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.     

The effects of model parameter deviations on the variance of a linearly filtered time series

We consider a general linear filtering operation on an autoregressive moving average (ARMA) time series. The variance of the filter output, which is an important quantity in many applications, is not known with certainty because it depends on the true ARMA parameters. We derive an expression for the sensitivity (i.e., the partial derivative) of the output variance with respect to deviations in the model parameters. The results provide insight into the robustness of many common statistical methods that are based on linear filtering and also yield approximate confidence intervals for the output variance. We discuss applications to time series forecasting, statistical process control, and automatic feedback control of industrial processes. © 2010 Wiley Periodicals, Inc. Naval Research Logistics, 2010     

Single‐machine scheduling with deadlines to minimize the total weighted late work

We consider scheduling a set of jobs with deadlines to minimize the total weighted late work on a single machine, where the late work of a job is the amount of processing of the job that is scheduled after its due date and before its deadline. This is the first study on scheduling with the late work criterion under the deadline restriction. In this paper, we show that (i) the problem is unary NP‐hard even if all the jobs have a unit weight, (ii) the problem is binary NP‐hard and admits a pseudo‐polynomial‐time algorithm and a fully polynomial‐time approximation scheme if all the jobs have a common due date, and (iii) some special cases of the problem are polynomially solvable.     

Optimal sample size allocation for tests with multiple levels of stress with extreme value regression

In this article, we discuss the optimal allocation problem in a multiple stress levels life‐testing experiment when an extreme value regression model is used for statistical analysis. We derive the maximum likelihood estimators, the Fisher information, and the asymptotic variance–covariance matrix of the maximum likelihood estimators. Three optimality criteria are defined and the optimal allocation of units for two‐ and k‐stress level situations are determined. We demonstrate the efficiency of the optimal allocation of units in a multiple stress levels life‐testing experiment by using real experimental situations discussed earlier by McCool and Nelson and Meeker. Monte Carlo simulations are used to show that the optimality results hold for small sample sizes as well. © 2006 Wiley Periodicals, Inc. Naval Research Logistics, 2007     

Untruthful probabilistic demand forecasts in vendor‐managed revenue‐sharing contracts: Coordinating the chain

Vendor‐managed revenue‐sharing arrangements are common in the newspaper and other industries. Under such arrangements, the supplier decides on the level of inventory while the retailer effectively operates under consignment, sharing the sales revenue with his supplier. We consider the case where the supplier is unable to predict demand, and must base her decisions on the retailer‐supplied probabilistic forecast for demand. We show that the retailer's best choice of a distribution to report to his supplier will not be the true demand distribution, but instead will be a degenerate distribution that surprisingly induces the supplier to provide the system‐optimal inventory quantity. (To maintain credibility, the retailer's reports of daily sales must then be consistent with his supplied forecast.) This result is robust under nonlinear production costs and nonlinear revenue‐sharing. However, if the retailer does not know the supplier's production cost, the forecast “improves” and could even be truthful. That, however, causes the supplier's order quantity to be suboptimal for the overall system. © 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2007     

Scheduling to minimize the total compression and late costs

We consider a single-machine scheduling model in which the job processing times are controllable variables with linear costs. The objective is to minimize the sum of the cost incurred in compressing job processing times and the cost associated with the number of late jobs. The problem is shown to be NP-hard even when the due dates of all jobs are identical. We present a dynamic programming solution algorithm and a fully polynomial approximation scheme for the problem. Several efficient heuristics are proposed for solving the problem. Computational experiments demonstrate that the heuristics are capable of producing near-optimal solutions quickly. © 1998 John Wiley & Sons, Inc. Naval Research Logistics 45: 67–82, 1998     

Sole sourcing versus dual sourcing under stochastic demands and lead times

The use of a single vendor for each inventoried item is usually assumed in most of the inventory models. However, there are situations where the use of more than one vendor should be considered, especially when lead times are stochastic. This research presents a theoretical investigation of the effect of cost structures on the relative performance of sole-sourcing versus dual-sourcing inventory control policies. We show that except for cases where the ordering cost is high, the lead-time variability is low, or the customer service level is low, dual sourcing performs better than sole sourcing under the normally distributed demand and shifted-exponential lead times. Moreover, the computational results indicate the dual sourcing provides a better service level than sole sourcing at the optimal solutions, and that dual sourcing results in larger order quantities than sole sourcing, which suggests that attractive quantity discounts may not be in jeopardy when dual sourcing is employed. Finally, because it is generally known that multiple sourcing can enhance the competition among suppliers, material managers should consider splitting purchase orders when two equally qualified suppliers are available. © 1994 John Wiley & Sons, Inc.     

Approximation algorithms for minimizing total weighted completion time of orders on identical machines in parallel

We consider the problem of scheduling orders on identical machines in parallel. Each order consists of one or more individual jobs. A job that belongs to an order can be processed by any one of the machines. Multiple machines can process the jobs of an order concurrently. No setup is required if a machine switches over from one job to another. Each order is released at time zero and has a positive weight. Preemptions are not allowed. The completion time of an order is the time at which all jobs of that order have been completed. The objective is to minimize the total weighted completion time of the orders. The problem is NP‐hard for any fixed number (≥2) of machines. Because of this, we focus our attention on two classes of heuristics, which we refer to as sequential two‐phase heuristics and dynamic two‐phase heuristics. We perform a worst case analysis as well as an empirical analysis of nine heuristics. Our analyses enable us to rank these heuristics according to their effectiveness, taking solution quality as well as running time into account. © 2006 Wiley Periodicals, Inc. Naval Research Logistics, 2006