Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

PURPOSE Emergency department observation units (EDOUs) have been shown to decrease length of stay and improve cost effectiveness. Yet, compared with noncancer patients, patients with cancer are placed in EDOUs less often. In this study, we aimed to describe patients who were placed in a cancer center's EDOU to discern their clinical characteristics and outcomes. METHODS We performed a retrospective observational study that included all patients age 18 years and older who presented to our emergency department (ED) and were placed in the EDOU between March 1, 2019, and February 29, 2020. The patients' electronic medical records were queried for demographics, comorbidities, diagnosis at the time of placement in the EDOU, length of stay, disposition from the EDOU, ED return within 72 hours after discharge from the EDOU, and mortality outcomes at 14 and 30 days. RESULTS A total of 2,461 visits were eligible for analysis. Cancer-related pain was the main reason for observation in more than one quarter of the visits. The median length of stay in the EDOU was approximately 23 hours, and 69.6% of the patients were discharged. The ED return rate for unscheduled visits at 72 hours was 1.9%. The 14- and 30-day mortality rates were significantly higher for patients who were admitted than for those who were discharged (14 days: 1.7% v 0.3%, P < .001; 30 days: 5.9% v 1.8%, P < .001). CONCLUSION Our data suggest that placing patients with cancer in EDOUs is safe, reduces admissions, and reserves hospital resources for patients who can receive the most benefit without compromising care.

Pengaruh Abu Vulkanis Gunung Agung dan Pupuk Kompos terhadap Beberapa Sifat Tanah dan Hasil Kacang Tunggak (Vigna unguiculata (L.) Walp.)

The Effect of the Mount Agung Volcanic Ash and Compost on Soil Properties and Yield of Tunggak Nuts (Vigna unguiculata (L.) Walp). The purpose of this study was to determine the effect of giving volcanic ash and compost as a soil amendment. The design used was a factorial randomized block design. The volcanic ash factor consisted of 3 levels: A0 = no volcanic ash, A1 = 15% volcanic ash and A2 = 30% volcanic ash. The compost factor consisted of 3 levels: K0 = without compost, K1 = 10 tons of compost ha-1, and K2 = 20 tons of compost ha-1. The combination treatments was repeated 3 times so that there were 27 observation units. Several parameters of soil properties and yield of tunggak nuts were studied to determine the effect of volcanic ash and compost as soil amendments. The results showed that the interaction between the treatment of volcanic ash and compost on the soil and plants was not significant, while the single treatment of compost had a significant effect on the growth and yield of tunggak nuts. The treatment of volcanic ash has not shown a significant effect, both on soil and on plant growth and yield.

Healthcare System-to-System Cost Variability in the Care of Pediatric Abdominal Pain-Associated Functional Gastrointestinal Disorders

The purpose of this study was to assess cost variability in the care of abdominal pain-associated functional gastrointestinal disorders (AP-FGIDS) in youth across health systems, races, and specific AP-FGID diagnoses. Patients, aged 8–17 years, with a priority 1 diagnosis corresponding to a Rome IV defined AP-FGID were identified within the Health Facts® database. Total costs were obtained across the continuum of care including outpatient clinics, emergency department, and inpatient or observation units. Cost variability was described comparing different health systems, races, and diagnoses. Thirteen thousand two hundred and fourteen patients were identified accounting for 17,287 encounters. Total costs were available for 38.7% of the encounters. There was considerable variability in costs within and, especially, across health systems. Costs also varied across race, urban vs. rural site of care, and AP-FGID diagnoses. In conclusion, there was considerable variability in the costs for care of AP-FGIDs which is sufficient to support multi-site studies to understand the value of specific tests and treatments. Significant differences in costs by race merit further investigation to understand key drivers.

US farm typology from agricultural census: labor resource analysis

This article analyzes the labor resources by farm type in the United States based on the 2017 Agricultural Census. The subject of the research is the system of statistical indicators of the availability and composition of labor resources, the object is the population of farms in the United States. Based on the study of the US experience, it is proposed to expand the program of the agricultural census of the Russian Federation under the section “Labor resources” and the system of groupings of observation units, including typological ones, when publishing the results. The analysis of labor resources by types of farms in the United States showed that there are significant differences in the availability and composition of labor resources.

Analisis Curah Hujan di Indonesia untuk Memetakan Daerah Potensi Banjir dan Tanah Longsor dengan Metode Cluster Fuzzy C-Means dan Singular Value Decompotition (SVD)

One of the climate changes impact is extreme rainfall. Extreme rainfall can cause some hydrometeorological disasters, especially floods and landslides. In 2016, BNPB recorded that there were 2,342 disaster events in Indonesia, 92% of which were disasters dominated by floods, landslides, and cyclones. There were 766 floods, 612 landslides, and 74 combinations of both. In this case, clustering is one of the important method to identify groups of areas with similar characteristics of high or low rainfall. Another analysis that can be applied is the identification of the extreme rainfall and the determination of dominant rainfall pattern using Singular Value Decomposition (SVD) for each region in Indonesia. The data was taken from Indonesia’s rainfall data in January 1998 - March 2017, obtained from the Tropical Rainfall Measuring Mission (TRMM) meteorological satellite, with 12,834 observation units. The highest average rainfall in Indonesia in December is 290,26 mm/month. Rainy season is predicted from November to April because they have the highest average rainfall. The SVD analysis formed four dominant rainfall patterns in Indonesia with a variance of 25.59%, where Papua and West Papua are the regions with the highest rainfall. The area around the Indian Ocean is the area with the most extreme rainfall events compared to other regions. Using Fuzzy C-means, three clusters can be formed, with criteria for areas of high, medium, and low rainfall. Based on the results of the analysis, the area has the potential for flooding and landslides due to high rainfall, so that preventive and mitigation efforts against the risk of flooding and landslides can be treated better.

Interaction between environmental and socioeconomic determinants for cutaneous leishmaniasis risk in Latin America

Objective. Determine and characterize potential risk areas for the occurrence of cutaneous leishmaniasis (CL) in Latin America (LA). Method. Ecological observational study with observation units defined by municipalities with CL transmission between 2014-2018. Environmental and socioeconomic variables available for at least 85% of the municipalities were used, combined in a single database, utilizing the R software. The principal component analysis methodology was combined with a hierarchical cluster analysis to group clusters of municipalities based on their similarity. The V-test was estimated to define the positive or negative association of the variables with the clusters and separation by natural breaks was used to determine which ones contributed the most to each cluster. Information on cases was also incorporated in the analyses to attribute CL risk for each cluster. Results. This study included 4,951 municipalities with CL transmission (36.5% of the total in LA) and seven clusters were defined by their association with 18 environmental and socioeconomic variables. The historical risk of CL is positively associated with the Amazonian, Andean and Savannah clusters in a decreasingly manner; and negatively associated with the Forest evergreen, Forest/crop and Forest/populated clusters. The Agricultural cluster did not reveal any association with the CL cases. Conclusions. The study made it possible to identify and characterize the CL risk by clusters of municipalities and to recognize the epidemiological distribution pattern of transmission, which provides managers with better information for intersectoral interventions to control CL.

PERTUMBUHAN BIBIT MALAPARIDARI PROVENAN UJUNG KULON PADA UMUR 5 BULAN DIPERSEMAIAN

Malapari (Pongamia pinnata) is one of tree species belonging to Family of Leguminosae. Malapari seed oil were known as potential source for biofuel. The previous study showed that Provenance from Taman Nasional Ujung Kulon Banten had highest oil content among provenances in Java. Seed exploration was carried out to determine variations among families on oil content and growth performance. This study was conducted to determine the variation among families on growth performance at nursery level. The seedlings were used as planting stocks for Progeny Test establishment. This study was arranged in randomized completely block design with 50 families, 10 seedlings per plot and repeated in 4 blocks resulting the total number of observation units were 2000 seedlings. Seedling survival rate, growth performance (height, diameter, leave number), and sturdiness ratio was measured monthly up to 5 months after sowing. Analyses of variance was used to find out differences among families. Correlation among characters/parameters was analyzed by Pearson Correlation Analyses. The results showed that variations among families were found on seedling growthperformance. The seedling survival rate at the age of 5 months was 84.60% (26,70-100%) with an average growth of 47.10 cm (31,2-59,7 cm) in height, 5.49 mm (4,7-6,5 mm) in diameter, 8.56 for seedlings sturdiness and 15.4 (10,9-18,8) for leave number

Analysis of Factors Affecting Leprosy Cases in East Java Province with Spatial Autoregressive Model (SAR)

Leprosy caused by Mycobacterium leprae is still a health problem in Indonesia. The incidence of leprosy in every regency/city in East Java Province indicates a spatial dependence. This study aims to describe the pattern of leprosy incidence and identify factors that influence the incidence of leprosy in East Java Province. This study used secondary data published by East Java Provincial Health Office and East Java Central Statistics Agency in 2018. The observation units in this study are 38 regencies/cities in East Java Province. The analytical method used is Spatial Autoregressive Model (SAR) which is a spatial approach based on area. Based on the results of analysis show that Moran's index value = 0.250 (p = 0.018) which means indicating a spatial dependency. The mean years' schools (p = 0.001) and the male population (p = 0.006) had a significant effect on the incidence of leprosy. Meanwhile, the percentage of healthy housing coverage (p = 0.111) and population density (p = 0.055) did not affect the incidence of leprosy. The spread pattern of leprosy in East Java Province is clustered in adjacent areas and factors that affect the incidence of leprosy are the mean years' schools and the male population.