This is the Introduction, giving very clever reasons for doing this.

Fatigue and it management are well recognised in the airline industry, with refs galore. Principles of roster construction, assessment of fatigue and mandatory periods away from operational duties have reduced the frequency and impact of fatigue on routine operations, apparently.

The impacts of fatigue are less well explored in medicine. Little data exists on the use of tools comparable to those used in aviation. Aeromedical retrieval offers a convenient way to study the reporting characteristics of those tools among medical staff, in an organisation which maintains current policies on fatigue reporting among its flight crew. I reckon.

1. To describe the outputs of a fatigue monitoring tool in aeromedical retrieval doctors.

2. To estimate the necessary characteristics of a future randomised controlled trial examining various inputs to fatigue, including roster pattern and mandatory down time.

Wherein the strategy and exciting results are described.

Fatigue itself, management in the airline industry. Fatigue in madicine, political angles. Any efforts in medicine.

Roster-fu.

Databases searched, grey literature types considered.

Actual search strings.

Actual google terms and such like.

The numbers and types found at first search, rejected, read, included here.

Preamble and general conclusions then

• list of

• concepts

• and approaches tried so far

Each dealt with not too deeply but with some clarity to explain the next steps needed.

because that would have the reviewers tired before the actual report

Which is distinct from the summary at the top by having the conclusions that the next steps needed are ... whatever they might be.

We did a survey among whoever, to do something.

Justifications for who is included.

Inclusions

1. in a

2. numbered list

Exclusions

1. you get

2. the picture

• and you can nest them, too

The construct being estimated by each potential answer, and the future use of that construct in deciding whether there is a problem or in solving that problem.

Then the questions in a list.

Survey Monkey or do you have an Australian version? Everyone likes Australian versions.

Response Rate increasing mechanisms.

Survey results.

Of ... the results I guess.

Definition of an individually randomised crossover trial of different roster types and feasibility.

Formed from the paper so far: roster A is superior to roster B in an outcome, without being inferior in other important outcomes.

As it says.

Among rosterers and the rostereds. Consent for randomisation, alternative arrangements if not consenting, relative acceptability of either.

Including callback and TOIL effects on total available roster hours, any need to cover emergency leave and the resulting effects on the trial's power.

Cost.

Detailed description of the rosters to which to be randomised, the washout period ( eg booked leave) and the method of application.

Fatigue, how measured? Self report? need for proxy or automated measures of fatigue effects such as reaction time?

Popularity, by best-worst scoring?

by ranking?

by utility function balancing fatigue and therefore feelings of safeness in work against home time and clinical exposure?

1. RCTs balance, in the long run, for observed and unobserved confounders present at the time of enrollment but not for those that are not present at the time of enrollment.

Such things introduce bias.

eg, roster A might be really bad for fatigue on shift, but popular because it gives time off between shifts. Those on roster A might sleep heavily and be only as tired as those on other rosters, knowing that they are only on the roster for a month. This can't be controlled, only acknowledged, and the need for monitoring emphasised in the report.

2. If the measures of fatigue are self reported then doctors may do what doctors always do and underreport; if this is differential in favour of roster A then a false positive will be made more likely.

of the results and the next steps.

To infinity and beyond.

• Paper on fatigue tool outputs

• Paper on cluster characteristics and feasibility for RCT

• Paper on the pilot

• Paper on the RCT

• Systematic review before the pilot?