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

Cadmium uptake by the water hyacinth: Effects of root mass, solution volume, complexers and other metal ions1

At a fixed Cd2+ concentration water hyacinth () plants with greater root mass (dry weight) take up more metal ions as a function of time, and more metal ions are taken up by a plant as the solution volume is increased. Experiments in which several different metal ion complexers were present suggest that (1) the roots possess sites which initially reversibly bind free Cd2+, (2) some added complexers can compete with these root sites for free Cd2+, and (3) with time Cd2+ bound to the roots is translocated into into the root tissues effectively removing it from the equilibrium processes in solution. Many metal ions are taken up by the plant but only the micronutrient Zn2+ competes well with Cd2+ for uptake. Thus, there may be binding sites on the roots for specific metal ions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25899/1/0000462.pd

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