Role of Ergonomic Improvements in Decreasing Repetitive Stress Injuries and Promoting Well-Being in a Radiology Department.

RATIONALE AND OBJECTIVES: To determine if ergonomic improvements in a radiology department can decrease repetitive stress injuries (RSIs), advance ergonomics knowledge, and improve well-being. MATERIALS AND METHODS: Radiologists in an academic institution were surveyed regarding physician wellness, workstations, RSIs, and ergonomics knowledge before and after interventions over 1 year. Interventions included committee formation, education, wrist pads and wireless mice, broken table and chair replacement, and cord organization. Mann-Whitney U test was used for analysis. RESULTS: Survey response was 40% preinterventions (59/147), and 42% (66/157) postinterventions. Preinterventions, of radiologists with RSI history, 17/40 (42%) reported the RSI caused symptoms which can lead to burnout, and 15/40 (37%) responded their RSI made them think about leaving their job. Twenty-three of 59 (39%) radiologists had an active RSI preinterventions. Postinterventions, 9/25 (36%) RSI resolved, 13/25 (52%) RSI improved, and 3/25 (12%) RSI did not improve. RSI improvements were attributed to ergonomic interventions in 19/25 (76%) and therapy in 2/25 (8%). Radiologists who thought their workstation was designed with well-being in mind increased from 9/59 (15%) to 52/64 (81%). The percentage of radiologists knowing little or nothing about ergonomics decreased from 15/59 (25%) to 5/64 (8%). After ergonomics interventions, more radiologists thought the administration cared about safety and ergonomics, equipment was distributed fairly, and radiologists had the ability to ask for equipment (p < .01). Fifty-three of 64 (83%) of radiologists after interventions said improving workstation ergonomic design contributed to well-being. CONCLUSION: Ergonomic improvements in radiology can decrease RSIs, advance ergonomics knowledge, and improve well-being.

Smart Glasses for Radial Arterial Catheterization in Pediatric Patients: A Randomized Clinical Trial.

BACKGROUND: Hand-eye coordination and ergonomics are important for the success of delicate ultrasound-guided medical procedures. These can be improved using smart glasses (head-mounted display) by decreasing the head movement on the ultrasound screen. The hypothesis was that the smart glasses could improve the success rate of ultrasound-guided pediatric radial arterial catheterization. METHODS: This prospective, single-blinded, randomized controlled, single-center study enrolled pediatric patients (n = 116, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the ultrasound screen group (control) or the smart glasses group. After inducing general anesthesia, ultrasound-guided radial artery catheterization was performed. The primary outcome was the first-attempt success rate. The secondary outcomes included the first-attempt procedure time, the overall complication rate, and operators' ergonomic satisfaction (5-point scale). RESULTS: In total, 116 children were included in the analysis. The smart glasses group had a higher first-attempt success rate than the control group (87.9% [51/58] vs. 72.4% [42/58]; P = 0.036; odds ratio, 2.78; 95% CI, 1.04 to 7.4; absolute risk reduction, -15.5%; 95% CI, -29.8 to -12.8%). The smart glasses group had a shorter first-attempt procedure time (median, 33 s; interquartile range, 23 to 47 s; range, 10 to 141 s) than the control group (median, 43 s; interquartile range, 31 to 67 s; range, 17 to 248 s; P = 0.007). The overall complication rate was lower in the smart glasses group than in the control group (5.2% [3/58] vs. 29.3% [17/58]; P = 0.001; odds ratio, 0.132; 95% CI, 0.036 to 0.48; absolute risk reduction, 24.1%; 95% CI, 11.1 to 37.2%). The proportion of positive ergonomic satisfaction (4 = good or 5 = best) was higher in the smart glasses group than in the control group (65.5% [38/58] vs. 20.7% [12/58]; P <0.001; odds ratio, 7.3; 95% CI, 3.16 to 16.8; absolute risk reduction, -44.8%; 95% CI, -60.9% to -28.8%). CONCLUSIONS: Smart glasses-assisted ultrasound-guided radial artery catheterization improved the first-attempt success rate and ergonomic satisfaction while reducing the first-attempt procedure time and overall complication rates in small pediatric patients.

Postural ergonomics and work-related musculoskeletal disorders in neurosurgery: lessons from an international survey.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) affect a significant percentage of the neurosurgical workforce. The aim of the current questionnaire-based study was to examine the prevalence of WMSDs amongst neurosurgeons, identify risk factors, and study the views of neurosurgeons regarding ergonomics. METHODS: From June to August 2020, members of the "European Association of Neurosurgical Societies," the "Neurosurgery Research Listserv," and the "Latin American Federation of Neurosurgical Societies" were asked to complete an electronic questionnaire on the topics of WMSDs and ergonomics. RESULTS: A total of 409 neurosurgeons responded to the survey, with a 4.7 male to female ratio. Most of the surgeons worked in Europe (76.9%) in academic public hospitals. The vast majority of the participants (87.9%) had experienced WMSDs, mainly affecting the shoulder, neck, and back muscles. The most common operations performed by the participants were "Craniotomy for convexity/intrinsic tumors" (24.1%) and "Open lumbar basic spine" (24.1%). Neurosurgeons agreed that ergonomics is an underexposed area in the neurosurgical field (84.8%) and that more resources should be spend (87.3%) and training curricula changes should be made (78.3%) in order to alleviate the burden of WMSDs on neurosurgeons. Univariate analysis did not reveal any associations between the development of WMSDs and age, gender, tenure, average duration of operation, operating time per week, type of operation, and surgical approach. CONCLUSIONS: The problem of WMSDs ought to be more closely addressed and managed by the neurosurgical community. More studies ought to be designed to investigate specific ergonomic parameters in order to formulate practice recommendations.

Ergonomics factors influencing school education during the COVID-19 pandemic: A literature review.

BACKGROUND: The school is one of the most critical social, educational, and training institutions and the main pillar of education in society. Education and, consequently, educational environments have the highest effect on the mentality, development, growth, welfare, concentration, performance, and learning efficiency of students. OBJECTIVES: The present study aimed to examine the effects of environmental ergonomics on the learning and cognition of pre-school students during the COVID-19 pandemic. METHODS: The study was carried out as a review article using some keywords, namely "children", "learning", "pre-school", "COVID-19", "ergonomics", and "environmental factors". Scopus, PubMed, Science Direct and Web of Science were searched to find related articles. RESULTS: Factors like color, form, and layout of classrooms, lighting and ventilation, interior decoration, and educational equipment are effective in creating interest and motivation for students to learn. CONCLUSIONS: A review of these articles showed that the presence of ergonomics in educational spaces for children increases the quality of learning and reduces stress and anxiety, and by observing health protocols, a healthy and safe environment can be provided for students.

Workforce perceptions of human factors as indicators of plant reliability and process safety.

Human factors, as perceived by the maintenance workforce, were used as the measure for comparing work areas within a petroleum company. These factors were then compared to an objective measure of reliability (Mean Time Between Failures) in order to determine which factors would be most predictive of plant reliability and process safety. Maintenance personnel were surveyed using scales based on Problem-solving, Vigilance, Design and maintenance, Job-related feedback and Information about change. Analysis of Variance was used to assess the strength of these variables in relation to Reliability Level. Significant differences were observed between different reliability levels based on workforce perceptions of problem-solving requirements and the design and maintainability of plant. Conclusions were that perceptions of human factors in the workplace can be predictive of group-level performance, and that if issues relating to design and maintainability are not addressed at the design stage, greater problem-solving abilities will be required from maintenance personnel. Practitioner summary: Workforce perceptions of plant performance could provide a statistically valid measure of current and future reliability. A survey of perceptions of human factors was conducted with maintenance personnel in a petroleum company. Results indicated significant relationships between reliability and requirements for Problem-solving, as well as Design and Maintenance of equipment. Abbreviations: HFIT: human factors investigation tool, FPSO: floating production, storage and offtake, MTBF: mean time between failures, CPS: cognitive problem- solving, WDS: work design questionnaire, SPSS: statistical package for the social sciences, PAF: principal axis factoring, ANOVA: analysis of variance, ANCOVA: analysis of co-variance, M: mean, SD: standard deviation.

Human factors/ergonomics to support the design and testing of rapidly manufactured ventilators in the UK during the COVID-19 pandemic.

BACKGROUND: This paper describes a rapid response project from the Chartered Institute of Ergonomics & Human Factors (CIEHF) to support the design, development, usability testing and operation of new ventilators as part of the UK response during the COVID-19 pandemic. METHOD: A five-step approach was taken to (1) assess the COVID-19 situation and decide to formulate a response; (2) mobilise and coordinate Human Factors/Ergonomics (HFE) specialists; (3) ideate, with HFE specialists collaborating to identify, analyse the issues and opportunities, and develop strategies, plans and processes; (4) generate outputs and solutions; and (5) respond to the COVID-19 situation via targeted support and guidance. RESULTS: The response for the rapidly manufactured ventilator systems (RMVS) has been used to influence both strategy and practice to address concerns about changing safety standards and the detailed design procedure with RMVS manufacturers. CONCLUSION: The documents are part of a wider collection of HFE advice which is available on the CIEHF COVID-19 website (https://covid19.ergonomics.org.uk/).

History of the Landmark U.S. Ergonomics Guidelines for Meatpacking.

OCCUPATIONAL APPLICATIONS The 1990 publication of the Ergonomics Program Management Guidelines for Meatpacking Plants by the U.S. Occupational Safety and Health Administration (OSHA) was a milestone in the history of occupational ergonomics and the prevention of Work-Related Musculoskeletal Disorders (WMSDs). This paper provides an overview of the development of these guidelines based on personal experience and perception, with special emphasis of the central role the industry trade association, the American Meat Institute (AMI). Industry-wide efforts were successful in reducing the extremely high rates of WMSDs in the U.S. meatpacking industry. Described here are the specific steps the AMI undertook, which serve as a model for other groups on ways to address shared problems. Insights are also offered on why these OSHA guidelines were accepted by industry and succeeded, while other equivalent standards did not - including to some extent the de facto application of concepts of cognitive ergonomics to government documents. This report addresses specific events in the U.S., but the implications are broader and have potential widespread relevance.

The effects of the seat cushion contour and the sitting posture on surface pressure distribution and comfort during seated work.

OBJECTIVES: The purpose of this paper is to investigate the effects of the seat cushion contour and the sitting posture on the seat pan interface pressure distribution and subjective comfort perception. MATERIAL AND METHODS: Overall, 16 volunteers typed a text passage on a laptop while seated, by assuming 3 kinds of common sitting postures (forward, relaxed and upright) in 4 seat cushion configurations: chair only, and chair with 1 of 3 supplementary cushions. Pressure data and cushion comfort ratings were collected in the experiment. RESULTS: It was found that the sitting posture and the seat cushion contour had different impacts on surface pressure. The seat cushion contour had an impact on pressure parameters and pressure distribution on the seat pan, while the sitting posture affected the location of peak pressure on the seat pan. The correlation analysis revealed that the subjective comfort rating was significantly correlated with average pressure (AP) and mean peak pressure (MPP). CONCLUSIONS: The conclusion was that the cushion contour had a greater effect on seat pan interface pressure parameters than the sitting posture. Notably, AP and MPP can be indicators for assessing seat cushion comfort in a short-term perspective. Int J Occup Med Environ Health. 2020;33(5):675-89.

Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of life and career length. This systematic review aims to ascertain this association and to search for preventive measures. METHODS: We conducted a PRISMA-P-based review on ergonomics and WMSDs in neurosurgery over the last 15 years. Twelve original articles were included, of which 6 focused on spine surgery ergonomics, 5 cranio-facial surgery (mainly endoscopic), and one on both domains. RESULTS: We found a huge methodological and content diversity among studies with 5 surveys, 3 cross-sectional studies, 2 retrospective cohorts, and 2 technical notes. Spine surgeons have sustained neck flexion and neglect their posture during surgery. In a survey, low back pain was found in 62% of surgeons, 31% of them with a diagnosed lumbar disc herniation, and 23% of surgery rate. Pain in the neck (59%), shoulder (49%), finger (31%), and wrist (25%) are more frequent than in the general population. Carpal tunnel syndrome showed a linear relationship with increasing cumulative hours of spine surgery practice. Among cranial procedures, endoscopy was also significantly related to shoulder pain while pineal region surgery received some attempts to optimize ergonomics. CONCLUSIONS: Ergonomics in neurosurgery remains underreported and lack attention from surgeons and authorities. Improvements shall target postural ergonomics, equipment design, weekly schedule adaptation, and exercise.

Ergonomic factors of school bags and their adaptation to the weight of students.

BACKGROUND: Students use a school bag to carry their school supplies which may not have the required standards and ergonomic factors. OBJECTIVE: This study was aimed to examine the ergonomic factors of schoolbags and their adaptation to the weight of elementary school students. METHODS: This cross-sectional study was carried out on 721 primary schoolchildren. To collecting data a checklist, which its final version was approved by the experts, was designed by researchers. Data were analyzed by using SPSS ver. 22 and Chi-square test, One-Way ANOVA, and univariate and multivariate logistic regression models. RESULTS: In this study, about 90.1% of students used a backpack to carry their items and most students carried backpacks with a weight up to 10% of their body weight. In 43.5% of the students, waist width was appropriate with backpack width at the bottom, and in 96.6% shoulder width was appropriate with backpack width at the top. Multivariate logistic regression showed that girls in compared to boys were more likely tolerated ratio of backpack weight to body weight, and also had more likely proportion of waist width and the backpack width at the bottom. The grades of the first, second, and fourth used more heavy backpacks. Students who their mothers were employee compared to housewives, carried heavier backpacks and had more likely proportion of waist width and the backpack width at the bottom. As the mother's age increased, the proportion of waist width and the backpack width at the bottom is diminished. CONCLUSION: The schoolbags weight of many students was more than the standard weight, and their schoolbags did not have the required standards. Educational interventions can increase the knowledge of students and parents about the ideal weight of a schoolbag and the criteria for choosing a proper school bag.

The association between janitor physical workload, mental workload, and stress: The SWEEP study.

BACKGROUND: Approximately 2.38 million janitors are employed in the U.S. While high physical workload may explain a lost-work days rate 2.7 times greater than other occupations, little is known about the association between janitors' physical workload, mental workload, and stress. OBJECTIVE: The objective of this study was to assess the associations between physical (ergonomic) and mental workload exposures and stress outcomes among janitors. METHODS: Questionnaire data, focused on ergonomic workload, mental workload and stress, were collected from Minnesota janitors for a one-year period. Physical workload was assessed with Borg Scales and Rapid Entire Body Assessments (REBA). Mental workload assessment utilized the NASA Task Load Index (TLX). Stress assessments utilized single-item ordinal stress scale (SISS) and Perceived Stress Scale-4 (PSS-4) measures. Descriptive and multivariable analyses, including bias adjustment, were conducted. RESULTS: Odds ratios (OR) and 95% confidence intervals (CI) for ergonomic workload (task frequency) effects on SISS were: REBA (1.18 OR, 1.02-1.37 CI); Borg (1.25 OR, 1.00-1.56 CI); combined REBA and Borg (1.10 OR, 1.01-1.20 CI). Mental workload was associated with higher PSS-4 levels (0.15 Mean Difference, 0.08-0.22 CI) and a 3% increased risk for each one-unit increase in the SISS scale (1.03 OR, 1.02-1.05 CI). CONCLUSIONS: This research demonstrated a moderate effect of physical and mental workloads on stress among janitors.

Analyzing working conditions for classical guitarists: Design guidelines for new supports and guitar positioning.

BACKGROUND: When performing, classical guitarists interact with many elements which constitute their own "workstation". One of those elements is the support for guitar positioning. Support dimensions, form and materials may determine posture and affect the musician's comfort and performance. OBJECTIVE: To propose design requirements for new supports for guitar positioning, based on postural assessment, anthropometric criteria, self-efficacy and comfort perception. METHODS: Nine healthy Classical Guitar students were recruited. A postural assessment was undertaken using REBA, and 3DSSPP software with three different supports for guitar positioning. After the use of each support, a questionnaire about self-efficacy and comfort perception was completed by the participants. RESULTS: The higher scores of risk and a significant difference (ANOVA, p =≤05) regarding the left leg elevation were found with footstool usage. However, this one was identified by participants as the best support in terms of self-efficacy and comfort assessment. CONCLUSIONS: To improve performance and prevent physical injuries for guitarists, there is a need for designing guitar positionings supports based on ergonomics principles. This paper proposes eleven guidelines for designing these supports.

Visual fatigue during control room work in process industries.

BACKGROUND: Working in front of computer screens is visually demanding and related to adverse eye symptoms. Occurrence of glare further increases visual fatigue. OBJECTIVE: This paper presents results from an examination of visual ergonomics in control room environments at two Swedish process industries. METHODS: Visual conditions were examined and evaluated in nine control rooms and eighteen process operators answered questions about their perceived workload and visual experiences. RESULTS: When working in the control rooms, the mental workload was rated significantly higher by the participants, compared to experienced performance. The operators further experienced significantly higher visual fatigue and blurred vision compared to double vision and sore eyes. Visual demands were increased in conditions where contrast glare was present, as well as frequent changes of focusing distances, and low contrast between background and characters in computer screens. CONCLUSIONS: Suboptimal visual working conditions in the control rooms contributes to increased visual demands on the operators. Presence of glare is leading to visual fatigue and an unnecessary high mental load. The findings support the relevance of considering principles of general and visual ergonomics when designing and organizing work in control rooms. Workstation design should also be flexible to allow for individual and contextual adjustments.

Functional parameters, wrist posture deviations and comfort: A comparison between a computer mouse and a touch pen as input devices.

BACKGROUND: Performing common computer tasks such as pointing, clicking, and dragging requires repetitive movements that cause musculoskeletal disorders in the wrists and hands. Given the growing use of touch screens and touch pens, further studies on the ergonomics of these devices are needed. This study aimed to compare a touch pen and an ordinary computer mouse in terms of movement time, error rate, wrist posture, and comfort of use. METHODS: Performance parameters (movement time and error rate), wrist postures, and comfort when using a mouse and a touch pen were measured based on ISO 9241-9 standard with the help of 27 participants. For data analysis, paired t test was performed using SPSS version 22. RESULTS: Using the touch pen resulted in better performance parameters than using the mouse (p < 0.05). Wrist extension and flexion were lower when performing the task with the computer mouse than with the touch pen (p < 0.05). When using the touch pen to perform the task, ulnar deviation and radial deviation were lower (p < 0.05). The overall comfort was higher when using the mouse than the touch pen. CONCLUSION: Our results showed that the touch pen had better performance parameters than the ordinary mouse and also resulted in lower ulnar and radial deviations. Given the impact of habit and proficiency on users' comfort in using input devices, it is reasonable to expect users becoming more comfortable by using touch pens on the long term.

Shoulder pain among male industrial workers: Validation of a conceptual model in two independent French working populations.

This study aims to validate a conceptual model for shoulder pain risk factors in two independent samples of male industrial workers: the Cosali cohort (n = 334) and one pharmaceutical company (n = 487). Direct and indirect relationships between work organization factors (automatic speed of a machine or movement of a product and work pace dependent on customers' demand), psychosocial factors (Job strain model), biomechanical factors (working with abducted arms, working with arms at or above shoulder level, and perceived physical exertion), perceived stress, and shoulder pain were explored using structural equation models. Shoulder pain was positively associated with biomechanical exposure in both samples, and with perceived stress only in the pharmaceutical preparation manufacturer, while factors related to work organization and psychosocial factors had indirect impacts on the risk of chronic shoulder pain in both samples. The results provide a deeper understanding of the complex relationships between workplace risk factors and shoulder pain.

SEIPS 3.0: Human-centered design of the patient journey for patient safety.

The Systems Engineering Initiative for Patient Safety (SEIPS) and SEIPS 2.0 models provide a framework for integrating Human Factors and Ergonomics (HFE) in health care quality and patient safety improvement. As care becomes increasingly distributed over space and time, the "process" component of the SEIPS model needs to evolve and represent this additional complexity. In this paper, we review different ways that the process component of the SEIPS models have been described and applied. We then propose the SEIPS 3.0 model, which expands the process component, using the concept of the patient journey to describe the spatio-temporal distribution of patients' interactions with multiple care settings over time. This new SEIPS 3.0 sociotechnical systems approach to the patient journey and patient safety poses several conceptual and methodological challenges to HFE researchers and professionals, including the need to consider multiple perspectives, issues with genuine participation, and HFE work at the boundaries.

Tertiary education in ergonomics and human factors: quo vadis?

In 2019, the Human Factors and Ergonomics (HFE) discipline turned 70; to celebrate, an international group of academics and educators have reflected on the status of HFE tertiary education across the globe. This paper draws on presentations and discussions from the 20th Triennial International Ergonomics Association (IEA) conference and considers the implications for HFE education programmes. Past, current, and future challenges are outlined and discussed with examples from different countries and programmes. This paper builds on 2012 strategy proposed by Dul and colleagues, to strengthen the demand, and application, of the HFE discipline and profession. It provides a considered set of reflections, noting the range of structural issues and financial pressures within the tertiary education system that create challenges for the viability of specialist programmes such as HFE. A need exists for the broader profession to collaborate and share innovations in HFE programme development, to ensure sustainable HFE education programmes. Practitioner summary: A range of structural issues and financial pressures exist within the tertiary education system that creates challenges for the viability of specialist programmes such as HFE. A need exists for the broader profession to collaborate and share innovations in HFE programme development, to ensure sustainable HFE education programmes. Abbreviation: HFE: Human Factors and Ergonomics; IEA: International Ergonomics Association; CIEHF: Chartered Institute of Ergonomics & Human Factors; UX: User Experience; CREE: Centre for Registration of European Ergonomist; BRICSplus: Brazil, Russia, India, China and South Africa; MOOCS: Massive Open Online Courses; STST: socio technical systems theory; LMIC: low and middle-income countries.

Ergonomics in Dermatologic Surgery: Lessons Learned Across Related Specialties and Opportunities for Improvement.

BACKGROUND: As the practice of dermatology becomes increasingly procedurally based, there is a concordant rise in musculoskeletal injury (MSI) risk. Dermatologic surgeons are most susceptible and, although the majority suffer from MSI, few have received any formal ergonomics training. This stems from a lack of awareness of this troubling trend and a paucity of research and education on the ergonomics of dermatologic surgery. OBJECTIVE: To highlight pertinent ergonomics principles and strategies from other specialties that could be translated into dermatology, and to synthesize general recommendations aimed at reducing MSI among dermatologic surgeons. MATERIALS AND METHODS: A comprehensive search of the PubMed and Cochrane Reviews databases from 1975 to 2019 was conducted, using a combination of ergonomics-related search terms, generating 6 publications from the dermatology literature and 58 from the fields of dentistry, medicine, and select surgical subspecialties. RESULTS: This multidisciplinary approach yielded multiple interventions that could be applied directly (i.e., adequate lighting, adjustable operating tables, and surgical seat heights) or indirectly pending further investigation into their feasibility (i.e., video displays of the surgical field to allow neutral head and neck postures). CONCLUSION: Although much can be learned from decades of prior ergonomics research from other specialties, considerations that are unique to dermatology remain and must be addressed with specialty-specific research.

Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study.

BACKGROUND: There is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability. OBJECTIVE: This study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children's physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives; (2) determine use of different features and functions incorporated into the accompanying app; and (3) identify parents' awareness of their child's current physical activity levels. METHODS: In total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25; 21 mothers and 4 fathers) completed a Web-based survey to record their child's activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subsample of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts. RESULTS: Parents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports. CONCLUSIONS: Most parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children's daily activity. However, several barriers were identified, which may impact sustained use over time; both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives.

Human factors challenges for the safe use of artificial intelligence in patient care.

The use of artificial intelligence (AI) in patient care can offer significant benefits. However, there is a lack of independent evaluation considering AI in use. The paper argues that consideration should be given to how AI will be incorporated into clinical processes and services. Human factors challenges that are likely to arise at this level include cognitive aspects (automation bias and human performance), handover and communication between clinicians and AI systems, situation awareness and the impact on the interaction with patients. Human factors research should accompany the development of AI from the outset.