Detection of Cardiac Disarrhythmia with Patients Post-Haemodialysis in Dialysis Center of General Kirkuk Hospital

Background : Cardiovascular disease (CVD) is a most common complication and  cause of death in patients with end stage renal disease (ESRD). Arrhythmias are complications that are frequently observed in patients attending to hemodialysis varies between 17 to 76%. Increased QT intervals dispersion is predisposing to ventricular arrhythmias and sudden cardiac death.Objective : The main objective of the study is to detect the cardiac disarrhythmia with patients at post-hemodialysis  and  to assess the effect of hemodialysis (HD) on corrected QT (QTc) intervals and their dispersions (QTd) in chronic hemodialyzed patients.Methods: A descriptive study a purposive (non-probability) sample of (60) patients were undergoing hemodialysis was carried out at Kirkuk general hospital/ dialysis center, from December 2013 to 28 March  2014.  The study sample consisted of 60 patients undergoing hemodialysis (61.7% males and 38.3% females), whose mean age was 66.79±13.16 years. All of them underwent  electrocardiograms  performed after one dialysis session. On a second phase, ECG was performed pre –post  hemodialysis .12-leads standard ECG were recorded using a Mortara instrument 1246, (USA) electrocardiograph at paper speed of 25 mm/s and 10 mm/mV, and a blood specimen was drawn to measure plasma electrolytes pre –post a single hemodialysis session. Results were tested for normality and expressed as mean ± SD,. Comparisons were made using t test or Mann-Whitney test (electrolyte values).Results :Post-dialysis arrhythmia showed 20(33.3%) of participants are suffer from Sinus bradycardia and 15 (25%) of them are suffer from irregularity with possible premature atrial  contraction. The mean of pre and post dialysis R-R intervals was (780.11±90.75 ms pre-HD vs. 811.16±81.45 post-HD, respectively (p>0.05). The mean of corrected QT cmax intervals increased significantly from 383.11±11.95 msec pre-HD vs. 422.16±18.70  msec post-HD, (p<0.05). The mean of QTc dispersion increases from 47.56±9.85 ms pre-HD to 59.25±11.93 ms post-HD (p<0.05) respectively. The changes in serum potassium and calcium levels were related with QT interval prolongation. a statistical  high  significant difference of  serum Changes ( (Potassium, Calcium, and Urea) at pre-post hemodialysis  with mean± SD (5.09±0.70 vs 3.96±0.54 , 7.34±0.90 vs 7.72±0.60 , 59.88±9.50 vs 21.97±4.81 ) respectively .Conclusions: This study showed that QTcmax and QT dispersion, markers of risk for arrhythmias and sudden death, are elevated in hemodialysis patients, and rise pos-dialysis.QTc interval and dispersion increase in HD patients. Keywords: Chronic renal disease, Hemodialysis, QT interval, Arrhythmi

Using Agency Theory in Understanding Switching Behavior in B2B Service Industries “I”

Understanding switching behavior is a cornerstone in sustaining customer led marketing efforts especially in services which depend on long-term relationships with the customers and where the switching process is compound and costly for both the customer and the service provider. The issue of understanding the motives and barriers behind agency-brand switching behavior still needs further conceptual support and empirical investigation in service industries context, where the emphasis placed on investigating the actual switching motives without trying to conceptualize the issue, which if done will result in better understanding for the whole switching process. In this paper, the authors attempt to bridge this gap in the literature by examining the criterion validity of the switching behavior model using the agency theory, as the relation between the business company (principle) and an Advertising agency (the agent) could be described as agency relationship. Furthermore, this approach helps in supporting the efforts for retaining the business-to-business customers, strengthening the relationship with them, developing and adopting globally integrated customer led strategies in different countries, a trend which is expected to dominate the marketing field in the future due to the increasing role of the agency brand selection and switching in today’s world markets.Brand switching, agency theory, business to business marketing, service marketing, international advertising research

An Examination Of Global Market Segmentation Bases And Strategic Positioning Decisions

This paper examines the conceptual linkages between global segmentation strategy and brand positioning from the perspective of firms operating in increasingly globalized markets.  The manuscript suggests the combined use of macro/country-level as well as micro/behavioral-level bases of segmentation in order to leverage similar strategic positioning across global markets.  The analysis presented paves the way for embarking on future research to enrich the academic understanding and managerial practice of linking global segmentation with strategic positioning decisions

Optimization of Cutting Parameters for Surfaces Roughness of Medium Carbon Steel C-45 in CNC Turning Machining by Using Taguchi Method

الهدف من هذه الدراسة هو الحصول على افضل متغيرات الة الخراطة الرقمية (CNC) و التي تعطى انعم نهاية لقطع مصنوعة من الصلب المتوسط الكربوني باستخدام عدة قطع كربيديه لديها مقاومة عالية لتأكل و الاحتكاك في وجود سوائل التبريد, وذلك لان نعومة السطح النهائية هي من أهم الخصائص المطلوبة للمنتج النهائي. اعتمادا على دراسات أجريت حديثا فى العالم وجد ان عملية  الخراطة الصلدة  لها اكثر فائدة مقارنة بعملية التجليخ, نذكر منها نقص التكلفة في الوقت المستهلك في خراطة الاجزاء, فى هذه الدراسة, تأثير خشونة السطح على مقاومة الاحتكاك للخراطة الصلدة النهأية للمعدن المتوسط الكربون عمليا وتحليليا وكذلك البنية المجهرية تم التحقق منها.    وللحصول على أفضل نهاية سطح تم استخـدام  تصميم تاقوتشي (Taguchi method) لأفضل  خراطة عملية معتمدا على تصميم المضروب الكلى لتحديد ثلاثة متغيرات مختلفة و مستويات باستخدام المصفوفات الثمانية, و تسع تجارب  تم  اجرائهاعمليا.  تم اختيار ثلاث متغيرات وهى (معدل التغذية، سرعة القطع، عمق القطـع )  كانت مهمة, تم اختبار متغيرات القطع على النحو التالي: معدل التغذية (0.075, 0.10, 0.125 مم/لفة) سرعة القطع (166.24, 180.70,  197.32 ملم/دقيقة ) عمق القطع (2.0  ,2.5 , 3.0مم ) هذه المتغيرات اختيرت كما هو مطلوب من شركة ساندفك لتصنيع العدة(SANDVIC Tool Manufacturing Company  ). عمليات الخراطة العملية التي انجزت  تم قياس خشونة السطح للقطع التي دُرست باستخـدام (MINITAB Statistical Software) و ذلك لحساب مؤشر (S/N) وكذلك تحليل التباين (ANOVA)، حيث تم الحصول على أفضل مستويات لأفضل متغيرات قطع و مدى تأثيرهـا على خشونة  السطح , وكذلك متغيرات تجربة خشونة السطح كانت بمعدل تغدية (0.075 مم/لفة) وسرعة القطع (180.70ملم/دقيقة) وبعمق قطع (3.0 مم) و هذه تم الحصول عليها فى التجربة رقم خمسة (5).  لتأكيد التجربة والحصول على المستوى الامثل لعملية التغيرات و التى اجريت لتحديد تـأثير كفاءة طريقة تاقوشى كأداة لقياس خشونة السطح.The objective of this study is to optimize the Computer Numerical Control machine (CNC) turning parameters that gives the fine surface finish for the parts that made of medium carbon steel C45 using carbide cutting tool (coated insert cemented carbide) which have high resistance of deflection, wear and fraction on CNC turning operation with coolant. The surface finish quality is one of the most specified requirements in the machining process. To obtain the optimal surface finish, the Taguchi method used for optimization of the turning experiments based on a full factorial design, to determine three different parameters and levels by using orthogonal arrays, 9 experiments were obtained. Choice of three parameters (feed rate, cutting speed and depth of cut) were important, the cutting parameters were selected as follow: Feed rate (0.075, 0.100, 0.125mm), cutting speed (166.24, 180.70, 197.32 mm/min), depth of cut (0.5, 0.75, 1.0 mm) these parameters were chosen according to SANDVIC Tool Manufacturing Company. The series of turning experiments were performed to measure the surface roughness. The MINITAB Statistical Software was used to calculate the signal-to-noise ratio (S/N), and analysis of the variance (ANOVA), the best optimal levels and the effect of the process parameters on surface roughness were obtained. The parameters for experiment surface roughness were the feed (0.075mm/rev), cutting speed (180.70 mm/min), depth of cut (3.0mm) and that conducted in experiment number five (5). A conformation of experiment to obtained optimal levels of process parameters was carried out in order to demonstrate the effectiveness and efficiency of the employed Taguchi method as a tool to measure surface roughness. &nbsp

Quantum simulation of quantum mechanical system with spatial noncommutativity

Quantum simulation has become a promising avenue of research that allows one to simulate and gain insight into the models of High Energy Physics whose experimental realizations are either complicated or inaccessible with current technology. We demonstrate the quantum simulation of such a model, a quantum mechanical system with spatial noncommutativity, which is inspired by the works in Noncommutative Geometry and Noncommutative Field theory for a universal quantum computer. We use the novel group theoretical formalism to map the Hamiltonian of such a noncommutative quantum system into the ordinary quantum mechanical Hamiltonian and then carry out the quantum simulation using the Trotter-Suzuki product formula. Furthermore, we distinguish the impact of the noncommutativity parameter on the quantum simulation, especially on the Trotter error, and point out how its sizable value affects the simulation.Comment: Discussion on entanglement entropy and noisy simulation added, accepted versio

Synergistic Factors Affecting Catalytic Performance of Fe(II) Phthalocyanine @ Titania-Pillared Bentonite Nanocomposites in Styrene Production

The hybrid nanocatalytic system under study consisted of iron (II) phthalocyanine complex (FePc) of 0.5 – ~10 wt % loading immobilized in the bentonite interlayers modified by pillaring with titania nanoparticles (88 nm). Various interactions facing FePc complex were discussed through the changes in different characteristics assessed by adopting XRD, FTIR, ICP-EDX, TGA-DrTGA, TEM, N2 adsorption-desorption and H2-chemisorption techniques. Intercalated FePc molecules could evolve excessive silanol and aluminol sites through interaction with various clay-interlayer sites and titania pillar. By applying this FePc @ Ti-PILB nanocomposite in oxidative dehydrogenation of ethyl benzene, synergistic combination of factors influencing selective production of styrene confirmed the optimum turnover frequency with maximum selectivity to styrene at 3.4 wt % FePc loading. Below this loading, redox pair factor linked with dispersion and orientation mode of FePc was predominating. In higher loaded samples of considerable silanol sites, clay acid-base pair balance became prevailing

LINEARNO PROGRAMIRANJE KAO ALAT ZA PROJEKTIRANJE SIROVINSKE SMJESE U TVORNICI CEMENTA

This study uses linear programming to develop a methodology for selecting the best raw material mix in an ASCOM cement plant in Egypt. In cement factories, this type adheres to Egyptian chemical composition criteria for raw feed (e.g. 82.5% calcium carbonate, 14.08% silica, 2.5% alumina and 0.92% iron oxide). Furthermore, the model is bound by industry-specific characteristics (e.g. lime saturation factor, silica modulus, alumina modulus and loss of ignition). The results reveal that the model is able to accurately reproduce the mixing of high-quality feed with varying constituent percentages. It is also capable of determining the combining limitations of each ingredient. Furthermore, it demonstrates optimality for additive sourcing short-term planning and capping limestone quality to meet changeable component combinations. Additionally, improving the raw mix reduces limestone feed quality from 51 to 50.6%, resulting in the inclusion of extra limestone reserves.Studija prikazuje metodu linearnoga programiranja uporabljenu sa svrhom odabira najbolje sirovinske smjese u tvornici cementa ASCOM (Egipat). Takva smjesa poštuje egipatske standarde kemijskoga sastava sirovine (npr. 82,5 % kalcijeva karbonata, 14,08 % silikata, 2,5 % aluminijeva oksida, 0,92 % željeznoga oksida). Također, model je uvjetovan industrijskim standardima (npr. faktorom zasićenja vapnom, silikatnim i aluminatnim modulom te gubitkom (oksida) žarenjem). Modelom se mogla točno izračunati visokokvalitetna mješavina različitih (postotnih) komponenti te je dokazan kao optimalan za brz izračun raznih aditiva i postizanje najveće kvalitete vapnenačke sirovine uz doziranje ostalih komponenti. Time je udjel vapnenca bilo moguće smanjiti na 50,6 – 51 %, što je otvorilo put eksploataciji dodatnih rezervi te sirovine

Fistules perilymphatiques post-traumatiques a propos de 13 cas

Introduction : La fistule péri-lymphatique (fPL) post-traumatique réalise une communication anormale entre le compartiment liquidien périlymphatique et l’oreille moyenne. Son diagnostic est souvent difficile du fait du tableau clinique parfois incomplet. L’imagerie est indispensable afin d’étayer le diagnostic. Le traitement repose sur la chirurgie.Patients et méthode : : il s’agit d’une étude rétrospective à propos de 13 patients colligés sur une période de 13 ans (1996-2008). un examen ORL complet, une audiométrie et une imagerie (tomodensitométrie des rochers) ont été réalisés dans tous les cas. Tous les patients ont bénéficié d’un traitement médical et ont été opérés sous anesthésie générale. Le contrôle ultérieur était clinique, audiométrique et radiologique avec un recul moyen de 22 mois.Résultats :L’âge moyen était de 29 ans (20-47 ans) et le sex-ratio 3,33. Les signes fonctionnels étaient essentiellement représentés par l’hypoacousie dans 12 cas (92,3%), les vertiges dans 11 cas (84,6%) et les acouphènes dans 4 cas (30,8%). L’écoulement d’un liquide eau de roche par l’oreille a été rapporté par 2 patients (15,4%). L’examen clinique trouvait un nystagmus spontané battant du côté controlatéral au traumatisme chez un seul patient, et un signe de la fistule positif chez 2 patients (15,4%). A l’audiométrie, 9 patients (69,3%) avaient une surdité de perception ou mixte dont 6 cas de cophose. une surdité de transmission a été objectivée dans 3 cas. un patient avait une audition subnormale. La TdM des rochers a montré une fracture extra-labyrinthique dans 5 cas (38,5%) et une fracture trans-labyrinthique ou mixte dans 6 cas (46,2%). un pneumolabyrinthe a été constaté chez 5 patients (38,5%). une exploration chirurgicale a été indiquée chez tous les patients. En per-opératoire, une fPL a été mise en évidence dans tous les cas. Le siège de la fistule était au niveau du promontoire et/ou au niveau des fenêtres. un colmatage de la fistule a été réalisé dans tous les cas. Les matériaux utilisés étaient essentiellement de l’aponévrose temporale superficielle, du périchondre tragal et de la graisse. En post-opératoire, les vertiges se sont améliorés chez  patients parmi les 11 vertigineux (81,8%). L’audition était améliorée chez 2 patients parmi les 9 ayant une surdité de perception ou mixte (18,2%).Conclusion : La fistule périlymphatique post-traumatique est de diagnostic difficile. Celui-ci est étayé par un faisceau d’arguments cliniques et paracliniques et n’est confirmé qu’en per-opératoire. L’indication d’une exploration chirurgicale et son délai dépendent essentiellement de la symptomatologie clinique et de son évolution dans le temps.Mots clés : fistule périlymphatique, traumatisme, vertige, surdité, tomodensitométrie, chirurgieObjective : Post-traumatic perilymphatic fistula (PLf) realises an abnormal communication between the perilymphatic fluid compartment and the middle ear. its diagnosis is often difficult because the clinical presentation is sometimes incomplete. imaging is essential in order to support the diagnosis. Treatment is based on surgery.Patients and methods : We carry a retrospective study about 13 patients collected over a period of 13 years (1996- 2008). A complete ENT examination, audiometry and imaging (petrous CT scan) were performed in all cases. All patients received medical treatment and were operated under general anaesthesia. Subsequent control was clinical, radiological and audiometric with a mean period of 22 months.Mean age was 29 years (20-47 years) and sex ratio 3.33. Symptoms were mainly hearing loss in 12 cases (92.3%), vertigo in 11 cases (84.6%) and tinnitus in 4 cases (30.8%). flow of liquid from the ear was reported by 2 patients (15.4%). Clinical examination showed spontaneous nystagmus beating to the contralateral side of the trauma in one patient, and a positive sign of the fistula in 2 patients (15.4%). At audiometry, 9 patients (69.3%) had sensorineural or mixed deafness, of which 6 cases of cophosis. Transmission deafness was found in 3 cases. One patient had a subnormal hearing. Petrous CT scan showed extra-labyrinthic fracture in 5 cases (38.5%) and trans-labyrinthic or mixed fracture in 6 cases (46.2%). A pneumolabyrinth was found in 5 patients (38.5%). Surgical exploration was indicated in all patients. PLf was found in all cases. The localization of the fistula was at the promontory and / or at the windows. Blockage of the fistula was achieved in all cases. Materials used were essentially superficial temporal fascia, tragal perichondrium and fat. Postoperatively, vertigo improved in 9 patients among 11 (81.8%). Hearing was improved in 2 patients among the 9 having sensorineural or mixed deafness (18.2%).Conclusion: TPost-traumatic perilymphatic fistula trauma is difficult to diagnose. This is supported by a beam of clinical and paraclinical arguments, and is confirmed intraoperatively. The indication for surgical exploration and its delay depend mainly on clinical symptomatology and its evolution over time.Keywords : perilymphatic fistula, trauma, vertigo, deafness, CT scan, surger

Fistules perilymphatiques post-traumatiques

Introduction : La fistule péri-lymphatique (FPL) post-traumatique réalise une communication anormale entre le compartiment liquidien périlymphatique et l’oreille moyenne. Son diagnostic est souvent difficile du fait du tableau clinique parfois incomplet. L’imagerie est indispensable afin d’étayer le diagnostic. Le traitement repose sur la chirurgie.Matériel et méthodes : Il s’agit d’une étude rétrospective à propos de 13 patients colligés sur une période de 13 ans (1996-2008). Un examen ORL complet, une audiométrie et une imagerie (tomodensitométrie des rochers) ont été réalisés dans tous les cas. Tous les patients ont bénéficié d’un traitement médical et ont été opérés sous anesthésie générale. Le contrôle ultérieur était clinique, audiométrique et radiologique avec un recul moyen de 22 mois.Résultats : L’âge moyen était de 29 ans (20-47 ans) et le sex-ratio 3,33. Les signes fonctionnels étaient essentiellement représentés par l’hypoacousie dans 12 cas (92,3%), les vertiges dans 11 cas (84,6%) et les acouphènes dans 4 cas (30,8%). L’écoulement d’un liquide eau de roche par l’oreille a été rapporté par 2 patients (15,4%). L’examen clinique trouvait un nystagmus spontané battant du côté controlatéral au traumatisme chez un seul patient, et un signe de la fistule positif chez 2 patients (15,4%). A l’audiométrie, 9 patients (69,3%) avaient une surdité de perception ou mixte dont 6 cas de cophose. Une surdité de transmission a été objectivée dans 3 cas. Un patient avait une audition subnormale. La TDM des rochers a montré une fracture extra-labyrinthique dans 5 cas (38,5%) et une fracture trans-labyrinthique ou mixte dans 6 cas (46,2%). Un pneumolabyrinthe a été constaté chez 5 patients (38,5%). Une exploration chirurgicale a été indiquée chez tous les patients. En per-opératoire, une FPL a été mise en évidence dans tous les cas. Le siège de la fistule était au niveau du promontoire et/ou au niveau des fenêtres. Un colmatage de la fistule a été réalisé dans tous les cas. Les matériaux utilisés étaient essentiellement de l’aponévrose temporale superficielle, du périchondre tragal et de la graisse. En post-opératoire, les vertiges se sont améliorés chez 9 patients parmi les 11 vertigineux (81,8%). L’audition était améliorée chez 2 patients parmi les 9 ayant une surdité de perception ou mixte (18,2%).Conclusion : La fistule périlymphatique post-traumatique est de diagnostic difficile. Celui-ci est étayé par un faisceau d’arguments cliniques et paracliniques et n’est confirmé qu’en per-opératoire. L’indication d’une exploration chirurgicale et son délai dépendent essentiellement de la symptomatologie clinique et de son évolution dans le temps.Mots-clés : fistule périlymphatique, traumatisme, vertige, surdité, tomodensitométrie, chirurgieIntroduction: Post-traumatic perilymphatic fistula (PLF) realises an abnormal communication between the perilymphatic fluid compartment and the middle ear. Its diagnosis is often difficult because the clinical presentation is sometimes incomplete. Imaging is essential in order to support the diagnosis. Treatment is based on surgery.Materials and Methods: We carry a retrospective study about 13 patients collected over a period of 13 years (1996-2008). A complete ENT examination, audiometry and imaging (petrous CT scan) were performed in all cases. All patients received medical treatment and were operated under general anaesthesia. Subsequent control was clinical, radiological and audiometric with a mean period of 22 months.Results: Mean age was 29 years (20-47 years) and sex ratio 3.33. Symptoms were mainly hearing loss in 12 cases (92.3%), vertigo in 11 cases (84.6%) and tinnitus in 4 cases (30.8%). Flow of liquid from the ear was reported by 2 patients (15.4%). Clinical examination showed spontaneous nystagmus beating to the contralateral side of the trauma in one patient, and a positive sign of the fistula in 2 patients (15.4%). At audiometry, 9 patients (69.3%) had sensorineural or mixed deafness, of which 6 cases of cophosis. Transmission deafness was found in 3 cases. One patient had a subnormal hearing. Petrous CT scan showed extra-labyrinthic fracture in 5 cases (38.5%) and trans-labyrinthic or mixed fracture in 6 cases (46.2%). A pneumolabyrinth was found in 5 patients (38.5%). Surgical exploration was indicated in all patients. PLF was found in all cases. The localization of the fistula was at the promontory and / or at the windows. Blockage of the fistula was achieved in all cases. Materials used were essentially superficial temporal fascia, tragal perichondrium and fat. Postoperatively, vertigo improved in 9 patients among 11 (81.8%). Hearing was improved in 2 patients among the 9 having sensorineural or mixed deafness (18.2%).Conclusion: Post-traumatic perilymphatic fistula trauma is difficult to diagnose. This is supported by a beam of clinical and paraclinical arguments, and is confirmed intraoperatively. The indication for surgical exploration and its delay depend mainly on clinical symptomatology and its evolution over time.Keywords: perilymphatic fistula, trauma, vertigo, deafness, CT scan, surger

How Does The Fasting of Ramadan Affect Breast Milk Constituents?

Background: Breast-feeding of infants is associated with their better biological, psychological and intellectual development. However, many factors affect the volume and composition of human milk such as stage of lactation and maternal diet. Many breast-feeding Muslim mothers fast the lunar month of Ramadan. The effects of fasting on milk constituents have not been previously studied in Sudan. Therefore, we aimed to investigate the variations between milk constituents during fasting and non-fasting periods among a group of Sudanese women.Materials and Methods: Twenty four healthy breast-feeding mothers volunteered to participate in this cross-sectional study. Each mother provided 100 ml of breast milk during fasting and again 2 weeks after end of the fasting month of Ramadan. Milk was properly stored and analyzed for the various constituents, using the appropriate laboratory methods. The main constituents analyzed were: ash, protein, lactose, iron and electrolytes.Results: The age range of lactating women was between 18 and 38 years, mean (+SD) 28.8 (± 5.15 years). Most mothers 17 (70.8%) were house-wives. Analysis of breast milk during fasting and non-fasting periods showed that: lactose, protein, sodium, potassium, calcium and phosphate were significantly decreased in the fasting breast milk compared with the non-fasting milk (p=0.01), while total soluble solid, moisture, ash and iron constituents had not significantly changed during fasting.Conclusion: Fasting of Ramdan significantly affects proteins, carbohydrates and electrolytes in breast milk.Keywords: breast-feeding, milk constituents, Ramadan, fasting