Pooled Surveillance Testing Program for Asymptomatic SARS-CoV-2 Infections in K-12 Schools and Universities

The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of new cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine Covid-19 testing that may ultimately reduce the overall viral burden in the community. We describe implementation of a testing program that included students, faculty and staff from K-12 schools and universities participating in the SalivaClear pooled surveillance method (Mirimus Clinical Labs, Brooklyn, NY). Over 400,000 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities and tested in pools of up to 24 samples over a 20-week period during this pandemic. Peaks of positive cases were seen in the days following the Halloween, Thanksgiving and New Year holidays. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (CT) values between pooled and individual samples) measures. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. Pooled testing is a fundamental component to the reopening of schools, minimizing transmission among students and faculty.

Benefits of linking civil registration and vital statistics with identity management systems for measuring and achieving Sustainable Development Goal 3 indicators.

A complete civil registration and vital statistics system is the best source of data for measuring most of the Sustainable Development Goal 3 indicators. However, civil registration does not include migration data, which are necessary for calculating the actual number of people living in a given area and their characteristics such as age and sex. This information is needed to facilitate planning, for example, for school places, health care, infrastructure, etc. It is also needed as the denominator for the calculation of a range of health and socioeconomic indicators. Obtaining and using these data can be particularly beneficial for measuring and achieving universal health coverage (Target 3.8), because civil registration can help to identify persons in need of health care and enable decision-makers to plan for the delivery of essential services to all persons in the country, including the most disadvantaged populations. By assigning unique identification numbers to individuals, for example, at birth registration, then using these numbers to link the individuals' data from civil registration, national identification, and other functional registers, including registers for migration and health care, more accurate and disaggregated population values can be obtained. This is also a key to improving the effectiveness of and access to social services such as education, health, social welfare, and financial services. When civil registration system in a country is linked with its national identification system, it benefits both the government and its citizens. For the government, having reliable and up-to-date vital events information on its citizens supports making informed program and policy decisions, ensuring the accurate use of funds and monitoring of development programs at all levels. For individuals, it makes it easier to prove one's identity and the occurrence of vital events to claim public services such as survivor benefits or child grants.

An introduction to the civil registration and vital statistics systems with applications in low- and middle-income countries.

In collaboration with development partners, the World Bank Group (WBG) has been working to strengthen civil registration and vital statistics (CRVS) systems in low- and middle-income countries through lending operations, technical assistance projects, advisory services and analytics, and knowledge sharing at various international, regional, and national conferences and fora and through publications. In 2017, it launched a comprehensive CRVS eLearning course, which provides practical tools and approaches to achieving twenty-first-century state-of-the-art CRVS systems that are linked to identity management systems and are tailored to local contexts. Some of the key lessons learned from the various initiatives and projects are presented in the eight peer-reviewed manuscripts included in this issue.

A multisectoral institutional arrangements approach to integrating civil registration, vital statistics, and identity management systems.

This paper reviews the essential components of a recommended institutional arrangements framework of integrated civil registration and vital statistics (CRVS) and civil identification systems. CRVS typically involves several ministries and institutions, including health institutions that notify the occurrence of births and deaths; the judicial system that records the occurrence of marriages, divorces, and adoptions; the national statistics office that produces vital statistics reports; and the civil registry, to name a few. Considering the many stakeholders and close collaborations involved, it is important to establish clear institutional arrangements-"the policies, practices and systems that allow for effective functioning of an organization or group" (United Nations Development Programme, Capacity development: a UNDP primer. New York: United Nations Development Programme, 2009). An example of a component of institutional arrangements is the establishment of a multisectoral national CRVS coordination committee consisting of representatives from key stakeholder groups that can facilitate participatory decision-making and continuous communication. Another important component of institutional arrangements is to create a linkage between CRVS and the national identity management system using unique identification numbers, enabling continuously updated vital events data to be accessible to the civil identification agency. By using birth registration in the civil registry to trigger the generation of a new identification and death registration to close it, this link accounts for the flow of people into and out of the identification management system. Expanding this data link to enable interoperability between different databases belonging to various ministries and agencies can enhance the efficiency of public and private services, save resources, and improve the quality of national statistics which are useful for monitoring the national development goals and the Sustainable Development Goals. Examples from countries that have successfully implemented the recommended components of an integrated CRVS and national identity management system are presented in the paper.

eLearning course for improving civil registration and vital statistics systems.

The World Bank Group (WBG), in partnership with the Global Civil Registration and Vital Statistics (CRVS) Group, the Korea Ministry of Economy and Finance, and the WBG Open Learning Campus, launched the first comprehensive CRVS eLearning course in May 2017. The development of this course demonstrates the commitment and collaboration of development partners and governments working closely together in building the capacity of national institutions to improve CRVS systems in low- and middle-income countries. As of December 2018, over 2300 learners from 137 countries have enrolled in the course. This paper discusses how the course has been developed, disseminated, and evaluated thus far. It also presents the challenges faced and how the course has improved based on feedback from course participants.

Unique health identifiers for universal health coverage.

Identifying everyone residing in a country, especially the poor, is an indispensable part of pursuing universal health coverage (UHC). Having information on an individuals' financial protection is also imperative for measuring the progress of UHC. This paper examines different ways of instituting a system of unique health identifiers that can lead toward achieving UHC, particularly in relation to utilizing universal civil registration and national unique identification number systems. Civil registration is a fundamental function of the government that establishes a legal identity for individuals and enables them to access essential public services. National unique identification numbers assigned at birth registration can further link their vital event information with data collected in different sectors, including in finance and health. Some countries use the national unique identification number as the unique health identifier, such as is done in South Korea and Thailand. In other countries, a unique health identifier is created in addition to the national unique identification number, but the two numbers are linked; Slovenia offers an example of this arrangement. The advantages and disadvantages of the system types are discussed in the paper. In either approach, linking the health system with the civil registration and national identity management systems contributed to advancing effective and efficient UHC programs in those countries.

Quasi-Qualitative Evaluation of Progressive Counting in Secure Accommodation in Scotland: an Exploratory Cluster Case Study.

This was the first study to introduce a brief exposure therapy, within a trauma-informed phase approach, into a secure facility in Scotland. An exploratory cluster case study was used to identify the perceptions of the first three youth who completed Progressive Counting (PC), a novel approach to brief exposure, within the Fairy Tale Model. The youth and their newly trained therapist received a semi-structured interview at 3 months following the completion of therapy. In-depth interviews involving rating scales and open-ended questions were conducted by telephone and digitally recorded. A quasi-qualitative approach was used to analyze data. Independent ratings by two researchers checked for inter-rater reliability. A retrospective expert rating was provided for treatment fidelity. Youth reported a range of gains in relation to program objectives including reduced distress and putting trauma into the past. Challenges of implementation are discussed. More rigorous evaluation of PC, including randomized control trials, is needed before PC can be recommended as a treatment of choice.

Unfavorable Pathology, Tissue Biomarkers and Genomic Tests With Clinical Implications in Prostate Cancer Management.

Prostate cancer management has traditionally relied upon risk stratification of patients based on Gleason score, pretreatment prostate-specific antigen and clinical tumor stage. However, these factors alone do not adequately reflect the inherent complexity and heterogeneity of prostate cancer. Accurate and individualized risk stratification at the time of diagnosis is instrumental to facilitate clinical decision-making and treatment selection tailored to each patient. The incorporation of tissue and genetic biomarkers into current prostate cancer prediction models may optimize decision-making and improve patient outcomes. In this review we discuss the clinical significance of unfavorable morphologic features such as cribriform architecture and intraductal carcinoma of the prostate, tissue biomarkers and genomic tests and assess their potential use in prostate cancer risk assessment and treatment selection.

Endovascular treatment of an aortic saddle embolism resulting in full neurologic recovery.

Aortic saddle embolism (ASE) and aortic saddle thrombosis are rare and occasionally associated with spinal ischemia and paraplegia. Patients have traditionally been treated with transfemoral balloon thromboembolectomy. In the following case report, we present a patient with suspected ASE and paraplegia, who was successfully treated by an endovascular approach using covered stents. Following intervention, the patient regained full neurologic function. To our knowledge, it is the first time that this type of endovascular treatment for ASE has been applied successfully.

Aortic aneurysmal repair with surtureless visceral revascularization using novel hybrid vascular graft and a gradual funneling technique.

This article details a novel technique in the treatment of a symptomatic thoracoabdominal aneurysm (TAA) involving the visceral segment and an infrarenal abdominal aortic aneurysm. The patient was treated in a 2-staged hybrid approach combining an endovascular repair of the infrarenal segment, followed by open TAA repair. The large visceral arteries were revascularized using expanded polytetrafluoroethylene GORE Hybrid Vascular Graft (GHVG) and a Gradual Funneling Technique with Dacron graft. This method assured a complete hemostatic seal and minimized visceral ischemic time. To our knowledge, this is the first case of sutureless visceral artery revascularization using GHVG reported in the literature.