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While workplace bullying is recognised as a serious issue for management concern around the world, the literature on approaches to prevent and manage it in international settings is sparse. This paper advances knowledge on managing workplace bullying by reporting an investigation of how and why ethical leadership may be an effective management style to address this issue across cultures. It draws on Social Learning and Social Exchange Theories to conceptualise interactional justice as a possible mediating mechanism by which workplace bullying can be reduced in the presence of ethical leadership. The researcher surveyed 636 employees working in an equivalent job context in Australia (N = 306) and Pakistan (N = 330) to determine the cross-cultural effectiveness of ethical leadership-based framing. Through the examination of direct and indirect effects (via interactional justice) of ethical leadership on workplace bullying, the findings indicated that employee exposure to such behaviour is significantly reduced because ethical leaders foster justice at work. This study has implications for improving international management practice in regard to workplace bullying.

Pure subdural hematoma with subarachnoid haemorrhage brought about by ruptured intracranial aneurysm is uncommon and is related to delayed analysis and treatment. We present an uncommon instance of spontaneous subdural hematoma because of intracranial aneurysmal rupture. Case description A 26-year-old female presented with sudden onset of thunderclap headache at midnight followed by an episode of generalized tonic-clonic seizure and loss of consciousness. There was no associated history of trauma. Computed tomography showed convexity subdural hematoma extending into tentorium without subarachnoid haemorrhage. The catheter angiography revealed a distal anterior cerebral artery aneurysm at the anterior internal frontal artery. Consequently, this aneurysm was embolized with squid with no residual filling. The patient was neurologically intact and was discharged on the third post-procedure day with left partial third nerve palsy. Conclusion This paper demonstrates characteristics, diagnostics, and treatment modalities of this rare condition of intracranial aneurysmal rupture associated with subdural hematoma along with the literature review.

Background Traumatic brain and spine injuries make up a significant fraction of cases presented for forensic examination. Such cases involve violent head injuries, including blunt head injuries and penetrating head injuries, and non-violent injuries as well. Our purpose is to evaluate the main clinical, radiological and medicolegal features of these cases and to determine the relationship between the variables associated with such cases. Materials & methods We retrospectively analyzed patients admitted in a 1 year period from 1st January 2019 to 1st January, 2020 at the Department of Neurosurgery at the Lahore General Hospital, Pakistan. Data contained medical and medicolegal reports. Severity of brain injury was analyzed according to GCS (Glasgow Coma Scale). Statistical analysis was done via GraphPad Prism 8.4.1.676 software. Five interesting cases are also discussed in further detail. Results A total of 61 cases were analyzed. 50 were male (82.0%) and 11 were female (18.0%), representing an age range from 2.5 years to 80 years. Among the 61 cases, 28 patients had mild brain injuries (45.9%), 13 had moderate brain injuries (21.3%) and 20 had severe brain injuries (32.8%). 4 patients had spinal injuries. The most common outcome was complete recovery in 38 patients (62.3%). Blunt head trauma was the most frequent type of trauma (50.8%), and all cases of this type of trauma were due to criminal assault. The most common mechanism of injury was direct impact. Intracranial hemorrhage was the most common type of intracranial lesion (27/86 injuries). The cause of death was severe head injury in 20 patients and exacerbation of moderate head injuries in 3 patients. The variables Gender and Medical Management have no significant association with any other variable or with each other. Other variables, such as the Severity of Injuries, Medical Outcome, Type of Incident (blunt force trauma, penetrative force trauma, etc.) and the Nature of the Case (criminal or non-criminal) were significantly associated with each other, with statistical significance being defined at p Conclusion Based on our results, the conclusion is the need to identify severe head injuries early and timely management is necessary as these injuries are the most common cause of death. In addition, mild to moderate head injuries must be cautiously managed to prevent the exacerbation of traumatic brain injury. Furthermore, case information (whether criminal or otherwise and cause of injury) can be deemed necessary for the neurosurgeon who is responsible for the management of the injuries.

Workflow scheduling is a key component behind the process for an optimal workflow enactment. It is a well-known NP-hard problem and is more challenging in the heterogeneous computing environment. The increasing complexity of the workflow applications is forcing researchers to explore hybrid approaches to solve the workflow scheduling problem. The performance of genetic algorithms can be enhanced by the modification in genetic operators and involving an efficient heuristic. These features are incorporated in the proposed Hybrid Genetic Algorithm (HGA). A solution obtained from a heuristic is seeded in the initial population that provides a direction to reach an optimal (makespan)solution. The modified two fold genetic operators search rigorously and converge the algorithm at the best solution in less amount of time. This is proved to be the strength of the HGA in the optimization of fundamental objective (makespan) of scheduling. The proposed algorithm also optimizes the load balancing during the execution side to utilize resources at maximum. The performance of the proposed algorithm is analyzed by using synthesized datasets, and real-world application workflows. The HGA is evaluated by comparing the results with renowned and state of the art algorithms. The experimental results validate that the HGA outperforms these approaches and provides quality schedules with less makespans. Proposed HGA (hybrid GA) to schedule workflow in heterogeneous environment.Simulation results are presented with synthesized and real-world workflows.HGA identifies lesser length of the workflows.HGA also improves load balancing.Significant improvement in schedule lengths as compared to existing work.

Background Direct puncture embolization with glue is an effective technique for pre-operative devascularization of craniofacial arteriovenous malformations. Venous outflow and arterial inflow of the lesion need to be limited during injection of embolic material. Manual compression is the standard procedure for flow reduction, but when an AVM has multiple channels of venous drainage, achieving successful blockage of blood is technically difficult. This study demonstrates the use of a circumferential cookie cutter ring to reduce flow, with better results compared to manual compression. Design and methods This is a retrospective study of ten patients, over a period of two years, with craniofacial arteriovenous malformations who were treated with direct percutaneous injection of glue. Pre-embolization angiography was performed to see arterial feeders and venous draining veins. Adjunctive maneuvers were used during embolization, including external compression of venous pouch with circular cookie cutter rings of different sizes varying based on lesion size. Glue cast was localized within and around the margins of circular cookie cutter ring without any distal migration. Results No neurological complications secondary to the embolization procedure were observed. The arteriovenous shunts were successfully occluded in all cases. There was partial occlusion in two cases. Total occlusion achieved in five cases when embolization was followed by surgery. Only one case required a second session to achieve total occlusion. Post embolization, there was minimal residual flow in one patient, who declined further treatment due to mitigation of symptoms. The shape of glue cast was changed in two cases after removal of cookie cutter when low concentrated glue was used. No skin necrosis was seen post embolization. Conclusions Percutaneous direct puncture embolization with glue saves time and is a safer method for superficial craniofacial AVMs with prominent venous pouch when external compression was applied with circumferential cookie cutters to reduce venous outflow.

Objectives: The characteristics of intracranial aneurysms display ethnic variations. The management strategy of unruptured aneurysms is influenced by the prevalence because the incidence of subarachnoid hemorrhage has been properly accessed. Data on this disease from Pakistan is non-existent.The objective of this retrospective study was to generate data on the local prevalence of ruptured and unruptured intracranial aneurysms in Pakistani population. Methods: All records of patients (1000) with intracranial aneurysms seen at our institution, the largest referral hospital of the country, drains whole country as well as neighboring countries on the west and north where still no dedicated NeuroIntervention facilities are present, over the period from January 2015 to January 2019, were examined for site, age, gender distribution, multiplicity and mirror aneurysms. Results: The study found the mean age of patients to be 43 years, females presented with same mean age but showed large number of patients in the age bracket of 30–39 and 50–59. Males only showed a large number of patients between 50 and 59. There were 622 females and 378 males in the study. The most common site for aneurysm was ACoA followed by MCA and ICA coming on third. 68% patients presented with ruptured aneurysms. Conclusion: This study provides valuable information on the epidemiology of intracranial aneurysms in the Pakistan population. This study finds the epidemiology of ruptured and unruptured aneurysms in Pakistan. It highlights the age and gender of patients that were presented as well as the locations and multiplicity and mirror aneurysms. Keywords: Epidemiology, Aneurysm, Population

Objectives Endovascular embolization of hyper vascular head and neck tumors is performed as a palliative measure and in order to reduce blood loss. We report the procedure and results of head and neck tumors embolized via trans-arterial route showing the safety and positive impact of our approach as well as contrasting various embolic agents and their results. Methods We collected data of all head and neck tumors embolized at our institution during a nineteen-month period from August 2016 to May 2018. Embolization procedure was conducted 3–7 days before surgery to allow for necrosis. Bilateral angiogram was performed, followed by super selective catheterization of feeding vessel. Particle size was decided according the lumen of the vessel, for smaller vessels we used smaller particles (45–150 μ) and increased particle size up to (150–250 μ) as we moved to larger vessels. Results A total of thirty-six patients who underwent the pre-operative and palliative embolization procedure were examined. All embolizations were completed in a single session. No procedure related clinical or technical complications were observed. Intra-operative blood loss was between 200 and 600 ml which is far lower as compared to surgery alone. Total devascularization was achieved in all cases by complete occlusion of supplying arterial feeders. Conclusion Pre-surgical embolization is an adjunct therapy that radically improves the surgical outcomes in patients. We found complete excision can easily be achieved using this adjunct therapy which is almost never the case when using surgery alone. Secondly, we found that in patients who could not be operated on embolization was a highly effective palliative measure that gives great symptomatic relief.

Background Few studies have examined the prevalence of intracranial aneurysms in association with other syndromes and cerebrovascular diseases. This study looks at the syndromes and diseases that are associated with intracranial aneurysms. Material and methods We discuss the fact that although there are various case studies reporting presence of intracranial aneurysms in association with other syndromes and cerebrovascular conditions, there is general lack of reviews, original articles and prospective studies on the subject and this article aims to fill that gap. We looked at more 300 cases, across the span of one year from June 2018 to May 2019, of intracranial aneurysms and found five cases with rare occurrences of aneurysms with other syndromes and other diseases. Conclusion The difference observed in the manifestation of intracranial aneurysms in such disease pathologies encourage future studies in better characterization of the pathophysiology, prevalence and ideal treatment options of neurovascular lesions in these patients who were presented with these rare combinations.