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.

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.

A Vendor-Independent Mobile Health Monitoring Platform for Digital Health Studies: Development and Usability Study.

BACKGROUND: Medical smartphone apps and mobile health devices are rapidly entering mainstream use because of the rising number of smartphone users. Consequently, a large amount of consumer-generated data is being collected. Technological advances in innovative sensory systems have enabled data connectivity and aggregation to become cornerstones in developing workable solutions for remote monitoring systems in clinical practice. However, few systems are currently available to handle such data, especially for clinical use. OBJECTIVE: The aim of this study was to develop and implement the digital health research platform for mobile health (DHARMA) that combines data saved in different formats from a variety of sources into a single integrated digital platform suitable for mobile remote monitoring studies. METHODS: DHARMA comprises a smartphone app, a Web-based platform, and custom middleware and has been developed to collect, store, process, and visualize data from different vendor-specific sensors. The middleware is a component-based system with independent building blocks for user authentication, study and patient administration, data handling, questionnaire management, patient files, and reporting. RESULTS: A prototype version of the research platform has been tested and deployed in multiple clinical studies. In this study, we used the platform for the follow-up of pregnant women at risk of developing pre-eclampsia. The patients' blood pressure, weight, and activity were semi-automatically captured at home using different devices. DHARMA automatically collected and stored data from each source and enabled data processing for the end users in terms of study-specific parameters, thresholds, and visualization. CONCLUSIONS: The increasing use of mobile health apps and connected medical devices is leading to a large amount of data for collection. There has been limited investment in handling and aggregating data from different sources for use in academic and clinical research focusing on remote monitoring studies. In this study, we created a modular mobile health research platform to collect and integrate data from a variety of third-party devices in several patient populations. The functionality of the platform was demonstrated in a real-life setting among women with high-risk pregnancies.

A usability assessment of riding lawn-mowing equipment with varying levels of design standards compliance.

The use of riding lawn equipment (RLE) is related to a significant number of accidents every year. To provide basis for product design and enhance user performance and safety, a usability and performance assessment of modern riding lawn-mowing tractor designs and features was conducted in a real-world test environment. Five current commercially available RLEs were tested with response measures including task performance time and accuracy, physiological workload, system usability scores (SUS), and subjective rankings of RLE models. This data was used to identify sensitivity of responses to variations in RLE design features and functionality. The data was also used to assess the validity of new tractor design standard conformance tool, the RLEval methodology. This tool made comprehensive evaluation of RLE models compliance with over 70 specific design standards and was applied by human factors experts. Experiment results revealed sensitivity of all response measures to design differences among the five RLE models, except the objective workload measures. Response measures including task performance, SUSs and subjective rankings showed partial agreement with the RLEval scores. In general, the study results demonstrated a comprehensive experimental methodology for usability and performance evaluations of RLEs as well as merit of using the RLEval as preliminary method to compare design features. Some aspects of the usability experimentation and the RLEval method appear to be complementary.

Effects of a PRECEDE-PROCEED model based ergonomic risk management programme to reduce musculoskeletal symptoms of ICU nurses.

OBJECTIVES: To evaluate effects of a PRECEDE-PROCEED Model based, nurse-delivered Ergonomic Risk Management Program (ERMP) in the aim of reducing musculoskeletal symptoms of intensive care unit (ICU) nurses. METHODS: This pre-test post-test design for non-equivalent control groups study comprised 72 ICU nurses from two hospitals. A randomised sampling was done through the study population. The ERMP was delivered as an intervention including 26weeks of follow-up. Data was collected by "Descriptives of Nurses and Ergonomic Risk Reporting Form", "Rapid Upper Risk Assessment Form (RULA)", "ICU Environment Assessment Form" and "Personal interviews form". RESULTS: There was no difference between sociodemographic characteristics, work and general health conditions within intervention and control group. One month after the intervention, nurses had significant decrease in their total RULA scores during bending down and patient repositioning movements as 1.40 and 0.82, respectively. Six months after the ERMP, the mean total RULA scores of nurses during the patient repositioning was 4.39±1.49 which meant "immediate further analyses and modifications recommended". After all, pain intensity scores, medication use due to pain, and RULA ergonomic risk scores were significantly decreased, while exercise frequency was increased. CONCLUSIONS: The ERMP was effective to increase exercise frequency and to decrease musculoskeletal pain and ergonomic risk levels of ICU nurses.

Posture and discomfort assessment in computer users while using touch screen device as compared with mouse-keyboard and touch pad-keyboard.

BACKGROUND: Touch screen computers require significant arm and hand movements. This can result to body discomfort and biomechanical load in users. OBJECTIVES: This study was carried out to examine posture and users' discomfort while using touch screen device as compared with mouse-keyboard and touch pad-keyboard. METHODS: Twenty three (23) students participated in this experimental study. The subjects completed pre-defined tasks in three 15 min trials by means of touch screen, touch pad-keyboard and mouse-keyboard as input devices. Postural angles were measured by Qualisys motion capture system. Body discomfort was assessed by a 10-cm visual analog scale. Rating scale was employed to assess the perception of subjects on the posture of body parts while utilizing the three devices. RESULTS: There was no significant difference in head inclination when using the three types of devices. Nevertheless, the mean of neck (p = 0.005) and trunk (p < 0.0001) inclinations as well as arm angle (p < 0.0001) while using touch screen, differed significantly from the two other devices and were more deviated from neutral posture. The type of input device was found to have significant effect on the right shoulder (p = 0.017), right elbow (p = 0.031), right wrist/hand (p = 0.004) and whole body discomfort (p = 0.026). Touch screen caused more discomfort in the mentioned regions when compared to the other two devices. Friedman test showed that differences of mean ratings for perceived shoulder and elbow postures in the 3 trials were significant (p = 0.005 and p = 0.011, respectively). Touch screen was the most unfavorable input device based on the subjects' judgment. CONCLUSION: Touch screen caused more deviated postural angles, increased body discomfort and unfavorable postures.

Human and organizational factors in Chinese hazardous chemical accidents: a case study of the '8.12' Tianjin Port fire and explosion using the HFACS-HC.

Human and organizational factors have been proven to be the prime causes of Chinese hazardous chemical accidents (HCAs). A modified version of the Human Factors Analysis and Classification System (HFACS), namely the HFACS-Hazardous Chemicals (HC), was developed to identify the human factors involved in Chinese HCAs. The '8.12' Tianjin Port fire and explosion, the costliest HCA in recent years, was reanalyzed using this framework, and the results were compared with the official accident inquiry report to determine their differences related to the identification of human and organizational factors. The study revealed that interacting human factors from different levels in Ruihai Company led to this catastrophe, and the inquiry report had limitations in the identification of human factors and the guidance for similar accident prevention. This study showed the applicability of the HFACS-HC in HCA analyses as well as the necessity to recommend this approach for future HCA investigations.

Virtual postural assessment of an assembly work in a small scale submersible pump manufacturing industry.

BACKGROUND: Depletion of groundwater has increased the depth of bore wells drilled to meet water requirements. Water from these bore wells are accessed by operating submersible pumps with multi-stages. The number of stages of submersible pump directly depends upon the depth of bore well. Health-related risk such as Musculoskeletal Disorders (MSDs) arises during the manual assembly of these pumps in an awkward posture. OBJECTIVE: The objective of this paper is to eliminate or reduce risk in the manual assembly of submersible pumps using virtual postural analysis. Secondary objective is to redesign the existing workstation incorporating ergonomic interventions. METHODS: It reports a case study in which postural analysis is carried out with the help of Rapid Upper Limb Assessment (RULA) method. RESULTS: It is observed that inserting the stage casing weighing around 1.5 Kg through top end of the shaft is the awkward working posture involving a flexion of the arm about 152°. RULA score (7) indicate a high level of risk exists in the workstation, calling for investigate and change the working posture immediately. In order to reduce this risk, a redesigned workstation has been proposed. CONCLUSION: This study results help in minimizing the awkward postures, thereby reducing the health-related risk. This will also increase the efficiency of the worker and his productivity.

Performance assessment of human resource by integration of HSE and ergonomics and EFQM management system.

Purpose The purpose of this paper is to present an integrated framework for performance evaluation and analysis of human resource (HR) with respect to the factors of health, safety, environment and ergonomics (HSEE) management system, and also the criteria of European federation for quality management (EFQM) as one of the well-known business excellence models. Design/methodology/approach In this study, an intelligent algorithm based on adaptive neuro-fuzzy inference system (ANFIS) along with fuzzy data envelopment analysis (FDEA) are developed and employed to assess the performance of the company. Furthermore, the impact of the factors on the company's performance as well as their strengths and weaknesses are identified by conducting a sensitivity analysis on the results. Similarly, a design of experiment is performed to prioritize the factors in the order of importance. Findings The results show that EFQM model has a far greater impact upon the company's performance than HSEE management system. According to the obtained results, it can be argued that integration of HSEE and EFQM leads to the performance improvement in the company. Practical implications In current study, the required data for executing the proposed framework are collected via valid questionnaires which are filled in by the staff of an aviation industry located in Tehran, Iran. Originality/value Managing HR performance results in improving usability, maintainability and reliability and finally in a significant reduction in the commercial aviation accident rate. Also, study of factors affecting HR performance authorities participate in developing systems in order to help operators better manage human error. This paper for the first time presents an intelligent framework based on ANFIS, FDEA and statistical tests for HR performance assessment and analysis with the ability of handling uncertainty and vagueness existing in real world environment.

Human factors and ergonomics assessment of food pantry work: A case study.

BACKGROUND: Research assessing work processes in food pantries has been limited to the client's experience and aspects of food donations [3-5]. Research on food pantries has yet to focus on understanding and evaluating worker-environment interaction. OBJECTIVE: The present case study examined the interaction between workers and their work environment while performing common tasks in a food pantry. METHODS: Data were collected through naturalistic observations and structured interviews. A task analysis was performed on the data. RESULTS: Several potential issues in the pantry were identified including with the workspace layout, environmental conditions, and signage. Human factors and ergonomics principles were then utilized to provide insights and recommendations (e.g., use of numbered rather than color-coded signage). CONCLUSIONS: Recommendations were provided to the case study food pantry for enhancing safety and productivity. Further research is needed to assess the generalizability of our findings to other food pantries.

Key Recommendations from the MedtecHTA Project.

There are particular characteristics of Medical Devices, such as the device-user interaction, the incremental nature of innovation and the broader organizational impact that lead to additional challenges for health technology assessment (HTA). The project explored key aspects of the conduct and methods of HTA for MDs. Systematic reviews and original research studies were conducted to determine improvements in processes and methods that could enhance the potential for HTA and optimize the diffusion of MDs. Regulatory processes for MDs should be more closely aligned, the HTA evaluative framework should be harmonized and processes for conditional coverage and evidence development should be used. The methods for HTA should consider MDs as complex interventions, require the establishment of high quality registries, consider an iterative approach to the evaluation over time, recognize and allow for the particular characteristics of devices and use appropriate approaches for confounder adjustment in comparative effectiveness studies. To optimize the diffusion, a common classification should be developed across countries in order to facilitate international comparisons, factors driving diffusion should be explored in HTA reports and physicians' personal goals and motivation should be better understood. The key recommendations of the MedtecHTA project should improve the conduct and use of HTA for MDs. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

Human Factors and Organizational Issues in 2015: The Increasing Complexity of the Healthcare Domain Calls for More Comprehensive Approaches.

OBJECTIVE: To summarize significant research contributions on human factors and organizational issues in medical informatics published in 2015. METHODS: An extensive search using PubMed/Medline and Web of Science® was conducted to identify the scientific contributions published in 2015 that address human factors and organizational issues in medical informatics. The selection process comprised three steps: (i) 15 candidate best papers were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of five best papers was conducted by the editorial board of the Yearbook. RESULTS: Noteworthy papers in 2015 emphasize the increasing complexity of the healthcare environment. They call for more comprehensive approaches and evaluation studies. All provide a real added-value in this direction. CONCLUSION: There is no more need to promote the contribution of human factors and ergonomics (HFE) approaches to health IT-related risks and patient safety. However, there is still a need for research on HFE methods to adapt health information technology tools to the complexity of the healthcare domain.

Integrating the Ergonomics Techniques with Multi Criteria Decision Making as a New Approach for Risk Management: An Assessment of Repetitive Tasks -Entropy Case Study.

BACKGROUND: Nowadays, the health work decision makers need to analyze a huge amount of data and consider many conflicting evaluation criteria and sub-criteria. Therefore, an ergonomic evaluation in the work environment in order to the control occupational disorders is considered as the Multi Criteria Decision Making (MCDM) problem. In this study, the ergonomic risks factors, which may influence health, were evaluated in a manufacturing company in 2014. Then entropy method was applied to prioritize the different risk factors. METHODS: This study was done with a descriptive-analytical approach and 13 tasks were included from total number of employees who were working in the seven halls of an ark opal manufacturing (240). Required information was gathered by the demographic questionnaire and Assessment of Repetitive Tasks (ART) method for repetitive task assessment. In addition, entropy was used to prioritize the risk factors based on the ergonomic control needs. RESULTS: The total exposure score based on the ART method calculated was equal to 30.07 ±12.43. Data analysis illustrated that 179 cases (74.6% of tasks) were in the high level of risk area and 13.8% were in the medium level of risk. ART- entropy results revealed that based on the weighted factors, higher value belongs to grip factor and the lowest value was related to neck and hand posture and duration. CONCLUSIONS: Based on the limited financial resources, it seems that MCDM in many challenging situations such as control procedures and priority approaches could be used successfully. Other MCDM methods for evaluating and prioritizing the ergonomic problems are recommended.

Ergonomics Climate Assessment: A measure of operational performance and employee well-being.

Ergonomics interventions have the potential to improve operational performance and employee well-being. We introduce a framework for ergonomics climate, the extent to which an organization emphasizes and supports the design and modification of work to maximize both performance and well-being outcomes. We assessed ergonomics climate at a large manufacturing facility twice during a two-year period. When the organization used ergonomics to promote performance and well-being equally, and at a high level, employees reported less work-related pain. A larger discrepancy between measures of operational performance and employee well-being was associated with increased reports of work-related pain. The direction of this discrepancy was not significantly related to work-related pain, such that it didn't matter which facet was valued more. The Ergonomics Climate Assessment can provide companies with a baseline assessment of the overall value placed on ergonomics and help prioritize areas for improving operational performance and employee well-being.

Evaluation of a clinical simulation-based assessment method for EHR-platforms.

In a procurement process assessment of issues like human factors and interaction between technology and end-users can be challenging. In a large public procurement of an Electronic health record-platform (EHR-platform) in Denmark a clinical simulation-based method for assessing and comparing human factor issues was developed and evaluated. This paper describes the evaluation of the method, its advantages and disadvantages. Our findings showed that clinical simulation is beneficial for assessing user satisfaction, usefulness and patient safety, all though it is resource demanding. The method made it possible to assess qualitative topics during the procurement and it provides an excellent ground for user involvement.

Comparison of concepts in easy-to-use methods for MSD risk assessment.

This article presents a comparative analysis of easy-to-use methods for assessing musculoskeletal load and the risk for developing musculoskeletal disorders. In all such methods, assessment of load consists in defining input data, the procedure and the system of assessment. This article shows what assessment steps the methods have in common; it also shows how those methods differ in each step. In addition, the methods are grouped according to their characteristic features. The conclusion is that the concepts of assessing risk in different methods can be used to develop solutions leading to a comprehensive method appropriate for all work tasks and all parts of the body. However, studies are necessary to verify the accepted premises and to introduce some standardization that would make consolidation possible.

Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries.

BACKGROUND: We conducted this study to investigate how physical and cognitive ergonomic workloads would differ between robotic and laparoscopic surgeries and whether any ergonomic differences would be related to surgeons' robotic surgery skill level. Our hypothesis is that the unique features in robotic surgery will demonstrate skill-related results both in substantially less physical and cognitive workload and uncompromised task performance. METHODS: Thirteen MIS surgeons were recruited for this institutional review board-approved study and divided into three groups based on their robotic surgery experiences: laparoscopy experts with no robotic experience, novices with no or little robotic experience, and robotic experts. Each participant performed six surgical training tasks using traditional laparoscopy and robotic surgery. Physical workload was assessed by using surface electromyography from eight muscles (biceps, triceps, deltoid, trapezius, flexor carpi ulnaris, extensor digitorum, thenar compartment, and erector spinae). Mental workload assessment was conducted using the NASA-TLX. RESULTS: The cumulative muscular workload (CMW) from the biceps and the flexor carpi ulnaris with robotic surgery was significantly lower than with laparoscopy (p < 0.05). Interestingly, the CMW from the trapezius was significantly higher with robotic surgery than with laparoscopy (p < 0.05), but this difference was only observed in laparoscopic experts (LEs) and robotic surgery novices. NASA-TLX analysis showed that both robotic surgery novices and experts expressed lower global workloads with robotic surgery than with laparoscopy, whereas LEs showed higher global workload with robotic surgery (p > 0.05). Robotic surgery experts and novices had significantly higher performance scores with robotic surgery than with laparoscopy (p < 0.05). CONCLUSIONS: This study demonstrated that the physical and cognitive ergonomics with robotic surgery were significantly less challenging. Additionally, several ergonomic components were skill-related. Robotic experts could benefit the most from the ergonomic advantages in robotic surgery. These results emphasize the need for well-structured training and well-defined ergonomics guidelines to maximize the benefits utilizing the robotic surgery.

Diretrizes metodológicas: elaboração de estudos para avaliação de equipamentos médicos assistenciais: estudo de caso: sistema de cirurgia robótica / Methodological guidelines: elaboration of studies to evaluate medical care equipment: case study: robotic surgery system

OBJETIVO: Aplicar a diretriz metodológica para o exemplo de caso Sistema de Cirrugia Robótica. TECNOLOGIA: Robótica/Sistema cirúrgico a ser utilizado em cirurgias minimamente invasivas. APLICAÇÃO NA SAÚDE: Urologia (Procedimentos: Prostatectomia, Nefrectomia Racical, Nefrectomia Parcial, Pieloplastica Reimplantes, Ureterais, Cistoprostatectomias, Cirurgias Pediátricas), Cirurgia do aparelho digestivo, Ginecologia, Cirurgia de Cabeça e Pescoço , Tórax e Cardíaca. Equipamentos (Nome, Fabricante, Marca e Modelo). Sistema Robótico Cirúrgico da Vinci: Intuitive Surgical, S2000 ­ Sistema 4-Arm 3D HD da Vinci. Plataforma Robótica da Vinci: Intuitive, Da Vinci ­ IS 2000.

Novel ergonomic postural assessment method (NERPA) using product-process computer aided engineering for ergonomic workplace design.

BACKGROUND: Musculoskeletal disorders (MSDs) that result from poor ergonomic design are one of the occupational disorders of greatest concern in the industrial sector. A key advantage in the primary design phase is to focus on a method of assessment that detects and evaluates the potential risks experienced by the operative when faced with these types of physical injuries. The method of assessment will improve the process design identifying potential ergonomic improvements from various design alternatives or activities undertaken as part of the cycle of continuous improvement throughout the differing phases of the product life cycle. METHODOLOGY/PRINCIPAL FINDINGS: This paper presents a novel postural assessment method (NERPA) fit for product-process design, which was developed with the help of a digital human model together with a 3D CAD tool, which is widely used in the aeronautic and automotive industries. The power of 3D visualization and the possibility of studying the actual assembly sequence in a virtual environment can allow the functional performance of the parts to be addressed. Such tools can also provide us with an ergonomic workstation design, together with a competitive advantage in the assembly process. CONCLUSIONS: The method developed was used in the design of six production lines, studying 240 manual assembly operations and improving 21 of them. This study demonstrated the proposed method's usefulness and found statistically significant differences in the evaluations of the proposed method and the widely used Rapid Upper Limb Assessment (RULA) method.

Stasis and adaptation.

Many of our most pressing societal challenges arise from our inability to move on from present practices and structures and do what is needed. Healthcare struggles to improve safety and quality. It resists adoption of best practices and persists in high levels of unwarranted variation in care delivery, and clings to financially unsustainable models of care. One explanation for this state of affairs is not a lack of will, but that we are experiencing system inertia--a consequence of the increasing complexity of our human systems. In this paper I explore three possible system level interventions that may help design systems that are less likely to approach inertia, as well as help change our current systems so that they again become adaptive, and move to the outcomes we desire. Firstly, I question our religious belief in the power of standards, an intervention designed to minimise adaptation and almost from first principles designed to lead to inertia. Next I explore the power of apoptosis, a process that sees existing structures and practices programmatically removed to free up resource for adaptation. Finally I explore a flexible but controversial approach to system management called market-based control. Whether any of these, together or in tandem, are a way out of inertia is an open question. However, it is time for us to engage with the challenge of system inertia, and find a way out.