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.     

Transient behavior of large Markovian multiechelon repairable item inventory systems using a truncated state space approach

Calculations for large Markovian finite source, finite repair capacity two-echelon repairable item inventory models are shown to be feasible using the randomization technique and a truncated state space approach. More complex models (involving transportation pipelines, multiple-item types and additional echelon levels) are also considered.     

Robustness of preallocated preferential defense with assumed attack size and perfect attacking and defending weapons

The problem is to protect a set of t targets by n perfect interceptors against an attack by m perfect weapons. If the defender solves for an optimal preallocated preferential defense and associated game value assuming m₁ attackers, and the attacker knows the assumption of the defender and utilizes m₂ attackers, he may be able to achieve significantly more damage than had the defender assumed that there would be m₂ attackers. The article treats the robustness of preallocated preferential defense to assumptions about the size of the attack and presents results of an alternative approach.     

Puzzle‐based storage systems

We introduce and develop models for a physical goods storage system based on the 15‐puzzle, a classic children's game in which 15 numbered tiles slide within a 4 × 4 grid. The objective of the game is to arrange the tiles in numerical sequence, starting from a random arrangement. For our purposes, the tiles represent totes, pallets, or even containers that must be stored very densely, and the objective is to maneuver items to an input–output point for retrieval or processing. We develop analytical results for storage configurations having a single empty location (as in the game) and experimental results for configurations with multiple empty locations. Designs with many empty locations can be made to form aisles, allowing us to compare puzzle‐based designs with traditional aisle‐based designs found in warehousing systems. © 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2007     

Kurtosis correction method for X̄ and R control charts for long‐tailed symmetrical distributions

This paper proposes a kurtosis correction (KC) method for constructing the X? and R control charts for symmetrical long‐tailed (leptokurtic) distributions. The control charts are similar to the Shewhart control charts and are very easy to use. The control limits are derived based on the degree of kurtosis estimated from the actual (subgroup) data. It is assumed that the underlying quality characteristic is symmetrically distributed and no other distributional and/or parameter assumptions are made. The control chart constants are tabulated and the performance of these charts is compared with that of the Shewhart control charts. For the case of the logistic distribution, the exact control limits are derived and are compared with the KC method and the Shewhart method. © 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2007     

(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.     

Counterinsurgency American style: Considering David Petraeus and twenty-first century irregular war

This article examines the complex legacy of David Petraeus who was a key figure in the emergence of the US military shift towards counterinsurgency doctrine in the years after 2006. Although Petraeus has been perceived by critics as a publicity seeker, he can be credited with laying the foundations for a more serious commitment to COIN involving in particular in integrating conventional and Special Forces in arenas like village stability operations. The article looks a Petraeus's role in both Iraq and Afghanistan: it concludes that, in the case of Afghanistan, it is too early to assess whether counterinsurgency has had a decisive impact of the outcome of the war against the Taliban.