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The prevalence of hepatitis B virus (HBV) infection in pregnant women is high in South Africa (SA), yet prophylaxis to prevent mother-to-child transmission (MTCT) falls short of international recommendations. We describe a 10-week-old infant who developed fulminant hepatic failure following MTCT. The mother was hepatitis e-antibody positive and had a viral load of only 760 IU/mL. Genetic analysis of virus from mother and infant showed that both had the G1896A mutation in the preC/C gene, which truncates hepatitis e antigen (HBeAg) during translation, causing an HBeAg-negative phenotype. HBeAg attenuates antiviral immune responses, and its absence was probably responsible for the infant’s fulminant hepatitis, due to an uncontrolled immune attack on infected liver cells. Pregnant women are not tested for HBV infection in SA and MTCT rates are unknown. Addition of a birth dose of vaccine, HBV screening of pregnant women and antiviral prophylaxis to positive mothers should be prioritised.

Abstract Introduction In recent decades, there has been a proliferation of mobile health (mHealth) interventions to address public health challenges such as HIV/AIDS. Hence, there is a need for standardizing the report of mHealth interventions and frameworks to enable effective knowledge sharing and promote developments. This study aims to review publications on mobile applications used for antiretroviral therapy (ART) adherence among people living with HIV (PLHIV) to evaluate their compliance with the standard reporting guideline by the WHO. Method A comprehensive search of published literature was conducted on PubMed, PubMed Central, and MEDLINE databases. We selected randomized controlled trials reporting mobile applications used to improve ART adherence among PLHIV. Only studies published in the last 10 years and the English language were included. Each selected study was reviewed by two independent reviewers against the standard 16-item checklist developed by the WHO. Results A total of 16 studies were included in the review. Most of the studies were conducted in the United States of America (n = 7). Only 4 (25%) of the studies reported more than 70% (11/16) of the items on the standard reporting checklist by WHO. More than 80% of the studies reported the intervention content (n = 15) and intervention delivery (n = 13). The least reported items were; interoperability/Health Information Systems (HIS) context (n = 2), infrastructure (population level such as electricity, internet connectivity, etc.) (n = 4), and cost assessment (n = 4). However, these are important factors that ensure the sustainability and usability of mHealth intervention, especially in low- and middle-income countries. Conclusion Most mHealth interventions promoting ART adherence did not comply with the standard reporting guideline. The lack of standardization of mHealth interventions may be responsible for increased siloed mobile applications. Hence, there is a need for global adoption of the checklist by Ministries of Health, international organizations, journals, and relevant authorities.

Abstract Background Oncogenic types of human Papillomavirus (HPV) infection cause substantial morbidity and mortality in Nigeria. Nigeria has low cervical cancer screening and vaccination rates, suggesting the need for community engagement to enhance reach and uptake. We organised a designathon to identify community-led, innovative approaches to promote HPV screening and vaccination for women and girls, respectively, in Nigeria. A designathon is a three-phase participatory process informed by design thinking that includes the preparation phase that includes soliciting innovative ideas from end-users, an intensive collaborative event to co-create intervention components, and follow-up activities. Methods We organised a three-phase designathon for women (30-65yrs) and girls (11-26yrs) in Nigeria. First, we launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. All eligible entries were graded by judges and 16 exceptional teams (with 4-6members each). All six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics. We present quantitative data on people who submitted and themes from the textual submissions. Results We received a total of 612 submissions to the open call from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n = 392), in-person (n = 99), email (n = 31), or via an instant messaging application (n = 92). Overall, 470 were eligible for judging after initial screening. The average age of participants for daughters was 19 years and 39 years for mothers. Themes from the top 16 proposals included leveraging local leaders (5/16), faith-based networks (4/16), educational systems (4/16), and other community networks (7/16) to promote awareness of cervical cancer prevention services. After an in-person collaborative event, eight teams were selected to join an innovation training boot camp, for capacity building to implement ideas. Conclusions Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria. Our designathon was able to facilitate Nigerian mother-daughter teams to develop cervical cancer prevention strategies. Implementation research is needed to assess the effectiveness of these strategies.

Abstract Background Osteoarthritis is a common, painful and disabling long-term condition. Delivery of high-quality guideline-informed osteoarthritis care that successfully promotes and maintains supported self-management is imperative. However, osteoarthritis care remains inconsistent, including under use of core non-pharmacological approaches of education, exercise and weight loss. Community pharmacies are an accessible healthcare provider. United Kingdom government initiatives are promoting their involvement in a range of long-term conditions, including musculoskeletal conditions. It is not known what an enhanced community pharmacy role for osteoarthritis care should include, what support is needed to deliver such a role, and whether it would be feasible and acceptable to community pharmacy teams. In this (PharmOA) study, we aim to address these gaps, and co-design and test an evidence-based extended community pharmacy model of service delivery for managing osteoarthritis. Methods Informed by the Theoretical Domains Framework, Normalisation Process Theory, and the Medical Research Council (MRC) framework for developing complex interventions, we will undertake a multi-methods study involving five phases: 1. Systematic review to summarise currently available evidence on community pharmacy roles in supporting adults with osteoarthritis and other chronic (non-cancer) pain. 2. Cross-sectional surveys and one-to-one qualitative interviews with patients, healthcare professionals and pharmacy staff to explore experiences of current, and potential extended community pharmacy roles, in delivering osteoarthritis care. 3. Stakeholder co-design to: a) agree on the extended role of community pharmacies in osteoarthritis care; b) develop a model of osteoarthritis care within which the extended roles could be delivered (PharmOA model of service delivery); and c) refine existing tools to support community pharmacies to deliver extended osteoarthritis care roles (PharmOA tools). 4. Feasibility study to explore the acceptability and feasibility of the PharmOA model of service delivery and PharmOA tools to community pharmacy teams. 5. Final stakeholder workshop to: a) finalise the PharmOA model of service delivery and PharmOA tools, and b) if applicable, prioritise recommendations for its wider future implementation. Discussion This novel study paves the way to improving access to and availability of high-quality guideline-informed, consistent care for people with osteoarthritis from within community pharmacies.

Abstract Background Supported self-management interventions for patients with musculoskeletal (MSK) conditions may not adequately support those with limited health literacy, leading to inequalities in care and variable outcomes. The aim of this study was to develop a model for inclusive supported self-management intervention(s) for MSK pain that take account of health literacy. Methods A mixed methods study with four work-packages was conducted: work package 1: secondary analysis of existing data to identify potential targets for intervention; work package 2: evidence synthesis to assess effective components of self-management interventions taking into account health literacy; work package 3: views of community members and healthcare professionals (HCPs) on essential components; work package 4: triangulation of findings and an online modified Delphi approach to reach consensus on key components of a logic model. Findings Findings identified targets for intervention as self-efficacy, illness perceptions, and pain catastrophizing. A range of intervention components were identified (e.g. information in diverse formats offered at specific times, action planning and visual demonstrations of exercise). Support should be multi-professional using a combination of delivery modes (e.g. remote, face-to-face). Conclusions This research has developed a patient-centred model for a multi-disciplinary, multi-modal approach to supported self-management for patients with MSK pain and varying levels of health literacy. The model is evidence-based and acceptable to both patients and HCPs, with potential for significant impact on the management of MSK pain and for improving patient health outcomes. Further work is needed to establish its efficacy.

Abstract Background Self‐harm in young people is a serious concern but a deeper understanding of the functions of self‐harm in young people can tailor care and inform new clinical interventions to reduce repeat self‐harm and suicide risk. General practitioners (GPs), as frontline healthcare professionals, have an important role in managing self‐harm in young people. This study aimed to explore the functions of self‐harm in young people and their perspectives on future GP‐led care. Methods A qualitative study using interviews with young people aged between 16 and 25 years with a personal history of self‐harm was conducted. Interviews were transcribed and analysed using reflexive thematic analysis. Findings Four distinct functions were identified: (1) handling emotional states; (2) self‐punishment; (3) coping with mental illness and trauma; and (4) positive thoughts and protection. Young people valued GP‐led support and felt future GP interventions should include self‐help and be personalised. Conclusions These findings support clinicians, including GPs, to explore the functions of self‐harm in young people aged 16–25 in a personalised approach to self‐harm care. It should be noted that self‐harm may serve more than one function for a young person and thus interventions should recognise this. Patient and Public Contribution A group consisting of young people with lived experience of self‐harm, carers, the public, and those who work with young people who harm themselves conceived this study idea, informed recruitment methods and the interview topic guide, and supported the interpretation of findings.

With looming global water-related issues, the monitoring of water quality for household and industrial consumption has become more pertinent. Rivers in nearby towns serve as primary water sources for Ekpoma town. 123 samples of stored river water were collected from 41 sampling locations and physical properties – pH, electrical conductivity (EC), salinity, temperature, and total dissolved solids (TDS) – were measured in situ using the Hanna edge® Multiparameter EC/TDS/Salinity Meter-HI2030. Atomic absorption spectrophotometry (AAS) was used to detect and measure the concentration of potentially toxic metals (PTMs): Al, Cr, Cu, Fe, Mn, Ni, Pb, and Zn. The measured concentrations were compared to the WHO, US EPA, and NSDWQ regulatory standards, and a spatiotemporal health risk analysis was performed using HERisk software. Twenty-five percent of the tested samples contained PTM concentrations within the allowable regulatory limits. Spatiotemporal health risk analysis showed that 98.8% of the cumulative carcinogenic risks (CRcum) were entirely from Pb contamination via oral ingestion. PTM concentrations in the samples suggest the degradation of river water quality due to agricultural activities, crude oil exploration activities, and soil composition in the region. Best management practices (BMPs) and treatment processes for the removal of detected contaminants are recommended to improve water quality. HIGHLIGHTS The water quality and human health risks from stored river water were examined.; Eight chemical elements were detected and analyzed from the collected samples.; Twenty-five per cent of the samples tested contained PTM concentrations within allowable limits.; Risk analysis showed that 98.8% of the cumulative carcinogenic risks (CRcum ) were derived entirely from Pb contamination via oral ingestion.; BMPs and treatment processes were recommended.;

Background: This study aims to study the histomorphological response of d-ribose-l-cysteine (DRLC) to ketamine-induced testicular damage in adult male Wistar rats. Methods: A total of 20 adult male Wistar rats were used for this experiment. The animals were randomly divided into four groups (A–D) (n = 5). Group A served as the control, receiving distilled water as placebo; animals in group B were administered with 50 mg/kg body weight (bw) of ketamine only; animals in group C were administered with 50 mg/kg bw of ketamine and 30 mg/kg bw of DRLC; animals in group D were administered with 30 mg/kg bw of DRLC only. At the end of the experiment, blood was taken from the heart via cardiac puncture and stored, semen was collected from the caudal epididymis for immediate sperm analysis, while the testes were excised and preserved for histological examination and biochemical analysis. Results: The results showed abnormalities marked by a significant decrease in the weights, sperm parameters, as well as antioxidants, serum hormonal levels and abnormal testicular microarchitecture in the rats as a result of ketamine treatment. However, DRLC exhibits significant quenching effects and attenuating activities on the ketamine-induced abnormalities by increasing the rats' weights, restoring the sperm parameters, as well as increasing the antioxidants and serum hormonal levels with restored testicular histoarchitecture. Conclusion: DRLC in the current study attenuated the toxic effects of ketam ine on the testes; therefore, it could be used as adjuvant therapy for reproductive toxicant-induced testicular toxicity due to its potent antioxidant property. Significance statement The testis is a vital secreting organ that produces and stores spermatozoa and is crucial for producing male sexual hormones and is thus the main target of infertility when overdoses of chemicals and toxins are introduced to it. In view of the facts above, studies of the potential of chemicals like ketamine to induce testicular toxicity are important as well as the methods aimed at mitigating this effect. Various stu dies have been conducted on the effectiveness of DRLC in subsiding different chronic health conditions, but there is no published literature on the effects of DRLC in ketamine-induced testicular toxicity in adult male Wistar rats. Hence we present this study.

Abstract Advances in musculoskeletal (MSK) research have been successfully curated into widely endorsed evidence-based recommendations and guidelines. However, there continues to exist significant variations in care and quality of care, and the global health and socio-economic burdens associated with MSK conditions continues to increase. Limited accessibility, and applicability of guideline recommendations have been suggested as contributory factors to less than adequate guideline implementation. Since patient and public involvement (PPI) is being credited with increasing relevance, dissemination and uptake of MSK research, the success of guidelines implementation strategies may also be maximised through increasing opportunities for PPI input. We therefore conducted a scoping review of literature to explore PPI in implementation of evidence-based guidance for MSK conditions. A comprehensive search was used to identify relevant literature in three databases (Medline, Embase, Cinahl) and two large repositories (WHO, G-IN), supplemented by grey literature search. Eligibility was determined with criteria established a priori and narrative synthesis was used to summarise PPI activities, contexts, and impact on implementation of MSK related evidence-based guidance across ten eligible studies (one from a low-and middle-income country LMIC). A prevalence of low-level PPI (mainly consultative activities) was found in the current literature and may partly account for current experiences of significant variations and quality of care for MSK patients. The success of PPI in MSK research may be lessened by the oversight of PPI in implementation. This has implications for both high- and low-resource healthcare systems, especially in LMICs where evidence is limited. Patient and public partnership for mobilising knowledge, maximising guideline uptake, and bridging the research-practice gap particularly in low resource settings remain important and should extend beyond PPI in research and guideline dissemination activities only. This review is a clarion call to stakeholders, and all involved, to transform PPI in MSK research into real world benefits through implementation approaches underpinned by patient and public partnerships. We anticipate that this will enhance and drive quality improvements in MSK care with patients and for patients across health and care settings.

Lassa fever is a viral hemorrhagic fever treated with supportive care and the broad-spectrum antiviral drug ribavirin. The pathophysiology, especially the role of hyperinflammation, of this disease is unknown. We report successful remission of complicated Lassa fever in 2 patients in Nigeria who received the antiinflammatory agent dexamethasone and standard ribavirin.

Abstract Background The increase in the demand for synthetic drugs due to the surge in the cases of drug-resistant infectious organisms has led to the search for new medicines in plants. Some plants have phytochemicals that can serve medicinal purposes. This study focuses on the antibacterial activity and antioxidant potential of Allium sativum and Allium cepa extract on bacterial isolates isolated from the wound of diabetic patients. Agar well-diffusion method was used for the antibacterial susceptibility. Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Escherichia coli were used for this study. The total phenolic content of the extract was determined using standard Spectrophotometric techniques. Results The ethanolic extract of each plant had higher inhibitory effects against the bacterial isolates than the aqueous extracts. The zone of inhibition of each ethanolic section ranged from 3 to 12.5 mm, while the aqueous extracts ranged from 4 to 10 mm. The highest antimicrobial activity was observed at 150 mg/ml in A. sativum ethanolic extract when tested against Staphylococcus aureus, which resulted in a zone of inhibition of 12.5 mm. The aqueous and ethanolic extracts of A. cepa have higher phenolic content than that of A. sativum. Conclusion This research showed that the ethanolic and aqueous extracts of both plants vary in their abilities to serve act as antioxidants and antimicrobials.

Abstract Trans-astaxanthin (TA), a keto-carotenoid found in aquatic invertebrates, possesses anti-oxidative and anti-inflammatory activities. Rotenone is used to induce oxidative stress-mediated Parkinson’s disease (PD) in animals. We probed if TA would protect against rotenone-induced toxicity in Drosophila melanogaster. Trans-astaxanthin (0, 0.1, 0.5, 1.0, 2.5, 10, and 20 mg/10 g diet) and rotenone (0, 250 and 500 μM) were separately orally exposed to flies in the diet to evaluate longevity and survival rates, respectively. Consequently, we evaluated the ameliorative actions of TA (1.0 mg/10 g diet) on rotenone (500 μM)-induced toxicity in Drosophila after 7 days’ exposure. Additionally, we performed molecular docking of TA against selected pro-inflammatory protein targets. We observed that TA (0.5 and 1.0 mg/10 g diet) increased the lifespan of D. melanogaster by 36.36%. Moreover, TA (1.0 mg/10 g diet) ameliorated rotenone-mediated inhibition of Catalase, Glutathione-S-transferase and Acetylcholinesterase activities, and depletion of Total Thiols and Non-Protein Thiols contents. Trans-astaxanthin prevented behavioural dysfunction and accumulation of Hydrogen Peroxide, Malondialdehyde, Protein Carbonyls and Nitric Oxide in D. melanogaster (p

A multistage mesocosm vertical flow constructed wetland system was designed to treat synthetic domestic wastewater with a high nitrogen (N) load. The study aim was to determine the impact of design and operational variables on N removal efficiency in such systems. A tidal flow operational strategy enhanced aeration and was coupled with a step-feeding approach to promote N removal. Over the 420-day running period N removal rates were between 70 and 77 gN/m3/d, for a step-feeding ratio range of 60:40 to 80:20. The system was able to remove 91–95% of chemical oxygen demand, 74–91% of ammonium and 66–81% of total-N. Tidal flow and step-feeding strategies significantly impacted nitrogen removal with the best performance at a step-feeding ratio of 80:20 providing a carbon to nitrogen (COD/N) ratio of 4–5. The bacterial diversity increased at each stage throughout the system with dominating phyla Proteobacteria, Firmicutes, Planctomycetes, Bacteroidetes, Chloroflexi, Verrucomicrobia and Acidobacteria. Dominant bacteria at the genus level were Thiothrix, Planctomyces, Azonexus, Pseudoxanthomonas, Hydrogenophaga, Gemmobacter and other genera suggesting that N removal was accomplished via diverse metabolic pathways, including autotrophic nitrification, heterotrophic denitrification, autotrophic denitrification, and possibly anammox. This study shows benefits of step-feeding strategies in tidal flow constructed wetlands as a cost-effective solution for minimizing external carbon input to achieve effective N removal.

Due to the increase in population and industrialization growth, most countries in the world depend on groundwater to meet agriculture demands for food production. The increase in water contamination due to indiscriminate solid wastes has necessitated the assessment of water quality and its suitability for agricultural usage. Twenty four groundwater and ten stream water samples were randomly collected from the downslope and upslope side of the dumpsite for all the major physio-chemical parameters. The pH of water samples indicates slightly acidic to alkaline in nature. High concentrations of nitrate, total dissolved solids and electrical conductivity suggest the impact of the waste on the water resource. Assessment of irrigation water quality based on Sodium Adsorption Ratio (SAR), Soluble Sodium Percentage (SSP), Permeability Index (PI) and Magnesium content (MC) indicated that most of the water samples fall within the permissible standard for irrigation water. Thus, the water should be used with caution on crops for long time agricultural sustainability.

Human-wildlife conflicts have become a significant issue in conservation and land management of a protected area. The study examines Hippo-Human relationship in selected communities around Kainji dam in New Bussa, Niger State, Nigeria. Data for the study was collected through pre tested structured questionnaires and analyzed using descriptive statistics. Findings from the results revealed that male Hippopotamus is the highest with 75.0% and that 37% were 50 years and above. Majority of the respondents had no formal education (42.0%). 79% of the respondents recorded that Hippopotamus was present in the study area while 82.0% have had to encounter Hippopotamus attack. The crops that are mostly grown by the respondents in the study area are Maize, Beans, Millet, Guinea corn, Rice and Groundnut. In which maize is the mostly grown and raided by Hippopotamus. The findings revealed that 69.0% of the respondents state that crop raiding is the major conflict. Various preventive measures undertaken include: fire and smoke, watch guarding, trapping, scare crow, thorn fencing and hunting, with fire and smoke being the most preferred by the respondents. The victims of these attacks are willing to prevent the attacks with fire and smoke as against killing the Hippopotamus, they should be encourage by factoring compensation into conservation policy to promote the conservation of this species in the study area.

Background: Self-harm in young people is a growing public health concern. Young people commonly present to their GP for help with self-harm, and thus general practice may be a key setting to support young people who have self-harmed. Aim: To examine the potential of general practice to support young people aged 10–25 years who have harmed themselves. Design & setting: A narrative review of published and grey literature. Method: The Scale for the Assessment of Narrative Review Articles (SANRA) was used to guide a narrative review to examine the potential of general practice to support young people who have self-harmed. The evidence is presented textually. Results: The included evidence showed that GPs have a key role in supporting young people, and they sometimes relied on gut feeling when handling uncertainty on how to help young people who had self-harmed. Young people described the importance of initial clinician responses after disclosing self-harm, and if they were perceived to be negative, the self-harm could become worse. Conclusion: In context of the evidence included, this review found that general practice is a key setting for the identification and management of self-harm in young people; but improvements are needed to enhance general practice care for young people to fulfil its potential.

Supplementing low crude protein (CP) diets for pigs with exogenous amino acid may help improve growth performance, minimize the environmental impact associated with nitrogen loss and improve the sustainability of pork production. A total number of thirty (30) Large white x Landrace weaned pigs between the age of 8-10 weeks and an average weight of 11.5 ± 0.39 kg were used to evaluate the effect of lysine supplementation of a low CP diet on growth performance, blood profile, and carcass characteristics of weaner piglets. Weaned pigs were acclimatized for seven days, randomly allotted to five (5) dietary treatments with six weaners per treatment and fed a weaner diet based on maize-soybean while wheat bran and dried cassava peel were added to balance the diet nutrients. The animals were allocated to either a control diet containing 22.6% CP or a diet with 2.5%, 5.0%, 7.5%, and 10% reduction in diet CP. Each animal consumed the respective diet for six weeks during which growth performance was monitored. Afterward, 5 mL of blood was sampled for analysis, and all the pigs were slaughtered for carcass analysis. Average daily gain, total weight gain, and average daily intake were not significantly different across the groups (p>0.05). While feed cost per kg was lower with the 7.5% and 10% diet CP reduction (p0.05). However, the abdominal fat percentage of carcass reduced slightly with the reduced diet CP. Therefore, up to 10% reduction in diet CP from 22.6%, with 0.1% lysine supplementation, had no negative impact on growth without compromising the immunity indicators of weaned pigs. Furthermore, there was no negative consequence on carcass characteristics and the primal cuts.

Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Methods: Eight databases [including MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Database of Systematic Reviews and World Health Organization (WHO) International Clinical Trials Registry] were searched from inception until April 2020. Randomised clinical/controlled trials of adult patients investigating the effects of nonsurgical (e.g. corticosteroid injections, therapeutic exercise, shockwave therapy) and surgical treatment for SSCs, compared with each other, placebo, usual care or no treatment, were retrieved. Pairs of reviewers screened studies independently, quality appraised eligible studies using the Cochrane risk of bias tool, extracted and checked data for accuracy. Primary outcomes were pain and disability in the short term (⩽3 months) and long term (⩾6 months). Direct and indirect evidence of treatment effectiveness was synthesised using random-effects network meta-analysis. Results: The review identified 177 eligible trials. Summary estimates (based on 99 trials providing suitable data, 6764 patients, 20 treatment options) showed small to moderate effects for several treatments, but no significant differences on pain or function between many active treatment comparisons. The primary analysis indicated that exercise and laser therapy may provide comparative benefit in terms of both pain and function at different follow-up time-points, with larger effects found for laser in the short term at 2–6 weeks, although direct evidence was provided by one trial only, and for exercise in the longer term [standardised mean difference (SMD) 0.39, 95% confidence interval (CI) 0.18, 0.59 at 3–6 months] compared with control. Sensitivity analyses excluding studies at increased risk of bias confirmed only the comparative effects of exercise as being robust for both pain and function up until 3-month follow-up. Conclusion: Current evidence shows small to moderate effect sizes for most treatment options for SSCs. Six treatments had a high probability of being most effective, in the short term, for pain and function [acupuncture, manual therapy, exercise, exercise plus manual therapy, laser therapy and Microcurrent (MENS) (TENS)], but with low certainty for most treatment options. After accounting for risk of bias, there is evidence of moderate certainty for the comparative effects of exercise on function in patients with SSCs. Future large, high-quality pragmatic randomised trials or meta-analyses are needed to better understand whether specific subgroups of patients respond better to some treatments than others.

Background: Self-harm is the leading risk factor for suicide, with elevated rates reported amongst older populations. This study explores how older adults experience self-harm, identifying factors leading to self-harm. Methods: Semi-structured interviews with older adults (≥60 years) engaging in self-harm and support workers from third sector services in England. Older adults were invited to participate in a follow-up interview. Interviews were recorded, transcribed verbatim and data analysed thematically. Ethical approval obtained from Keele University's Ethics Review Panel. A Patient Involvement group contributed to study design, data analysis and interpretation. Outcomes: Between September 2017 to September 2018, 24 interviews were conducted involving 16 participants: nine older adults and seven support workers. Eight older adults consented to follow-up interviews. All older adults reported diagnoses of mental illness in addition to physical illness. Participants identified diverse stressors accumulating over the life-course leaving older adults particularly vulnerable to self-harm. Such stressors included adverse events, loss, interpersonal and health problems. A sense of shame and stigma amongst older people using self-harm to manage distress was also reported. Interpretation: Self-harm is often concealed due to stigma and shame, being further accentuated amongst older adults, which may result in low levels of medical help-seeking behaviour for self-harm. Self-harm occurred along a spectrum of no-suicidal intent to high-levels of intent, suggesting self-harm holds different functions to older adults. Clinicians should be aware of the existence of self-harm in this age-group, and the heightened risk amongst those with comorbidities so adequate assessment, support and/or referral is provided. Keywords: Self-harm, Qualitative, Suicide, Older adults

The maritime industry is globally recognized as one of the most economically viable industry capable of facilitating sustainable development thus, amicable settlement of maritime disputes is paramount to guarantee unhindered trade and commerce environment. Arbitration is an age-long Alternative Dispute Resolution (ADR) mechanism applied in the amicable settlement of disputes in a relaxed and semi-formal environment. It is particularly suitable for resolving commercial disputes because of the enforceability of arbitral awards as depicted by the existing international arbitral jurisprudence. Various law of the Sea tribunals such as the International Tribunal for the Law of the Sea (ITLOS) or an ad hoc panels expressly recognizes arbitration as one of the models for settlement of disputes as a suitable alternative to litigation. In Africa, as nations recover from the era of ocean blindness, maritime practice and administration is prioritized to aid economic growth. The objective of this study is to evaluate application of arbitration as an ADR mechanism for settling maritime disputes in Nigeria’s maritime practices with the aim of identifying the challenges confronting Nigerian’s involvement in maritime business, particularly as it relates to application of Arbitration to dispute settlement. It was found that there are certain loopholes in relevant laws which work hardship against local businesses in cases of maritime disputes settlement. The study suggests viable solutions based on lessons from other climes to create level playing field for parties who opt for arbitration to settle maritime related disputes.

INTRODUCTION:The demand for musculoskeletal (MSK) care is rising, and is a growing challenge for general practice. Direct access to physiotherapy and other healthcare services may offer appropriate care for MSK pain patients but there is uncertainty regarding the effectiveness or efficiency of this approach in practice. This study aimed to review the evidence regarding characteristics, outcomes, barriers and facilitators of MSK triage and direct access services. METHODS:A comprehensive search of eight databases (including MEDLINE, EMBASE, and Cochrane library) up to February 2018 was conducted to identify studies (trials, cohorts and qualitative evidence) on direct access services for MSK in primary care settings. Using predefined inclusion and exclusion criteria, titles, abstracts, and subsequent full texts were independently screened by reviewers. Methodological quality of eligible studies was assessed using the mixed methods appraisal tool, and extracted data regarding study characteristics and results were independently reviewed. A narrative synthesis and grading of evidence was undertaken. Approaches to MSK triage and direct access were profiled along with their respective outcomes of care relating to patient-oriented and socioeconomic outcomes. Barriers and facilitators of each model of direct access services were also highlighted. RESULTS:9010 unique citations were screened, of which 26 studies were eligible. Three approaches (open access, combination and service pathway models) to MSK triage and direct access shared similar goals but were heterogeneous in application. MSK patients using direct access showed largely similar characteristics (age, sex and duration of symptoms) compared to GP-led care, although they were often younger, slightly more educated and with better socio-economic status than patients seen through GP-led care. Although many studies showed limitations in design or methods, outcomes of care (patient oriented outcomes of pain, and disability) did not show large differences between direct access and GP-led care. In most studies direct access patients were reported to have lower healthcare utilisation (fewer physiotherapy or GP consultations, analgesics or muscle relaxants prescriptions, or imaging procedures) and less time off work compared to GP-led care. DISCUSSION:This study provides insight into the current state of evidence regarding MSK triage and direct access services and highlights potential implications for future research, healthcare services planning, resource utilisation and organising care for MSK patients in primary care. There is consistent, although limited, evidence to suggest that MSK triage and direct access services lead to comparable clinical outcomes with lower healthcare consumption, and can help to manage GP workload. However, due to the paucity of strong empirical data from methodologically robust studies, a scale up and widespread roll out of direct access services cannot as yet be assumed to result in long term health and socio-economic gains. PROSPERO-ID: CRD42018085978.

Reusable waste plastic drip chamber of infusion sets were retrofitted and evaluated for drip irrigation applications. The drip chambers were carefully collected from local hospitals in Abeokuta, sorted and sterilized in hydrogen peroxide solution for 24 h and were evaluated for its systems characteristics and applicability for drip irrigation on the field using an extra early cultivar (NHAe47-4) of Okro (Abelmoschus esculentus) as a test crop. The study revealed that the emitter has a mean discharge, emission uniformity (Eu), Manufacturers’ Coefficient of Variation (Cv), Christiansen’s Uniformity Coefficient (CUC), Distribution Uniformity (DU) and Statistical Uniformity (SU) of 1.83 l h-1, 88.12%, 0.06, 96.71%, 95.73% and 95.87% respectively at an operating pressure of 65.6 mbar, which implied that it performed creditably well in conformity to international drip irrigation standards. The system delivered the daily water requirement for okro in 14.3 min. Mean plant height, leaf area index and mean fresh fruit weight of okro at 76 days after sowing (DAS) was 1.12 m, 0.96 and 0.68 g per plant stand respectively. Crop yield of 15.1 tons ha-1 obtained indicates that the system performance is very satisfactory in comparison to okro yield in the region, while the low system cost of $1.4/m2 is very cheap for Sub-Saharan Africa. The system is recommended for use to maximize water use, enhance crop production and reduce hospital solid waste. However, for health reasons, only those drip chambers used to deliver dextrose in hospitals are recommended for reuse after sterilization.

This paper presents an efficient technique in the reduction of frequent handover for macro-femto cells in Long Term Evolution (LTE) networks. A key design feature for handover decision algorithms is to guarantee seamless handover process between wireless access technologies without degrading the Quality of Service (QoS) and Quality of Experience (QoE) of the users. There are unwanted scenarios in vertical handover schemes where due to poor handover process, frequent handovers occur resulting in wastage of network resources, handover failures, and subsequent dissatisfaction of the users. Despite a number of efforts made to mitigate this problem of poor handover, network users still experience significant degradation in call quality owing to the dissimilarities in access technologies available and the changing speed of the user. A handover decision algorithm, which is based on the user’s changing speed and network connection time, was proposed in this work and it involves the incorporation of a dwell time into a proximity model prediction technique in order to make the handover decision better. Results obtained using MATLAB R2015b version showed that the proposed algorithm attained a 77.46% reduction in the number of unnecessary handover.

As the volume of medical information stored electronically increase, so do the need to enhance how it is secured. The inaccessibility to patient record at the ideal time can prompt death toll and also well degrade the level of health care services rendered by the medical professionals. Criminal assaults in social insurance have expanded by 125% since 2010 and are now the leading cause of medical data breaches. This study therefore presents the combination of 3DES and LSB to improve security measure applied on medical data. Java programming language was used to develop a simulation program for the experiment. The result shows that medical data can be stored, shared, and managed in a reliable and secure manner using the combined model.

This study accessed the extent and determinants of poverty among local rice processors in Kwara state. Primary data were obtained through questionnaire and interview schedule. Data were subjected to descriptive statistics, Foster-Greer-Thorbecke (FGT) class of decomposable poverty and logistics regression analysis. The result of the descriptive statistics show that majority (97.5%) of the rice processors are female and substantial number (83.33%) of the rice processors do not have other source of income apart from rice processing. The result of the FGT class of decomposable poverty showed that poverty is more intense or severe in households with small household size. The results of the logit regression showed that gender (female), educational status, income and household size were significant poverty determinants in the study area. Higher educational status, larger income and larger household size are poverty reducing while increase in gender (female) is poverty enhancing. It is therefore recommended that government and other stakeholders should invest more in the education of the rice processors. The rice processors should as well be encouraged to engage secondary occupation so as to earn more income. Also, men should be encouraged to be involved in rice processing in the study area

An analysis of measured global solar radiation (GR) in Osogbo (7.77oN, 4.57oE, 288m) is presented in the form of hourly average, monthly average and percentage frequency distribution. The experimental data corresponds to a year data of 2017. The results reveal that the monthly average values of daily total radiation exhibit seasonal variation with maximum value in dry season month of March (16.59MJ/m2) and minimum value in wet season month of August (8.98 MJ/m2). The annual average GR value is 14.20 MJ/m2 while the annual cumulative GR is 5122 MJ/m2. The solar radiation climate of Osogbo has also been compared to those reported for a number of locations. The percentage frequency of days possessing irradiation rate greater than 15 MJ/m2 is 14 percent whereas that possessing less than 10 MJ/m2 is 61 percent. We conclude, based upon the above analysis that Osogbo is characterized by relatively low global solar radiation. Keywords: Global solar radiation, Cumulative frequency, Measured, Seasons

This work investigated the quality of signal strength coverage of the existing Digital Terrestrial Television (DTTV) operator in Nigeria using Startimes Ibadan as a case study. Signal strength and altitude data at different locations within a 40km radius of the Startimes transmitting station were measured to determine the quality of signal strength reception of Startime's digital television in Ibadan metropolis. A signal analyzer, a 10-meter cable, Yaggi external antenna and Global Positioning System (GPS) were used for the measurements at various locations in Ibadan within 40km radius distance of Startimes based station at Agodi in Ibadan. The city was grouped into six different zones for proper signal testing and efficient data collation. Parameters such as signal strength, distance, altitude, signal to noise ratio, modulation error rate, pre-bit error rate and post-bit-error rate were measured and recorded. The effects of distance and altitude were analyzed. It was observed from the result that there is a direct relationship between power level and altitude. In addition, there is an inverse relationship between power level and distance. Keywords: DTTV, Signal Strength, Altitude, Distance, DVB-T

Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach.Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.