Analysis of Customer's Expectations and Satisfaction in the Zanjan Municipality Using Fuzzy Multi-Criteria Decision Making (FMCDM) Approach

Customer satisfaction is the most important step in the process of identifying customer expectations. Identify customer expectations ‎without referring to him and get his view, is impossible. In order to identify customer expectations, service suppliers are also using ‎statistical techniques, surveyed their customers. According to the studies, there is no appropriate framework for expectation model to ‎prioritize regions of organizations and make the favorable selection according to the organization’s policies and strategies. In this ‎research, a combination of fuzzy multiple criteria decision making is used for the optimal selection. The research method used in this ‎study is of descriptive and applied type, and field method is used to collect data. For Identifying customer expectations, data has ‎been collected from study population (customers of Zanjan municipality) is 303 people through random sampling method. To ranking ‎the dimensions of customer's expectations and make optimal selections of municipality zones, data has been collected from study ‎population (engineer contractor of the municipality) is 30 people. The data collection instrument was questionnaire and interview, which ‎had been valid. The Expert Choice, Web-based TOPSIS, SPSS and Excel software were used for calculations. It is interesting to ‎observe that the choices of the best municipality zone solely depend on the criterion having the maximum priority value. Based on ‎calculations on the stages of the proposed model, "municipality Zone 2" was selected as the optimal the region and had the highest rating ‎in response to customer expectations. Results show that the proposed model has a systematic fit with the defined procedures and known ‎inputs.â€

The Identification of Noun Modifiersʼ Type and Number in Persian Children’Writing (10-12).

The purpose to do the present research is the identification of the type and the number of noun modifiers in Persian students’ texts (students (10-12) in grades four, five and six) in which the number 9 area of Tehran was selected in purposive sampling and also 6 schools were selected by cluster random sampling. Then, the corpus of texts written by students in grades four, five and six was collected in these schools. In total, 9 classes in grade 4, 10 and 9 ones in grade 5 and 6 respectively were involved in this research and there were 889 students. According to Morgan table, 300 texts were randomly selected in which 2203 noun phrases were analyzed according to Dependency Grammar. Based on the findings, students (10-12) have produced noun postmodifiers (6/62%) by far more than noun premodifiers (2/45%) which indicates that the production of postmodifiers is much easier for the students in these grades and they have produced the genitive modifiers in eighth position (4/03%), attributive adjectives in seventh position (1/39%), in particular, numeral and superlative adjectives in third position (1/22%) respectively more than other positions. While the index in the sixth position (0/01%) has had the lowest average percentage. Students in grade 6 have had the highest average (12/44%), showing the older the students become, the more complex noun phrases they produce. The findings of this research along with identifying the amount of  syntactic complexity of the children’s noun phrases shows the view of their language enhancement

The effect of job-stress on patient-safety in hospitals affiliated to Alborz University of Medical Sciences, Iran

BACKGROUND: Patient-safety is one of the main pillars of healthcare. Given that nurses are the largest group associated with patients, so with safety harms, job-stress among then can reduce patient-safety in hospitals. The aim of this article was to investigate the effects of job-stress on patient-safety in hospitals affiliated to Alborz University of Medical Sciences, Karaj, Iran.METHODS: In this cross-sectional study, data gathering tools consisted of a reliable researcher-made job-stress questionnaire, and a patient-safety checklist. 320 nurses in hospitals affiliated to Alborz University of Medical Sciences, who were selected using simple randomized sampling method, completed the questionnaire, and the checklist was filled by the researcher. Data were analyzed at two levels of inferential and descriptive statistics.RESULTS: Job-stress and also patient-safety were at average levels in studied hospitals. Among the demographic factors, only the relationship between job-stress and marital status was statistically significant (P < 0.050). There were no significant relationships between different aspects of job-stress among nurses and patient-safety.CONCLUSION: According to average level of job-stress among studied nurses, the quality of offered services would decrease and patient-safety would become undermined, if no action take place to reduce the job-stress among them. Therefore, it is necessary to increase nurses’ physical, psychological, and social health to increase patient-safety

Radiation-induced breast angiosarcoma: report of two patients after accelerated partial breast irradiation (APBI) and review of the literature

BACKGROUND: Angiosarcoma may rarely complicate radiotherapy of breast cancer. This so-called radiation-induced angiosarcoma (RIAS) occurs in less than 0.3% of patients that underwent breast conservation surgeries, usually years after completion of radiotherapy. CASE PRESENTATION: we introduce two cases of invasive ductal carcinoma who underwent lumpectomy and accelerated partial breast irradiation (APBI) as an alternative protocol to whole breast irradiation (WBI). They received adjuvant partial breast radiotherapy on tumor cavity for a total dose of 38.5 Gy in 10 fractions in 5 days using 3D-external-beam RT. In both cases, RIAS occurred eight years after radiotherapy, in the sub-cicatricial area in one patient and outside the irradiated area in the other one. They both underwent radical surgery and chemotherapy was performed in one patient. DISCUSSION: The underlying mechanism for development of RIAS is not well known, but its incidence seems to be increasing. RIAS after partial breast irradiation is very rare and has been reported in two cases so far. As it may be suggested in case 2, it is still a matter of debate if the risk of radiation-induced sarcoma is radiation-dose dependent. Although mastectomy is considered as a standard treatment, choice of treatment should be made according to the patient’s specifications. CONCLUSION: There are very few studies in the literature that report RIAS after APBI. Present study is the only one reporting two cases after the external 3D technique APBI. Prognosis of RIAS remains poor. Only a careful evaluation in a multidisciplinary context can offer to the patients the best result in terms of local control and surviva

Gastrointestinal adverse effects of antiepileptic drugs in intractable epileptic patients

AbstractGastrointestinal (GI) discomforts are among the most common side effects of antiepileptic drugs (AEDs) that might lead to discontinuation or irregular consumption of the drugs. This study was conducted to evaluate the frequency of GI side effects of different AEDs in intractable epileptic patients treated with single or multiple drugs. GI discomfort of 100 epileptic patients (aged 35–76 years) treated with one or multiple AEDs was assessed. Seventy six patients (76%) were treated with two or more AEDs, and 24 (24%) were on monotherapy. The most common prescribed drug for monotherapy was carbamazepine and the most frequent combination was phenytoin and carbamazepine. Patients were suffering from different GI side effects including heartburn (34.6%), nausea (33.7%), constipation (26%), vomiting (22.1%), diarrhea (21.2%) and dysphagia (19.2%). Nausea and vomiting were significantly higher in patients receiving monotherapy with carbamazepine and valproic acid, respectively. When phenytoin, gabapentine, or valproic acid was added to the other AEDs, the risk of the occurrence of diarrhea, dysphagia, or heartburn was significantly increased, respectively. Addition of gabapentine to the other AEDs in multiple drug therapy was accompanied with the highest frequency of GI complications. This study indicated that GI side effects, which can affect drug absorption and utilization, were common in intractable epileptic patients with long-term AEDs treatment. This may influence the efficacy of the therapy with AEDs and enhance the probability of further attacks

Comparative Neurocognitive Functions of Schizophrenics and temporal lobe epileptic Patients

Introduction: Shared neuropathology hypothesis in schizophrenia and temporal lobe epilepsy has been introduced long term ago. Similar neuropathology leads to the analogous clinical features like neuropsychological features as an example. The aim of this study was to examine this hypothesis by the means of comparing neuropsychological functions in these two patient groups.Method: Present study consisted of 28 DSM_IV_TR schizophrenics and 29 patients with temporal lobe epilepsy recruited from Roozbeh, Razi and khatamolanbia hospital in Tehran by convenient sampling method. SCID in schizophrenic group and EEG, MRI in epileptic patients were taken in regard to diagnostic determination. Neuropsychological tests were taken later. Package of neuropsychological tests consisted of Modified Wisconsin Card Sorting Test, Stroop Color- Word Test, Logic Memory, Visual Reproduction and Digit Span subscales of Wechsler Memory Scale- Revised and Block Design, Vocabulary and Symbol Digit subscales of Wechsler Adult intelligence Scale- Revised.Result:  there was no significant difference in two groups of patients with respect to demographic and clinical (Age, Depression, premorbid function and duration) variables. Analysis of MANOVA was taken to compare two groups of patients in neuropsychological functions. The results revealed no significant differences between schizophrenics and temporal lobe epileptic patients except for Symbol Digit subscale that was significantly lower in schizophrenic group (p<0.05).Conclusion: the result of current study is consistent with shared neuropathology hypothesis in schizophrenia and temporal lobe epilepsy. Profile of neuropsychological functions in both groups was generalized and beyond temporal lobe. Keywords: schizophrenia, temporal lobe epilepsy, neuropsychological function

A new scheme of symmetric multilevel inverter with reduced number of circuit devices

In this paper, a sophisticated configuration for symmetric multilevel voltage source inverters is proposed. In multilevel inverters, the costs, circuit size so installation space, complexness of control scheme and reliability are directly depended to the amount of circuit devices required. The provided comparison study among proposed inverter, CHB and recently introduced converters, validates that the proposed inverter reduces the requirements for circuit devices, including power semi-conductor switches, IGBTs, diodes, gate driver circuits and DC voltage sources. The given simulation results confirms the feasibleness of the projected modular structure. Also, to approve the practicality of the proposed inverter, a prototype of the proposed topology has been implemented. Finally simulation and experimental results are compared with one another and therefore the provided comparison shows that the obtained results are in sensible agreements

Primary dural lymphoma: a comprehensive literature review and report of a case

Primary dural lymphoma (PDL) is a subtype of primary central nervous system (CNS) lymphoma (PCNSL) with only an extra-axial dural location. It accounts for less than 1% of all CNS lymphomas. PDL is a sporadic CNS tumor, and in the preoperative period, because of imaging characteristics, it is usually mimicking a meningioma. Usually, PDL is a low-grade B-cell lymphoma with a relatively good response to surgical resection with or without radiotherapy. Here we reviewed 102 case reports of PDL in the literature. Then, we present the case of our patient with PDL and explain the complexity of our treatment approach

Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review

(1) Background: Epilepsy is a frequent comorbidity in patients with brain tumors, in whom seizures are often drug-resistant. Current evidence suggests that excess of glutamatergic activity in the tumor microenvironment may favor epileptogenesis, but also tumor growth and invasiveness. The selective non-competitive -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist perampanel (PER) was demonstrated to be efficacious and well-tolerated in patients with focal seizures. Moreover, preclinical in vitro studies suggested a potential anti-tumor activity of this drug. In this systematic review, the clinical evidence on the efficacy and tolerability of PER in brain tumor-related epilepsy (BTRE) is summarized. (2) Methods: Five databases and two clinical trial registries were searched from inception to December 2022. (3) Results: Seven studies and six clinical trials were included. Sample size ranged from 8 to 36 patients, who received add-on PER (mean dosage from 4 to 7 mg/day) for BTRE. After a 6–12 month follow-up, the responder rate (% of patients achieving seizure freedom or reduction 50% of seizure frequency) ranged from 75% to 95%, with a seizure freedom rate of up to 94%. Regarding tolerability, 11–52% of patients experienced non-severe adverse effects (most frequent: dizziness, vertigo, anxiety, irritability). The retention rate ranged from 56% to 83%. However, only up to 12.5% of patients discontinued the drug because of the adverse events. (4) Conclusions: PER seems to be efficacious, safe, and well-tolerated in patients with BTRE. Further randomized studies should be conducted in more homogeneous and larger populations, also evaluating the effect of PER on tumor progression, overall survival, and progression-free survival

Description of Epidemiological Features, Symptoms and Mortality of the Patients with COVID-19 in Some Provinces of Iran

Background: Clinical manifestations of COVID-19 are different. There are some risk factors for COVID-19. This study aimed to describe the epidemiological features, symptoms and mortality of the patients with COVID-19 in Iran. Methods: This were a cohort study performed on 103,179 patients with COVID-19. The demographic and clinical data were collected in selected provinces. The required data of all patients was extracted from the COVID registry system and analyzed using STATA version 14 and Excel 2016. Results: The mean age was 52.40 years for men and 52.41 years for women. About 55.2% of the study population were male and 44.8% were female. Totally, 60.9% (5085) of deaths happened in men and 39.1% (3263) in women. The mean time from onset of symptoms to hospitalization in men and women were 3.47 and 3.48 days, respectively. The mean time from onset of symptoms to isolation was 2.81 days in men and was 2.87 days in women, from onset of symptoms to death was 9.29 and 9.54 days, respectively, from onset of symptoms to discharge was 7.47 and 7.39 days, and from hospitalization to death was 6.76 and 7.05 days. Cough and shortness of breath were the most common symptoms in the patients. Conclusion: According to the results, the overall mortality rate was higher in men than women. Women with cardiovascular disease and diabetes were more likely to die. The mean time from onset of symptoms to hospitalization, isolation, and discharge was similar in men and women