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115 APPENDIX A PROJECT STATEMENT OF WORK (I) Literature Review on Health- Related Issues Associated Suggested panel members with Hours of Work * Roger Rosa, PhD. (NIOSH): Shift work Literature review of the body of scientific research concerning HOS * Ellison Wittels, MD: Cardiovascular: and CMV operator health. The purpose of the literature review is to * John Sheridan, PhD.: Diabetes (John leads FMCSA support ser- provide information that clearly discusses in a scientific, experi- vices contractor team on the diabetes program) mental, and quantitative way the relationship between the hours a * Melvyn Sterling, MD: Gastrointestinal, musculoskeletal, hearing person works or the structure of the work schedule (on-duty/off-duty * Gerald Krueger, PhD., and James W. Curran, MD: Wellness cycles, sleep time, etc.) and the impact on some medical conditions. * Lee Husting or Stephanie Pratt (both of NIOSH): Occupational The search should be limited to studies conducted in the United safety States, Canada, Australia, or European Union on CMV operators on * Peter Orris, MD and Toni Alterman (NIOSH): Occupational interstate highways, transit systems, aviation, and maritime trans- health * Kenneth Wells, MD: Mental health portation. Studies that do not correspond to these specifications can * David Dinges, PhD. (University of Pennsylvania): Sleep disorders be included in the review if the panel deems them important for under- standing specific scientific developments. The results of the review (II) Literature Review on Fatigue Issues Associated with Hours shall be presented in language understandable to a non-subject mat- of Work ter expert. Literature review of the body of scientific research concerning HOS Period to be covered: 1975 to present and CMV operator performance and fatigue health. The purpose of the literature review is to provide information that clearly discusses Suggested topics to be covered in a scientific, experimental, and quantitative way the relationship between the hours a person works or the structure of the work sched- (1) CV Operator ule (on-duty/off-duty cycles, time on task, sleep time, etc.) and the (2) CV Operator Health Issues impact on driver fatigue and performance. The search should be lim- (3) Age and gender ited to studies conducted in the United States, Canada, Australia, (4) Lifestyle (e.g., exercise, diet) and European Union on CMV operators on interstate highways, tran- (5) Driving hours sit systems, aviation, and maritime transportation. Studies that do (6) Duration of workweeks not correspond to these specifications can be included in the review (7) Length of sleep time and sleep deprivation if the panel deems them important for understanding specific scien- (8) Shift work tific developments. The results of the review shall be presented in (9) Schedule regularity and irregularity language understandable to a non-subject matter expert. (10) Exposure to harmful/toxic substances (11) Occupational health: cardiovascular (e.g., blood pressure), Period to be covered: 1995 to present immune system, diabetes, gastrointestinal, musculoskeletal (e.g., lower back pain, sciatica), hearing and vision, mental Suggested topics to be covered health, sleep disorders, obesity, sleep apnea (1) CMV Operator (2) CMV Operator Performance Issues Additional questions (3) Age and gender (4) Lifestyle (e.g., exercise, diet) (a) Is there any scientific literature that addresses specifically the (5) Driving hours relationship between number of driving hours above a certain (6) Duration of work weeks threshold and operator's health issues? (7) Length of sleep time and sleep deprivation (b) Is there any scientific literature addressing health concerns in (8) Shift work the areas of musculoskeletal, vibration, noise, blood pressure, (9) Time on task as manifested in the 11th hour of driving? (10) Schedule regularity and irregularity (c) Is there any scientific literature addressing gender-specific reac- (11) Exposure to harmful/toxic substances tion to some conditions, such as environmental heat? (12) Sleep deprivation countermeasures, e.g., naps (13) Hours-of-service regulations: general considerations, sched- Suggested panel leader ules, shift rotation, multi-day shifts, outcomes of pilot tests and waivers, operational and performance models Michael Belzer or Gerald Krueger (14) Technological approaches to CMV driver alertness management

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116 (15) Personal wellness the actual panel members based on their knowledge and on the (16) Alertness expert's availability. It is expected that there would be three people (17) Fatigue on each panel in addition to the panel leader. (18) Distraction (19) Reaction time Suggested process for each review Additional questions 1. Preparation (Weeks 1 and 2) (a) Is there any scientific literature that addresses specifically the 1.1. The panel leader meets with FMCSA to clarify the scope relationship between number of driving hours above a certain of the literature review threshold and operator's fatigue? 1.2. Based on the suggestions received from FMCSA and (b) Is there any research that shows how fatigue builds or does his/her own knowledge, the Panel leader forms a panel of not build under certain conditions or scenarios, e.g., 11/14 hr experts that will support the literature review driving/working days, working more than 60 hr in 7 days? 1.3. The panel leaders develop an outline of the Literature (c) Is there any scientific literature that focuses on the impact on Review Report fatigue of splitting the sleep time into shorter periods? 1.4. The panel leader reports progress to FMCSA and gets (d) Are there documented differences in the quality of sleep between consensus on the outline when the truck is parked vs. when the truck is in motion? 2. Development of preliminary findings (Weeks 2 through 8) (e) Is there research on the definition of a cumulative fatigue factor 2.1. The panel leader, with the support of the experts of the and the factors that affect it?? panel, assembles a list of papers for the literature review 2.2. The panel leader summarizes the most significant papers Suggested panel leader on the list and prepares an interim report with preliminary findings Alison Smiley, Transport Canada 2.3. FMCSA reviews the interim report and provides feed- back to the panel leader and to the panel of experts on the Suggested panel members continuation of the effort 3. Development of the literature review report (Weeks 8 through 12) * David Dinges, PhD. (University of Pennsylvania): Sleep disorders 3.1. The panel leader develops, with the help of the panel * Roger Rosa, PhD. (NIOSH): Shift work members, the draft literature review according to the * Ellison Wittels, MD: Cardiovascular: agreed outline * Gerald Krueger, PhD., and James W. Curran, MD: Wellness * Lee Husting or Stephanie Pratt (both of NIOSH): Occupational 3.2. The panel leader sends the draft to the panelists for com- safety ment and integration * Peter Orris, MD and Toni Alterman (NIOSH): Occupational 3.3. The panel leader updates the draft health 3.4. The panel leader presents the draft to FMCSA * Kenneth Wells, MD: Mental health 3.5. FMCSA reviews the draft and provides comments * Gregory Belenky, PhD. 4. Development of the final version of the literature review report * Tom Dingus, PhD. (VTTI) (Weeks 12 through 14) * Merrill Mitler 4.1. The panel leader updates, with the help of the panel mem- bers, the draft literature review Note: There are several experts on both panels because they repre- 4.2. The panel leader briefs FMCSA on the findings and sent suggestions coming from FMCSA. The panel leader will choose delivers the final version to FMCSA