Despite the success of recent efforts to increase access to improved water, sanitation, and hygiene (WASH) globally, approximately one-third of schools around the world still lack adequate WASH services. A lack of WASH in schools can lead to the spread of preventable disease and increase school absences, especially among women. Inadequate financing and budgeting has been named as a key barrier for integrating successful and sustainable WASH programs into school settings. For this reason, the purpose of this review is to describe the current knowledge around the costs of WASH components as well as financing models that could be applied to WASH in schools. Results show a lack of information around WASH costing, particularly around software elements as well as a lack of data overall for WASH in school settings as compared to community WASH. This review also identifies several key considerations when designing WASH budgets or selecting financing mechanisms. Findings may be used to advise future WASH in school programs.

Introduction: Asthma evidence-based interventions (EBI) are implemented in the home, school, community or primary care setting. Although families are engaged in one setting, they often have to navigate challenges in another setting. Objective: Our objective is to design and implement a comprehensive plan which integrates EBI's and connects the four sectors in underserved communities such as Philadelphia. Methods: September 2015-April 2016 we implemented a three-pronged strategy to understand needs and resources of the community including 1) focus groups and key informant interviews, 2) secondary data analysis and 3) pilot testing for implementation to determine gaps in care, and opportunities to overcome those gaps. Results: Analysis of the focus group and key informant responses showed themes: diagnosis fear, clinician time, home and school asthma trigger exposures, school personnel training and communication gaps across all four sectors. EBI's were evaluated and selected to address identified themes. Pilot testing of a community health worker (CHW) intervention to connect home, primary care and school resulted in an efficient transfer of asthma medications and medication administration forms to the school nurse office for students with uncontrolled asthma addressing a common delay leading to poor asthma management in school. Conclusion: Thus far there has been limited success in reducing asthma disparities for low-income minority children. This study offers hope that strategically positioning CHWs may work synergistically to close gaps in care and result in improved asthma control and reduced asthma disparities.

Despite the success of recent efforts to increase access to improved water, sanitation, and hygiene (WASH) globally, approximately one-third of schools around the world still lack adequate WASH services. A lack of WASH in schools can lead to the spread of preventable disease and increase school absences, especially among women. Inadequate financing and budgeting has been named as a key barrier for integrating successful and sustainable WASH programs into school settings. For this reason, the purpose of this review is to describe the current knowledge around the costs of WASH components as well as financing models that could be applied to WASH in schools. Results show a lack of information around WASH costing, particularly around software elements as well as there is a lack of data overall for WASH in school settings as compared to community WASH. This review also identifies several key considerations when designing WASH budgets or selecting financing mechanisms. Findings may be used to advise future WASH in school programs.

Figure outlines the flow of wastewater from the community where a norovirus GII outbreak occurred to two wastewater treatment facilities (Wastewater Treatment Facilities A and B). Plots are shown to demonstrate that norovirus GII was measured at these wastewater treatment facilities over time. Norovirus is a leading cause of acute gastrointestinal illness (AGI). Norovirus is not notifiable in the United States; therefore, health departments typically only receive reports of norovirus outbreaks. While wastewater surveillance has been demonstrated to be useful for tracking community norovirus case reports, its value during outbreak investigations is less understood. This study evaluates the impact of a single norovirus outbreak on wastewater measurements in a community. Norovirus genogroup 2 (GII) concentrations were measured at two wastewater treatment facilities (WWTFs) near a restaurant experiencing a norovirus GII outbreak (Restaurant A). The largest increase in norovirus GII RNA concentrations (increase of 13,111.8 gc/mL) at the WWTF serving Restaurant A (WWTF A) occurred on the same day most (44%) outbreak case patients reported symptom onset. This increase occurred 1 day before the outbreak was reported to public health, 2 days before norovirus was identified in clinical specimens, and 3 days before clinical specimens were genotyped at the public health laboratory. At a second local WWTF, WWTF B, norovirus GII RNA concentrations also increased at the same time but peaked 2 days after WWTF A. These findings suggest wastewater measurements can serve as a leading indicator of norovirus outbreaks and inform outbreak response efforts.