Quantifying the macroeconomic cost of night-time bathroom visits: an application to the UK

Little is known on the impact that nocturia (the need to wake up at night to urinate) has on a nation’s economy. While there are many individual factors associated with inadequate sleep (e.g. bad sleep hygiene, chronic sleep disorders such as insomnia or sleep apnea), frequently having to wake up at night to urinate fragments sleep, with negative consequences on an individual’s health and well-being as well as daytime functioning. Using a large-scale UK workforce data, we estimate the prevalence of nocturia in the working population and quantify the lost worker productivity caused by nocturia, measured by absenteeism and presenteeism. This enters our multi-country general equilibrium model, which we calibrate to the UK economy, to estimate the annual macroeconomic cost of nocturia. We find the annual cost of clinically significant nocturia (waking up at least twice to urinate) is around £5.4 billion, or equivalently £1996 per worker with nocturia. This cost estimate is larger than previous estimates on the productivity effects of nocturia using cost-of-illness (COI) methods, suggesting the importance of taking into account general equilibrium effects when assessing the economic burden of health conditions

The biological cost of consciousness

Some philosophers maintain that consciousness as subjective experience has no biological function. However, conscious brain events seem very different from unconscious ones. The cortex and thalamus support the reportable qualitative contents of consciousness. Subcortical structures like the cerebellum do not. Likewise, attended sensory stimuli are typically reportable as conscious, while memories of those stimuli are not so reportable until they are specifically recalled. 

Reports of conscious experiences in normal humans always involve subjectivity and an implicit observing ego. Unconscious brain events are not reportable, even under optimal conditions of report. While there are claimed exceptions to these points, they are rare or poorly validated. 

Normal consciousness also implies high availability (rapid conscious access) of the questions routinely asked of neurological patients in the Mental Status Examination, such as common sense features of personal identity, time, place, and social context. Along with “current concerns,” recent conscious contents, and the like, these contents correspond to high frequency items in working memory. While working memory contents are not immediately conscious, they can be rapidly re-called to consciousness. 

The anatomy and physiology of reportable conscious sensorimotor contents are ultraconserved over perhaps 200 million years of mammalian evolution. By comparison, full-fledged language is thought to arise some 100,000 years ago in homo sapiens, while writing, which enables accel-erated cultural development, dates between 2.5 and 6 millennia. Contrary to some claims, therefore, conscious waking precedes language by hundreds of millions of years. 

Like other major adaptations, conscious and unconscious brain events have distinctive biological pros and cons. These involve information processing efficiency, metabolic costs and benefits, and behavioral pros and cons. The well known momentary limited capacity of conscious contents is an example of an information processing cost, while the very large and energy-hungry corticothalamic system makes costly metabolic demands. 

After a century of scientific neglect, fundamental concepts like “conscious,” “unconscious,” “voluntary” and “non-voluntary” are still vitally important, because they refer to major biopsychological phenomena that otherwise are difficult to discuss. 
&#xa

Stability of diurnal cortisol measures across days, weeks, and years across middle childhood and early adolescence: Exploring the role of age, pubertal development, and sex.

Effective regulation of the hypothalamic-pituitary-adrenal axis (HPA-axis) has been linked to numerous health outcomes. Within-person variation in diurnal measures of HPA-axis regulation assessed over days, months, and years can range between 50-73% of total variation. In this study of 59 youth (ages 8-13), we quantified the stability of the cortisol awakening response (CAR), the diurnal slope, and tonic cortisol concentrations at waking and bedtime across 8 days (2 sets of 4 consecutive days separated by 3 weeks), 3 weeks, and 3 years. We then compared the stability of these indices across three key developmental factors: age, pubertal status, and sex. Youth provided 4 saliva samples per day (waking, 30 min post-waking, before dinner, and before bedtime) for 4 consecutive days during the 3rd week of an ongoing 8-week daily diary study. Youth repeated this same sampling procedure 3 weeks and 3 years later. Using multi-level modeling, we computed the amount of variance in diurnal HPA-axis regulation that was accounted for by nesting an individual's diurnal cortisol indices within days, weeks, or years. Across days, diurnal slope was the most stable index, whereas waking cortisol and CAR were the least stable. All indices except bedtime cortisol were similarly stable when measured across weeks, and all indices were uniformly stable when measured across 3 years. Boys, younger participants, and youth earlier in their pubertal development at study enrollment exhibited greater HPA-axis stability overall compared with females and older, more physically mature participants. We conclude that important within- and between-subjects questions can be answered about health and human development by studying HPA-axis regulation, and selection of the index of interest should be determined in part by its psychometric characteristics. To this end, we propose a decision tree to guide study design for research in pediatric samples by longitudinal timeframe and sample characteristics

Association Between Sedentary Time and Quality of Life From the Osteoarthritis Initiative: Who Might Benefit Most From Treatment?

Objective To investigate the relationship between sedentary behavior and quality-adjusted life years (QALYs) among participants in the Osteoarthritis Initiative. Design Longitudinal, observational design. Setting Osteoarthritis Initiative cohort. Participants Individuals (N=1794) from a prospective, multicenter longitudinal cohort were classified into quantile groups based on average daily sedentary time (most sedentary, quartile 1 [Q1] ≥11.6h; 10.7h≤ Q2 Interventions Not applicable. Main Outcome Measures Individual QALYs were estimated over 2 years from the area under the curve of health-related utility scores derived from the Medical Outcomes Study 12-Item Short-Form Health Survey versus time. The relationship between baseline sedentary behavior and median 2-year QALYs was estimated using quantile regression adjusted for socioeconomic factors and body mass index. Results Lower QALYs over 2 years were more frequently found among the most sedentary (Q1, median 1.59), and QALYs increased as time spent in baseline sedentary behavior decreased (median QALYs for Q2, 1.64; Q3, 1.65; Q4, 1.65). The relationship of sedentary time and median QALY change was only significant for the most sedentary Q1 group, where an additional hour of sedentary behavior significantly reduced QALYs by −.072 (95% confidence interval, −.121 to −.020). Conclusions Our findings suggest that individuals with the most extreme sedentary profiles may be vulnerable to additional losses of quality of life if they become more sedentary. Targeting these individuals to decrease sedentary behavior has the potential to be cost-effective

Reported light in the sleep environment: enhancement of the sleep diary.

BackgroundLight is the primary synchronizing cue for the circadian timing system, capable of exerting robust physiological effects, even with very dim and/or brief photic exposure. Mammals, including humans, are particularly susceptible to light at night. As such, measures of light in the sleeping environment are critical for evaluating sleep health. Sleep diaries provide inexpensive measures of sleep, but do not typically include light information.MethodsFour questions probing visual perception of light in the bedtime and waking environments were added to the Consensus Sleep Diary for Morning administration. As part of a lighting intervention study, 18 hospital Labor and Delivery Department personnel completed the sleep diary for 1 week in each of two experimental conditions while wearing Actiwatch devices equipped with photosensors. Diary responses were evaluated against photosensor values from the beginning and end of each rest interval (n=194 rest intervals), as well as against sleep measures, utilizing linear mixed models.ResultsResponses to light questions were related to actual light measures at bedtime, controlling for shift type and experimental condition. In addition, subjective light information at bedtime and waking was related to both objective and subjective sleep parameters, with data generally indicating poorer sleep with light in the sleeping environment.ConclusionQuestions addressing perception of light in the sleeping environment may provide a crude yet affordable metric of relative photic intensity. Further, as responses relate to sleep outcomes, subjective light information may yield valuable insights regarding mechanisms and outcomes of clinical significance in sleep and circadian research

A network-aware framework for energy-efficient data acquisition in wireless sensor networks

Wireless sensor networks enable users to monitor the physical world at an extremely high fidelity. In order to collect the data generated by these tiny-scale devices, the data management community has proposed the utilization of declarative data-acquisition frameworks. While these frameworks have facilitated the energy-efficient retrieval of data from the physical environment, they were agnostic of the underlying network topology and also did not support advanced query processing semantics. In this paper we present KSpot+, a distributed network-aware framework that optimizes network efficiency by combining three components: (i) the tree balancing module, which balances the workload of each sensor node by constructing efficient network topologies; (ii) the workload balancing module, which minimizes data reception inefficiencies by synchronizing the sensor network activity intervals; and (iii) the query processing module, which supports advanced query processing semantics. In order to validate the efficiency of our approach, we have developed a prototype implementation of KSpot+ in nesC and JAVA. In our experimental evaluation, we thoroughly assess the performance of KSpot+ using real datasets and show that KSpot+ provides significant energy reductions under a variety of conditions, thus significantly prolonging the longevity of a WSN

Video Evidence That London Infants Can Resettle Themselves Back to Sleep After Waking in the Night, as well as Sleep for Long Periods, by 3 Months of Age

Objective: Most infants become settled at night by 3 months of age, whereas infants not settled by 5 months are likely to have long-term sleep-waking problems. We assessed whether normal infant development in the first 3 months involves increasing sleep-period length or the ability to resettle autonomously after waking in the night. Methods: One hundred one infants were assessed at 5 weeks and 3 months of age using nighttime infrared video recordings and parental questionnaires. Results: The clearest development was in sleep length; 45% of infants slept continuously for 5 hours or more at night at 3 months compared with 10% at 5 weeks. In addition, around a quarter of infants woke and resettled themselves back to sleep in the night at each age. Autonomous resettling at 5 weeks predicted prolonged sleeping at 3 months suggesting it may be a developmental precursor. Infants reported by parents to sleep for a period of 5 hours or more included infants who resettled themselves and those with long sleeps. Three-month olds fed solely breast milk were as likely to self-resettle or have long sleep bouts as infants fed formula or mixed breast and formula milk. Conclusions: Infants are capable of resettling themselves back to sleep in the first 3 months of age; both autonomous resettling and prolonged sleeping are involved in “sleeping through the night” at an early age. Findings indicate the need for physiological studies of how arousal, waking, and resettling develop into sustained sleeping and of how environmental factors support these endogenous and behavioral processes

Employment conditions in the scottish social care voluntary sector : impact of public funding constraints in the context of economic recession

This report uses data to assess the impact of public funding constraints on employment conditions in the Scottish social care voluntary sector, in the context of the recent economic recessionand future public expenditure cuts

Cardio-metabolic impact of changing sitting, standing, and stepping in the workplace

According to cross-sectional and acute experimental evidence, reducing sitting time should improve cardio-metabolic health risk biomarkers. Furthermore, the improvements obtained may depend on whether sitting is replaced with standing or ambulatory activities. Based on data from the Stand Up Victoria multi-component workplace intervention, we examined this issue using compositional data analysis - a method that can examine and compare all activity changes simultaneously.Participants receiving the intervention (n=136 ≥0.6 full-time equivalent desk-based workers, 65% women, mean±SD age=44.6 ±9.1 years from seven worksites) were asked to improve whole-of-day activity by standing up, sitting less and moving more. Their changes in the composition of daily waking hours (activPAL-assessed sitting, standing, stepping) were quantified, then tested for associations with concurrent changes in cardio-metabolic risk (CMR) scores and 14 biomarkers concerning body composition, glucose, insulin and lipid metabolism. Analyses were by mixed models, accounting for clustering (3 months, n=105-120; 12 months, n=80-97).Sitting reduction was significantly (