Long-term persistency and costs associated with the use of iron chelation therapies in the treatment of Sickle cell disease within Medicaid programs.

OBJECTIVE: This retrospective study evaluated iron chelating therapy (ICT) discontinuation and costs in Sickle cell disease (SCD) Medicaid recipients using healthcare claims from 2006-2010. METHODS: Patients with ≥1 SCD diagnosis claim, ≥2 claims for deferoxamine (DFO) or deferosirox (DFX), and continuous enrollment ≥6 months prior to and 18 months following ICT initiation were included. Outcomes included treatment discontinuation, persistence (i.e., refill gaps ≥6 weeks), and total healthcare costs. RESULTS: The average age among 404 SCD patients meeting study inclusion criteria was 18.7 (±11.0) years, with 45.8% being males and 66.7% being Blacks. Switches or combinations from DFO at index occurred in 124 (74.7%) patients compared to 10 (4.2%) with DFX at index. The Cox regression model that assessed long-term medication persistence indicated a 1.30-times higher likelihood of treatment discontinuation with DFO compared to DFX (95% CI: 1.06-1.61). Some 19.7% of patient remained on DFX relative to 4.8% on DFO. Both inpatient and total costs were similar in DFX and DFO treatment groups. Following 1 year of treatment, 37.4% remained on DFX compared to 15.7% on DFO. Meaningful differences in treatment discontinuation between the two treatment groups did not occur until 220+ days during the study period. At 18-months, treatment discontinuation rates were high in both groups; 95% for DFO and 80% for DFX. CONCLUSION: This study of SCD Medicaid patients found more therapeutic switches from DFO to DFX and a higher medication persistency rate with DFX than DFO. The conclusions are limited by the study\u27s retrospective nature, which depends on multivariate statistics to account for patient heterogeneity and risk factors

A strong form of almost differentiability

We present a uniformization of Reeken's macroscopic differentiability (see [5]), discuss its relations to uniform differentiability (see [6]) and classical continuous differentiability, prove the corresponding chain rule, Taylor's theorem, mean value theorem, and inverse mapping theorem. An attempt to compare it with the observability (see [1, 4]) is made too. © 2009 Springer Science+Business Media, Inc.CEOCFCTFEDER/POCT

Comparative efficacy of deferiprone, deferoxamine and combination of deferiprone and deferoxamine on serum ferritin value in Beta-Thalassemia patients

Background: Iron overload is a predictable and life-threatening complication in patients with thalassemia. Effective and convenient iron chelation remains one of the main targets of clinical management of thalassemia major. The development of a safe and effective chelator has been the goal for many years. Aims and Objective: It was aimed to compare the effect of deferiprone, deferoxamine and combination of deferiprone and deferoxamine on serum ferritin value in beta-thalassemia patients. Material and Methods: This controlled clinical trial was conducted on 46 major beta-thalassemic patients. Fifteen patients in deferiprone group received deferiprone 75mg/kg/day three times a day orally. Nineteen patients in deferoxamine group received deferoxamine 30-50 mg/kg/day subcutaneously for 8-12 hours/day and 5 days per week. Twelve patients in combined therapy group received deferiprone 75 mg/kg/day three times a day orally with deferoxamine 30–50 mg/kg subcutaneously every other day. Serum ferritin value was measured at the beginning and at the end of 6th and 12th months of study. Results: The mean of serum ferritin value in deferiprone group insignificantly increased from 2731± 1398.5 μg/L at the beginning to 2788.5 ± 978.6 μg/L and to 3331.8 ± 1833.9 μg/L at the end of 6th and 12th months of study, respectively. The mean of serum ferritin value in deferoxamine group insignificantly increased from 2883.5 ± 1598.1 μg/L at the beginning to 2935.3 ± 1258.2 μg/L at the end of 6th month of study and decreased to 2773.8 ± 1216.1 μg/L and 12th month of study. The mean of serum ferritin level in combined therapy group significantly decreased from 7498.7 ± 3512.9 μg/L at the beginning to 4839.9 ± 2698.2 μg/L (P < 0.001) and to 4298.2 ± 2288.7 μg/L (P < 0.001) at the end of 6th and 12th months of study, respectively. Conclusion: Combined therapy significantly decreases serum ferritin level. Study suggests deferiprone as a significant addition to support therapy in patients with betathalassemia major on regular transfusion regimens. © 2015 Journal of Krishna Institute of Medical Sciences University

A conceptual framework for circular design

Design has been recognised in the literature as a catalyst to move away from the traditional model of take-make-dispose to achieve a more restorative, regenerative and circular economy. As such, for a circular economy to thrive, products need to be designed for closed loops, as well as be adapted to generate revenues. This should not only be at the point of purchase, but also during use, and be supported by low-cost return chains and reprocessing structures, as well as effective policy and regulation. To date, most academic and grey literature on the circular economy has focused primarily on the development of new business models, with some of the latter studies addressing design strategies for a circular economy, specifically in the area of resource cycles and design for product life extension. However, these studies primarily consider a limited spectrum of the technical and biological cycles where materials are recovered and restored and nutrients (e.g., materials, energy, water) are regenerated. This provides little guidance or clarity for designers wishing to design for new circular business models in practice. As such, this paper aims to address this gap by systematically analysing previous literature on Design for Sustainability (DfX) (e.g., design for resource conservation, design for slowing resource loops and whole systems design) and links these approaches to the current literature on circular business models. A conceptual framework is developed for circular economy design strategies. From this conceptual framework, recommendations are made to enable designers to fully consider the holistic implications for design within a circular economy