Clinical Characterization of Insomnia among Veterans with PTSD: Identifying Risk Factors for Diagnosis and Treatment with Sedative-Hypnotics

Abstract

Insomnia is prevalent among Veterans with post-traumatic stress disorder (PTSD), it exacerbates PTSD symptoms, and it contributes to impaired functioning and quality of life. To improve treatment outcomes, it is important to identify risk factors for insomnia and sedative-hypnotic use. Classification and regression trees and logistic regression models were used to identify variables associated with insomnia or sedative-hypnotic use. Key findings include low insomnia diagnosis rates (3.5–5.6%) and high rates of sedative-hypnotics (44.2–49.0%). Younger Veterans and those without a breathing-related sleep disorder (BRSD) were more likely to receive an insomnia diagnosis. Veterans with greater service connection and those with an alcohol/substance use disorder were more likely to be prescribed sedative-hypnotics. Interaction terms may have identified potential groups at risk of being under-diagnosed with insomnia (i.e. non-black Veterans with psychiatric co-morbidity, black Veterans without psychiatric co-morbidity) as well as groups at risk for sedative-hypnotic use (i.e. younger Veterans without BRSD). In sum, Veterans with PTSD have high rates of sedative-hypnotic use despite minimal evidence they are effective. This is counter to recommendations indicating behavioral interventions are the first-line treatment. Policy changes are needed to reduce use of sedative-hypnotics and increase access to behavioral insomnia interventions.     

Adjacency‐based local top‐down search method for finding maximal efficient faces in multiple objective linear programming

It is well‐known that the efficient set of a multiobjective linear programming (MOLP) problem can be represented as a union of the maximal efficient faces of the feasible region. In this paper, we propose a method for finding all maximal efficient faces for an MOLP. The new method is based on a condition that all efficient vertices (short for the efficient extreme points and rays) for the MOLP have been found and it relies on the adjacency, affine independence and convexity results of efficient sets. The method uses a local top‐down search strategy to determine maximal efficient faces incident to every efficient vertex for finding maximal efficient faces of an MOLP problem. To our knowledge, the proposed method is the first top‐down search method that uses the adjacency property of the efficient set to find all maximal efficient faces. We discuss this and other advantages and disadvantages of the algorithm. We also discuss some computational experience we have had with our computer code for implementing the algorithm. This computational experience involved solving several MOLP problems with the code.     

A general age replacement model with minimal repair

A general age replacement is introduced which incorporates minimal repair, planned and unplanned replacements, and costs which depend on time. Finite and infinite horizon results are obtained. Various special cases are considered. Furthermore, a shock model with general cost structure is considered.     

Warranty design under buyer and seller risk aversion

This paper provides a framework in which warranty policies for non-repairable items can be evaluated according to risk preferences of both buyers and sellers. In particular, a warranty price schedule is established such that sellers are indifferent among the policies. Given this schedule, a buyer's response is expressed by selecting the price-warranty combination that minimizes disutility. Within this framework, a warranty can be viewed as an instrumet of risk management that can induce more sales and greater profitability. For given utility functions, analytical results for the development of a price schedule are developed. Numerical results illustrate the substitution effects between warranty terms, prices, and risk parameters.     

纳米级定位的简单化设计——采用滚珠球轴承的扭轮摩擦传动

作者在前面的文章中报导了扭轮摩擦传动能实现亚纳米级的定位分辨率。然而,这套装置在结构上的复杂之处就是在于采用了静压轴承支撑扭轮。本文指出了扭轮摩擦传动在结构上如何可以简化为采用球轴承支撑扭轮。在简化之后,实验表明定位分辨率小于1纳米。本文得出结论,采用球轴承的扭轮摩擦传动对于在洁净环境下要求实现纳米级定位的制造过程变得更为方便,而且可以取代滚珠丝杠以及常规摩擦传动方式。     

塑性状态下光学及电子镜面的亚纳米级精密磨削

本文讲述了由PC机控制的多用途超精机床(MPUMT)的设计及光学镜平滑表面的加工。已研制出的机床可用于磨削、切削、研磨或抛光塑性状态下的硬脆材料。作为建立新的加工系统的关键部分,采用了大型磁致伸缩调节器(GMA),在没有放大器元件的情况下,它具有大功率的输出和大于压电陶瓷调节器几倍的纳米级的位移。切削DOC的深度和控制塑性状态过程的微塑性区域能够被调节器设置为具有高于1nm的精度,并能用金刚石磨削砂轮研磨。在当前研究中所用到的镜为多晶体、非晶体,也有加固玻璃。磨削实验的结果表明,已研制出来的超精机床能够实现对塑性状态下的玻璃和陶瓷材料的加工。材料特性参数和微裂纹之间的关系已被检测到,适用于大多数被研究玻璃的脆性到塑性磨削方式的转换已经确定。运用AFM、SEM和ZYGO对磨削表面进行了分析,例如BK7和TRC5(新材料;加固玻璃)的磨削表面分别具Ra=0.15nm和Ra=0.32nm的表面粗糙度。