Patients view about healthcare service delivery is a neglected subject in many developing countries such as Lebanon. Patients are viewed as passive beneficiary of healthcare service with muted voices. However, the patients’ perceptions of service quality and satisfaction with healthcare services can assist management and policy makers in the design, implementation and evaluation of services which in turn assist to better improve and deliver qualitative healthcare to the populace. Thus, this study aims to contribute to the development of knowledge on patient satisfaction. More specifically, it attempts to distinctively identify the key healthcare dimensions that impact patient satisfaction with primary care services in Lebanon. The research is conducted at Mount Lebanon Clinic on a sample of 385 outpatients. Multiple regression analysis is used to test the hypotheses. The results of this research show a model which details relationships between influencing factors and patient satisfaction is proposed and validated in the Lebanese context. It is designed to view patient satisfaction more holistically and to provide guidelines for healthcare providers.
The aim of this study is to determine whether the preoperative measurement of tumor size, by imaging modalities, deviate from the postoperative pathological measurement in breast cancer.\n Material and methods: retrospective study done at King Fahad Hospital of University. For two years 2014-2015 all breast cancer patients included studied by reviewing US which was reported by two radiologists and gross size reports by five pathologists. The correlation of ultrasound, with pathology was studied. \nResults: 118 cases were collected from January 2014 to December 2015 with diagnosis of breast carcinoma. 36 patients were excluded from the study. Finally, a total of 82 were included in the analysis. Invasive ductal carcinoma (IDC) found in 57patients (69.5%), 44 patients (53.7%) underwent breast conserving surgeries. 46 patient (56.1%) found to be either over or underestimated by US or Pathology.\nConclusion: Despite the importance of accuracy of tumor size in management planning this study reflect marked discrepancy in sizes. More collaboration between radiologist and pathologist will yield accurate measurement which will impact positively on outcome.
Already in the 1980s, the World Health Organization (WHO) has postulated to analyze in all medical fields differences between the sexes. But until now there is a disturbing lack of scientifically based and meaningful data over the whole area of gender dentistry – for prevention as well as for treatment. The aim of this study was to evaluate the actual situation described as an IS-analysis of literature review on the topic of gender dentistry with the sub-themes periodontal disease and tooth decay in the leading medical databases (Medline, Embase, BIOSIS Previews, Your Journals@Ovid, The Cochrane Library). We discuss these on the basis of an evidence-based guideline. For periodontal diseases we found no clear trend. Some studies showed no gender difference, others showed a higher prevalence for women or a higher prevalence for men. At the juvenile periodontitis and the occurring bacteria of periodontitis there were conflicting results as well. No simple statement can be made with respect to tooth decay, too. Respective studies merely show age as an important item. Totally it has to be noted that the scientific validity of some studies is not without any doubt as they are conducted with a too low number of clinical trials. Several studies are more than 15 years old, therefor providing a serious gender specific treatment in dentistry, future studies must increasingly incorporate and intensively discuss gender specific aspects.
To complement the process of breaking walnut shells with mechanical approaches, a walnut shell-kernel separation device was designed. Stiffness at different positions of the walnut shell was analyzed by the theory of elastic mechanics, which contributed the critical force of instability of different positions. The internal force and deformation of the walnut shell upon extrusion were analyzed by the theory of thin shells. The results showed that the position at which the forces are concentrated is the point of fracture. The critical force of cracking and breakage at different positions of the walnut shell were reported. Based on the flexible-belt shearing extrusion breakage system, conditions for the walnut entering the extrusion space as well as the extruding-in angle (α0) and the extrusion angle (α) of the walnut during breakage were assessed theoretically and empirically. Results show that when 0°<α0≤44°, the walnut can enter the extrusion space. When the upper working belt (i.e., the extruding roller) is 23 mm away from the lower working belt, walnut shells crack when α is 20° and break when α is 15°. A mathematical model of extrusion force and shear force on walnut shells by upper and lower working belts was built theoretically. Conditions for crack extension after walnut shell breakage were analyzed and calculated by the fracture mechanics theory. The results demonstrated when the mean crack length is 20 mm, the critical external force for crack extension is 19.1 N.
One of the actual problems which we face in everyday life is communication. Non-verbal communication is very important for each of us. Still people do not know about the existence of the body language despite its importance in their life. Only by the end of twentieth century a new type of scientist-sociologist of nonverbals appeared. As an ornithologist enjoys watching the behavior of birds, a non-verbal person enjoys watching non-verbal signs and signals of communicating people. He watches them whenever individuals interact with each other. He studies behaviors of people, tries to learn more about his companions in order to learn more about himself and improve his relationships with others. It seems impossible that sociologists began studying the body language only at the beginning of 60s and the public became aware of it only in 1970.
Aristolochia lilloralis Parodi, an invasive species reported from various countries, has been found growing in open forest of Kailash Sacred Landscape under Pithoragarh district of Uttarakhand and reported here