The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study.

BACKGROUND: In the United States, people with relapsing-remitting multiple sclerosis (RRMS) can face difficulty accessing disease-modifying therapies (DMTs) because of insurance, pharmacy, or provider policies. These barriers have been associated with poor adherence and negative health outcomes. OBJECTIVE: The goals of this study were to describe the overall occurrence of difficulties and delays associated with gaining access to DMTs among people with RRMS, to assess DMT adherence during periods of reduced access, and to contextualize the patients\u27 journey from receipt of a prescription for DMT to obtaining and taking their medication when faced with access barriers. METHODS: We recruited US-based adults self-reporting RRMS from a Web-based health data-sharing social network, PatientsLikeMe. Individuals were invited to complete a Web-based survey if they reported a diagnosis of RRMS and were prescribed a DMT for MS. Follow-up phone interviews were conducted with 10 respondents who reported experiencing an MS-related relapse during the time they had experienced challenges accessing DMTs. RESULTS: Among 507 survey completers, nearly half were either currently experiencing an issue related to DMT assess or had difficulty accessing a DMT in the past (233/507, 46.0%). The most frequently reported reasons for access difficulty were authorization requirements by insurance companies (past issues: 78/182, 42.9%; current issues: 9/42, 21%) and high out-of-pocket costs (past issues: 54/182, 29.7%; current issues: 13/42, 31%). About half (20/39, 51%) of participants with current access issues and over a third (68/165, 41.2%) of those with past issues went without their medication until they could access their prescribed DMT. Relapses were reported during periods of reduced DMT access for almost half (56/118, 47.5%) of those with past issues and nearly half (22/45, 49%) of those with current issues. Resolving access issues involved multiple stakeholder agents often coordinated in a patient-led effort. Among those who had resolved issues, about half (57/119, 47.9%) reported that doctors or office staff were involved, under half (48/119, 40.3%) were involved themselves, and about a third (39/119, 32.8%) reported the drug manufacturer was involved in resolving the issue. Follow-up interviews revealed that the financial burden associated with obtaining a prescribed DMT led to nonadherence. Additionally, participants felt that DMT treatment delays and stress associated with obtaining the DMT triggered relapses or worsened their MS. CONCLUSIONS: This study expands current research by using a patient-centered, mixed-methods approach to describe barriers to MS treatment, the process to resolve barriers, and the perceived impact of treatment barriers on outcomes. Issues related to DMT access occur frequently, with individuals often serving as their own agents when navigating access difficulties to obtain their medication(s). Support for resolution of DMT access is needed to prevent undue stress and nonadherence

The utilize of gamma radiation on the examination of mechanical properties of polymeric materials

The article deals about the application area of radiation crosslinking of plastics, which follows after the injection moulding. The main objective of the presented article is the research of influence irradiation dosage on mechanical properties of materials: PP filled by 15 % of mineral filler – talc. Mechanical properties - tensile strength and impact strength by Charpy were examined in dependence on absorbed dose of the gamma rays on various conditions and were compared with non-irradiated samples. Radiation processing involves mainly the use of either electron beams from electron accelerators or gamma radiation from Cobalt-60 sources

Comment on ``Critical Behavior in Disordered Quantum Systems Modified by Broken Time--Reversal Symmetry''

In a recent Letter [Phys. Rev. Lett. 80, 1003 (1998)] Hussein and Pato employed the maximum entropy principle (MEP) in order to derive interpolating ensembles between any pair of universality classes in random matrix theory. They apply their formalism also to the transition from random matrix to Poisson statistics of spectra that is observed for the case of the Anderson-type metal-insulator transition. We point out the problems with the latter procedure.Comment: 1 page in PS, to appear in PRL Sept. 2

The generalized localization lengths in one dimensional systems with correlated disorder

The scale invariant properties of wave functions in finite samples of one dimensional random systems with correlated disorder are analyzed. The random dimer model and its generalizations are considered and the wave functions are compared. Generalized entropic localization lengths are introduced in order to characterize the states and compared with their behavior for exponential localization. An acceptable agreement is obtained, however, the exponential form seems to be an oversimplification in the presence of correlated disorder. According to our analysis in the case of the random dimer model and the two new models the presence of power-law localization cannot be ruled out.Comment: 7 pages, LaTeX (IOP style), 2 figure

Chemical ordering and composition fluctuations at the (001) surface of the Fe-Ni Invar alloy

We report on a study of (001) oriented fcc Fe-Ni alloy surfaces which combines first-principles calculations and low-temperature STM experiments. Density functional theory calculations show that Fe-Ni alloy surfaces are buckled with the Fe atoms slightly shifted outwards and the Ni atoms inwards. This is consistent with the observation that the atoms in the surface layer can be chemically distinguished in the STM image: brighter spots (corrugation maxima with increased apparent height) indicate iron atoms, darker ones nickel atoms. This chemical contrast reveals a c2x2 chemical order (50% Fe) with frequent Fe-rich defects on Invar alloy surface. The calculations also indicate that subsurface composition fluctuations may additionally modulate the apparent height of the surface atoms. The STM images show that this effect is pronounced compared to the surfaces of other disordered alloys, which suggests that some chemical order and corresponding concentration fluctuations exist also in the subsurface layers of Invar alloy. In addition, detailed electronic structure calculations allow us to identify the nature of a distinct peak below the Fermi level observed in the tunneling spectra. This peak corresponds to a surface resonance band which is particularly pronounced in iron-rich surface regions and provides a second type of chemical contrast with less spatial resolution but one that is essentially independent of the subsurface composition.Comment: 7 pages, 5 figure

Relation between the phenomenological interactions of the algebraic cluster model and the effective two--nucleon forces

We determine the phenomenological cluster--cluster interactions of the algebraic model corresponding to the most often used effective two--nucleon forces for the $^{16}$O + $\alpha$ system.Comment: Latex with Revtex, 1 figure available on reques

Jet fuel property changes and their effect on producibility and cost in the U.S., Canada, and Europe

The effects of changes in properties and blending stocks on the refinery output and cost of jet fuel in the U.S., Canada, and Europe were determined. Computerized refinery models that minimize production costs and incorporated a 1981 cost structure and supply/demand projections to the year 2010 were used. Except in the West U.S., no changes in jet fuel properties were required to meet all projected demands, even allowing for deteriorating crude qualities and changes in competing product demand. In the West U.S., property changes or the use of cracked blendstocks were projected to be required after 1990 to meet expected demand. Generally, relaxation of aromatics and freezing point, or the use of cracked stocks produced similar results, i.e., jet fuel output could be increased by up to a factor of three or its production cost lowered by up to $10/cu m. High quality hydrocracked stocks are now used on a limited basis to produce jet fuel. The conversion of U.S. and NATO military forces from wide-cut to kerosene-based jet fuel is addressed. This conversion resulted in increased costs of several hundred million dollars annually. These costs can be reduced by relaxing kerosene jet fuel properties, using cracked stocks and/or considering the greater volumetric energy content of kerosene jet fuel