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.     

(Re-)emergent orders: understanding the negotiation(s) of rebel governance

Abstract

The concept of order is often neglected in the study of conflict – seemingly such a ‘disordering’ process. With the recent increase in the examination of rebel governance however, bringing order back into our understanding of rebel and insurgent groups has much to offer in exploring the everyday politics which connect authorities, rebel movements and the population itself, in a complex mass of intersubjective and power-based interactions and negotiations. Rebels both shape and are shaped by existing forms of order in complex and ongoing ways. This article explores how varying elements interact in the negotiation, framing and enforcement of order and develops an original analytical framework to examine the perpetual negotiations of rebel movements in their attempts to cement their control.     

Reassessing Military Assistance to the Civil Powers: Are Traditional British Anti-Terrorist Responses Still Effective?

The provision of Military Assistance to the Civil Powers (MACP) encapsulates the traditional approach towards countering terrorism on the British mainland, which emphasises minimum force, proportionality, police primacy and the rule of law, with the military retained as a supporting instrument, being employed only as a measure of last resort. Recent terrorist incidents in major urban centres do, however, question the effectiveness of these established methods. This analysis initially codifies the conceptual issues that underscore the tensions between civil policing and military anti-terrorist approaches in the UK, and proceeds to evaluate and compare a number of operations that indicate the nature of the challenges facing the MACP apparatus. In particular, potential shortcomings in the MACP provisions are identified in the form of threat perception and deployment and enforcement gaps. The assessment finds that there are facets of MACP that are of enduring relevance in the current era, yet a continuing need persists to reconcile police and military imperatives toward serious civil disorder contingencies and conditions of emergency.     

面向混部云失败批处理作业的预测算法

为了降低混部云失败批处理作业的风险,使用K-means聚类算法将批处理作业分为四类,在分类的基础上提出了二层嵌套分类模型(two-layer nested classification model, TLNM),实现了基于TLNM的预测算法。基于Ali Trace 2018数据集上的实验结果表明,该算法的接受者操作特性(receiver operating characteristic, ROC)曲线明显优于其他常用分类器,ROC曲线下面积(即AUC)可以达到0.978,表明该算法具有良好的分类性能。同时召回率可以达到0.951,通过混淆矩阵可以看出TLNM算法能够准确预测出执行失败的批处理作业。     

A cost-benefit analysis of military aircraft replacement policies

This paper describes a method of solving aircraft service life problems. The particular application concerns aircraft in the Naval Advanced Jet Training Command. The method of solution is comparative present value analysis of alternative replacement policies. The likely risks of estimation errors are reflected in the comparisons of present values. Differences are noted in the benefits associated with each policy, but external to Naval Aviation. Since the values of these benefits can be determined only at a higher level of decision-making, the result of the study is not a conclusive selection among policies, but a schedule of present values on the basis of which, together with values of the external benefits, a decision can be reached. This paper discusses replacement policies for aircraft used in the Naval Advanced Jet Pilot Training mission. Taking engineering technology and the training syllabus as given, four feasible plans for introducing replacement aircraft into service are evaluated in terms of the present values of differential costs associated with the plans and in terms of the likely errors in cost estimates used in calculation of the present values. The trade-off between present value of costs and planning flexibility is emphasized in choosing a recommended time pattern of aircraft replacement. The specific aircraft mixes considered are the TF–9J/TAF–9J and the TA–4F/A–4B. The first is the currently employed mix; the second is the proposed replacement. The problem is to select an optimal time-pattern of replacement of F–9's by A–4's, given technological differences favoring the A–4 and increasing costs of maintaining squadrons of F–9's. Replacements by aircraft types other than the A–4 are considered impractical. Four feasible plans for introducing A–4's through a 5-year period are evaluated in terms of current best estimates of the related costs of the plans and in terms of the flexibility of modifying each plan given future better information concerning the relevant costs. The method of analysis is comparative present value of expected costs.     

Optimization of strategic defenses to provide specified post-attack production capacities

This paper presents a model for choosing a minimum-cost mix of strategic defenses to assure that specified production capacities for several economic sectors survive after a nuclear attack. The defender selects a mix of strategic defenses for each of several geographic regions. The attacker chooses an allocation of attacking weapons to geographic regions, within specified weapon inventories. The attack is optimized against any economic sector. This formulation allows the defense planner the capability to assess the results of the optimal defense structure for a “worst case” attack. The model is a mathematical program with nonlinear programming problems in the constraints; an example of its application is given and is solved using recently developed optimization techniques.     

Lanchester-type models of warfare and optimal control

The optimization of the dynamics of combat (optimal distribution of fire over enemy target types) is studied through a sequence of idealized models by use of the mathematical theory of optimal control. The models are for combat over a period of time described by Lanchester-type equations with a choice of tactics available to one side and subject to change with time. The structure of optimal fire distribution policies is discussed with reference to the influence of combatant objectives, termination conditions of the conflict, type of attrition process, and variable attrition-rate coefficients. Implications for intelligence, command and control systems, and human decision making are pointed out. The use of such optimal control models for guiding extensions to differential games is discussed.