Accuracy of antigen and nucleic acid amplification testing on saliva and naopharyngeal samples for detection of SARS-CoV-2 in ambulatory care

Background: Nasopharyngeal sampling for nucleic acid amplification testing (NAAT) is the current standard diagnostic test for of coronavirus disease 2019 (COVID-19). However, the NAAT technique is lengthy and nasopharyngeal sampling requires trained personnel. Saliva NAAT represents an interesting alternative but diagnostic performances vary widely between studies. Objective: To assess the diagnostic accuracy of a nasopharyngeal point-of-care antigen (Ag) test and of saliva NAAT for detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), as compared to nasopharyngeal NAAT. Design: Prospective participant enrollment from 19 October through 18 December 2020. Setting: Two community COVID-19 screening centers in Paris, France. Participants: 1452 ambulatory children and adults referred for SARS-CoV-2 testing. Interventions: NAAT on a saliva sample (performed with three different protocols for pre-processing, amplification and detection of SARS-CoV-2) and Ag testing on a nasopharyngeal sample. Measurements: Performance of saliva NAAT and nasopharyngeal Ag testing. Results: Overall, 129/1443 (9%) participants tested positive on nasopharyngeal NAAT (102/564 [18%] in symptomatic and 27/879 [3%] in asymptomatic participants). Sensitivity was of 94% (95% CI, 86% to 98%), 23% (CI, 14% to 35%), 94% (CI, 88% to 97%) and 96% (CI, 91% to 99%) for the nasopharyngeal Ag test and the three different protocols of saliva NAAT, respectively. Estimates of specificity were above 95% for all methods. Diagnostic accuracy was similar in symptomatic and asymptomatic individuals. Limitations: Few children (n=122, 8%) were included. Conclusion: In the ambulatory setting, diagnostic accuracy of nasopharyngeal Ag testing and of saliva NAAT seems similar to that of nasopharyngeal NAAT, subject to strict compliance with specific pre-processing and amplification protocols. Registration number: NCT04578509 Funding Sources: French Ministry of Health and the Assistance Publique-Hopitaux de Paris Foundation.

Informed consent for next-generation nucleotide sequencing studies: Aiding communication between participants and investigators

IntroductionObtaining informed consent from prospective participants for research studies that include next-generation nucleotide sequencing (NGS) presents significant challenges because of the need to explain all the potential implications of participating, including the possible return of “incidental” findings, in easy-to-understand language.Methods and ResultsAfter reviewing the consent processes at other institutions, we decided to supplement the protocol-specific informed consent form with the following: (1) a short pamphlet for the prospective participant that includes a series of questions that she or he is encouraged to ask the investigator, and (2) a more detailed companion guide for investigators to help them develop simple-language answers to the questions. Both documents are available to use or modify.ConclusionsWe propose an approach to obtaining informed consent for NGS studies that encourages discussion of key issues without creating a complex, comprehensive document for participants; it also maximizes investigator flexibility. We also suggest mechanisms to return restricted information to participants.

Intercultural and lifelong learning based on educational drama

This paper is an attempt to propose multidimensional research projects and therefore it is addressed to researchers and theatre/drama-pedagogues. Our principal aim of this paper is to suggest ways to investigate the role of drama both as a methodology in itself in the fields of education and lifelong learning, and as a means suitable for implementation in many other arenas. Our focus on alternative dramatic forms such as puppetry, dramatised narration and creative writing in role, enhances the implication of a rather broad spectrum of prospective participant groups beyond students, such as immigrants, prison convicts and the elderly. We also aim at the facilitation of the involvement of all people who seek ways of improving their professional competence and who could benefit from the implementation of drama techniques in workplaces such as museums, public libraries, and in some sectors of the tourism industry. We firmly believe that the role of educational drama deserves to be consolidated in many areas of social science and social work.

Three Problems with Contractarian-Consequentialist Ways of Assessing Social Institutions

With each of our three criminal-law topics—defining offenses, apprehending suspects, and establishing punishments—we feel, I believe, strong moral resistance to the idea that our practices should be settled by a prospective-participant perspective. This becomes quite clear when we look at how the “reforms” suggested by institutional viewing might combine once we consider all three topics together: imagine a more extensive and swifter use of the death penalty in homicide cases coupled with somewhat lower standards of evidence; or think of backing a strict-liability criminal statute with the death penalty. Of course, such “reforms” would increase the execution of innocents; but, their proponents will tell us, any penal system involves the punishment of some innocents, and, if it provides for the death penalty, the execution of some innocents. Moreover, why is it worse for innocents to be punished than for innocents to suffer an equivalent harm in some other way? Formulated from a prospective-participant perspective: Why not run a small risk of being innocently executed in exchange for reducing, much more significantly, the risk of dying prematurely in other ways?