Testing for Cryptococcosis at a Major Commercial Laboratory-United States, 2019-2021.

Background: Cryptococcosis is a serious opportunistic fungal disease, and the proportion of cases among patients with immunosuppressive conditions other than HIV or organ transplant has increased. Understanding laboratory testing patterns for cryptococcosis is useful for estimating its true burden and developing testing guidance. Methods: We identified cryptococcosis tests (cryptococcal antigen [CrAg], cryptococcal antibody, and fungal cultures) performed at a major national commercial laboratory ordered during March 1, 2019-October 1, 2021, and analyzed test results, patient and provider features, reasons for testing, geography, and temporal trends. Results: Among 29 180 serum CrAg tests, 4422 (15.2%) were positive, and among 10 724 cerebrospinal fluid (CSF) CrAg tests, 492 (4.6%) were positive. Frequent reasons for serum CrAg testing in nonhospital settings (10 882 tests) were HIV (44.6%) and cryptococcosis (17.0%); other underlying conditions were uncommonly listed (<10% total). Serum CrAg positivity declined from 25.6% in October 2019 to 11.3% in September 2021. The South had the highest positivity for serum CrAg tests (16.6%), CSF CrAg tests (4.7%), and fungal cultures (0.15%). Among 5009 cryptococcal antibody tests, 5 (0.1%) were positive. Conclusions: Few outpatient serum CrAg tests were performed for patients with immunocompromising conditions other than HIV, suggesting potential missed opportunities for early detection. Given the high positive predictive value of CrAg testing, research is needed to improve early diagnosis, particularly in patients without HIV. Conversely, the low yield of antibody testing suggests that it may be of low value. The decline in CrAg positivity during the COVID-19 pandemic warrants further investigation.

Harnessing Exaptation and Ecosystem Strategy for Accelerated Innovation: Lessons From The VentilatorChallengeUK

The COVID-19 crisis has underlined the need for accelerated innovation to rapidly help business solve social problems. These problems require access to capabilities and knowledge that no single organization or existing supply chain possesses. Drawing on the experience of the open innovation and rapid-scale-up achieved by the VentilatorChallengeUK to address a shortage of ventilators required by patients seriously ill with COVID-19, this article develops a framework for accelerated innovation and delivery that crosses traditional industry boundaries. It offers a series of important lessons for how open innovation, exaptation, and ecosystem strategies?backed by a set of enabling initiatives?can be used to solve multi-faceted social and business problems at speed.

De-Globalisation and Decoupling: Post-COVID-19 Myths versus Realities

According to a recent Korean study of re-shoring, just 68 companies have returned their production back to Korea since 2014. A supply chain relying solely on limited local capacity hampered by a local lockdown, by contrast, would be unable to rapidly increase production to meet demand that might rise by ten or even one hundred times almost overnight. [...]a GVC will be able to identify and access countries where local institutions and infrastructure enable production to be expanded more flexibly and rapidly. China's more flexible labour laws compared with Europe, for example, enabled companies such as medical equipment producer Zoncare to respond to a flood of inquiries from Spain to Saudi Arabia in late February 2020 by drawing on China's huge and flexible supply base and running its assembly lines twenty hours per day to increase its weekly output sixfold (Yu et al., 2020). [...]it already had relevant international networks, skilled supply chain managers, and experience that could be redeployed at short notice to produce COVID-19 test kits.