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Rotating shift work, which disrupts circadian rhythms, has also been associated with a 4% increased risk for ischemic stroke for every 5 years, with an increased risk of stroke in women with longer durations of shift work ( 15 years) ( Together, the literature supports the notion that a time of day variation in stroke outcome exists, and that patients who experience stroke-like symptoms during the morning, or onset of the active period, have an increased risk for poor outcome