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The period of the year from spring to fall, when clocks in most parts of the United States are set one hour ahead of standard time, is called daylight saving time, and its beginning and ending dates and times are set by federal law. The human biological clock is regulated by the timing of light and darkness, which then dictates sleep and wake rhythms. In daily life, the timing of exposure to light is generally linked to the social clock. When the solar clock is misaligned with the social clock, desynchronization occurs between the internal circadian rhythm and the social clock. The yearly change between standard time and daylight saving time introduces this misalignment, which has been associated with risks to physical and mental health and safety, as well as risks to public health. In 2020, the American Academy of Sleep Medicine (AASM) published a position statement advocating for the elimination of seasonal time changes, suggesting that evidence best supports the adoption of year-round standard time. This updated statement cites new evidence and support for permanent standard time. It is the position of the AASM that the United States should eliminate seasonal time changes in favor of permanent standard time, which aligns best with human circadian biology. Evidence supports the distinct benefits of standard time for health and safety, while also underscoring the potential harms that result from seasonal time changes to and from daylight saving time.

The prothrombin time (PT) and activated partial thromboplastin time (APTT) are screening tests used to detect congenital or acquired bleeding disorders. An unexpected PT and/or APTT prolongation is often evaluated using a mixing test with normal plasma. Failure to correct (\"noncorrection\") prolongation upon mixing is attributed to an inhibitor, whereas \"correction\" points to factor deficiency(ies). To define an optimal method for determining correction or noncorrection of plasma mixing tests through an international, multisite study that used multiple PT and APTT reagents and well-characterized plasma samples. Each testing site was provided 22 abnormal and 25 normal donor plasma samples, and mixing studies were performed using local PT and APTT reagents. Mixing study results were evaluated using 11 different calculation methods to assess the optimal method based on the expected interpretation for factor deficiencies (correction) and noncorrection (inhibitor effect). Misprediction, which represents the failure of a mixing study interpretation method, was assessed. Percentage correction was the most suitable calculation method for interpreting PT mixing test results for nearly all reagents evaluated. Incubated PT mixing tests should not be performed. For APTT mixing tests, percentage correction should be performed, and if the result indicates a factor deficiency, this should be confirmed with the subtraction III calculation where the normal pooled plasma result (run concurrently) is subtracted from the mixing test result with correction indicated by a result of 0 or less. In general, other calculation methods evaluated that performed well in the identification of factor deficiency tended to have high misprediction rates for inhibitors and vice versa. No single method of mixing test result calculation was consistently successful in accurately distinguishing factor deficiencies from inhibitors, with between-reagent and between-site variability also identified.

Combining original historical research with literary analysis, Adam Barrows takes a provocative look at the creation of world standard time in 1884 and rethinks the significance of this remarkable moment in modernism for both the processes of imperialism and for modern literature. As representatives from twenty-four nations argued over adopting the Prime Meridian, and thereby measuring time in relation to Greenwich, England, writers began experimenting with new ways of representing human temporality. Barrows finds this experimentation in works as varied as Victorian adventure novels, high modernist texts, and South Asian novels—including the work of James Joyce, Virginia Woolf, H. Rider Haggard, Bram Stoker, Rudyard Kipling, and Joseph Conrad. Demonstrating the investment of modernist writing in the problems of geopolitics and in the public discourse of time, Barrows argues that it is possible, and productive, to rethink the politics of modernism through the politics of time.

Anticoagulation (AC) is effective in reducing thromboembolic events for individuals with atrial fibrillation (AF) or mechanical heart valve (MHV), but maintaining patients in target range for international normalized ratio (INR) can be difficult. Evidence suggests increasing INR testing frequency can improve time in target range (TTR), but this can be impractical with in-clinic testing. The objective of this study was to test the hypothesis that more frequent patient-self testing (PST) via home monitoring increases TTR. This planned substudy was conducted as part of The Home INR Study, a randomized controlled trial of in-clinic INR testing every 4 weeks versus PST at three different intervals. The setting for this study was 6 VA centers across the United States. 1,029 candidates with AF or MHV were trained and tested for competency using ProTime INR meters; 787 patients were deemed competent and, after second consent, randomized across four arms: high quality AC management (HQACM) in a dedicated clinic, with venous INR testing once every 4 weeks; and telephone monitored PST once every 4 weeks; weekly; and twice weekly. The primary endpoint was TTR at 1-year follow-up. The secondary endpoints were: major bleed, stroke and death, and quality of life. Results showed that TTR increased as testing frequency increased (59.9 ± 16.7 %, 63.3 ± 14.3 %, and 66.8 ± 13.2 % [mean ± SD] for the groups that underwent PST every 4 weeks, weekly and twice weekly, respectively). The proportion of poorly managed patients (i.e., TTR <50 %) was significantly lower for groups that underwent PST versus HQACM, and the proportion decreased as testing frequency increased. Patients and their care providers were unblinded given the nature of PST and HQACM. In conclusion, more frequent PST improved TTR and reduced the proportion of poorly managed patients.

Purpose: This paper proposes model-based standard times estimates, using multiple linear regression, nonlinear optimization, and fuzzy systems in four real cases assembly lines. The work includes a description of the models and a comparison of their performance with values obtained using the conventional chronometer method. These models allow estimating standard times without reconducting field studies. Design/methodology/approach: For the development of the time study, the methodology applied by the International Labour Organization (ILO) was used as a baseline. This methodology is structured in three phases: selection of the case study, registration of the process by direct observation, and calculation/estimation of the standard time. The selected case studies belong to real assembly lines of motorcycles, television sets, printed circuit boards, and bicycles. Findings: In the motorcycle's assembly case, the study allowed constructing seven linear regression models to estimate standard times for assembling the front parts, and seven linear regression models to predict standard times for the rear parts of the different motorcycle types. Compared to the classical chronometer method, the results obtained never exceeded 10%. Regarding the case studies of assembling TV sets and PCBs, the study considered the construction of nonlinear optimization models that allow making appropriate predictions of the standard times in their assembly lines. Finally, for the bicycle assembly line, a fuzzy logic model to represent the standard time was constructed and validated. Research limitations/implications: For reasons of confidentiality of information, this work omitted the names of companies, services, and models of manufactured products. Originality/value: The literature consulted does not refer to the representation of standard time on assembly lines using mathematical models. The construction of these models with empirical data from actual assembly lines was a valuable aid to the companies involved in supporting activity planning.

Background The English National Health Service has multiple waiting time standards relating to cancer diagnosis and treatment. Targets can have unintended effects, such as prioritisation based on targets instead of clinical need. In this case, a `threshold effect’ will appear as a spike in hospitals just meeting the target. Methods We conducted a retrospective study of publicly available cancer waiting time data, including a 2-week wait for a specialist appointment, a 31-day decision to first treatment and a 62-day referral to treatment standard that attracted a financial penalty. We examined the performance of hospital trusts against these targets by financial year to look for threshold effects, using Cattaneo et al. manipulation density test. Results Trust performance against cancer waiting targets declined over time, and this trend accelerated since the start of the Covid-19 pandemic. Statistical evidence of a threshold effect for the 2-week and 31-day standard was only present in a few years. However, there was strong statistical evidence of a threshold effect for the 62-day standard across all financial years ( p  < 0.01). Conclusion The data suggests that the effect of threshold targets alters hospital behaviour at target levels but does not do so equally for all standards. Evidence of threshold effects for the 62-day standard was particularly strong, possibly due to some combination of a smaller volume of eligible patients, a larger penalty, multiple waypoints where hospitals can intervene, baseline performance against the target and where the target is set (i.e. how much headroom is available). RCTs of the use of threshold targets and of different designs for such targets in the future would be extremely informative.

Abstract Daylight saving time (DST) refers to the practice of advancing clock time by 1 h each spring, with a return (setting back) to standard time (ST) each fall. Numerous sleep and circadian societies other than the Sleep Research Society have published statements in support of permanent ST, and permanent ST has also received support from multiple medical societies and organizations. This perspective discusses the positive and negative health and economic consequences of permanent DST, permanent ST, and maintaining the status quo (DST for part of the year). After a thorough review of the existing literature, the SRS advocates the adoption of permanent ST.

To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. Randomised, multicentre clinical trial. Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site. Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's. ACTRN12615000607572 (pilot site); ACTRN12616000618459.

Depositional sequences originating in semi-enclosed basins with endemic biota, partly or completely isolated from the open ocean, frequently do not allow biostratigraphic correlations with the standard geological time scale (GTS). The Miocene stages of the Central Paratethys represent regional chronostratigraphic units that were defined in type sections mostly on the basis of biostratigraphic criteria. The lack of accurate dating makes correlation within and between basins of this area and at global scales difficult. Although new geochronological estimates increasingly constrain the age of stage boundaries in the Paratethys, such estimates can be misleading if they do not account for diachronous boundaries between lithostratigraphic formations and for forward smearing of first appearances of index species (Signor-Lipps effect), and if they are extrapolated to whole basins. Here, we argue that (1) geochronological estimates of stage boundaries need to be based on sections with high completeness and high sediment accumulation rates, and (2) that the boundaries should preferentially correspond to conditions with sufficient marine connectivity between the Paratethys and the open ocean. The differences between the timing of origination of a given species in the source area and timing of its immigration to the Paratethys basins should be minimized during such intervals. Here, we draw attention to the definition of the Central Paratethys regional time scale, its modifications, and its present-day validity. We suggest that the regional time scale should be adjusted so that stage boundaries reflect local and regional geodynamic processes as well as the opening and closing of marine gateways. The role of eustatic sea level changes and geodynamic processes in determining the gateway formation needs to be rigorously evaluated with geochronological data and spatially-explicit biostratigraphic data so that their effects can be disentangled.

Our objective was to maintain low interlaboratory variation and bias in international normalized ratio (INR) results following a network change in instrumentation and reagents, using a process of ongoing standardization and harmonization. Network-wide standardization to new common instrument and reagent platforms followed by network-wide application of a simple novel process of verification of international sensitive index and mean normal prothrombin time values for each new lot of prothrombin time (PT) reagent that does not require use of World Health Organization reference thromboplastin or INR calibration/certified plasma. The network transitioned from mechanical hemostasis detection instruments with associated PT reagent (Diagnostica Stago; NeoPTimal) to optical detection (ACL TOPs) with associated PT reagent (Werfen; RecombiPlasTin 2G). Comparing 3 years of data for each situation, the network (n = 27 laboratories) maintained low INR variability and bias relative to general mechanical and optical groups and other laboratories. Harmonized support for patient management of vitamin K antagonists such as warfarin was continuously maintained in our geography, with potentially positive implications for other coagulation laboratories and geographies. For the United States in particular, paucity of US Food and Drug Administration-cleared INR certified plasmas potentially compromises INR test accuracy; our novel approach may provide workable alternatives for other laboratories/networks.