Importance of Clinical Suspicion in Rapid Diagnostic Test Negativity in Malaria: Two Case Reports

Introduction: Malaria is a life-threatening disease caused by infection with Plasmodium parasites. Rapid diagnostic tests (RDTs) have been used for the diagnosis of malaria without special equipment by unskilled personnel over the last 15 years. The treatment should only be given after the clinical diagnosis confirmed by RDT or microscopy. RDTs' specificity and sensitivity have been reported as >95% by the World Health Organization - Foundation for Initiative New Diagnostics (WHO-FIND). Case report: A 30-years-old male and a 23-years-old female presented to our emergency department with fever and history of a visit to a malaria-endemic country. Plasmodium trophozoites were seen in the blood smear samples via light microscopy. However, RDTs were negative. The patients were treated according to their pathogens. Conclusion: Rarely, RDT might result in a false negative in the diagnosis of malaria. People travelling to endemic areas should be closely monitored. Emergency department physicians should not neglect microscopy which is the gold standard for diagnosis of malaria

Rectangular ring lasers based on total reflection mirrors and three waveguide couplers

Novel rectangular ring lasers containing active and passive sections are fabricated and characterized. The rectangular laser cavity is formed using four low-loss total internal reflection (TIR) mirrors and an output coupler made out of passive three coupled waveguides. The fabrication process is exactly the same as for other active and passive devices except for one deep etch step for TIR mirror fabrication. Two different lasers having active section lengths of 250 and 350 mu m and total cavity lengths of 580 and 780 pm are fabricated. For both devices, lasing thresholds of 38 mA are obtained at room temperature and under continuous-wave operation. Lasing is predominantly single-mode with a sidemode suppression ratio better than 20 dB. The power loss of a single TIR mirror is also determined to be about 0.5 dB. Such low-loss TIR mirrors enabled lasers with very small footprints

Total internal reflection mirror-based InGaAsP ring resonators integrated with optical amplifiers

Novel ring resonators combining very small multimode interference (MMI) couplers, low loss total internal reflection (TIR) mirrors, and a semiconductor optical amplifier in InGaAsP material system are reported for the first time. The MMI length of 113 /spl mu/m is among the shortest reported. Average TIR mirror loss is about 1.1 dB per mirror. The material platform and fabrication process used are the same used for other active and passive devices except for a deep etch step. Hence, such resonators are easily integrated with other active and passive devices. A free spectral range of approximately 2 nm is observed near 1568 nm along with an on-off ratio of 14 dB, a full-width at half-maximum of about 0.3 nm, a finesse of more than 6, and a Q-factor of more than 4900

Multimode-interference-coupled ring resonators based on total-internal-reflection mirrors

We investigate the properties of a multimode-interference (MMI) coupled ring cavity resonator with total-internal-reflection (TIR) mirrors and a semiconductor optical amplifier (SOA) in an InGaAsP material system. The TIR mirrors were fabricated by the self-aligned process with a loss of about 1.4 dB per mirror. The resulting free spectral range (FSR) was approximately 0.8 nin (97 GHz) near 1569 rim. The on-off ratio and the full width at half maximum (FWHM) were 8 dB and 0.152 nm, respectively, corresponding to a finesse of 5.2 and a Q factor of 10,322. Hence, such resonators can be directly integrated with other devices making possible the fabrication of compact and highly functional photonic integrated circuits

Integrating patient management, reflective practice, and ethical decision-making in an emergency medicine intern boot camp

Background: Integration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns’ patient management skills, ethical decision-making, and reflection skills. Methods: A multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group’s performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students’ performances, and common achievements and mistakes of students. Results: 133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill. Conclusion: The multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context