Littérature scientifique sur le sujet « 929/.343 »

We conducted a systematic aerial transect survey of Peary caribou (Rangifer tarandus pearyi) and muskoxen (Ovibus moschatus) on Banks Island, Northwest Territories, in July 2010. The population estimate of adult Peary caribou was 1097 ± 343 (95% Confidence Interval: CI), which is not significantly different from the 2005 estimate of 929 ± 289 (95% CI; P < 0.05). The current number, however, is a 4- to 9-fold decrease since the 1980s. The adult muskoxen population estimate was 36 676 ± 4031 (95% CI), which is significantly lower than the 2005 estimate of 47 209 ± 3997 (95% CI; P < 0.05).

Abstract Introduction: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common sub-type of non-Hodgkin lymphoma. Despite advances in immunochemotherapy, a significant portion of individuals with DLBCL are refractory or relapse following initial treatment and eventually succumb to the disease. Real world studies on DLBCL treatment patterns beyond first-line therapy are limited, and the health care costs associated with relapsed DLBCL are unknown. Using 100% Medicare claims data, our study set out to measure health care utilization following completion of first-line therapy for DLBCL. Methods: This retrospective study used 100% Medicare claims data (Inpatient, outpatient, Part D, SNF, HHA, Hospice, DME) to identify older adults (≥65 years) diagnosed with DLBCL (ICD9-CM diagnosis code: 200.7x) between Jan 1st 2010 - June 30th2014. Individuals were required to have prescription claims for a DLBCL chemotherapy treatment regimen 90 days pre-, or up to 1 year post-initial DLBCL claim. To limit our initial cohort selection to treatment-naïve patients, we excluded those with a DLBCL claim or prescription for a DLBCL related treatment at any time prior to the initial diagnosis date or treatment initiation date. All included patients were required to have continuous medical enrollment for 12 months before treatment initiation and receive at least one full cycle of valid DLBCL regimen. We then created our post first-line therapy study cohort by defining the end of first-line treatment by a gap of ≥60 days in therapy. Beneficiaries who initiated a second-line regimen during the follow-up period composed our relapsed group, whereas, individuals who completed first-line therapy without initiating any other chemotherapy treatment composed our non-relapse group. The index date for our health care utilization analysis was defined as the first-line treatment end date plus 60 days. Beneficiaries in both groups were required to have continuous medical benefits ≥1 year after this date or until death. Our primary outcome of health care resource utilization following first-line therapy were calculated as per patient per month and compared between our relapse and non-relapse groups using the chi-square test and t-test. Results:We identified 5,909 Medicare beneficiaries who completed first-line treatment for DLBCL, of which 1,552 had claims indicating second-line therapy during follow up (relapsed group). The mean age for the relapsed group was 77 years compared to 76 years for the non-relapse group (p=0.006). Other baseline characteristics were similar between our relapsed versus non-relapsed cohort. Compared to the non-relapse group, patients in our relapsed cohort were less likely to receive R-CHOP as first-line therapy (56.3% vs 80.5%, p<0.001), but more likely to receive rituximab monotherapy (20.8% vs. 6.0%, p<0.001), bendamustine-rituximab (9.0% vs. 3.4%, p<0.001), and CVP regimens (7.9% vs. 4.9%, p<0.001). The mean (median) follow-up time after first-line therapy was similar between groups with 915 (863) and 929 (893) days for the relapsed and non-relapsed cohorts, respectively. In the period following first-line therapy, our relapsed cohort had higher healthcare utilization with more patients having claims for hospital admissions (60.7% vs. 41.1%, p<0.001), emergency room visits (51.7% vs. 43.0%, p<0.001), use of skilled nursing facilities (19.3% vs. 12.5%, p<0.001), home health agency (35.5% vs. 23.3%, p<0.001), and hospice services (19.9% vs. 6.3%, p<0.001) compared to non-relapse patients. Major cost drivers among relapsed patients were inpatient costs ($1,147 vs. $511, p<0.001), outpatient office visits ($3,036 vs. $691, p<0.001), and ambulatory costs ($1,730 vs. $343, p<0.001). Consequently, higher total all-cause health care costs per patient per month were observed in the relapse group ($6,566 vs. $1,951, p<0.001). Conclusions: Our analysis found a significant portion of Medicare beneficiaries treated for DLBCL receive therapy beyond the first-line setting. Complete Medicare claims allowed us to capture comprehensive health care utilization, including end-of-life and supportive care not typically included in cost estimates. Our data confirms the expectations of higher health care utilization with relapsed DLBCL and suggest that improvements in first-line DLBCL therapy in older adults may offer significant health care savings in addition to improved clinical outcomes. Disclosures Huntington: Johnson & Johnson: Consultancy; Oncosec Medical: Equity Ownership; Geron: Equity Ownership; Exelixis: Equity Ownership; Celgene: Consultancy, Honoraria; Pharmacyclics: Honoraria. Keshishian:STATinMED Research: Employment. Xie:Celgene: Research Funding. Baser:STATinMED Research: Employment. McGuire:Celgene Corporation: Employment, Equity Ownership.

Abstract Background Invasive pneumococcal disease (IPD) isolates forming genomic clusters can reflect rapid disease transmission between vulnerable individuals. Methods We performed whole genome sequencing of 2820 IPD isolates recovered during 2019 through Centers for Disease Control and Prevention’s Active Bacterial Core surveillance to provide strain information (serotypes, resistance, genotypes), and 2778 of these genomes were analyzed to detect highly related genomic clusters. Results Isolates from persons experiencing homelessness (PEH) were more often within genomic clusters than those from persons not experiencing homelessness (PNEH) (105/198 [53.0%] vs 592/2551 [23.2%]; P &lt; .001). The 4 western sites accounted for 33.4% (929/2778) of isolates subjected to cluster analysis yet accounted for 48.7% (343/705) of clustering isolates (P &lt; .001) and 75.8% (150/198) of isolates recovered from PEH (P &lt; .001). Serotypes most frequent among PEH were (in rank order) 12F, 4, 3, 9N, 8, 20, and 22F, all of which were among the 10 serotypes exhibiting the highest proportions of clustering isolates among all cases. These serotypes accounted for 44.9% (1265/2820) of all IPD cases and are included within available vaccines. Conclusions We identified serotype-specific and geographic differences in IPD transmission. We show the vulnerability of PEH within different regions to rapidly spreading IPD transmission networks representing several pneumococcal serotypes included in available vaccines.