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Decades have now passed since Colin Pittendrigh first proposed a model of a circadian clock composed of two coupled oscillators, individually responsive to the rising and setting sun, as a flexible solution to the challenge of behavioral and physiological adaptation to the changing seasons. The elegance and predictive power of this postulation has stimulated laboratories around the world in searches to identify and localize such hypothesized evening and morning oscillators, or sets of oscillators, in insects, rodents, and humans, with experimental designs and approaches keeping pace over the years with technological advances in biology and neuroscience. Here, we recount the conceptual origin and highlight the subsequent evolution of this dual oscillator model for the circadian clock in the mammalian suprachiasmatic nucleus; and how, despite our increasingly sophisticated view of this multicellular pacemaker, Pittendrigh's binary conception has remained influential in our clock models and metaphors., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

PM 2.5 concentrations are higher during rush hours at background stations compared to the average concentration across these stations. Few studies have investigated PM 2.5 concentration and its spatial distribution during rush hours using machine learning models. This study employs a geospatial-artificial intelligence (Geo-AI) prediction model to estimate the spatial and temporal variations of PM 2.5 concentrations during morning and dusk rush hours in Taiwan. Mean hourly PM 2.5 measurements were collected from 2006 to 2020, and aggregated into morning (7 a.m.-9 a.m.) and dusk (4 p.m.-6 p.m.) rush-hour mean concentrations. The Geo-AI prediction model was generated by integrating kriging interpolation, land-use regression, machine learning, and a stacking ensemble approach. A forward stepwise variable selection method based on the SHapley Additive exPlanations (SHAP) index was used to identify the most influential variables. The performance of the Geo-AI models for morning and dusk rush hours had accuracy scores of 0.95 and 0.93, respectively and these results were validated, indicating robust model performance. Spatially, PM 2.5 concentrations were higher in southwestern Taiwan for morning rush hours, and suburban areas for dusk rush hours. Key predictors included kriged PM 2.5 values, SO 2 concentrations, forest density, and the distance to incinerators for both morning and dusk rush hours. These PM 2.5 estimates for morning and dusk rush hours can support the development of alternative commuting routes with lower concentrations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The intensive data typically collected by mobile health (mHealth) apps allows factors associated with persistent use to be investigated, which is an important objective given users' well-known struggles with sustaining healthy behavior., Objective: Data from a commercial meditation app (n=14,879; 899,071 total app uses) were analyzed to assess the validity of commonly given habit formation advice to meditate at the same time every day, preferably in the morning., Methods: First, the change in probability of meditating in 4 nonoverlapping time windows (morning, midday, evening, and late night) on a given day over the first 180 days after creating a meditation app account was calculated via generalized additive mixed models. Second, users' time of day preferences were calculated as the percentage of all meditation sessions that occurred within each of the 4 time windows. Additionally, the temporal consistency of daily meditation behavior was calculated as the entropy of the timing of app usage sessions. Linear regression was used to examine the effect of time of day preference and temporal consistency on two outcomes: (1) short-term engagement, defined as the number of meditation sessions completed within the sixth and seventh month of a user's account, and (2) long-term use, defined as the days until a user's last observed meditation session., Results: Large reductions in the probability of meditation at any time of day were seen over the first 180 days after creating an account, but this effect was smallest for morning meditation sessions (63.4% reduction vs reductions ranging from 67.8% to 74.5% for other times). A greater proportion of meditation in the morning was also significantly associated with better short-term engagement (regression coefficient B=2.76, P<.001) and long-term use (B=50.6, P<.001). The opposite was true for late-night meditation sessions (short-term: B=-2.06, P<.001; long-term: B=-51.7, P=.001). Significant relationships were not found for midday sessions (any outcome) or for evening sessions when examining long-term use. Additionally, temporal consistency in the performance of morning meditation sessions was associated with better short-term engagement (B=-1.64, P<.001) but worse long-term use (B=55.8, P<.001). Similar-sized temporal consistency effects were found for all other time windows., Conclusions: Meditating in the morning was associated with higher rates of maintaining a meditation practice with the app. This is consistent with findings from other studies that have hypothesized that the strength of existing morning routines and circadian rhythms may make the morning an ideal time to build new habits. In the long term, less temporal consistency in meditation sessions was associated with more persistent app use, suggesting there are benefits from maintaining flexibility in behavior performance. These findings improve our understanding of how to promote enduring healthy lifestyles and can inform the design of mHealth strategies for maintaining behavior changes., (©Vincent Berardi, Rylan Fowers, Gavriella Rubin, Chad Stecher. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.04.2023.)

Background: Understanding, predicting, and reducing the harms associated with cannabis use is an important field of study. Timing (i.e., hour of day and day of week) of substance use is an established risk factor of severity of dependence. However, there has been little attention paid to morning use of cannabis and its associations with negative consequences., Objectives: The goal of the present study was to examine whether distinct classifications of cannabis use habits exist based on timing, and whether these classifications differ on cannabis use indicators, motives for using cannabis, use of protective behavioral strategies, and cannabis-related negative outcomes., Methods: Latent class analyses were conducted on four independent samples of college student cannabis users (Project MOST 1, N=2,056; Project MOST 2, N=1846; Project PSST, N=1,971; Project CABS, N=1,122)., Results: Results determined that a 5-class solution best fit the data within each independent sample consisting of the classes: (1) "Daily-morning use",(2) "Daily-non-morning use", (3) "Weekend-morning use", (4) "Weekend-night use", and (5) "Weekend-evening use." Classes endorsing daily and/or morning use reported greater use, negative consequences and motives, while those endorsing weekend and/or non-morning use reported the most adaptive outcomes (i.e., reduced frequency/quantity of use, fewer consequences experienced, and fewer cannabis use disorder symptoms endorsed)., Conclusions: Recreational daily use as well as morning use may be associated with greater negative consequences, and there is evidence that most college students who use cannabis do avoid these types of use. The results of the present study offer evidence that timing of cannabis use may be a pertinent factor in determining harms associated with use., (© 2023 Authors et al.)

We evaluated the effects of different exercise types suitable for a home/work setting on the postprandial glucose response. Twenty-three healthy, active, young individuals performed one of two studies (12 in Study 1 and 11 in Study 2), with four randomized protocols each. After a meal high in carbohydrate content (1 g of carbohydrate per kg of body weight), in Study 1, participants performed 30 min of either walking (WALK), bench stepping exercise (STEP) or isometric wall squat (SQUAT); in Study 2, participants performed 30 min of either walking (WALK), neuromuscular electrical stimulation alone (P&#95;NMES) or superimposed on voluntary muscle contraction (VC&#95;NMES). In both studies, participants performed a prolonged sitting condition (CON) that was compared to the exercise sessions. In Study 1, WALK and STEP significantly reduced the glucose peak compared to CON (p < 0.011). In Study 2, the peak was significantly reduced in WALK compared to CON, P&#95;NMES and VC&#95;NMES (p < 0.011) and in VC&#95;NMES compared to CON and P&#95;NMES (p < 0.011). A significant reduction of 3 h glucose iAUC was found for WALK and VC&#95;NMES compared to CON and P&#95;NMES (p < 0.033). In conclusion, WALK is the most effective strategy for improving the postprandial glycemic response. However, STEP and VC&#95;NMES can also be used for reducing postprandial glycemia.

Morning hypertension is an important clinical target in the management of hypertension for perfect 24-h blood pressure (BP) control. Morning hypertension is generally categorized into two types: "morning surge" type and "sustained nocturnal and morning hypertension" type. The "morning surge" type is characterized by an exaggerated morning blood pressure surge (MBPS), and the "sustained nocturnal and morning hypertension" type with continuous hypertension from nighttime to morning (non-dipper/riser type). They can be detected by home and ambulatory blood pressure measurements (HBPM and ABPM). These two forms of morning hypertension both increase the risk of cardiovascular and renal diseases, but may occur via different pathogenic mechanisms and are associated with different conditions. Morning hypertension should be treated to achieve a morning BP level of < 135/85 mmHg, regardless of the office BP. The second target morning BP levels is < 125/75 mmHg for high-risk patients with morning hypertension and concomitant diseases. Morning hypertension is more frequently found in Asians, than in Westerners. Thus, the management of morning hypertension is especially important in Asia. The detection of morning hypertension and the individual home BP-guided treatment approach targeting morning BP in combination with ABPM, and the optimal treatment of morning hypertension would reduce cardiovascular events in Asia., (© 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Public Health Significance: Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Background: CLOCK 3111T/C has been shown to be closely associated with morningness-eveningness, such as sleep-wake rhythms in healthy humans. However, previous studies examined the physical activity (PA) in a single day, and no study has investigated the relationships between CLOCK 3111T/C polymorphism and PA for an entire week. It was hypothesized that the CLOCK 3111T/C polymorphism might be associated with diurnal PA patterns, especially on the weekends., Methods: Eighty-one university students (male, n = 14; female, n = 67; age, 20.4 ± 2.9 years) wore a digital accelerometer for 7 successive days, including the weekend, to collect hour-by-hour objectively-measured PA. CLOCK 3111T/C polymorphism was assessed using the oral mucosa. During the study, participants recorded their wake time and bedtime each day. Furthermore, lifestyle-related variables (i.e. morningness-eveningness, habitual meal and sleep timings) were collected using questionnaires. Linear mixed-effects models assessed the association of polymorphism (TT carriers vs. TC+CC carriers) with wake time and bedtime as well as daily PA throughout the week (time)., Results: TT carriers had an earlier wake time (weekly mean: 44 min [95% CI, -82 to -5 min], time interaction: p = 0.026) and bedtime (weekly mean: 30 min [95% CI, -61 min to - 15 s], time interaction: p = 0.048) than TC+CC carriers. Furthermore, TT carriers' wake time and bedtime on Saturday were significantly later than on other days (gene interaction: all p < 0.05). On Saturday, the hour-by-hour PA in TT carriers was significantly greater than that in TC+CC carriers (hourly mean 1.7 min [95% CI, 0.2 to 3.4 min], time: p < 0.001, group: p = 0.028, interaction: p = 0.155)., Conclusions: CLOCK 3111T/C polymorphism may be associated with objectively measured hour-by-hour PA only on Saturday. Academic/social obligations may mask the genetically determined biological rhythm of PA on weekdays., (Copyright © 2022. Published by Elsevier Inc.)

Purpose: The purpose of this study was to investigate how time-of-day training preference influences resistance-exercise performance. Methods: Resistance trained males ( n = 12) were recruited for this study. In a crossover, counterbalanced design, participants completed two separate bench-press exercise trials at different times of day: (a) morning (AM; 8:00 hr) and (b) evening (PM; 16:00 hr). Participants answered a questionnaire on time-of-day training preference and completed a preferred (PREF) and nonpreferred (NON-PREF) time-of-day trial. For each trial, motivation was measured using a visual analog scale prior to exercise. Participants completed 2 sets × 2 repetitions at 75% 1-RM with maximum explosiveness separated by 5 min of rest. Mean barbell velocity was measured using a linear position transducer. Participants then completed 1 set × repetitions to failure (RTF) at 75% 1-RM. Rate of perceived exertion (RPE) was measured immediately following exercise. Results: Regardless of preference, velocity ( p = .025; effect size (ES) = 0.43) was higher during the PM versus AM trial. However, there were no significant differences in velocity ( p = .368; ES = 0.37) between PREF and NON-PREF time of day. There were no significant differences for repetitions between PREF and NON-PREF times ( p = .902; ES = 0.03). Motivation was higher in the PREF time versus NON-PREF ( p = .015; ES = 0.68). Furthermore, RPE was significantly lower during the PREF time of day ( p = .048; 0.55). Conclusions: Despite higher barbell velocity collectively at PM times, time-of-training preference did not largely influence resistance-exercise performance, while motivation is higher and RPE is lower during preferred times.

Light perception at dawn plays a key role in coordinating multiple molecular processes and in entraining the plant circadian clock. The Arabidopsis mutant lacking the main photoreceptors, however, still shows clock entrainment, indicating that the integration of light into the morning transcriptome is not well understood. In this study, we performed a high-resolution RNA-sequencing time-series experiment, sampling every 2 min beginning at dawn. In parallel experiments, we perturbed temperature, the circadian clock, photoreceptor signaling, and chloroplast-derived light signaling. We used these data to infer a gene network that describes the gene expression dynamics after light stimulus in the morning, and then validated key edges. By sampling time points at high density, we are able to identify three light- and temperature-sensitive bursts of transcription factor activity, one of which lasts for only about 8 min. Phytochrome and cryptochrome mutants cause a delay in the transcriptional bursts at dawn, and completely remove a burst of expression in key photomorphogenesis genes (HY5 and BBX family). Our complete network is available online (http://www-users.york.ac.uk/∼de656/dawnBurst/dawnBurst.html). Taken together, our results show that phytochrome and cryptochrome signaling is required for fine-tuning the dawn transcriptional response to light, but separate pathways can robustly activate much of the program in their absence., (Copyright © 2021 The Author. Published by Elsevier Inc. All rights reserved.)

Purpose: Self-measured blood pressure at home (HBP) is quite important for the management of hypertension. We hypothesized that winter HBP measured according to the recommendation of the guidelines, but not HBP measured inside bed before getting up, is elevated in response to cold ambient temperatures in winter. This study aimed to investigate differences in HBP measured before and after getting up in winter and summer. Methods: Hypertensive subjects whose blood pressure was stably controlled were enrolled ( n  = 46, 73 years). They were instructed to measure HBP while in bed just after waking (HBP-bed), in addition to the ordinary HBP measurement in the morning (HBP-morning) according to the guidelines. The mean value of HBP for 7 consecutive days before the day of a regular hospital visit was considered as the HBP of each subject, and characteristics of the winter and summer BPs were investigated. Results: HBP-morning was significantly higher ( P  < .001) in winter than in summer, but HBP-bed was lower in winter than in summer ( P  < .05). HBP-morning was significantly higher than HBP-bed in winter, while HBP-morning was not different from HBP-bed in summer, resulting in greater changes in HBP after getting up in winter than in summer ( P  < .0001). Changes in HBP after getting up were significantly correlated with serum creatinine levels and the urinary albumin-to-creatinine ratio. Conclusions: These findings imply that elevated HBP-morning in winter reflects the response of BP to cold after getting up. Seasonal profiles of HBPs before and after getting up should be noted in the management of hypertension.

Purpose: Effective antiplatelet therapy can significantly reduce the incidence and mortality rate of cardiovascular and cerebrovascular diseases. Aspirin is widely used in the secondary prevention of cardiovascular and cerebrovascular diseases; however, there is widespread debate as to when patients should take an enteric-coated aspirin tablet on a daily basis. In the present study, we evaluated the efficacy and safety of different aspirin medication times (morning or before bedtime) in terms of the primary and secondary prevention of cardiovascular and cerebrovascular diseases using meta-analysis., Methods: Studies with randomized control trials (RCT) or crossover trials regarding to the usage of aspirin (morning or before bedtime) for the primary or secondary prevention of cardiovascular and cerebrovascular diseases were searched in Medline, EMbase, Cochrane Library, CNKI, Wanfang Data, VIP Database and CBM. Review Manager 5 (RevMan 5, v5.3), a Cochrane systematic reviews software, was used to perform meta-analysis based on the recommendation of the Cochrane Handbook for risk assessment tools., Results: Meta-analysis showed that taking low-dose aspirin tablets before bed reduced systolic and diastolic blood pressure compared with taking it in the morning. At the same time, the number of studies on platelet aggregation rate, C-reactive protein (CRP), serum nitric oxide (NO) or thromboxane B 2 (TXB 2 ) is too small to be reliable. However, there was a large heterogeneity across the studies. The quality of some studies was not high enough., Conclusion: Additional blood pressure benefits can be achieved by taking aspirin before bedtime, but it does not affect its antiplatelet effect and does not pose a higher risk of bleeding.

Background: In Dielmo, Senegal, the widespread use of long-lasting insecticidal nets has decreased both the incidence of malaria and the density of the Anopheles population. However, persistent low-level malaria transmission may hamper efforts to eliminate the disease. Therefore, continuous monitoring of the vector population is needed in order to improve knowledge of Anopheles biting behaviour and to readjust control interventions., Methods: In 2015, Anopheles were collected every month for a whole year and each specimen was identified using morphological and molecular techniques. The biting pattern of each species was analysed according to night (7 pm-7am) and morning (7am-11am) periods, the place of biting and the season. The ELISA CSP technique was used to assess the Plasmodium falciparum sporozoite rate to evaluate the entomological inoculation rate (EIR)., Results: Anopheles arabiensis and Anopheles funestus sensu stricto were found to be the main vectors biting humans. Overall, the biting rate was low, at 3.84bites per night (bpn) and 1.27 bites per morning (bpm), respectively (IRR = 3.04, CI [1.84-5.00], p < 0.001). The EIR was 2.51 and 5.03 infectious bites per year during the night and morning, respectively. During the night, the An. arabiensis and An. funestus biting rate was 1.81 bpn and 1.71 bpn, respectively (IRR = 0.95, CI [0.46-1.92], p = 0.88). During the morning, their density decreased to 0.51 bpm and 0.73 bpm for An. arabiensis and An. funestus, respectively (IRR = 1.47, CI [0.58-3.71], p = 0.41). During the night and the morning, no specific trend of indoor or outdoor biting was observed in the dry and rainy season for both vectors., Conclusion: This study highlighted low level Anopheles nocturnal and diurnal biting and the associated risk of malaria transmission. It showed also the influence of the season on the indoor and outdoor biting pattern, indicating that the human population could be exposed all year round to a low level of Anopheles bites. Control programmes should increase awareness of the use of bed nets throughout the year and promote the development and implementation of complimentary tools to target Anopheles biting shortly after dawn when people are still indoors and outside the bed nets.

Objective: The aim of this study was to examine the effect of carbohydrate restriction in the morning in the framework of a hypocaloric Mediterranean diet on weight loss and metabolic parameters., Methods: Seventy overweight/obese individuals were randomized to two hypocaloric dietary regimens: one Mediterranean diet (Med-D) and one morning carbohydrate-restriction diet (MCR-D). Participants assigned to the MCR-D were permitted to consume a breakfast low in carbohydrate content, whereas typical Mediterranean morning meals were allowed in the Med-D group. Both diets were identical from midday on. Participants were followed over a period of 2 mo., Results: Individuals in both groups achieved significant reductions in body weight, body mass index, waist circumference, and body fat mass. These reductions were more pronounced in the MCR-D than in the Med-D group (all P < 0.001). More participants in the MCR-D group achieved loss of 5% to 10% of body weight by the end of the first month, as well as 5% to 10% and >10% of body weight by the end of the second month (all P < 0.001). All participants achieved loss of ≥5% baseline body weight by the end of the intervention. Both groups achieved similar reductions in fasting serum glucose, glycated hemoglobin, and serum triacylglycerols as well as improvement in insulin sensitivity. Individuals in the Med-D group showed reductions in total and low-density lipoprotein cholesterol, whereas no such effect was observed in the MCR-D group., Conclusions: Integration of morning carbohydrate restriction into a Mediterranean-type hypocaloric diet resulted in greater weight loss while retaining metabolic benefits in glycemia-related parameters., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The acquisition and retention of motor skills is necessary for everyday functioning in the elderly and may be critical in the context of motor rehabilitation. Recent studies indicate that motor training closely followed by sleep may result in better engagement of procedural ("how to") memory consolidation processes in the elderly. Nevertheless, elderly individuals are mostly morning oriented and a common practice is to time rehabilitation programs to morning hours. Here, we tested whether the time-of-day wherein training is afforded (morning, 8-10:30 a.m., or evening, 6-9 p.m.) affects the long-term outcome of a multi-session motor practice program (10 sessions across 3-4 weeks) in healthy elderly participants. Twenty-nine (15 women) older adults (60-75 years) practiced an explicitly instructed five-element key-press sequence by repeatedly generating the sequence "as fast and accurately as possible." The groups did not differ in terms of sleep habits and quality (1-week long actigraphy); all were morning-oriented individuals. All participants gained robustly from the intervention, shortening sequence tapping duration and retaining the gains (> 90%) at 1-month post-intervention, irrespective of the time-of-day of training. However, retesting at 7-months post-intervention showed that the attrition of the training induced gains was more pronounced in the morning trained group compared to the evening group (76 and 56.5% loss in sequence tapping time; 7/14 and 3/14 participants showed a > 5% decline in accuracy relative to end of training, respectively). Altogether, the results show that morning-oriented older adults effectively acquired skill in the performance of a sequence of finger movements, in both morning and evening practice sessions. However, evening training leads to a significant advantage, over morning training, in the long-term retention of the skill. Evening training should be considered an appropriate time window for motor skill learning in older adults, even in individuals with morning chronotype. The results are in line with the notion that motor training preceding a sleep interval may be better consolidated into long-term memory in the elderly, and thus result in lower forgetting rates., (Copyright © 2019 Gal, Gabitov, Maaravi-Hesseg, Karni and Korman.)

Objective: Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Daily Parent Rating of Evening and Morning Behavior Scale, Revised (DPREMB-R) morning score as a measure of morning behaviors impaired by ADHD., Method: We used data from a clinical trial of HLD200 treatment in pediatric participants with ADHD to address our objectives., Results: The DPREMB-R morning score showed significant internal homogeneity, test-retest reliability ( r = .52-.45), and good concurrent validity ( r = .50-.71)., Conclusion: The DPREMB-R morning score could be a useful instrument for assessing treatment efficacy in the morning before school.

Objective: Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Before-School Functioning Questionnaire (BSFQ) as a measure of morning behaviors impaired by ADHD., Method: We used pre-treatment data from a randomized crossover study of 6- to 12-year-old participants comparing the methylphenidate transdermal delivery system (MTS) with a placebo transdermal system (PTS) for a total of 4 weeks., Results: The BSFQ investigator-rated scale shows very good internal homogeneity (Cronbach's α = .91), good test-retest reliability ( r = .60), good concurrent validity ( r range = .42-.86), and a strong treatment effect (effect size = -.93). The self-rated BSFQ showed lower levels of reliability and validity., Conclusion: The investigator-rated BSFQ should be used in future trials of ADHD medications aimed at assessing efficacy in the morning before school.

Background: Patients with chronic obstructive pulmonary disease (COPD) experience symptoms that vary over the day. Symptoms at the start of the day might influence physical activity during the rest of the day. Therefore, physical activity during the course of the day was studied in patients with low and high morning symptom scores., Methods: This cross-sectional observational study included patients with moderate to very severe COPD. Morning symptoms were evaluated with the PRO-morning COPD Symptoms Questionnaire (range 0-60); the median score was used to create two groups (low and high morning symptom scores). Physical activity was examined with an accelerometer. Activity parameters during the night, morning, afternoon and evening were compared between patients with low and high morning symptom scores using independent t-tests or Mann-Whitney U tests., Results: Seventy nine patients were included. Patients were aged (mean ± SD) 65.6 ± 8.8 years with a mean forced expiratory volume in 1 s of 55 ± 17%predicted. Patients with low morning symptom scores (score < 17.0) took more steps in the afternoon (p = 0.015) and morning (p = 0.030). There were no significant differences during the evening and night., Conclusion: Patients with high morning symptom scores took significantly fewer steps in the morning and afternoon than those with low morning symptom scores. Prospective studies are needed to prove causality between morning symptoms and physical activity during different parts of the day.

Objective: Children with attention-deficit/hyperactivity disorder (ADHD) frequently manifest early morning functional (EMF) impairments before school. We conducted a quantitative research survey to assess the impact of these EMF impairments on the family unit (caregiver, spouse/partner, and siblings)., Study Design: We developed an online survey questionnaire to collect data from 300 primary caregivers of children with ADHD and 50 primary caregivers of children who did not have ADHD., Results: Although the ADHD children we surveyed were currently treated with stable doses of stimulants as their primary ADHD medication for at least 3 months, their parents reported high levels of EMF impairments in the child, which had a substantial negative effect on the emotional well-being of parents, on parents' functioning during the early morning routine, and on the level of conflict with siblings. The impact of EMF impairments on family functioning was mediated by the severity of the index child's impairments., Conclusions: EMF impairments exert a pervasive and significantly negative emotional and functional burden on not only the primary caregiver but also on the spouse/partner and siblings. This work suggests that adequate ADHD symptom control during the early morning period may be an unmet need for school-age children with ADHD being treated with stimulants. More work is needed to confirm this finding and determine the degree to which symptom control at other times of day is also an unmet need.

Background: The morning tends to be the most difficult time of day for many patients with chronic obstructive pulmonary disease (COPD) when symptoms can limit one's ability to perform even simple activities. Morning symptoms have been linked to higher levels of work absenteeism, thereby increasing the already substantial economic burden associated with COPD. A validated patient-reported outcome (PRO) instrument designed to capture morning symptoms will allow for a more comprehensive approach to the evaluation of treatment benefit in COPD clinical trials., Methods: A qualitative interview study was conducted among a sample of symptomatic adults with COPD. Concept elicitation interviews (n = 35) were conducted to identify COPD morning symptoms, followed by cognitive interviews (n = 21) to ensure patient comprehension of the items, instructions and response options of the draft COPD Morning Symptom Diary (COPD-MSD). All interview transcript data were coded using ATLAS.ti software for content analysis., Results: Mean age of the concept elicitation and cognitive interview sample was 65.0 years (±7.5) and 62.3 years (±8.3), respectively. The study sample represented the full range of COPD severity (Global Initiative for Chronic Lung Disease [GOLD] classifications I-IV) and included a mix of racial backgrounds, employment status and educational achievement. During the concept elicitation interviews, the three most frequently reported morning symptoms were shortness of breath (n = 35/35; 100 %), phlegm/mucus (n = 31/35; 88.6 %), and cough (n = 30/35; 85.7 %). A group of clinical and instrument development experts convened to review the concept elicitation data and develop the initial 32-item draft COPD-MSD. Cognitive interviews indicated subjects found the draft COPD-MSD to be comprehensive, clear, and easy to understand. The COPD-MSD underwent minor editorial revisions and streamlining based on cognitive interviews and input from the experts to yield the final 19-item daily diary., Conclusions: This study supports the content validity of the new COPD-MSD and positions the diary for quantitative psychometric testing.

Background: Advantageous times for different people are different to some extent, considering the effective physiological changes during the circadian rhythm, in terms of the peak time of physiological activities. The goal of this study is to compare the educational achievement of students, with different morning-evening habits, in completing difficult and easy courses., Materials and Methods: This research is a retrospective descriptive-analytical study, which has been conducted on students of the fifth semester of General Medicine in the Faculty of Medicine, Isfahan University of Medical Sciences. The morning-evening habits of the students were determined by the Horne-Strauss 19-item questionnaire. The students were asked to determine the courses that were 'difficult' and 'easy,' using a researcher-made questionnaire. The students' scores in the considered courses during the five semesters were obtained from the Education Department of the Faculty and analyzed using the descriptive t-test, analysis of variance (ANOVA), and the multivariate regression test in the SPSS software., Results: Sixty-three students (67% girls and 33% boys) participated in this study, of whom 11, 60, and 29% were morning, morning-evening, and evening students, respectively. The mean scores of the difficult courses in all five semesters were reduced in the evening pattern compared to the morning and morning-evening patterns. Reduction of the mean score in the difficult courses, in the evening group, compared with the morning-evening and morning groups was observed in all five semesters among girls, but in three semesters among boys., Conclusion: This study showed that evening students experienced academic failure in difficult courses, which required a more cognitive performance. It is recommended that difficult specialized courses be presented at hours when all student groups have a better cognitive performance.

The extent that neural responsiveness to visual food stimuli is influenced by time of day is not well examined. Using a crossover design, 15 healthy women were scanned using fMRI while presented with low- and high-energy pictures of food, once in the morning (6:30-8:30 am) and once in the evening (5:00-7:00 pm). Diets were identical on both days of the fMRI scans and were verified using weighed food records. Visual analog scales were used to record subjective perception of hunger and preoccupation with food prior to each fMRI scan. Six areas of the brain showed lower activation in the evening to both high- and low-energy foods, including structures in reward pathways (P < 0.05). Nine brain regions showed significantly higher activation for high-energy foods compared to low-energy foods (P < 0.05). High-energy food stimuli tended to produce greater fMRI responses than low-energy food stimuli in specific areas of the brain, regardless of time of day. However, evening scans showed a lower response to both low- and high-energy food pictures in some areas of the brain. Subjectively, participants reported no difference in hunger by time of day (F = 1.84, P = 0.19), but reported they could eat more (F = 4.83, P = 0.04) and were more preoccupied with thoughts of food (F = 5.51, P = 0.03) in the evening compared to the morning. These data underscore the role that time of day may have on neural responses to food stimuli. These results may also have clinical implications for fMRI measurement in order to prevent a time of day bias.

Purpose: To examine the effect of active warm-up duration on short-term maximal performance assessed during Ramadan in the morning., Methods: Twelve healthy active men performed four Wingate tests for measurement of peak power and mean power before and during Ramadan at 09:00 a.m. The tests were performed on separate days, after either a 5-min or a 15-min warm-up. The warm-up consisted in pedaling at 50% of the power output obtained at the last stage of a submaximal multistage cycling test. Oral temperature was measured at rest and after warming-up. Furthermore, ratings of perceived exertion were obtained immediately after the Wingate test., Results: Oral temperature was higher after the 15-min warm-up than the 5-min warm-up throughout the study. Moreover, peak power and mean power were higher after the 15-min warm-up than the 5-min warm-up before Ramadan. However, during Ramadan, there was no significant difference between the two warm-up durations. In addition, ratings of perceived exertion were higher after the 15-min warm-up than the 5-min warm-up only during Ramadan., Conclusions: There is no need to prolong the warm-up period before short-term maximal exercise performed during Ramadan in the morning.

Objective: To evaluate the effects of 2 low-calorie diets but with different distributions of calories throughout the day on weight loss and other major obesity-related metabolic parameters., Methods: We randomly assigned 42 nonsmoking homemakers (age = 46.3 ± 2.3 years, body mass index [BMI] = 35.7 ± 0.8 kg/m(2), mean ± SD) in 2 groups of 21 subjects (G1 and G2). The participants underwent a 3 month individualized Mediterranean-style diet (55% carbohydrate, 30% fat, 15% protein and fiber > 30 g), calorie (600 kcal daily deficit compared to the total energy expenditure measured by a metabolic Holter). Diets consisted of the same food and complied with cardiovascular disease prevention guidelines but differed in the distribution of calories throughout the day (G1: 70% breakfast, morning snack, lunch and 30% afternoon snack and dinner; G2: 55 breakfast, morning snack, lunch and 45% afternoon snack and dinner). Dual-energy X-ray absorptiometry was used for pre- and postintervention body composition assessment., Results: Thirty-six subjects completed the study (G1 = 18, G2 = 18). Both groups had significant improvements in body composition and metabolic parameters but G1 had enhanced results for weight loss (G1: -8.2 ± 3.0 kg; G2: -6.5 ± 3.4 kg; p = 0.028), waist circumference reduction (G1: -7 ± 0.6 cm; G2: -5 ± 0.3 cm; p = 0.033), and fat mass loss (G1: -6.8 ± 2.1 kg, G2: -4.5 ± 2.9 kg, p = 0.031; mean ± SD). Improvements were detected in both groups for blood pressure and blood and lipid parameters. G1 subjects showed a greater improvement in insulin sensitivity measured by homeostasis model assessment-estimated insulin resistance (G1: -1.37 ± 0.27, G2: -0.74 ± 0.12, p = 0.017)., Conclusions: These data suggest that a low-calorie Mediterranean diet with a higher amount of calories in the first part of the day could establish a greater reduction in fat mass and improved insulin sensitivity than a typical daily diet.

Background/aims: Patients with chronic obstructive pulmonary disease (COPD) experience more problematic respiratory symptoms and have more trouble performing daily activities in the morning. The aim of this study was to assess the perception of COPD symptoms related to morning activities in patients with severe airflow limitation., Methods: Data of 133 patients with severe airflow limitation were analyzed in a prospective, non-interventional study. A clinical symptom questionnaire was completed by patients at baseline. In patients having morning symptoms, defined by at least one or more prominent or aggravating symptom during morning activities, a morning activity questionnaire was also completed at baseline and following 2 months of COPD treatment., Results: The most frequently reported COPD symptom was breathlessness (90.8%). Morning symptoms were reported in 76 (57%) patients; these had more frequent and severe clinical COPD symptoms. The most frequently reported morning activity was getting out of bed (82.9%). The long acting muscarinic antagonist (odds ratio [OR], 6.971; 95% confidence interval [CI], 1.317 to 11.905) and chest tightness (OR, 0.075; 95% CI, 0.011 to 0.518) were identified as significantly related to absence of morning symptoms. There was no significant correlation between the degree of forced expiratory volume in 1 second improvement and severity score differences of all items of morning activity after 2-month treatment., Conclusions: Fifty-seven percent of COPD patients with severe airflow limitation have morning symptoms that limit their morning activities. These patients also have more prevalent and severe COPD symptoms. The results of this study therefore provide valuable information for the development of patient-reported outcomes in COPD.