Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan.

INTRODUCTION: Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based). MATERIAL AND METHODS: In phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility- and home-based births separately, using Stata version 14.1. RESULTS: There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (β = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (β = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (β = 0.94, 95% CI 0.13, 1.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education. CONCLUSION: In order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions

A Spill over Relationship - Corporate Governance and Investor Reaction: A Case of Karachi Stock Exchange

The current study aims to investigate the relation of corporate governance with reaction of investor towards investment. The sample of the study contains on 114 companies of manufacturing sectors specifically and sample is acquired from (2004-2013). Thus, single and composite correlation is applied to check relationship of variables. Moreover, univariate and multivariate both regression methods are applied and study concluded negative insignificant relationship of variables of study. Keywords: Corporate Governance, Investor Reaction, Univariate, Multivariate, Composite

Barricades in Implementation and Adoptation Level of ISO-9001 in Construction Industry of Pakistan

The quality of construction projects and products is purely dependant on the development of such industry and is associated with the implementation of Quality management system in this industry. From the last two decade the certification of ISO- 9001 has been taken up in construction industry at the international level. Many benefits gathered throughout the globe by its effective implementation. The awareness of adaptation is weak in the developing countries and is unaware of the everlasting benefits of this standard. Pakistan is also one of the developing countries which are unaware of its benefits specially gathered in foreign countries such as UK, United States, Australia and Japan etc. ISO which stands for International organisation for standardization is alliance of global standards. There is a special technical committee which is TC-176 which formulates all the standards of ISO-9001. Draft is circulated through technical members of board for approval of standards which requires 75% minimum votes for approval as a standard. There are more than 2100 companies which are certified with ISO-9001 in Pakistan and over 200 auditing agencies which time to time audit the certified firms. The study draws attention to the advantages, disadvantages and barricades facing by construction firms by the implementation of ISO-9001 in construction industry of Pakistan. Also some beneficial suggestions for better adopting ISO-9oo1 is given with the help of this research which can be helpful for the future of Pakistan’s construction Industry. The research highlights that construction firms of Pakistan should gain from the advantages gathered by the construction firms of developed countries and take apt measures for implementing ISO-9001 standards. The government as well as public sector should ensure its implication by all firms before tendering any project for better quality works. Keywords: ISO-9001, implementation, standard, auditing agencie

Novel mechanisms for the post-transcriptional regulation of monocyte-macrophage tissue factor expression

Post-transcriptional regulation of mRNA is an important determinant of net gene expression. Tissue factor (TF) is the key stimulus for thrombus formation and plays critical roles in atherothrombosis. Little is known about its post-transcriptional regulation. Tristetraprolin (TTP) is the most widely studied mRNA-binding protein, and binds to the adenylate-uridylate rich elements (AREs) in the 3’ untranslated region (3’UTR) of target mRNAs and promotes degradation. Poly(ADP-ribose)-polymerase-14 (PARP-14), belongs to a family of ~17 proteins with a PARP domain that generates negatively charged poly(ADP-ribose) adducts on intracellular proteins – a post-translational modification implicated in diverse cellular functions. Preliminary findings in our laboratory have identified PARP-14 as a novel RNA-binding protein, and found it to regulate inflammatory mRNA. This study sought to establish the roles for TTP and PARP-14 in regulating TF mRNA stability in LPS-stimulated monocyte-macrophages. Preliminary experiments demonstrated that TF mRNA, TF protein and TF mRNA stability were increased in Ttp-/- and Parp14-/- macrophages. Similarly, TF expression was increased in vivo in Parp14-/- mice. Furthermore, intravital microscopy demonstrated accelerated thrombosis following ferric-chloride injury in LPS-stimulated Parp14-/- mice. RNP immunoprecipitation, RNA biotin pulldown and co-immunoprecipitation assays demonstrated an interdependency for PARP-14 and TTP to form a ternary complex with TF mRNA. Both proteins interacted within the same 3’UTR segment containing a highly conserved palindromic ARE (AUAAUUUAUUUAAUA) comprising 2 overlapping AUUUAUUUA and UUAUUUAAU nonamers, both of which appeared to be critical in mediating this interaction. Inhibition of p38, which classically results in accelerated decay of TTP-regulated transcripts, reduced TF mRNA stability in WT but not Ttp-/- or Parp14-/- macrophages. Inhibition of PARP activity reduced TF mRNA stability in WT but not in Parp14-/- macrophages. Interestingly, PARP-14 conferred selectivity for TTP to degrade TF mRNA, as PARP-14 had no effect on TNFα expression, an established target of TTP. Similarly, PARP inhibition had no effect on TNFα mRNA decay. These data define novel roles for TTP and PARP-14 in the selective regulation of TF mRNA turnover, and demonstrates for the first time how the actions of TTP may be selectively regulated. PARP-14 functions as an accessory RNA-binding protein which is required for TTP to bind and degrade TF mRNA. Inhibition of either p38 or PARP catalytic activity accelerated TF mRNA decay. Thus one may propose that both PARP-14-mediated ADP-ribosylation and p38-mediated phosphorylation events are necessary for inactivating TTP-mediated TF mRNA decay. The selective destabilization of TF mRNA via pharmacological inhibition of PARP-14 may offer a novel therapeutic strategy in atherosclerosis and cardiovascular disease where thrombosis is linked to TF expression.Open Acces

INFLUENCING THE ATTITUDE TOWARDS SMS ADVERTISEMENT: AN EMPIRICAL STUDY IN PAKISTAN

This research paper aims to examine the relationship betweenthe predictors and consequences of SMS advertising value alongwith its mediating effect in the perspective of Islamic Republic ofPakistan. For this purpose causal and cross-sectional study withminimal researchers’ interference and focus on the attitude ofindividuals was put forward. A personally-administered questionnaire was used to collect data from those 194 undergraduate and graduate students of universities who were the users of cell phone. Structural Equation Modeling (SEM) was used to test the proposed hypotheses.There is significant relationship between infotainment, credibilityand SMS advertising value. Conversely irritation has no significant association with SMS advertising value. Advertising Value, in turns, has strong impact on attitude towards SMS advertisement. Advertising value also has full mediating effect between infotainment, credibility and attitude towards SMS advertisement and has no mediating effect between irritation and attitude towards SMS advertisement. This study imparts the enterprises and businesses with the modern and economical tool of advertisement and also a value addition to the literature

Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan

Background: Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women\u27s empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan.Methods: A cross-sectional survey was conducted during August-November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO\u27s framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1.Results: Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women\u27s empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of β coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05.Conclusion: There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women\u27s empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support

Determinants of capital structure : an empirical study of KSE listed MNCs in Pakistan

Multinational Corporations (MNCs) are generally financed with a mixture of internal debt and equity from the parent corporation. Yet, financial theory has relatively little to say regarding the capital structure and its determinants in an international setting. This research empirically examines the major determinants of capital structure decisions of Multinational Corporations listed on the Karachi Stock Exchange for the period 2005-2017. The data was studied using panel data regression analysis. Results suggest that apart from traditional determinants such as profitability, tangibility, size, Non Debt Tax Shield (NDTS) etc., specific international factors such as political risk, exchange rate risk, agency costs and bankruptcy costs are relevant to the multinational capital structure decision. The results are broadly consistent with theory. It is therefore recommended that the management of listed MNCs in Pakistan should always consider their positions using these capital structure determinants as important inputs before embarking on debt financing decision.peer-reviewe

PICTORIAL REVIEW OF EXTRAOSSEOUS EWING’S TUMOUR: A SINGLE CENTER EXPERIENCE

Purpose: Ewing’s family tumour is an extremely rare tumour, with annual incidence rates amongst Caucasian children <21 years being in the range of 2–3 cases per million in the U.S. There are mainly three subtypes including Ewing’s sarcoma (ES) of bone, extraosseous (EO) Ewing’s tumour and Peripheral primitive neuroectodermal tumour. Although extremely rare, this study represents a review of various types of cases and the significance of imaging including its baseline and post-treatment response radiological characteristics. There are a very few cases of EO ES in the current literature with variable spectrum of tumour site and their imaging characteristics.Materials and Methods: Electronic records were retrospectively reviewed from 1 May 2011 to 1 May 2016 with patients who were diagnosed as histologically proven ES. A number of patients, gender and base line computed tomography (CT)/magnetic resonance imaging findings for staging were reviewed.Results: A total of 568 patients with diagnosed ES were analysed, of which 15 patients had EO type of ES. Of these only 8 patients had baseline imaging available which included tumours arising from the occipital region, orbit, anterior mediastinum, anterior abdominal wall, mesentery, kidney, prostate gland and presacral region.Conclusion: EO ES is a rare entity and can involve a wide array of soft tissue organs. A cross-sectional imaging with CT and MR has a key role in pre- and post-treatment assessment.Key words: Computed tomography, Ewing’s sarcoma, extraosseous Ewing’s, magnetic resonance imaging, peripheral primitive neuroectodermal tumou