Malaria elimination in Iran, importance and challenges

Background: The aim of study is to assess the importance and challenges of Malaria elimination (ME) in Iran's health system. Material: Opinion of experts from Ministry of Health and Medical Education and the chancellors of medical universities affected by malaria were gathered using Focus Group Discussions and in­depth interviews. We asked them about the importance and main challenges of ME in Iran. Results: Main factors on importance of ME were: it's a struggle to reach to equity in the poorest regions of county, prevention of emerging disease in susceptible regions, lowering the cost of control and its effects on the region's socioeconomic condition. Main challenges were Iran's long border with malaria­endemic countries Pakistan and Afghanistan and illegal immigrants, underdevelopment in rural areas, system's insensitivity and diagnosis problem due to reduction of cases. Conclusion: Quantitative and holistic researches are needed for assessing the consequences of ME

Multiscale design of nonlinear materials using a shape optimization scheme based on an interface-enriched GFEM

Motivated by key advances in manufacturing techniques, the tailoring of materials with specific macroscopic properties has been the focus of active research in mechanical engineering and materials science over the past decade. The key challenge in this line of work is how to optimize the material microstructure to achieve a desired macroscopic constitutive response. The overwhelming majority of this type of inverse design work relies on topology optimization based, primarily, on linear theory. In this work, we develop and implement a method to design particulate composites at the mesoscale using a shape optimization scheme to minimize or maximize a nonlinear cost function at the macroscale while satisfying a set of constraints associated, for example, with the volume fraction of inclusions or with the manufacturing technique. The optimization method relies on three key ‘modules’: multiscale modeling, sensitivity analysis, and optimization. The multiscale modeling is based on a nonlinear finite element solver, which combines a classical homogenization scheme with a NURBS-based Interface-enriched Generalized Finite Element Method (NIGFEM) used to capture accurately and efficiently the displacement field in a heterogeneous material with a finite element discretization that does not conform to the material interfaces. Damage evolution is captured using a three-parameter isotropic damage model able to simulate a wide range of failure responses. The proposed gradient-based shape optimization scheme relies on the stationary nature of the non-conforming meshes used to discretize the periodic unit cell, thereby avoiding mesh distortion issues that plague conventional finite-element-based shape optimization studies. In the current approach, the finite element approximation space used in the NIGFEM is augmented with NURBS to allow for the accurate capture of the weak discontinuity present along complex, curvilinear material interfaces. NURBS are also used to parameterize the design geometry precisely and compactly by a small number of design variables. To compute the derivatives of the cost and constraint functions with respect to the design variables, we also formulate an analytic nonlinear sensitivity, which is simplified by the fact that only the enrichment control points on material interfaces move, appear or disappear during the shape optimization process. The derivations uncover subtle but important new terms involved in the sensitivity of shape functions and their spatial derivatives. Our analytic nonlinear shape sensitivity avoids the technical difficulties encountered in the finite difference or semi-analytical schemes when the boundary intersects an element very close to a node in a non-conforming mesh. In these situations, the boundary may move to another element during the design perturbation step, resulting in changes of the mesh topology, making the differentiation of the stiffness matrix and load vector problematic. We apply the NIGFEM shape optimization scheme to several 2D and 3D structural problems including some benchmark and application examples to demonstrate the performance and accuracy of the method. Based on the multiscale approach, we also design the microstructure of a periodic particulate composite to optimize the volume fraction and distribution of the inclusions for a desired macroscopic nonlinear stress-strain curve

Defining and detecting malaria epidemics in south-east Iran

<p>Abstract</p> <p>Background</p> <p>A lack of consensus on how to define malaria epidemics has impeded the evaluation of early detection systems. This study aimed to develop local definitions of malaria epidemics in a known malarious area of Iran, and to use that definition to evaluate the validity of several epidemic alert thresholds.</p> <p>Methods</p> <p>Epidemic definition variables generated from surveillance data were plotted against weekly malaria counts to assess which most accurately labelled aberrations. Various alert thresholds were then generated from weekly counts or log counts. Finally, the best epidemic definition was used to calculate and compare sensitivities, specificities, detection delays, and areas under ROC curves of the alert thresholds.</p> <p>Results</p> <p>The best epidemic definition used a minimum duration of four weeks and week-specific and overall smoothed geometric means plus 1.0 standard deviation. It defined 13 epidemics. A modified C-SUM alert of untransformed weekly counts using a threshold of mean + 0.25 SD had the highest combined sensitivity and specificity. Untransformed C-SUM alerts also had the highest area under the ROC curve.</p> <p>Conclusions</p> <p>Defining local malaria epidemics using objective criteria facilitated the evaluation of alert thresholds. This approach needs further study to refine epidemic definitions and prospectively evaluate epidemic alerts.</p

Knowledge of Dental Residents at Shahid Beheshti Dental School about COVID-19

Objectives After the onset of coronavirus disease-2019 (COVID-19) pandemic in 2019, it turned out to be one of the most important issues in public health, and the healthcare community must have adequate knowledge about it; therefore, this study was conducted to evaluate the knowledge level of dental residents at Shahid Beheshti Dental School about COVID-19. Methods The knowledge level of 104 dental residents at Shahid Beheshti Dental School about COVID-19 was evaluated with a standardized questionnaire that was developed, and its reliability and validity were confirmed. The questionnaire had 4 parts of (I) virology, basic information, and epidemiology, (II) clinical and oral manifestations, (III) prevention of virus transmission and vaccination, and (IV) diagnosis and treatment. The questionnaires were administered in both printed and online forms. Results The overall response rate was 72%. The mean number of correctly answered questions was 7.2 ± 2.6 out of 14. Correct answers were 44.5% in virology, basic information, and epidemiology, 49.2% in clinical and oral manifestations, 48,5% in prevention of virus and vaccination, and 69% in diagnosis and treatment. The knowledge level of dental residents was weak in 12%, average in 52%, and good in 36%. Conclusion The majority of dental residents had average knowledge about COVID-19. Considering the importance of adequate knowledge for proper diagnosis and management of COVID-19, it is suggested to arrange educational programs for dental residents’ knowledge enhancement

Outcomes of Health Care Reform Implementation in Slum Areas of Isfahan: a qualitative study

Background & Objectives: In slum areas, due to the economic, cultural and social reasons and how health services are delivered, the health status of people needs serious attention. Implementation of health reform plan in Iran led to increased attention to the health of slum area population. The present study was conducted to assess the outcomes of implementation of primary health care services reform in comprehensive health service centers at slum areas in Isfahan. Methods: This qualitative research with phenomenology approach was conducted in 2018. Study samples consisted of 21 experts of health deputy and health providers of comprehensive health services centers in Isfahan University of Medical Sciences selected using purposive and snowball sampling methods. Data gathering was done by semi-structure interview. Data analysis was done using content analysis and through the 10th version of MAXQD software. Results: The outcomes of health Reform Plan implementation in primary health care services provision, at Isfahan's slum area Health Services Centers were organized and classified in 6 main themes and 51 sub-themes. Main themes were promotion of health care availability, private sector participation, management, improvement of staff education and providing resources based on the needs and establishing electronic health records with 51 sub-themes. Conclusion: Feasibility of using public-private partnership models in building, operating, transferring, needs assessing, system evaluation and monitoring of the Comprehensive Health Service Center and compiling the required human resources chart can improve the outcomes of this plan. Key­words: Milestones, Health care reform, Primary health care, Private sector, Slum area Citation: Raeisi AR, Shaarbafchizadeh N, Aghdak P, Fouladi Z. Outcomes of Health Care Reform Implementation in Slum Areas of Isfahan: a qualitative study. Journal of Health Based Research 2019; 5(1): 81-100. [In Persian

Shape optimization of microvascular composites used in active cooling applications

Inspired by microchannels networks in biological systems, microvascular composites are being used for various applications including active cooling, autonomic healing, and sensing. The recent development of a manufacturing technique for microvascular composites based on a sacrificial fiber approach has enabled the creation of complex networks of microchannels embedded in composite parts [1]. Motivated by these recent improvements in manufacturing of microvascular composites, we study design of an actively cooled composite plate. We examine the impact of microchannels configuration on the thermal response of the microvascular composite. Here, the composite plate is subjected to a heat flux that causes a high surface temperature in the absence of the active cooling by microchannels. The objective of this study is to determine the optimal configuration of the microchannels to maximize the thermal efficiency of microchannels to keep the domain temperature below a critical temperature value. We present a new gradient-based Isogeometric Interface-enriched Generalized Finite Element Method (IIGFEM) [2–4] optimization scheme that allows for the accurate and efficient extraction of the sensitivity of objective functions and constraints on the design parameters that define the geometry of the microchannels. At the heart of the modeling effort, the IIGFEM allows for the very accurate and efficient capture of the thermal impact of the embedded microchannel network on the thermal field in the composite part. Because the microchannels diameters are typically much smaller than other characteristic dimensions of the problem, we model microchannels as line (or curve) sinks. The IIGFEM solver allows for the capture of curved and branched microchannels over a mesh that does not conform to the geometry of the microchannels. One of the key challenges associated with the conventional finite element-based shape optimization of microvascular composites is the large mesh distortion that often takes place during the optimization process, as the finite element mesh must conform to the evolving microstructural elements. This mesh distortion may affect the accuracy of the optimum solution. Because of the stationary nature of the nonconforming mesh used by the IIGFEM, the issue of mesh distortion disappears. In this study, we adopt an isogeometric IGFEM-based adjoint shape sensitivity approach, which is simplified by the fact that only the enrichment (interface) nodes move, appear or disappear during the shape optimization process. To demonstrate the performance of the method, a set of microstructural shape optimization problems for the design of microvascular composites are presented

Simulation of the microlevel damage evolution in polymer matrix composites

A 3D Isogeometric Interface-Enriched Generalized Finite Element Method (IIGFEM) is developed to analyze problems with complex, discontinuous gradient fields commonly observed in the structural analysis of heterogeneous materials including polymer matrix composites [1]. In the proposed approach, the mesh generation process is significantly simplified by utilizing simple structured meshes that do not conform to the complex microstructure of the heterogeneous media. Non-Uniform Rational B-Splines, commonly used in computer-aided design, are adopted in the IIGFEM to augment the finite element approximation space and capture the weak discontinuity present along material interfaces. The IIGFEM offers many advantages, such as the simplicity and accuracy of numerical integration, the straightforward implementation of essential boundary conditions, and the flexibility in the choice of the local solution refinement The ability to model complex material interfaces and the mesh independence are two of key features of the IIGFEM that enable it to tackle problems with evolving material response, such as computational study of damage in solids. Here, we utilize the IIGFEM scheme to study the impact of microstructural details on the initiation and evolution of the damage in polymer matrix composites. For this purpose, in this study, we incorporate a three-parameter isotropic damage model [2] into our IIGFEM solver to capture the fracture response of the matrix in a unidirectional composite layer. To bypass numerical issues associated with mesh bias, we use a viscous regularization scheme proposed by Simo and Ju [3]. The numerical stability of the proposed approach is studied and its advantages and limitations are discussed in detail. Finally, a number of numerical examples are presented to demonstrate the effect of RVE size and filler volume fraction on the damage behavior of fiber-reinforced polymer matrix composites. REFERENCES [1] Safdari, M., Najafi, A.R., Sottos, N.R., Geubelle, P.H. An Isogeometric Interface-Enriched Generalized Finite Element Method (IGFEM) for problems with complex discontinuous gradient field. Submitted (2014). [2] Matous, K., Kulkarni, M.G., Geubelle, P.H. Multiscale cohesive failure modeling of heterogeneous adhesives. Journal of the Mechanics and Physics of Solids. 2008, 56, 1511–1533. [3] Simo, J.C., Ju, J.W. Strain- and stress-based continuum damage models—ii. computational aspects. International Journal of Solids and Structures. 1987, 23(7), 841–869

Seasonal Abundance and Host-Feeding Patterns of Anopheline Vectors in Malaria Endemic Area of Iran

Seasonal abundance and tendency to feed on humans are important parameters to measure for effective control of malaria vectors. The objective of this study was to describe relation between feeding pattern, abundance, and resting behavior of four malaria vectors in southern Iran. This study was conducted in ten indicator villages (based on malaria incidence and entomological indices) in mountainous/hilly and plain regions situated south and southeastern Iran. Mosquito vectors were collected from indoor as well as outdoor shelters and the blood meals were examined by ELISA test. Over all 7654 female Anopheles spp. were captured, the most common species were Anopheles stephensi, An. culicifacies, An. fluviatilis, and An. d'thali. The overall human blood index was 37.50%, 19.83%, 16.4%, and 30.1% for An. fluviatilis, An. stephensi, An. culicifacies, and An. d'thali, respectively. In addition, An. fluviatilis fed on human blood during the entire year but the feeding behavior of An. stephensi and An. culicifacies varied according to seasons. Overall, the abundance of the female mosquito positive to human blood was 4.25% per human shelter versus 17.5% per animal shelter. This result indicates that the vectors had tendency to rest in animal shelters after feeding on human. Therefore, vector control measure should be planned based on such as feeding pattern, abundance, and resting behavior of these vectors in the area

An interface-enriched generalized finite-element method for efficient electromagnetic analysis of composite materials

An interface-enriched generalized FEM is presented for analyzing electromagnetic problems involving composite materials. To avoid of generating conformal meshes in highly inhomogeneous domains, enriched vector basis functions are introduced over the intersections of material interfaces and the nonconforming elements to capture the normal derivative discontinuity of the tangential field component. These enrichment functions are directly constructed from a linear combination of the vector basis functions of the subelements. Several numerical examples are presented to verify the algorithm with analytical solutions and demonstrate its h-refinement convergence rate. Finally, two illustrative examples, involving multiple microvascular channels and circular inclusions, are solved