443:. While keeping the ACGME's recommendations of an 80-hour work week averaged over 4 weeks, the IOM report recommends that duty hours should not exceed 16 hours per shift for interns (PGY 1). The IOM also recommended strategic napping between the hours of 10pm and 8am for shifts lasting up to 30 hours. The ACGME officially recommended strategic napping between the hours of 10pm and 8am on 30-hour shifts for residents who are post graduate year 2 and above but did not make this a requirement for program compliance. The report also suggests residents be given variable off-duty periods between shifts, based on the timing and duration of the shift, to allow residents to catch up on sleep each day and make up for chronic sleep deprivation on days off.
447:
trial conducted from July 2014 to June 2015 in 117 general surgery residency programs. In the
Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, programs were randomly assigned to a group following current ACGME duty-hour restrictions or a group with more flexible policies that waived rules on maximum shift lengths and time off between shifts. When looking at primary outcomes of 30-day rate of postoperative death or serious complications, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications. Starting July 1, 2017, the ACGME raised the maximum number of consecutive hours a first year resident can work from 16 hours to 24 hours.
214:, and low birth weight of their newborns. It has also been shown that slow-wave sleep assists in clearing out toxins that build up during the day. Consequently, the disruption of slow-wave sleep increases the level of amyloid-beta, a protein aggregate commonly found in Alzheimer's, present in cerebrospinal fluid the following morning. Chronic sleep deprivation and the resulting fatigue and stress can affect job productivity and the incidence of workplace accidents. There are also social effects. Married fathers in the United States who work fixed night shifts are 6 times more likely than their counterparts who work days to face divorce; for married mothers, fixed nights increase the odds by a factor of 3.
463:, in which an 18-year-old college student died of a drug interaction after being treated by a fatigued intern and resident in a New York hospital, led to the establishment of the Bell Commission in 1987 to address physician training hours. Although the serotonin syndrome was not widely known at the time (neither by the house staff nor the attending physician), the Bell Commission continued to address the house officer sleep deprivation issue. Its recommendations were adopted by the state of New York in 1989, and limited residents to no more than 24 consecutive hours in the hospital, and no more than 80 hours a week with an in-house supervising attending physician present at all times.
254:
Pennsylvania, which will end in 2019, assigned residents in 32 medical training programs to shifts as long as 30 hours. It used 31 other programs as a control group. Despite the longer shifts, the other overall rules were still adhered to. The other study, led by
Northwestern University and ending in 2015, was similar in design. Both were conducted with the approval of the ACGME. In neither study were residents and patients necessarily told they were part of a human subjects experiment and informed consent was not required, which caused some controversy.
234:. Chronically sleep-deprived people also tend to strongly underestimate their degree of impairment. A study found that after 24 hours of sustained wakefulness, hand-eye coordination decreased to a level equal to the performance observed at a blood alcohol concentration of roughly 0.10%. In a meta-analysis of 959 physicians, staying awake for a continuous 24 to 30 hours decreased physicians' overall performance by nearly 1 standard deviation and clinical performance by more than 1.5 standard deviations.
333:
interrupted continuity of care and increased errors. Also, most studies show that residents see more patients now, despite having less time, leading to more administrative work and less time for direct patient care and education. One systematic review found that resident learning has been unfavorably impacted by duty hour regulations, and because medical education affects knowledge and competence, this may result in poor decision-making and medical errors.
325:
under-report duty hours exists for a few important reasons: One is that statutes do not provide whistleblower protections to residents who report work hour violations. Second, the penalty for work hour violation is loss of accreditation, which would adversely affect medical residents and prevent them from becoming board certified. Finally, some residents may be pressured by their residency programs to underreport hours or even punished if they do not.
25:
101:
show that about 40% of this work is not direct patient care, but ancillary care, such as paperwork. Trainee doctors are often not paid on an hourly basis, but on a fixed salary; in some locations, they are paid for booked overtime. Limits on working hours have led to misreporting, where the resident works more hours than they record.
242:
simulation when working on the night shift than the day shift. First year medical residents given an EKG arrhythmia-detection task performed significantly worse while sleep-deprived than when well-rested. Medical residents were also found to take more time and make more errors on laparoscopic procedures after one night on call.
480:(OSHA) rejected a petition seeking to restrict medical resident work hours, opting to rely on standards adopted by ACGME, a private trade association that represents and accredits residency programs. On July 1, 2003, the ACGME instituted duty hours requirements for all accredited residency programs, since revised in 2011.
1591:
Ahmed, Najma; Devitt, Katharine S.; Keshet, Itay; Spicer, Jonathan; Imrie, Kevin; Feldman, Liane; Cools-Lartigue, Jonathan; Kayssi, Ahmed; Lipsman, Nir; Elmi, Maryam; Kulkarni, Abhaya V.; Parshuram, Chris; Mainprize, Todd; Warren, Richard J.; Fata, Paola; Gorman, M. Sean; Feinberg, Stan; Rutka, James
555:
Although strategic napping is recommended by the ACGME, no studies have assessed the effect of napping as a fatigue mitigation technique. Requiring naps during long shifts could be a small step toward reducing fatigue and potentially decreasing errors. Resident surveys suggest that a greater emphasis
546:
There are still inherent problems with the current ACGME policy. Resident duty hour restrictions are difficult to assess and enforce. Also, it is unclear who is ultimately responsible for monitoring duty hour adherence (i.e. state licensing boards, residency programs, attendings, residents, etc.).
542:
Another related issue regarding the imposition of maximum hour policies for medical residents is the question of enforcement, where some enforcement proposals have included extending U.S. federal whistle-blower protection to medical residents in order to ensure compliance and afford medical residents
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The trainee shall not work in excess of 24 consecutive hours inclusive of morning and noon educational programs. Allowances for inpatient and outpatient continuity, transfer of care, educational debriefing and formal didactic activities may occur, but may not exceed 6 hours. Residents may not assume
446:
Though the ACGME regulations were intended to increase medical resident sleep hours and improve patient safety, they had also created unintended negative consequences in the education of new residents and the workplace learning culture. In 2017, the ACGME changed its regulations once again, citing a
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The
Accreditation Council for Graduate Medical Education (ACGME) has limited the number of work-hours to 80 hours weekly, overnight call frequency to no more than one in three, 30-hour maximum straight shifts, and at least 10 hours off between shifts. While these limits are voluntary, adherence has
364:
Where there is a shortage of doctors, proposed solutions include reducing the costs of medical training and more extensive training for nurses, who then take over duties formerly done by doctors. Improving the working conditions of doctors might also increase recruitment and decrease burnout leading
245:
A 2004 landmark study found reducing sleep deprivation substantially reduced errors in intensive care units. The study redesigned first-year junior doctors' schedules to minimize the effects of sleep deprivation, circadian disruption, and handover problems, assigning four shifts where there had been
162:
There are financial incentives for overworking junior doctors. Since the least-experienced staff are usually paid less, it is cheaper to assign paid overtime to them. Deliberate understaffing and paid or unpaid overtime for junior doctors is thus used to reduce costs for medical facilities, although
144:, meaning residents must accept all conditions of employment, including very long work hours, and that they must also, in many cases, contend with poor supervision. This process, they contend, reduces the competitive pressures on hospitals, resulting in low salaries and long, unsafe work hours. The
241:
Many studies have found performance impairment in medical residents due to sleep deprivation. The average sleep time was less for the same emergency department residents working night shifts than when working day shifts, and they took longer to intubate a mannequin and made more errors in a triage
332:
Duty hour regulations may not address the root causes of medical errors, and may inadvertently create new problems that impact patient outcomes. In order to adhere to duty-hour standards, residents must handoff their patients to other residents more frequently, which can lead to miscommunication,
271:
Many of the studies rely on self-reported hours, self-reported errors, and self-reported sleep deprivation, with large opportunities for bias. More objective measures, such as tracking, perceptual tests, and blood hormone levels, are generally not used. Measurements of patient deaths and harm are
126:
estimated that globally in 2016, more than 745,000 persons died as a result of having a heart disease event or a stroke attributable to having worked long hours (here defined as 55 or more hours per week), making exposure to long working hours the occupational risk factor with the largest disease
100:
in the United States of
America, residents are allowed to work a maximum of 80 hours a week averaged over a 4-week period. Residents work 40–80 hours a week depending on specialty and rotation within the specialty, with residents occasionally logging 136 (out of 168) hours in a week. Some studies
534:
The trainee and training institution must always remember the patient care responsibility is not precluded by the work hour policy. In cases where a trainee is engaged in patient responsibility which cannot be interrupted, additional coverage should be provided as soon as possible to relieve the
237:
Competence is affected by the number of work hours, number of continuous work hours, regularity of sleep, and frequency and speed of handovers to the next shift. "Night float" seems to have particularly bad effects, due to the circadian misalignment cause by abrupt switches between day and night
351:
anti-trust case sought more freedom for medical residents to negotiate working conditions. In order to obtain accreditation as doctors, American medical residents are required to enter into a contract to accept whatever residency position they are assigned; they are then matched to a job by the
450:
Despite the sleep deprivation medical residents constantly experience due to long working hours, a minority of residents still wish to not have work hour regulations at all. In the survey of 4510 obstetric-gynecologic residents, about one in five opposed any limits on their work hours. These
406:
However, junior doctors may choose to work more than 48 hours a week, or opt out of the EWTD entirely by signing a waiver with the employer. They may not be punished for not working more than the directed hours. Many trainees nonetheless feel obliged to work longer hours. The rest times are
324:
It is largely felt that actual duty hours (opposed to reported duty hours) have not changed substantially: prior to the implementation of work hour regulations, residents were already working an average of 82 hours per week. Many studies rely on self-reported hours, but significant bias to
253:
In 2015 two controlled studies of the effect of the ACGME-mandated maximum shift began, involving nearly 190 hospitals and residency training programs. The studies randomly assigned medical residents to shifts longer than specified by the ACGME regulations. A study led by the
University of
2602:
Bilimoria, Karl Y.; Chung, Jeanette W.; Hedges, Larry V.; Dahlke, Allison R.; Love, Remi; Cohen, Mark E.; Hoyt, David B.; Yang, Anthony D.; Tarpley, John L.; Mellinger, John D.; Mahvi, David M.; Kelz, Rachel R.; Ko, Clifford Y.; Odell, David D.; Stulberg, Jonah J.; Lewis, Frank R. (2016).
341:
The most commonly proposed method is regulation of working hours, but this is ineffective if regulations are ignored. Whistle-blower protection laws, protecting residents who report violations of working-hour regulations from losing their residencies and thus their route to professional
356:
and told what the working conditions and pay are. The plaintiffs allege that this is an anti-competitive practice, and that the defendants artificially limit the number of resident positions available. The suit had some early success, but failed when the U.S. Congress enacted the
294:
Another systematic review of 27 studies conducted in 2015 found similar results, and a 2007 study of over 8 million hospital admissions of
Medicare beneficiaries that compared mortality rate before and after implementation of the ACGME standards showed no difference in mortality.
427:
capped the work-week at 80 hours. As of 2018, shifts are capped (with limited exceptions) at a maximum of 24 consecutive hours of direct patient care with an additional 4 hours for transition of care (sign out, completing notes, etc.) for first, second, and third year residents.
1685:
Volpp, Kevin G.; Rosen, Amy K.; Rosenbaum, Paul R.; Romano, Patrick S.; Even-Shoshan, Orit; Canamucio, Anne; Bellini, Lisa; Behringer, Tiffany; Silber, Jeffrey H. (2007). "Mortality Among
Patients in VA Hospitals in the First 2 Years Following ACGME Resident Duty Hour Reform".
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Moreover, these studies – particularly the ones that find favorable results - may fail to account for confounders that positively impact outcomes, including the wide adoption of electronic medical records, a shift toward team-based care, and implementation of best practices.
267:
Regulatory duty hour restrictions, in theory, should reduce the number of duty hours worked. In practice, they may not because the restrictions are not always followed. Studies to evaluate the effects of duty hour restrictions on patient outcomes have been somewhat mixed.
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The medical culture has also been blamed. "Generation-bashing", where senior doctors look down on junior doctors who work fewer residency hours than they did, can push junior doctors to overwork. A desire for formal recognition, such as promotion, may also be important. A
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on education, decreased workload, and more ancillary support would better improve patient outcomes. Focusing on hospital best practices and physician incentives like pay-for-performance in residency could help with the implementation of some of these solutions.
803:"Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury"
135:
Medical residencies usually require lengthy hours of trainees. Trainees are traditionally required to be present for set shifts, with the ending time of the shift dependent on momentary circumstances. The flexibility of this system makes it easy to abuse.
315:
When surveyed about duty hour restrictions, both medical and surgical residents, as well as residency faculty perceive that patient safety hasn't changed or has suffered as a result. Additionally, many residents note an increase in self-reported errors.
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Upon conclusion of a 24-hour duty shift, trainees shall have a minimum of 10 hours off before being required to be on duty again. Upon completing a lesser hour duty period, adequate time for rest and personal activity must be
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three and allowing an hour's overlap for handovers at the ends of shifts. Each junior doctor was closely observed under both schedules. Errors were recorded (and corrected); they were then rated for severity by other doctors
559:
Techniques to reduce circadian misalignment include avoiding abrupt changes in shift time, getting more sleep, which makes the sleep schedule more flexible, and the use of caffeine and ambient light of specific wavelengths.
174:
There is also a belief that long hours do, or can, improve training. The ability to follow a patient from admission through the next 30 or 40 hours may be valued more than observing several patients for shorter periods.
1539:
1323:
Landrigan, Christopher P.; Rothschild, Jeffrey M.; Cronin, John W.; Kaushal, Rainu; Burdick, Elisabeth; Katz, Joel T.; Lilly, Craig M.; Stone, Peter H.; Lockley, Steven W.; Bates, David W.; Czeisler, Charles A. (2004).
139:
Junior doctors often lack bargaining power and have difficulty changing employers. This leaves them with little say over their working conditions. Critics of long residency hours note that resident physicians in the US
1001:
Ju, Yo-El S.; Ooms, Sharon J.; Sutphen, Courtney; MacAuley, Shannon L.; Zangrilli, Margaret A.; Jerome, Gina; Fagan, Anne M.; Mignot, Emmanuel; Zempel, John M.; Claassen, Jurgen A.H.R.; Holtzman, David M. (2017).
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Another study found that the 2003 ACGME reform restrictions were associated with a small reduction in the relative risk for death in 1,268,738 non-surgical patients drawn from a national survey of hospitals.
2297:
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One 2014 systematic review of 135 studies spanning 1980 to 2013 showed no overall improvement in patient safety but still indicated that duty hour restrictions have increased morbidity in some cases.
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In emergencies and in chronically understaffed health systems, all staff, including junior doctors, may be overworked. In some cases, excess work may be disproportionately assigned to junior doctors.
104:
Medical resident work hours have become a hot topic of discussion due to the potential negative results of sleep deprivation on both residents and their patients. According to a study of 4,510
2150:
Hundert, S. A.; White, A. A.; Reilly, D. F. (2015). "Number of
General Medicine Hospital Admissions Performed by Internal Medicine Residents Before and After the 2011 Duty-Hour Regulations".
1091:"The Cumulative Cost of Additional Wakefulness: Dose-Response Effects on Neurobehavioral Functions and Sleep Physiology from Chronic Sleep Restriction and Total Sleep Deprivation"
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often used as response variables. Many of the studies that have been done on this topic are specialty specific and so cannot be generalized to all medical residency programs.
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Sen, Srijan; Kranzler, Henry R.; Didwania, Aashish K.; Schwartz, Ann C.; Amarnath, Sudha; Kolars, Joseph C.; Dalack, Gregory W.; Nichols, Breck; Guille, Constance (2013).
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One study of 318,636 patients done in a
Veterans Administration setting showed that work hour restrictions reduced mortality substantially for a similar set of diagnoses.
969:
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Curtis, Stuart H.; Miller, Robert H.; Weng, Cindy; Gurgel, Richard K. (2014). "The Effect of Duty Hour
Regulation on Resident Surgical Case Volume in Otolaryngology".
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residents cited "additional experience" as the most common reason (69.0%), followed by "opportunity to see rare cases" (46.5%) and "continuity with patients" (31.8%).
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allowed many studies comparing patient outcomes before and after the reforms. They generally show little effect. This corresponds to the impressions of medical staff.
149:
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In a survey of 3,604 first- and second-year residents, 20% reported sleeping an average of 5 hours or less per night, and 66% averaged 6 hours or less per night.
35:
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Smith-Coggins, Rebecca; Rosekind, Mark R.; Hurd, Stacy; Buccino, Kenneth R. (1994). "Relationship of day versus night sleep to physician performance and mood".
477:
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The trainee shall not be assigned to work physically on duty in excess of 80 hours per week averaged over a 4-week period, inclusive of in-house night call.
1644:; Rosen, Amy K.; Rosenbaum, Paul R.; Romano, Patrick S.; Even-Shoshan, Orit; Wang, Yanli; Bellini, Lisa; Behringer, Tiffany; Silber, Jeffrey H. (2007).
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Research from Europe and the United States on nonstandard work hours and sleep deprivation found that late-hour workers are subject to higher risks of
473:, has called for re-evaluation of the residency training process, declaring "We need to take a look again at the issue of why is the resident there."
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Taffinder, NJ; McManus, IC; Gul, Y.; Russell, RCG; Darzi, A. (1998). "Effect of sleep deprivation on surgeons' dexterity on laparoscopy simulator".
353:
632:
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Cavallo, Anita; Ris, M. Douglas; Succop, Paul (2003). "The night float paradigm to decrease sleep deprivation: good solution or a new problem?".
864:
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Increasing the bargaining power of residents has been proposed, on the argument that they would then choose the best training programs. The 2002
1594:"A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery: Impact on Resident Wellness, Training, and Patient Outcomes"
1225:"The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review"
466:
Though other federal regulatory and legislative attempts to limit medical resident work hours have materialized, none have attained passage.
2556:
Asch, David A.; Bilimoria, Karl Y.; Desai, Sanjay V. (2017). "Resident Duty Hours and Medical Education Policy — Raising the Evidence Bar".
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Pega, Frank; Nafradi, Balint; Momen, Natalie; Ujita, Yuka; Streicher, Kai; Prüss-Üstün, Annette; Technical Advisory Group (September 2021).
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The trainee shall have on alternate weeks 48-hour periods off, or at least one 24-hour period off each week, averaged over a 4-week period.
606:
145:
141:
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Wilkey, Robert Neil (2003). "Federal Whistleblower Protection: A Means to Enforcing Maximum-Hour Legislation for Medical Residents".
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U.S. Congress Office of Technology Assessment (September 1991). "Chapter 8: Case Study: Registered Nurses and Resident Physicians".
123:
69:
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Thomas J. Nasca; Susan H. Day; E. Stephen Amis (July 8, 2010). "The New Recommendations on Duty Hours from the ACGME Task Force".
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Shetty, Kanaka D.; Bhattacharya, Jayanta (2007). "Changes in Hospital Mortality Associated with Residency Work-Hour Regulations".
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Rotations in which trainee is assigned to Emergency Department duty shall ensure that trainees work no longer than 12-hour shifts.
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Additionally, a one-size-fits all solution may not be ideal, since the need for certain duty hours may vary among specialties.
383:
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2746:"Accreditation Document for Postdoctoral Training Institutions and the Basic Document for Postdoctoral Training Programs"
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The trainee may not be assigned to call more often than every third night averaged over any consecutive four-week period.
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to which treatment the errors had occurred under. Doctors and observers inevitably knew that they were part of a study.
762:"Sleep Deprivation and Fatigue in Residency Training: Results of a National Survey of First- and Second-Year Residents"
419:, where federal regulations did not limit the number of hours that can be assigned during a graduate medical student's
1857:
Choby, B.; Passmore, C. (2007). "Faculty perceptions of the ACGME resident duty hour regulations in family medicine".
1967:"Surgical Residents' Perceptions of 2011 Accreditation Council for Graduate Medical Education Duty Hour Regulations"
1646:"Mortality Among Hospitalized Medicare Beneficiaries in the First 2 Years Following ACGME Resident Duty Hour Reform"
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119:
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Defoe, D. (June 2001). "Long hours and little sleep: work schedules of residents in obstetrics and gynecology".
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51:
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One day in 7 free from patient care and educational obligations, averaged over 4 weeks, inclusive of call; and
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The public and the medical education establishment recognize that long hours can be counter-productive, since
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48 working hours per week (down from 56 under the old UK regulations), calculated over a period of 26 weeks.
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The desire to continue caring for a patient frequently leads doctors to work for longer than is permitted.
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A 24-hour limit on continuous duty, with up to 6 additional hours for continuity of care and education;
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Friedman, Richard C.; Bigger, J. Thomas; Kornfeld, Donald S. (1971). "The Intern and Sleep Loss".
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510:(AOA) followed suit. Below are the requirements adopted by the American Osteopathic association.
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The evidence for harm to people who are deprived of sleep, or work irregular hours, is robust.
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1488:"Laparoscopic performance after one night on call in a surgical department: prospective study"
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IMPACT OF ACUTE AND CHRONIC SLEEP RESTRICTION ON PVT PERFORMANCE: A STUDY OF MEDICALRESIDENTS
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All off-duty time must be totally free from assignment to clinical or educational activity.
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Philibert I, Friedmann P, Williams WT (2002). "New requirements for resident duty hours".
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1326:"Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units"
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An 80-hour weekly limit, averaged over 4 weeks, inclusive of all in-house call activities;
976:, vol. 1, Luxembourg: Office for Official Publications of the European Communities,
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1181:"Sleep Loss and Performance in Residents and Nonphysicians: A Meta-Analytic Examination"
818:
663:"Are Duty Hour Regulations Promoting a Culture of Dishonesty Among Resident Physicians?"
171:, with work conditions poor enough to burn out some residents, may be actively desired.
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2060:"Duty Hours, Quality of Care, and Patient Safety: General Surgery Resident Perceptions"
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Van Dongen, Hans P.A.; Maislin, Greg; Mullington, Janet M.; Dinges, David F. (2003).
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shifts, but is the most commonly used method of adapting to duty hour restrictions.
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898:. New developments in neuroscience. U.S. Government Printing Office. p. 155.
2605:"National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training"
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Drolet, Brian C.; Sangisetty, Suma; Tracy, Thomas F.; Cioffi, William G. (2013).
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2246:"Challenging the Medical Residency Matching System through Antitrust Litigation"
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mandatory, but may be taken at another time if it cannot be taken as scheduled.
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2296:. Montana Department of Labor & Industry: Research & Analysis Bureau.
2231:"Jung v. Association of American Medical Colleges: A Special Interest Victory"
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439:(IOM) built upon the recommendations of the ACGME in the December 2008 report
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1818:"Results of a National Neurosurgery Resident Survey on Duty Hour Regulations"
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Garg, Megha; Drolet, Brian C.; Tammaro, Dominick; Fischer, Staci A. (2014).
1565:"Northwestern-led study of medical residents working 28-hour shifts decried"
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1942:. 23rd Annual Meeting of the Associated Professional Sleep Societies, LLC.
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1004:"Slow wave sleep disruption increases cerebrospinal fluid amyloid-β levels"
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1540:"Some new doctors are working 30-hour shifts at hospitals around the U.S."
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The ACGME duty hour standards that went into effect in July 2003 require:
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residents, 71.3% reported sleeping less than 3 hours while on night call.
2569:
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Grantcharov, T. P.; Bardram, L.; Funch-Jensen, P.; Rosenberg, J. (2001).
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in 2004, which exempting matching programs from federal antitrust laws.
1886:"Resident Duty Hours: A Survey of Internal Medicine Program Directors"
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In-house call no more than once every 3 nights, averaged over 4 weeks.
1816:
Fargen, Kyle M.; Chakraborty, Anindita; Friedman, William A. (2011).
1769:"Effects of the 2011 Duty Hour Reforms on Interns and Their Patients"
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for residents, despite work for many more residents being available.
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Ulmer, Cheryl; Wolman, Dianne Miller; Johns, Michael M. E. (2009).
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A 10-hour rest period between duty periods and after in-house call;
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No new patients to be accepted after 24 hours of continuous duty;
423:. Starting in 2003, with revisions in 2011, regulations from the
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this may also reduce quality of care, which can be expensive.
150:
accused of deliberately limiting the available residency posts
18:
2504:
Resident duty hours: enhancing sleep, supervision, and safety
142:
have no alternatives to the position that they are matched to
506:
Following the ACGME's proposed regulation of duty hours the
441:
Resident Duty Hours: Enhancing Sleep, Supervision and Safety
2323:"Juniors rota gaps and the European Working Time Directive"
1068:
Working in a 24/7 Economy: Challenges for American Families
892:
Biological Rhythms: Implications for the Worker, OTA-BA-463
2477:"ACGME Duty Hours Not the Only Big Change in Requirements"
2058:
Borman, Karen R.; Jones, Andrew T.; Shea, Judy A. (2012).
1055:. Oslo, Norway: European Industrial Relations Association.
760:
Baldwin, Dewitt C.; Daugherty, Steven R. (15 March 2004).
2470:
2468:
518:
responsibility for a new patient after working 24 hours.
1053:
The 24-Hour Society and Industrial Relations Strategies
43:
933:
Scandinavian Journal of Work, Environment & Health
118:
In a recent landmark study published in May 2021, the
929:"Shift work, risk factors and cardiovascular disease"
2447:
Accreditation Council for Graduate Medical Education
2443:"Duty Hours in the Learning and Working Environment"
2287:"Healthcare Labor Shortages and Potential Solutions"
425:
Accreditation Council for Graduate Medical Education
98:
Accreditation Council for Graduate Medical Education
2008:"Duty Hour Reform in a Shifting Medical Landscape"
478:U.S. Occupational Safety and Health Administration
280:The 2003 working-hour restrictions imposed in the
2437:
2435:
2184:: CS1 maint: DOI inactive as of September 2024 (
865:"Medical Residents Work Long Hours Despite Rules"
218:Effects of resident sleep deprivation on patients
1533:
1531:
348:Jung v. Association of American Medical Colleges
2597:
2595:
1762:
1760:
1586:
1584:
85:refers to the (often lengthy) shifts worked by
656:
654:
652:
650:
415:The issue is politically controversial in the
2650:Journal of the American College of Cardiology
2053:
2051:
1944:Journal of Sleep and Sleep Disorders Research
1218:
1216:
1132:"Fatigue, alcohol and performance impairment"
633:"AMA expected to take up resident work hours"
32:The examples and perspective in this article
8:
712:
710:
708:
706:
396:one day off each week, or two days off each
276:Observations on the ACGME restrictions in US
2064:Journal of the American College of Surgeons
974:Bulletin of European Studies on Time (BEST)
661:Fargen, Kyle M.; Rosen, Charles L. (2013).
402:20 minutes of continuous rest every 6 hours
2263:10.1001/virtualmentor.2015.17.2.hlaw1-1502
927:Bøggild, Henrik; Knutsson, Anders (1999).
2722:. Public Citizen, Health Research Group.
2661:
2620:
2261:
2197:
2195:
2083:
2031:
1982:
1909:
1833:
1792:
1661:
1617:
1511:
1341:
1248:
1196:
1147:
1106:
1027:
944:
858:
856:
836:
826:
777:
686:
187:Effects of sleep deprivation on residents
70:Learn how and when to remove this message
1270:
1268:
16:Medical residency shifts done by interns
2779:Medical regulation in the United States
2006:Jena, Anupam B.; Prasad, Vinay (2013).
1735:10.7326/0003-4819-147-2-200707170-00161
595:
2789:Medical education in the United States
2685:Lerner, Barron H. (28 November 2006).
2177:
1318:
1316:
1314:
1223:Bolster, Lauren; Rourke, Liam (2015).
337:Proposed methods of reducing workloads
2333:from the original on 22 December 2023
1538:Bernstein, Lenny (October 28, 2015).
1229:Journal of Graduate Medical Education
1070:. New York: Russell Sage Foundation.
667:Journal of Graduate Medical Education
626:
624:
601:
599:
469:Dr. Richard Corlin, president of the
7:
2453:from the original on 8 December 2015
2109:Otolaryngology–Head and Neck Surgery
2012:Journal of General Internal Medicine
1890:Journal of General Internal Medicine
1130:Dawson, Drew; Reid, Kathryn (1997).
320:Problems with duty hour restrictions
2475:Doolittle, Benjamin (25 May 2017).
1563:Russell, John (November 19, 2015).
968:Wedderburn, Alexander, ed. (2000),
365:to fewer doctors leaving medicine.
342:accreditation, have been proposed.
2755:. 2006. p. 45. Archived from
2303:from the original on 19 March 2023
863:Schultz, David (5 December 2012).
146:National Resident Matching Program
14:
2726:from the original on 3 March 2016
2285:Connell, William (January 2013).
2076:10.1016/j.jamcollsurg.2012.02.010
1933:Czeisler, Charles (9 June 2009).
432:been mandated for accreditation.
263:Effects of duty hour restrictions
124:International Labour Organization
2753:American Osteopathic Association
508:American Osteopathic Association
393:11 hours continuous rest per day
23:
2609:New England Journal of Medicine
2558:New England Journal of Medicine
1946:. Vol. 32. pp. A160.
1410:New England Journal of Medicine
1330:New England Journal of Medicine
607:"Medical Residents' Work Hours"
543:certain employment protection.
384:European Working Time Directive
2720:"Medial Residents' Work Hours"
1785:10.1001/jamainternmed.2013.351
631:Gupta, Sanjay (15 June 2001).
1:
2164:10.14423/SMJ.0000000000000323
1779:(8): 657–62, discussion 663.
1457:10.1016/S0140-6736(98)00034-8
1387:10.1016/S0196-0644(94)70209-8
731:10.1016/S0029-7844(01)01363-1
2687:"A Case That Shook Medicine"
1835:10.1227/NEU.0b013e3182245989
1610:10.1097/SLA.0000000000000595
1375:Annals of Emergency Medicine
1066:Presser, Harriet B. (2003).
828:10.1016/j.envint.2021.106595
471:American Medical Association
455:Towards an 80-hour work week
232:attention and working memory
2294:Montana Economy at a Glance
2204:William Mitchell Law Review
1723:Annals of Internal Medicine
1422:10.1056/NEJM197107222850405
1289:10.1080/0014013031000085671
719:Obstetrics & Gynecology
89:and residents during their
83:Medical resident work hours
46:, discuss the issue on the
2805:
2663:10.1016/j.jacc.2014.11.007
1179:Philibert, Ingrid (2005).
359:Pension Funding Equity Act
196:gastrointestinal disorders
2024:10.1007/s11606-013-2439-8
1984:10.1001/jamasurg.2013.169
1902:10.1007/s11606-014-2912-z
1504:10.1136/bmj.323.7323.1222
1241:10.4300/JGME-D-14-00612.1
807:Environment International
679:10.4300/JGME-D-13-00220.1
120:World Health Organization
2644:Patel, Nachiket (2014).
2509:National Academies Press
2152:Southern Medical Journal
2121:10.1177/0194599814546111
1198:10.1093/sleep/28.11.1392
1051:Kauppinen, Timo (2001).
131:Causes of high workloads
96:As per the rules of the
2383:10.1001/jama.288.9.1112
2166:(inactive 2024-09-12).
2244:Weinmeyer, R. (2015).
1773:JAMA Internal Medicine
1700:10.1001/jama.298.9.984
1663:10.1001/jama.298.9.975
1108:10.1093/sleep/26.2.117
970:"Shiftwork and Health"
779:10.1093/sleep/27.2.217
611:internetfreespeech.org
585:Working Time Directive
378:Junior doctors in the
258:Duty hour restrictions
200:cardiovascular disease
169:higher "entry barrier"
152:, thus decreasing the
2622:10.1056/NEJMoa1515724
2418:10.1056/NEJMsb1005800
2250:AMA Journal of Ethics
437:Institute of Medicine
2570:10.1056/NEJMp1703690
2353:"Regulation changes"
1343:10.1056/NEJMoa041406
1020:10.1093/brain/awx148
52:create a new article
44:improve this article
34:may not represent a
2691:The Washington Post
2329:. 8 February 2022.
2229:Turner, Miranda W.
1498:(7323): 1222–1223.
819:2021EnInt.15406595P
411:American regulation
386:, which specifies:
226:increases rates of
2646:"Learning Lessons"
2507:. Washington, DC:
617:on March 10, 2007.
535:resident involved.
2656:(25): 2802–2804.
2564:(18): 1704–1706.
1896:(10): 1349–1354.
1598:Annals of Surgery
1336:(18): 1838–1848.
1191:(11): 1392–1402.
946:10.5271/sjweh.410
580:Work–life balance
551:Coping mechanisms
421:medical residency
224:sleep deprivation
182:Effects on health
91:medical residency
80:
79:
72:
54:, as appropriate.
2796:
2764:
2763:
2762:on 13 June 2010.
2761:
2750:
2742:
2736:
2735:
2733:
2731:
2716:
2710:
2709:
2707:
2705:
2682:
2676:
2675:
2665:
2641:
2635:
2634:
2624:
2599:
2590:
2589:
2553:
2547:
2546:
2498:
2492:
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2489:
2487:
2472:
2463:
2462:
2460:
2458:
2439:
2430:
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2401:
2395:
2394:
2366:
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2357:
2349:
2343:
2342:
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2338:
2319:
2313:
2312:
2310:
2308:
2302:
2291:
2282:
2276:
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2265:
2241:
2235:
2234:
2226:
2220:
2219:
2199:
2190:
2189:
2183:
2175:
2147:
2141:
2140:
2104:
2098:
2097:
2087:
2055:
2046:
2045:
2035:
2018:(9): 1238–1240.
2003:
1997:
1996:
1986:
1962:
1956:
1955:
1941:
1930:
1924:
1923:
1913:
1881:
1875:
1874:
1854:
1848:
1847:
1837:
1828:(6): 1162–1170.
1813:
1807:
1806:
1796:
1764:
1755:
1754:
1718:
1712:
1711:
1682:
1676:
1675:
1665:
1638:
1632:
1631:
1621:
1604:(6): 1041–1053.
1588:
1579:
1578:
1576:
1575:
1560:
1554:
1553:
1551:
1549:
1535:
1526:
1525:
1515:
1483:
1477:
1476:
1440:
1434:
1433:
1405:
1399:
1398:
1370:
1364:
1363:
1345:
1320:
1309:
1308:
1272:
1263:
1262:
1252:
1220:
1211:
1210:
1200:
1176:
1170:
1169:
1151:
1127:
1121:
1120:
1110:
1086:
1080:
1079:
1063:
1057:
1056:
1048:
1042:
1041:
1031:
1014:(8): 2104–2111.
998:
992:
991:
990:
988:
965:
959:
958:
948:
924:
918:
917:
897:
886:
880:
879:
877:
875:
860:
851:
850:
840:
830:
798:
792:
791:
781:
757:
751:
750:
725:(6): 1015–1018.
714:
701:
700:
690:
658:
645:
644:
643:on May 27, 2006.
639:. Archived from
628:
619:
618:
613:. Archived from
603:
575:Stress (biology)
75:
68:
64:
61:
55:
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26:
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2481:NEJM Knowledge+
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2005:
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1859:Family Medicine
1856:
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1720:
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1684:
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1679:
1642:Volpp, Kevin G.
1640:
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1590:
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1582:
1573:
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1569:Chicago Tribune
1562:
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1543:Washington Post
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648:
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629:
622:
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597:
593:
566:
553:
461:Libby Zion case
457:
413:
382:fall under the
376:
371:
339:
322:
313:
301:
278:
265:
260:
220:
189:
184:
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87:medical interns
76:
65:
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56:
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28:
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2791:
2786:
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2771:
2770:
2766:
2765:
2737:
2711:
2677:
2636:
2615:(8): 713–727.
2591:
2548:
2525:
2517:10.17226/12508
2493:
2464:
2431:
2396:
2361:
2344:
2314:
2277:
2236:
2221:
2191:
2142:
2115:(4): 599–605.
2099:
2047:
1998:
1957:
1925:
1876:
1849:
1808:
1756:
1713:
1677:
1633:
1580:
1555:
1527:
1478:
1451:(9135): 1191.
1435:
1416:(4): 201–203.
1400:
1381:(5): 928–934.
1365:
1310:
1283:(7): 653–663.
1264:
1235:(3): 349–363.
1212:
1171:
1122:
1101:(2): 117–126.
1081:
1058:
1043:
993:
960:
919:
904:
881:
852:
793:
772:(2): 217–223.
752:
702:
673:(4): 553–555.
646:
620:
594:
592:
589:
588:
587:
582:
577:
572:
570:Libby Zion Law
565:
562:
552:
549:
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321:
318:
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309:
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297:
277:
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264:
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228:medical errors
219:
216:
188:
185:
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180:
148:has also been
132:
129:
78:
77:
38:of the subject
36:worldwide view
31:
29:
22:
15:
13:
10:
9:
6:
4:
3:
2:
2801:
2790:
2787:
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2777:
2776:
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2423:
2419:
2415:
2411:
2407:
2400:
2397:
2392:
2388:
2384:
2380:
2377:(9): 1112–4.
2376:
2372:
2365:
2362:
2354:
2348:
2345:
2332:
2328:
2324:
2318:
2315:
2299:
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2288:
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2278:
2273:
2269:
2264:
2259:
2256:(2): 149–53.
2255:
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2222:
2217:
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2209:
2205:
2198:
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2161:
2158:(8): 476–81.
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2114:
2110:
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2017:
2013:
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1999:
1994:
1990:
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1977:(5): 427–33.
1976:
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1728:
1724:
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1701:
1697:
1694:(9): 984–92.
1693:
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1678:
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1669:
1664:
1659:
1656:(9): 975–83.
1655:
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1149:10.1038/40775
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