Decreased antihyperglycemic drug use driven by high out-of-pocket costs despite medicare coverage gap closure

OBJECTIVE Using the 2016 Medicare Part D coverage gap as an example, we explored effects of increased out-of-pocket costs on adherence to branded dipeptidyl peptidase 4 inhibitors (DPP-4i) in patients without financial subsidies relative to subsidized patients who do not experience increased spending during the gap. We also explored seasonality of reinitiation, because discontinuers may be more likely to reinitiate in January when benefits reset. RESEARCH DESIGN AND METHODS We identified DPP-4i or sulfonylurea initiators, aged ‡66 years, from a 20% sample of 2015–2016 Medicare claims. Difference-in-differences Poisson regression was used to compare adherence before and after entering the coverage gap between nonsubsidizedand subsidized patients.Among discontinuers, monthly hazardratios (HRs) for reinitiation relative to January 2016 were derived with Cox models. As a second control, we repeated analyses using sulfonylureas, generic low-cost alternatives. RESULTS In 2016, 8,096 subsidized and 6,173 nonsubsidized DPP-4i initiators entered the coverage gap. For nonsubsidized patients, copayment in the coverage gap was 45% ($227 per DPP-4i prescription), and adherence decreased from 68.4% to 49.0% after gap entry. Accounting for adherence differences in subsidized patients, nonsubsidized patients demonstrated reduced adherence to DPP-4i (differencein-difference: 216.9%; 95% CI 218.7%, 215.1%) but not sulfonylureas (21.6%; 95% CI 23.4%, 0.2%). Reinitiation was lowest in the months before January (HR 0.4–0.5) among nonsubsidized DPP-4i patients, demonstrating a strong seasonal pattern. CONCLUSIONS Increased out-of-pocket costs negatively affect adherence and reinitiation of branded antihyperglycemic drugs among patients without financial subsidies. Despite closure of the coverage gap, affordability remains a concern given increasing list prices for many drugs on Medicare and the growing use of deductibles and coinsurance by commercial health plans

Mass Suppression in Octet Baryon Production

There is a striking suppression of the cross section for production of octet baryons in $e^+ e ^-$ annihilation, as the mass of the produced hadron increases. We present a simple parametrization for the fragmentation functions into octet baryons guided by two input models: the SU(3) flavor symmetry part is given by a quark-diquark model, and the baryon mass suppression part is inspired by the string model. We need only eight free parameters to describe the fragmentation functions for all octet baryons. These free parameters are determined by a fit to the experimental data of octet baryon production in $e^+ e ^-$ annihilation. Then we apply the obtained fragmentation functions to predict the cross section of the octet baryon production in charged lepton DIS and find consistency with the available experimental data. Furthermore, baryon production in $pp$ collisions is suggested to be an ideal domain to check the predicted mass suppression.Comment: 20 pages, 5 figure

A simple approach to describe hadron production rates in e+e−e^+ e^- annihilation

We show that, based on the idea of string fragmentation, the production rates of light flavored mesons and baryons originating from fragmentation can be described by the spin, the binding energy of the particle, and a strangeness suppression factor. Apart from a normalization factor, $e^+ e^-$ data at different center-of-mass energies can be described simultaneously. Applying to the heavy flavor production, we find that our predictions are in good agreement with data.Comment: latex(stwol.sty), 4 pages, 2 figure

A case-only study to identify genetic modifiers of breast cancer risk for BRCA1/BRCA2 mutation carriers

Breast cancer (BC) risk for BRCA1 and BRCA2 mutation carriers varies by genetic and familial factors. About 50 common variants have been shown to modify BC risk for mutation carriers. All but three, were identified in general population studies. Other mutation carrier-specific susceptibility variants may exist but studies of mutation carriers have so far been underpowered. We conduct a novel case-only genome-wide association study comparing genotype frequencies between 60,212 general population BC cases and 13,007 cases with BRCA1 or BRCA2 mutations. We identify robust novel associations for 2 variants with BC for BRCA1 and 3 for BRCA2 mutation carriers, P < 10−8, at 5 loci, which are not associated with risk in the general population. They include rs60882887 at 11p11.2 where MADD, SP11 and EIF1, genes previously implicated in BC biology, are predicted as potential targets. These findings will contribute towards customising BC polygenic risk scores for BRCA1 and BRCA2 mutation carriers

THE EFFECTS OF METALLIC INTERLAYER FORMATION ON THE ADHESION PROPERTIES OF PACVD - TiN FILMS ON TOOL STEEL

The adhesion of PACVD - TiN films on tool steel (AISI M2) has been investigated as a function of interfacial chemistry and the metallic interlayer formation between TiN films and substrate steel. Prior to TiN deposition, thin metallic interlayers such as Ti, Cr, Cu films were deposited on a steel substrate with thickness range of 200 - 2000 A by Magnetron sputtering. TiN films were deposited by RF Glow Discharge PACVD technique using the gaseous mixture of TiCl4, N2, H2 and Ar at 520 °C. The adhesion strength of TiN films was investigated by Scratch Adhesion Tester (REVETEST model) with a diamond stylus. The critical load in adhesion test was about 35 N in the case of no metallic interlayer and it was increased up to 60 N in the presence of 200 Å thick Ti interlayer. The interfacial composition profile was investigated by Auger depth profile. The experimental results indicated that a thin Ti intermediate layer ([MATH] 600 Å) could increase the adhesion and the critical normal force in the scratch adhesion test was up to 60 N. In the case of Ti interlayer formation, the oxygen in the interfacial region plays an important role on the adhesion of TiN coating by the formation of a Ti(ON) type phase

The health needs and health promotion issues relevant to the Chinese community in England Final report

Available from British Library Document Supply Centre-DSC:q97/25733 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo