Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial.

BACKGROUND: The optimal time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer is unknown and has traditionally been 4-6 weeks in clinical practice. Observational studies have suggested better outcomes, especially in terms of histological response, after prolonged delay of up to 3 months after nCRT. The NeoRes II trial is the first randomised trial to compare standard to prolonged TTS after nCRT for oesophageal cancer. PATIENTS AND METHODS: Patients with resectable, locally advanced oesophageal cancer were randomly assigned to standard delay of surgery of 4-6 weeks or prolonged delay of 10-12 weeks after nCRT. The primary endpoint was complete histological response of the primary tumour in patients with adenocarcinoma (AC). Secondary endpoints included histological tumour response, resection margins, overall and progression-free survival in all patients and stratified by histologic type. RESULTS: Between February 2015 and March 2019, 249 patients from 10 participating centres in Sweden, Norway and Germany were randomised: 125 to standard and 124 to prolonged TTS. There was no significant difference in complete histological response between AC patients allocated to standard (21%) compared to prolonged (26%) TTS (P = 0.429). Tumour regression, resection margins and number of resected lymph nodes, total and metastatic, did not differ between the allocated interventions. The first quartile overall survival in patients allocated to standard TTS was 26.5 months compared to 14.2 months after prolonged TTS (P = 0.003) and the overall risk of death during follow-up was 35% higher after prolonged delay (hazard ratio 1.35, 95% confidence interval 0.94-1.95, P = 0.107). CONCLUSION: Prolonged TTS did not improve histological complete response or other pathological endpoints, while there was a strong trend towards worse survival, suggesting caution in routinely delaying surgery for >6 weeks after nCRT.

Taking to "heart" the proposed legislation for permanent daylight saving time.

In March 2022, the US Senate passed the Sunshine Protection Act that would abolish the biannual change in clocks each fall and spring and permanently adopt daylight saving time that aligns with the "spring forward" time change each March. A number of scientific and medical societies have endorsed the abolishment of the biannual clock change, but oppose the permanent adoption of daylight saving time. Instead, leading organizations such as the American Academy of Sleep Medicine (AASM) and the Society for Research on Biological Rhythms (SRBR) position statements highlight peer-reviewed evidence in favor of a permanent shift to standard time. The present perspectives will summarize some of the key AASM and SRBR recommendations, with a particular focus on the potential cardiovascular implications of a legislative change that would result in a permanent switch to either standard time or daylight saving time. Collectively, although there is building scientific consensus that abolishing the biannual time change has several sleep and circadian health benefits, the preponderance of evidence is opposite to the current legislation and instead suggests a permanent switch to standard time may offer the maximum health and safety benefits. This scientific evidence should be considered as the United States House of Representatives considers the Sunshine Protection Act.

[On the issue of normative legal regulation of the work of a doctor in a dental office of a multidisciplinary hospital]. / K voprosu normativnogo pravovogo regulirovaniya truda vracha stomatologicheskogo kabineta mnogoprofil'noi bol'nitsy.

OBJECTIVE: The purpose of the study is to investigate the existing normative legal documents governing the activities of doctors specializing in «dentistry¼, providing medical care in a multidisciplinary hospital. MATERIAL AND METHODS: The normative legal coverage of medical workers' activities on delivering dental care for adult population with infectious diseases in stationary conditions for a thirty-year period was analyzed. The research and information method and content analysis were used. RESULTS: The existing regulatory legal framework governing the activities of medical workers does not contain time standards for one patient who is on inpatient treatment to visit doctors specializing in «dentistry¼ in a multidisciplinary hospital, which does not correspond with modern requirements and does not allow determining the workload norms and standard numbers of these specialists. CONCLUSION: Despite the presented modern possibilities of introducing the latest technologies and intensifying the activities of doctors specializing in «dentistry¼ on an outpatient basis, the organization of medical care and the delivering of dental services in a hospital including to infectious patients require further improvement.

Validation of standard times and influencing factors during the development of the Workload Indicator for Nursing.

BACKGROUND: A tool to assist in optimal allocation of available nursing resources is of paramount importance. AIMS: The goals of this study were as follows: (1) to determine whether the standard time values of the Belgian Nursing Minimum Dataset are a valid basis for the development of a Workload Indicator for Nursing; (2) to quantify the impact of factors that most influence nursing workload; and (3) to examine the cross-impact of items of the Belgian Nursing Minimum Dataset. DESIGN: This research project is a prospective observational study with exploratory aspects. METHODS: The data for this prospective study were collected during September 2010 from a convenience sample of 23 nursing units in four hospitals in Belgium. The data collection included three parts: (1) the registration of the items of the Belgian Nursing Minimum Dataset; (2) the amount of time committed to direct patient care; and (3) analysis of variables, which influence the nursing workload at patient and unit level. RESULTS: The correlation coefficients for the sum of Direct and Indirect Patient Care and the Workload Indicator for Nursing-score of the surgical, internal medicine and intensive care units were 0·85, 0·88 and 0·89 respectively. Significant differences in standard time utilization for nursing activities at the patient level are directly related to the level of mobility assistance required. Units needing significantly more time for Direct and Indirect Patient Care than predicted by the Workload Indicator for Nursing-score had a higher mean number of complex nursing activities per patient. CONCLUSIONS: The high correlation coefficients between the total time utilized for direct patient care and the WiN-score indicate that the standard time values of the Belgian Nursing Minimum Dataset are valid.

Permanent standard time is the optimal choice for health and safety: an American Academy of Sleep Medicine position statement.

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. CITATION: Rishi MA, Cheng JY, Strang AR, et al. Permanent standard time is the optimal choice for health and safety: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2024;20(1):121-125.

A Data-Informed Perspective on Public Preferences for Retaining or Abolishing Biannual Clock Changes.

Scientific, public, and political discourse around the perennial changing of the clocks during the transitions into and out of daylight saving time (DST) is a touchstone issue for the translation of fundamental chronobiology into societal impacts. The Society for Research on Biological Rhythms, along with other sleep science bodies, has issued a position statement that advocates for the abolition of the biannual clock changes and the adoption of permanent standard time for the optimization of population circadian health. However, there is a paucity of data on preexisting public perceptions and preferences with regard to these issues. In this perspective, we examine 5 issues that we believe are pertinent for chronobiologists to consider to enable effective advocacy on these policies; in particular, we discuss public preference for permanent DST and steps that may need to be taken to understand this preference. We inform our discussion with reference to cross-sectional studies we undertook in Spring 2020 and Fall 2019, around the transition out of and into DST Ireland. We conclude that there appears to be a gap between existing public perceptions and preferences around the clock changes and chronobiological and sleep science-informed positions, and that the chronobiology community may benefit from interdisciplinary collaboration with colleagues with specific social sciences expertise to most effectively advocate for these research-informed positions.

Longitudinal Location Influences Preference for Daylight Saving Time.

The chronobiology community advocates ending the biannual practice in many countries of adjusting their clocks to observe Daylight Saving Time (DST). Many governments are actively considering abandoning this practice. While sleep and circadian experts advocate the adoption of year-round standard time, most jurisdictions are instead considering permanent DST. In guiding advocacy, it is useful to understand the factors that lead governments and citizens to prefer the various options. In October 2021, the Canadian province of Alberta conducted a province-wide referendum on adopting year-round DST, in which more than 1 million valid votes were cast. As this referendum was tied to province-wide municipal elections, the results of the referendum were reported at the community level, allowing a geospatial analysis of preference for permanent DST. While the referendum proposal was narrowly defeated (49.8% in favor), a community-level analysis demonstrated a significant East-West gradient, with eastern communities more strongly in favor and western communities more strongly opposed to the year-round DST. Community size and latitudinal position also contributed to preference, with smaller and more northern communities showing more preference for year-round DST. These findings help identify how geospatial location can influence how citizens feel about the various time options and can further help guide public advocacy efforts by the sleep and circadian communities.

It is time to abolish the clock change and adopt permanent standard time in the United States: a Sleep Research Society position statement.

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.

Traffic crash changes following transitions between daylight saving time and standard time in the United States: New evidence for public policy making.

INTRODUCTION: This study examined the impact of daylight saving time changes on traffic crashes in the United States. Using a data-driven regression analysis approach, the study analyzed 2014-2016 crash data from six states spanning all four major time zones in the contiguous United States. METHOD: The researchers developed regression models for a number of analysis scenarios and by days of week separately. Based on the crash data, the team used an eight-week impact period for the spring time change and a four-week impact period for the fall time change. RESULTS: The regression analysis showed that the spring time change was followed by an overall crash reduction of 18% during the eight-week period immediately after the time change, with a considerably higher crash reduction for freeway crashes (24%), rural crashes (24%), or non-intersection crashes (21%). The time change back to SDT in fall was followed by a 6% overall crash increase during the following four weeks, with considerably higher increases for freeway crashes (15%), non-intersection crashes (9%), nighttime crashes (28%), single-vehicle crashes (28%), and crashes in urban areas (12%). This study provides additional insights, including in many cases more comprehensive knowledge on how the changes to and from DST each year affect roadway traffic crashes. PRACTICAL APPLICATIONS: The findings of this project further add to the current understanding on how the time changes affect public health in the form of traffic crashes. They also serve as additional evidence for public policy makers to better weigh the benefits and impacts associated with the time changes in the United States for relevant policy makings.

A chronobiological evaluation of the risks of canceling daylight saving time.

The long-term impact of seasonal regulation of clocks (Daylight Saving Time) is analyzed showing that it helped to mitigate the advance of the phase of human activity during the twentieth century and the exposure to the hours of the dawn in winter. The increased risks induced by circadian misalignment around transition dates are balanced by a better alignment of social clocks to the natural day in summer and in winter.

Researchers in cardiology - Why and how to get on Twitter?

Social media (SoMe) for professional use has gained importance for scientific impact. In cardiology, Twitter is among the preferred SoMe platforms for scientific dissemination. We are in the middle of a paradigm shift within scientific dissemination as more scientific content is presented on Twitter, and it is crucial to embrace it. Therefore, this paper includes a description and discussion of the existing literature reporting the impact of Twitter on research dissemination, as well as a guide on how to get started. In addition, we describe a case of the Danish Cardiovascular Academy Summer Meeting 2021 as an example of a scientific event that was promoted on Twitter before, during and after the event and present a survey showing that participants were inspired to increase the use of SoMe professionally. Finally, the paper addresses limitations of Twitter and SoMe for scientific use and discuss a need for an increased evidence base.

Daylight Saving Time: Pros and Cons.

The original rationale for the adoption of daylight saving time (DST) was to conserve energy; however, the effects of DST on energy consumption are questionable or negligible. Conversely, there is substantial evidence that DST transitions have the cumulative effect on sleep deprivation with its adverse health effects. In light of current evidence, the European Commission in 2018 decided that biannual clock change in Europe would be abolished. Current indirect evidence supports the adoption of perennial standard time, which aligns best with the human circadian system and has the potential to produce benefits for public health and safety.

Perspective: Daylight Saving Time-An Advocacy for a Balanced View and against Fanning Fear.

As experts, scientists must inform the public and political actors about relevant topics by providing a well-balanced analysis and overview of existing as well as missing scientific evidence. Particularly in cases where evidence is not solid, they must remain objective and not fan fear. Maintaining good scientific practice can be challenging, especially when a debate is emotionally charged and simple answers for complex issues are demanded. Recently, this was the case with the debate about (perennial) standard time vs. daylight saving time. In this publication, we address the common misconceptions and pitfalls for good scientific practice that accompany this discussion and deduce suggestions for future directions, which may help resolve them. Beyond this, we argue that it is not wise to simply "explain away" the public opinion or preference and we therefore recommend strategies that could support a discourse aiming at getting the public "on board". Finally, we suggest that, in societies where the light environment is becoming increasingly complex, it may be time to reconsider the prevailing current relationships between solar and social clocks.

The effects of age to meet the standard production rate.

BACKGROUND: This study evaluated the energy expenditure of workers in physical work tasks in order to determine if people of different ages and gender carry out repetitive activities according to the recommended limits of energy at work. OBJECTIVE: Exploring whether age is a significant factor to achieve industrial production rates and determine its possible consequences. METHODS: A laboratory experiment was conducted with people age 20 to 58 years split by gender into four age groups. Oxygen consumption and heart rate were measured as variables of response to the physical workloads. RESULTS: When carrying out repetitive moderate load operations, women aged over 30 years exceeded the recommended energy expenditure (95% CI). For heavy activities, only men in the age groups 20-39 and 30-40 years could perform these tasks without exceeding the recommended oxygen consumption (95% CI). CONCLUSIONS: The industrial predetermined motion time systems do not take into account the effects of age and gender difference on energy production when obtaining cycle times in activities with significant aerobic loads. Manufacturing processes have specific standard times that might be inappropriate if they are performed by individuals who do not meet the standard energy production capacity.

Melatonin ameliorates chronic mild stress induced behavioral dysfunctions in mice.

Melatonin, a neurohormone, is known to regulate several physiological functions, especially the circadian homeostasis, mood and behavior. Chronic exposure to stress is involved in the etiology of human affective disorders, and depressed patients have been reported to show changes in the circadian rhythms and nocturnal melatonin concentration. The present study was conducted to evaluate a possible beneficial action of chronic night-time melatonin treatment against chronic mild stress (CMS) induced behavioral impairments. As expected in the present study, the stress exposed mice showed reduced weight gain, hedonic deficit, cognitive deficits and decreased mobility in behavioral despair test. Interestingly, CMS exposed mice showed less anxiety. Chronic night-time melatonin administration significantly ameliorated the stress-induced behavioral disturbances, especially the cognitive dysfunction and depressive phenotypes. In conclusion, the present findings suggest the mitigating role of melatonin against CMS-induced behavioral changes, including the cognitive dysfunctions and reaffirm its potential role as an antidepressant.

Application strategy of standard time management in hospital logistics / 中华医院管理杂志

The standardized management strategy is put into practice of hospital logistics. The standard time management as used in sample delivery service, is cited as an example for analysis of the rationality and efficiency of standard operating practice in hospital logistic services. The purpose is to identify causes of lost operation time and the countermeasures,thus improving working efficiency,performance-based management method,and scoring better operating performance and standard operation process reengineering.

Identifying standard time and demands on doctors for clinical departments at Health Central of Thanh Oai district, Ha Tay province

A qualitative study on health workers, pharmacists working at Health Center of Thanh Oai district, Ha Tay province to identify standard time and needs about doctors for this center in 2005. The highest need was that having doctors working at examination department (50%), surgery department (74%), tuberculosis - infectious disease department (81%), pediatric department - emergency and intensive care department (90%). The number of doctors at internal medicine department, traditional medicine department, imaging diagnosis department exceeded the need from 17-142%