Effect on hypnotic prescribing of a quality improvement collaborative for primary care of insomnia: segmented regression analysis

Introduction Patients with insomnia commonly present to general practice. Hypnotic misuse and underuse of psychological treatments demonstrates scope for improved care. To explore this, we undertook a feasibility study using a Quality Improvement Collaborative (QIC) across 8 general practices, investigating the effect of implementing sleep assessment and psychological interventions on hypnotic prescribing. Methods We used a before-after analysis of the time series of prescribing of benzodiazepines (e.g. diazepam, temazepam, lorazepam) and Z-drugs (e.g. zopiclone, zolpidem, zaleplon) across intervention practices. We contrasted results with those for 8 control practices not subject to the QIC. Data were constructed as average daily quantity of hypnotic prescribed per Specific Therapeutic group Age-sex weightings Related Prescribing Unit (STAR–PU) for the period October 2005 to March 2010. Modelling was by 2-segment intercept-trend regression performed on the 24 month periods either side of the 6-month operation of the QIC (October 2007 to March 2008). Estimation was by either least squares or corrected using the Prais-Winsten method if error serial correlation was present in the errors. We then jointly re-estimated across all intervention practices (repeated on all control practices) using seemingly unrelated regressions to allow for any potential correlations in the models’ errors. Testing whether the intervention had been successful in inducing a structural break such that post-QIC prescribing of either drug was reduced, we constructed a bespoke test S based on the mean prediction error in the post-QIC period for aggregated intervention practices. Results Comparing the two prescribing periods, there was a noteworthy and significant reduction in benzodiazepine prescribing in intervention practices over the shorter post-QIC term of 12 months (S=-2.46, p=0.007), but this was not sustained for the full 24 months post-QIC (S=-0.72, p=0.236). However, for Z-drugs prescribing reductions in intervention practices were sustained into the longer post-QIC period (12 months: S=-1.98, p=0.024; 24 months, S=-1.90, p=0.029). The before-after comparison to control practices showed no significant reduction in prescribing of either drug. Conclusion Efficacy of the QIC in reducing hypnotic prescribing was shown, giving support to the need for a full scale trial. Varying length of persistence of outcomes warrants attention

The omnivorous Tyrolean Iceman: colon contents (meat, cereals, pollen, moss and whipworm) and stable isotope analyses

The contents of the colon of the Tyrolean Iceman who lived Ga. 5300 years ago include muscle fibres, cereal remains, a diversity of pollen, and most notably that of the hop hornbeam (Ostrya carpinifolia) retaining cellular contents, as well as a moss leaf (Neckera complanata) and eggs of the parasitic whipworm (Trichuris trichiura). Based almost solely on stable isotope analyses and ignoring the work on the colon contents, two recently published papers on the Iceman's diet draw ill- founded conclusions about vegetarianism and even veganism. Neither the pollen nor the moss is likely to have been deliberately consumed as food by the Iceman. All the available evidence concerning the Iceman's broad-based diet is reviewed and the significance of the colon contents for matters other than assessment of food intake is outlined

A SURVEY ON THE FRAUDULENT USE OF ANABOLIC SUBSTANCES IN BOVINES SLAUGHTERED IN MOLISE

An investigation has been performed on the fraudulent use of anabolic substances in the Region of Molise. One hundred fourty-four bovines (12-24 months old, 123 males and 21 females) have been included in the survey. Ante-mortem assessment on their behaviour and clinical analysis on some target organs were carried out. After slaughtering, samples of prostate, bulbo-urethral glands, Bartholin's glands, mammary gland, ovaries, thymus and thyroid were collected and processed for an anatomo-histopathological evaluation, as suggested in the guidelines of the Italian National Plan for Residues (PNR) 2009. Overall, the 15% of the subjects analysed have been classified as "suspect", whereas the 44% as "uncertain" and the remaining 59% as "negative". The lesion most frequently found was a serious atrophy of the thymic parenchyma with fat infiltration (15% of males and 14% of females), suggesting a prevalence of an illegal use of cortisonic drugs

Construction of an Instrumentation Kit for Identification and Control of DC Motors

This paper presents the development of an instrumentation kit of voltage and current measurement for identification of the dynamic model and control of direct current (DC) motors. In the methodology for the parameters identification is used the responses of input voltage and current, and angular velocity of the DC motor. The validation of the obtained dynamic model is done through the comparison of the simulated and experimental responses, and the application of a control system based on state feedback and complete eigenstructure assignment (tracking system). The responses are compared through the normalized root-mean-square error criterion

Control of a Modified Ball and Beam System Using Tracking System in Real Time with a DC Motor as an Actuator

This paper presents amodified ball and beam system, with the intention of realizing a test bed, to study new control techniques in real-time.The ball and beam system consists of a ball over a long beam where the control objective is to stabilizethe position of the ball on the beam by changing the angular position of the beam.In this paper, the ball of the conventional system is replaced by a cart with an embedded microcontroller, enabling the use of a linear encoder as position sensor and allowing to transmit the position via RF (Radio Frequency). The mathematical model of the ball and beam is obtained through the equations of Newton-Euler and the equations were linearized. The system is controlled using the hardware-in-the-loop technique with MATLAB/Simulink.It is applied a tracking control system with entire eigenstructure assignment to control the position of the cart. The actuator used is a DC motor, and a PID(proportional, integral and derivative) control is used to perform the angular position control of beam.The simulation results and the experimental results are compared to validate the mathematical model. The results obtained were satisfactory with adequate accuracy