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.     

维吾尔史诗《福乐智慧》及其数学思想解读

《福乐智慧》是一部反映古代维吾尔人社会生活的百科全书,广泛地涉及到哲学、政治、法律、军事、伦理、宗教、天文学、数学等领域,其中的数学与数学教育思想尤为丰富。《福乐智慧》探讨了诸如什么是数学,为什么要学习数学,学习什么内容,如何学习数学,以及学习数学对人的一生有什么影响等问题。《福乐智慧》所涉及的数学内容包括算术、几何学、三角、代数,尤其是特别提到了欧几里得的《几何原本》。总结发掘《福乐智慧》的数学教育思想,对于批判继承中华民族的优秀文化成果,让国内其他兄弟民族乃至世界各国客观全面地了解新疆古代维吾尔数学发展史,填补我国数学发展史和中亚数学发展史上的空白等有重要意义。     

The two-on-one stochastic duel

The one-on-one stochastic duel is extended to the general two-on-one duel for the first time. The state equations, win probabilities, mean value, and variance functions are derived. The case where one side has Erlang (2) firing times and the other is negative exponential is compared with the corresponding “Stochastic Lanchester” and Lanchester models to demonstrate their nonequivalence.     

Notes on contributors

In 1897 and 1898, Winston Churchill participated in what late Victorian Britain termed ‘small wars’, first on India's northwest frontier and then in the vast wasteland of the Sudan. Churchill chronicled his experiences in these conflicts in personal letters, dispatches to newspapers, and in his first two books, The Story of the Malakand Field Force and The River War. These writings provide a snapshot of a particular period in the formative years of the great statesman, demonstrating through Churchill's eloquent analyses many of the contradictions concerning the conduct of small wars that have emerged in the present era.     

提升大学生学习力之浅见

二十一世纪是终身学习、终身教育的社会。当代大学生要跟上社会发展的步伐,必须确立较强的学习力,储备良好的核心竞争力。本文在调查的基础上,经过分析总结,从学习力的内涵、现状分析、提升的途径和策略、采取相应措施等方面进行了初步的解析和阐述。     

The stochastic duel with time-dependent hit probabilities

The fundamental stochastic duel considers two opponents who fire at each other at either random continuous or fixed-time intervals with a constant hit probability on each round fired. Each starts with an unloaded weapon, unlimited ammunition, and unlimited time. The first to hit wins. In this article we extend the theory to the case where hit probabilities are functions of the time since the duel began. First, the marksman firing at a passive target is considered and the characteristic function of the time to a hit is developed. Then, the probability of a given side winning the duel is derived. General solutions for a wide class of hit probability functions are derived. Specific examples of both the marksman and the duel problem are given.