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Background This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels. Methods and findings A cohort of individuals aged [greater than or equal to]18 years in England with records in the primary care-COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band. A cohort of 49,303,410 individuals aged [greater than or equal to]18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (-19 per 1,000) overall, in people aged 18 to 39 (-23%; -18 per 1,000), 60 to 79 (-17%; -27 per 1,000), and [greater than or equal to]80 (-31%; -57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (-20%; -23 per 1,000) from expectation compared to least deprived quintile (-13%; -15 per 1,000). Conclusions There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern., Author(s): Frederick K. Ho 1,*, Caroline Dale 2, Mehrdad A. Mizani 3, Thomas Bolton 3, Ewan R. Pearson 3,4, Jonathan Valabhji 5, Christian Delles 6, Paul Welsh 6, Shinya Nakada [...]

BackgroundThis study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.Methods and findingsA cohort of individuals aged ≥18 years in England with records in the primary care-COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band. A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (-19 per 1,000) overall, in people aged 18 to 39 (-23%; -18 per 1,000), 60 to 79 (-17%; -27 per 1,000), and ≥80 (-31%; -57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (-20%; -23 per 1,000) from expectation compared to least deprived quintile (-13%; -15 per 1,000).ConclusionsThere was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.

Having good and correct financial reports using the Financial Accounting Standards for Micro, Small, and Medium Entities for MSMEs makes a benchmark for representing how the ongoing business performance is so that it can determine the future direction of the business smoothly The method used in this Community Service Activity (CSA) is Participatory Action Research (PAR). There are three main pillars of the PAR method, starting from the research methodology, the action dimension, and finally the participation dimension. The evaluation results of the implementation of activities for two days showed that the participants were very enthusiastic about making and preparing financial reports by utilizing the menu in the MSME Business Financial Records Application (Toko Ku). Participants can also utilize the report menu which consists of sales reports, expense reports, profit/loss reports, and general reports. These reports are outputs from menus such as cash, products, inventory, sales, receivables, payables, and expenses.

Objective: To identify highest-risk subgroups for COVID-19 and Long COVID(LC), particularly in contexts of influenza and cardiovascular disease(CVD). Methods: Using national, linked electronic health records for England (NHS England Secure Data Environment via CVD-COVID-UK/COVID-IMPACT Consortium), we studied individuals (of all ages) with COVID-19 and LC (2020-2023). We compared all-cause hospitalization and mortality by prior CVD, high CV risk, vaccination status (COVID-19/influenza), and CVD drugs, investigating impact of vaccination and CVD prevention using population preventable fractions. Results: Hospitalization and mortality were 15.3% and 2.0% among 17,373,850 individuals with COVID-19 (LC rate 1.3%), and 16.8% and 1.4% among 301,115 with LC. Adjusted risk of mortality and hospitalization were reduced with COVID-19 vaccination ≥ 2 doses(COVID-19:HR 0.36 and 0.69; LC:0.44 and 0.90). With influenza vaccination, mortality was reduced, but not hospitalization (COVID-19:0.86 and 1.01, and LC:0.72 and 1.05). Mortality and hospitalization were reduced by CVD prevention in those with CVD, e.g., anticoagulants- COVID:19:0.69 and 0.92; LC:0.59 and 0.88; lipid lowering- COVID-19:0.69 and 0.86; LC:0.68 and 0.90. COVID-19 vaccination averted 245044 of 321383 and 7586 of 8738 preventable deaths after COVID-19 and LC, respectively. Interpretation: Prior CVD and high CV risk are associated with increased hospitalization and mortality in COVID-19 and LC. Targeted COVID-19 vaccination and CVD prevention are priority interventions. Funding: NIHR. HDR UK.

In recent years, food and packaging industries have worked together to minimize food wastes. Fruit and vegetable by-products, which are known to be among the most abundant food wastes and a great source of bioactive compounds, have the potential to improve food product packaging properties. The antioxidant and antimicrobial properties of pomegranate peel in food active packaging have been the subject of numerous studies. Pomegranate peel has an impact on the films' microstructure and physical properties, such as thickness, water vapor permeability, mechanical properties, optical properties, and thermal properties. Moreover, pomegranate peel incorporated films demonstrate great antioxidant and antimicrobial properties. Reviewing current advancements in the physical and functional properties of active packaging films containing pomegranate peel is the goal of this study.

Introduction None of the studies of type 2 diabetes (T2D) subtyping to date have used linked population-level data for incident and prevalent T2D, incorporating a diverse set of variables, explainable methods for cluster characterization, or adhered to an established framework. We aimed to develop and validate machine learning (ML)-informed subtypes for type 2 diabetes mellitus (T2D) using nationally representative data.Research design and methods In population-based electronic health records (2006–2020; Clinical Practice Research Datalink) in individuals ≥18 years with incident T2D (n=420 448), we included factors (n=3787), including demography, history, examination, biomarkers and medications. Using a published framework, we identified subtypes through nine unsupervised ML methods (K-means, K-means++, K-mode, K-prototype, mini-batch, agglomerative hierarchical clustering, Birch, Gaussian mixture models, and consensus clustering). We characterized clusters using intracluster distributions and explainable artificial intelligence (AI) techniques. We evaluated subtypes for (1) internal validity (within dataset; across methods); (2) prognostic validity (prediction for 5-year all-cause mortality, hospitalization and new chronic diseases); and (3) medication burden.Results Development: We identified four T2D subtypes: metabolic, early onset, late onset and cardiometabolic. Internal validity: Subtypes were predicted with high accuracy (F1 score >0.98). Prognostic validity: 5-year all-cause mortality, hospitalization, new chronic disease incidence and medication burden differed across T2D subtypes. Compared with the metabolic subtype, 5-year risks of mortality and hospitalization in incident T2D were highest in late-onset subtype (HR 1.95, 1.85–2.05 and 1.66, 1.58–1.75) and lowest in early-onset subtype (1.18, 1.11–1.27 and 0.85, 0.80–0.90). Incidence of chronic diseases was highest in late-onset subtype and lowest in early-onset subtype. Medications: Compared with the metabolic subtype, after adjusting for age, sex, and pre-T2D medications, late-onset subtype (1.31, 1.28–1.35) and early-onset subtype (0.83, 0.81–0.85) were most and least likely, respectively, to be prescribed medications within 5 years following T2D onset.Conclusions In the largest study using ML to date in incident T2D, we identified four distinct subtypes, with potential future implications for etiology, therapeutics, and risk prediction.

Key Clinical Message Here we present a case of a 4‐year‐old girl who suffered from vulvovaginitis caused by Enterobius vermicularis. All members of her family were also infected by this helminth. Treatment with mebendazole was administered to all family members and it was found that the entire family had been cured. Abstract Vulvovaginitis, an inflammation of the vulvovaginal mucous membranes, is a common reason for pediatric gynecology consultations. One of the causes of this condition is a parasitic worm known as Enterobius vermicularis (E. vermicularis). In girls, adult worms can infiltrate the vagina and release eggs, leading to the development of vulvovaginitis. Furthermore, these worms have the ability to invade the endometrial cavity too. Here we present a case of a 4‐year‐old girl who suffered from vulvovaginitis caused by E. vermicularis. All members of her family were also infected by this parasitic helminth. In the vaginal sample, apart from the eggs, the female adult worm was observed under the microscope. Treatment with mebendazole was administered to all family members, and their progress was followed for a period of 3 weeks, during which it was found that the entire family had been cured. This patient experienced significant improvement in symptoms related to severe anxiety, nervousness, vaginal inflammation, itching, and vulvovaginitis caused by E. vermicularis. To prevent infection by E. vermicularis, it is crucial to disinfect underwear and bed sheets. In kindergartens, the spread of this parasite should not be underestimated, and asymptomatic individuals who have been exposed to infected persons should receive treatment to prevent an epidemic. Maintaining cleanliness and hygiene, especially after using the toilet, is of the most importance, particularly for girls who are more susceptible to E. vermicularis infection. Additionally, it is essential for all family members to be aware of the transmission routes of this parasite.

The aim of this research is to find out how to create an electronic header using Flip PDF Professional software. The limited availability of teaching materials in schools causes this problem. Apart from that, e-modules are not technically used as teaching materials by educators. Apart from that, because teachers have not created their own e-module-based teaching materials, learning only depends on textbooks. Researchers carry out research and development (R&D) or development using a four-stage development version, which consists of defining, designing, development (developing), and dissemination (disseminating). This research uses validity and practicality test sheets. The study shows that the product is an e-module that uses a professional PDF flip. The validation results of the E-module show that it is very feasible in terms of appropriateness of content, media, and language. An average score of 87% is categorized as very appropriate in terms of language eligibility. Apart from that, 96% of students and 95% of teachers stated that the E-module could be used as teaching material for reading the proclamation text for class V UPT SDN 23 Cubadak.

Parasitic infections are the most common diseases worldwide, and enterobiasis is a common parasitic infection in children. Various studies have reported on the prevalence of Enterobius vermicularis in different regions of the world. However, no study has gathered and analyzed this data systematically. Our systematic review and meta-analysis investigated the overall prevalence of E. vermicularis among children globally. Data were extracted from 4 available databases for studies published from January 2002 to April 2022. The quality of the included studies was scored based on the standard Strengthening the Reporting of Observational Studies in Epidemiology. A random-effect model was chosen to calculate the pooled prevalence and corresponding 95% confidence interval (CI) according to the degree of heterogeneity in the included studies. Thus, 40 publications (42 data sets) that included 3,279 children with enterobiasis met all criteria and were included in the analysis. The meta-analysis showed that heterogeneity among the included studies was high (Q=4,399.35, I2=99.96%; df=41; p

Smart contracts (SCs) are crucial in maintaining trust within blockchain networks. However, existing methods for analyzing SC vulnerabilities often lack accuracy and effectiveness, while approaches based on Deep Neural Networks (DNNs) struggle with detecting complex vulnerabilities due to limited data availability. This paper proposes a novel approach for analyzing SC vulnerabilities. Our method leverages an advanced form of the Genetic Algorithm (GA) and includes the development of a comprehensive benchmark dataset consisting of 36,670 Solidity source code samples. The primary objective of our study is to profile vulnerable SCs effectively. To achieve this goal, we have devised an analyzer called SCsVulLyzer based on GAs, designed explicitly for profiling SCs. Additionally, we have carefully curated a new dataset encompassing a wide range of examples, ensuring the practical validation of our approach. Furthermore, we have established three distinct taxonomies that cover SCs, profiling techniques, and feature extraction. These taxonomies provide a systematic classification and analysis of information, improving the efficiency of our approach. Our methodology underwent rigorous testing through experimentation, and the results demonstrated the superior capabilities of our model in detecting vulnerabilities. Compared to traditional and DNN-based approaches, our approach achieved higher precision, recall, and F1-score, which are widely used metrics for evaluating model performance. Across all these metrics, our model showed exceptional results. The customization and adaptations we implemented within the GA significantly enhanced its effectiveness. Our approach detects SC vulnerabilities more efficiently and facilitates robust exploration. These promising results highlight the potential of GA-based profiling to improve the detection of SC vulnerabilities, contributing to enhanced security in blockchain networks.

Background Heart failure (HF), type 2 diabetes (T2D) and chronic kidney disease (CKD) commonly coexist. We studied characteristics, prognosis and healthcare utilisation of individuals with two of these conditions.Methods We performed a retrospective, population-based linked electronic health records study from 1998 to 2020 in England to identify individuals diagnosed with two of: HF, T2D or CKD. We described cohort characteristics at time of second diagnosis and estimated risk of developing the third condition and mortality using Kaplan-Meier and Cox regression models. We also estimated rates of healthcare utilisation in primary care and hospital settings in follow-up.Findings We identified cohorts of 64 226 with CKD and HF, 82 431 with CKD and T2D, and 13 872 with HF and T2D. Compared with CKD and T2D, those with CKD and HF and HF and T2D had more severe risk factor profile. At 5 years, incidence of the third condition and all-cause mortality occurred in 37% (95% CI: 35.9%, 38.1%%) and 31.3% (30.4%, 32.3%) in HF+T2D, 8.7% (8.4%, 9.0%) and 51.6% (51.1%, 52.1%) in HF+CKD, and 6.8% (6.6%, 7.0%) and 17.9% (17.6%, 18.2%) in CKD+T2D, respectively. In each of the three multimorbid groups, the order of the first two diagnoses was also associated with prognosis. In multivariable analyses, we identified risk factors for developing the third condition and mortality, such as age, sex, medical history and the order of disease diagnosis. Inpatient and outpatient healthcare utilisation rates were highest in CKD and HF, and lowest in CKD and T2D.Interpretation HF, CKD and T2D carry significant mortality and healthcare burden in combination. Compared with other disease pairs, individuals with CKD and HF had the most severe risk factor profile, prognosis and healthcare utilisation. Service planning, policy and prevention must take into account and monitor data across conditions.

MTs Ahliyah IV Palembang adalah salah satu lembaga pendidikan swasta yang sedang berupaya untuk meningkatkan layanan dan daya saingnya terhadap kompetitornya. Salah satu upaya yang dilakukan adalah menerapkan Sistem Informasi/Teknik Informatika (SI/TI) untuk mempelancar proses manajemen di MTs Ahliyah IV Palembang. Namun dikarenakan belum mempunyai sebuah perancangan strategi SI/TI mengakibatkan belum optimalnya pemanfaatan SI/TI untuk menunjang aktivitas manajemen sekolah. Kurangnya SDM ahli pada bidang IT juga menjadi penghambatnya. Metode Ward and Peppard digunakan pada perancangan perencanaan strategis SI/TI di MTs Ahliyah IV Palembang, dimulai dengan melakukan analisis lingkungan bisnis internal menggunakan analisis Value Chain, kemudian analisis Porter’s Five Forces dipilih sebagai analisis lingkungan bisnis eksternal sehingga menghasilkan sebuah tabel rekomendasi berisi 9 sistem informasi baru untuk MTs Ahliyah IV Palembang. Dan Analisis McFarlan’s Strategic Grid untuk memetakan SI/TI untuk menunjang sebuah sistem informasi yang dihasilkan dalam bentuk Future Application Portfolio untuk MTs Ahliyah IV Palembang. Hasil akhir yang dihasilkan adalah sebuah dokumen renstra SI/TI yang efektif dalam membantu proses bisnis pada MTs Ahliyah IV Palembang.

Abstract Background The CVD-COVID-UK consortium was formed to understand the relationship between COVID-19 and cardiovascular diseases through analyses of harmonised electronic health records (EHRs) across the four UK nations. Beyond COVID-19, data harmonisation and common approaches enable analysis within and across independent Trusted Research Environments. Here we describe the reproducible harmonisation method developed using large-scale EHRs in Wales to accommodate the fast and efficient implementation of cross-nation analysis in England and Wales as part of the CVD-COVID-UK programme. We characterise current challenges and share lessons learnt. Methods Serving the scope and scalability of multiple study protocols, we used linked, anonymised individual-level EHR, demographic and administrative data held within the SAIL Databank for the population of Wales. The harmonisation method was implemented as a four-layer reproducible process, starting from raw data in the first layer. Then each of the layers two to four is framed by, but not limited to, the characterised challenges and lessons learnt. We achieved curated data as part of our second layer, followed by extracting phenotyped data in the third layer. We captured any project-specific requirements in the fourth layer. Results Using the implemented four-layer harmonisation method, we retrieved approximately 100 health-related variables for the 3.2 million individuals in Wales, which are harmonised with corresponding variables for > 56 million individuals in England. We processed 13 data sources into the first layer of our harmonisation method: five of these are updated daily or weekly, and the rest at various frequencies providing sufficient data flow updates for frequent capturing of up-to-date demographic, administrative and clinical information. Conclusions We implemented an efficient, transparent, scalable, and reproducible harmonisation method that enables multi-nation collaborative research. With a current focus on COVID-19 and its relationship with cardiovascular outcomes, the harmonised data has supported a wide range of research activities across the UK.

Abstract The COVID-19 pandemic has raised many problems in the education sector, one of which is the increasing trend toward student loneliness owing to a lack of interpersonal connections in online learning activities. The present study explicitly aims to examine the relationship between loneliness and academic achievement for university students in Indonesia. Moreover, we propose moderating God’s locus of control (i.e., God’s control over behavior-related learning) (GLC) and learning student engagement, playing mediating roles in these relationships. The data were collected from 324 respondents among university students in Indonesia during emergency remote teaching. The moderated-mediated regression analysis using Hayes’ PROCESS macro found loneliness negatively related to engagement and academic achievement. Student engagement had a positive relationship with academic achievement and served as a mediator between loneliness and academic achievement. Furthermore, GLC was found to moderate the relationship between loneliness and learning engagement as well as loneliness and academic achievement. This study’s findings uncover GLC’s role as a boundary condition, and confirms that learning-engagement intermediates the relationship between loneliness and academic achievement. Students with high perceived God control tend to anticipate the impact of loneliness on learning behavior amid isolation and loneliness because of the pandemic.

The ability to develop teaching preparation, in the sense that a teacher is not only at the level of learning planning design, but also in the process and evaluation of learning, for example, being able to design plans, formulate goals, compile, present materials, media, determine basic competencies, strategy, follow up carry on. The problem in this research is how the teacher's ability to develop teaching preparation in MTSn 1 Banjarmasin. The purpose of this research is to determine the teacher's ability to develop teaching preparation in subjects moral aqidah at MTSn 1 Banjarmasin. This type of research is descriptive qualitative research. The population in this study was 1 teacher at MTSn 1 Banjarmasin. The data in this study were collected using observation, interview, and documentation techniques. Furthermore, the collected data were analyzed using the percentage formula. The results of data analysis through observation and interviews can be concluded as follows: The ability of teachers to develop teaching preparation in subjects the moral creed in MTSn 1 Banjarmasin reached 62.82% and was categorized as good because it was located at an interval of 61% -80%.

Abstract Background The consumption of uncooked or undercooked food from infected intermediate hosts can result in Toxoplasma gondii infection in humans. However, few studies have investigated the genetic diversity of this protozoan parasite in Iran. The aim of the present study was to genetically characterize isolates of T. gondii from intermediate host animals in Mazandaran Province, Iran. Methods Blood and heart tissue samples were collected from 204 ruminants, and brain tissue was collected from 335 birds. The prevalence of T. gondii infection in these samples was determined serologically using the modified agglutination test and by conventional PCR assays. Those PCR samples positive for T. gondii DNA and 13 DNA samples extracted from aborted fetuses in a previous study were genotyped with 12 genetic markers using the multilocus-nested PCR-restriction fragment length polymorphism (Mn-PCR–RFLP) technique. Results Antibodies for parasites were found in 35.7% of the ruminant (39.1% of sheep and 26.4% of goats) samples and in 51.3% of the bird (100% of geese, 52.3% of free-range chickens and 46% of ducks) samples. Molecular detection by PCR of the repetitive 529-bp DNA fragment revealed contamination of 13.2% of ruminant (14.6% of sheep and 9.4% of goats) samples and of 9.6% of bird (11.1% of chickens, 5.7% of ducks and 0% of geese samples). The results from 30 DNA samples revealed five ToxoDB (genome database for the genus Toxoplasma) PCR–RFLP genotypes, including #1 (Type II), #2 (Type III), #10 (Type I), #27 and #48, with genotype #1 the most predominant. Conclusions As evidenced by the results of this study, ruminants and birds are infected with T. gondii in the region, suggesting that they are likely to be involved in the transmission of T. gondii to humans through meat consumption. The identification of different genotypes may suggest a higher genetic diversity of this parasite in Mazandaran, reflecting local environmental contamination. These results have important public health implications for the prevention and control strategies of infection. Graphical Abstract

This study was designed to determine how impulsivity, self-regulation, and response withholding are related to one another and to university students' drinking behavior. Participants (N = 108) completed measures of impulsivity, self-regulation, and alcohol consumption. In addition, a computerized Go/No Go task and a backward memory task were used to measure participants' behavioral impulsivity and their memory capacity. The aim was to determine whether (a) light/moderate and heavy drinkers would respond differently when the task stimuli were alcohol-related compared to when they were alcohol-unrelated and (b) whether the accuracy of participants' responses was related to their cognitive ability. Compared to light/moderate drinkers, heavy drinkers were low in self-regulation and high in impulsivity. Heavy drinkers and those with lower memory capacity were also poorer at withholding responses on No Go trials. These findings point to personality/cognitive characteristics that influence university students' alcohol consumption. [ABSTRACT FROM AUTHOR]

Summary: In this paper, a new high‐step‐up DC‐DC converter without any coupled inductors or transformers is introduced. The structure of the introduced converter consists of two boost techniques, namely, switched inductor and switched capacitor, used simultaneously. The drawbacks of each technique are mitigated according to the proposed structure and the introduced control method. Therefore, the main contribution of the introduced converter is its ability to use boost techniques while avoiding high input current ripples and inrush currents in the path of semiconductor devices. Thus, there is no need for an auxiliary inductor. Additionally, the number of required components is low, and it benefits from a common ground, which are advantages of this converter in terms of economy and reliability. Another advantage is the high efficiency of the proposed converter in comparison with recent topologies, making it suitable for renewable energy applications such as photovoltaic (PV) systems and fuel cell applications. The proposed converter has been implemented in a laboratory to verify its performance. It operates at 94.51% efficiency with a 200 W output power, a 40 kHz switching frequency, a 40 V input voltage, and a 240 V output voltage. [ABSTRACT FROM AUTHOR]

Objectives: To investigate healthcare utilisation and cost in individuals with long COVID (LC) at population level. Design: Case–control cohort analysis with multiple age-, sex-, ethnicity-, deprivation-, region- and comorbidity-matched control groups: (1) COVID only, no LC; (2) pre-pandemic; (3) contemporary non-COVID; and (4) pre-LC (self-controlled, pre-COVID pandemic). Setting: National, population-based, linked UK electronic health records (British Heart Foundation/NHS England Secure Data Environment). Participants: Adults aged ≥18 years with LC between January 2020 and January 2023. Main outcome measures: Healthcare utilisation (number of consultations/visits per person: primary care (general practitioner [GP]), secondary care (outpatient [OP], inpatient [IP] and emergency department [ED], investigations and procedures) and inflation-adjusted cost (£) for LC and control populations per month, calendar year and pandemic year for each category. Results: A total of 282,080 individuals with LC were included between January 2020 and January 2023. The control groups were COVID only, no LC (n = 1,112,370), pre-pandemic (n = 1,031,285), contemporary non-COVID (n = 1,118,360) and pre-LC (n = 282,080). Healthcare utilisation per person (per month/year) was higher in LC than controls across GP, OP and ED. For IP, LC had higher healthcare utilisation than pre-LC and contemporary non-COVID (all p < 0.0001). Healthcare utilisation of the LC group increased progressively between 2020 and 2023, compared with controls. Median cost per patient/year was also higher in individuals with LC than all control groups. Conclusions: LC has been associated with substantial, persistent healthcare utilisation and cost over the last three years. Future funding, resources and staff for LC prevention, treatment and research must be prioritised to reduce sustained primary and secondary healthcare utilisation and costs. [ABSTRACT FROM AUTHOR]

Background: Trichostrongylus is an intestinal parasite that is highly prevalent in humans and livestock worldwide. There is limited information about the prevalence and epidemiology of Trichostrongylus species among the infected livestock in Mazandaran Province, northern Iran. This study aimed to identify Trichostrongylus spp. among small ruminants using morphometric and molecular methods. Materials and Methods: Small intestinal organs of sheep and goats, slaughtered in Mazandaran Province, were examined for infectivity with Trichostrongylus parasites. Primary species identification was conducted based on the morphological characterization of the male worms. The internal transcribed spacer (ITS) II regions of the ribosomal DNA of the worm tissues were amplified using the polymerase chain reaction (PCR) assay and then the product was subjected to sequencing. Subsequently, the PCR products of the ITS II region were subjected to digestion by HinfI and DraI restriction enzymes using the PCR-restriction fragment length polymorphism (RFLP). Results: Of 180 samples, 98 (54.44%) were confirmed positive for Trichostrongylus based on the conventional PCR. The digestion of the PCR products with HinfI and DraI facilitated the identification of three Trichostrongylus species, namely Trichostrongylus colubriformis (35%, 90.81%), Trichostrongylus axei (4%, 4.08%), and Trichostrongylus vitrinus (5%, 5.1%). Both morphometric and RFLP techniques resulted in the differentiation of the three Trichostrongylus species. Conclusion: The present study was the 1st attempt in the last 30 years for the identification of Trichostrongylus species in small ruminants in Mazandaran Province. The findings of this study can be helpful for epidemiological and ecological studies, the establishment of effective control programs, and the management of gastrointestinal parasites in Mazandaran Province.

Summary: Background: Although chronic kidney disease (CKD) is associated with high multimorbidity, polypharmacy, morbidity and mortality, existing classification systems (mild to severe, usually based on estimated glomerular filtration rate, proteinuria or urine albumin-creatinine ratio) and risk prediction models largely ignore the complexity of CKD, its risk factors and its outcomes. Improved subtype definition could improve prediction of outcomes and inform effective interventions. Methods: We analysed individuals ≥18 years with incident and prevalent CKD (n = 350,067 and 195,422 respectively) from a population-based electronic health record resource (2006–2020; Clinical Practice Research Datalink, CPRD). We included factors (n = 264 with 2670 derived variables), e.g. demography, history, examination, blood laboratory values and medications. Using a published framework, we identified subtypes through seven unsupervised machine learning (ML) methods (K-means, Diana, HC, Fanny, PAM, Clara, Model-based) with 66 (of 2670) variables in each dataset. We evaluated subtypes for: (i) internal validity (within dataset, across methods); (ii) prognostic validity (predictive accuracy for 5-year all-cause mortality and admissions); and (iii) medications (new and existing by British National Formulary chapter). Findings: After identifying five clusters across seven approaches, we labelled CKD subtypes: 1. Early-onset, 2. Late-onset, 3. Cancer, 4. Metabolic, and 5. Cardiometabolic. Internal validity: We trained a high performing model (using XGBoost) that could predict disease subtypes with 95% accuracy for incident and prevalent CKD (Sensitivity: 0.81–0.98, F1 score:0.84–0.97). Prognostic validity: 5-year all-cause mortality, hospital admissions, and incidence of new chronic diseases differed across CKD subtypes. The 5-year risk of mortality and admissions in the overall incident CKD population were highest in cardiometabolic subtype: 43.3% (42.3–42.8%) and 29.5% (29.1–30.0%), respectively, and lowest in the early-onset subtype: 5.7% (5.5–5.9%) and 18.7% (18.4–19.1%). Medications: Across CKD subtypes, the distribution of prescription medication classes at baseline varied, with highest medication burden in cardiometabolic and metabolic subtypes, and higher burden in prevalent than incident CKD. Interpretation: In the largest CKD study using ML, to-date, we identified five distinct subtypes in individuals with incident and prevalent CKD. These subtypes have relevance to study of aetiology, therapeutics and risk prediction. Funding: AstraZeneca UK Ltd, Health Data Research UK.

The educational environment can be in the form of physical or psychological, which is related to the life of the child, including the family, school and community environment, which must be fostered in a conducively, to make noble educational goals. This study aims to show the development of an educational environment with Islāmic nuances for common or Islāmic elementary school children. For this reason, this research a type library research, whose data sources are taken from the texts of the Qur’an and al-Hadith, books, and journals about Islamic education. While the data analysis used descriptive qualitative analysis. The results of this study illustrate that fostering an Islāmic educational environment for common or Islāmic elementary school children in the family environment must cultivate an Islāmic life, starting from eating, drinking, talking, dressing, decorating the house, using social media and others. At school, an Islāmic atmosphere is created, there is a prayer room, congregational prayers, Ramadan Islāmic boarding schools, reading Qur'an, congregational Zuhr prayers, donations for orphans, Friday alms, and commemoration of Islāmic holidays. In the community, mosques were built with congregational prayers, Friday prayers, tarawih prayers, eclipse prayers, Qur'an education, learning together with Shaikh, receiving and distributing Zakat, and commemorating major Islāmic holidays, and the community also maintained morals of children, thus causing disobedience