scholarly journals Viral Transport Media (VTM) Pooling To Scale-Up COVID-19 Diagnostics: Resource Optimization at Population Level Screening

2021 ◽  
Author(s):  
Pramod Gautam ◽  
Faraz Ahmad ◽  
Jyoti Sharma ◽  
Jasmine Samal ◽  
Sugandha Singh ◽  
...  
Keyword(s):  
Public Health ◽  
Scale Up ◽  
Population Level ◽  
Positive Sample ◽  
Viral Loads ◽  
Pooled Testing ◽  
Viral Transport ◽  
The Face ◽  
Single Positive ◽  
Multiple Variables

Abstract Background: The threat of coronavirus disease 2019 (COVID-19) is still looming large on humankind. Pooled-testing can serve as a method of choice for current and future mass surveillance. The aim is to economically benefit in the face of resource-paucity in overburdened public health systems. Methods: This study assesses the viability of pooled-testing with viral transport media (VTM) for COVID-19 diagnosis. For this, we designed high-dilution pools using samples with wide-ranging viral loads. The testing employs common TaqMan-based RT-PCR assay considering biological as well as technical replicates. Results: We successfully detected a single positive sample in a pool (up to 1/32 dilutions) without loss of sensitivity. The results from biological and technical replicates were found to be satisfactory and reproducible for the objective. We have also discussed multiple variables that can influence the final outcome of pooled testing strategy. Conclusions: We show that pooling approach can be efficiently applied for the detection of SARS-CoV-2. We report improved pooling success compared to published studies, even with very low input volume of media, in very high pool-sizes using low-viral load samples. We consider these features to be unique to this study. The study outcomes are encouraging and can be implemented in public health settings to conserve precious resources.

scholarly journals Recommendations for sample pooling on the Cepheid GeneXpert® system using the Cepheid Xpert® Xpress SARS-CoV-2 assay

2020 ◽  
Author(s):  
Michael G. Becker ◽  
Tracy Taylor ◽  
Sandra Kiazyk ◽  
Dana R. Cabiles ◽  
Adrienne F.A. Meyers ◽  
...  
Keyword(s):  
Public Health ◽  
Limit Of Detection ◽  
Point Of Care ◽  
Test Site ◽  
Viral Loads ◽  
Pooled Testing ◽  
Point Of Care Test ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Sample Pooling

AbstractThe coronavirus disease 2019 (Covid-19) pandemic, caused by SARS-CoV-2, has resulted in a global testing supply shortage. In response, pooled testing has emerged as a promising strategy that can immediately increase testing capacity. Here, we provide support for the adoption of sample pooling with the point-of-care Cepheid Xpert® Xpress SARS-CoV-2 molecular assay. Corroborating previous findings, the Xpert® Xpress SARS-CoV-2 assay limit of detection was comparable to central laboratory reverse-transcription quantitative PCR tests with observed SARS-CoV-2 detection below 100 copies/mL. The Xpert® Xpress assay detected SARS-CoV-2 after samples with minimum viral loads of 461 copies/mL were diluted into six sample pools. Based on these data, we recommend the adoption of pooled testing with the Xpert® Xpress SARS-CoV-2 assay where warranted by population public health needs. The suggested number of samples per pool, or pooling depth, is unique for each point-of-care test site and should be determined by assessing positive test rates. To statistically determine appropriate pooling depth, we have calculated the pooling efficiency for numerous combinations of pool sizes and test rates. This information is included as a supplemental dataset that we encourage public health authorities to use as a guide to make recommendations that will maximize testing capacity and resource conservation.

scholarly journals Recommendations for sample pooling on the Cepheid GeneXpert® system using the Cepheid Xpert® Xpress SARS-CoV-2 assay

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241959
Author(s):  
Michael G. Becker ◽  
Tracy Taylor ◽  
Sandra Kiazyk ◽  
Dana R. Cabiles ◽  
Adrienne F. A. Meyers ◽  
...  
Keyword(s):  
Public Health ◽  
Limit Of Detection ◽  
Point Of Care ◽  
Viral Loads ◽  
Pooled Testing ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Sample Pooling ◽  
Testing Site ◽  
The Individual

The coronavirus disease 2019 (Covid-19) pandemic, caused by SARS-CoV-2, has resulted in a global testing supply shortage. In response, pooled testing has emerged as a promising strategy that can immediately increase testing capacity. In pooled sample testing, multiple samples are combined (or pooled) together and tested as a single unit. If the pool is positive, the individual samples can then be individually tested to identify the positive case(s). Here, we provide support for the adoption of sample pooling with the point-of-care Cepheid Xpert® Xpress SARS-CoV-2 molecular assay. Corroborating previous findings, the limit of detection of this assay was comparable to laboratory-developed reverse-transcription quantitative PCR SARS-CoV-2 tests, with observed detection below 100 copies/mL. The Xpert® Xpress assay detected SARS-CoV-2 after samples with minimum viral loads of 461 copies/mL were pooled in groups of six. Based on these data, we recommend the adoption of pooled testing with the Xpert® Xpress SARS-CoV-2 assay where warranted based on public health needs. The suggested number of samples per pool, or the pooling depth, is unique for each point-of-care testing site and can be determined by the positive test rates. To statistically determine appropriate pooling depth, we have calculated the pooling efficiency for numerous combinations of pool sizes and test rates. This information is included as a supplemental dataset that we encourage public health authorities to use as a guide to make recommendations that will maximize testing capacity and resource conservation.

scholarly journals Estimating epidemiologic dynamics from single cross-sectional viral load distributions

2020 ◽  
Author(s):  
James A. Hay ◽  
Lee Kennedy-Shaffer ◽  
Sanjat Kanjilal ◽  
Marc Lipsitch ◽  
Michael J. Mina
Keyword(s):  
Public Health ◽  
Growth Rate ◽  
Viral Load ◽  
Population Level ◽  
Accurate Estimation ◽  
Cross Sectional ◽  
Individual Level ◽  
Viral Loads ◽  
Single Cross ◽  
Testing Practices

AbstractVirologic testing for SARS-CoV-2 has been central to the COVID-19 pandemic response, but interpreting changes in incidence and fraction of positive tests towards understanding the epidemic trajectory is confounded by changes in testing practices. Here, we show that the distribution of viral loads, in the form of Cycle thresholds (Ct), from positive surveillance samples at a single point in time can provide accurate estimation of an epidemic’s trajectory, subverting the need for repeated case count measurements which are frequently obscured by changes in testing capacity. We identify a relationship between the population-level cross-sectional distribution of Ct values and the growth rate of the epidemic, demonstrating how the skewness and median of detectable Ct values change purely as a mathematical epidemiologic rule without any change in individual level viral load kinetics or testing. Although at the individual level measurement variation can complicate interpretation of Ct values for clinical use, we show that population-level properties reflect underlying epidemic dynamics. In support of these theoretical findings, we observe a strong relationship between the time-varying effective reproductive number, R(t), and the distribution of Cts among positive surveillance specimens, including median and skewness, measured in Massachusetts over time. We use the observed relationships to derive a novel method that allows accurate inference of epidemic growth rate using the distribution of Ct values observed at a single cross-section in time, which, unlike estimates based on case counts, is less susceptible to biases from delays in test results and from changing testing practices. Our findings suggest that instead of discarding individual Ct values from positive specimens, incorporation of viral loads into public health data streams offers a new approach for real-time resource allocation and assessment of outbreak mitigation strategies, even where repeat incidence data is not available. Ct values or similar viral load data should be regularly reported to public health officials by testing centers and incorporated into monitoring programs.

scholarly journals A systems approach to scale-up for population health improvement

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Harriet Koorts ◽  
Harry Rutter
Keyword(s):  
Public Health ◽  
Population Health ◽  
Systems Approach ◽  
Scale Up ◽  
Health Behaviours ◽  
Population Level ◽  
Scaling Up ◽  
Health Impact ◽  
Health Improvement ◽  
Global Public Health

AbstractDespite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and equitable population health improvement. Systems change plays a major role in the relation between implementation processes and at-scale institutionalisation of public health interventions. However, in research, systems approaches remain underutilised in scaling up. Public health scale-up models have typically centred on intervention replication through linear expansion. In this paper, we discuss current conceptualisations and approaches used when scaling up in public health, and propose a new perspective on scaling that shifts attention away from the intervention to focus instead on achieving the desired population-level health outcomes. In our view, ‘scaling up’ exists on a continuum. At one end, effective scaling can involve a linear, intervention-orientated expansive approach that prioritises the spread of evidence-based interventions into existing systems in order to drive expansion in the application of that intervention. At the other end, we contend that scale-up can sit within a complex systems paradigm in which interventions are conceptualised as events in systems. In this case, implementation and scale-up activities should focus on generating changes within the system itself to achieve the desired outcome. This we refer to as ‘systems-orientated scale-up’ to achieving population health improvement, which can complement traditional approaches in relevant situations. We argue that for some health behaviours, our proposed approach towards scaling up could enhance intervention implementation, sustainability and population health impact.

PENERAPAN CLUSTERING PADA PENDUDUK YANG MEMPUNYAI KELUHAN KESEHATAN DENGAN DATAMINING K-MEANS

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Nurul Rofiqo ◽  
Agus Perdana Windarto ◽  
Dedy Hartama
Keyword(s):  
Public Health ◽  
Data Mining ◽  
Population Level ◽  
Research Data ◽  
Health Complaints ◽  
Public Health Services ◽  
National Statistics ◽  
Central Java ◽  
Indonesian Population ◽  
The Government

This study aims to utilize Clushtering Algorithm in grouping the number of people who have health complaints with the K-means algorithm in Indonesia. The source of this research data was collected based on the documents of the provincial population which had health complaints produced by the National Statistics Agency. The data used in this study are data from 2013-2017 consisting of 34 provinces. The method used in this research is K-means Algorithm. Data will be processed by clushtering in 3 clushter, namely clusther high health complaints, clusther moderate and low health complaints. Centroid data for high population level clusters 37.48, Centroid data for moderate population level clusters 27.08, and Centroid data for low population level clusters 14.89. So that obtained an assessment based on the population index that has health complaints with 7 provinces of high health complaints, namely Central Java, Yogyakarta, Bali, West Nusa Tenggara, East Nusa Tenggara, South Kalimantan, Gorontalo, 18 provinces of moderate health complaints, and 9 other provinces including low health complaints. This can be an input to the government to give more attention to residents in each region who have high health complaints through improving public health services so that the Indonesian population becomes healthier without health complaints.Keywords: data mining, health complaints, clustering, K-means, Indonesian residents

Fidelity and Its Relationship to Implementation Effectiveness, Adaptation, and Dissemination

2017 ◽  
Author(s):  
Jennifer D. Allen ◽  
Rachel C. Shelton ◽  
Karen M. Emmons ◽  
Laura A. Linnan
Keyword(s):  
Public Health ◽  
Treatment Strategies ◽  
Implementation Fidelity ◽  
Population Level ◽  
The United States ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Health Gains ◽  
Significant Public Health ◽  
Research Continuum

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.

Pandemic Disease, Public Health, and Ethics

2019 ◽  
pp. 796-811 ◽  
Author(s):  
Maxwell Smith ◽  
Ross Upshur
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Ethical Challenges ◽  
Pandemic Preparedness ◽  
Scarce Resources ◽  
Ethical Frameworks ◽  
Health Measures ◽  
Care Workers ◽  
The Face ◽  
Conducting Research

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.

Tobacco as a Matter of Public Health: Ethical Issues

2019 ◽  
pp. 494-510
Author(s):  
Kristin Voigt
Keyword(s):  
Public Health ◽  
Tobacco Use ◽  
Ethical Issues ◽  
Population Level ◽  
Third Parties ◽  
Background Factors ◽  
Normative Issues

This chapter considers normative issues that tobacco raises at the population level, particularly with respect to the anti-smoking strategies policymakers might pursue and the reasons and justifications underlying these strategies. After setting out several background factors that shape the debate, the chapter discusses different grounds on which state and public health actors might seek to restrict tobacco use, considering in turn those justifications that focus on protecting smokers and those that seek to protect third parties. The chapter then considers normative problems arising in relation to specific anti-smoking strategies, such as restrictions on the sale, use, and marketing of cigarettes; taxation; incentives for cessation; and denormalization strategies. Issues of paternalism and the stigma associated with smoking are also discussed.

scholarly journals Are public health measures and individualised care compatible in the face of a pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic

2021 ◽  
pp. 026921632110198
Author(s):  
Catriona R Mayland ◽  
Rosemary Hughes ◽  
Steven Lane ◽  
Tamsin McGlinchey ◽  
Warren Donnellan ◽  
...  
Keyword(s):  
Public Health ◽  
Family Support ◽  
Online Survey ◽  
Free Text ◽  
Professional Networks ◽  
Dying Patients ◽  
The Face ◽  
Individualised Care ◽  
The Impact ◽  
Informative Communication

Background: COVID-19 public health restrictions have affected end-of-life care experiences for dying patients and their families. Aim: To explore bereaved relatives’ experiences of quality of care and family support provided during the last days of life; to identify the impact of factors associated with perceived support. Design: A national, observational, open online survey was developed and disseminated via social media, public fora and professional networks (June–September 2020). Validated instruments and purposively designed questions assessed experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. Participants: Individuals (⩾18 years) who had experienced the death of a relative/friend (all care settings) within the United Kingdome during the COVID-19 pandemic. Results: Respondents ( n = 278, mean 53.4 years) tended to be female ( n = 216, 78%); over half were ‘son/daughter’ (174, 62.6%) to the deceased. Deceased individuals (mean 81.6 years) most frequently died in their ‘usual place of care’ ( n = 192, 69.3%). Analysis established five conceptual themes affecting individualised care: (1) public health restrictions compounding the distress of ‘not knowing’; (2) disparate views about support from doctors and nurses; (3) challenges in communication and level of preparedness for the death; (4) delivery of compassionate care; (5) emotional needs and potential impact on grief. Male respondents (OR 2.9, p = 0.03) and those able to visit (OR 2.2, p = 0.04) were independently associated with good perceptions of family support. Conclusion: Despite public health restrictions, individualised care can be enabled by proactive, informative communication; recognising dying in a timely manner and facilitating the ability to be present before death.

Dilemmas of nudging in public health: an ethical analysis of a Danish pamphlet

2020 ◽  
Author(s):  
Jacob Busch ◽  
Emilie Kirstine Madsen ◽  
Antoinette Mary Fage-Butler ◽  
Marianne Kjær ◽  
Loni Ledderer
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Screening Programme ◽  
Screening Program ◽  
Ethical Analysis ◽  
Choice Making ◽  
The Face ◽  
Information Materials ◽  
The Individual ◽  
To Receive

Summary Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people’s choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people’s reflective capabilities. Information materials are, on the face of it, meant to engage citizens’ reflective capacities. Recipients are likely to receive information materials with this expectation, and thus not expect to be affected in other ways. Non-educative nudges may therefore be particularly problematic in the context of information on screening, also as participating in screening does not always benefit the individual.

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