“…Whereas the alignment of work hours with respect to the temporal regulation of sleep and waking alertness is the primary driver of performance, safety and health outcomes, a variety of other work-related factors also play a role. These include schedule configuration considerations, such as early starts, 77 forward and (especially) backward rotating shifts, 78,79 irregular shift schedules, 72 quick returns, 80 work breaks, 81 number of consecutive shifts, 82 time off between duty cycles, 76,83 and cumulative work hours across weeks, months and years 54 and the frequency and extent to which these factors occur alone or in combination. Furthermore, working conditions play a role, including physical, cognitive and/or emotional workload, [84][85][86][87] environmental conditions, 5 inherent hazard exposure, 88 and workplace culture and policies.…”