One complete ambulation trial from each subject post-stroke, which included 4 views of the same ambulation trial, was examined by the licensed physical therapists using the WGS. An opportunity was provided to review the tool and a practice trial was performed using an additional videotape not included in the analysis. Gait was examined on 2 different occasions separated by a period of approximately 21 days to minimize the effects of recall bias. Intraclass Correlation Coefficients (ICC) were used to examine the interrater and intrarater reliability of the WGS. RESULTS: Interrater (ICC = 0.83) and intrarater (ICC = 0.91) reliability were both good. The standard error of the measurement (SEM) was 1.47 and the MDC95 was 4.24. There was no statistically significant difference between the scores on the WGS when comparing the 2 different sessions. CONCLUSIONS: The WGS shows promise as an instrument that can make observational gait analysis more reliable. High intrarater reliability and low SEM suggests that the WGS is stable when administered across multiple sessions by the same rater. The ICC for interrater reliability was also good, which suggests that multiple examiners can effectively use the instrument. With minimal training, the physical therapists in the study were able to produce highly reliable results using the WGS to objectively document gait dysfunction.

Vaccinia virus infections in martial arts gym, Maryland, USA, 2008.

Vaccinia virus is an orthopoxvirus used in the live vaccine against smallpox. Vaccinia virus infections can be transmissible and can cause severe complications in those with weakened immune systems. We report on a cluster of 4 cases of vaccinia virus infection in Maryland, USA, likely acquired at a martial arts gym.

The effect of a teaching hospital's financial crisis and reorganization on a group of residents.

PURPOSE: Allegheny General Hospital (AGH) in Pittsburgh, Pennsylvania, was part of a statewide health care system that underwent a financial crisis and operational reorganization between 1998 and 2000. This study assessed internal medicine (IM) residents' perceptions of the effects of AGH's financial crisis on their residencies METHOD: A confidential, program-based questionnaire was distributed to 75 IM residents at AGH in spring 2000 and included questions on demographic information, inpatient and outpatient medical education, and the hospital's financial crisis. Residents were asked to assess the effects of the financial crisis on their residencies, personal experiences, and attitudes toward health care systems. Outcomes included consideration of transfer, recommendation of the program to a medical student, concerns about fellowship opportunities, opinions about large health care systems, and medicine as a career recommendation. RESULTS: A total of 71 residents (95%) responded to the questionnaire. Fifty-five (79%) had experienced effects on their residencies due to the financial crisis, but perceptions differed widely. Eighteen (25%) considered transferring from the program, but 44 of 59 (75%) would have recommended the program to a medical student. Because of the financial crisis, respondents reported significant changes in concerns about fellowship opportunities (p <.001), opinions about large health care systems (p <.001), and opinions about recommending medicine as a career (p <.001). CONCLUSION: This study highlights the fact that residents serve as program ambassadors and their experiences may influence recruitment and retention. Thus, programs should consider ways to assess and address residents' concerns during any system crisis or reorganization.