Insomnia - treatment pathways, costs and quality of life

<p>Abstract</p> <p>Background</p> <p>Insomnia is perhaps the most common sleep disorder in the general population, and is characterised by a range of complaints around difficulties in initiating and maintaining sleep, together with impaired waking function. There is little quantitative information on treatment pathways, costs and outcomes. The aims of this New Zealand study were to determine from which healthcare practitioners patients with insomnia sought treatment, treatment pathways followed, the net costs of treatment and the quality of life improvements obtained.</p> <p>Methods</p> <p>The study was retrospective and prevalence based, and was both cost effectiveness (CEA) and a cost utility (CUA) analysis. Micro costing techniques were used and a societal analytic perspective was adopted. A deterministic decision tree model was used to estimate base case values, and a stochastic version, with Monte Carlo simulation, was used to perform sensitivity analysis. A probability and cost were attached to each event which enabled the costs for the treatment pathways and average treatment cost to be calculated. The inputs to the model were prevalence, event probabilities, resource utilisations, and unit costs. Direct costs and QALYs gained were evaluated.</p> <p>Results</p> <p>The total net benefit of treating a person with insomnia was $482 (the total base case cost of$145 less health costs avoided of $628). When these results were applied to the total at-risk population in New Zealand additional treatment costs incurred were$6.6 million, costs avoided $28.4 million and net benefits were$21.8 million. The incremental net benefit when insomnia was "successfully" treated was $3,072 per QALY gained.</p> <p>Conclusions</p> <p>The study has brought to light a number of problems relating to the treatment of insomnia in New Zealand. There is both inadequate access to publicly funded treatment and insufficient publicly available information from which a consumer is able to make an informed decision on the treatment and provider options. This study suggests that successful treatment of insomnia leads to direct cost savings and improved quality of life.</p

Event-by-Event Direction Reconstruction of Solar Neutrinos in a High Light-Yield Liquid Scintillator

The direction of individual $^8$B solar neutrinos has been reconstructed using the SNO+ liquid scintillator detector. Prompt, directional Cherenkov light was separated from the slower, isotropic scintillation light using time information, and a maximum likelihood method was used to reconstruct the direction of individual scattered electrons. A clear directional signal was observed, correlated with the solar angle. The observation was aided by a period of low primary fluor concentration that resulted in a slower scintillator decay time. This is the first time that event-by-event direction reconstruction in high light-yield liquid scintillator has been demonstrated in a large-scale detector

Ice XII in its second regime of metastability

We present neutron powder diffraction results which give unambiguous evidence for the formation of the recently identified new crystalline ice phase[Lobban et al.,Nature, 391, 268, (1998)], labeled ice XII, at completely different conditions. Ice XII is produced here by compressing hexagonal ice I_h at T = 77, 100, 140 and 160 K up to 1.8 GPa. It can be maintained at ambient pressure in the temperature range 1.5 < T < 135 K. High resolution diffraction is carried out at T = 1.5 K and ambient pressure on ice XII and accurate structural properties are obtained from Rietveld refinement. At T = 140 and 160 K additionally ice III/IX is formed. The increasing amount of ice III/IX with increasing temperature gives an upper limit of T ~ 150 K for the successful formation of ice XII with the presented procedure.Comment: 3 Pages of RevTeX, 3 tables, 3 figures (submitted to Physical Review Letters

A beta-alpha coincidence counting system for measurement of trace quantities of 238U and 232Th in aqueous samples at the Sudbury Neutrino Observatory

The Sudbury Neutrino Observatory experiment was built to measure the total flux of 8B solar neutrinos via the neutral current disintegration deuterium nuclei. This process can be mimicked by daughter isotopes of 232Th and 238U which can photo-disintegrate the deuterium nucleus. Measurement of the concentration of such radioisotopes in the heavy water was critical to the success of the experiment. A radium assay technique using Hydrous Titanium Oxide coated filters was developed for this purpose and it was used in conjunction with a delayed beta-alpha coincidence counting system. The design, calibration and operation of this counting system are described in this paper. The counting efficiency for 232Th (224Ra) and 238U (226Ra) were measured to be 50 +/- 5% and 62 +/- 7

Simultaneous measurement of the muon neutrino charged-current cross section on oxygen and carbon without pions in the final state at T2K

This paper reports the first simultaneous measurement of the double differential muon neutrino charged-current cross section on oxygen and carbon without pions in the final state as a function of the outgoing muon kinematics, made at the ND280 off-axis near detector of the T2K experiment. The ratio of the oxygen and carbon cross sections is also provided to help validate various models' ability to extrapolate between carbon and oxygen nuclear targets, as is required in T2K oscillation analyses. The data are taken using a neutrino beam with an energy spectrum peaked at 0.6~GeV and comprises 57.34$\times$10$^{19}$ protons on target. The extracted measurement is compared with the prediction from different Monte Carlo neutrino-nucleus interaction event generators, showing particular model separation for very forward-going muons. Overall, of the models tested, the result is best described using Local Fermi Gas descriptions of the nuclear ground state with RPA suppression

Supporting the advancement of science: Open access publishing and the role of mandates

In December 2011 the United States House of Representatives introduced a new bill, the Research Works Act (H.R.3699), which if passed could threaten the public's access to US government funded research. In a digital age when professional and lay parties alike look more and more to the online environment to keep up to date with developments in their fields, does this bill serve the best interests of the community? Those in support of the Research Works Act argue that government open access mandates undermine peer-review and take intellectual property from publishers without compensation, however journals like Journal of Translational Medicine show that this is not the case. Journal of Translational Medicine in affiliation with the Society for Immunotherapy of Cancer demonstrates how private and public organisations can work together for the advancement of science

New Superhard Phases for 3D C60-based Fullerites

We have explored new possible phases of 3D C60-based fullerites using semiempirical potentials and ab-initio density functional methods. We have found three closely related structures - two body centered orthorhombic and one body centered cubic - having 52, 56 and 60 tetracoordinated atoms per molecule. These 3D polymers result in semiconductors with bulk moduli near 300 GPa, and shear moduli around 240 GPa, which make them good candidates for new low density superhard materials.Comment: To be published in Physical Review Letter

Plastic optical fibre sensor for spine bending monitoring

peer-reviewedThis paper presents a study on the application of plastic optical fibre for spine bending monitoring based on an intensity modulation. The bending angle is measured as the angle between the emitting and receiving fibres is changed. The measured light attenuation is compared with a theoretical evaluation and the differences between these values are discussed. It was found that the light attenuation for the light intensity agreed well (margin of error < 15%) with the theoretical value for the range between 180o (representing no bend) and 200o and it was significantly increased for the bending angle beyond that value due to the effect of fibre gap increment which resulted in a less reliable experimental estimation.PUBLISHEDpeer-reviewe

First combined measurement of the muon neutrino and antineutrino charged-current cross section without pions in the final state at T2K

This paper presents the first combined measurement of the double-differential muon neutrino and antineutrino charged-current cross sections with no pions in the final state on hydrocarbon at the off-axis near detector of the T2K experiment. The data analyzed in this work comprise 5.8$\times$10$^{20}$ and 6.3$\times$10$^{20}$ protons on target in neutrino and antineutrino mode respectively, at a beam energy peak of 0.6 GeV. Using the two measured cross sections, the sum, difference and asymmetry were calculated with the aim of better understanding the nuclear effects involved in such interactions. The extracted measurements have been compared with the prediction from different Monte Carlo generators and theoretical models showing that the difference between the two cross sections have interesting sensitivity to nuclear effects