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The complete coding sequence of a rabies lyssavirus (RABV) detected in a black bear (Ursus americanus) was generated. RNA extracted from brain tissues was amplified using reverse transcription followed by tiling PCR sequencing to obtain RABV whole viral genome. Sequencing was performed using an Illumina ISeq 100 instrument.

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INTRODUCTION: Midwives in Connecticut lack resources for current, state-specific data regarding compensation, benefits, work hours, and scope of practice. The primary purpose of this study was to provide detailed information about the work and services provided by midwives in Connecticut and how they are compensated. METHODS: Certified nurse-midwives (CNMs) licensed in Connecticut were recruited for a 53-question online survey between October 2021 and February 2022. The survey included topics such as compensation, benefits, practice patterns, and precepting. RESULTS: For full-time salaried CNMs in Connecticut, compensation was higher than the national average for midwives. A majority of CNMs in the state work 40 hours per week or less in physician-owned private practices and are preceptors. DISCUSSION: For midwives planning to negotiate contracts in Connecticut, this report provides important information to ensure fair compensation and work hours. The survey also serves as a roadmap for midwives in other states who wish to collect and disseminate similar workforce data.

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It is unclear if surveillance bias (increased reports to Child Protective Services [CPS] related to program involvement) has a substantial impact on evaluation of home visiting (HV) prevention programs. We estimated surveillance bias using data from Connecticut's HV program, birth certificates, CPS, and hospitals. Using propensity score matching, we identified 15,870 families similar to 4015 HV families. The difference-in-differences approach was used to estimate surveillance bias as the change in investigated reports from the last 6 months of program involvement to the next 6 months. The median age of the children at program exit was 1.2 years (range: 60 days, 5 years). We estimated that 25.6% of investigated reports in the HV group resulted from surveillance bias. We reviewed CPS reports of 194 home-visited families to determine if a home visitor made the report and found that 10% were directly from home visitors. Program evaluations should account for surveillance bias.

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Lymphocytic choriomeningitis virus is an underreported cause of miscarriage and neurologic disease. Surveillance remains challenging because of nonspecific symptomatology, inconsistent case reporting, and difficulties with diagnostic testing. We describe a case of acute lymphocytic choriomeningitis virus disease in a person living with HIV in Connecticut, USA, identified by using quantitative reverse transcription PCR.

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Recurrent Clostridioides difficile infection (RCDI) causes an increased burden on the healthcare system. We calculated RCDI incidence and identified factors associated with RCDI cases in New Haven County, Connecticut, USA, during 2015-2020 by using data from population-based laboratory surveillance. A subset of C. difficile cases had complete chart reviews conducted for RCDI and potentially associated variables. RCDI was defined as a positive C. difficile specimen occurring 2-8 weeks after incident C. difficile infection. We compared cases with and without RCDI by using multiple regression. RCDI occurred in 12.0% of 4,301 chart-reviewed C. difficile cases, showing a U-shaped time trend with a sharp increase in 2020, mostly because of an increase in hospital-onset cases. Malignancy (odds ratio 1.51 [95% CI 1.11-2.07]) and antecedent nitrofurantoin use (odds ratio 2.37 [95% CI 1.23-4.58]) were medical risk factors for RCDI. The 2020 increase may reflect the impact of the COVID-19 pandemic.

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Vaccination remains the leading control method against infectious bronchitis (IB) in poultry despite the frequently observed IB outbreaks in vaccinated flocks. Here, two vaccination regimes were evaluated against challenge with the Massachusetts (Mass) infectious bronchitis virus (IBV) strain that was linked to egg production defects in Western Canada. One vaccination strategy included live attenuated IB vaccines only, and the other used both inactivated and live attenuated IB vaccines. The two immunization programs involved priming with a monovalent live attenuated IB vaccine (Mass serotype) at day-old, followed by intervals of bivalent live attenuated IB vaccines containing the Mass and Connecticut (Conn) serotypes given to the pullets at 2-, 5-, 9-, and 14-week-old. Inactivated IB vaccine (Mass serotype) was administrated to only one group of the vaccinated birds at 14-week-old. At the peak of lay, the hens were challenged with the Mass IBV isolate (15AB-01) via the oculo-nasal route. The efficacy of the vaccines was assessed following the challenge by observing clinical signs, egg production, egg quality parameters, seroconversion, and systemic T-cell subsets (CD4+ and CD8+ cells). Moreover, the viral genome loads in the oropharyngeal (OP) and cloacal (CL) swabs were quantified at predetermined time points. At 14 days post-infection (dpi), all the hens were euthanized, and different tissues were collected for genome load quantification and histopathological examination. Post-challenge, both vaccination regimes showed protection against clinical signs and exhibited significantly higher albumen parameters, higher anti-IBV serum antibodies, and significantly lower levels of IBV genome loads in OP swabs (at 3 and 7 dpi) and trachea and cecal tonsils compared to the mock-vaccinated challenged group. However, only the birds that received live attenuated plus inactivated IB vaccines had significantly lower IBV genome loads in CL swabs at 7 dpi, as well as decreased histopathological lesion scores and IBV genome loads in magnum compared to the mock-vaccinated challenged group, suggesting a slightly better performance for using live attenuated and inactivated IB vaccines in combination. Overall, the present findings show no significant difference in protection between the two vaccination regimes against the Mass IBV challenge in laying hens.

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Policymakers in Connecticut are considering various state-funded policy options to improve insurance coverage among undocumented and legally present recent immigrants in the state - almost 60 percent of whom lack health insurance. In particular, they are removing immigration status requirements from Medicaid eligibility. They are also considering whether to provide state-funded subsidies to undocumented immigrants enrolled in individual market plans. A key challenge for this analysis was determining what share of undocumented immigrants would be likely to take up insurance coverage if it were available to them. Because few states have expanded coverage to their undocumented populations and because the denominator is uncertain, estimates of take-up rates are highly uncertain. There is similar uncertainty in estimating how much health care undocumented populations will use once they become insured. To address these uncertainties, the authors conducted sensitivity analyses that varied both the take-up and utilization rates. Using the RAND Corporation's COMPARE microsimulation model, the authors estimate the impacts of each policy scenario on enrollment, premiums, state spending, and hospital spending on uncompensated care. Their analysis suggests that removing immigration status requirements for Medicaid and individual market subsidy eligibility would decrease uninsurance among the undocumented and legally present recent immigrant populations by 32 to 37 percent and could improve insurance coverage and affordability in Connecticut for these populations while not substantially impacting other Connecticut residents.

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Abstract Introduction: Assessing olfactory perception in olfactory disorders is of utmost importance in therapy management. However, the University of Pennsylvania Smell Identification Test and the Sniffin' Sticks are the only tests validated in Brazil. Objectives: To evaluate the correlation and agreement between the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test - University of Pennsylvania Smell Identification Test - in healthy participants and in participants with olfactory disorders based on the results and technical aspects of both tests. Methods: Fifty participants without olfactory complaints and 50 participants with olfactory disorders who underwent the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test were included. The following tests were used for statistical analysis: Mann-Whitney U test, Spearman's correlation, intraclass correlation coefficient and Bland-Altman plot. An alpha error (significance level) of 0.05 was considered in the statistical analysis. Results: Both tests were effective in distinguishing the groups without the presence of overlapping values for the measured markers. Additionally, there was a strong correlation between Spearman's correlation and intraclass correlation coefficient between the tests and for both nostrils. However, the correlations were lower when the groups were individually evaluated. The Bland-Altman plot showed no bias when all participants were simultaneously evaluated. Conclusions: The tests to assess olfactory perception presented a high level of agreement. In our sample, we could infer that the Connecticut Chemosensory Clinical Research Center olfactory test is similar to the Brief-Smell Identification Test and can be used in the routine diagnosis of patients with complaints of olfactory disorders, considering the advantage of its low cost.

Resumo Introdução: Avaliar a percepção olfativa em distúrbios olfativos é de extrema importância para a correta conduta terapêutica. No entanto, apenas o teste University of Pennsylvania smell identification test e o teste sniffin'sticks são validados no Brasil. Objetivos: Avaliar a correlação e concordância entre os testes Connecticut chemosensory clinical research center e do brief-smell identification test e University of Pennsylvania smell identification test em participantes saudáveis e em participantes com distúrbios olfativos de acordo com os resultados e aspectos técnicos dos dois testes. Método: Cinquenta participantes sem queixas olfativas e 50 participantes com distúrbios olfativos submetidos ao teste Connecticut chemosensory clinical research center e ao brief-smell identification test foram incluídos. Os seguintes testes foram usados para análise estatística: teste U de Mann-Whitney, correlação de Spearman, coeficiente de correlação intraclasse e plotagem de Bland-Altman. Um erro alfa (nível de significância) de 0,05 foi considerado nas análises estatísticas feitas no estudo. Resultados: Ambos os testes foram eficazes para diferenciar os grupos sem a presença de valores sobrepostos para os marcadores medidos. Além disso, houve uma forte correlação entre a correlação de Spearman e o coeficiente de correlação intraclasse entre os testes e para as duas narinas. Entretanto, as correlações foram menores quando os grupos foram avaliados individualmente. O gráfico de Bland-Altman não mostrou viés quando todos os participantes foram avaliados simultaneamente. Conclusões: Os testes para avaliar a percepção olfativa apresentaram um elevado nível de concordância. Em nossa amostra, podemos inferir que o Connecticut chemosensory clinical research center é equivalente ao brief-smell identification test e pode ser usado no diagnóstico de rotina de pacientes com queixas de distúrbios olfativos, considerando a vantagem de seu baixo custo.

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Policymakers in Connecticut are considering various options to increase the affordability of insurance in the state, such as expansions to premium and cost-sharing reduction subsidies on the state's health insurance marketplace, as well as expanded plan offerings, including extending eligibility for the state employee health plan (SEHP) to other groups and a publicly contracted, privately operated plan (the public option plan) offered to individuals on the marketplace. The authors used the RAND Corporation's COMPARE microsimulation model to estimate the impacts of such policy options. For each policy scenario, they calculated enrollment, premiums, consumer spending, and state spending and considered whether the results differed by race, ethnicity, or income group. The individual market reforms substantially increased affordability for people with incomes between 175 and 200 percent of the federal poverty level (FPL), reducing out-of-pocket spending as a share of income by 50 percent in some scenarios. Changes to affordability for higher-income groups were smaller, in part because the proposed policy changes for people with incomes between 200 and 400 percent of FPL were relatively modest and focused only on reducing cost-sharing (not premiums). New costs to the state for 2023 ranged from $19 million to $94 million, depending on the scenario. All four SEHP specifications led to the same bottom-line conclusion that offering a SEHP plan would improve insurance coverage and affordability for those eligible for the plan. Expanding eligibility for the SEHP holds promise for stabilizing or reducing consumer costs, improving plan generosity, and bringing more people into the market.

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The state of Connecticut is considering a number of policy options to improve health insurance affordability, access, and equity. To create policies designed to increase insurance coverage and access to care in underserved communities and reduce racial and ethnic disparities, state policymakers need an accurate picture of the current distributions of insurance enrollment across these dimensions. The authors combine data from the American Community Survey Public Use Microdata Sample, which includes demographic characteristics, as well as insurance status, with various data sources from the state to provide a fuller picture of insurance enrollment among those under the age of 65 in Connecticut. They also use existing high-level estimates of 2020 insurance enrollment to provide estimates of how enrollment in the state was affected during the early months of the pandemic. The authors find that insurance enrollment in Connecticut in 2019 was generally high but that there were substantial differences in insurance coverage by race and ethnicity. Asian individuals had the highest rates of employer-sponsored insurance coverage, and Black individuals had the highest rates of Medicaid coverage. Hispanic individuals had a higher rate of Medicaid coverage than non-Hispanic individuals. High-level estimates of changes in insurance coverage during the early months of the COVID-19 pandemic suggest that uninsurance decreased slightly, Medicaid coverage increased, and private insurance coverage fell. This study provides the state of Connecticut with estimates of enrollment in detailed health insurance categories by age, gender, race, and ethnicity and highlights the need for better, more-detailed health insurance enrollment data.

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We assessed the role of Time Perspective (TP) and acculturative stress on adaptive and maladaptive coping strategies, across healthy and treatment-seeking Puerto Ricans living in the island of Puerto Rico (PR), as well as at the state of Connecticut in mainland United States (US). Participants were comprised of 197 adults from the island of PR, as well as 138 adults from Connecticut. TP was measured through five categories assessed by the Zimbardo TP Inventory (Past Positive, Past Negative, Present Fatalistic, Present Hedonistic, and Future), the Deviation from a Balanced Time Perspective-revisited (DBTPr) coefficient, and the Deviation from the Negative Time Perspective (DNTP) coefficient. Acculturative stress was measured with the Acculturative Distress Scale. Adaptive and maladaptive stress-coping were measured through the Brief COPE Inventory. DNTP predicted adaptive coping, whereas acculturative stress, Present Hedonistic, and DBTPr predicted maladaptive coping. Puerto Ricans living in Connecticut engaged more often in maladaptive coping than those in PR. Acculturative stress partially mediated the influence of DBTPr on maladaptive coping. DNTP mediated the influence of state on adaptive coping. DBTPr and acculturative stress totally mediated the influence of state on maladaptive coping. These findings suggest that assessing TP, levels of acculturative stress, and coping strategies could assist in tailoring evidence-based interventions to the specific needs of Puerto Rican populations. Doing so could be effective in promoting a Balanced Time Perspective, reducing acculturative stress, increasing adaptive coping, and improving mental as well as physical health, on Puerto Ricans living in PR or mainland US.

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Approximately 476,000 cases of Lyme disease are diagnosed in the United States annually, yet comprehensive economic evaluations are lacking. In a prospective study among reported cases in Lyme disease-endemic states, we estimated the total patient cost and total societal cost of the disease. In addition, we evaluated disease and demographic factors associated with total societal cost. Participants had a mean patient cost of ≈$1,200 (median $240) and a mean societal cost of ≈$2,000 (median $700). Patients with confirmed disseminated disease or probable disease had approximately double the societal cost of those with confirmed localized disease. The annual, aggregate cost of diagnosed Lyme disease could be $345-968 million (2016 US dollars) to US society. Our findings emphasize the importance of effective prevention and early diagnosis to reduce illness and associated costs. These results can be used in cost-effectiveness analyses of current and future prevention methods, such as a vaccine.

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INTRODUCTION: Assessing olfactory perception in olfactory disorders is of utmost importance in therapy management. However, the University of Pennsylvania Smell Identification Test and the Sniffin' Sticks are the only tests validated in Brazil. OBJECTIVES: To evaluate the correlation and agreement between the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test - University of Pennsylvania Smell Identification Test - in healthy participants and in participants with olfactory disorders based on the results and technical aspects of both tests. METHODS: Fifty participants without olfactory complaints and 50 participants with olfactory disorders who underwent the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test were included. The following tests were used for statistical analysis: Mann-Whitney U test, Spearman's correlation, intraclass correlation coefficient and Bland-Altman plot. An alpha error (significance level) of 0.05 was considered in the statistical analysis. RESULTS: Both tests were effective in distinguishing the groups without the presence of overlapping values ​​for the measured markers. Additionally, there was a strong correlation between Spearman's correlation and intraclass correlation coefficient between the tests and for both nostrils. However, the correlations were lower when the groups were individually evaluated. The Bland-Altman plot showed no bias when all participants were simultaneously evaluated. CONCLUSIONS: The tests to assess olfactory perception presented a high level of agreement. In our sample, we could infer that the Connecticut Chemosensory Clinical Research Center olfactory test is similar to the Brief-Smell Identification Test and can be used in the routine diagnosis of patients with complaints of olfactory disorders, considering the advantage of its low cost.

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Objective: The objective of this study was to compare the effect of miniscrew-supported maxillary incisor intrusion and conventional intrusion mechanics on maxillary incisors and molar inclination. Material and Methods: Search databases (PubMed, Scopus, Web of Science, Embase, EBSCOhost, and the Cochrane Library) were searched for randomized trials on intrusion of maxillary incisors via miniscrew-supported and conventional mechanics. The revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used. Five outcomes ([i] inclination change of upper incisors, [ii] inclination change of upper molars, [iii] intrusion of incisors, [iv] vertical change in upper first molars, and [v] overbite correction achieved) were statistically pooled using Review Manager 5.3. Subgroup analysis was conducted to receive sturdiness in meta-analysis. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. Results: Out of 1777 studies, 7 were finally subjected to quality assessment, and 6 were included in the meta-analysis. The incisor inclination following maxillary incisor intrusion increased in miniscrew-supported intrusion in comparison to Connecticut intrusion arch (CTA) subgroup with standard mean difference of 0.66 mm (95% confidence interval = 0.16, 1.03, I2 = 0%). All the included studies showed an increase in molar inclination (distal tipping) in the CTA subgroup compared to the micro-implant group. Of all the seven included studies, only one study was identified with some concerns for the risk of bias, and the other six were judged to have an overall high risk of bias. Conclusion: The incisal proclination during deep-bite correction by miniscrew-supported incisal intrusion is more than that in the CTA subgroup; however, the difference may not be clinically very relevant. There is a very low quality of evidence in favor of miniscrew-supported intrusion as compared to conventional intrusion, necessitating the need for good-quality trials.

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BACKGROUND: Historically, Blacks and Hispanics have had lower opioid-involved overdose death rates in Connecticut (CT). We examined if a shift has taken place where rates of Black fatal overdoses have now surpassed Whites in the state. METHODS: Drug overdose fatality rates were calculated by number of deaths per year per 100,000 population from 2012 to 2019 in Connecticut. Measures were by race (White, Hispanic, Black, and Asian or Pacific Islander), age groups, and types of drugs, including fentanyl, heroin, cocaine, and other opioids. Poisson regression was used to test the interactions (race × age); joinpoint regression analysis was used to evaluate trend lines of fatality rate by racial/ethnic group within each age group with a significance level of p < 0.05. RESULTS: Drug overdose fatality rates in CT from 2012 to 2019 showed a significant increase for all races combined, estimated 3.6 deaths per 100,000 population per year. For Whites, overdose deaths were 4.6 per year from 2012 to 2017 with no change from 2017 to 2019. The overdose fatality rate for Hispanics was 3.0 and for Asian or Pacific Islanders 0.6 per year from 2012 to 2019. For Blacks, the death rates were statistically flat between 2012 and 2014; however, from 2015 to 2019, this group saw the largest average increase of 6.0 overdose deaths per 100,000 population each year. By 2019, the overdose fatality rate was higher in Blacks than in Whites, (39 vs. 38 per 100,000, respectively). Further, Blacks ages 50 years and over reported the highest overdose fatality rates among all race/age groups, an increase of 8.5 deaths per 100,000 population since 2014. CONCLUSIONS AND RELEVANCE: Connecticut is a microcosm of the opioid overdose trend in the New England region of our country. The majority of overdose deaths in CT involved illicit drugs, fentanyl, heroin, and cocaine, rather than prescription drugs. Blacks 50-years-old and over showed the fastest growing overdose death rates. Opioid deaths are now shifting to the Black community, creating an urgent public health crisis.

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PURPOSE: The objective was to clarify whether standardized multibracket therapies-differing only in finishing-wire dimensions (0.016â€¯× 0.022 inch vs. 0.017â€¯× 0.025 inch CNA [Connecticut New Archwire]) and excluding any extraction treatment or additional appliances other than intermaxillary elastics-can produce normal incisor inclinations starting from different baseline inclinations. METHODS: We analyzed pre- and posttreatment cephalograms of 156 patients (age: 15.6 ± 1.3 years) treated with Roth system (0.018 inch slot). Each archwire group (n = 89 or 67) was divided into subjects with initially retroclined, orthograde, or proclined upper and/or lower incisors (U1, L1). For the resultant 12 subgroups, descriptive statistics were compiled relative to five reference planes (NL, ML, NA, NB, BOP), followed by multiple intragroup (Kolmogoroff-Smirnoff and Wilcoxon signed-rank test) and intergroup (Kruskal-Wallis and Mann-Whitney U test) comparisons relative to NL or ML. RESULTS: The following intra- (1, 2) and intergroup (3, 4) differences were statistically significant (p ≤ 0.05) in both archwire groups: (1) post- vs. pretreatment inclinations in the subgroups initially retroclined U1, retroclined L1 and orthograde U1, but without normal values being achieved (subgroups retroclined U1, L1) or preserved (subgroup orthograde U1); (2) observed vs. expected alterations for the subgroups initially orthograde and proclined U1 and L1; (3) posttreatment inclinations for the subgroups initially retroclined vs. orthograde L1 and proclined L1; (4) observed alterations for the subgroups initially retroclined vs. proclined U1 and L1, but neither retroclined nor proclined vs. orthograde. Archwire thickness influenced the outcome to only a limited extent under the special circumstances of this study. CONCLUSION: The bracket/archwire combinations evaluated did not lead to normal incisor inclinations in most cases. Posttreatment values did significantly depend on the pretreatment situation. Most frequently, alterations were protrusive in direction, which notably even included incisors that showed norm values at the outset of treatment. It can be concluded that bracket torque will influence but not dominate incisor inclinations.

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AIM AND OBJECTIVE: This study aimed to compare cephalometrically the rate of maxillary incisor intrusion using mini implants, Connecticut intrusion arches, and segmental intrusion arches. MATERIALS AND METHODS: Thirty-two adult patients with deep bite were divided into three groups: 10 patients in mini implant and Connecticut intrusion arch group each and 12 patients in segmental intrusion arch group. Bilateral mini implants were used for intrusion in Group 1. Connecticut intrusion arch and Burstone's three-piece intrusion arch were used for intrusion in Group 2 and Group 3, respectively. Intrusion was carried out in all the patients for 4 months. Lateral cephalograms were taken just after alignment and leveling (T1) and after 4 months of intrusion (T2). RESULTS: The mean amount of intrusion observed was 1.7 mm (0.425 mm/month) in mini implant group, 1.4 mm (0.35 mm/month) in Connecticut intrusion arch group, and 1.66 mm (0.415 mm/month) in segmental intrusion arch group. No statistically significant difference was found in the extent of incisor intrusion in the three groups (p <0.05). CONCLUSION: The study failed to reject the null hypothesis, and there was no statistically significant difference in the amount and rate of incisor intrusion achieved among the three groups (p >0.05). CLINICAL SIGNIFICANCE: Significant amount of incisor intrusion was carried out by all the three methods. There was no statistically significant difference in the amount and rate of incisor intrusion achieved by the three methods. Clinically, mini implants can be considered superior to the conventional techniques as it provides absolute anchorage which eliminates unwanted effects of incisor intrusion.

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We report the first detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 3-month-old dog in Connecticut that died suddenly and was submitted to the state veterinary diagnostic laboratory for postmortem examination. Viral RNA was detected in multiple organs of the dog by reverse transcription real time-PCR (RT-qPCR). Negative and positive sense strands of viral RNA were visualized by in situ hybridization using RNAscope technology. Complete genome sequencing and phylogenetic analysis of the hCoV-19/USA/CT-CVMDL-Dog-1/2021 (CT_Dog/2021) virus were conducted to identify the origin and lineage of the virus. The CT_Dog/2021 virus belonged to the GH/B1.2. genetic lineage and was genetically similar to SARS-CoV-2 identified in humans in the U.S. during the winter of 2020-2021. However, it was not related to other SARS-CoV-2 variants identified from companion animals in the U.S. It contained both the D614G in spike and P323L in nsp12 substitutions, which have become the dominant mutations in the United States. The continued sporadic detections of SARS-CoV-2 in companion animals warrant public health concerns about the zoonotic potential of SARS-CoV-2 and enhance our collective understanding of the epidemiology of the virus.

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In fall 2020, a coronavirus disease cluster comprising 16 cases occurred in Connecticut, USA. Epidemiologic and genomic evidence supported transmission among persons at a school and fitness center but not a workplace. The multiple transmission chains identified within this cluster highlight the necessity of a combined investigatory approach.

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We report a case of envenomation by Steatoda borealis (Hentz, 1850) in Connecticut in late spring 2021. The bitten subject was a 60-yr-old female Caucasian. The bite occurred upon disturbing some books in her basement. She reported a painful stinging bite on her finger followed by the formation of an erythematous macule at the site of the bite which was gone the next day. There was no sign of necrosis. The spider was recovered directly at that time. The victim reported that later that night she experienced heart palpitations. This is the first report of envenomation by S. borealis, a common spider in Connecticut.

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