Concealed Malfunction of The Temporary Pacemaker

The 12-lead ECG shows sequential atrial and ventricular pacing (Figure 1A). A tracing, obtained simultaneously during pacemaker interrogation, disclosed pacemaker functioning as VDD mode (Figure 1B). The careful examination of this pacemaker tracing showed that there is a pacing stimulus before each P wave (compatible with DDD mode). This paradox can only be explained by displacement of the temporary pacing lead to right atrium and right atrial stimulation by temporary pacemaker. In this setting, each temporary pacemaker-induced atrial depolarization is tracked by the right atrial lead of the permanent pacemaker as intrinsic P wave. Fluoroscopic study confirmed this explanation (Figure 2). The displaced temporary pacing lead was seen near the lateral right atrial wall. Temporary pacemaker lead had been inserted before replacement of permanent pacemaker

Infra-His Block in a Normal Heart

A 55 year old man with history of palpitation was referred for electrophysiologic study. Baseline ECG, physical examination and transthoracic echocardiographic study were normal. Electrophysiologic study revealed normal AH and HV intervals. Pacing of right atrium with a cycle length of 300 msec showed 2:1 AV block. AH interval was 252 msec and the block was infra-his (Figure 1). With continual of right atrial pacing, one to one AV conduction with increasing AH interval to 282 msec and QRS widening (LBBB pattern) were being observed. HV intervals during 2:1 block and during 1:1 AV conduction were normal. What is the mechanism? Is it an abnormal finding in this patient

Prioritizing social determinants of health in East Azerbaijan: a qualitative research

Background: In order to improve health-centered decision making and planning to reduce inequalities in health, it is important to identify, classify, and prioritize social determinants of health. This study aimed to identify and rank three major social determinants of health in East Azerbaijan. Methods: This research was conducted using a qualitative approach in grounded theory. Through purposeful sampling, 40 key informants from East Azerbaijan, North West of Iran, were selected and in-depth interviews were performed. The collected data was analyzed with a three-step coding method including open, axial, and selective coding using Corbin and Strauss’s systemic approach. Also, Interpretive Structural Modeling and “Matrice d'Impacts Croisés Multiplication Appliquée à un Classement” (MICMAC) analysis were used to identify and rank social determinants of health in East Azerbaijan. Results: Of the 40 participants, 27 (68%) were male and 13 (32%) were female. The mean age was 39.28± 12.46 years. 63% had a doctoral degree. According to the result of MICMAC analysis, social harm, social capital, and good governance were identified as three major social determinants of health in East Azerbaijan province. Conclusion: Social determinants of health have a significant and crucial role in human welfare and by identifying and prioritizing social determinants of health at a local level and/or national level, the first step can be taken toward social welfare

Medindo a satisfação dos moradores do município de Mehregan, em Mashhad, na perspectiva da habitação sustentável

Demographic developments in Mashhad and surrounding rural areas which are now considered urban break points It is well established that these areas have become centers of attraction for low-income immigrants who intend to migrate to Mashhad, as well as low-income urban strata that have previously lived in Mashhad. Since all four types of worn-out urban textures, including urban heritage, non-urban, marginal and rural urban textures, are the middle and lower decay habitats, "The 5000 unit project of Mehregan Town of Mashhad" has played an important role in the physical and functional organization of these tissues and responding to the needs of the poor. In view of the above, and several years after the project was inaugurated, the superstructure and infrastructure problems of the project are the subject of research in this research. The research method in this study was descriptive-analytical and applied. According to the number of households in the city that formed the statistical population of the study, and based on Cochran's formula, the sample population was 366 persons. Also, Delphi method has distributed 32 questionnaires to expert experts. Descriptive and inferential statistical analysis of completed questionnaires and experts has been done with the help of nonparametric and parametric statistical methods. The results of field surveys showed that the observed frequency of low-satisfaction residents was 222 and above all, so it is safe to say that 95% of respondents are not satisfied with their residence in Mehregan town. It is believed that the residential units constructed in Mehregan town of Mashhad have poor compliance with the standards and standards of sustainable housing.Desenvolvimentos demográficos em Mashhad e áreas rurais circunvizinhas que agora são consideradas pontos de ruptura urbana Está bem estabelecido que essas áreas se tornaram centros de atração para imigrantes de baixa renda que pretendem migrar para Mashhad, bem como estratos urbanos de baixa renda que anteriormente morava em Mashhad. Como todos os quatro tipos de texturas urbanas desgastadas, incluindo herança urbana, texturas urbanas não urbanas, marginais e rurais, são habitats de decadência média e baixa, "O projeto da unidade de 5000 unidades da cidade de Mehregan, Mashhad" desempenhou um papel importante. a organização física e funcional desses tecidos e a resposta às necessidades dos pobres. Tendo em vista o exposto, e vários anos após a inauguração do projeto, os problemas de superestrutura e infraestrutura do projeto são objeto de pesquisa nesta pesquisa. O método de pesquisa neste estudo foi descritivo-analítico e aplicado. De acordo com o número de domicílios da cidade que formaram a população estatística do estudo, e com base na fórmula de Cochran, a população da amostra era de 366 pessoas. Além disso, o método Delphi distribuiu 32 questionários para especialistas. A análise estatística descritiva e inferencial dos questionários e especialistas preenchidos foi realizada com a ajuda de métodos estatísticos não paramétricos e paramétricos. Os resultados de pesquisas de campo mostraram que a frequência observada de residentes de baixa satisfação era 222 e, acima de tudo, portanto, é seguro dizer que 95% dos entrevistados não estão satisfeitos com sua residência na cidade de Mehregan. Acredita-se que as unidades residenciais construídas na cidade de Mashhad, em Mehregan, não cumpram com os padrões e padrões de habitação sustentável

Effect of cold temperature on morphological development and quality characteristics of some population of Festuca arundinaceae Schreb

Con el objeto de evaluar el efecto de la temperatura baja sobre las características fenológicas de la festuca alta (Festuca arundinaceae) se recolectaron semillas de cultivares Bejnord, Esfahan, Brojen, Kamiran, Mashhad en bancos de germoplasma. Estas fueron sembradas en recipientes con temperaturas fluctuantes de 20 ± 5°C durante el día y de 5 - 12°C durante la noche. Posteriormente el semillero de 15 días de edad se cultivo a una temperatura base de 4 °C durante 30 días. Los materos fueron retornados a condiciones normales de invernadero y de campo hasta su etapa de floración. En la etapa de floración, las características morfológicas incluyeron: altura de planta, longitud de pedúnculo, longitud de panícula, número de panículas y longitud de la hoja bandera, peso fresco y seco y los pesos de la semilla, características de calidad como la digestibilidad de materia seca (DMD), proteína cruda (CP), carbohidratos solubles en agua (WSC), fibra detergente ácida (ADF) y cenizas totales, se registraron. Los resultados mostraron que las poblaciones de los cvs. Mashhad y Esfahan presentaron valores superiores para altura de la planta, longitud del pedúnculo, longitud de la panícula, peso de la semilla, peso fresco y seco conrespecto a otras poblaciones. Exceptuando la población Esfahan, las otras cuatro poblaciones fueron evaluadas por su buen valor nutritivo debido al alto contenido de carbohidrato soluble en agua. Los resultados también mostraron que los días grados crecimiento (GDC) de aquellas poblaciones que estaban sujetas a temperatura fría, presentaron menor estado de floración que el tratamiento control. Se concluyó que la temperatura fría no presentó efecto alguno sobre los desarrollos vegetativos, particularmente sobre la etapa de floración, pero redujo las fechas de floración en la etapa generativa

Shortening of ventriculoatrial interval after ablation of an accessory pathway

A 21-year old man with history of 8 year palpitation was referred for electrophysiologic study and possible radiofrequency ablation. Physical examination and transthoracic echocardiographic study did not disclose any abnormality. Baseline ECG showed normal sinus rhythm with normal PR and QRS intervals and no evidence of preexcitation. Antiarrhythmic drugs (propranolol and verapamil) were discontinued two days before the procedure. Baseline intervals in sinus rhythm were as follows: sinus cycle length=690 msec, AH=74 msec, HV=37 msec, QRS=90 msec, PR=133 msec. The minimal pacing cycle length maintaining 1:1 antegrade conduction (AVWP) was 320 msec and the minimal pacing cycle length maintaining 1:1 retrograde conduction (VAWP) was 400 msec. Single extrastimulus testing in the right atrium and the right ventricular apex leaded to a sustained narrow complex tachycardia. The arrhythmia was a short PR- long RP tachycardia with following characteristics: cycle length=376 msec, AH=141 msec, HV=42 msec, VA=200 msec, HA (HRA) =236 msec, HA (His) =243 msec and eccentric atrial activation during the arrhythmia (Figure 1). The arrhythmia was easily reproducible with stable hemodynamic

Un estudio de los cambios en el conocimiento y creencias de docentes, después de un taller con software educativo matemático, analizado mediante el método Fuzzy

In this paper, the effect of holding a math training workshop using GeoGebra software has been studied on the changes on teachers' knowledge and beliefs . The selected sample is 40 male and female teachers in Iran. Before and after the intervention were administered a pre and post questionnaire with two components: TPACK knowledge and teachers’ beliefs. Fuzzy logic and Fuzzy TOPSIS methods were used to analyze the data. The results of this method showed a significant difference between the results before and after the workshop.El estudio contempla el efecto de un taller de matemáticas con GeoGebra sobre los cambios en el conocimiento y las creencias de los docentes. La muestra seleccionada considera 40 docentes en Irán. Se administró un cuestionario, antes y después de la intervención, enfocado en dos componentes: el TPACK y las creencias. Los datos se analizaron aplicando herramientas del método Fuzzy mediante el cual se evidencia una diferencia significativa entre los resultados antes y después del taller

Effectiveness of Care for Child Development Program on the Sensitivity and Responsiveness Skills of Mothers

Abstract Objectives The Present study aimed to analyze the Impact of “Care for Child Development" program on the sensitivity and responsiveness skills of mothers of children who are at risk of developmental delay. Materials & Methods  This study is a quasi-experimental research planned in pretest-posttest with experimental and control groups. The statistical population included all mothers with children at risk of developmental delay in Tabriz. 50 mothers were selected through purposive sampling. Then, they were randomly divided into two groups of 25 (one experimental group and one control group). The experimental group received training about the program of “Care for child Development “ in 4 group session, while the control group did not receive the same training . The social-emotional assessment/evaluation measure family profile (SEAM TM  family profile)  and maternal caregiving quality scale were the research measurement tools. The obtained data were evaluated by analysis of covariance (ANCOVA) and independent t-test using SPSS software version 20. Results There was a significant difference between the experimental and control groups in maternal caregiving quality and responsiveness, provision of appropriate activities, predictable programs, and provision of play environment and safe home (P <0.05). Conclusions  The results showed that the ‘care for child development’ program has positive effect on sensitivity and responsiveness skills of mothers of at risk children and could be considered and applied as a practical plan in national health policies