Musculoskeletal and Cognitive Effects of a Movement Intervention During Prolonged Standing for Office Work.

OBJECTIVE: To investigate whether use of a movement intervention when undertaking prolonged standing affected discomfort and cognitive function. BACKGROUND: Alternate work positions to break up prolonged sitting for office workers are being trialed, such as standing. Prolonged standing has potential negative health implications, including low back and lower limb discomfort, and may influence cognitive function. Introducing movement during standing may provide a healthy and productive alternative work posture. METHOD: Twenty adult participants undertook a laboratory study of 2 hr of standing and standing with movement (using a footrest) while performing computer work. Changes in discomfort and cognitive function, with muscle fatigue, low back angle, pelvis movement, lower limb swelling, and mental state, were investigated. RESULTS: Discomfort increased significantly over time across all body regions. Ankle/foot differed between conditions (incident rate ratio [95% confidence interval]: 1.89 [1.10-3.23]), with higher discomfort during standing with movement. Creative problem-solving errors increased during standing with movement and decreased during standing (Time × Condition: ß = 0.64 [0.10-1.18]), with no other cognitive function measure differences. Mental state deteriorated over time for both conditions, greater during standing with movement (Time × Condition: ß = 2.44 [0.23-4.66]). No significant interaction effects were found for the other outcome variables. CONCLUSION: Standing with movement provided no advantage in discomfort or cognitive function. There were some negative effects for ankle/foot discomfort and creative problem solving. An alternate footrest design and protocol for use may yield more favorable results. APPLICATION: Based on the results from this study, footrest use to raise alternative foot for forced 5-min intervals would not be recommended to assist with managing discomfort while prolonged standing in workplaces.

A detailed description of the short-term musculoskeletal and cognitive effects of prolonged standing for office computer work.

Due to concerns about excessive sedentary exposure for office workers, alternate work positions such as standing are being trialled. However, prolonged standing may have health and productivity impacts, which this study assessed. Twenty adult participants undertook two hours of laboratory-based standing computer work to investigate changes in discomfort and cognitive function, along with muscle fatigue, movement, lower limb swelling and mental state. Over time, discomfort increased in all body areas (total body IRR [95% confidence interval]: 1.47[1.36-1.59]). Sustained attention reaction time (ß = 18.25[8.00-28.51]) deteriorated, while creative problem solving improved (ß = 0.89[0.29-1.49]). There was no change in erector spinae, rectus femoris, biceps femoris or tibialis anterior muscle fatigue; low back angle changed towards less  lordosis, pelvis movement increased, lower limb swelling increased and mental state decreased. Body discomfort was positively correlated with mental state. The observed changes suggest replacing office work sitting with standing should be done with caution. Practitioner Summary: Standing is being used to replace sitting by office workers; however, there are health risks associated with prolonged standing. In a laboratory study involving 2 h prolonged standing discomfort increased (all body areas), reaction time and mental state deteriorated while creative problem-solving improved. Prolonged standing should be undertaken with caution.

High alcohol use a strong and significant risk factor for repetitive self-harm in female and male youth: a prospective cohort study.

BACKGROUND: Deliberate self-harm (DSH) is reported by between 5 and 17% of youth aged 14-25 years. Current management measures focus on repetition prevention in high-risk groups. OBJECTIVES: To examine risk factors and predictors of DSH and DSH repetition in a community sample, by gender. METHODS: A prospective cohort of 20,822 young adults (aged 17-24 years) was recruited when obtaining their driving license. A random sample of 5000 was approached for follow-up 12-18 months; 2991 (60%) responded and formed the cohort for this analysis. Patterns of self-harm, using a modified Beck Suicide Inventory, were investigated with logistic regression. RESULTS: DSH was reported by 4.1% (123/2991) at baseline. Over the following 12 months, 3.0% (90/2991) reported new instances of DSH which included 20% (25) respondents who had engaged in DSH at baseline. Psychological distress was a risk factor for engaging in DSH in the past 12 months, OR 3.55 (95% CI 2.06-6.14). Although several clinical risk factors differed between genders, high alcohol use, OR 23.6 (95% CI 3.64-153) and psychological distress, OR 4.97 (95% CI 1.08-22.9) were significant risk factors for repeat DSH in both males and females. CONCLUSION: In this community cohort, 1 in 25 youth had self-harmed in the year prior; of these, 4 in 5 did not repeat DSH over the following year. High alcohol use stands out as a strong risk factor for DSH repetition. Assessing alcohol use may help clinicians identify those who are at greatest risk for repetitive self-harm.

Sacred cow gone to pasture: a systematic evaluation and integration of evidence-based practice.

BACKGROUND: Sacred cows (SC) are old habits in practice, considered routine and above dispute, regardless of evidence to the contrary. PURPOSE: This is the first known report that aims to conduct a systematic evaluation of practices that have been described in the literature as SC and strategies for planned implementation of evidence-based practices (EBP). METHODS: A large, complex, academic medical center department of nursing compared SC to EBP. Nurses systematically reviewed and rated the degree to which current practices adhered to best-evidence versus SC. This initiative, "Sacred Cow: Gone to Pasture," was developed, structured, and implemented according to the Iowa Model of Evidence-Based Practice to Promote Quality Care, as well as Everett Rogers' Diffusions of Innovations Theory. Implementation of EBP followed a phase plan using the Implementation Strategies for Evidence-Based Practice to help to support adoption and integration. RESULTS: Review of organization-specific policies and procedures and reports of actual practices revealed that SC persist, even in a center internationally recognized as a leader in EBP. The SC initiative caught the attention of busy clinicians, and raised awareness of SC and the importance of adherence to EBP. The SC initiative resulted in policy and practice changes and sparked new EBP and research, resulting in numerous improvements, including a significant decline in catheter-associated urinary tract infections and shifting from basins to commercially prepared cloths for patient bathing. LINKING EVIDENCE TO ACTION: A strategic approach is crucial to eliminating SC and integrating EBP. This report calls nurses globally to action, to identify and abandon ineffective healthcare practices. Further research should compare and test the efficacy of implementation strategies, in particular how to sustain EBP in clinical settings.

The role of sleepiness, sleep disorders, and the work environment on heavy-vehicle crashes in 2 Australian states.

Heavy-vehicle driving involves a challenging work environment and a high crash rate. We investigated the associations of sleepiness, sleep disorders, and work environment (including truck characteristics) with the risk of crashing between 2008 and 2011 in the Australian states of New South Wales and Western Australia. We conducted a case-control study of 530 heavy-vehicle drivers who had recently crashed and 517 heavy-vehicle drivers who had not. Drivers' crash histories, truck details, driving schedules, payment rates, sleep patterns, and measures of health were collected. Subjects wore a nasal flow monitor for 1 night to assess for obstructive sleep apnea. Driving schedules that included the period between midnight and 5:59 am were associated with increased likelihood of crashing (odds ratio = 3.42, 95% confidence interval: 2.04, 5.74), as were having an empty load (odds ratio = 2.61, 95% confidence interval: 1.72, 3.97) and being a less experienced driver (odds ratio = 3.25, 95% confidence interval: 2.37, 4.46). Not taking regular breaks and the lack of vehicle safety devices were also associated with increased crash risk. Despite the high prevalence of obstructive sleep apnea, it was not associated with the risk of a heavy-vehicle nonfatal, nonsevere crash. Scheduling of driving to avoid midnight-to-dawn driving and the use of more frequent rest breaks are likely to reduce the risk of heavy-vehicle nonfatal, nonsevere crashes by 2-3 times.

What do human factors and ergonomics professionals value in research publications? Re-examining the research-practice gap.

The research-practice gap is of concern in human factors/ergonomics (HF/E) as there is a belief that HF/E research may not be making an impact on practice in the 'real world'. A potential issue is what researchers and practitioners perceive as important in HF/E journal articles as a primary means of conveying research findings to practitioners. This study examined the characteristics that make scientific journal articles appeal to HF/E researchers and practitioners using a web-based survey. HF/E researchers and practitioners were more similar than expected in judgements of important attributes and the selection of articles. Both practitioners and researchers considered practical significance to be more important than theoretical significance, in direct contrast to professionals from a related discipline--psychology. Well-written articles were appreciated across disciplines. The results signal a strong interest in practical applications in HF/E, but a relative lack of focus on development of theories that should be the basis for practical applications.

Risk factors for unintentional poisoning in children aged 1-3 years in NSW Australia: a case-control study.

BACKGROUND: Unintentional poisoning in young children is an important public health issue. Age pattern studies have demonstrated that children aged 1-3 years have the highest levels of poisoning risk among children aged 0-4 years, yet little research has been conducted regarding risk factors specific to this three-year age group and the methodologies employed varied greatly. The purpose of the current study is to investigate a broad range of potential risk factors for unintentional poisoning in children aged 1-3 years using appropriate methodologies. METHODS: Four groups of children, one case group (children who had experienced a poisoning event) and three control groups (children who had been 'injured', 'sick' or who were 'healthy'), and their mothers (mother-child dyads) were enrolled into a case-control study. All mother-child dyads participated in a 1.5-hour child developmental screening and observation, with mothers responding to a series of questionnaires at home. Data were analysed as three case-control pairs with multivariate analyses used to control for age and sex differences between child cases and controls. RESULTS: Five risk factors were included in the final multivariate models for one or more case-control pairs. All three models found that children whose mothers used more positive control in their interactions during a structured task had higher odds of poisoning. Two models showed that maternal psychiatric distress increased poisoning risk (poisoning-injury and poisoning-healthy). Individual models identified the following variables as risk factors: less proximal maternal supervision during risk taking activities (poisoning-injury), medicinal substances stored in more accessible locations in bathrooms (poisoning-sick) and lower total parenting stress (poisoning-healthy). CONCLUSIONS: The findings of this study indicate that the nature of the caregiver-child relationship and caregiver attributes play an important role in influencing poisoning risk. Further research is warranted to explore the link between caregiver-child relationships and unintentional poisoning risk. Caregiver education should focus on the benefits of close interaction with their child as a prevention measure.

Learning With a Supervisor Who has Traffic Offences and Young Driver Crashes: The DRIVE Study 13-Year Follow-Up.

PURPOSE: Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by someone who they perceived had traffic offences versus no offences had different crash records over a period of 13 years postlicensing. METHODS: DRIVE is an Australian prospective cohort study of more than 20,000 drivers who were aged 17-24 years and newly licensed during 2003-2004. They completed detailed baseline questionnaires, including whether the person they identified as supervising their learner driving the most had perceived traffic offences in the past 12 months. Responses were linked to their state crash, hospitalization, and death records to 2016. A parametric survival model was created to calculate hazard ratios of time to crash for those reporting that their supervisor had 0 versus 1 and 0 versus 2+ perceived offences, adjusting for the participants' prior crash history and other covariates. RESULTS: After adjusting for covariates, 369 participants reporting supervisory drivers with 2+ perceived offences, compared to 15,451 participants reporting no such offences, had up to 1.67 (95% confidence interval 1.10-2.53 at 6 months) times the rate of any crash for the first 2.5 years and up to 2.01 (95% confidence interval 1.26-3.19 at 3.5 years) times the rate of crashes resulting in injury for 5.5 years. DISCUSSION: Although overall supervision by a driver with two or more perceived offences was low, further attention is needed to ensure improved supervised driving experiences, with mentoring programs and professional instructor partnerships worthy of exploration.

Leading causes of injury hospitalisation in children aged 0-4 years in New South Wales by injury submechanism: a brief profile by age and sex.

AIM: To identify the leading causes of injury in children aged 0-4 years by single year of age using injury submechanisms and present a brief epidemiologic profile of each cause. METHODS: Hospitalisation data for New South Wales from 1999 to 2009 were used to identify the leading causes of injury for children aged 0-4 years by single year of age. For each leading cause, rates over time and by sex were calculated by single year of age. Associated age and sex risk ratios were estimated. RESULTS: The leading causes of injury for children aged <1, 1 and 2 years were falls while being carried, burns by hot non-aqueous substances and poisoning by other and unspecified pharmaceutical substances, respectively. Falls involving playground equipment ranked first for children aged 3-4 years. Each leading injury cause exhibited an age pattern that remained stable over time and by sex. Age predicted falls while being carried and both age and sex predicted the remaining leading injury causes, with age and sex interacting to predict burns by hot non-aqueous substances. CONCLUSIONS: Epidemiologic analysis using single-year age intervals and injury submechanisms results in a clearer picture of injury risk for young children. The findings of this study provide detailed information regarding the leading causes of hospitalised injury in young children by age and sex. Child health-care providers can use this information to focus discussions of child development and injury risk with families of young children and suggest appropriate prevention measures in terms of a child's age and sex.

Driving monotonous routes in a train simulator: the effect of task demand on driving performance and subjective experience.

Although monotony is widely recognised as being detrimental to performance, its occurrence and effects are not yet well understood. This is despite the fact that task-related characteristics, such as monotony and low task demand, have been shown to contribute to performance decrements over time. Participants completed one of two simulated train-driving scenarios. Both were highly monotonous and differed only in terms of the level of cognitive demand required (i.e. low demand or high demand). These results highlight the seriously detrimental effects of the combination of monotony and low task demands and clearly show that even a relatively minor increase in cognitive demand can mitigate adverse monotony-related effects on performance for extended periods of time. Monotony is an inherent characteristic of transport industries, including rail, aviation and road transport, which can have adverse impact on safety, reliability and efficiency. This study highlights possible strategies for mitigating these adverse effects. Practitioner Summary: This study provides evidence for the importance of cognitive demand in mitigating monotony-related effects on performance. The results have clear implications for the rapid onset of performance deterioration in low demand monotonous tasks and demonstrate that these detrimental performance effects can be overcome with simple solutions, such as making the task more cognitively engaging.

Practice Adjustments Made by Family Physicians During the COVID-19 Pandemic.

INTRODUCTION: COVID-19 pandemic-related health care disruptions necessitated rapid adaptation among family physicians to safely meet patient needs while protecting themselves and their staff. On April 1, 2020, the American Board of Family Medicine (ABFM) introduced a COVID Performance Improvement (PI) activity for physicians to report on and receive Family Medicine certification credit for practice adjustments they made during the early stages of the pandemic. We aimed to understand the types of interventions implemented, and lessons physicians learned from the efforts. METHODS: We analyzed data from COVID-PI activities submitted by self-selected family physicians between April 1 and June 30, 2020. We summarized the COVID-related topics chosen for improvement and performed a qualitative content analysis on a random sample of open-text responses about lessons learned. RESULTS: The most common practice changes among 1259 unique COVID-PI activity submissions related to virtualization of patient visits, implementing new workflows, developing screening protocols, and obtaining and preserving personal protective equipment. We identified 12 themes regarding lessons learned, most commonly regarding patient and staff safety, modified practice processes and workflows, positive perceptions of and future plans for virtual visits, access to care, and patient satisfaction. Most submitters noted early successes with their interventions. CONCLUSION: A PI activity template designed for continuous board certification allowed family physicians to report on how they successfully implemented short term practice changes during the early stages of the COVID-19 pandemic. Reflections from this subset of physicians regarding lessons learned may prove useful in informing future COVID-19 related practice changes.

Dynamic in vivo mapping of model moisturiser ingress into human skin by GARfield MRI.

We describe the development of in vivo one-dimensional MRI (profiling) using a GARField (Gradient At Right angles to Field) magnet for the characterisation of side-of-hand human skin. For the first time and in vivo, we report measurements of the NMR longitudinal and transverse relaxation parameters and self-diffusivity of the upper layers of human skin with a nominal spatial resolution better than 10 µm. The results are correlated with in vivo confocal Raman spectroscopy measurements of water concentration and natural moisturiser factors, and discussed in terms of known skin biology and microstructure of the stratum corneum and viable epidermis. The application of model moisturiser solutions to the skin is followed and their dynamics of ingress are characterised using the MRI methodology developed. Selected hydrophilic and lipophilic formulations are studied. The results are corroborated by standard in vivo measurements of transepidermal water loss and hydration status. A further insight into moisturisation mechanisms is gained. The effect of two different penetration enhancers on a commonly used skin care oil is also discussed, and different timescales of oil penetration into the skin are reported depending on the type of enhancer.

Defining the drivers for accepting decision making automation in air traffic management.

Air Traffic Management (ATM) operators are under increasing pressure to improve the efficiency of their operation to cater for forecasted increases in air traffic movements. One solution involves increasing the utilisation of automation within the ATM system. The success of this approach is contingent on Air Traffic Control Operators' (ATCOs) willingness to accept increased levels of automation. The main aim of the present research was to examine the drivers underpinning ATCOs' willingness to accept increased utilisation of automation within their role. Two fictitious scenarios involving the application of two new automated decision-making tools were created. The results of an online survey revealed traditional predictors of automation acceptance such as age, trust and job satisfaction explain between 4 and 7% of the variance. Furthermore, these predictors varied depending on the purpose in which the automation was to be employed. These results are discussed from an applied and theoretical perspective. STATEMENT OF RELEVANCE: Efficiency improvements in ATM are required to cater for forecasted increases in air traffic movements. One solution is to increase the utilisation of automation within Air Traffic Control. The present research examines the drivers underpinning air traffic controllers' willingness to accept increased levels of automation in their role.

Thermal taster status: Temperature modulation of cortical response to sweetness perception.

Temperature is known to impact taste perception, but its reported effect on sweet taste perception in humans is inconsistent. Here, we assess whether thermal taste phenotype alters the temperature modulation of the brains' response to sweet samples and sweet taste perception. Participants (n = 24 balanced for thermal tasters (TT) and thermal non-tasters (TnT), 25 ± 7 years (mean ± SD), 10 males) underwent a thermal taste phenotyping session to study responses to cooling and warming of the tongue using a thermode. In a separate session, functional Magnetic Resonance Images (fMRI) were collected during sweet samples (87 mM sucrose) delivery at two temperatures ('cold' (5 ± 2 °C) and 'ambient' (20 ± 2 °C)) and the perceived sweetness intensity rated.In the phenotyping session, TTs had heightened perceptual temperature sensitivity to cooling and warming of the tongue using a thermode compared to TnTs. Although there was no significant effect during the fMRI session, the fMRI response to the 'cold sweet' sample across all participants was significantly increased in anterior insula/frontal operculum and mid-insula compared to the 'ambient sweet' sample, likely to reflect the perceptual difference to temperature rather than taste perception. TTs showed significantly increased fMRI activation patterns compared with TnTs and an interaction effect between thermal taster status and sample temperature, with TTs showing selectively greater cortical responses to 'cold sweet' samples compared to TnTs in somatosensory regions (SI and SII).The increase in cortical activation in somatosensory cortices to the 'cold sweet' stimulus correlated with perceptual ratings of temperature sensitivity to the thermode. The results highlight the importance of investigating the effects of thermal taster phenotype across a range of temperatures representing the reality of consumer consumption to beverages.

Estimates of drowning morbidity and mortality adjusted for exposure to risk.

OBJECTIVES: To estimate the rate of unintentional drowning mortality and hospitalised morbidity using population-based, population-risk and person-time denominator data and to compare the estimates obtained. To then compare exposure-based rates for drowning with road traffic death rates. METHOD: Retrospective analysis of unintentional drowning mortality and hospitalised morbidity of New South Wales (NSW, Australia) residents 16+ years of age during 1 January to 31 December 2005. Information on population-risk and person-time risk was obtained from the 2005 NSW Population Health Survey. Analysis of road traffic death data from NSW and population and person-time risk estimates from the Survey of Vehicle Use, Household Travel Surveys and Roads and Traffic Authority Speed Surveys in 2005. RESULTS: Estimated drowning mortality and hospitalised morbidity rates for adults were higher using population-risk and person-time risk exposures compared to a population-based exposure. Population-based estimates of road traffic mortality were four times higher than drowning mortality rates. In contrast, exposure adjusted person-time estimates for drowning were 200 times higher than road traffic fatalities. CONCLUSIONS: Many injury risks are underestimated when the total age-specific population is used to calculate an injury rate instead of actual population-risk or person-time exposure. This can result in the identification of misleading priorities for injury prevention. Drowning risk is strikingly higher than previously thought based on population-based estimates. This information is important for decision-making and policy development as it provides a basis for comparing the inherent risk in exposure to hazards with potential to cause injury.

Accuracy of self-report of on-road crashes and traffic offences in a cohort of young drivers: the DRIVE study.

In order to determine the accuracy of self-report of on-road crashes and traffic offences among participants in the DRIVE study, 2991 young drivers in New South Wales, Australia who completed the follow-up questionnaire were asked whether they had been involved in an on-road crash or were convicted for a traffic offence while driving during the year prior to the survey. This information was linked to police crash data to determine the level of accuracy of self-report of on-road crashes. There was a high level of accuracy in young drivers' self-report of police recorded crashes (85.1%; 95% CI 78.2% to 92.1%) and of police recorded traffic offences (83.0%; 95% CI 79.4% to 86.6%). Results suggest that surveys may be useful tools for estimating the incidence of on-road crashes and traffic offences in young drivers. The findings are particularly relevant to jurisdictions where access to administrative data is limited.

The heavy vehicle study: a case-control study investigating risk factors for crash in long distance heavy vehicle drivers in Australia.

BACKGROUND: Heavy vehicle transportation continues to grow internationally; yet crash rates are high, and the risk of injury and death extends to all road users. The work environment for the heavy vehicle driver poses many challenges; conditions such as scheduling and payment are proposed risk factors for crash, yet the precise measure of these needs quantifying. Other risk factors such as sleep disorders including obstructive sleep apnoea have been shown to increase crash risk in motor vehicle drivers however the risk of heavy vehicle crash from this and related health conditions needs detailed investigation. METHODS AND DESIGN: The proposed case control study will recruit 1034 long distance heavy vehicle drivers: 517 who have crashed and 517 who have not. All participants will be interviewed at length, regarding their driving and crash history, typical workloads, scheduling and payment, trip history over several days, sleep patterns, health, and substance use. All participants will have administered a nasal flow monitor for the detection of obstructive sleep apnoea. DISCUSSION: Significant attention has been paid to the enforcement of legislation aiming to deter problems such as excess loading, speeding and substance use; however, there is inconclusive evidence as to the direction and strength of associations of many other postulated risk factors for heavy vehicle crashes. The influence of factors such as remuneration and scheduling on crash risk is unclear; so too the association between sleep apnoea and the risk of heavy vehicle driver crash. Contributory factors such as sleep quality and quantity, body mass and health status will be investigated. Quantifying the measure of effect of these factors on the heavy vehicle driver will inform policy development that aims toward safer driving practices and reduction in heavy vehicle crash; protecting the lives of many on the road network.

Self-harm and risk of motor vehicle crashes among young drivers: findings from the DRIVE Study.

BACKGROUND: Some motor vehicle crashes, particularly single-vehicle crashes, may result from intentional self-harm. We conducted a prospective cohort study to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers. METHODS: We prospectively linked survey data from newly licensed drivers aged 17-24 years to data on licensing attempts and police-reported motor vehicle crashes during the follow-up period. We investigated the role of recent engagement in self-harm on the risk of a crash. We took into account potential confounders, including number of hours of driving per week, psychological symptoms and substance abuse. RESULTS: We included 18 871 drivers who participated in the DRIVE Study for whom data on self-harm and motor vehicle crashes were available. The mean follow-up was 2 years. Overall, 1495 drivers had 1 or more crashes during the follow-up period. A total of 871 drivers (4.6%) reported that they had engaged in self-harm in the year before the survey. These drivers were at significantly increased risk of a motor vehicle crash compared with drivers who reported no self-harm (relative risk [RR] 1.42, 95% confidence interval [CI] 1.15-1.76). The risk remained significant, even after adjustment for age, sex, average hours of driving per week, previous crash, psychological distress, duration of sleep, risky driving behaviour, substance use, remoteness of residence and socio-economic status (RR 1.37, 95% CI 1.09-1.72). Most of the drivers who reported self-harm and had a subsequent crash were involved in a multiple-vehicle crash (84.1% [74/88]). INTERPRETATION: Engagement in self-harm behaviour was an independent risk factor for subsequent motor vehicle crash among young drivers, with most crashes involving multiple vehicles.

The development of an evaluation framework for injury surveillance systems.

BACKGROUND: Access to good quality information from injury surveillance is essential to develop and monitor injury prevention activities. To determine if information obtained from surveillance is of high quality, the limitations and strengths of a surveillance system are often examined. Guidelines have been developed to assist in evaluating certain types of surveillance systems. However, to date, no standard guidelines have been developed to specifically evaluate an injury surveillance system. The aim of this research is to develop a framework to guide the evaluation of injury surveillance systems. METHODS: The development of an Evaluation Framework for Injury Surveillance Systems (EFISS) involved a four stage process. First, a literature review was conducted to identify an initial set of characteristics that were recognised as important and/or had been recommended to be assessed in an evaluation of a surveillance system. Second, this set of characteristics was assessed using SMART criteria. Third, those surviving were presented to an expert panel using a two round modified-Delphi study to gain an alternative perspective on characteristic definitions, practicality of assessment, and characteristic importance. Finally, a rating system was created for the EFISS characteristics. RESULTS: The resulting EFISS consisted of 18 characteristics that assess three areas of an injury surveillance system - five characteristics assess data quality, nine characteristics assess the system's operation, and four characteristics assess the practical capability of an injury surveillance system. A rating system assesses the performance of each characteristic. CONCLUSION: The development of the EFISS builds upon existing evaluation guidelines for surveillance systems and provides a framework tailored to evaluate an injury surveillance system. Ultimately, information obtained through an evaluation of an injury data collection using the EFISS would be useful for agencies to recommend how a collection could be improved to increase its usefulness for injury surveillance and in the long-term injury prevention.

The musculoskeletal and cognitive effects of under-desk cycling compared to sitting for office workers.

Alternate work positions are being considered as a way to address sedentary behaviour for office workers. This study evaluated the effect of two hours of just-sitting versus sitting while under-desk cycling on musculoskeletal discomfort and cognitive function (sustained attention and creative problem solving). To consider mechanisms, muscle fatigue, kinematics and mental state were also measured. Discomfort increased significantly across all body areas with knee and ankle discomfort greater (in a clinically meaningful manner) in under-desk cycling. Sustained attention reaction time was the only cognitive measure to show a difference between conditions (slower for under-desk cycling [ß-34.82 CI (-62.12 to -7.53)]). There was no evidence of muscle fatigue, while kinematic differences between conditions were identified. Mental state deteriorated over time in both conditions. This study found no clear benefit of under-desk cycling compared to just-sitting for musculoskeletal health and cognitive function measures.