Fatigue Risk Management Research Articles

Integrated Modeling of Fatigue Impacts on C-17 Approach and Landing Performance

ABSTRACT Objective The current effort develops an initial integrated model of fatigue in the context of C-17 approach and landing operations. Specifically, we integrate a biomathematical fatigue model with a task network model to estimate pilot performance degradation. Background Fatigue risk management is a critical process in aviation and flight deck operations, given its dramatic impact on aviation safety and pilot health. Biomathematical fatigue models are useful tools in several aviation fatigue risk management programs that can be embedded in electronic device applications. However, these tools are limited in terms of identifying specific performance outcomes affected by fatigue, as well as individualizing fatigue estimates to individual pilots. Integrating computational cognitive models and biomathematical fatigue models can help address these issues. Methods Forty-four aircrew members completed the study with 10 performing 33 landings with sets of corresponding actigraph data and C-17 performance metrics. We developed a task network model of C-17 approach and landing operations and integrated biomathematical fatigue model predictions based on actigraph data from the aircrew. We then compared predictions from this integrated model with C-17 performance metrics from the missions. Results We successfully predicted delays in setting flaps, landing gear, and engaging the speed brake. Conclusion After further development and validation, this integrated model can be implemented within an application to provide real-time information on pilot fatigue and expected performance on specific aircraft operations.

Differences in perception of the importance of process safety indicators between experts in Iran and the West

Introduction: The importance of safety in high-risk industries such as oil and gas facilities has been reported previously. Process safety performance indicators can provide insight into improving the safety of process industries. This paper aims to rank the process safety indicators (metrics) by Fuzzy Best-Worst Method (FBWM) using the data gathered through a survey. Method: The study uses a structured approach considering the UK Health and Safety Executive (HSE), the Center for Chemical Process Safety (CCPS), and the IOGP (International Association of Oil and Gas Producers) recommendations and guidelines to generate an aggregate set of indicators. It calculates the level of importance of each indicator based on the opinions of experts from Iran and some Western countries. Results: The findings of the study demonstrate that some lagging indicators such as the number of times processes do not proceed as planned due to insufficient staff competence and the number of unexpected disruptions of the process due to failure in instrumentation and alarms are important in process industries in both Iran and Western countries. Western experts identified process safety incident severity rate as an important lagging indicator, whereas Iranian experts considered this as relatively unimportant. In addition, leading indicators such as sufficient process safety training and competency, the desired function of instrumentation and alarms, and proper management of fatigue risk play an important role in enhancing the safety performance of process industries. Experts in Iran viewed permit to work as an important leading indicator, while experts in the West focused on fatigue risk management. Practical Applications: The methodology used in the current study gives a good view to managers and safety professionals in regard to the most important indicators of process safety and allows them to focus more on important process safety indicators.

The Emergency Medical Services Sleep Health Study: A cluster-randomized trial

BackgroundGreater than half of emergency medical services (EMS) clinician shift workers report poor sleep, fatigue, and inadequate recovery between shifts. We hypothesized that EMS clinicians randomized to receive tailored sleep health education would have improved sleep quality and less fatigue compared to wait-list controls after 3 months. MethodsWe used a cluster-randomized, 2-arm, wait-list control study design (clinicaltrials.gov identifier: NCT04218279). Recruitment of EMS agencies (clusters) was nationwide. Our study was powered at 88% to detect a 0.4 standard deviation difference in sleep quality with 20 agencies per arm and a minimum of 10 individuals per agency. The primary outcome was measured using the Pittsburgh Sleep Quality Index (PSQI) at 3-month follow-up. Our intervention was accessible in an online, asynchronous format and comprised of 10 brief education modules that address fatigue mitigation topics prescribed by the American College of Occupational Environmental Medicine. ResultsIn total, 36 EMS agencies and 678 individuals enrolled. Attrition at 3 months did not differ by study group (Intervention = 17.4% vs. Wait-list control = 18.2%; p = .37). Intention-to-treat analyses detected no differences in PSQI and fatigue scores at 3 months. Per protocol analyses showed the greater the number of education modules viewed, the greater the improvement in sleep quality and the greater the reduction in fatigue (p < .05). ConclusionsWhile intention-to-treat analyses revealed no differences in sleep quality or fatigue at 3 months, per protocol findings identified select groups of EMS clinician shift workers who may benefit from sleep health education. Our findings may inform fatigue risk management programs.

O061 Sleep hygiene guidelines for shift workers: consensus guidelines via a Delphi study

Abstract Introduction Current sleep hygiene guidelines are impractical for shift workers, given their inability to maintain regular sleep schedules. Further, the present guidelines contradict fatigue risk management advice (e.g., advising against caffeine and daytime napping). The aim of the present study is to develop a set of tailored sleep hygiene guidelines for shift workers via a Delphi approach. Methods Draft guidelines were developed by the research team, who reviewed the current guidelines and examined existing evidence on sleep hygiene in shift workers. Experts from sleep, shift work, and occupational health fields (n=155) were invited to review these draft guidelines via a three-round series of online questionnaires. In each round, experts voted on each guideline, with consensus reached once there was 70% agreement on including the item as written. Expert feedback from each round was discussed and incorporated by the research team as appropriate. Results The research team drafted 17 sleep hygiene recommendations, covering sleep scheduling, napping, sleep environment, substance consumption, diet, and exercise. Of those experts invited, 68 (44%) agreed to participate, with 55 of these (81%) completing all three rounds. Consensus was reached on all original items after three rounds, with two additional items (medication use and sleep inertia) and an introductory statement developed, to create a final set of guidelines with 19 items. Discussion This is the first study to create evidence-based, expert-developed sleep hygiene guidelines for shift workers. Future research is planned to investigate the acceptability and implementation of the guidelines amongst end-users.

The next generation of fatigue prediction models: evaluating current trends in biomathematical modelling

Biomathematical models (BMMs) are parametric models that quantitatively predict fatigue and are routinely implemented in fatigue risk management systems in increasingly diverse workplaces. There have been consistent calls for an improved ‘next generation’ of BMMs that provide more accurate and targeted predictions of human fatigue. This article examines the core characteristics of next-generation advancements in BMMs, including tailoring with field data, individual-level parameter tuning and real-time fatigue prediction, extensions to account for additional factors that influence fatigue, and emerging nonparametric methodologies that may augment or provide alternatives to BMMs. Examination of past literature and quantitative examples suggests that there are notable challenges to advancing BMMs beyond their current applications. Adoption of multi-model frameworks, including quantitative joint modelling and machine-learning, was identified as crucial to next-generation models. We close with general recommendations for researchers, practitioners, and model developers, including focusing research efforts on understanding the cognitive dynamics underpinning fatigue-related vigilance decrements, applying emerging dynamic modelling methods to fatigue data from field settings, and improving the adoption of open scientific practices in fatigue research.

The duration of work-related fatigue as a criterion for assessing the workload and the cause of chronic diseases of workers

Introduction. The developers of fatigue risk management systems in the workplace note that there is no universal definition and a consistent way to measure workload, and that scientists have not sufficiently studied the relationship between workload and fatigue. The study aims to analyze the impact of the workload, estimated by the duration of the state of production-related fatigue of workers, on their subjective health and the risk of chronic diseases. Materials and methods. The study involved employees in three areas of employment: healthcare (697 employees), industry (751), education (687). Experts have determined four indicators of the risk of violation of the subjective health of employees during the year: the presence of chronic fatigue syndrome (Rcfs), deterioration of employee health during the year (Rdh), long-term illnesses during the year (Rli), fatigue accumulation during the year (Rfa). We have analyzed the diseases detected during periodic medical examination. The researchers have calculated the HFweek indicator - the duration of the fatigue state - "hours of fatigue per working week": HFweek (hour) = PRN (hour) × Kdf × Kff, where: PRN (hour) is the actual duration of the working week; Kdf and Kff are coefficients that take into account the degree and frequency of fatigue. We also have calculated the relative risk (RR). Results. The researchers have found that with more than 25 hours per week in 108 sample groups of workers in 25 cases, RR exceeded the control level by more than 5 times; in 44 comparison groups by 2.1-5 times and in 35 groups by 1.1-2.0 times. With a HFweek of more than 25 hours, there is an annual accumulation of fatigue (Rfa), similar in workers of all spheres of employment. At HFweek&gt;15 hours, the RR of chronic diseases of the musculoskeletal, respiratory, nervous systems and skin was in the range of 1.31-1.83. The RR of diseases of the genitourinary system (women) and endocrine system increased by 1.13 times; diseases of hypertension, diseases of the digestive system, visual system RR÷1,05-1,07. Conclusion. The HFweek indicator is the physiological equivalent of the professional workload of employees in various fields of employment. With HFweek&gt;25 hours, there is a sharp increase in health risks.

86 Sleep and Fatigue in Residency: Identifying Needs for a Pilot Fatigue Risk Management Plan

Abstract Background Fatigue is inevitable in healthcare professions, given that patient care is provided 24 hours a day, 7 days a week. Due to the potential for fatigue to decrease both physiological and cognitive performance, fatigue in healthcare professionals comes with an elevated risk for both patients and providers. Residents in particular are at high risk for fatigue given the demands of post-graduate training. Fatigue negatively impacts a resident physician's own health and wellbeing and, importantly, increases the risk of serious medical errors affecting patient safety. Given that fatigue is an inevitable aspect of healthcare training, it is a resident training program's responsibility to ensure that residents can work safely when fatigued to minimize harm to themselves and their patients. The National Steering Committee on Resident Duty Hours in Canada recommended that all residency programs develop a Fatigue Risk Management Plan (FRMP) to address this issue. Objectives The University of Ottawa Pediatrics Residency program was tasked to create and pilot a fatigue risk management plan (FRMP) for their residents with support from the Royal College of Physicians and Surgeons of Canada (RCPSC); the first step in the project involved determining the present state of fatigue in the training program. The aim of this study was to perform a baseline fatigue scan of current residents to further quantify the risk and explore the residents’ experience involving fatigue during their training. Design/Methods Twenty-six pediatric residents completed demographic surveys and 14-day diaries to assess sleep quantities/patterns and pre- and post-shift fatigue levels. Focus groups further explored fatigue experiences during training. Quantitative data identified shifts with high-risk of fatigue-related errors, with previous research suggesting cut-offs of &amp;lt;5h of sleep in the previous 24h or &amp;lt;12h in 48h, and shift length &amp;gt; 10h. Qualitative thematic analysis was performed to draw key themes from the focus groups. Results Sleep diaries captured 111 work shifts, with longest shifts being 26h on-call. Our data showed that 48.6% of shifts were greater than 10h, 11.9% of shifts residents had &amp;lt;12h of sleep in the preceding 48h, 2% of shifts residents had &amp;lt;5h in the past 24h. 12.9% of pre-shift wakefulness levels and 30.9% of post-shift levels were in the severe (score 8-9) range. Analysis of focus groups identified key themes: (1) Organizational Fatigue Prevention/Management Strategies, (2) Organizational culture factors influencing perceptions/attitudes towards fatigue, (3) Recognizing Fatigue in Self, and (4) Barriers to Sleep/Contributing Factors to Fatigue at Work. Conclusion This study provides a baseline of current residents’ fatigue levels, suggesting a proportion of shifts were high-risk for fatigue-related errors based on prior sleep-wake data. Key themes identified potential topics for educational interventions as well as targets for organizational improvements with regards to fatigue risk management. This data will be the basis of next steps to implement an FRMP within our organization.

Measuring Occupational Fatigue among Higher and Middle Management at a Specialized Cancer Center during the COVID-19 Pandemic.

This study aims to measure the occupational fatigue level and describe the sources and consequences of occupational fatigue among middle and higher management at an international specialized cancer center during the COVID-19 pandemic. A mixed-method design was used in this study. A convenience sampling technique was utilized to select the participants from King Hussein Cancer Center, Amman, Jordan. The data was collected through a self-administered questionnaire. This questionnaire included both quantitative and qualitative sections. We utilized Fatigue Risk Assessment and Management in High-Risk Environments (FRAME)-26 items scale for the quantitative section. Two main questions were included in the survey to identify the sources and consequences of occupational fatigue. The results show that the average mean of occupational fatigue was 2.95/5 (SD=0.70). The level of changes in fatigue levels after the COVID-19 pandemic increased by 0.87/3 (SD=1.45). The sources of occupational fatigue could be categorized into five themes: workload, work environment, staffing, psychological, and physical sources. There are four themes categorizing occupational fatigue: social, economic, health, and daily activity and lifestyle. This study affords valuable insight into the level, source, and consequences of occupational fatigue among middle and higher management at an international specialized cancer hospital in developing countries. The results indicate that the occupational fatigue level was moderate, and the fatigue level was negatively impacted by the COVID-19 pandemic.

Modelling the root causes of fatigue and associated risk factors in the Brazilian regular aviation industry

This work evaluates the potential root causes of fatigue and its relationships with accident risks using a bio-mathematical model approach and a robust sample (N = 8476) of aircrew rosters from the Brazilian regular aviation, extracted from the Fadigômetro database. The fatigue outcomes derive from the software Sleep, Activity, Fatigue, and Task Effectiveness Fatigue Avoidance Scheduling Tool (SAFTE-FAST), which considers the homeostatic process, circadian rhythms and the sleep inertia. The analyses include data from January 2019 until March 2020 and show relevant group effects comparing early 2019 and 2020, with the latter presenting lower fatigue outcomes in most cases. The average minimum SAFTE-FAST effectiveness during critical phases of flight (departures and arrivals) decreases cubically with the number of shifts that elapse totally or partially between mid-night and 6 a.m. within a 30-day period (NNS). As a consequence, the relative fatigue risk increases by 23.3% (95% CI, 20.4–26.2%) when increasing NNS from 1 to 13. The average maximum equivalent wakefulness in critical phases also increases cubically with the number of night shifts and exceeds 24 h for rosters with NNS above 10. The average fatigue hazard area in critical phases of flight varies quadratically with the number of departures and arrivals within 2 and 6 a.m. (NWocl). These findings demonstrate that both NNS and NWocl represent potential root causes of fatigue and therefore should be considered key performance indicators and kept as low as reasonably practical when building aircrew rosters, in order to properly manage the fatigue risk. The effectiveness scores obtained at 30-minute time intervals allowed a model estimate for the relative fatigue risk as a function of the time of the day, whose averaged values show reasonable qualitative agreement with previous measurements of pilot errors in the cockpit. Moreover, the 2019 data revealed a risk exposure factor two times (14%) higher than the figures reported by de Mello et al. (2008) (7%), within 0h00 do 05h59. Tailored analyses of the SAFTE-FAST inputs for afternoon naps before night shifts, commuting from home to station and vice-versa, and bedtime before early-start shifts were carried out using the responses of a questionnaire. The average fatigue hazard area in critical phases of flight increases by 43 to 63% switching off the afternoon naps, 14 to 21% increasing the commuting from one to two hours and 35 to 54% switching off the advanced bedtime criterion, with significant group effects in all cases (p<0.001), evidencing the need of a better and more accurate understanding of these parameters when modelling fatigue risk factors. The non-linear relationships between SAFTE-FAST outcomes and key roster’s parameters, such as NNS and NWocl, provided a novel statistical approach for risk assessment and led to few safety recommendations to the aviation sector regarding regulatory reviews and fatigue risk management and mitigation policies.

Fatigue Risk Management Systems Diagnostic Tool: Validation of an Organizational Assessment Tool for Shift Work Organizations

BackgroundThis study aimed to determine and define the elements of an Fatigue Risk Management System (FRMS) diagnostic tool to assist an organization in systematically assessing its level of implementation of an FRMS. MethodsA modified Delphi process was used involving 16 participants with expertise in sleep science, chronobiology, and fatigue risk management within occupational settings. The study was undertaken in two stages 1) review of elements and definitions; 2) review of statements for each element. Each stage involved an iterative process, and a consensus rule of ≥ 60% was applied to arrive at a final list of elements, definitions, and statements. ResultsStage 1: a review of elements (n = 12) and definitions resulted in a final list of 14 elements and definitions with a consensus of ≥ 60% achieved after 2 Delphi rounds. Stage 2: a review of statements (n = 131) resulted in a final list of 119 statements with a consensus of ≥ 60% achieved after 2 Delphi rounds. ConclusionThe final FRMS diagnostic tool will enable an organization to systematically assess the level of implementation of their current FRMS and identify gaps and opportunities to reduce risk.

Approaches to managing work-related fatigue to meet the needs of American workers and employers.

On September 13-14, 2019, the National Institute for Occupational Safety and Health (NIOSH) hosted a national forum entitled "Working hours, sleep and fatigue: Meeting the needs of American workers and employers."The purpose of this inaugural meeting was to discuss current evidence about the broad-based risks and effective countermeasures related to working hours, sleep, and fatigue, with further considerations to tailor solutions for specific industries and worker populations. We aimed to identify the knowledge gaps and needs in this area and future directions for research. We also sought to identify similarities across industries with the goal of sharing lessons learned and successful mitigation strategies across sectors. Participants included an international representation of academics, scientists, government representatives, policymakers, industry leaders, occupational health and safety professionals, and labor representatives.A total of eight manuscripts were developed following stakeholder comments and forum discussions. Six focused on sector-specific approaches (i.e., Agriculture, Forestry & Fishing; Healthcare & Social Assistance; Mining; Oil and Gas Extraction; Public Safety; Transportation, Warehousing & Utilities) to identify unique factors for fatigue-risk and effective countermeasures. Two additional manuscripts addressed topic areas that cut across all industries (disproportionate risks, and economic evaluation).Findings from the Forum highlight that the identification of common risk factors across sectors allows for transfer of information, such as evidence for effective mitigation strategies, from sectors where fatigue risk has been more widely studied to those sectors where it has been less so. Further considerations should be made to improve knowledge translation activities by incorporating different languages and modes of dissemination such that information is accessible for all workers. Additionally, while economic evaluation can be an important decision-making tool for organizational- and policy-level activities, multi-disciplinary approaches combining epidemiology and economics are needed to provide a more balanced approach to economic evaluation with considerations for societal impacts. Although fatigue risk management must be tailored to fit industries, organizations, and individuals, knowledge gained in this forum can be leveraged, modified, and adapted to address these variabilities. Our hope is to continue sharing lessons learned to encourage future innovative, multi-disciplinary, cross-industry collaborations that will meet the needs of workers and employers to mitigate the risks and losses related to workplace fatigue.

비행 임무에 따른 조종사 스트레스 차이에 대한 연구

This study is a study to analyze the stress difference of pilots according to the category of aircraft. According to previous studies, pilot stress is affected by several factors such as flight time, fatigue regulation, and operating environment, and it is known that stress also affects cardiac variability. In this paper, we analyzed that there is a difference in stress according to the operating environment through airline pilots and pilots of educational institutions, and then tested the difference in stress between airplane pilots and helicopter pilots. This study differs in that it is a study that has almost no empirical research on pilot fatigue and stress considering the role of flight crew members and operational conditions for each mission. If we expand and verify the sample of the results for the stress difference in the future, it will be a great contribution to practical aviation safety research in connection with the fatigue risk management system in the future.

0140 Operationalizing Sleep for the Military: Advancing an Infrastructure for Fatigue Risk Management with Wearable Technology

Abstract Introduction A recent investigation on fatigue within United States (US) Naval Surface Force by the Government Accountability Office recommended that the US Navy incorporate methods to empirically monitor and manage fatigue-related threats. In response, a feasibility effort was undertaken to assess two commercial wearable devices previously evaluated against polysomnography by our group for potential use within a novel fatigue monitoring system onboard US warships. Methods 501 Sailors from three warships (415 men, 85 women, 1 response missing; 29.1±7.4 years, mean±SD) were included in analyses. During multi-day missions at sea, participants were instructed to continuously wear a wrist-worn Fatigue Science Readiband and an Oura Ring. Participants met with the research team daily to sync wearable devices and complete self-ratings of sleep and fatigue on a tablet. While returning to port, participants completed a user experience questionnaire that included 5-point scales for device comfort and interference with daily activities (larger values indicate greater comfort or interference). Results There were no overall differences in total sleep time (TST) and sleep efficiency (SE) between devices (TST: Ring=352.23±87.1, Readiband=353.89±97.79; p=0.45, d=-0.01; SE: Ring=84.59±7.08, Readiband=84.20±10.24; p=0.06, d=0.04). There were 9 days for TST and 4 days for SE (of 66 total days) that resulted in effect sizes &amp;gt;0.50 between devices (for &amp;gt;0.20: TST, 39/66; SE, 29/66). Preliminary analyses between TST and self-reported exhaustion and inability to function suggest predictive relationships with the wearables (Ring: r=-0.20; Readiband: r=-0.21), with no relationship with SE across devices (both r&amp;lt;0.01). Average comfort ratings for Ring (3.74) exceeded Readiband (3.59), but this difference was small (p=0.04, d=0.12). Interference with daily activities was also similar between devices (Ring=2.10, Readiband=2.20; p=0.14, d=0.08). Conclusion Both commercial wearables performed similarly for their TST and SE assessments, and TST was associated with self-rated fatigue within this operational environment. While the ring form factor was selected more for comfort than the wrist form factor, the difference was small. Collectively, findings indicate that both devices show promise for operational use within fatigue monitoring systems. Further testing is being conducted to better understand the strengths and limitations of wearable devices for monitoring sleep in warship environments. Support (If Any) Military Operational Medicine Research Program

0291 Social Desirability Mediates Self-Reported Sleepiness during a Laboratory Total Sleep Deprivation Study

Abstract Introduction Total sleep deprivation (TSD) increases sleepiness and impairs vigilant attention. There are large individual differences in vulnerability to sleep loss, but individuals’ self-ratings of sleepiness often do not align with their objective performance impairment. Here we investigated whether the trait of social desirability – the desire to conform to social standards – plays a role. Methods N=39 healthy adults (ages 27.6±4.6y; 22 men) completed a 3-night/4-day in-laboratory study with 10h baseline and recovery sleep opportunities (22:00–08:00) preceding and following a 38h period of TSD. Every 2–4h during TSD, subjects completed the Karolinska Sleepiness Scale (KSS) and a 10min Psychomotor Vigilance Test (PVT) to assess subjective sleepiness and vigilant attention, respectively. Throughout the study, subjects were behaviorally monitored by the researchers. Prior to the study, subjects completed the Marlow-Crowne Social Desirability (MCSD) scale. Based on standard criteria, subjects were categorized post hoc into average (n=13) and high (n=26) social desirability groups (no subjects in the sample scored low on social desirability). Self-reported sleepiness scored on the KSS and lapses (reaction times ≥500ms) on the PVT were analyzed using mixed-effects ANOVA with fixed effects for time awake and MCSD group and their interaction. Results As expected, there was a main effect of time awake for KSS score (F[12,441]=31.48, p&amp;lt;0.001) and PVT lapses (F[12,441]=16.27, p&amp;lt;0.001), with sleepiness and lapses increasing during TSD. We found a main effect of MCSD group for KSS score (F[1,441]=4.56, p=0.033), with the high MCSD group reporting lower levels of sleepiness than the average MCSD group. However, there was no effect of MCSD group for PVT lapses (p=0.93) and no time awake by MCSD interaction for either KSS (p=0.86) or PVT (p=0.99). Conclusion Subjects high in social desirability reported less sleepiness during TSD than those with average social desirability yet their objective performance was equally degraded. This finding has implications for fatigue risk management because individuals with high social desirability may underreport their sleepiness. This may undermine the reliability of self-report assessments of sleepiness and ability to work safely. [ 1] Whether there is bias in self-reported sleepiness for individuals low in social desirability as well remains to be investigated. Support (If Any) Support: ONR N00014-13-1-0302 and PRMRP W81XWH-20-1-0442

Work schedule and seasonal influences on sleep and fatigue in helicopter and fixed-wing aircraft operations in extreme environments

Sleep and fatigue were investigated in aviation search and rescue, firefighting, emergency medical services and offshore transfer operations in 210 participants, for 21 days each, across 17 datasets in seven countries. Sleep data were collected using wrist-worn actigraphs and sleep diaries. Sustained attention was assessed using a 5-min Psychomotor Vigilance Task (PVT). Duty information was provided from corporate IT systems. Despite the number of 24 h operations, most work occurred during daytime hours, and most sleep occurred at night. There were seasonal changes in work and sleep patterns, with naps used to augment total sleep time. The proportion of sleep occurring during duty varied from zero to 30%. Differences in PVT response times were trivial to small. Legislation that defines flight, duty time and minimum rest limits assume that sleep is not obtained during duty periods, apart from some napping under Fatigue Risk Management Systems (FRMS). However, especially in cases where the aviation service requires waiting for tasks (e.g. search and rescue, emergency medical response), this assumption may not always hold. FRMS should accommodate different modes of working that safely facilitate sleep during duty time where appropriate.

How professional pilots perceive interactions of working conditions, rosters, stress, sleep problems, fatigue and mental health. A qualitative content analysis

IntroductionSo far, no qualitative content analysis (QCA) has analysed pilots’ experiences and perceptions regarding weaknesses of fatigue risk management (FRM), flight time limitations (FTL), rosters, fatigue-severity, sleep problems, and how they relate to pilots’ mental health and well-being. ObjectiveThis research analyses pilots’ described perceptions of stress, fatigue, aviation safety and how regulations like FTL can affect their health and well-being. MethodIn total, 119 international pilots described their perceptions of FTL, rosters, aviation safety, and how they relate to fatigue and health. The QCA was conducted to analyse interactions of working conditions, stressors, fatigue, sleep problems and mental health of EASA-based and Australian pilots. ResultsAlthough pilots were rostered for only 60.8% to 62.5% of the legally allowed duty and flight hours/month, 78.6% reported severe or very high fatigue, 22.8% significant depression, 12.3% significant anxiety symptoms, 10.5% reported significant depression and anxiety symptoms. Pilots uttered severe concerns about FTL, sleep restrictions associated with early starts, minimum rest, etc. Pilots also expressed distinct fears regarding more fatigue-related crashes, and how adverse working conditions, work-related and psychosocial stress could impair their health. ConclusionsThis QCA provided valuable insights into interactions of working conditions, fatigue, sleep restrictions, physical and mental health. Progressive health impairment due to lack of sleep and accumulated fatigue promote burnout, mental and physical health problems, which not only threaten flight safety, but also sustainability of aviation.

Mindfulness and burnout among Chinese civil pilots: Mediation through fatigue and proactive coping

We explored the possibility of a relationship between mindfulness and burnout among Chinese civil pilots, and investigated the mediating effects of fatigue and proactive coping in this relationship. Participants were 319 civil pilots employed by China Southern Airlines, who completed a survey. Structural equation modeling was used to test the hypothesized parallel mediation model. Results show that the direct effect of mindfulness on burnout was not significant, but mindfulness had an important preventative effect on burnout. Furthermore, fatigue and proactive coping completely mediated the effect of mindfulness on burnout. Consequently, our findings corroborate the predictive role of fatigue and proactive coping in mediating the indirect effect that mindfulness exerted on burnout. Theoretical implications and practical recommendations for pilots' mindfulness training practice and fatigue risk management systems are discussed.

Addressing Occupational Fatigue in Nurses: A User-Centered Design Approach for Fatigue Risk Management.

To understand hospital nurses' current fatigue risk management (FRM), identify design goals and principles, and obtain feedback on FRM design concepts. FRM systems can address fatigue and associated risks, yet they are not widely implemented in hospital nursing. This may be due to a lack of contextually appropriate FRM tools. A user-centered design approach was used, including interviews with 21 hospital nursing stakeholders. Nurses described integrated fatigue monitoring and management activities to pursue balance between work demands and capacity to meet those demands as individual nurses, within the unit, across the hospital, and over time. Seven principles were identified and applied to 2 initial design concepts for tools to support FRM. Participants' feedback on designs was positive. This study advances the science and practice for FRM in nursing. The design principles and concepts from this study can be used to facilitate implementation of FRM systems in hospitals.

Psychophysiological coherence training to moderate air traffic controllers' fatigue on rotating roster.

The nature of the current rotating roster, providing 24-h air traffic services over five irregular shifts, leads to accumulated fatigue which impairs air traffic controllers' cognitive function and task performance. It is imperative to develop an effective fatigue risk management system to improve aviation safety based upon scientific approaches. Two empirical studies were conducted to address this issue. Study 1 investigated the mixed effect of circadian rhythm disorders and resource depletion on controllers' accumulated fatigue. Then, study 2 proposed a potential biofeedback solution of quick coherence technique which can mitigate air traffic controllers' (ATCOs') fatigue while on controller working position and improve ATCOs' mental/physical health. The current two-studies demonstrated a scientific approach to fatigue analysis and fatigue risk mitigation in the air traffic services domain. This research offers insights into the fluctuation of ATCO fatigue levels and the influence of a numbers of factors related to circadian rhythm and resource depletion impact on fatigue levels on study 1; and provides psychophysiological coherence training to increase ATCOs' fatigue resilience to mitigate negative impacts of fatigue on study 2. Based on these two studies, the authors recommended that an extra short break for air traffic controllers to permit practicing the quick coherence breathing technique for 5 min at the sixth working hour could substantially recharge cognitive resources and increase fatigue resilience. Application: Present studies highlight an effective fatigue intervention based on objective biofeedback to moderate controllers' accumulated fatigue as a result of rotating shift work. Accordingly, air navigation services providers and regulators can develop fatigue risk management systems based on scientific approaches to improve aviation safety and air traffic controller's wellbeing.

Findings from a systematic review of fatigue interventions: What's (not) being tested in mining and other industrial environments.

Fatigue negatively impacts mineworker health and safety. In this paper, we identify fatigue interventions tested on industrial shiftworkers and explore their effects and the factors that may influence application in an industrial setting such as a mine site. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A structured, systematic search of the literature was conducted to identify relevant studies published between 1980 and 2020. Researchers independently conducted article screening and study quality appraisals against pre-established criteria, and then extracted data and conducted a narrative synthesis of the included studies. Seven intervention studies, out of 1651 articles initially screened, were retained for narrative synthesis. Four studies tested the alerting effects of bright-light treatment, one evaluated the effectiveness of blue-light blocking glasses at improving daytime sleep quality and nighttime vigilance, and two examined whether sleep hygiene and alertness management trainings improved sleep quality or alertness. There was substantial evidence for the use of bright-light treatments to improve night shiftworker alertness, but insufficient evidence to draw conclusions about the effectiveness of blue-light blocking glasses and sleep hygiene and alertness management trainings due to the small number of studies included. Shiftworkers were mostly male and employed in industrial subsectors such as production and manufacturing, oil and gas, and transportation. No mining-specific intervention studies were identified. Future research is needed to identify effective fatigue risk management interventions for the mining industry as well as best practices for implementing these interventions with mineworkers.