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.     

Numerical modelling of non-ideal detonation in ANFO explosives applying Wood-Kirkwood theory coupled with EXPLO5 thermochemical code

Ammonium nitrate and fuel oil (ANFO) based explosive is a classic example of non-ideal high explosives. Its detonation is characterized by a strong dependence of detonation parameters on explosive charge diameter, presence and characteristics of confinement, as well as incomplete consumption of explosive at the sonic point.In this work we propose a detonation model based on the Wood-Kirkwood (WK) theory coupled with the thermochemical code EXPLO5 and supplemented with reaction rate models. Our objective is to analyze the validity of the model for highly non-ideal ANFO explosives, with emphasis on effect of reaction rate models.It was found that both single-step and two-step pressure-based models can be calibrated to reproduce experimental detonation velocity-charge radius data of ANFO at radii significantly above the failure radius (i.e. for D/D_id > ∼0.6). Single-step pressure-based model, with the pressure exponent equal to 1.4, proved to be the most accurate, even in the vicinity of the failure radius. The impact of the rate models is most evident on temporal (and spatial) distribution of flow parameters in detonation driving zone, especially when it comes to the conversion and width of detonation driving zone.     

‘Ser Eleno’: Insurgent identity formation in the ELN

In conflict studies, identity has been posited as an explanatory factor of the resilience of insurgencies. This article focuses on the identity formation of the National Liberation Army (ELN), a leftist insurgency group in Colombia. As a Marxist–Leninist organisation, the ELN aims to overcome capitalism. In their perception, this is possible via the transformation of the individual into a ‘collective personality’. Along the dimensions of ‘content’ and ‘contestation’, we will demonstrate the mechanisms they impose for such identity formation. Identity, as we will argue, is a main factor in explaining why people participate in this insurgency and thereby enhance its resilience.     

A case study of redundant defence workers

In this article, the influence of conflict on the economies of neighbouring countries is discussed. The results from previous papers show a strong negative effect for an entire area around a country suffering from conflict, but this paper reaches a different conclusion, by using more recent data and adjusting the methodology previously employed. Additionally, a new type of contiguity matrix is constructed and used in the actual analysis. The final analysis consists of a large number of regressions and concludes that conflict actually has two opposing effects. First, like conflict countries themselves, directly contiguous countries actually suffer from the negative effects of proximate conflict. Secondly, however, there is also a positive spillover of conflict, which affects non‐contiguous countries and this effect is larger for countries that are closer to the conflict country. The results from the paper predominantly hold for the most violent kind of conflict.     

Prospect theory and foreign policy decision-making: Underexposed issues,advancements, and ways forward

How much mileage can we get out of prospect theory to explain foreign policy decision-making? To answer this question, we first argue that risk as outcome uncertainty is the appropriate definition in prospect-theoretical applications. Then, we indicate that probability weighting—a crucial component of prospect theory—is typically ignored in such applications. We argue why this is problematic and suggest how to move forward. Next, we discuss how to establish the reference point in the face of outcomes in multiple dimensions, as is typically the case in foreign policy decision-making. Finally, we discuss what we have learnt regarding prospect theory’s scope conditions and the differences across individuals in the theory’s applicability. Overall, our contribution lies in identifying several underexposed or neglected issues (e.g., the definition of risk and probability weighting), in examining the advancements regarding prospect theory’s scope conditions, and in discussing avenues for further research.