AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to exa...AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques. Treatments included somatostatin analogues(SSA),cytotoxic chemotherapy(CC),targeted therapy(TT),interferon(IF) and combinations. We identified patients at least 18 years of age,with ≥ 1 inpatient or ≥ 2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14. A 6 mo clean period prior to first treatment ensured patients were newly treated. Patients were followed until end of enrollment or the study end date,whichever was first.RESULTS We identified 2258 newly treated GI NET patients: mean(SD) age was 55.6 years(SD = 9.7),47.2% of the patients were between 55 and 64 years,and 48.8% were female. All regions of the United States were represented. 59.6% started first-line therapy with SSA monotherapy(964 with octreotide LAR,380 with octreotide SA,and 1 with lanreotide),33.3% CC,3.6% TT,and 0.5% IF. The remainder received combinations. Mean follow up was 576 d. Overall mean first-line therapy duration was 361 d(449 d for SSA,215 for CC,267 for TT). 58.9% of patients had no pharmacological treatment beyond first line. The most common secondline was combination therapy with SSA. In graphical pattern analysis,there was no clear pattern visible after first line therapy.CONCLUSION In this study,60% of patients initiated treatment with SSA alone or in combination. The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.展开更多
The objective of this paper was to project possible impacts of climate change on heavy rainfall-related water damage insurance claims and incurred losses for four selected cites (Kitchener-Waterloo, London, Ottawa, an...The objective of this paper was to project possible impacts of climate change on heavy rainfall-related water damage insurance claims and incurred losses for four selected cites (Kitchener-Waterloo, London, Ottawa, and Toronto) located at Ontario, Canada. To achieve this goal, the future climate change scenarios and rainfall simulations, at local scale, were needed. A statistical downscaling method was used to downscale five global climate model (GCM) scenarios to selected weather stations. The downscaled meteorological variables included surface and upper-air hourly temperature, dew point, west-east and south-north winds, air pressure, and total cloud cover. These variables are necessary to project future daily rainfall quantities using within-weather-type rainfall simulation models. A model result verification process has been built into the whole exercise, including rainfall simulation modeling and the development of downscaling transfer functions. The results of the verification, based on historical observations of the outcome variables simulated by the models, showed a very good agreement. To effectively evaluate heavy rainfall-related water damage insurance claims and incurred losses, a rainfall index was developed considering rainfall intensity and duration. The index was evaluated to link with insurance data as to determination of a critical threshold of the rainfall index for triggering high numbers of rainfall-related water damage insurance claims and incurred losses. The relationship between rainfall index and insurance data was used with future rainfall simulations to project changes in future heavy rainfall-related sewer flood risks in terms of water damage insurance claims and incurred losses. The modeled results showed that, averaged over the five GCM scenarios and across the study area, both the monthly total number of rainfall-related water damage claims and incurred losses could increase by about 13%, 20% and 30% for the periods 2016-2035, 2046-2065, and 2081-2100, respectively (from the four-ci展开更多
基金Supported by Novartis Pharmaceuticals,One Health Plaza,East Hanover,No.NJ 07936-1080,United State
文摘AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques. Treatments included somatostatin analogues(SSA),cytotoxic chemotherapy(CC),targeted therapy(TT),interferon(IF) and combinations. We identified patients at least 18 years of age,with ≥ 1 inpatient or ≥ 2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14. A 6 mo clean period prior to first treatment ensured patients were newly treated. Patients were followed until end of enrollment or the study end date,whichever was first.RESULTS We identified 2258 newly treated GI NET patients: mean(SD) age was 55.6 years(SD = 9.7),47.2% of the patients were between 55 and 64 years,and 48.8% were female. All regions of the United States were represented. 59.6% started first-line therapy with SSA monotherapy(964 with octreotide LAR,380 with octreotide SA,and 1 with lanreotide),33.3% CC,3.6% TT,and 0.5% IF. The remainder received combinations. Mean follow up was 576 d. Overall mean first-line therapy duration was 361 d(449 d for SSA,215 for CC,267 for TT). 58.9% of patients had no pharmacological treatment beyond first line. The most common secondline was combination therapy with SSA. In graphical pattern analysis,there was no clear pattern visible after first line therapy.CONCLUSION In this study,60% of patients initiated treatment with SSA alone or in combination. The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.
文摘The objective of this paper was to project possible impacts of climate change on heavy rainfall-related water damage insurance claims and incurred losses for four selected cites (Kitchener-Waterloo, London, Ottawa, and Toronto) located at Ontario, Canada. To achieve this goal, the future climate change scenarios and rainfall simulations, at local scale, were needed. A statistical downscaling method was used to downscale five global climate model (GCM) scenarios to selected weather stations. The downscaled meteorological variables included surface and upper-air hourly temperature, dew point, west-east and south-north winds, air pressure, and total cloud cover. These variables are necessary to project future daily rainfall quantities using within-weather-type rainfall simulation models. A model result verification process has been built into the whole exercise, including rainfall simulation modeling and the development of downscaling transfer functions. The results of the verification, based on historical observations of the outcome variables simulated by the models, showed a very good agreement. To effectively evaluate heavy rainfall-related water damage insurance claims and incurred losses, a rainfall index was developed considering rainfall intensity and duration. The index was evaluated to link with insurance data as to determination of a critical threshold of the rainfall index for triggering high numbers of rainfall-related water damage insurance claims and incurred losses. The relationship between rainfall index and insurance data was used with future rainfall simulations to project changes in future heavy rainfall-related sewer flood risks in terms of water damage insurance claims and incurred losses. The modeled results showed that, averaged over the five GCM scenarios and across the study area, both the monthly total number of rainfall-related water damage claims and incurred losses could increase by about 13%, 20% and 30% for the periods 2016-2035, 2046-2065, and 2081-2100, respectively (from the four-ci
