Recursive expectations approach in policymaking

The primary contribution of modern economics to policy analysis may be the recognition of the crucial role of expectations in policy intervention. The essence of expectations is to think about others' thinking. We argue that policymakers need recursive thinking, that is, the ability to think about thinking and review three policy episodes related to the lack of recursive thinking. We see that the disciplinary divide or the limited scope of recursive thinking on the side of policymakers can cause huge damage to social welfare in times of crisis. Finally, we consider two examples of future agendas in the recursive approach. © 2023, The Author(s).

Home urinary tract infection testing: patient experience and satisfaction with polymerase chain reaction kit.

INTRODUCTION AND HYPOTHESIS: We sought to evaluate patient satisfaction with a novel multiplex PCR UTI home collection kit for symptomatic UTI in a urogynecologic population. We secondarily sought to characterize reported uropathogens and resistance profiles of uropathogens in this population. We hypothesized that patients would be satisfied. METHODS: This was a cross-sectional study of women who were surveyed later about their experience undergoing evaluation for a UTI with a home UTI test at a large tertiary care urogynecology practice in 2020. Symptomatic patients were sent a home UTI kit. We assessed patient satisfaction at a later time with a 5-point Likert scale and collected baseline information. The primary outcome was patient satisfaction with this experience. Secondary outcomes included type and number of uropathogens on testing. RESULTS: A total of 30 patients [73% white race, mean age 71.9 (SD 12.0) years] were surveyed. Patients responded with a mean score of 4.7/5 to all satisfaction questions. Overall, 86% (26/30) of patients would choose this test again. Of those asked if they would choose this test again outside of the COVID-19 pandemic, 86% responded affirmatively. The most common symptoms reported included dysuria (53%), urgency (37%) and frequency (30%). The most common pathogens identified included Escherichia coli (70%), Enterococcus faecalis (60%) and Aerococcus urinae (43%). CONCLUSIONS: Patients were satisfied with home UTI PCR testing and the majority would choose this option again. Home UTI PCR testing revealed common uropathogens for a population with a high proportion of recurrent UTI, but additional research comparing home versus in-office urine PCR testing is necessary.

Prospective Performance Evaluation of the miDiagnostics COVID-19 PCR Test for Rapid SARS-CoV-2 Detection on Nasopharyngeal Swabs.

Rapid diagnosis or exclusion of SARS-CoV-2 infection is essential for correct medical management decisions regarding COVID-19. High-throughput laboratory-based reverse transcriptase (RT)-PCR testing is accurate with longer turnaround times, while rapid antigen tests show moderate sensitivity. In search of a fast and reliable COVID-19 test, we aimed to validate the rapid miDiagnostics COVID-19 PCR test. We recruited symptomatic and asymptomatic participants in a mobile COVID-19 test center in Belgium. We collected three nasopharyngeal samples from each participant. The index sample was tested on the miDiagnostics COVID-19 PCR reader, the reference sample was tested on the reference TaqPath COVID-19 PCR test in the Belgian Reference Center for Respiratory Pathogens of University Hospitals Leuven, and a third sample was collected for discordance testing with the PerkinElmer SARS-CoV-2 PCR kit. A total of 770 participants yielded 763 sets of included nasopharyngeal samples. Overall positive percent agreement and negative percent agreement of the miDiagnostics COVID-19 PCR test were 95.5% (92.6% to 97.4%) and 94.9% (92.3 to 96.8%), rising to 98.6% (96.5% to 99.6%) and 96.5% (92.6% to 98.7%) in symptomatic patients. Discordance testing reclassified 15 of 21 false-positive cases as true positive. A retest of the miDiagnostics PCR test was performed in 61 tests (7.4%) due to a technical error. The miDiagnostics COVID-19 PCR test showed excellent clinical accuracy. The fast and reliable results allow for rapid correct diagnosis and tailored medical management decisions regarding COVID-19.

Estimating COVID-19 Virus Prevalence from Records of Testing Rate and Test Positivity

Introduction: PCR testing for COVID-19 is not done at random but selectively on suspected cases. This paper presents a method to estimate a "genuine virus prevalence” by quantifying and removing the bias related to selective testing. Methods: The data used was from nine (9) neighbouring countries in Western Europe that recorded similar epidemic trends despite differences in testing rate. Regression analysis was used to establish a relationship of declining test positivity with increased testing rate. By extrapolating this trend to an "infinitely complete” testing rate, an unbiased test positivity or "genuine virus prevalence” was computed. Via pairing of "genuine virus prevalence” with excess-deaths, a "genuine infection fatality rate” (IFR) was also derived. Results: Peak levels of "genuine virus prevalence” were around 0.5 to 2% during the 1st epidemic "wave” (week 10 to week 20) and are approaching similar levels in the ongoing 2nd "wave” (week 34 onward). "Genuine virus prevalence” estimates are relatively close to reported seroprevalence in the studied countries with a correlation coefficient of 0.54. "Genuine” IFR is found comparable to closed-community model IFR. Finally, results of community mass-testing in Slovakia are within the estimated range of "genuine virus prevalence”. Conclusions: Estimates of "genuine virus prevalence” benchmark favourably to other indications of virus prevalence suggesting the estimation method is robust and potentially deployable beyond this initial dataset of countries. "Genuine virus prevalence” curves suggest that during the 1st epidemic "wave”, curve flattening and waning happened at very modest levels of infection spread, either naturally or facilitated by government measures. © 2021 The Author(s)..

High-Performance, All-Scenario COVID-19 Pathogen Detection, Prevention, and Control System

Given the COVID-19 pandemic, this paper aims at providing a full-process information system to support the detection of pathogens for a large range of populations, satisfying the requirements of light weight, low cost, high concurrency, high reliability, quick response, and high security. The project includes functional modules such as sample collection, sample transfer, sample reception, laboratory testing, test result inquiry, pandemic analysis, and monitoring. The progress and efficiency of each collection point as well as the status of sample transfer, reception, and laboratory testing are all monitored in real time, in order to support the comprehensive surveillance of the pandemic situation and support the dynamic deployment of pandemic prevention resources in a timely and effective manner. Deployed on a cloud platform, this system can satisfy ultra-high concurrent data collection requirements with 20 million collections per day and a maximum of 5 million collections per hour, due to its advantages of high concurrency, elasticity, security, and manageability. This system has also been widely used in Jiangsu, Shaanxi provinces, for the prevention and control of COVID-19 pandemic. Over 100 million NAT data have been collected nationwide, providing strong informational support for scientific and reasonable formulation and execution of COVID-19 prevention plans. © 2022 IEEE.

2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines.

CLINICAL IMPORTANCE: Feline infectious peritonitis (FIP) is one of the most important infectious diseases and causes of death in cats; young cats less than 2 years of age are especially vulnerable. FIP is caused by a feline coronavirus (FCoV). It has been estimated that around 0.3% to 1.4% of feline deaths at veterinary institutions are caused by FIP. SCOPE: This document has been developed by a Task Force of experts in feline clinical medicine as the 2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines to provide veterinarians with essential information to aid their ability to recognize cats presenting with FIP. TESTING AND INTERPRETATION: Nearly every small animal veterinary practitioner will see cases. FIP can be challenging to diagnose owing to the lack of pathognomonic clinical signs or laboratory changes, especially when no effusion is present. A good understanding of each diagnostic test's sensitivity, specificity, predictive value, likelihood ratio and diagnostic accuracy is important when building a case for FIP. Before proceeding with any diagnostic test or commercial laboratory profile, the clinician should be able to answer the questions of 'why this test?' and 'what do the results mean?' Ultimately, the approach to diagnosing FIP must be tailored to the specific presentation of the individual cat. RELEVANCE: Given that the disease is fatal when untreated, the ability to obtain a correct diagnosis is critical. The clinician must consider the individual patient's history, signalment and comprehensive physical examination findings when selecting diagnostic tests and sample types in order to build the index of suspicion 'brick by brick'. Research has demonstrated efficacy of new antivirals in FIP treatment, but these products are not legally available in many countries at this time. The Task Force encourages veterinarians to review the literature and stay informed on clinical trials and new drug approvals.

Simulation of SARS-CoV-2 epidemic trends in Tokyo considering vaccinations, virus mutations, government policies and PCR tests.

The eighth wave of COVID-19 infection in the Tokyo area has brought daily confirmed cases to a new higher level. This paper aims to explain the previous seven epidemic waves and forecast the eighth epidemic trend of the area using agent-based modeling and extended SEIR denotation. Four key considerations are investigated in this research, that are: 1. Vaccination, 2. Virus mutations, 3. Governmental policies and 4. PCR tests. Our study finds that the confirmed cases in the previous seven epidemic waves were only the tip of the iceberg. Using data prior to December 1 2022, the eighth wave is expected to hover high in December 2022 and January 2023. Our research pioneers in the simulation of antibody declination on an individual level. Comparing the simulated results, we find that the arrival of new epidemic waves are related to the decline in the number of antibody possessors, especially the sixth and the seventh epidemic waves. Our simulation also suggests that faced with low severe and death rates, PCR tests would not make much difference to reduce overall infections. In this case, maintaining PCR tests to a low level helps to reduce both social cost and public anxiety. However, if faced with the opposite case, PCR tests should be adjusted to a higher level to detect early infections. Such level of PCR tests should be compatible with available medical resources.

Process Intensification and Increased Safety for the On-Demand Continuous Flow Synthesis of Dithiothreitol, a Crucial Component in Polymerase Chain Reaction Testing Kits

The importance of rapid access to diagnostics tools in the identification of pathogens-including their crucial component, bioreagents-was recently underscored in the COVID-19 pandemic. The currently adopted synthesis of dithiothreitol (DTT) involves four steps in batch with long reaction times and which generates a highly carcinogenic and mutagenic bis-epoxide intermediate. In this work, we have developed an intensified telescoped three-step continuous flow synthesis of DTT involving a base-mediated ring closure epoxidation, a nucleophilic epoxide opening with thioacetic acid, and an acid-mediated deacetylation. One of the key features is that the first two steps are conducted in a telescoped continuous flow fashion, allowing generation and consumption of the hazardous intermediate in situ, suppressing the need for its isolation, and improving the overall safety of the synthesis. The process is completed by an acid-catalyzed deacetylation and a subsequent recrystallization to afford the desired DTT. Flow chemistry allows here to intensify the process by using high temperatures and high pressures while minimizing the number of unit operations and improving the overall safety of the process. Our protocol permits the on-demand production of DTT in case of future outbreaks.

Quantitative Analysis of the Effectiveness of Antigen- and Polymerase Chain Reaction-Based Combination Strategies for Containing COVID-19 Transmission in a Simulated Community.

The number of coronavirus disease 2019 (COVID-19) cases continues to surge, overwhelming healthcare systems and causing excess mortality in many countries. Testing of infectious populations remains a key strategy to contain the COVID-19 outbreak, delay the exponential spread of the disease, and flatten the epidemic curve. Using the Omicron variant outbreak as a background, this study aimed to evaluate the effectiveness of testing strategies with different test combinations and frequencies, analyze the factors associated with testing effectiveness, and optimize testing strategies based on these influencing factors. We developed a stochastic, agent-based, discrete-time susceptible-latent-infectious-recovered model simulating a community to estimate the association between three levels of testing strategies and COVID-19 transmission. Antigen testing and its combination strategies were more efficient than polymerase chain reaction (PCR)-related strategies. Antigen testing also showed better performance in reducing the demand for hospital beds and intensive care unit beds. The delay in the turnaround time of test results had a more significant impact on the efficiency of the testing strategy compared to the detection limit of viral load and detection-related contacts. The main advantage of antigen testing strategies is the short turnaround time, which is also a critical factor to be optimized to improve PCR strategies. After modifying the turnaround time, the strategies with less frequent testing were comparable to daily testing. The choice of testing strategy requires consideration of containment goals, test efficacy, community prevalence, and economic factors. This study provides evidence for the selection and optimization of testing strategies in the post-pandemic era and provides guidance for optimizing healthcare resources.

Increase in Colorado Tick Fever Virus Disease Cases and Effect of COVID-19 Pandemic on Behaviors and Testing Practices, Montana, 2020.

In 2020, Montana, USA, reported a large increase in Colorado tick fever (CTF) cases. To investigate potential causes of the increase, we conducted a case-control study of Montana residents who tested positive or negative for CTF during 2020, assessed healthcare providers' CTF awareness and testing practices, and reviewed CTF testing methods. Case-patients reported more time recreating outdoors on weekends, and all reported finding a tick on themselves before illness. No consistent changes were identified in provider practices. Previously, only CTF serologic testing was used in Montana. In 2020, because of SARS-CoV-2 testing needs, the state laboratory sent specimens for CTF testing to the Centers for Disease Control and Prevention, where more sensitive molecular methods are used. This change in testing probably increased the number of CTF cases detected. Molecular testing is optimal for CTF diagnosis during acute illness. Tick bite prevention measures should continue to be advised for persons doing outdoor activities.

Process Intensification and Increased Safety for the On-Demand Continuous Flow Synthesis of Dithiothreitol, a Crucial Component in Polymerase Chain Reaction Testing Kits

The importance of rapid access to diagnostics tools in the identification of pathogens-including their crucial component, bioreagents-was recently underscored in the COVID-19 pandemic. The currently adopted synthesis of dithiothreitol (DTT) involves four steps in batch with long reaction times and which generates a highly carcinogenic and mutagenic bis-epoxide intermediate. In this work, we have developed an intensified telescoped three-step continuous flow synthesis of DTT involving a base-mediated ring closure epoxidation, a nucleophilic epoxide opening with thioacetic acid, and an acid-mediated deacetylation. One of the key features is that the first two steps are conducted in a telescoped continuous flow fashion, allowing generation and consumption of the hazardous intermediate in situ, suppressing the need for its isolation, and improving the overall safety of the synthesis. The process is completed by an acid-catalyzed deacetylation and a subsequent recrystallization to afford the desired DTT. Flow chemistry allows here to intensify the process by using high temperatures and high pressures while minimizing the number of unit operations and improving the overall safety of the process. Our protocol permits the on-demand production of DTT in case of future outbreaks. © 2023 American Chemical Society.

Nonlinear Modeling of COVID-19 and the Significance of Testing: The Case of Kazakhstan

It has been more than two years since the world faced a global pandemic of COVID-19, which affected the global economy negatively and took many human lives. This paper considers the extended susceptible-exposed-infectious-recovered (SEIR) model and finds out whether it is effective for the government of Kazakhstan to conduct massive free PCR testing of the exposed population. To this end, we constructed a new mathematical model and the government cost function that incorporates the hospital cost for the COVID-19 treatment and the cost of PCR testing. To address the above-mentioned objectives, we constructed nonlinear differential equations for our epidemic model and numerically solved them. Furthermore, the government's cost was modeled as a function that depends on the rate of PCR tests. The findings of the numerical analysis show that the government's cost is minimized if the exposed individuals were tested for the disease as often as possible. Moreover, testing both susceptible and exposed individuals is not beneficial in terms of the economic cost. © 2022 IEEE.

Principles of Forming a Strategy for Reducing the Psychological Tension of Social Network Users

Aims: The purpose of the study was to develop principles of a strategy for influencing the psychological state of social network users using the example of the Russian-language segment of Twitter, one of the reasons for which is the lack of awareness about aspects of the coronavirus infection. Background(s): In contrast to the existing works on mood management and Emotion Regulation Strategies, there are principles based not on emotional regulation (cognitive reappraisal and expressive suppression), but on information processing of the content of social media messages and forums. Objective(s): The objective of the study was to develop principles of a strategy for reducing the psychological tension of social network users (further - Strategy) based on the Russian-language segment of Twitter. Method(s): The proposed research methodology includes a study of the discussion field in the active forum of the Runet (the qualitative aspect of emotionality as a reflection of psychological tension) and the Russian-language segment of Twitter (the quantitative aspect of terminology frequency). The qualitative research consisted in isolating the sensitive words used by vaccine opponents to describe their beliefs. A multi-stage methodology has been developed for the meaningful analysis of Twitter users' messages. Result(s):. The result of the study is a methodology for developing principles of the Strategy. Based on this methodology, the following aspects of the problem have been developed: 1) the principle of clarifying the definition of psychological tension;2) the principle of comparing the user and scientific meanings of terms, taking into account the contexts of their use;3) the principle of contextual comparison of the user's and scientific meanings of the term;4) the principle of visual popularization of scientific knowledge. Conclusion(s): An original methodology was created for developing principles of the Strategy. In contrast to the existing works on mood management and Emotion Regulation Strategies, there are principles based not on emotional regulation (cognitive reappraisal and expressive suppression [1]), but on information processing of the content of social media messages and forums. Other: A new approach to reducing the psychological tension of social media users can contribute to sharing timely, accurate and positive information about COVID-19, and reduce excessive discussions about COVID-19, which can positively affect the psychological well-being of the general public. Copyright © 2022 Khakimova et al.

Performance evaluation of a new on-demand molecular test for the rapid identification of severe acute respiratory syndrome coronavirus 2 in pediatric and adult patients.

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has increased the need to identify additional rapid diagnostic tests for an accurate and early diagnosis of infection. Here, we evaluated the diagnostic performance of the cartridge-based reverse transcription polymerase chain reaction (RT-PCR) test STANDARD M10 SARS-CoV-2 (SD Biosensor Inc., Suwon, South Korea), targeting the ORF1ab and E gene of SARS-CoV-2, and which can process up to eight samples in parallel in 60 min. From January 2022 to March 2022, STANDARD™ M10 assay performance was compared with Xpert® Xpress SARS-CoV-2 (Cepheid, Sunnyvale CA) on 616 nasopharyngeal swabs from consecutive pediatric (N = 533) and adult (N = 83) patients presenting at the "Istituto di Ricovero e Cura a Carattere Scientifico" (IRCCS) Ospedale Pediatrico Bambino Gesù, Roma. The overall performance of STANDARD M10 SARS-CoV-2 was remarkably and consistently comparable to the Xpert® Xpress SARS-CoV-2 with an overall agreement of 98% (604/616 concordant results), and negligible differences in time-to-result (60 min vs. 50 min, respectively). When the Xpert® Xpress SARS-CoV-2 results were considered as the reference, STANDARD™ M10 SARS-CoV-2 had 96.5% sensitivity and 98.4% specificity. STANDARD M10 SARS-CoV-2 can thus be safely included in diagnostic pathways because it rapidly and accurately identifies SARS-CoV-2 present in nasopharyngeal swabs.

The development of SARS-CoV-2 PCR testing methods at a designated medical institution for specific infectious diseases in Japan.

Due to the coronavirus disease 2019 (COVID-19) pandemic, we have been conducting polymerase chain reaction (PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at this facility since March 2020. In the early days, the PCR testing system had limited capabilities, so testing had to be conducted manually and only a few tests were conducted. Moreover, we lacked sufficient experience to conduct PCR testing manually, so we struggled with the manual work, which required intense concentration, and we felt pressured not to make mistakes such as allowing contamination. Since we introduced upgraded equipment, new methods, and additional staff for testing and we cooperated with the clinical technologist on the night shift in the Emergency Department, we are currently able to conduct urgent PCR testing on more than 2,000 specimens per month 24 hours a day. We will continue to meet new needs for COVID-19 treatment with the cooperation of other departments.

Strategies for Safely Maintaining Surgical Volume During the COVID-19 Pandemic: A Mixed-Methods Study.

Resuming elective surgeries that were canceled during the COVID-19 pandemic necessitated a change to preprocedure patient preparation at a pediatric tertiary care center in middle Tennessee. We conducted a prospective, observational, mixed-methods study to determine the effectiveness of a preprocedure COVID-19 testing team to prevent COVID-19-related cancellations among pediatric patients receiving planned anesthesia. The intervention involved family member and patient education and a change in health record reporting to include COVID-19 test results. A team tasked with follow-up reviewed test results, consulted with families, and coordinated the administration of rapid tests if necessary. We compared preimplementation and postimplementation cancellation rates in four procedural areas and found no significant difference in the cancellation or rescheduling rates (P = .89, 95% confidence interval = -4.29 to 3.09). The team-based intervention was associated with the preservation of low procedural cancellation rates by mitigating barriers to preprocedural testing.

Performance of STANDARD™ M10 SARS-CoV-2 Assay for the Diagnosis of COVID-19 from a Nasopharyngeal Swab.

The STANDARD™ M10 severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) assay (M10 assay) (SD Biosensor Inc., Suwon, Korea) is a rapid, fully-automated, cartridge-type molecular diagnostic assay that detects SARS-CoV-2 RNA using primers and probes for each target gene (ORF1ab gene, E gene). This study evaluated its performance by assessing its concordance with the approved SARS-CoV-2 real-time PCR assay. Tests were performed on 80 nasopharyngeal samples. The sensitivity and specificity of the M10 assay were 100%. The M10 assay effectively diagnosed SARS-CoV-2 infection, and it was comparable to the approved SARS-CoV-2 real-time PCR assay. It is a viable point-of-care test due to its short turnaround time.

Testing for coronarvirus disease 2019 before cardiac surgery-safe outcome of infected patients.

BACKGROUND: The aim was to analyze routine preoperative testing for coronavirus disease 2019 (COVID-19) performed to avoid infected cardiac surgical patients transmitting virus during the pandemic. METHODS: Every patient scheduled to undergo cardiac surgery from March 2020 through December 2021 had preoperative polymerase-chain-reaction (PCR) test for COVID-19 by nasopharynx swabs. Any history of COVID-19 was recorded. RESULTS: In 15 of 1870 patients (0.8%) with minimal or no airway symptoms unexpected positive PCR tests were detected, and surgery was deferred for two weeks. Totally 38 patients with negative tests had recovered without sequelae from previous COVID-19 a mean of 5 months before the operation. Sixteen patients (0.8%) developed airway symptoms within six weeks after the operation and had positive COVID-19 tests. Body Mass Index was higher and female gender, diabetes mellitus, chronic obstructive pulmonary disease and reduced left ventricular ejection fraction were more common in patients with than in those without COVID-19. Early postoperative outcomes did not differ significantly in patients with versus without COVID-19. CONCLUSIONS: An unexpected preoperative positive COVID-19 test was detected in less than one percent of patients admitted for cardiac surgery during the pandemic. These operations were deferred to avoid transmission of virus in the hospital. Additionally, one percent of patients were diagnosed with positive COVID-19 tests within six weeks after the operation. There was no outbreak of COVID-19 among hospital staff or patients. All patients with COVID-19 before the operation were operated on safely and postoperative outcomes did not differ significantly compared with COVID-19 negative patients.

Rapid Adaptation of Established High-Throughput Molecular Testing Infrastructure for Monkeypox Virus Detection.

Beginning in May 2022, a rising number of monkeypox cases were reported in non-monkeypox-endemic countries in the Northern Hemisphere. We adapted 2 published quantitative PCRs for use as a dual-target monkeypox virus test on widely used automated high-throughput PCR systems. We determined analytic performance by serial dilutions of monkeypox virus reference material, which we quantified by digital PCR. We found the lower limit of detection for the combined assays was 4.795 (95% CI 3.6-8.6) copies/mL. We compared clinical performance against a commercial manual orthopoxvirus research use only PCR kit by using clinical remnant swab samples. Our assay showed 100% positive (n = 11) and 100% negative (n = 56) agreement. Timely and scalable PCR tests are crucial for limiting further spread of monkeypox. The assay we provide streamlines high-throughput molecular testing for monkeypox virus on existing broadly established platforms used for SARS-CoV-2 diagnostic testing.

A MobileNet-V2 COVID-19: Multi-class Classification of the COVID-19 by Using CT/CXR Images

COVID-19 is one of the most dangerous virus that has been separated among the entire world. At the beginning stage of COVID-19 virus, the RT-PCR is the only testing method to detect the virus. Later, the medical professions analyze the different medical scanning approaches for the detecting of COVID-19. The computer tomography (CT) and chest X-ray (CXR) images are well-suited for detecting the virus. In image processing algorithms, there is lots of deep learning (DL) algorithms are employed for identifying the diseases which are affected in the human body. Hence, the paper presents the deep learning approach of COVID-19 detection by using the CT/CXR medical images. Here, the pre-trained MobileNetV2 is fully loaded with training dataset of COVID-19 images. Initially, the testing medical images are preprocessed by DnCNN algorithm to get the residual image of the corresponding medical image and forwarded to the feature extraction unit, and finally, the classifier finds the COVID-19, non-COVID-19, and pneumonia from the testing dataset. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.