MARKETING STARTEGY OF COPRA IN INDRAGIRI HILIR REGENCY RIAU PROVINCE

The problem facing the copra business is fluctuating copra prices in the market, resulting in small profits for entrepreneurs and farmers. Fluctuations in copra prices are an obstacle due to inefficient marketing of copra, this is due to the large number of intermediary traders who act as marketers, and farmers only as price takers. This study was conducted with a qualitative and quantitative descriptive analysis. The overall score of the IFE Matrix for Copra Marketing Strategy is 2.7742 and the EFE Matrix score is 2.5546. Based on the IE matrix, Indragiri Hilir Regency Copra is in moderate inside and outside positions, namely 2.7742 and 2.5546, which means the company is in the 'V' quadrant. Strategies derived from the SWOT analysis include: 1) IT-based market development to provide greater access to market share; 2) service improvement through a customer relationship management (CRM) system that integrates processes, people and IT; 3) improvement of vehicles and infrastructure services; 4) opening opportunities for collaboration/collaboration with research institutes, government and the private sector in the field of waste management, so that they are more productive and have salable value, 5) developing the quality of human resources, production capacity and infrastructure and reducing distribution channels; 6) development of a competitive business strategy, intensification of land functions and cooperation with partners

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570