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The semi-annual tradition of changing the clock an hour ahead and an hour back has been reported to result in a high incident of work-related illness. A study in the New England Journal of Medicine reports, "More than 1.5 billion men and women are exposed to the transitions involved in daylight saving time: turning clocks forward by an hour in the spring and backward by an hour in the autumn. These transitions can disrupt chronobiologic rhythms and influence the duration and quality of sleep, and the effect lasts for several days after the shifts." This may result in an increase of work-related accidents in the days following the time adjustment.