Tamoxifen Initiation After Ductal Carcinoma In Situ

Endocrine therapy initiation after ductal carcinoma in situ (DCIS) is highly variable and largely unexplained. National guidelines recommend considering tamoxifen for women with estrogen receptor-positive (ER+) DCIS or who undergo excision alone. We evaluated endocrine therapy use after DCIS over a 15-year period in an integrated health care setting to identify factors related to initiation

Gold price forecasting using multivariate stochastic model

Commodities prices are pivotal to the mineral investment decision and have a considerable impact on mining companies\u27 financial performance and countries that depend on mineral resources. Therefore, understanding the future mineral price movement is critical for revenue-based planning both for the company and the country. In this article, the Autoregressive Distribution Lag (ARDL) model was used to forecast annual gold prices using gold demand, treasury bills rates, and lagged gold prices as covariates. Augmented Dickey Fuller and the Phillips Perron methods were used to test for unit roots and found that all the variables were integrated of order one. Subsequently, the cointegration test was undertaken, which indicated that there is no cointegration between the variables. This entailed application of the short-run version of the ARDL to forecasts and consequent analysis. A Granger causality analysis show that gold demand Granger causes gold price; and that treasury bill rates do not Granger cause gold price. Lastly, the ARDL (4, 4, 2) model, which provides best ARDL forecast results, was evaluated against two other forecasting methods namely stochastic mean reverting, and Autoregressive Integrate Moving Average (ARIMA). Results showed that the ARDL model emerged as a best of all the three forecasting methods to forecast annual gold prices

Integrating flexibility in open pit mine planning to survive commodity price decline

Historically the mining industry grew substantially across the globe, acquiring new licenses, investing in exploration activities, and opening new mines along with the boom in commodity prices. However, the steady decline in mineral commodities prices significantly affects mineral industry as well as commodity producing nations. Mining risk management is undertaken to mitigate the adverse effects of uncertainties such as price fluctuations using Net Present Value (NPV). In this article risk management of commodity price decline was undertaken by integrating a recourse action with mine planning. The framework was presented in four distinct phases namely commodity price simulation using autoregressive distributed lag forecasting method; formulation of the mathematical stochastic phase design structure of the stochastic graph framework, and parametric solution of the graph problem; estimation and analysis of risk by Value at Risk (Var) and Weibull exceedance of losses concepts respectively, and minimizing the risk by optimizing operating level using the Lagrange model on Cobb-Douglass model. The proposed methodology was applied on an anonymous gold mine and the analysis of potential losses using Gumbel exceedance shows that mine could incur an annual loss of $20 million with a recurrence period of 1 in 1.38 years with a probability of 0.72. The recourse action was identified using the Lagrange model on the Cobb-Douglass model which reduced the cost by about 50% and subsequently the production level. The NPVs for the stochastic minimum cut models after application of the recourse action was 54% of the NPV at full production showing that there is an increase in the value of the project

Tamoxifen Initiation After Ductal Carcinoma In Situ

BACKGROUND. Endocrine therapy initiation after ductal carcinoma in situ (DCIS) is highly variable and largely unexplained. National guidelines recommend considering tamoxifen for women with estrogen receptor-positive (ER+) DCIS or who undergo excision alone. We evaluated endocrine therapy use after DCIS over a 15-year period in an integrated health care setting to identify factors related to initiation. METHODS. Female Group Health Cooperative enrollees ages 18–89 years with a DCIS diagnosis during 1996–2011 were eligible for inclusion. Endocrine therapy was identified through pharmacy records. Tumor and treatment information were from tumor registry reports; demographics and other risk factors were from questionnaires and electronic medical records. Relative risks (RRs) and 95% confidence intervals (CIs) for endocrine therapy initiation were calculated using multivariable generalized linear models. RESULTS. We identified 727 women with a DCIS diagnosis, including 163 (22%) who initiated endocrine therapy (149 tamoxifen, 14 aromatase inhibitor). Younger women were more likely to initiate endocrine therapy (RR 1.69; 95% CI 1.16–2.46 for ages 45–54 vs. 65–74 years). Compared with breast-conserving surgery (BCS) with radiation, women who had BCS alone (RR 0.46; 95% CI 0.25–0.84) or mastectomy (RR 0.54; 95% CI 0.39–0.75) were less likely to use endocrine therapy. ER testing increased from 4% of DCIS cases in 2001 to 71% in 2011; however, endocrine therapy initiation decreased from 58% of ER+ DCIS in 2001–2005 to 37% in 2009–2011. CONCLUSION. Increasing ER testing since 2001 has not corresponded to parallel increases in endocrine therapy initiation. Age, surgery, and radiation were the primary factors associated with initiation. IMPLICATIONS FOR PRACTICE: National guidelines recommend considering tamoxifen for women with ductal carcinoma in situ (DCIS) who are estrogen receptor-positive (ER+) or who undergo excision alone. In this study, the rapid increase in ER testing caused by tamoxifen’s approval in 2000 did not lead to increases in endocrine therapy initiation, despite recognition of an increasing number of DCIS tumors as ER+ each year. Contrary to the suggested guidelines, women who had breast-conserving surgery without radiation were less likely to use tamoxifen than those who had radiation. Future Food and Drug Administration approval of new endocrine agents for DCIS (such as aromatase inhibitors) may provide an opportunity to reemphasize benefits by ER and surgery status

Sex Differences in Comorbid Mental and Substance Use Disorders Among Primary Care Patients With Opioid Use Disorder

OBJECTIVE: The authors sought to characterize the 3-year prevalence of mental disorders and nonnicotine substance use disorders among male and female primary care patients with documented opioid use disorder across large U.S. health systems. METHODS: This retrospective study used 2014-2016 data from patients ages ≥16 years in six health systems. Diagnoses were obtained from electronic health records or claims data; opioid use disorder treatment with buprenorphine or injectable extended-release naltrexone was determined through prescription and procedure data. Adjusted prevalence of comorbid conditions among patients with opioid use disorder (with or without treatment), stratified by sex, was estimated by fitting logistic regression models for each condition and applying marginal standardization. RESULTS: Females (53.2%, N=7,431) and males (46.8%, N=6,548) had a similar prevalence of opioid use disorder. Comorbid mental disorders among those with opioid use disorder were more prevalent among females (86.4% vs. 74.3%, respectively), whereas comorbid other substance use disorders (excluding nicotine) were more common among males (51.9% vs. 60.9%, respectively). These differences held for those receiving medication treatment for opioid use disorder, with mental disorders being more common among treated females (83% vs. 71%) and other substance use disorders more common among treated males (68% vs. 63%). Among patients with a single mental health condition comorbid with opioid use disorder, females were less likely than males to receive medication treatment for opioid use disorder (15% vs. 20%, respectively). CONCLUSIONS: The high rate of comorbid conditions among patients with opioid use disorder indicates a strong need to supply primary care providers with adequate resources for integrated opioid use disorder treatment