The first case series of malaria overlapped with COVID-19 in Iran

Introduction: Although indigenous malaria cases have dramatically declined over the past decades, the COVID pandemic has continued to affect the programs designed to combat malaria, particularly in those countries where hydroxychloroquine and chloroquine have been used as medications for treating COVID. Two immigrants entered Iran illegally from neighboring countries (i.e., Afghanistan and Pakistan). This study mainly aimed to assess the effects of coronavirus disease (COVID-19) on these cases from all aspects (i.e., case-finding, diagnosis, and treatment). Case Presentation: Both cases presented with common symptoms such as fever and shaking chills. In addition, they had no sign of COVID-19, and their oxygen level and CT images were normal in some cases, but they were mistakenly treated as COVID-19 patients long after the onset of malaria symptoms. One of the suspected coronavirus cases was given chloroquine on a voluntary basis for one day, which may have been responsible for the possible relapse in vivax or resistance of plasmodium vivax to chloroquine and the recurrence of parasitemia in falciparum. Conclusions: The active case detection of malaria was affected by the COVID-19 pandemic. Case finding was dramatically decreased with the onset of coronavirus, thereby causing a spurt in malaria incidence. Moreover, the malaria treatment strategy was negatively affected by the misdiagnosis of COVID-19

On-Axis Brilliance and Power of In-Vacuum Undulators for the Advanced Photon Source.

A request for studying the spectral performance of in-vacuum undulators (IVUs) for the APS storage ring was recently put forward. In-vacuum undulators are prevalent at other synchrotron radiation facilities such as the ESRF and the Spring-8. However, they never made it into the arsenal of undulators at the APS because the brilliance tuning curves were sufficiently wide due to the fact that the undulator minimum gap could be set as low as 10.5 mm. For sector 3, which in the past used a narrow-gap vacuum chamber, the minimum undulator pole gap was allowed to be set as low as 8.5 mm, providing contiguous tuning curves between the first and third harmonic radiation for a 2.7-cm-period device. (Subsequently, the narrow-gap vacuum chamber was removed and replaced with a standard vacuum chamber, which allows a minimum gap of 10.5 mm.) For sector 4, which currently holds the only narrow-gap vacuum chamber at the APS, the minimum gap is 9.5 mm. In this sector, a permanent magnet hybrid undulator with SmCo magnets is used instead of NdFeB magnets because of their higher radiation resistance and their better protection against radiation-induced demagnetization of the magnets. In the realm of looking to the future, new concepts and technologies are being revisited. Most notable is the superconducting undulator (SCU) technology, which provides the ultimate highest magnetic field of any technology and design. The SCU program has been ongoing at the APS for several years and substantial progress has been made.3,4 However, the in-vacuum undulators may bridge some of the user demands, and it is therefore worthwhile revisiting their potential at the APS. In this work, the following were assumed or required: (1) the smallest in-vacuum beam-stay-clear gap is 5.0 mm, (2) a beam-liner of 2 x 0.060 mm, which increases the pole gap by the same amount, (3) both NdFeB and SmCo magnets shall be studied, even though SmCo magnets are the preferred choice for very small gaps, (4) compare the in-vacuum undulators with superconducting NbTi undulators with a wall thickness/space of 2 x 1.0 mm, and (5) all undulators will have an effective magnetic length of 2.4 m. Three short undulator period lengths were chosen somewhat arbitrary and studied. We will compare the performance of undulators with period lengths of 2.5 cm and 2.0 cm to one with a 1.6-cm period, which is the chosen period length of the first designed and tested short-length SCU for the APS. Additionally, we will make comparisons with the undulator A, which has a period length of 3.3 cm

Long-term impact of four different strategies for delivering an on-line curriculum about herbs and other dietary supplements

BACKGROUND: Previous research has shown that internet education can lead to short-term improvements in clinicians' knowledge, confidence and communication practices. We wished to better understand the duration of these improvements and whether different curriculum delivery strategies differed in affecting these improvements. METHODS: As previously described, we conducted a randomized control trial comparing four different strategies for delivering an e-curriculum about herbs and other dietary supplements (HDS) to clinicians. The four strategies were delivering the curriculum by: a) email over 10 weeks; b) email within one week; c) web-site over 10 weeks; d) web-site within one week. Participants were surveyed at baseline, immediately after the course and 6–10 months after completing the course (long-term). Long-term outcomes focused on clinicians' knowledge, confidence and communication practices. RESULTS: Of the 780 clinicians who completed the course, 385 (49%) completed the long-term survey. Completers and non-completers of the long-term survey had similar demographics and professional characteristics at baseline. There were statistically significant improvements from baseline to long-term follow-up in knowledge, confidence and communication practices; these improvements did not differ by curriculum delivery strategy. Knowledge scores improved from 67.7 ± 10.3 at baseline to 78.8 ± 12.3 at long-term follow-up (P < 0.001). Confidence scores improved from 53.7 ± 17.8 at baseline to 66.9 ± 12.0 at long term follow-up (P < 0.001); communication scores improved from 2.6 ± 1.9 at baseline to 3.6 ± 2.1 (P < 0.001) at long-term follow-up. CONCLUSION: This e- curriculum led to significant and sustained improvements in clinicians' expertise about HDS regardless of the delivery strategy. Future studies should compare the impact of required vs. elective courses and self-reported vs. objective measures of behavior change

Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure Current Status and Prospects for Further Research

More than 1 million heart failure hospitalizations occur annually, and congestion is the predominant cause. Rehospitalizations for recurrent congestion portend poor outcomes independently of age and renal function. Persistent congestion trumps serum creatinine increases in predicting adverse heart failure outcomes. No decongestive pharmacological therapy has reduced these harmful consequences. Simplified ultrafiltration devices permit fluid removal in lower-acuity hospital settings, but with conflicting results regarding safety and efficacy. Ultrafiltration performed at fixed rates after onset of therapy-induced increased serum creatinine was not superior to standard care and resulted in more complications. In contrast, compared with diuretic agents, some data suggest that adjustment of ultrafiltration rates to patients' vital signs and renal function may be associated with more effective decongestion and fewer heart failure events. Essential aspects of ultrafiltration remain poorly defined. Further research is urgently needed, given the burden of congestion and data suggesting sustained benefits of early and adjustable ultrafiltration. (C) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)