Number Of Visits Research Articles

Factors influencing clinical trial participation of women with fibromyalgia across the United States: a cross-sectional survey

ABSTRACT Although fibromyalgia is a widespread chronic pain condition where 90 percent of patients are women, they are underrepresented in Randomized Clinical Trials (RCTs). We aim to describe the willingness to participate, assess different factors, and explore the impact of sociodemographic and clinical characteristics on perceived barriers to trial participation. This is a cross-sectional survey targeting women with fibromyalgia. Univariate and multivariate logistic regression were performed. Of the 436 women with fibromyalgia, 56 percent were very likely to participate in RCTs. Minorities expressed less interest than non-minorities, while higher pain scores, previous participation, and younger patients reported a higher interest. Barriers significantly associated with a reduced willingness were: the participant’s perception (side effects, distance, potential negative impact), the center (reputation), the trial protocol (number of visits, placebo), and trial awareness by their physician. In a multivariate analysis, older age, low education, lower income, and higher pain scores were associated with perceived barriers to RCT participation. Despite the high interest to participate, factors such as side effects, the center’s distance, number of visits, placebo treatments, and the institution’s reputation must be considered in clinical trials for women with fibromyalgia.

The Impact of Telehealth on Obstetrical Outcomes during the COVID-19 Pandemic.

Nationwide, obstetric clinics modified prenatal care to include telehealth visits in response to the COVID-19 pandemic, enabling the opportunity to investigate its impact on patient outcomes. We hypothesized that use of prenatal telehealth visits would increase the number of prenatal visits, decrease the frequency of urgent triage/emergency department (ED) visits, and improve perinatal outcomes. To determine the impact of telehealth on number of obstetric prenatal visits and urgent triage/ED visits amidst the COVID-19 pandemic. This is a retrospective cohort of patients from a federally qualified health center (FQHC) in central Texas. Patients with a singleton gestation who delivered after 32 weeks were included. Comparison groups were made between those patients who delivered between May 2020 to December 2020 (presumed modified prenatal visit schedule with in-person and telehealth) and those patients delivering between June 2019 to February 2020 (the traditional care model with in-person visits only). Multivariable linear and logistic regression models were used to estimate differences in the number of prenatal visits and unscheduled triage/ED visits. A total of 1654 patients were identified with 801 (48.4%) patients undergoing modified prenatal care and 853 (51.6%) patients receiving traditional care during the study period. No significant differences were seen in overall prenatal attendance or triage/ED presentations. However, when stratified by parity, multiparous patients undergoing modified prenatal care were less likely to experience an urgent triage/ED presentation (8.7% vs. 12.7%; odds ratio, 1.69; 95% confidence interval, 1.10-2.61). When compared to a traditional prenatal visitation cohort pre-pandemic, patients who received modified telehealth prenatal care during the COVID-19 pandemic had similar prenatal attendance and unscheduled emergency presentations. However, multiparous patients experienced a decreased rate of unscheduled emergency presentations. Supplementing prenatal care with telehealth may provide overall comparable prenatal care delivery.

Tourism-related economic loss and damage from the North Island weather events on New Zealand conservation land and waters

Extreme weather events are causing increasing levels of loss and damage, including to natural assets and associated nature-based tourism economies. This article provides estimates of the economic impacts on public conservation lands and waters in New Zealand's North Island from the flooding events of Cyclone Hale and Cyclone Gabrielle in early 2023. Losses and damage are estimated in four buckets: regional tourism GDP losses from cancelled visitor bookings at Department of Conservation accommodation facilities; lost business revenue of companies operating in protected areas; lost value of government-managed visitor assets; and regional tourism GDP losses from estimated reductions in visitor numbers at three iconic protected area sites. The research also attributes a proportion of these losses to climate change, assisting learning and future planning for New Zealand's conservation agency.

The Mental Health Toll of the COVID-19 Pandemic on Adolescents Receiving Inpatient Psychiatric Treatment.

Objective: During the COVID-19 pandemic, the prevalence of depression and anxiety among children and adolescents significantly increased, along with the number of visits to emergency departments due to suicidality and/or suicide attempts. Relatedly, health care workers experienced significant burnout and symptoms of anxiety, depression, and posttraumatic stress disorder during this time. However, the corresponding impact on psychiatric inpatient treatment has not yet been researched. We hypothesized that during the pandemic, adolescents hospitalized in an acute care psychiatric inpatient unit had increased incidents of suicide attempts and nonsuicidal self-injurious behaviors and of aggressive behaviors toward others, resulting in greater use of constant observation and restraints. Method: This study was a retrospective chart review based on electronic medical record data examining use of restraints and constant observation one year before the pandemic (March 2019 to February 2020) and 1 year following the onset of the pandemic (March 2020 to February 2021) in an acute-care adolescent (12 to 17 years old) psychiatric inpatient unit. Results: There were 571 admissions during the year before the pandemic and 500 admissions during the pandemic. The number of patients who were restrained (χ2 = 7.86, p = 0.005), number of patients who were placed on constant observation (χ2 = 13.41, p < 0.001), and number of constant observation orders per patient (χ2 = 91.90, p < 0.001) were all significantly greater during the pandemic. Conclusion: Psychiatrically hospitalized adolescents during the pandemic received more intensive interventions such as restraints and constant observation. Severe patient psychopathology and staff shortages, as well as limitations of and decreases to the dialectical behavior therapy program, may have been the contributing factor.

Dynamic Home Care Routing and Scheduling with Uncertain Number of Visits per Referral

Despite the rapid growth of the home care industry, research on the scheduling and routing of home care visits in the presence of uncertainty is still limited. This paper investigates a dynamic version of this problem in which the number of referrals and their required number of visits are uncertain. We develop a Markov decision process (MDP) model for the single-nurse problem to minimize the expected weighted sum of the rejection, diversion, overtime, and travel time costs. Because optimally solving the MDP is intractable, we employ an approximate linear program (ALP) to obtain a feasible policy. The typical ALP approach can only solve very small-scale instances of the problem. We derive an intuitively explainable closed-form solution for the optimal ALP parameters in a special case of the problem. Inspired by this form, we provide two heuristic reduction techniques for the ALP model in the general problem to solve large-scale instances in an acceptable time. Numerical results show that the ALP policy outperforms a myopic policy that reflects current practice, and is better than a scenario-based policy in most instances considered. Funding: This work was supported by the Natural Sciences and Engineering Research Council of Canada [Grants RGPIN-2018-05225 and RGPIN-2020-210524] and by the Telfer School of Management SMRG Postdoctoral Research Fellowship Support [Grant 2020]. Supplemental Material: The electronic companion is available at https://doi.org/10.1287/trsc.2023.0120 .

Orthopedic treatment of patients with upper jaw resection after undergoing SARS COVID-19

In the last few years, postcovoid osteonecrosis has become increasingly common among the causes of defects in the upper jaw, as a complication after a coronavirus infection.Purpose. To increase the effectiveness of orthopedic treatment of defects of the upper jaw formed as a result of postcovoid osteonecrosis of the maxillofacial region by applying a material for soft relocation GC COE-Soft Professional Package to the obturator of a compound jaw prosthesis made according to the method of Y.M. Zbarzh.Materials and methods. Over the past three years nine patients with postcovoid osteonecrosis of the upper jaw have had complex-jaw prostheses made according to the method of Y.M. Zbarzha with the application of GC COE-Soft Professional Package soft relocation material to the obturating part of the prosthesis to accelerate patient adaptation.Results. A postresection prosthesis made according to the method of Y.M. Zbarzha, which restores the defect of the upper jaw, turns out to be hollow, which greatly facilitates the design and improves the fixation of the prosthesis in the oral cavity. The use of Remanium button clamps from Dentaurum has confirmed its effectiveness. Due to the application of acrylic material for soft relocation GC COE-Soft Professional Package to the obturating part of the prosthesis, the patient’s adaptation is accelerated, the number of visits for correction is reduced.

The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study

BackgroundPatients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users’ perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers.MethodsA community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval.ResultsA typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0–10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091).ConclusionsService users’ perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users’ perceptions, with a special emphasis on improving health care providers’ communication skills and removing facility-level access barriers.

Harnessing Text and Web Analytics to Enhance Decision-Making in Job Opportunity Categorization

Text analytics is defined as a method of analyzing compilations of structured text such as dates, times, locations, semi structured text, such as HTML and JSON as well as unstructured text, such as word documents, videos, and images, to extract and discover trends and relationships without requiring the exact words or terms to convey those concepts. Web analytics on the other hand is the technology that collects, measures, analyses, and provides reports of data on how users use websites and web applications. It is used to track a number of aspects of direct user-website interactions, such as the number of visits, time spent on the site, and click pathway. It also aids in the identification of user interest areas and the enhancement of web application features. We used clustering techniques to categorize the job opportunities that are available for the job seekers. By implementing text analytics, text data may be grouped with the goal of providing outcomes in the form of word frequency distribution, pattern identification, and predictive analytics. Text analytics may create one-of-a-kind values to use in the improvement of decision-making and business processes, as well as the development of new business models.

АНАЛИЗ ДЕЯТЕЛЬНОСТИ ВРАЧЕЙ-ДЕРМАТОВЕНЕРОЛОГОВ, ОКАЗЫВАЮЩИХ МЕДИЦИНСКУЮ ПОМОЩЬ СЕЛЬСКОМУ НАСЕЛЕНИЮ В РЕСПУБЛИКЕ БАШКОРТОСТАН

Relevance. Currently, there is a low staffing of medical organizations with local doctors and medical specialists, including dermatovenerologists. This determines the low availability of primary medical care for the rural population for diseases of the skin and subcutaneous tissue. Purpose of the study. To analyze the activities of dermatovenerologists in providing primary specialized medical care to the rural population for diseases of the skin and subcutaneous tissue in the Republic of Bashkortostan. Materials and methods. The calculation of indicators characterizing the activities of dermatovenerologists in the Republic of Bashkortostan for 2017-2021 was carried out: the provision of the population with dermatovenereologists, staffing of regular positions of dermatovenereologists, staffing with individuals, part-time ratio, share of visits per one rural resident and one patient with skin diseases, number of visits in connection with the disease, in connection with the preventive purpose. Results. Level of supply of dermatovenerologists in the Republic of Bashkortostan in 2021. amounted to 0.54 per 10 thousand population. In recent years, the provision of dermatovenerologists in the rural population remains low: in 11.1% of rural areas there are no dermatovenerologists, and in 31.5% the level of provision is insufficient. For the period 2017-2021 a decrease in the number of visits to a dermatovenerologist for skin diseases was established by 16.3% (per rural resident from 0.29 to 0.24 visits per resident), as well as a decrease in the number of visits to a dermatovenerologist by 22.0% . (from 4.63 to 3.61 visits per patient). An extremely low volume of telemedicine consultations was revealed, which is a significant factor in reducing the availability of medical care for the rural population. Conclusions. In the Republic of Bashkortostan in recent years, the provision of dermatovenerologists for the rural population remains insufficient. Thus, there is a need to develop measures aimed at improving primary specialized medical care provided by dermatovenerologists to the rural population of the Republic of Bashkortostan.

Home-Visiting Programming in Kindergarten-Readiness Interventions: Retention and Loss of Families

Abstract Background Home-visiting programs are an often-used intervention for supporting the well-being of families with young children, and there is long-standing interest among researchers in ensuring the effectiveness of this practice. Especially, retention and attrition play important roles in achieving desired outcomes of the intervention. Objective This study aims to examine home-visit participation levels among low-income families and explore correlates of the participation levels. It also aims to evaluate patterns of attrition over time and to investigate child and family characteristics that potentially contribute to completion of the program. Methods We examined data from 113 families whose children participated in a 15-month kindergarten-transition intervention. All families received supplemental home-visiting activities as a key component of the intervention, beginning at the start of preschool and extending through middle of kindergarten year. Results We found that, on average, families completed four out of nine planned home visits, with large dispersion in the number of visits completed. Survival analyses suggested that families who dropped out were most likely to do so at the beginning of the program, with 39% of caregivers maintained to the final visit. Participation in the home-visiting program was related to children’s age and race, as well as children’s academic skill levels. Conclusion Study findings have implications for the design and implementation of kindergarten-readiness initiatives targeting low-income families, especially in terms of advancing strategies to maintain families in longitudinal activities.

Patient Characteristics on Satisfaction with Healthcare Quality in a Teaching Hospital in Nepal

This study aimed to examine the relationship between patient demographics (gender, age) and service factors (number of hospital visits) on patient satisfaction with healthcare quality in a teaching hospital in Nepal. A quantitative cross-sectional study was conducted using a convenience sample of 40 patients attending the hospital. Data was collected using a questionnaire to assess satisfaction across various dimensions of care. The sample mainly comprised younger females attending the hospital for the first time. Most patients reported average satisfaction with sense of wellbeing, treatment received, staff skills and information provided. No significant correlations were found between gender, age, number of visits and overall satisfaction (p&gt;0.05). Patient demographics and prior hospital experience did not significantly influence satisfaction levels in this study. However, scope remains for improving various quality domains to enhance patient experience. Further research with a larger sample is needed to better understand drivers of satisfaction in the Nepalese healthcare context.

Assessing the resilience of HIV healthcare services provided to adolescents and young adults after the COVID-19 pandemic in the city of Beira (Mozambique): an interrupted time series analysis

BackgroundThe COVID-19 pandemic has put the provision of health services globally at risk. In Sub-Saharan Africa, it had a major impact on HIV services. However, there is a lack of data on the post-pandemic period. This study aims to evaluate the resumption of HIV services and retention in care for adolescents and young people in the period following the COVID-19 pandemic.MethodsA retrospective cohort study was conducted using interrupted time series analysis. Three periods were considered: pre-pandemic (form June 2019 to March 2020), pandemic (form April 2020 to March 2022) post-pandemic (from April 2022 to March 2023). Six outcome measures were considered: number of outpatient visits, HIV tests, HIV positivity ratio, the antiretroviral treatment (ART) non-adherence ratio, recall ratio, and the return ratio for adolescent and young adults on ART.ResultsDuring the study period, 447,515 outpatient visits and 126,096 HIV tests were recorded. After a reduction at the beginning of the pandemic period, both visits and tests increased during the pandemic (p < 0.05) and decreased in the post-pandemic (p < 0.05), recovering the pre-pandemic trends. The HIV positivity ratio slightly decreased from 3.3% to 1.7% during the study period (p < 0.05). The ART non-adherence ratio decreased from 23.4% to 2.4% throughout the study period (p < 0.05), with a drop at the beginning of the post-pandemic period (p < 0.05). The recall ratio increased during the study period (p < 0.05) with a drop at the beginning of the pandemic and post-pandemic periods (p < 0.05). The return ratio decreased at the beginning of the pandemic (p < 0.05) but returned to the pre-pandemic ratio in the post-pandemic period.ConclusionsThe post-pandemic values of the investigated outcomes were comparable to pre-pandemic period, or even improved. Differently from other services, such as the community activities, that have been severely affected by COVID-19 pandemic, the HIV service system has shown resilience following emergency situation.

Cardiac Sympathetic Denervation as a Treatment for Ventricular Arrhythmias Refractory to Conventional Treatment: A Case Series

Background: Ventricular arrhythmias are a leading cause of sudden death. The objective of this study was to characterise the results of patients with ventricular arrhythmias refractory to standard medical management, undergoing Video-assisted thoracoscopic cardiac sympathetic denervation (VAT-CSD) during 2012–2022 in Cali, Colombia. Methods: This was an observational retrospective study, using the Institutional General Thoracic Surgery Database for patient identification and retrospectively reviewing the clinical charts for data description and analysis. Results: Clinical records of 19 patients who underwent VAT-CSD for ventricular arrhythmia were analysed. The patients were predominantly male (73.7%) with an mean age of 62 years. Ischaemic heart disease was the main underlying condition (52.6%); all individuals had a diagnosis of heart failure, with comorbidities such as hypertension (63.1%), acute MI (57.8%) and diabetes (26.3%) also present. The procedure was performed bilaterally in 89.4% of cases and was successful with minimal perioperative complications. Postoperative follow-up showed improvement in symptoms, including a significant reduction in the number of ICD shocks and emergency department visits. Conclusion: VAT-CSD is a viable, safe and palliative therapeutic option for patients with ventricular arrhythmias who have not responded to conventional treatments, achieving a significant decrease in symptoms with low mortality and perioperative complications.

Development of an assessment tool for designated medical institutions in China——Based on the application of an online assessment system

BackgroundDue to the expanding coverage of medical insurance and the growth of medical expenses, the ability to assess the performance of designated medical institutions (DMIs) in supporting the delivery of high-quality patient care and the standardized use of funds represents a priority in China. Despite such interest, there has yet to be an operable standard and labor-saving method for assessing DMIs in China.ObjectiveThe main objectives include two aspects: (1) establishing an evaluation index system for DMIs based on contracts; (2) designing and developing an online evaluation platform.MethodsA group of 20 experts with theoretical and practical expertise in medical insurance regulation and performance evaluation were invited to select available indicators. A combination weighting method based on analytic hierarchy process and entropy method was used to determine the weight coefficient. Shanghai was taken as the sample area, and 760 DMIs were included in the empirical research. The test-retest reliability method and criterion-related validity method was used to test the reliability and the validity of the evaluation result.ResultsAn assessment index system that included 6 domains and 56 indicators was established in this study. Furthermore, we developed an online platform to assist in the implementation of the assessment. The results showed that the average score of assessment was 94.39, the median was 96.92. The test-retest reliability value was 0.96 (P ≤ 0.01), which indicated high stability of the assessment. In addition, there was a significant negative relationship between assessment score and the penalty amount of DMIs (R = −0.133, P &amp;lt; 0.001). After adjusting for the basic characteristics of medical institutions, the number of visits and revenue, the negative relationship was still significant (B = −0.080, P &amp;lt; 0.05). These results are consistent with expectations, indicating that the assessment had good criterion-related validity.ConclusionsThis study established an operable assessment measure and developed an online platform to assess the performance of DMIs. The results showed good feasibility and reliability in empirical research. Our research findings provided an operable Chinese solution for DMI assessment that saves manpower and time, which would have good enlightening significance in other regions of China and in low-income and middle-income countries internationally.

Levels of engagement among office-based opioid treatment (OBOT) patients with concurrent methamphetamine use.

Recent increases in methamphetamine use among people seeking treatment for opioid use disorder (OUD) has created significant demand for effective approaches to support this clinical population. This study assessed the extent to which office-based opioid treatment (OBOT) patients, who were diagnosed with methamphetamine use disorder (MUD), engaged with providers. A retrospective analysis was conducted of adult patients (n = 470) seeking treatment for OUD who attended at least one visit between March 2020 and March 2023 at a rural regional OBOT provider. Approximately one quarter (28.7%) of patients were diagnosed with MUD in addition to receiving an OUD diagnosis. Bivariate methods and multivariate negative binomial regression models were estimated to examine the associations between clinical measures and the numbers of office visits, peer visits, and telehealth visits. Regression results indicated patients who met criteria for MUD in addition to OUD attended a higher rate of peer visits (incidence rate ratio [IRR] = 2.63, p = .036) when compared to patients who did not meet criteria for MUD. In contrast, patients with MUD and OUD diagnoses displayed significantly lower (IRR = 0.68, p < .001) engagement rates through fewer office visits relative to those who did not meet MUD criteria. Patients seeking treatment for OUD who meet criteria for MUD are more likely to engage through peer support specialists rather than office visits. This study demonstrates the ways patients who meet criteria for OUD and MUD engage with providers to receive treatment.

The impact of doctors' facial attractiveness on users' choices in online health communities: A stereotype content and social role perspective

This study examines the impact of doctors' facial attractiveness on users' choices in online health communities (OHCs). We conducted a field study using a sample of 14,897 doctors registered on a Chinese OHC. The results indicate a significant negative relationship between the facial attractiveness of doctors and the number of visits to their homepage by users. However, this relationship only holds true for male surgeons and female internal medicine doctors, not for female surgeons or male internal medicine doctors. These findings suggest the possible presence of gender-specialty bias in the influence of facial attractiveness on patients' decision-making. To further investigate how facial attractiveness influences users' inclination to choose a particular doctor, we develop our research model drawing upon the stereotype content and social role perspective. Through a laboratory experiment, we found that OHC users' perceptions of doctors' warmth and competence act as mediating factors in the relationship between facial attractiveness and user choice. Additionally, this relationship is influenced by stereotypical gender-specialty fit.

Epidemioloical characteristics and economic burden analysis of palmoplantar pustulosis in urban areas of China

Objective: To analyze the epidemiological characteristics and economic burden of palmoplantar pustulosis (PPP) in China. Methods: A population-based retrospective study was conducted using the data from China's Urban Basic Medical Insurance data from January 1, 2012, to December 31, 2016. International Classification of Diseases code and diagnoses in Chinese for PPP were used to identify cases and estimate the prevalence, incidence, and cost. Subgroup analyses were performed according to age and sex, and sensitivity analyses were conducted to evaluate the robustness of the results. Age-adjusted prevalence rates were calculated based on the 2010 national census data. Results: The crude prevalence and incidence rate of PPP in 2016 were 2.730/100 000 (95%CI: 2.218/100 000-3.242/100 000) and 1.556/100 000 (95%CI: 1.154/100 000-1.958/100 000), and the prevalence rate of females (2.910/100 000) was higher than that of males (2.490/100 000, χ2=97.48, P=0.001). The incidence rate of females (1.745/100 000) was also higher than that of males (1.418/100 000, χ2=85.02, P=0.001). The age peak of incidence and prevalence of patients with PPP was in the 30-39-year age group and a small peak existed in the 0-3-year age group among people under 20 years old. From 2012 to 2016, the average number of visits was (2.44±0.04) per patient, and the total per-capita cost per year was (982.40±39.19) yuan. Conclusion: In 2016, the prevalence and incidence rate of PPP in China were higher in females than in males, and the highest age peak was in the 30-39-year age group.

Validity of Administrative Coding for Nonarteritic Ischemic Optic Neuropathy.

Administrative claims have been used to study the incidence and outcomes of nonarteritic ischemic optic neuropathy (NAION), but the validity of International Classification of Diseases (ICD)-10 codes for identifying NAION has not been examined. We identified patients at 3 academic centers who received ≥1 ICD-10 code for NAION in 2018. We abstracted the final diagnosis from clinical documentation and recorded the number of visits with an NAION diagnosis code. We calculated positive predictive value (PPV) for the overall sample and stratified by subspecialty and the number of diagnosis codes. For patients with ophthalmology or neuro-ophthalmology visit data, we recorded presenting symptoms, examination findings, and laboratory data and calculated PPV relative to case definitions of NAION that incorporated sudden onset of symptoms, optic disc edema, afferent pupillary defect, and other characteristics. Among 161 patients, PPV for ≥1 ICD-10 code was 74.5% (95% CI: 67.2%-80.7%). PPV was similar when restricted to patients who had visited an ophthalmologist (75.8%, 95% CI: 68.4%-82.0%) but increased to 86.8% when restricted to those who had visited neuro-ophthalmologists (95% CI: 79.2%-91.9%). Of 113 patients with >1 ICD-10 code and complete examination data, 37 (32.7%) had documented sudden onset, optic disc swelling, and an afferent pupillary defect (95% CI: 24.7%-42.0%). Of the 76 patients who did not meet these criteria, 54 (71.0%) still received a final clinical diagnosis of NAION; for most (41/54, 75.9%), this discrepancy was due to lack of documented optic disc edema. The validity of ICD-10 codes for NAION in administrative claims data is high, particularly when combined with provider specialty.

Strategi Pemasaran dalam Meningkatkan Jumlah Wisatawan di Pantai Air Manis Padang

The number of visitors at this Padang Air Manis Beach tourist attraction has increased and decreased the number of visitors based on the results obtained from the recapitulation of tourist visits in 2015 as many as 14,067 people, an increase in 2016 as many as 48,400 people, in 2017 as many as 23,200 people. In 2018 there were 442,694 people, in 2019 it increased again to 548,471 people. However, in 2020 there was a drastic decline of 138,557 people. The purpose of this research is to analyze the marketing strategy in increasing the number of tourists at Air Manis Beach, Padang City. Data collection methods are Field Research (Field Research) and Library Research (Library Research). Types and sources of data are primary data and secondary data. The population in this study were visitors to the Air Manis Padang tourist attraction as the research population totaling 138,557 people and a sample of 100 people. The method of analysis using SWOT analysis. The results of the study are: (The IE matrix above is a map of the EFAS and IFAS matrix scores. According to Rangkuti in Maulana (2017) the IE matrix is ??based on two key dimensions, namely the total IFAS weighting score on the horizontal axis and the total EFAS weighting score on the vertical axis. The total score IFAS weighting in this study showed a result of 3.67 while the results of EFAS mapping in this study showed a result of 3.83. As seen in the picture above, the company's position is in cell 1. namely the GROWH position. Growth through concentration can be achieved through vertical integration backward integration This is the main strategy for companies that have a strong competitive market position (high market share) in a highly attractive competition, in order to increase their business strength.

274 Socialization of piglets during suckling enhanced feed intake after weaning but did not alter their response to dietary amino acid concentration

Abstract The present study hypothesized that pre-weaning socialized piglets would reduce damaging behavior and when fed an increased dietary standardized ileal digestible (SID) Lys (and amino acids) to net energy (NE) ratio post-weaning would increase early post weaning feed intake (FI) and growth performance, and in nursery pigs. Socializing included two groups of five sows and their litters for which farrowing pen walls were removed allowing piglets to co-mingle for 10 d before weaning (S) whereas traditionally housed piglets pertained to housing a single sow with her litter (T; n = 15). At weaning, 120 mixed-gender piglets [7.2 ± 0.7 kg body weight (BW)] were allocated based on litter origin, sow parity, and piglet BW to 12 pens equipped with single-space electronic feeding stations with 10 pigs/pen for a 41-d study. In this 2 × 2 factorial arrangement, factors were litter background (socialized vs. traditional) and dietary SID Lys: NE (High 1.32 vs. Low 1.15 SID Lys:NE MJ/kg). Daily individual FI and BW and skin injuries at different timepoints after weaning were determined. Wheat-barley based diets were isoenergetic (10.6 MJ/kg) and offered in two phases (i.e., d 0-14 and d 14-41). The day after weaning, socializing reduced the proportion of piglets with more than five skin injuries from 45.7% to 3.0% compared with traditional housing (P &amp;lt; 0.05). Early post-weaning, daily FI was 50% greater for S-LowLys:NE pigs than S-HighLys:NE on d1, then, T-LowLys:NE was greatest (~25% above other treatments) during d 3-6 (all P &amp;lt; 0.05). The trend maintained during d 6-8 with T-LowLys:NE and S-HighLys:NE being similar each other (P &amp;gt; 0.05). The average number of visits per day during the first 10 d was greater (P &amp;lt; 0.01) for S-HighLys:NE and T-LowLys:NE (33 visits each) compared with T-HighLys:NE (24 visits). Overall, S-HighLys:NE pigs tended (P &amp;lt; 0.10) to have a greater end BW (23.8 vs. 22.1 kg) and a greater d 0-41 average daily gain (ADG) than T-HighLys:NE (530 vs. 472 g/d). For d22-29, the average daily gain (ADG), average daily feed intake (ADFI), and feed efficiency (FE), were greater for S-HighLys:NE and T-LowLys:NE compared with S-LowLys:NE and T-HighLys:NE (P &amp;lt; 0.05). No other meaningful interactions were observed between socializing and Lys:NE on growth performance. However, looking at main factors, socializing increased ADG during d 29-41 by 9% (P = 0.01) coinciding with a 4% greater FE (P = 0.09). The data suggest that traditionally housed piglets fed a HighLys:NE diet post-weaning had lower daily FI and growth performance compared with T-LowLys:NE and socialized piglets irrespective of the Lys:NE contrast. In conclusion, the present study led to a better understanding of nutritional requirements and FI in situations with different pre-weaning housing schemes of piglets. In the present conditions, pre-weaning socialization of pigs may stimulate feed intake earlier post-weaning and allow a better transition independently from the Lys (and amino acid) to NE ratio.