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.     

Mean residual life of coherent systems consisting of multiple types of dependent components

Mean residual life is a useful dynamic characteristic to study reliability of a system. It has been widely considered in the literature not only for single unit systems but also for coherent systems. This article is concerned with the study of mean residual life for a coherent system that consists of multiple types of dependent components. In particular, the survival signature based generalized mixture representation is obtained for the survival function of a coherent system and it is used to evaluate the mean residual life function. Furthermore, two mean residual life functions under different conditional events on components’ lifetimes are also defined and studied.     

Adjacency‐based local top‐down search method for finding maximal efficient faces in multiple objective linear programming

It is well‐known that the efficient set of a multiobjective linear programming (MOLP) problem can be represented as a union of the maximal efficient faces of the feasible region. In this paper, we propose a method for finding all maximal efficient faces for an MOLP. The new method is based on a condition that all efficient vertices (short for the efficient extreme points and rays) for the MOLP have been found and it relies on the adjacency, affine independence and convexity results of efficient sets. The method uses a local top‐down search strategy to determine maximal efficient faces incident to every efficient vertex for finding maximal efficient faces of an MOLP problem. To our knowledge, the proposed method is the first top‐down search method that uses the adjacency property of the efficient set to find all maximal efficient faces. We discuss this and other advantages and disadvantages of the algorithm. We also discuss some computational experience we have had with our computer code for implementing the algorithm. This computational experience involved solving several MOLP problems with the code.     

Properties of a mean residual life function arising from renewal theory

The present article discusses the properties of the mean residual life function in a renewal process. We examine the relationship this function has with the failure rate function and the conventional mean, variance and coefficient of variation of residual life. We also discuss some monotonicity properties of the mean residual life function. A partial order based on the renewal mean residual function is introduced along with its interrelationship with some existing stochastic orders. © 2010 Wiley Periodicals, Inc. Naval Research Logistics, 2010     

Suppression of enemy air defenses (SEAD) as an information duel

Blue strike aircraft enter region ? to attack Red targets. In Case 1, Blue conducts (preplanned) SEAD to establish air superiority. In the (reactive) SEAD scenario, which is Case 2, such superiority is already in place, but is jeopardized by prohibitive interference from Red, which threatens Blue's ability to conduct missions. We utilize both deterministic and stochastic models to explore optimal tactics for Red in such engagements. Policies are developed which will guide both Red's determination of the modes of operation of his engagement radar, and his choice of Blue opponent to target next. An index in the form of a simple transaction kill ratio plays a major role throughout. Published 2002 Wiley Periodicals, Inc. Naval Research Logistics 49: 723–742, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/nav.10046     

New inequalities for finite and infinite group problems from approximate lifting

In this paper, we derive new families of facet‐defining inequalities for the finite group problem and extreme inequalities for the infinite group problem using approximate lifting. The new valid inequalities for the finite group problem include two‐ and three‐slope facet‐defining inequalities as well as the first family of four‐slope facet‐defining inequalities. The new valid inequalities for the infinite group problem include families of two‐ and three‐slope extreme inequalities. These new inequalities not only illustrate the diversity of strong inequalities for the finite and infinite group problems, but also provide a large variety of new cutting planes for solving integer and mixed‐integer programming problems. © 2008 Wiley Periodicals, Inc. Naval Research Logistics, 2008     

A discounted machine-replacement model with an expected future technological breakthrough

A machine-replacement problem is analyzed in a technological-development environment, in which a new-type machine (built by a new technology) may appear in the future. The solution of the replacement problem depends on purchasing, operating, and resale costs, and on the probability distribution of the market debut of the new technology, and it indicates whether to replace the existing machine now with an available similar type of machine, or to continue to operate the existing machine for at least one more period. A dynamic discounted cost model is presented, and a method is suggested for finding the optimal age for replacement of an existing machine (under rather general conditions of a technological environment). A solution procedure and a numerical example are given.