Continuous glucose monitoring (CGM) generates dense physiological time-series data sampled every 5 min across 24-h periods. Standard analytical approaches impose calendar-based temporal boundaries-treating midnight as a natural segmentation point-despite glucose homeostasis operating through continuous circadian oscillators that recognize no such delimiter. This structural misalignment introduces a systematic measurement artifact: biologically continuous overnight patterns are bisected at 00:00, artificially inflating glycemic variability estimates and obscuring individual circadian phase relationships. We analyzed approximately 60 days of CGM data, comparing three binning strategies: (1) 24 linear hour-bins (conventional), (2) 36 linear 40-min bins (resolution control), and (3) 36 angular 10° bins (circular topology). Shannon entropy with variance-weighted probabilities quantified information content. Bootstrap resampling (1000 iterations) and null topology permutation (random within-day time-permutation, 1000 iterations) distinguished genuine temporal structure from mathematical artifact. Circular representation demonstrated 12.1% higher information entropy compared to linear binning at matched resolution (3.56 vs. 3.18 bits, P < 0.001, bootstrap percentile method), with nonoverlapping confidence intervals (95% CI: 3.41-3.71 vs. 3.06-3.30). Increasing from 24 to 36 bins in linear space produced zero entropy change (3.18→3.18), isolating topological continuity as the information-preserving factor. Midnight boundary created 2.8-fold reduction in continuity correlation (r = 0.31 vs. r = 0.87, P < 0.001) for biologically adjacent timepoints. Analysis showed nonrandom angular variance structure (P < 0.001), with 1.97-fold variance differential between evening (21:20-00:00) and midday (11:20-14:00) zones. Midnight segmentation introduces quantifiable information loss through temporal discontinuity. Circular time representation-mapping 24-h cycles onto angular coordinates using established directional statistics-eliminates this artifact while preserving temporal information. Current glycemic variability metrics (coefficient of variation, time-in-range) calculated within midnight-bounded periods inherit discontinuity artifacts, potentially misclassifying normal circadian oscillations as pathological variability. Adoption of circular frameworks would align CGM analytics with chronobiological principles and enable individual circadian phenotyping without data manipulation. This represents methodological infrastructure requiring prospective validation for clinical utility.
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Hospitalizations for opioid use disorder (OUD) are rising, yet overnight clinicians rarely receive targeted OUD education. Our interprofessional initiative implemented two overnight training sessions specifically for night-shift physicians, nurses, pharmacists, and advanced practice providers, emphasizing buprenorphine initiation, stigma reduction, harm reduction, and patient-centered communication. Participants in the program demonstrated increased confidence in OUD management and a self-reported rise in overnight buprenorphine initiation, highlighting the impact of this tailored night-shift education. Administrative support enabled participation through scheduling adjustments and incentives, while collaboration with TeachOUD enriched content with community resources. To improve overnight care in resource-limited hospitals, we highlight no-cost resources, including teleconsultation hotlines, quick-reference tools, and training designated night-shift OUD champions, promoting accessible and sustainable strategies to enhance OUD care at all hours of the day.
Pheochromocytoma is a catecholamine-producing tumor that may exhibit atypical hormonal profiles. Emerging evidence suggests an association with cortisol dysregulation in the absence of overt Cushing syndrome; however, systematic cortisol evaluation is not routinely performed. This study investigated the prevalence and clinical characteristics of absent nocturnal cortisol decline in pheochromocytoma. This retrospective study included 53 patients with histologically confirmed pheochromocytoma treated between 2011 and 2024. All eligible patients diagnosed during the study period were included. Among them, 22 had paired morning (8:00 AM) and midnight serum cortisol measurements for analysis of nocturnal cortisol decline. Adrenocorticotropic hormone (ACTH) and the 1-mg dexamethasone suppression test (DST) were assessed when available. Patients were stratified by midnight cortisol level (≥1.8 µg/dL vs < 1.8 µg/dL). Among the 22 patients, 18 (82%) had elevated midnight cortisol, indicating absent nocturnal decline (mean midnight, 5.1 µg/dL; mean morning, 13.7 µg/dL). The elevated group (n = 18) was older than the normal group (n = 4) (median, 64 vs 43 years). Metabolic comorbidities were more frequent in the elevated group, including diabetes (50% vs. 25%), dyslipidemia (61% vs. 25%), and cardiovascular disease (44% vs. 0%). DST was performed in 10 patients and showed adequate suppression in 7 of 8 patients with paired cortisol measurements, arguing against autonomous cortisol secretion. No patients had clinical features of overt Cushing syndrome. Absent nocturnal cortisol decline was common and may reflect a pseudo-Cushing state associated with catecholamine excess. These findings support further evaluation of cortisol regulation and its clinical implications.
Postoperative urinary retention (POUR) is a common complication in prolapse surgery patients. However, there is no consensus regarding the optimal timing for postoperative indwelling urinary catheter (IUC) removal. To provide effective and evidence-based healthcare, we compare same-day midnight removal with IUC removal the morning after surgery. In this retrospective cohort study, 602 patients who underwent prolapse surgery between January 2020 and September 2023 were included. In the early removal group (n = 309), the IUC was removed at midnight on the day of the surgery; in the late removal group (n = 293), it was removed the following morning. Information regarding risk factors for POUR and discharge time was retrieved and analyzed. No differences regarding the risk of POUR were found between the early and late removal groups OR 1.05 (95% CI 0.68, 1.60). An increased Charlson Comorbidity Index (CCI), stage III and IV prolapse, longer surgery time, spinal anesthesia, and pain are considered independent risk factors for POUR; a higher body mass index (BMI) reduces the risk of POUR. Patients diagnosed and treated for urinary retention had a significantly higher chance of developing urinary tract infections during recovery. Patients within the early removal groups were discharged approximately 9 h earlier. Midnight removal of the IUC after prolapse surgery does not lead to an increased incidence of POUR and is considered a safe alternative for catheter removal the following morning. In addition, this may contribute to more effective healthcare and optimization of hospital capacity.
This study aimed to elucidate the effects of single versus double-shift work schedules on salivary cortisol concentrations among nurses. This research was designed as a comparative descriptive study utilizing repeated measures to assess changes over time and shift types. A total of fifty-two female nurses, working in rotating shifts, participated in the study. Saliva cortisol samples were collected from all participants before, after, and at midnight for both a single and a double shift. To assess interactions between time (07:30-08:30, 15:30-16:30, 23:00-24:00) and shift type (single and double), a repeated-measures two-way analysis of variance (ANOVA) was used. Analyses encompassing both time and shift type demonstrated significant main effects for both variables. Salivary cortisol concentrations were maximal between 07:30 and 08:30, while the trough levels were recorded at midnight. Inspection of the main effect associated with shift type revealed that double-shift workers exhibited higher mean cortisol concentrations. Specifically, cortisol levels were nearly two-fold higher at midnight in double-shift workers compared to single-shift workers. Additionally, a significant interaction effect between time and shift type was found. The pronounced effects of double shifts, as evidenced by significant changes in cortisol levels, warrant urgent consideration by healthcare policymakers and administrators, balancing operational efficiency with nurses' well-being and patient safety. No patient or public contribution.
The association between pre-pregnancy sleep patterns and postpartum depression as well as the modifying effect of parity, remains insufficiently understood. This study examined the longitudinal associations of sleep before and during pregnancy on the risk of postpartum depression at one month postpartum, with additional analyses stratified by parity. Data were obtained from the Japan Environment and Children's Study, a nationwide birth cohort study conducted between 2011 and 2014. A total of 65,477 women who completed questionnaires on demographic characteristics, obstetric factors, sleep patterns before and during pregnancy, and postpartum depression at one month postpartum were included. Relative risks (RRs) and 95% confidence intervals (CIs) for postpartum depression were estimated according to sleep duration, bedtime, sleep depth, and morning mood after adjusting for relevant covariates. A pre-pregnancy sleep duration of 8-9 h was associated with a lower risk of postpartum depression (RR = 0.94, 95% CI: 0.89-0.99). During pregnancy, sleeping less than 6 h and having bedtimes outside the 9:00 pm-midnight or midnight-3:00 am ranges were associated with increased risks of postpartum depression (RR = 1.19, 95% CI: 1.10-1.30; RR = 1.20, 95% CI: 1.07-1.35, respectively). Very light and light sleep were strongly associated with higher risks (RR = 1.88, 95% CI: 1.76-2.01; RR = 1.37, 95% CI: 1.31-1.44, respectively). Additionally, waking in a very bad or bad mood during pregnancy markedly increased the risk of postpartum depression (RR = 2.22, 95% CI: 1.99-2.47; RR = 1.72, 95% CI: 1.64-1.79, respectively). In parity-stratified analyses, multiparous women with bedtimes between midnight and 3:00 am before or during pregnancy had elevated risks of postpartum depression, with significant effect modification (pre-pregnancy: RR = 1.11, 95% CI: 1.03-1.19, p = 0.001; pregnancy: RR = 1.12, 95% CI: 1.04-1.22, p = 0.01). Among multiparous women, waking in a very bad or bad mood during pregnancy was also strongly associated with postpartum depression, with a significant effect modification (RR = 2.65, 95% CI: 2.28-3.09; RR = 1.93, 95% CI: 1.80-2.06, respectively, p < 0.001). Pre-pregnancy and pregnancy sleep patterns are associated with the risk of postpartum depression. Particularly, among multiparous women, late bedtimes before and during pregnancy may increase this risk. Improving sleep habits before and during pregnancy may contribute to the prevention of postpartum depression. Clinical trial number: Not applicable.
Recent randomized controlled trials (RCTs) challenge the routine practice of keeping patients NPO ("nil per os") after midnight before diagnostic cardiac catheterization. Shorter fasting durations improve patient experience without increasing risks; however, systematic uptake into routine practice remains limited. At a high-volume cardiac care centre, patients were still being required to fast from midnight, despite emerging evidence. To assess the feasibility of shifting long‑standing practice patterns, we established a >70% adherence target for uptake of a shortened fasting protocol. A structured quality improvement initiative using sequential Plan-Do-Study-Act (PDSA) cycles modified pre-procedural fasting protocols to permit a light meal up to 2 hours before cardiac catheterization and clear fluids until the procedure (i.e., intervention). Patient experience surveys were administered to intervention and control groups in 2 PDSA cycles, followed by a post-implementation intervention group. The primary outcome was adherence to shortened fasting protocols (>70% target). Secondary outcomes included patient comfort, satisfaction, safety events, and sustained uptake. Cycle 1 included 97 outpatients (37 control, 60 intervention), cycle 2 included 84 inpatients (40 control, 44 intervention), and 45 patients were in the post-implementation group. Target adherence was met (77% in cycle 1, 82% in cycle 2, and 79% at post-implementation). Patients in the intervention groups reported lower hunger (cycle 1 outpatients) and lower nausea (cycle 2 inpatients), while satisfaction scores remained consistently high across all groups. No aspiration, intubation, or escalation to higher-level care was observed. Shortening fasting requirements to 2 hours before cardiac catheterization was feasible to implement in a high‑volume cardiac centre.
To examine coffee consumption patterns and their associations with sleep quality indicators among Saudi youth, and to identify independent predictors of poor sleep outcomes using multivariate regression. A cross-sectional study was conducted among 1458 consenting Saudi youth (aged 16-30 years) using an online questionnaire adapted from the Pittsburgh Sleep Quality Index (PSQI). Chi-square tests examined associations between coffee consumption patterns (type, timing, pre-bedtime cessation) and sleep variables. Binary logistic regression identified independent predictors of late bedtime (sleeping after midnight), adjusting for demographic covariates. The sample was predominantly female (69.4%, n = 1012) and aged 18-22 years (65.7%, n = 958). Evening/night-time coffee consumption was a strong independent predictor of sleeping after midnight (OR = 3.04, 95% CI: 2.30-4.02, p < 0.001), adjusting for cessation strategy, sex, age, and student status. Chi-square analyses confirmed that coffee consumption timing showed highly significant associations with bedtime patterns (χ2 = 57.806, p < 0.001), sleep duration (χ2 = 42.759, p < 0.001), and daytime sleep behaviours (χ2 = 27.247, p < 0.001). Pre-bedtime cessation timing was significantly associated with bedtime patterns (χ2 = 73.075, p < 0.001) and nighttime awakenings (χ2 = 28.912, p = 0.007). Temporal aspects of coffee consumption demonstrate stronger and more consistent associations with sleep quality than coffee type selection. Evening coffee use is an independent risk factor for delayed sleep timing. Strategic timing interventions may be more effective than content-based restrictions for improving sleep health in Saudi youth.
This study sought to determine the change in sleep quality and duration among children hospitalized on acute care units when overnight vital signs (VS) monitoring is eliminated, compared with children who receive standard-of-care VS monitoring. This is a nonrandomized controlled study among children hospitalized on medical-surgical units (n = 109). The study intervention involved forgoing VS measurement at 0000 and 0400. The primary outcome was actigraphy-measured total sleep time, with secondary outcomes of actigraphy-measured wake status at midnight and 0700; actigraphy-measured and self-reported nocturnal wake frequency and duration; and self-reported total sleep time, restfulness upon waking, and sleep disturbances. Actigraphy total sleep time in the intervention group was 49.2 minutes longer than in the control group (P = .04). Sleep efficiency, wake after sleep onset, and wake episodes were not different. There was also no difference in the number of children asleep at midnight, but more children in the intervention group were asleep at 0700 than in the control group (77% vs 55%, P = .03). Self-reported restfulness and sleep disturbances were also superior in the intervention group. There were no unplanned pediatric intensive care unit (ICU)/cardiac ICU transfers, rapid response activations, code sepsis alerts, or code blue events. Forgoing overnight VS measurement among children hospitalized on medical-surgical units was associated with an increase in overnight sleep duration but did not decrease the overall number of nighttime interruptions or time awake during the night. VS measurement reduction was also safe and may be important for children to achieve adequate sleep in the hospital.
Although various tests are used for Cushing's syndrome (CS) screening and diagnosis, none exhibit ideal sensitivity or specificity. This study evaluates the association of the blood urea nitrogen (BUN)/creatinine ratio with disease status in CS and subclinical Cushing's syndrome (SCS), and with postoperative changes in patients with CS. A single-center, observational, cross-sectional study conducted at Endocrinology and Metabolic Diseases Clinic of a tertiary training and research hospital in Istanbul, Turkey (2017-2022). This study included 229 individuals: 151 CS/SCS patients and 78 healthy controls. CS cases were classified as adrenocorticotropic hormone (ACTH)-dependent (n = 52) or ACTH-independent (n = 34). BUN/creatinine ratios were compared among CS, SCS, and control groups, as well as between pre- and posttreatment states in CS patients. Correlations between BUN/creatinine ratio and standard CS diagnostic tests were analyzed. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory performance of the BUN/creatinine ratio between CS and control groups. BUN/creatinine ratios were significantly higher in CS, ACTH-independent CS, and SCS groups compared to controls. Cutoff values were > 15.34 for CS, > 13.67 for ACTH-independent CS, and > 19.8 for SCS. The BUN/creatinine ratio correlated positively with basal plasma cortisol, 1 mg dexamethasone suppression test (DST), and midnight serum cortisol in ACTH-dependent CS (p = 0.047, 0.038, 0.004). In all CS patients, it correlated with 1-mg DST and midnight serum cortisol (p = 0.041, 0.049). In ACTH-dependent CS, a positive correlation was found between pituitary adenoma diameter and the preoperative BUN/creatinine ratio (p = 0.036). The BUN/creatinine ratio may provide supportive information associated with CS status and postoperative changes in patients with CS, particularly when standard tests are unavailable or inconclusive. Larger multicenter studies are needed to confirm its clinical utility.
Radon is the leading cause of lung cancer after smoking, and its concentration can reach critical levels when it accumulates inside a dwelling through pores and cracks connecting the basement to the living space. This concentration can be influenced by other factors, such as atmospheric parameters. The values of these variables were measured inside 21 dwellings in the village of Villy. These variables are measured using a corentium pro equipped with a silicon detector to quantify radon and four sensors to measure meteorological parameters and detect movement during data acquisition. Inside each dwelling, a short-term measurement is taken for 48 h. The results show that radon-222 concentrations ranged from[Formula: see text] to [Formula: see text], with an average value of [Formula: see text]. The inside temperature ranged from 32.3[Formula: see text]0.5 to 38.8[Formula: see text] °C, with an average value of 36[Formula: see text] °C. Humidity ranged from 12.5[Formula: see text] to 40.4[Formula: see text] %rh, with an average value of 28.1[Formula: see text] %rh and pressure ranged from 97.3175[Formula: see text] to 97.7171[Formula: see text] kPa, with an average of 97.5350[Formula: see text] kPa. During the day, radon concentration is highest at 4 a.m. and lowest at 11 a.m. This concentration follows a two-way pattern. It increases between midnight and 7 a.m. and between 6 p.m. and midnight, then decreases from 7 a.m. to 6 p.m. The spatiotemporal distribution reveals that atmospheric parameters influence radon concentration. A decrease in temperature corresponds to an increase in humidity and pressure, leading to an increase in indoor radon concentration. Conversely, an increase in temperature corresponds to a decrease in humidity and pressure, leading to a decrease in indoor radon concentration.
Artificial light at night (ALAN) disrupts natural light-dark cycles, posing ecological challenges for wildlife in urban environments. This study investigated ALAN's effects on gene expression in the brain, liver, eyes, gonad and skin of green anole lizards (Anolis carolinensis), increasingly exposed to urban light pollution. We hypothesized that ALAN would alter circadian rhythms by disrupting nighttime darkness and predicted differential expression of genes involved in photoreception, circadian regulation, metabolism and photoperiodic responses. To identify affected pathways, we analysed the expression of circadian and metabolic genes under three conditions: midday in full light, midnight in full darkness and midnight under artificial light. Differential expression analysis revealed that clock-related genes were significantly altered in the brain, liver and skin following ALAN exposure. Genes involved in glucagon signalling and lipid metabolism were differentially expressed in the liver, indicating potential metabolic disruptions. The skin showed distinct responses, with genes related to cellular processes such as wound healing upregulated under natural light-dark conditions, suggesting compromised repair mechanisms under ALAN. Our findings demonstrate that ALAN disrupts core circadian genes and physiological processes, providing the first transcriptomics evidence of light pollution's impact on green anoles. We also developed an interactive online database for exploring gene expression changes under ALAN.
This study examined the impact of extended wakefulness on interoceptive accuracy and how individual differences in interoception related to subjective sleepiness. Twenty-four healthy university students participated in the study. Interoceptive accuracy was assessed using the heartbeat-counting task during daytime and midnight sessions. Interoceptive accuracy did not differ significantly between the sleep conditions. However, subjective sleepiness was negatively correlated with interoceptive accuracy at midnight. Individual differences in interoceptive function may be associated with variability in perceived sleepiness under sleep pressure. These findings highlight the potential role of interoception in explaining why some individuals experience a mismatch between subjective and objective sleepiness.
This case highlights the multidisciplinary coordination required to manage perforation peritonitis in a young patient with disseminated tuberculosis, undiagnosed human immunodeficiency virus (HIV), and hemophagocytic lymphohistiocytosis (HLH). A 29-year-old woman presented to the hospital at midnight in septic shock, requiring inotropic support. Collateral history revealed a one-year history of significant weight loss. On examination, the patient appeared cachectic with a grossly distended and tender abdomen. CT imaging showed free fluid, locules of free air, and clustered small bowel loops in the mid-abdomen. Following resuscitation in line with the sepsis-6 protocol, the patient underwent emergency laparotomy. Intraoperatively, matted and dusky small bowel loops were observed, along with 2.5 litres of purulent fluid and widespread white nodules on both visceral and parietal peritoneal surfaces. A damage control approach was adopted: the abdomen was extensively lavaged, biopsies were taken, and drains were inserted, while bowel dissection was deliberately avoided to prevent further injury. Cultures later confirmed atypical mycobacteria and polymicrobial flora. Histology demonstrated caseating granulomas, and further testing revealed newly diagnosed HIV with a high viral load and a severely depleted CD4 count. In the postoperative period, the patient developed migrating enterocutaneous fistulas, which were managed through an intestinal failure protocol alongside anti-tuberculosis therapy. A concurrent diagnosis of HLH delayed the initiation of antiretroviral therapy, necessitating a carefully sequenced treatment approach. Despite the high predicted mortality and complexity of presentation, the patient gradually improved, transitioned to oral feeding, regained weight, and resumed full-time work within a year. This case underscores the importance of early damage control surgery, prompt microbiological and histological sampling, and coordinated multidisciplinary care. Lessons from this case may help inform the management of similarly complex presentations in time-critical and resource-constrained settings.
Frequent use of resting boxes by Culiseta melanura (Coquillett) during the day-time may offer the opportunity for use of these artificial resting sites as delivery substrates for insecticides to manage populations of this eastern equine encephalitis virus (EEEV) vector. In field studies at EEEV-endemic foci in southwestern Michigan, abundance in black-painted resting boxes of adult male and female Cs. melanura varied within the 24-h diel cycle, by whether the interiors of the boxes were treated with a microencapsulated formulation of lambda cyhalothrin (Demand CSTM), and from before to after treatment of boxes at field sites. Abundance was highest at noon, diminished to nil at midnight, and increased by noon the following day. Abundance of Cs. melanura was lower in insecticide-treated boxes compared to untreated boxes, and declined at field sites sampled after treatment of boxes with microencapsulated lambda cyhalothrin, compared to before treatment and to control sites. This population suppression effect lasted at least 30 days and exceeded 90% reduction. Field-caught Cs. melanura males and females experienced high mortality when exposed to lambda cyhalothrin-treated bottles in bottle bioassays and in overnight exposures to treated boxes set in the laboratory. Prolonged daily visits to resting boxes, resulting in exposure to residual insecticide, may explain the sustained, diminishing effect on abundance of field populations of Cs. melanura. Results support use of insecticide-treated boxes distributed into wooded upland edges of natural larval habitats as an intervention against EEEV transmission.