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Background Nonspecific neck pain (NSNP) is a well-established global burden affecting. It is also a common problem in Pakistan. The burden of neck pain is also increasing day by day due to poor work ergonomics, and increased use of computers and mobiles after the pandemic. An individual’s poor posture is often associated with forward head posture (FHP). Limited evidence is available about the effects of neck stabilization (NSE) and dynamic exercises (NDE) for nonspecific neck pain particularly in patients with FHP. This aimed to compare the effects of NSE versus NDE among patients having NSNP with FHP in reducing pain, disability, forward head posture and improving neck range of motion. Methods It is a single-blinded randomized clinical trial with 60 patients aged 18–40 years, with moderate intensity NSNP for > 3 weeks and < 6 months along with FHP with a moderate disability on neck disability index (NDI) randomly assigned to the treatment groups. Group 1 was doing NSE and group 2 was doing NDE. Transcutaneous Electical Nerve Stimulation, cold packs, and stretching exercises were given to both groups. A total of 9 sessions (3 sessions/ week) were given to participants. NDI questionnaire, Visual analogue scale (VAS), goniometry, and plumb line measurement tool were used as baseline and assessment at the end of 3rd week. The data was analyzed on SPSS version 21. Descriptive analysis was performed. Independent t-test was used for between group comparison and paired t-test used for within group comparison. A p-value less than 0.05 was considered statistically significant. Results After treatment within-group analysis of both NSE and NDE showed significant ( p  < 0.001) improvement in pain on VAS, all ROMs of the neck including flexion, extension, left and right lateral flexion and left rotation, plumb line and NDI score with very large effect size. However, between-group analysis showed non-significant differences ( p  > 0.05) for post-treatment mean VAS, neck ROM, NDI and plumb line measurement. Conclusion Between NSE and NDE, no one is more beneficial than another. Both are equally effective in alleviating pain, increasing ROM, decreasing functional disability, and improving forward head posture in patients with NSNP. Trial Registration Registered trial at ClinicalTrials.gov Identifier: NCT05298631, 28/03/2022, prospectively registered.

This empirical investigation examines the mediating mechanisms through which unethical leadership influences employee work deviant behavior in the healthcare sector, specifically focusing on psychological empowerment and performance attitudes as potential mediating variables. Furthermore, the research explores the moderating role of financial job dependency in the relationship between unethical leadership and employee work deviant behavior. Utilizing a systematic stratified sampling methodology, data were collected from 384 manager-employee dyads within healthcare organizations in developing countries. The results demonstrate that both psychological empowerment and performance attitudes serve as significant mediating mechanisms in the relationship between unethical leadership and work deviant behavior. Additionally, the findings reveal that financial job dependency moderates the relationship between unethical leadership and psychological empowerment, although no significant moderating effect was observed in the relationship between unethical leadership and employee workplace behaviors. These findings contribute to the existing literature on organizational behavior and healthcare management while offering practical implications for healthcare administrators seeking to mitigate workplace deviance. The results provide empirically-grounded insights that can inform the development of targeted interventions and management strategies within healthcare organizations.

ABSTRACT Introduction: Abnormal Implantation of the Placenta in uterine walls is the condition known as Morbidly Adherent Placenta. It includes Placenta accreta, increta and percreta. It is mostly reported after history of placental previa and C-section. The irreversible damages from Abnormal Placentation that includes morbidity and mortality in women can be prevented by a holistic approach of treatment. Objective: To determine the frequency of hysterectomy in morbidly adherent placenta in post-cesarean section patients. Methodology: A Hospital based descriptive cross-sectional study of 8 months, from September 2019 to April 2020 was carried out at the Obstetrics and Gynecology department. A total of 210 participants were selected for the study. Non probability consecutive sampling technique was used for data collection. Results: The Frequency of Hysterectomy in morbidly adherent placenta in post Cesarean section women was reported 166 (79.04%), out of the remaining 44 (20.96%) patients the Triple P was reported in 21 (10%) patients and B-Lynch done in 15 (7.14%) patients and 8 (3.8%) were reported with Balloon Tamponade.   Conclusion: The frequency of hysterectomy in MAP is high. Attention is required to be given to conservative methods to protect fertility. 

Background: Adequate amniotic fluid is vital for fetal growth, with reduced levels, especially borderline oligohydramnios posing potential risks despite often being asymptomatic. Borderline oligohydramnios, defined as an AFI of 5.1-8 cm, lacks clear management guidelines and is frequently idiopathic. Objective: To study maternal morbidity in the form of operative delivery and fetal morbidity in terms of APGAR score at 5 min, birth weight of neonate, admission in NICU, in patients with borderline oligohydramnios. Study type, settings and duration: This descriptive study was done at Islamabad Medical Complex Hospital, Islamabad from August 2021 to July 2022. Methodology: A total of 551 Patients delivered in obstetrical unit during the study period were included in this study detailed history and examination were done. All standardized investigations were performed. Borderline oligohydramnios was confirmed by measuring AFI (amniotic fluid index) by radiologist. Results: Out of total 551 cases incidence of borderline oligohydramnios was 121 (22%). Mean maternal age borderline oligohydramnios was 29.65 years and average gestational age was 33.45 weeks. The most common cause of oligohydramnios was idiopathic 50 (45.5%) patients, followed by anaemia 48 (43.6%) patients. Operative morbidity was significant 80 (80.9%) patients delivered by lower segment caesarean section. Borderline oligohydramnios was associated with low birth weight and extremely low birth weight in 49 (44.5%) patients and 2 (1.8%) cases respectively. Low APGAR at 5 minutes was in 15 (13.6%) patients and 34 (30.9%) had admission in NICU. No significant difference was found between mode of delivery and gestational age of the patient (p-value is 0.660). Conclusion: Oligohydramnios is quite common in our population. Timely detection and appropriate management can decrease maternal and perinatal morbidity.

This article presents the E-parametric metric space, which is a generalized concept of parametric metric space. After that, the discussion is concerned with the existence of fixed points of single and multivalued maps on E-parametric metric spaces satisfying some contractive inequalities defined by an auxiliary function.

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha’il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se.

Background: We assessed risk factors, antenatal and intrapartum complications associated with early-onset Gestational diabetes mellitus (GDM) in comparison with late-onset GDM. Methods: This retrospective study included 161 GDM women having singleton pregnancies, without previous medical disorder and delivered at a tertiary care Hospital in Ha’il City, KSA from Dec 2020 till Jun 2021. Women diagnosed at < 24 weeks of pregnancy were grouped as early-onset GDM (n=71) and those diagnosed at ≥ 24 weeks as late-onset GDM (n=90). Both groups were matched for background variables. Chi-square and binary logistic regression analysis were applied with P-value significance at 0.05. Results: Past history of GDM, macrosomia and stillbirth were significant predictors for early-onset GDM (P value 0.000, 0.002 and 0.040 respectively). Regression analysis showed early-onset GDM significantly increases the risk for recurrent urinary tract infections (AOR 2.35), polyhydramnios (AOR 2.81), reduced fetal movements (AOR 2.13), intrauterine fetal demise (AOR 8.06), macrosomia (AOR 2.16), fetal birth trauma (2.58), low APGAR score at birth (AOR 8.06), and neonatal ICU admissions (AOR 2.65). Rate of preterm birth, hypertensive disorders, labor onset (natural vs. induced) and cesarean section and intrapartum maternal complications were same in both groups. Conclusion: Early-onset GDM significantly increases certain maternal (recurrent urinary tract infections, polyhydramnios and reduced fetal movements) and fetal complications (intrauterine fetal demise, macrosomia fetal birth trauma, low APGAR score at birth and neonatal ICU admissions). Most of these adverse pregnancy outcomes can be prevented through early registration and screening, close follow up, growth ultrasounds, and provision of efficient emergency and neonatal care services.

Treatment tolerability and treatment environment are two major spheres of infertility care that may associate with women's emotional health and coping mechanisms. The present study aimed at assessing the relationship between infertility treatment quality and various aspects of emotion-focus coping, problem-focus coping, and avoidance coping mechanisms. The study was completed by using standardized tools and data from this descriptive, cross-sectional, correlational study were collected from 350 women undergoing infertility treatments in private reproductive healthcare centers in Quetta, Pakistan. Treatment tolerability was found to be positively associated with positive reframing (p < 0.02) and negatively associated with the use of emotional support (p < 0.03); acceptance (p < 0.01); humor (p < 0.03); behavioral disengagement (p < 0.01) and venting (p < 0.01). The quality of the treatment environment demonstrated a negative correlation between religious coping (p < 0.02) and behavioral disengagement (p < 0.01), whereas it showed a positive correlation with active coping (p < 0.03) and planning (p < 0.02). The linear regression analysis demonstrated that treatment tolerability significantly increased with positive reframing (R2 = 0.118, F(304) = 2.22, p < 0.03). Behavioral disengagement significantly decreased with better treatment environment (R2 = 0.111, F(304) = 2.09, p < 0.02). We discussed the findings keeping in view the role of social, cultural, and economic factors related to infertility care in the context South-Asian culture, and recommendations are made to promote women's mental health and coping by improving some specific aspects of infertility treatment quality. High treatment tolerability may associate with some useful aspects of emotion-focus coping, such as positive reframing, whereas low treatment tolerability may associate with avoidance coping, such as behavioral disengagement and venting. Besides, the quality of the infertility treatment environment enables women to use problem-focus coping mechanisms, such as planning and active coping.

In today’s world, digital data such as images, videos, and texts are easily accessible to just about anyone, posing significant security and copyright concerns. An effective tool to address this concern is digital watermarking. We propose a new digital watermarking technique for color images based on discrete cosine transform (DCT) and a triple-byte nonlinear component of a block cipher. We have first constructed a triple byte nonlinear component of block cipher i.e. 24×24 substitution box (S-box) based on the Galois ring GR(23,8) and then we use it in watermarking procedure by dividing it into 3 bytes and each byte deals with Red (R), Green (G) and Blue (B) channels separately. We split the watermark and original image into R, G, and B channels. Then we embed the combined S-box substituted R, G, and B channel of the watermark image in the combined DCT applied R, G, and B channel of the original image. Experimental and comparative analysis shows that our proposed method is more secure,effective, and robust than previous schemes.

Context In the renewable industry, pressure-dependent CsPbBr 3 perovskite has a lot of potential due to its exceptional properties. Present work revealed the mechanical stability of CsPbBr 3 between 0 to 50 GPa. The bandgap of unstressed CsPbBr 3 is 2.90 eV, indicating a direct bandgap. Band gap values decrease by increasing external pressure. CsPbBr 3 structure showed a direct band gap from 0 to 35 GPa and in-direct from 40 to 50 GPa. The unit cell volume and lattice constants are substantially decreased. Mechanical parameters, i.e., Young’s modulus, bulk modulus, anisotropy factor, shear modulus, and poison’s ratio are obtained. Under ambient conditions, the mechanical properties of CsPbBr 3 showed ductile behavior and with induced pressure, their ductility has significantly improved. By applying stresses ranging from 0 to 50 GPa, the considerable fluctuation in values of dielectric function (imaginary and real), absorption, reflectivity, loss function, refractive index (imaginary and real), and conductivity (imaginary and real), was also identified. When pressure rises, the optical parameters increase and drag in the direction of high energies. Response functions are used to predict the density of states and the phonon lattice dispersion to study the phonon properties. By using the quasi-harmonic Debye model, the thermal effect on the free energy, entropy, enthalpy, and heat capacity were predicted and compared. These results would be useful for theoretical research and indicate how external pressure significantly affects the physical characteristics of CsPbBr 3 perovskites, which may open up new possibilities for use in optoelectronic, photonic, and solar cell applications. Methods The structural, electrical, mechanical, optical, and thermal properties of cesium lead bromide (CsPbBr 3 ) are investigated by applying external pressure from 0 to 50 GPa, using generalized gradient approximations (GGA) and Perdew-Burke-Ernzerhof (PBE) with CASTEP code built-in material studio by density functional theory (DFT).