Sleep and Pain in Older Adults: The Role of Negative and Positive Affect

Poor sleep is known to contribute to increased levels of pain. Preliminary findings suggest that negative and positive affect may mediate this relationship. Given that older adults are prone to both sleep disturbance and pain, the main objectives of the present study were to: 1) examine the relationship between sleep and pain in a non-clinical pain sample of community-dwelling older adults and 2) to examine whether negative and positive affect mediate the relationship between sleep and pain. Baseline measures from 82 older adults participating in the Active Adult Mentoring Project (AAMP) were used for secondary data analysis. A daily sleep diary was used to assess sleep efficiency (SE), total wake time (TWT), total sleep time (TST), and sleep quality (SQ). Affect was measured using the Positive and Negative Affect Schedule (PANAS), while pain was assessed on an 11-point Likert-scale. Findings only partially corroborated past research; SE, SQ, and TWT each predicted pain, while TST did not. In addition, neither positive nor negative affect was found to mediate the relationship between sleep and pain. Methodological and theoretical explanation for the lack of significant mediation are discussed. Nevertheless, the findings suggest that the assessment and treatment of poor sleep among older adults with pain may be clinically relevant

Performance comparison between SiC and Si inverter modules in an electrical variable transmission application

This paper evaluates the performance of Silicon Carbide MOSFET and Silicon IGBT modules in a threephase inverter for Electrical Variable Transmission systems. For this purpose, two practical inverter setups were developed and compared. An increase of several percentage points is visible over the entire operating range for the Silicon Carbide prototype. The total energy efficiency increased by 3.7% for the rotor and by 11.2% for the stator, for the same test conditions

Loneliness and sleep: A systematic review and meta-analysis

Despite the mounting evidence linking loneliness with health, the mechanisms underlying this relationship remain obscure. This systematic review and meta-analysis on the association between loneliness and one potential mechanism—sleep—identified 27 relevant articles. Loneliness correlated with self-reported sleep disturbance (r = .28, 95% confidence interval (.24, .33)) but not duration, across a diverse set of samples and measures. There was no evidence supporting age or gender as moderators or suggesting publication bias. The longitudinal relationship between loneliness and sleep remains unclear. Loneliness is related to sleep disturbance, but research is necessary to determine directionality, examine the influence of other factors, and speak to causality

IoT on the Road to Sustainability: Vehicle or Bandit?

The Internet of Things (IoT) can support the evolution towards a digital and green future. However, the introduction of the technology clearly has in itself a direct adverse ecological impact. This paper assesses this impact at both the IoT-node and at the network side. For the nodes, we show that the electronics production of devices comes with a carbon footprint that can be much higher than during operation phase. We highlight that the inclusion of IoT support in existing cellular networks comes with a significant ecological penalty, raising overall energy consumption by more than 15%. These results call for novel design approaches for the nodes and for early consideration of the support for IoT in future networks. Raising the 'Vehicle or bandit?' question on the nature of IoT in the broader sense of sustainability, we illustrate the need for multidisciplinary cooperation to steer applications in desirable directions

Pain coping skills training for African Americans with osteoarthritis (STAART): study protocol of a randomized controlled trial

Background: African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA. Methods/Design: This is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System. Discussion: This culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities.Funded by Patient-Centered Outcomes Research Institute (PCORI) Award (AD-1408-19519)

A non-inferiority randomized controlled trial comparing behavioral sleep interventions in women veterans: An examination of pain outcomes.

OBJECTIVE: Insomnia is known to exacerbate pain symptoms. The purpose of the present study was to compare the secondary effects of cognitive behavioral therapy for insomnia (CBTI) against a novel treatment for insomnia called acceptance and behavioral changes for insomnia (ABC-I) among individuals with comorbid pain. Differences in the potential mechanisms through which these treatments impact pain were also examined. METHODS: Data consisted of a secondary analysis from a randomized comparative effectiveness trial of CBT-I and ABC-I among women veterans with insomnia and comorbid pain. Pain outcomes, beliefs about sleep, and psychological flexibility were assessed at baseline, post-treatment, and at three-months follow-up. RESULTS: At baseline, 93 women veterans reported comorbid insomnia and pain (mean age = 46.7; 33.3% Black, 24.7% Hispanic/Latina). Both CBT-I (n = 48) and ABC-I (n = 45) were associated with decreased pain intensity (p < .001, Cohens d = 0.41-0.67) and pain interference (p < .001, Cohens d = 0.71-0.77) at post-treatment and three-months follow-up, with results indicating that ABC-I was non-inferior to CBT-I for pain improvement. Both conditions were associated with greater psychological flexibility post-treatment, and CBT-I resulted in larger reductions in dysfunctional beliefs about sleep (p = .01, Cohens d = 0.59). CONCLUSION: CBT-I and ABC-I both had positive secondary effects on pain with ABC-I being non-inferior to CBT-I with respect to its impact on pain. The mechanisms of change associated with these treatments may differ with CBT-I leading to greater reductions in dysfunctional beliefs. Hybrid treatments which incorporate an acceptance and commitment approach to both insomnia and pain warrant further examination

Pain in your day? Get sleep treatment anyway! The role of pain in insomnia treatment efficacy in women veterans.

Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans. Using data from a comparative effectiveness clinical trial of two insomnia behavioural treatments (both including sleep restriction, stimulus control, and sleep hygiene education), we examined the impact of pain severity and pain interference on sleep improvements from baseline to post-treatment and 3-month follow-up. We found no significant moderation effects of pain severity or interference in the relationship between treatment phase and sleep outcomes. Findings highlight opportunities for using behavioural sleep interventions in patients, particularly women veterans, with comorbid pain and insomnia, and highlight areas for future research

An Electrical Perspective on Building-Integrated Photovoltaic Systems. Designing Safe and Reliable BIPV Installations

PhotoVoltaic (PV) generation has a lot of momentum nowadays. The use of PV modules for electricity generation is driven by economical reasons such as decreasing module prices, the easyness to scale and low maintenance. Also the increased public awareness regarding climate change accelerates the strive of governments and individuals for more renewable energy sources, such as PV, in the energy mix. Due to the easyness to scale PV installations, it is found in both very large utility-scale systems (PV farms) as well as in small-scale installations around buildings. The most common form of PV generation in the built environment is Building-Applied PV (BAPV), where PV modules are placed on an existing building. A common BAPV example are modules that are placed on an existing roof. However, alternatives exist where the PV cells are an integral part of the construction elements. This technology is referred to as Building-Integrated PV (BIPV). Tesla's Solar Roof tiles are a well-known example of BIPV although a variety of forms exists such as shaders, parapets and façade modules, all covered by the term BIPV. The use of BIPV is driven by cost savings, as multiple functions can be combined in one product; by a greener image, e.g. when a company wants to highlight their efforts for climate change; and by policy, e.g. the European Performance on Buildings Directive (EPBD) which requires that all new buildings from 2020 on are Near Zero Enerygy Buildings (NZEBs). This requirement can be challenging for tall buildings, where the available roof space for PV is scarce compared to the building's energy demand. The use of façade BIPV then comes in handy to meet the prescribed regulations. Up to now, the electrical installation of BIPV systems is typically done using a string inverter, similar to BAPV systems. In this thesis, that approach is questioned. More specifically, this thesis investigates how the electrical architecture of BIPV modules should be implemented to achieve a high energetic efficiency, a high level of safety, a long lifetime, at the lowest possible cost. In the first chapter, the rationale behind the thesis is described in more detail and an overview of the research questions of each chapter is also included. In the second chapter, different electrical architectures such as string inverters, micro-inverters, series power optimizers and parallel power optimizers are compared and held against key performance indicators of BIPV installations. The parallel power optimizer, hereafter referred to as a Module Level Converter (MLC), approach turns out to be the best solution, especially for BIPV façades where partial shading occurs. However, a market research revealed that the commercially available MLCs do not comply with BIPV requirements in terms of dimensions and electro-thermal properties. The third chapter focuses on safety aspects of the electrical installation. The MLCs are connected together on a Low-Voltage DC (LVDC) bus. Converter controlled LVDC systems are a relatively new phenomenon and the fault behaviour of these systems requires further investigation. In this thesis, contact voltages for different grounding strategies are derived and a selective protection methodology is proposed and experimentally validated. Two important parameters that influence the system efficiency are the DC voltage level and the type of solar cells. The influence of these parameters is investigated for two case study buildings in chapter four by the development of an electrical loss model that comprises the losses in the MLC, in the cabling and in the voltage balancing converter. The model is ran using one-day experimental data and shows that not only the losses but also the loss distribution is strongly affected by the DC voltage and the PV technology. In the fifth chapter, an alternative for regular cabling in BIPV systems is proposed. Using laminated bus bars benefits the voltage stability of the system and allows to reduce the MLC output capacitance, leading to reduced costs and increased reliability. An experimental prototype was designed and tested to highlight the electrical advantages and lead to the insight that the interconnection between the modules is an important design aspect to use the full potential of a bus bar system. The sixth and seventh chapter discuss the influence of respectively components and control on converter reliability. An overview of recommendations is presented for the selection of components and topologies. Furthermore, MLC prototypes that were developed during this thesis are discussed in detail. Finally, the impact of control on transistor lifetime is investigated using a one-year experimental dataset to highlight the influence of the conduction mode and the phase-shedding control strategy.status: publishe