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Background: Strokes occur in sickle cell disease (SCD), and are associated with significant morbidity and mortality. Objectives: To determine the prevalence of strokes amongst children with SCD, and document the major clinical features, complications, effect of treatment with chronic transfusion therapy (CTT) and outcome. Methods: A descriptive retrospective study of SCD children with strokes seen at the National Hospital Abuja, Nigeria over a 2.5 year period from January 2009 – June 2012. Data was collected by scrutinizing case files obtained from the hospital medical records unit. Information obtained included demographic data, clinical features, packed cell volume (PCV), brain imaging, long term neurologic deficits, effect of CTT, stroke recurrence and outcome. Results: There were 31 children with strokes among 596 children with SCD documented in the register, giving a prevalence of 5.2%. Twenty six (26) case notes were retrieved. There were 12 males and 14 females, M: F ratio of 0.9:1; mean age was 6.4 years (SD 3.4) range: 1 year 7 months – 14 years; mean PCV at the time of strokes was 21.1% (SD 3.9) range 14 – 29%. All (100%) had Haemoglobin SS on electrophoresis. Presentations were convulsions 18, inability to use limbs 11, weakness of limbs 10; long term neurological deficits were hemiplegia 11, cognition loss 11. Three (3) children had no deficits. Brain imaging (Computed Tomography Scan and Magnetic Resonance Imaging) done in 16 (61.5%) children showed cerebral atrophy in 10, acute cerebral infarcts in 9, chronic cerebral infarcts in 6, acute intra cranial haemorrhage in 1 and normal imagings in 4 children. Twelve (12) children (46.2%) children had recurrences of stroke ranging in number from 1 to 4, which occurred 6 months to 3 years after the initial stroke. There were no statistical significant differences between the children with recurrences of stroke compared to those without regarding the age, sex, weight or PCVs p > 0.05. Fifteen (15) children (57.7%) were enrolled in CTT. Two (2) out of 7children (28.6%) that had reglar CTT had stroke recurrence; compared to 5 out of 11 children (45.4%) with no CTT (p > 0.05). Four (4) out of 6 (66.7%) children with irregular CTT and 1 of 2 children who stopped CTT had stroke recurrence. Outcome: 17 children were alive, 7 were lost to follow up, 1 died and 1 was referred to another center. Conclusion: Strokes were an important cause of morbidity in Nigerian children with SCD, with major long term neurologic deficits. CTT appeared beneficial in preventing stroke recurrences. Primary prevention strategy by Trans Cranial Doppler ultrasound studies of the cerebral arteries, with the aim of promptly initiating appropriate preventive therapy for stroke is strongly advocated.

Background: Recurrent Respiratory Papillomatosis (RRP) is a non-cancerous tumour of the upper airway caused by the human papilloma virus, presenting as “wart-like” growth, which could be anywhere from the nose to the lungs commonly in the larynx. Design and Setting: Review of two cases at the National Hospital Abuja (NHA). Objectives: To highlight the challenges in the management of RRP. Subjects: Two patients diagnosed with RRP were referred to the paediatric respiratory clinic between 2009 and 2012. Case one is four year old female who presented with persistent hoarseness of voice, breathing difficulty and noisy breathing of one year duration. She was born at term by spontaneous vertex delivery to a mother who had vaginal warty lesion excised during pregnancy. A neck X-ray showed opacities around the laryngeal region with total obliteration of air column with histological confirmation of squamous papilloma. She had eight excision surgeries within a two years period with treatment with oral acyclovir, interferon, and methotrexate and tracheotomy tube in situ. Case two, a six year old female presented with persistent hoarseness of voice that progressed to loss of voice, noisy and difficulty in breathing, snoring and frequent arousal from sleep of 1½ years. Histology was diagnostic of laryngeal Papillomatosis and she had two excisions surgeries and treatment with oral acyclovir and tracheotomy tube in place. Conclusion: RRP though a slow growing tumour, presently has no definitive cure. Excision surgeries provide temporal relief and antiviral agents adjuvant therapies. Prevention with vaccination is desirable.

Objective: To determine the prevalence and pattern of malnutrition among adolescents in senior secondary schools in The Abuja Municipal area council Methods: Study design: this is a cross-sectional study conducted among adolescents (10-19 years) in secondary schools. A multistage sampling technique was employed to select a total of 1700 students from classes in selected schools. All schools in the Abuja Municipal Area council (AMAC) were stratified into urban and rural schools. Eight schools were selected by balloting from a list of schools obtained from the Education centre. A school was selected from each of the four major districts of AMAC and four schools were selected from the rural making a total of 8 schools. Although the consent of the school authorities was obtained, individual subject also consented to the study before being enrolled. The study excluded those adolescents who were physically challenged thus limiting physical activity. Information was obtained via the use of questionnaires that were administered by rained personnel. Subject’s height and weight was taken using the floor-type height (H) and weight (W) measuring scale model ZT-120 using Massachusetts department of public health protocol. The nutritional status was determined using the formula: BMI= W/H2 , where W =weight (in kilograms) and H= height (in meters). The age and sex specific height and BMI percentile for each subject was determined using the 2007 WHO Height and BMI growth charts for age 5-19years. The students were then classified into one of the following categories using previously used standards: normal, stunted, wasted, overweight or obese. Data was analyzed using SPSS version 17 statistical package. Results: The mean age was 14.43±1.94 years; male 688, female 862, M:F ratio 1.1.3. Mean BMI, weight and height were 20.31±3.07kg/m2, 51.07± 10.80 kg, and 157.88±9.33 cm. The prevalence of wasting, stunting, overweight and obesity was documented as 1.7% (27/1550), 11.3% (175/1550), 13.2% (205/1550), and 2.6% (41/1550) respectively. Those in urban schools had higher mean BMI (20.91±3.22 kg/m2 versus 19.71±2.78 kg/m2) and height (160.41±9.14 cm versus 155.32±8.81 cm) and p values

Background: There is a growing awareness and demand for quality health care across the world; hence the need to describe the level of health care and services provided to meet the patient centered care by the frontline stakeholders. Aim of study: To determine the current level of care provided in a tertiary hospital in a developing country setting. Study design: prospective, descriptive and questionnaire based survey. Methods: The study was conducted at the National Hospital Abuja, a tertiary care setting in Nigeria. 157 health workers were enrolled, who responded to questions on the clinical, support and corporate services of the hospital. Response were either yes, no or do not know. The result were analyzed and presented in tables and charts. Results: Of 157 respondents, 66 males (42.0%) 91 females (58.0%). Doctors and nurses formed 64.3% of the study population. 114 (72.6%) of the health staff agreed that patients received appropriate medical needs and treatments, 118 (75.2%) that care was planned with patient involvement, 107(68.2%) that patients were informed of results and final care processes, 127 (80.9%) that patient were aware of consent processes and 112 (71.3%) that patients at discharge were aware of their ongoing and subsequent care. 90 (57.3%) of the respondents agreed that the patients records were accurate with patients’ participation and medications well managed to prevent errors and adverse reactions (75.2%). Infection control and routine surveillance were low. Safe blood sample collection measures (74.5%), measures to reduce break in skin integrity (77.7%), and bed sores rare and effectively managed (38.9%).Some agreed that patient received appropriate nutrition (58.0%). Information on patients’ rights and responsibilities, and continuous quality control measures rates were low. Others were adverse incidences reported and treated (50.3%), feedbacks mechanism (66.9%) and complaints management rates (54.8%). Hand washing practice rates were low among doctors and nurses and patient relatives. Staff rated that both workforces planning that supported needs and recruitment and appointment systems low.Records were not updated to meet with international standards (ICD- 10); (22.9%) and had low rates for use in future purposes. Also low were the level of medical and environmental research, informal relationship and security, but the management had a high level of social responsibility in form of emergency and disaster management to the immediate community; (83.4%). Conclusion: Health workers agreed that some of the patients’ needs were met.

Background: Adolescents with tuberculosis (TB) form a significant proportion of childhood TB cases presenting with specifics clinical patterns. Objective: To describe the clinical resentation of tuberculosis in adolescent at National Hospital Abuja (NHA), Nigeria. Subjects and method: This is a descriptive and retrospective study of adolescents aged 10- 15 years seen at the department of Paediatrics NHA Nigeria from August 2009 to July 2013. Result: Thirty- six adolescents diagnosed with tuberculosis were reviewed. Adolescent TB accounted for 18.8%(36/192) of total cases of children aged 0- 15years seen at the Department of Paediatrics Respiratory Clinic during the study period. The mean (SD) age was 12.3(1.76) years. Twenty seven patients (75.0%) were females and 9(25.0%) were males. Thirty (83.3%) were of lower socioeconomic class. History of contact with a case of TB was obtained in 17(47.2%). The commonest symptoms identified in these adolescents were; cough 27(75.0%), weight loss 22 (61.1%), fever18(50.0%), sputum 14(38.9%), body swelling 7(19.4%), emoptysis 2(5.6%); while signs were underweight, pyrexia and chest findings. Nine (25.0%) had associated retroviral disease. Thirty four (94.4%) presented at time of diagnosis with clinical symptoms while 2(5.6%) were asymptomatic; identified during contact tracing as latent TB infection (LTBI). Abnormal chest radiograph findings were; widespread lung infiltrate in 10(27.8%), hilar opacities 7(19.4%), cavitatory lesions 4(11.1%), pleural Effusion 3(8.3%) and military opacities 1(2.7%). AFB was isolated in 5(13.9%), while 23(63.9%) had a raised ESR above 30mm/hr. Twenty seven (75.0%) of the adolescents completed treatment for tuberculosis, 7(19.4%) were lost to follow up and 2(5.6%) died while 4(11.1%) had re-treatment for TB from relapse. Clinical presentations were pulmonary TB (PTB) 22(61.1%), and extrapulmonary TB 12(33.3%); distributed as TB adenitis 4(11.1%), TBM 3(8.3%), Pericardial TB 3(8.3%), Miliary TB 1(2.8%) and Spinal TB 1(2.8). Of the nine with HIV- TB coinfection, the clinical presentation were; PTB 5(55.6%), and extrapulmonary 4(44.4%). Conclusion: The patterns of TB in adolescents are admixture as seen in younger children and adult from clinical and radiological characteristic findings. TB remains a preventable disease condition and is curable with early appropriate treatment

Background: The global disease burden associated with bronchial asthma has continued to increase particularly among children. Asthma-related quality of life is a health related assessment of disease impact on patient and care givers. Aim: To determine the perceived quality of life (QOL) among children with bronchial asthma and their caregivers as well as the related factors. Subjects and methods: This was a prospective study of children diagnosed with bronchial asthma and the caregivers attending the Respiratory Clinic of the National hospital Abuja, Nigeria. Using the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) information from the various domains was obtained. The PAQLQ 23 questions assessed the child physical domain (5), emotional (8) and social behaviors (10), and the PACQLQ 13 questions assessed the caregivers’ activity limitation domain (4) and emotional function (9).Mean QOL scores from each domain and overall scores were calculated based on a seven-point scale. A QOL score of 7 was reported as best with no impairment; score one as least and severest impairment; score 4 as mid point in the range from 2-6 of moderate degree impairment. Other information on the demographic biodata and clinical information from child and caregivers was also obtained. Results: Forty-three children and 43 caregivers each were enrolled, from August to December 2014. Patients were aged 7-15years; 25(58.1%) males, 18(41.9%) females; while caregiver’s were males 23(53.5%), females 20(46.5%), age range 21- 48years. 25(58.1%) caregivers were of middle- lower socio-economic status; 20(46.5%) children had persistent asthma, 22(51.2%) well controlled, 21(48.8%) partly controlled. Medication use were; none, 17 (39.5%); long acting beta2 agonist/ inhaled corticosteroids (LABA/ ICS), 13(30.2%); antihistamine, 8 (18.6%); leukotriene receptor antagonist (LTRA),5(11.6%). Overallmean QOL was 4.89(4.54- 5.24;95% CI) for the children and 4.6 (3.91- 4.82; 95% CI) for caregivers; correlation (R) 0.438 p=0.003.Mul t iple regression showed that females gender had significant impairment in mean QOL scores in the activity domain (p= 0.022), and those with poor control and severe asthma also had significant impairment in mean QOL (p

Background: Diseases of the liver contribute to childhood morbidities and mortality. Early recognition and proper management of liver diseases can limit the progression to irreparable damage which requires liver transplant. However, there is scarcity of data in the pattern of liver disease in Nigerian children. Objective: To describe the pattern of paediatric liver diseases among children seen at the National Hospital, Abuja. Methods: A retrospective, descriptive study conducted at the Paediatric Gastroenterology, Hepatology and Nutrition (PGHAN) clinic and the Emergency Paediatric Unit (EPU) of National Hospital Abuja, over a 5- year period (2009 – 2014). The diagnosis of liver diseases was made from clinical and laboratory features. The data extracted from the retrieved hospital records were analyzed. Results: Forty-two out of 52 documented cases were analyzed. The children were aged 2 months to 15 years ith the mean of 7.24 ± 4.77 years. Twenty-six (62.0%) were aged >5 years (p>0.05). They comprised 31 (73.8%) males and11 (26.2%) females; 28 (66.7%) belonged to the lower socioeconomic classes while 23 (54.8%) had various forms malnutrition. Common symptoms included jaundice (30; 71.4%), abdominal pain (17; 40.5%), fever (15; 35.7%), abdominal swelling (12; 28.6%) and bleeding (8;19.0%). The signs included jaundice (30; 71.4%), hepatomegaly (16; 38.1%) and splenomegaly (8; 19.0%). Twenty-four (57.1%) had chronic viral infections while the others included neonatal hepatitis syndrome and biliary atresia (6; 14.3%), acute hepatitis (6; 14.3%) and chronic hepatitis of unidentified aetiology (4; 9.5%). Overall, the mean values of the liver enzymes and serum bilirubin were elevated while the mean values of total serum proteins and albumin levels were reduced. Five (11.9%) children improved and were discharged, 15 (35.7%) were lost to follow up with three deaths. Conclusion: Risk factors associated with liver diseases in this study included age over 5 years and lower socio-economic classes. Jaundice was the commonest clinical presentation while the most common aetiology was chronic Hepatitis B virus infection.

Background: Childhood Acute Lower Respiratory Tract Infection (ALRTI) remains an important public health problem in the developing world, with significant morbidity and mortality a challenge. An understanding of risk factors in the development of childhood ALRTI may offer clues to prevention of the disease; identify conditions that lead to progression to severe disease, complications and even death in a child receiving treatment. Aim: to determine risk factors for ALRTI among Under five children hospitalized. Methods: A prospective study of children aged 2-60 months admitted into hospital with diagnosis of pneumonia and bronchiolitis from November 2011 to September 2012 at the National Hospital, Abuja, Nigeria. With a questionnaire data on socio- demographic and potential risk factors for ALRTI were obtained. Results: A total of 50 children aged 2-60 months were enrolled, 92.0 % had pneumonia while 8.0% had bronchiolitis. 86.0% of pneumonia subjects were 24months and below, while all those with bronchiolitis were infants. 43(86.0%) of subjects were hospitalized in the rainy season. The weights for height z score was less than minus 2 in 12 (24.0 %) of the subjects. Significant risk factor for ALRTI was the use of kerosene and solid fuel for domestic cooking, 33 (66.0%), p value 0.0001; Mortality was four percent among the infants. We conclude that younger ageunder 24 months and exposure to hydrocarbon and biomass from indoor pollution was contributing risk factors for ALRTI in Under five children.

Background: Dietary intake assessment is essential to understanding the nutritional status. Healthy eating pattern promotes optimal health, growth and intellectual development and prevents diseases, while poor dietary eating choices may cause malnutrition. Aims: To determine the dietary eating patterns and nutritional status among adolescents in secondary schools within Abuja Municipal area council (AMAC). Subjects and Methods: cross- sectional among adolescents, 10 – 19years in secondary schools within AMAC, Nigeria. Using a multistage stratified sampling technique, four urban and four rural schools, 1550 students, were enrolled. Subject’s bio data, dietary habits and knowledge of nutrition and general physical examination were obtained. Dietary assessment included intake of main meals (breakfast, lunch and dinner), skipping meals; methods used to control weight in the previous 30days; knowledge and preference of a balanced diet and food choices. Subject’s height and weight and Body Mass Index (BMI) were determined using the 2007 WHO charts. Data was analyzed using SPSS version 17 statistical package and p value less than 0.05 was significant. Results: 1550 students were recruited, males 688 (44.4%) and females 862 (55.6%); mean age 14.43±1.94 years. Of the 780 urban adolescents, 502 (64.4%) were of upper class and 68 (8.7%) lower class; and of the 770 (49.7%) rural, 206 (26.8%) and 232 (30.1%) belong to upper and lower class respectively, p=.000. Stunting 174(11.2%) and overweight 195(12.6%) were the major forms of malnutrition recorded. Food preferences was based mainly on good taste in 546 (35.2%), balanced diet 530 (34.2%); and 539 (34.8%) had good nutritional knowledge of a balanced diet. Five hundred and forty six (35.2%) admitted to taking carbonated drinks within the previous 7days and 147 (9.5%) missed breakfast, lunch and supper as single meal. Breakfast only was skipped by 71(4.6%) while 160 (10.3%) took lunch outside the home. The methods used to control weight were eating less food or fats, fasting, use of diet pills, inducing vomiting/use of laxatives. Skipping meals and taking meals outside the home was significant for the sex, (p value

Background: Alagille syndrome (AGS) is a rare cause of prolonged jaundice. It has an autosomal dominant inheritance pattern expressed variably, with a reported incidence of 1:100,000 live births in the United States. The objective is to highlight the clinical features and diagnostic challenges to this rare cause of cholestatic jaundice. Case Report: T.O, Female 11 years, had a history of recurrent episodes of yellowness of the eyes, first noticed soon after birth, associated with pale stools, dark urine, and body itching. From age three she was noticed to have progressive loss of sight, recurrent body swellings and irrational talks. She was diagnosed to have a cardiac murmur at age six, when diagnosis of ALS was made due to features of, recurrent jaundice and perculiar facies of broad forehead, flat nasal bridge, prognathia and genetic report of no mutation in JAG 1 gene, karyotype 46XX. At the time of current hospital admission she was in addition small for age, had hepatosplenomegy, ascities and talked irrationally. Chest radiograph showed multiple butterfly vertebrae; Echocardiograph aortic and pulmonary stenosis; Liver aminotransferase were marked elevated. Brain MRI showed multiple chronic infarcts. She was diagnosed with Allagille syndrome presenting in hepatic failure with encephalopathy. Conclusion: Allagille syndrome should be considered early in older children with persistent cholestatic jaundice.

Background: The young child can be at risk of accidental poisoning because of its being very inquisitive to mouth objects. The prevalence and types of poisoning vary within Nigeria and different parts of the world. Aim: To describe the socio- demographics, clinical features and outcome in childhood poisoning seen at the National hospital Abuja (NHA) Nigeria. Subjects and Methods: A descriptive prospective study on children admitted for acute poisoning from September 2014 -August 2016. Consecutive children with a history of poisoning were recruited during the study period. The children were examined, and poison severity scores were recorded into a proforma, and followed up till discharge or demise. Results: Twenty-two children were admitted for acute poisoning, out of the 2336 children seen during the study period, with a prevalence rate of 0.94%. Fourteen (63.6%) were of upper social class, with 12 (54. 5%) mothers having tertiary level education. The mean time (±SD) of presentation was 11.9 ± 23.9 hours, while the mean (SD) duration of hospital stay was 4.8 ± 6.2 days; hospital stay was significant with types of poisoning (Fisher exact test 22.062, p

Background: Malnutrition is pervasive among displaced populations worldwide. Adequate nutrition is essential to the growth and development of all children, particularly in the preschool age. Methodology: This cross-sectional study was conducted in four internally displaced person (IDP) settlements and their host communities within the Abuja municipal area council between April and May 2019. Using a multistage sampling method, subjects were recruited after parents’ informed consent, from the IDP settlements and equal numbers were drawn from their host communities. The proportion of acute malnutrition using weight for height, MUAC, BMI-for-age Z scores were compared to the 2006 WHO standards. Predictors were determined by logistic regression and statistical significance was set at p less than 0.05. Results: There were 1,179 children aged six to 59 months recruited in each group. The prevalence of wasting was 7.7% (91), moderate acute malnutrition was 7.2% (85), and severe acute malnutrition was 3.1% (37) among the IDPs while they were 7.1% (84), 6.5% (77) and 2.9% (34) respectively in the host communities. The predictors for wasting in both groups were age below 24months (Adj OR, 95% CI - 3.88, 2.38 - 6.32), low birth weight (Adj OR, 95% CI – 2.70, 1.55 – 4.71) and diarrheal disease (Adj OR, 95% CI - 5.45, 2.38 - 12.44). Location was predictive only in the host communities (Adj OR, 95% CI – 2.69, 1.37 – 5.28). Conclusion and recommendation: Acute malnutrition was high among the pre-school children in this study. The nutritional needs of displaced children in the FCT should be met and their families educated on prompt recognition and treatment of diarrhoea.

Objective The object of this study was to investigate the effect of replacing soybean meal with Clostridium autoethanogenum protein (CAP) in broiler diets on growth performance, blood indicators, antioxidant capacity, and immune function. Methods A total of 180 Arbor Acres broilers were randomly divided into three treatments, each treatment with six replicates and 10 broilers per replicate for a 42-day feeding trial. The control group (CON) was fed corn-soybean meal based diet. The CAP-1 and CAP-2 groups were considered to use CAP to replace 25% or 50% of soybean meal in the diet, respectively. The average daily gain and average daily feed intake of broilers at 1 to 21 d, 22 to 42 d, and 1 to 42 d were measured, and the feed conversion ratio was calculated. At the 42nd day of age, two broilers with similar weights and fasted for 12 h were selected in each replicate for blood collection from the brachial wing vein. The blood routine indicators, serum biochemical indicators, serum antioxidant capacity, and immunoglobulin content of broiler chickens were measured. Results Replacement of soybean meal with 25% (CAP-1) and 50% (CAP-2) CAP significantly increased the average daily gain of 22 to 42 d and 1 to 42 d and decreased the average daily feed intake and feed conversion rate (p

Background: Atherosclerosis is a multi-factorial disease, and low-density lipoprotein cholesterol (LDL-C) is a critical risk factor in developing atherosclerotic cardiovascular disease (ASCVD). Cholesteryl-ester transfer-protein (CETP), synthesized by the liver, regulates LDL-C and high-density lipoprotein cholesterol (HDL-C) through the bidirectional transfer of lipids. The novelty of CETP inhibitors (CETPis) has granted new focus towards increasing HDL-C, besides lowering LDL-C strategies. To date, five CETPis that are projected to improve lipid profiles, torcetrapib, dalcetrapib, evacetrapib, anacetrapib, and obicetrapib, have reached late-stage clinical development for ASCVD risk reduction. Early trials failed to reduce atherosclerotic cardiovascular occurrences. Given the advent of some recent large-scale clinical trials (ACCELERATE, HPS3/TIMI55-REVEAL Collaborative Group), conducting a meta-analysis is essential to investigate CETPis’ efficacy. Methods: We conducted a thorough search of randomized controlled trials (RCTs) that commenced between 2003 and 2023; CETPi versus placebo studies with a ≥6-month follow-up and defined outcomes were eligible. Primary outcomes: major adverse cardiovascular events (MACEs), cardiovascular disease (CVD)-related mortality, all-cause mortality. Secondary outcomes: stroke, revascularization, hospitalization due to acute coronary syndrome, myocardial infarction (MI). Results: Nine RCTs revealed that the use of a CETPi significantly reduced CVD-related mortality (RR = 0.89; 95% CI: 0.81–0.98; p = 0.02; I2 = 0%); the same studies also reduced the risk of MI (RR = 0.92; 95% CI: 0.86–0.98; p = 0.01; I2 = 0%), which was primarily attributed to anacetrapib. The use of a CETPi did not reduce the likelihood any other outcomes. Conclusions: Our meta-analysis shows, for the first time, that CETPis are associated with reduced CVD-related mortality and MI.

Introduction The English National Health Service (NHS) Diabetic Eye Screening Programme (DESP) performs around 2.3 million eye screening appointments annually, generating approximately 13 million retinal images that are graded by humans for the presence or severity of diabetic retinopathy. Previous research has shown that automated retinal image analysis systems, including artificial intelligence (AI), can identify images with no disease from those with diabetic retinopathy as safely and effectively as human graders, and could significantly reduce the workload for human graders. Some algorithms can also determine the level of severity of the retinopathy with similar performance to humans. There is a need to examine perceptions and concerns surrounding AI-assisted eye-screening among people living with diabetes and NHS staff, if AI was to be introduced into the DESP, to identify factors that may influence acceptance of this technology.Methods and analysis People living with diabetes and staff from the North East London (NEL) NHS DESP were invited to participate in two respective focus groups to codesign two online surveys exploring their perceptions and concerns around the potential introduction of AI-assisted screening.Focus group participants were representative of the local population in terms of ages and ethnicity. Participants’ feedback was taken into consideration to update surveys which were circulated for further feedback. Surveys will be piloted at the NEL DESP and followed by semistructured interviews to assess accessibility, usability and to validate the surveys.Validated surveys will be distributed by other NHS DESP sites, and also via patient groups on social media, relevant charities and the British Association of Retinal Screeners. Post-survey evaluative interviews will be undertaken among those who consent to participate in further research.Ethics and dissemination Ethical approval has been obtained by the NHS Research Ethics Committee (IRAS ID: 316631). Survey results will be shared and discussed with focus groups to facilitate preparation of findings for publication and to inform codesign of outreach activities to address concerns and perceptions identified.

This study explored the experiences of inclusion and exclusion of African academics in Norway in various sectors of the society and their participation in these sectors. Using a mixed method research approach, 166 African academics completed a 20-item questionnaire entitled Perceived Exclusion Scale (PES) and two open-ended questions about their mental effects and coping mechanisms of exclusion. Descriptive statistics and qualitative analysis procedures were used to analyze the data. The results showed that the participants experienced exclusion in almost all the sectors of the Norwegian society with concomitant effects of depression and insomnia for most of the participants. Participants mentioned acceptance, confrontational strategy, avoidance strategy, theological group discussion and positive attitudes as key coping mechanisms to exclusion and discrimination. This study could be used as a baseline for future research on the psychological and mental health effects of discrimination of Africans and African-Norwegians. The study is a pointer to the public discourses on the positive sides of immigration in general and the role of migrants' contribution to the Norwegian society.

Online education presents itself as an option that can yield benefits for developing countries like Pakistan. The education sector of Pakistan was greatly affected due to the pandemic that forced the schools' operation to be run online like many other businesses and industries which provided the researchers and policy makers with a chance to study the possibilities associated with online education in the Pakistani context. This study focuses on researching the effects this transition had on parents by measuring their satisfaction levels. The instrument used to collect quantitative data for this study includes categories, school-level technological support, schoollevel instructional support, curricular programs, social interaction and overall satisfaction with the online education. Differences of parental satisfaction in these categories and the factors that influence them such as school fee, educational levels of parents and number of enrolled children per family have been studied. The findings revealed that parents are satisfied given the challenges and hurdles that schools have faced transitioning from on-campus to online education. A few significant differences were found between number of children enrolled in online education and parental satisfaction with technological support as well as social interaction. Significant differences were also found between school fee and parental satisfaction with curricular programs. These findings provide us with future directions for further research in the direction of integrating online education in Pakistani school setting.

The use of language in digital discourse for marketing has rapidly developed through mass media. This paper elucidates how advertisers employ various pragmatic strategies to persuade the recipient to act (behavior) by purchasing specific products. This study utilized different theoretical and conceptual frameworks (Theory of Reasoned Action and Aristotle's Models of Persuasion) to address the shortcomings of the social cognitive approach in studying persuasion, to investigate how language of advertisements can influence the recipient's thinking of a product from a psychological perspective. Guided by the principles of TRA, the present study argues that persuasion in advertisements is structured by three dimensions: attraction (through language features and appeals), evaluation (through beliefs, attitudes, and intention), and behavior (social acceptance or reluctance). This study revealed eight persuasion techniques employed by advertisers including demonstrating distinction, honoring commitment, expressing authority, hyperbolizing, glorification, providing proofs, expressing solidarity, and proving success. Showing distinction and Honoring commitment were the most frequently used strategies. Additionally, the study found that strategies of persuasion involved ethical, logical, and emotional appeals for their large effect on the recipient as they contribute to the recipient's positive evaluations. Appealing to reasoning (logic) is the most common one in slogans.

This study aimed at investigating the impact of story-based extracurricular tasks on enhancing the speaking skills of EFL learners. The parameters of grammar, pronunciation, vocabulary, and fluency were examined. A pre-test/post-test one shot case study design was adopted. A sample of 20 students, enrolled in the common first year program at Jouf University, Saudi Arabia, participated in the study. The results showed that learners' speaking skills improved due to the use of the story-based extracurricular tasks. Findings also showed that the highest improvement in students' speaking skills was in pronunciation, followed by vocabulary, and then, grammar. Fluency was the least improved skill. The study recommends the incorporation of story-based extracurricular tasks in EFL programs for enhancing speaking skills. Educators should choose culturally relevant stories that correspond to the learners' proficiency level. They should involve students in conversations and arguments about the stories, prompting them to examine the themes and implicit messages. This study also recommends to use other resources such as language games, quizzes, and dramatization for enhancing speaking skills of EFL learners.

The English reading ability of university students is crucial for their academic achievement, regardless of whether they are studying English or any other subject in English. Examining the affective factors that influence this ability is critical for understanding its development. Research has been conducted on the correlation between first language (L1) and English as a second language (ESL/EFL) reading attitudes, but there is limited research on the correlation between L2 and L1. This research seeks to investigate the similarities in reading perspectives between Arabic-speaking international students and English-speaking university students. The study employed surveys and semi-structured interviews to evaluate individuals' viewpoints on bilingual reading. The objective was to assess individuals' attitudes towards reading in two languages. Both quantitative and qualitative analyses were conducted. The study revealed that students' reading preferences remained consistent across different languages. However, the relationship between second-language reading attitudes and first-language reading attitudes was found to be minimal. The implications of the current study suggest that enhancing reading attitudes in both languages may enhance reading ability. The study utilised subjective data and targeted a specific demographic, limiting its generalizability to more diverse student populations.

This research examines the effects of technostress on educators' productivity within Jordan's higher education sector, highlighting gender differences. Technostress, characterized by techno-overload, techno-invasion, techno-complexity, techno-insecurity, and techno-uncertainty, adversely affects productivity. The study gathered data from 500 educators through a structured online survey, achieving a 73% response rate. Analysis revealed that technostress generally decreases productivity, with a more pronounced negative impact on male educators than females. The findings underscore the necessity for targeted interventions to mitigate technostress, particularly among male educators. Strategies recommended include training programs, policy adjustments, and organizational support to enhance the digital teaching environment. This study contributes to the understanding of technostress in Jordanian educational settings. It offers practical recommendations for enhancing e-learning practices and improving the overall educational experience and productivity in Jordan's higher education sector.

It is widely acknowledged that the relationship between education, security, and stability is bidirectional. In times of war, access to quality education becomes compromised, and conversely, the absence of proper education constrains individuals to a life under constant threat, disrupting education provision. War, viewed as a "lifetime and life-wide status," evolves into a self-fulfilling prophecy, both at an individual and collective level, making it challenging to break free from, particularly within the broader context of education provision. Although, scant information exists about how education is maintained during wars, hindering the right to education in such contexts. This study therefore addresses this gap by synthesizing the literature to identify and present 14 educational scenarios and teaching strategies on how education was maintained from different war contexts over time. The findings reveal that education during wars can be digital-based (i.e., facilitated by technology) and non-digital based (without technology). Additionally, various teaching strategies are applied during wars, including inspirational, hands-on and practical, fun-based, among others. Finally, teaching during wars is not limited to teachers only, but it could also involve parents, neighbors, etc. The findings of the literature can help to ensure the right to education in crises like wars and reveal the importance of open education in such crises. They can also contribute to enriching the ongoing theoretical and practical debate on how to maintain education in crises like wars. This can help to better be prepared for future education in crises, which is the focus of several international organizations.

While examining the findings, this study concentrated on academic success, critical thinking, and motivation for demonstration. Secondary school students studying English are involved in digital story-telling research. A quasi-experimental approach was employed in the research with 48 11th grade students who took pretests and posttests. Teaching as DST in the experimental group and teaching as teaching in the control group were the two degrees of CT-integrated instruction that were used. Gather both quantitative and qualitative information, such as responses to academic questions and the outcomes of tests of English language and cognitive skills. Through the addition of unique cultural narratives with a Palestine focus, the work advances the DST tradition. This program sheds information on how learning outcomes for students are impacted by daylight saving time. Because ANCOVA yields effective and objective results, it was utilized in the data analysis process.

This research examines the factors that influence students' choices to pursue Science, Technology, Engineering, and Mathematics (STEM) degrees in the United Arab Emirates. Our study investigates the impact of psychosocial variables, including math anxiety, educational stress, and family expectations, on the decision of 558 children to pursue STEM education. We have discovered that there is a positive correlation between greater levels of school stress and parental expectations and the possibility of enrolling in STEM fields. Moreover, gender appears as a notable indicator, as males have a greater propensity towards STEM. The study emphasises the necessity of implementing comprehensive treatments to tackle math anxiety, educate parents about STEM jobs, and offer efficient stress management assistance for pupils. The implications have a wide reach, including politicians, educators, and parents that aim to foster a varied and driven community of STEM students in the UAE. Additional investigation is advised to explore the complex interactions of psychological elements that influence educational decisions.

Background: Layperson cardiopulmonary resuscitation (CPR) is an important skill with the potential to save millions of lives. However, CPR courses often require commercial, complicated, and expensive manikins. To increase access to CPR training worldwide at very low costs, Do-It-Yourself (DIY) devices may be a suitable tool for practising compressions. Objective: This scoping review is the first step in scoping and mapping the evidence on the effectiveness of DIY devices for laypersons learning adult CPR, along with defining gaps for future research. Method: This inquiry was structured by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search of 14 academic databases and popular media archives, with additional hand searches, identified academic reports and resources describing DIY compression device construction and/or implementation. Research studies were synthesized narratively, and the main characteristics of all resources were presented in a table. Results: Fifteen studies compared learning outcomes of CPR practice either pre-post DIY practice or between DIY and commercial manikins. Studies varied in the intervention (e.g., learning modality, time, manikin) and measurement, which precluded formal meta-analysis. Of the 55 different DIY devices described throughout all resources, 26 (47.3%) used plastic bottles for compression practice. Analysis of the resources revealed gaps in the current evidence base, such as a lack of clear assessment criteria, standardized procedures for comparisons, and sociocultural questions. Conclusion: This scoping review has identified a small number of studies which described different DIY devices for learning basic CPR skills to different extents. While there is a need for a more comprehensive search and full systematic review, the findings serve as a starting point for future investigations and support evidence-based choices regarding DIY manikins for teaching adult CPR.

This study investigated the degree of practicing soft skills by science teachers using the descriptive approach. To achieve the study's objective, an observation card was developed. It was used to monitor three lessons for each subject (n=60) science teachers, who were distributed into six groups according to work experience and educational qualification, in the Directorate of Education of Bani Kinanah District in Irbid Governorate. The results showed that science teachers practice soft skills such as communication, problem-solving, negotiation, planning and time management, teamwork, leadership, and critical thinking to a high degree, with an explained variance (9.13%), on all dimensions of the observation card. However, the results also indicated statistically significant differences ([alpha] = 0.05) between the arithmetic means of the teaching practices of soft skills among science teachers resulting from the different levels of educational qualification and teaching experience. Thus, teachers with educational qualifications typically practice soft skills to a greater extent with an average level of (14.48%) than their peers without educational degrees. Teachers with advanced experience are more likely to exercise soft skills with an average level of (11.73%) than their counterparts with medium and simple experience. Therefore, the study recommended including soft skills practice as a university course, endorsing it in universities, and continuous training for science teachers on teaching practices for soft skills through training courses and workshops.

This research aimed to identify the role of the secondary school in confronting cyberterrorism in the kingdom of Saudi Arabia. The research used the descriptive approach with a questionnaire to achieve the aim of this study. The questionnaire consisted of (37) statements which are distributed for four dimensions which are: the role of each teacher, the role of the school administration, the role of school courses and activities and the role of the school counselor in confronting cyberterrorism. The research revealed a great important role of the school in confronting cyberterrorism with a mean of (3.62) as it came after the role of school courses and activities which was followed by the role of the teacher, the role of the counselor, and the role of the school administration came last. In addition, the research recommended of developing the role of the school in confronting cyberterrorism by various thoughts, activities, and suggestions.

The ongoing underrepresentation of Iraqi school students in science, mathematics, and PE (physical education) (SMPE) in general, and especially in PE demonstrates the need to develop and implement strategic high impact practice, such as new effective teaching strategies that not only improve students' academic outcomes but also foster student development holistically. In Iraqi schools, there is a need to help students persist and remain interested in their discipline and academic level; hence, this study aims to explore the effects of various PE STA (spectrum teaching approaches), the TGFU (teaching game for understanding), and TTA (traditional teaching approach) on intermediate school students' HBS (basic handball skills). A total of 90 male students participated in the present study. In EGs (experimental groups), the STA and TGFU were employed for EG1 (experimental group one) and EG2 (experimental group two), while the TTA was used for CG (control group). The results of the SPANOVA test showed a significant effect of the STA and TGFU approaches in enhancing the BHS in favour of the STA. However, there were no statistically significant differences in the interaction between Test time and teaching groups. The value of research does not require only coming up with solutions to a problem (under study) but also revealing new concerns worthy of investigation and analysis, such as investigating this tool's effectiveness in teaching other sports.

The experiences of students with disabilities are the focus of the study, guided by the research question: What can we learn about inclusive formative assessment in work-integrated learning (WIL) from the experiences of students with disabilities? The capability approach was drawn on to theorize how inclusive formative assessment in WIL could contribute to students' success and well-being. Five narrative interviews with six students were conducted over the course of their first year. The study found that students valued formative assessment tasks that combined engaged learning with preparation for working life. Formative assessment provided opportunities to showcase strengths and develop areas of weakness in a safe space. Above all, students appreciated lecturers who adapted assessment tasks to their needs. The study contributes to an understanding of inclusive formative assessment from the perspectives of students with disabilities and diverse learning needs.

This study is focused on promoting self-reflection and self-regulation of learning through the use of digital tools to improve the academic performance of university students. Specifically, the main objective is to evaluate the impact of the use of collaborative ePortfolios on facilitating the comprehension of the concepts being studied. During the 2021/2022 academic term, a voluntary survey was administered to 60 students in the Adaptation Course of the Primary Education Degree Program. Through a structural equation analysis, a theoretical model was analyzed in which the intensity of participation in the ePortfolio appears as a mediating variable between the different independent variables and the improvement in academic learning. The results of the study confirm this mediating function for some variables, while at the same time they show a direct positive relationship between the intensity of participation in the ePortfolio and comprehension of the course concepts. The findings of this study can have important implications for the promotion of digital tools, such as ePortfolios, to improve learning in the university context. In addition, the work offers methodological alternatives to the recurring problem of analyzing complex relationships (both direct and indirect effects) with small samples.

The metaverse has the potential to revolutionise education in several ways. It can provide students with immersive learning experiences, allowing them to explore and interact with virtual worlds and objects that are difficult or impossible to replicate in the real world. Yet, studies investigating the impact of the metaverse on students' skills and performance are limited due to its novelty. The key objective of the current research is to unveil the overall effect size of integrating metaverse technologies into educational contexts and the significance of several factors that could influence the effectiveness of such technology on the learning ecosystem. The research as adopted the quantitative research methodology to address the research questions, which focused on following the principles of meta-analysis with calculating the effect size of relevant studies, by mainly using PRISMA. It an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. Accordingly, twenty-four experimental studies conducted between 2020-2023 were statistically analysed. The results have explicitly that employing the metaverse generally has a large effect size (d=0.94) on learning, indicating that integrating the metaverse in educational settings can significantly enhance students' performance. Other variables, such as educational level, skills targeted, subject taught and technology used, were also investigated. A discussion of these findings and their implications are presented.

Transferable skills are embedded within assessments throughout Higher Education such as organisation, timekeeping and working as part of a team (during groups assessments) amongst some of the skills. Despite this, there is little evidence to suggest that students are fully aware of the importance of reflective practice upon their personal development as a possible transferable skill. In this study, we aimed to assess if and what students understood by the term 'reflective practice', and whether they identify its practice and benefits within their studies and for their potential future careers. Quantitative data, was collected during the first teaching block of the 2021-2022 academic year using specific reflective based questions in a paper-based questionnaire, with results indicating that students who undertook our foundation route, which instilled reflective practice-based assessments were more used to reflective practice than standard degree entry students, and emphasised skill development through reflection; confidence to tackle new task (38%), time management (25%), effective communication (25%) and prioritising tasks (13%). The data also suggested that across all levels of our degrees, students preferred to reflect once feedback of an assessment was received (60%) and after personal tutor meetings (43%), meaning, we as an institution should adapt our practice to develop this further. Embedding reflective practice early in a student's educational curriculum, could therefore enhance how students approach their course, by providing them with key reflective based skills which they can transfer to their journey within Higher Education and their career.

Intussusception, defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one, is a rare cause of abdominal pain in the adult population due to underlying benign or malignant pathology. With the liberal use of CT in the evaluation of patients with abdominal pain, the diagnosis became more reliable. Resection of the bowel segment is the recommended treatment in most cases. We are presenting the case of a 76-year-old male patient who presented with a three-week history of abdominal pain and diarrhea. The evaluation was consistent with ileocolic intussusception. Robotic resection of the right colon was performed. Pathology revealed poorly differentiated adenocarcinoma of the cecum as the underlying pathology.