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.     

What Is Known About Defence Research And Development Spill-Overs?

This article surveys the body of available evidence regarding the spill-over effects of defence R&D. It reviews the routes through which defence R&D spills over to the economy with positive externalities – in terms of new products, technologies or processes; the barriers that impede or block such a process; potential negative repercussions, and the measure of such effects. The main conclusion is that the uncertainty of these effects, and the inaccurate appraisal of their value, hardly supports informed decisions concerning defence R&D policies.     

A Question of ‘Government’ Control: Afghanistan DDR Programs Since 2001

Since the fall of the Taliban in late 2001, the Islamic Republic of Afghanistan (GIRoA), the United States, the United Nations, and the International Security Assistance Force (ISAF) have funded and led three different Disarmament, Demobilization, and Reintegration (DDR) programs. Despite a significant investment in time and treasure, all of them have failed to significantly reduce the number of insurgents or arbaki (militia). This article explores why these programs failed despite incorporating ideas from the prominent DDR schools of thought. Utilizing Stathis Kalyvas’ theory of The Logic of Violence in Civil War as a lens, this article argues that GIRoA and ISAF did not have sufficient control of territory to entice insurgents or arbaki to reconcile and/or reintegrate with the government. Further, in areas GIRoA nominally controlled in northern and western Afghanistan, regional powerbrokers who controlled these areas balked at these programs.     

An attacker‐defender model for analyzing the vulnerability of initial attack in wildfire suppression

Wildfire managers use initial attack (IA) to control wildfires before they grow large and become difficult to suppress. Although the majority of wildfire incidents are contained by IA, the small percentage of fires that escape IA causes most of the damage. Therefore, planning a successful IA is very important. In this article, we study the vulnerability of IA in wildfire suppression using an attacker‐defender Stackelberg model. The attacker's objective is to coordinate the simultaneous ignition of fires at various points in a landscape to maximize the number of fires that cannot be contained by IA. The defender's objective is to optimally dispatch suppression resources from multiple fire stations located across the landscape to minimize the number of wildfires not contained by IA. We use a decomposition algorithm to solve the model and apply the model on a test case landscape. We also investigate the impact of delay in the response, the fire growth rate, the amount of suppression resources, and the locations of fire stations on the success of IA.     

COSMIC掩星电子密度廓线的质量检核

利用COSMIC掩星任务自2010年至2014年的电离层电子密度廓线,使用只考虑廓线自身特性的4种参数进行质量检核,并对廓线质量的时空分布进行分析。发现在廓线质量的空间分布上,廓线不合格率在高纬地区最高,其次是低纬地区,在中纬地区最低,这可能与电子密度分布在磁赤道附近存在赤道异常、两极地区的磁场强度最大有关。廓线质量的季节变化较明显,在南、北半球,冬、春两季的廓线不合格率均显著高于夏、秋两季。另外,廓线质量具有一定昼夜分布特性,不合格率白天明显较夜晚低,且在晨昏分界线上变化较大。合格廓线的电子密度峰值和峰值高度分布在磁赤道附近明显高于其他区域,呈现"双驼峰"现象。     

军民融合产业概念及范畴研究

军民融合产业概念及范畴不明确一直是困扰决策部门和研究部门的问题,影响了军民融合发展的顺利推进。本文在梳理总结军民融合产业概念及范畴的研究现状以及政府文件表述的基础上,认为军民融合作为一种发展模式,定义军民融合产业概念并非易事,但出于当前工作要求,需要相关管理部门整合力量,加强研究,尽快明确军民融合产业概念和范畴,构建科学合理的军民融合产业统计体系。     

大力弘扬改革创新时代精神 加快建设世界一流高等教育院校

习主席在庆祝改革开放40周年大会上的重要讲话,是新时代改革开放再出发的宣言书和动员令。学习贯彻习主席重要讲话精神,关键要全面推进学校深化改革创新,深刻认清弘扬改革创新精神对于建设世界一流高等教育院校的重大意义,牢牢扭住全面深化改革创新的主攻方向,科学处理深化改革创新的重大关系,既以顽强的战略定力坚定不移深化改革,又运用科学的工作方法积极稳妥地推进改革。     

虚拟现实在心理战中的应用及展望

虚拟现实是用虚拟的情境模拟现实的世界,通过虚拟的多维空间,使用户体验到身临其境的感觉。文章通过深度剖析虚拟现实的历史沿革、发展现状与技术特点,结合其在军事中的运用以及发展前景,提出虚拟现实能够对心理战参战人员的心理训练、战场环境模拟和心理战效果评估提供借鉴和支持。     

美国空军研究实验室组织管理与科研规划分析

美国空军研究实验室是一个在空中、太空和网络空间领域处于全球领先地位的科研机构,承担着美国空军国防高技术项目的规划、管理和实施工作,是美国空军保持技术优势的重要研究力量。本文剖析了美国空军实验室的使命任务、组织管理和科研规划,总结了实验室在人才培养和科研任务制定方面的经验和方法。     

Value management of diagnostic equipment with cancelation,no‐show,and emergency patients

Magnetic resonance imaging and other multifunctional diagnostic facilities, which are considered as scarce resources of hospitals, typically provide services to patients with different medical needs. This article examines the admission policies during the appointment management of such facilities. We consider two categories of patients: regular patients who are scheduled in advance through an appointment system and emergency patients with randomly generated demands during the workday that must be served as soon as possible. According to the actual medical needs of patients, regular patients are segmented into multiple classes with different cancelation rates, no‐show probabilities, unit value contributions, and average service times. Management makes admission decisions on whether or not to accept a service request from a regular patient during the booking horizon to improve the overall value that could be generated during the workday. The decisions should be made by considering the cancelation and no‐show behavior of booked patients as well as the emergency patients that would have to be served because any overtime service would lead to higher costs. We studied the optimal admission decision using a continuous‐time discrete‐state dynamic programming model. Identifying an optimal policy for this discrete model is analytically intractable and numerically inefficient because the state is multidimensional and infinite. We propose to study a deterministic counterpart of the problem (i.e., the fluid control problem) and to develop a time‐based fluid policy that is shown to be asymptotically optimal for large‐scale problems. Furthermore, we propose to adopt a mixed fluid policy that is developed based on the information obtained from the fluid control problem. Numerical experiments demonstrate that this improved policy works effectively for small‐scale problems. © 2016 Wiley Periodicals, Inc. Naval Research Logistics 63: 287–304, 2016