• Asian Pacific Journal of Cancer Prevention
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• v.17 no.5
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• pp.2679-2681
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• 2016

Background: Gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN) are relatively rare tumors, not equally distributed in gastro-intestinal system. In 2010, a revised version of the WHO classification of GEP-NENs was published. This study reports for the first time the distribution and characteristics of GEP-NEN in a Lebanese population. Materials and Methods: This descriptive retrospective study concerns all the digestive neuroendocrine tumors with their characteristics diagnosed in $H\hat{o}tel$ Dieu de France in Beirut, Lebanon from 2001 to 2012, all the pathology reports being reanalyzed according to the latest WHO 2010 classification. The characteristics and features of GEP-NEN analyzed in this study were age, gender, grade and site. Results: A total of 89 GEP-NENs were diagnosed, representing 28.2% of all neuroendocrine tumors. The mean age of GEP-NEN patients was 58.7 years and the M/F sex ratio was 1.2. The primary localization was as follows: 21.3%(19) pancreatic, 18% (16) gastric, 15.7% (14) duodenal, 11.2% (10) appendix, 10.1% (9) intestinal, 10.1% (9) colorectal (7.9% colonic and 2.2% rectal), 5.6% (4) hepatic, 2.2% (2) ampulla, 1.1% (1) esophageal and 7.9%(5) NOS digestive (metastatic with unknown primary). Of the 89 patients with GEP-NEN, 56.2% (50) were diagnosed as grade I, 11.2% (10) as grade II, 20.2% (18) as grade III and 12.4% (11) were considered as mixed adeno-neuroendocrine carcinomas (MANEC). Conclusions: This study, one of the rare examples based on the 2010 WHO classification of neuroendocrine tumors in the literature, indicates that in the Lebanese population, all duodenal and appendicular tumors are G1 and the majority of MANEC tumors are gastric and pancreatic tumors. Moreover, more duodenal tumors and fewer rectal tumors were encountered in our study compared to European reports.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.1
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• pp.363-365
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• 2015

Background: Kidney cancer is the third most frequent urologic cancer in Lebanon after prostate and bladder cancer, accounting for 1.5% of all diagnosed cancers. In this paper, we report the histologic characteristics and distribution of kidney cancer, never described in Lebanon or the Middle East. Materials and Methods: Pathology results of operated kidney cancer were collected during a two year period (2010-2011) from two different Lebanese hospitals (Hotel-Dieu de France University Hospital and Saint Joseph Hospital). A total of 124 reports were reviewed and analyzed according to WHO classification of 2009. Results: The 124 patients diagnosed with kidney cancer had a median age of 62.4 [18-86], 75% being men and 25% women. Some 71 % of the lesions were renal cell carcinoma (RCC), 25.8% had a urothelial histology, 1.6% were lymphomas and 1.6% were metastases to the kidney. Patients having RCC had a median age of 60.3 [18-85], 77.3% were men and 22.7% women. Of the RCCs, 59.1% were clear cell carcinoma, 22.7% papillary, 11.4% chromophobic, 3.4% rom the collecting ducts of Bellini and 3.4% were not otherwise classified. Conclusions: Histological distribution of Lebanese kidney cancer seems unusual when compared to the literature. The percentage of urothelial renal pelvis tumors is strikingly high. Moreover, clear cell carcinoma accounts for only 59.1% of RCCS in contrast to the 75% described elsewhere, while papillary carcinoma represents more than 22.7% compared to 10%.

• The Journal of Asian Finance, Economics and Business
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• v.9 no.2
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• pp.93-102
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• 2022

The goal of this study was to see how big data analytics (BDA) affected external audit procedures in the Middle East. The measurement model and structural model of this investigation were evaluated using PLS-SEM (3.3.3). The study sample members were (361) auditors who work in auditing companies in Kuwait, Saudi Arabia, the United Arab Emirates, Jordan, Bahrain, Egypt, Lebanon, and Iraq. A questionnaire was chosen to the study sample members electronically, and the study sample members were (5093) auditors who work in auditing companies in Kuwait, Saudi Arabia, the United Arab Emirates, Jordan, Bahrain, Egypt, Lebanon, and Iraq. To choose the sample, the researchers used a stratified random sampling procedure. The findings show that BDA has an impact on audit procedures at all phases of the auditing process, where it contributes to information delivery that helps auditors understand the client's internal and external environments, which in turn influences the choice to accept the audit assignment. Furthermore, by providing essential information, BDA enables auditors to simply run analytical procedures, estimate client risks, and understand and evaluate the internal control system. As a result, auditors must develop their abilities in the BDA field, as it adds to the creation of additional value for both auditors and their clients.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.21
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• pp.9471-9473
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• 2014

Background: Since 2002, from October till December of each year, the Lebanese Ministry of Public Health conducts a mammogram based breast cancer screening campaign in the whole country for women over 40 years of age. These mammograms are performed free of charge in governmental hospitals or for reduced fees in private hospitals. The aim of this study is to analyze the direct impact of this campaign on cancer detection and subsequent treatment. Materials and Methods: Radiologic records of women screened with a mammogram during the campaign period from October till December 2012 at Saint Joseph Hospital, Baouchrieh, Beirut, were reviewed. Results of mammograms were reported using the ACR score. Women with ACR score ${\geq}4$ were tracked and investigated. Results: 900 screening mammograms were performed; median age was 55.2 years (range:31-81 years). Some 826 (91.8%) had an ACR score of ${\leq}2$; 66 (7.3%) an ACR =3 and only 8 (0.89%) an ACR=4. Thus, less than 1% (8/900) of all screened women were considered at high risk and needed a close follow-up. Among these 8 women, 4 underwent surgery for an early breast cancer, one had synchronous metastatic breast cancer and two were lost to follow-up. Conclusions: To coclude, Among 900-screened women for BC, less than 1 % (8 out of 900) were at high risk of hiding a BC (ACR=4), half of them benefited from early therapy (4 women out of 900) and one was a false positive. Larger studies on national level should be accomplished to have a complete data on breast cancer screening in Lebanon. The results of these studies can affect the Lebanese health policy regarding BC.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.14
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• pp.6081-6087
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• 2015

Purpose: This study aimed to investigate the incidence and mortality of breast cancer, and its relationship with human development index (HDI) and its components in Asia in 2012. Materials and Methods: This study was an ecologic study in Asia for assessment of the correlation between age-specific incidence rate (ASIR) and age-specific mortality rate (ASMR) with HDI and its details that include: life expectancy at birth, mean years of schooling and gross national income (GNI) per capita. Data about SIR and SMR for every Asian country for the year 2012 were obtained from the global cancer project. We used a bivariate method for assessment of the correlation between SIR and SMR and HDI and its individual components. Statistical significance was assumed if P<0.05. All reported P-values are two-sided. Statistical analyses were performed using SPSS (Version 15.0, SPSS Inc.). Results: In 2012, 639,824 cases of breast cancer were recorded in Asian countries. Countries with the highest standardized incidence rate (ASIR) (per 100,000) were Israel (80.5), Lebanon (78.7), Armenia (74.1) and the highest standard mortality rate (ASMR) was observed in Pakistan (25.2), Armenia (24.2), and Lebanon (24). There was a positive correlation between the ASIR of breast cancer and HDI (r = 0.556, p <0.001), whereas there was a negative correlation between the ASMR of breast cancer and HDI (r = -0.051). Conclusions: Breast cancer incidence in countries with higher development is greater, while mortality is greatest in countries with less development. There was a positive and significant relationship between the ASIR of breast cancer and HDI and its components. Also there was a negative but non significant relationship between the ASMR of breast cancer and HDI.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.2329-2336
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• 2016

Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.

• Nutrition Research and Practice
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• v.8 no.1
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• pp.103-111
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• 2014

This study aims to determine the effect of a trained dedicated dietitian on clinical outcomes among Lebanese hemodialysis (HD) patients: and thus demonstrate a viable developing country model. This paper describes the study protocol and baseline data. The study was a multicenter randomized controlled trial with parallel-group design involving 12 HD units: assigned to cluster A (n = 6) or B (n = 6). A total of 570 patients met the inclusion criteria. Patients in cluster A were randomly assigned as per dialysis shift to the following: Dedicated Dietitian (DD) (n = 133) and Existing Practice (EP) (n = 138) protocols. Cluster B patients (n = 299) received Trained Hospital Dietitian (THD) protocol. Dietitians of the DD and THD groups were trained by the research team on Kidney Disease Outcomes Quality Initiative nutrition guidelines. DD protocol included: individualized nutrition education for 2 hours/month/HD patient for 6 months focusing on renal osteodystrophy and using the Trans-theoretical theory for behavioral change. EP protocol included nutrition education given to patients by hospital dietitians who were blinded to the study. The THD protocol included nutrition education to patients given by hospital dietitian as per the training received but within hospital responsibilities, with no set educational protocol or tools. Baseline data revealed that 40% of patients were hyperphosphatemics (> 5.5 mg/dl) with low dietary adherence and knowledge of dietary P restriction in addition to inadequate daily protein intake ($58.86%{\pm}33.87%$ of needs) yet adequate dietary P intake ($795.52{\pm}366.94$ mg/day). Quality of life (QOL) ranged from 48-75% of full health. Baseline differences between the 3 groups revealed significant differences in serum P, malnutrition status, adherence to diet and P chelators and in 2 factors of the QOL: physical and social functioning. The data show room for improvement in the nutritional status of the patients. The NEMO trial may be able to demonstrate a better nutritional management of HD patients.

• Journal of Arbitration Studies
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• v.32 no.2
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• pp.3-30
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• 2022

On 27 October the Supreme Court of UK handed down its much anticipated decision in Kabab-Ji SAL (Lebanon) v Kout Food Group (Kuwait) [2021] UKSC 48. The issues for the Supreme Court to decide were as follows: (1) which law governed the validity of the arbitration agreement; (2) if English law applied, whether, as a matter of English law, there was any real prospect that a court might find that KFG became a party to the arbitration agreement, and (3) whether, procedurally, the Court of Appeal was correct in giving summary judgment refusing recognition and enforcement the award, or whether there should have been a full rehearing of whether there was a valid and binding arbitration agreement for the purposes of the New York Convention and the AA 1996 (the 'procedural' issue) The decision in Kabab-Ji provides further reassuring clarity on how the governing law of the arbitration agreement is to be determined under English law where the governing law is not expressly stated in the arbitration agreement itself. The Supreme Court's reasoning is consistent with its earlier decision on the same issue, albeit in the context of enforcement pursuant to the New York Convention, rather than considering the arbitration agreement before an award is rendered. This paper presents some implications of Kabab-Ji case. Also, it seeks to provide a meaningful discussion and theories on the arbitration system in Korea.

• Safety and Health at Work
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• v.13 no.2
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• pp.155-162
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• 2022

Background: Workers are exposed to several risks in academic laboratories due to the presence of potentially hazardous substances. The main objective of this study was to assess the prevalence of accident occurrence and associated risk factors among laboratory workers at the scientific laboratories of the public university in Lebanon and the impact of safety measures training and availability. Methods: In this observational study, a survey was conducted for one year in scientific laboratories at faculties of the public university. Results: Among the participants (N = 220), 45.0% have had accidents; the main cause was exposure to chemicals (73.7%) and more specifically by inhalation (45.4%). Females (85.9%) were more exposed to accidents than males. Laboratory workers with a master's degree, a full-time schedule, and more than ten years of experience were significantly more exposed to accidents (p < 0.05). A significant association was found between accident occurrence and training on management of hazardous products (p = 0.044), risks related to workplace (p = 0.030), eyewash and emergency shower (p < 0.001), first aid (p = 0.012), and facial protection availability (p = 0.019). In spite of the lack of safety culture and efficient training on laboratory safety, participants have shown a very good perception regarding safety measures to be applied in case of work accidents. Conclusion: Based on our findings, the prevalence of accident occurrence is elevated among lab workers at the public university. The impact of regular training on laboratory safety preventive measures is of great importance to ensure the efficiency of occupational health and safety in scientific laboratories.

• Journal of the Korean Society of Tobacco Science
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• v.32 no.2
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• pp.63-69
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• 2010

In the chemical, mineral and electronics, mechanically stirred tanks are widely used for complex liquid mixing processes. The paper present results from a computational fluid dynamics (CFD) model for the mixing tank in casing process. We used CFD software, FLUENT(Fluent, Inc, Lebanon, NH, version 6.2). A species transport model was used to model the problem. The flow patterns in a mixing tank, 1.6 m in diameter and 2.0 m in height, were studied using CFD. Numerical analysis results show that improved mixing tank was reduced low speed flow region and turbulent region in internal flow of mixing tank.