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.     

Covariance of weibull order statistics

Let X₁ < X₂ <… < X_n denote an ordered sample of size n from a Weibull population with cdf F(x) = 1 - exp (?x^p), x > 0. Formulae for computing Cov (X_i, X_j) are well known, but they are difficult to use in practice. A simple approximation to Cov(X_i, X_j) is presented here, and its accuracy is discussed.     

Computerized scheduling of seagoing tankers

Computerized Scheduling of Seagoing Tankers The tanker scheduling problem considered in this paper is that of the Defense Fuel Supply Center (DFSC) and the Military Sealift Command (MSC) in the worldwide distribution of bulk petroleum products. Routes and cargoes which meet delivery schedule dates for a multiplicity of product requirements at minimum cost are to be determined for a fleet of tankers. A general mathematical programming model is presented, and then a mixed integer model is developed which attempts to reflect the true scheduling task of DFSC and MSC as closely as possible. The problem is kept to within a workable size by the systematic construction of a set of tanker routes which does not contain many possible routes that can be judged unacceptable from practical considerations alone.     

Generalized programming by linear approximation of the dual gradient: Equality constraints

A modified generalized programming procedure is presented for solving concave programming problems with equality constraints. The procedure constructs convenient linear approximations of the gradient of the dual and finds points where the approximating functions vanish. In the quadratic programming case, the procedure is finitely convergent. Global convergence is established for the non-quadratic case. Illustrative numerical examples are included.     

An n-step, 2-variable search algorithm for the component placement problem

The component placement problem is a specialization of the quadratic assignment problem that has been extensively studied for a decade and which is of considerable practical value. Recently, interest in component placement algorithms has risen primarily as a result of increased activity in the field of computer-aided design automation. This paper deals with the methodology of component placement and is based on the results of considerable operational experience. A tutorial presentation of tree search placement algorithms is provided, and an improved placement procedure is described which is demonstrated to be effective in generating near optimal solutions to the component placement problem. These solutions are completely reproducible and are obtained at an acceptable expenditure of computational resources. An additional objective is an assessment of performance of the class of near optimal algorithms. In particular, the question- how close to optimal are the near optimal solutions- is examined.     

The Hungarian method for the assignment problem

This paper has been presented with the Best Paper Award. It will appear in print in Volume 52, No. 1, February 2005.     

Making sense of the Southern African Development Community

SADC has a poor record in advancing peace and security in Southern Africa. Many identify poor policy frameworks and weak technical capacities as the major obstacles. Laurie Nathan goes beyond these easy explanations in his important new book on SADC. Absence of common democratic values and reluctance to surrender state sovereignty are key factors preventing SADC from making progress according to this book. This article argues that Nathan overstates the case and that there are real prospects and potentials for making further progress in regional cooperation. The lessons from the history of European integration also points to the important role of regional leadership. South Africa, in coalition with other likeminded countries, may still be in a position to move the SADC project forward.     

Icons Off the Mark

In two landmark articles, longtime scholars Kenneth N. Waltz and Thomas C. Schelling have re-emphasized the utility of nuclear deterrence over nuclear nonproliferation (Waltz) and nuclear disarmament (Schelling). While the thrust of the articles is seemingly different, both are rooted in the same intellectual ground: an epistemology that assumes problem-free inferences, drawn from past experiences, are applicable in future scenarios; a foundational rooting in strategic rationality that entangles them in unsolvable contradictions concerning comparable risks of different nuclear constellations, namely deterrence versus proliferation and disarmament; and a bias in framing the empirical record that makes nuclear deterrence more conducive to security than nuclear disarmament. The common normative-practical denominator, then, is to let a nuclear weapon-free world appear both less desirable and less feasible than it might actually be.     

What is Doctrine?

‘Doctrine’ has been part of military vernacular for at least a century. Nonetheless, it is a concept which is rather under-explored. The aim of this article is thus to break doctrine down into its component parts in order to grasp what a military doctrine actually is. Thereafter, the article points out different ways to utilise doctrine as a military devise. A doctrine cannot be, or rather should not be, all things to all men. On the contrary, doctrine can be a tool of command, tool of education or a tool of change. The main upshot of the article is that the future of doctrine is far brighter than its critics want us to believe.