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.     

System comparison procedures for automatic target recognition systems

Estimating the performance of an automatic target recognition (ATR) system in terms of its probability of successfully identifying a target involves extensive image collection and processing, which can be very time‐consuming and expensive. Therefore, we investigate the Wald sequential test for the difference in two proportions as a sample size‐reducing alternative to ranking and selection procedures and confidence intervals. An analysis of the test parameters leads to a practical methodology for implementing the Wald test for fairly comparing two systems, based on specific experimental goals. The test is also extended with the modified, sequentially rejective Bonferroni procedure for the multiple pairwise comparison of more than two systems. Two sampling schemes for different experimental goals are also discussed. The test methodology is applied to actual data to compare different configurations of a specific ATR system, with the results demonstrating that the modified Wald sequential procedure is a useful alternative to comparing proportions with confidence intervals, particularly when data are expensive. © 1999 John Wiley & Sons, Inc. Naval Research Logistics 46: 357–371, 1999     

NUCLEAR WEAPONS AS THE CURRENCY OF POWER

There are important similarities between the pattern of behavior Karl Marx identified with respect to commodities—a pattern he called “fetishism”—and the pattern of behavior identified in this article with respect to military force. Marx identified money as the mature expression of commodity fetishism; the author identifies nuclear weapons as the mature expression of the fetishism of force. As such, nuclear weapons function as the currency of power in the international system. This article lays out a theory of nuclear fetishism by adapting four themes that are characteristic of the pattern of behavior known as fetishism: materiality, historicality, efficacy, and reification. By applying these categories to the fetishism of nuclear weapons, the author shows that nuclear weapons represent a new social form consistent with, yet distinct from, other fetish objects.     

Successful or Failed Rebellion? The Casamance Conflict from a Framing Perspective

Empirical evidence and theoretical work suggest that conflicts over self-determination are particularly likely to escalate into very violent and protracted civil wars. However, the intensity of the secessionist conflict in Casamance, Senegal, remained low. As prevailing theories on armed conflicts fail to explain the limited escalation in Casamance, this article resorts to framing theory. Framing helps to include a micro-approach towards conflict studies in order to overcome deficits of macro-approaches. It reveals how movements interpret and construct their environment in order to mobilise potential followers to participate in their activities with the help of strategic communication. However, framing only leads to collective action, if it effectively resonates with the population addressed. The article shows that the movement's framing successfully initiated rebellion in Casamance, but did not broadly resonate with the population, which accounts for the limited intensity of violence.     

Order-statistic calculation,costs, and service in an (s,Q) inventory system

A retailer or distributor of finished goods, or the manager of a spare-parts inventory system, must generally forecast the major portion of demand. A specific customer-service level p (fraction of replenishment intervals with no stockout) implies two challenges: achieve the service within a small interval plus or minus, and do so with a minimum-cost investment in inventory. The pth fractile of lead-time demand (LTD) is the reorder point (ROP) for this service measure, and is often approximated by that fractile of a normal distribution. With this procedure, it is easy to set safety stocks for an (s, Q) inventory system. However, Bookbinder and Lordahl [2] and others have identified cases where the normal approximation yields excessive costs and/or lower service than desired. This article employs an order-statistic approach. Using available LTD data, the ROP is simply estimated from one or two of the larger values in the sample. This approach is sufficiently automatic and intuitive for routine implementation in industry, yet is distribution free. The order-statistic method requires only a small amount of LTD data, and makes no assumptions on the form of the underlying LTD distribution, nor even its parameters μ and ρ. We compare the order-statistic approach and the normal approximation, first in terms of customer service and then using a model of expected annual cost. Based upon characteristics of the available LTD data, we suggest a procedure to aid a practitioner in choosine between the normal and order-statistic method. © 1994 John Wiley & Sons, Inc.     

Born violent: Armed political parties and non-state governance in Lebanon's civil war

We know little of the internal governing practices of non-state actors once in control of territory. Some territories have witnessed the establishment of new institutions of public goods remarkably similar to state institutions. This article compares four armed political parties governing territory during the Lebanese civil war. These non-state violent actors established complex political and economic institutions and administrative structures. Despite the wide range of ideologies and identities of these actors, they all converged in their institutional priorities, although not in their capacities or the particular ways of achieving those priorities. Data from interviews and the actions of the armed political parties suggest a combination of ideology and desire for control is causal in generating public institutions, partly attributable to the high degree of citizen activism marking the Lebanese case.     

Cost allocation and communication

This article considers a special class of cost allocation problems, where the communication possibilities among the agents are restricted. Integral formulas are derived for two allocation rules: The Myerson value and the position value. © 1993 John Wiley & Sons, Inc.