The effect of gag reflex on cardiac sympatovagal tone

Objectives: Heart velocity may be influenced by gagging. The medulla oblongata receives the afferents of gag reflex. Neuronal pools of vomiting, salivation and cardiac parasympathetic fibers are very close in this area. So, their activities may be changed by spillover from each other. Using the heart rate variability (HRV) analysis, the effect of gagging on cardiac sympatovagal balance was studied. Methods: ECG was recorded from 9 healthy nonsmoker volunteer students for 10 minutes in the sitting position between 10 and 11 AM. Gagging was elicited by tactile stimulation of the posterior pharyngeal wall. At 1 kHz sampling rate, HRV was calculated. The mean of heart rate at low and high frequencies (LF: 0.04-0.15; HF: 0.15-0.4 Hz) were compared before and after the stimulus. Results: The mean of average heart rate, LF and HF in normalized units (nu) and the ratio of them (LF/HF) before and after the gagging were 89.9 ± 3 and 95.2 ± 3 bpm; 44.2 ± 5.8 and 21.2 ± 4; 31.1 ± 5.3 and 39.4 ± 3.8; and 1.7 ± 0.3 and 0.6 ± 0.2 respectively. Conclusion: Gagging increased heart velocity and had differential effect on two branches of cardiac autonomic nerves. The paradoxical relation between average heart rate and HRV indexes of sympatovagal tone may be due to unequal rate of change in autonomic fiber activities which is masked by 5 minutes interval averaging. © OMSB, 2012

Ageing and ankle pulse pressure

Background: Pulse pressure (PP) is a marker of arterial stiffness. Ageing of the arterial system is accompanied by atherosclerosis of coronary arteries and atherosclerosis of popliteal artery. However, severe impairment of the brachial artery is rare. This study investigates whether there is any significant inter-limb (brachial/ankle) PP difference. Methods: Blood pressure was measured in a group of young and a group of old non-smoking men; all were free from medication and disease with a mean age of 22 &#177; 1.3 and 59 &#177; 2 years respectively. The blood pressure was taken while they were in a supine position on three separate occasions. Lower limb pressure was measured by placing the cuff on the calf muscle. For auscultation of Korotkoff sounds the stethoscope was placed on the posterior surface of the internal malleolus. The mean of the second and third readings were rounded off and used for analysis. Results: Significant differences were found between brachial and ankle PP in both groups (p < 0.01). The ratio of brachial PP to ankle PP in the young men was greater than 1. In the old men it was less than 0.15. There was no significant difference between the brachial PP in the two groups, but on both sides the ankle PP was significantly greater in the old men (p < 0.01). Conclusions: With the ageing of the arterial system, raised PP is more prominent in the lower limb (e.g. ankle). Cuff measurement of blood pressure at this site may be a useful index of peripheral PP changes with ageing. (Cardiol J 2010; 17, 2: 163-165

Investigating the Influence of Penetration Length of Cut-off Wall on its Dynamic Interaction with Core and Foundation of Earth Dam

Seepage and flow of water in the soil is one of the most important issue and effective elements in designing embankment dams. One of the methods to control seepage in alluvial foundation of earth dams is to use a plastic concrete cutoff-wall. For better seepage control, the cutoff-wall extends inside the clayey core as the one of common method of connection of cut-off wall and the core. Due to the stiffness difference of the core material and cutoff-wall, and also due to geological situation, physical and mechanical properties of rock and foundation, interaction of core and foundation with cut-off wall in different static and dynamic load cases is very considerable. Failure of cut-off wall occurs in cut-off wall and core joint.  So the study of their interaction, especially during an earthquake is very important. Karkheh dam cut-off wall with an area of about 150000 m2 is chosen for this study. FLAC software has been used to study the effect of cutoff-wall penetration length variation, inside the clay core of Karkheh earth dam under dynamic loading.  In numerical analysis of Karkheh earth dam model, all construction stages and seepage through dam are modelled. The model is first calibrated according to the results obtained from the dam instrumentations. After calibrating, according to available seismic studies of region, a suitable acceleration was selected and applied to the model. In this research, in order to find the optimum length, the effect of 0, 5, 10, 15 and 20 meters penetration length of cut-off wall in aforementioned conditions has been investigated. The results of the numerical study showed that the horizontal displacement and the maximum shear strain in the cutoff-wall is occurred adjacent to the clay core and the interface of core and foundation is a critical point for the cut-off wall, and also the stress in cut off wall joint increases with the elongation of penetration depth of the wall

Pin-point effect determination using a rigorous approach

A new method for evaluating the pin-point effect of pile yarn of carpets before weaving has been introduced. The method has been initially accomplished by presenting a standard method for bundle preparation and consequently the pin-point index is presented by image analysis technique. To this end, yarns with different twists are heat set at various times and temperatures. Comparison of the results shows that increasing the twist, time and temperature positively contribute to the pin-point index. In the last section, an adaptive neuro fuzzy model (ANFIS) and an artificial neural network model (ANN) have been designed to predict the pin-point index of the heat set yarns based on training with the experimental data.  The input parameters are twist, time and temperature, and the output is the pin-point index. The results illustrate that the learning capability of the ANFIS model is superior and its generalization ability is slightly better than that of a standalone ANN model

Analyzing Islamic Architecture Visual Quality in Bushehr City; Case Study: Religious Space Kazeruni Barhah (Hosseiniye)

Islamic architecture can be studied from different aspects. This paper introduces a religious place in Bushehr city of Iran, a Bahrah or Hosseiniye that is used in especial religious ceremony and was built a century ago and after recent renovations is still in use and applicable. The research tries to quantify and analyze its visual quality as an important quality in the built environment with a tool called isovist in Syntax 2D software. In this study isovist indexes of six different spaces have been evaluated in this. The research shows interesting findings of spatial form and location and its visibility; for example it shows that spaces with circulation role have more visibility also spaces of the higher floor show higher visibility than the ground floor

Gendered Representations of Male and Female Social Actors in Iranian Educational Materials

This research investigates the representations of gendered social actors within the subversionary discourse of equal educational opportunities for males and females in Iranian English as a Foreign Language (EFL) books. Using critical discourse analysis (CDA) as the theoretical framework, the authors blend van Leeuwen’s (Texts and practices: Readings in critical discourse analysis, Routledge, London, 2003) ‘Social Actor Network Model’ and Sunderland’s (Gendered discourses, Palgrave Macmillan, Hampshire, 2004) ‘Gendered Discourses Model’ in order to examine the depictions of male and female social actors within this gendered discourse. The gendered discourse of equal opportunities was buttressed by such representations within a tight perspective in proportion to gender ideologies prevailing in Iran. Resorting to CDA, we can claim that resistance against such gendered discourse in Iranian EFL textbooks militates against such gender norms. These representations of male and female social actors in school books are indicative of an all-encompassing education, reinforcing that the discourse of equal opportunities is yet to be realized in the education system of Iran

Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models.

BACKGROUND: The post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements. METHODS: 11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy. FINDINGS: Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31-62%) and a 72% reduction in mortality (range 64-82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis. INTERPRETATION: Major reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End TB Strategy targets at country level. FUNDING: Bill and Melinda Gates Foundation

Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008

Background: In Zanzibar, the Ministry of Health and partners accelerated malaria control from September 2003 onwards. The impact of the scale-up of insecticide-treated nets (ITN), indoor-residual spraying (IRS) and artemisinin-combination therapy (ACT) combined on malaria burden was assessed at six out of seven in-patient health facilities. Methods. Numbers of outpatient and inpatient cases and deaths were compared between 2008 and the pre-intervention period 1999-2003. Reductions were estimated by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period. Results: In 2008, for all age groups combined, malaria deaths had fallen by an estimated 90% (95% confidence interval 55-98%)(p < 0.025), malaria in-patient cases by 78% (48-90%), and parasitologically- confirmed malaria out-patient cases by 99.5% (92-99.9%). Anaemia in-patient cases decreased by 87% (57-96%); anaemia deaths and out-patient cases declined without reaching statistical significance due to small numbers. Reductions were similar for children under-five and older ages. Among under-fives, the proportion of all-cause deaths due to malaria fell from 46% in 1999-2003 to 12% in 2008 (p < 0.01) and that for anaemia from 26% to 4% (p < 0.01). Cases and deaths due to other causes fluctuated or increased over 1999-2008, without consistent difference in the trend before and after 2003. Conclusions: Scaling-up effective malaria interventions reduced malaria-related burden at health facilities by over 75% within 5 years. In high-malaria settings, intensified malaria control can substantially contribute to reaching the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015

Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.

BACKGROUND: The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. METHODS: We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. FINDINGS: Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. INTERPRETATION: Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. FUNDING: Bill & Melinda Gates Foundation

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations