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ImportanceWork-related musculoskeletal disorders are common among otolaryngologists and can be associated with decreased productivity, missed workdays, and reduced quality of life. Ergonomic risk for surgeons is elevated during common otolaryngology procedures; current ergonomic interventions lack the ability to provide real-time feedback. The ability to quantify and mitigate ergonomic risk during surgery may reduce work-related musculoskeletal disorders.ObjectiveTo quantify the association of vibrotactile biofeedback with intraoperative ergonomic risk to surgeons during tonsillectomy.Design, Setting, and ParticipantsThis cross-sectional study was conducted between June 2021 and October 2021 at a freestanding tertiary care children’s hospital and included 11 attending pediatric otolaryngologists. Data analysis was conducted from August to October 2021.InterventionsReal-time quantification of ergonomic risk during tonsillectomy and the use of a vibrotactile biofeedback posture monitor.Main Outcomes and MeasuresAssociation of vibrotactile biofeedback with objective measures of ergonomic risk. Assessment tools included the Rapid Upper Limb Assessment, craniovertebral angle, and time spent in an at-risk posture.ResultsEleven surgeons (mean [SD] age 42 [7] years; 2 women [18%]) performed 126 procedures with continuous posture monitoring in the presence (80 [63%]) and absence (46 [37%]) of vibrotactile biofeedback. No complications or delays associated with the device were reported. Intraoperative vibrotactile biofeedback was associated with improved Rapid Upper Limit Assessment neck, trunk, and leg scores by 0.15 (95% CI, 0.05-0.25), improved craniovertebral angle by 1.9 (95% CI, 0.32-3.40), and decreased overall time spent in an at-risk posture by 30% (95% CI, 22%-39%).Conclusions and RelevanceThe results of this cross-sectional study suggest that use of a vibrotactile biofeedback device to quantify and mitigate ergonomic risk for surgeons is feasible and safe while performing surgery. Vibrotactile biofeedback was associated with reduced ergonomic risk during tonsillectomy and may have a role in improving surgical ergonomics and preventing work-related musculoskeletal disorders.

This paper draws on interviews with 20 touring professional golfers to examine the influence of the global spread of European tournaments on players’ approaches to the game. Results indicate that a variety of processes, such as attempts to standardize course set up and typography of host country, have led to a diminishing of contrasts and, at the same time, increasing varieties in the way that golfers approach the game. Players are constrained to develop similar types of play to each other, with a greater emphasis on hitting long accurate shots, while also being required to manage constant varieties of grass types, climates, and altitudes. The theory of diminishing contrasts and increasing varieties is used to help explain the growing homogenization of players’ games while also recognizing the variety alongside this, both in terms of playing style, at different levels, and styles of courses, at all levels.

This work investigated the relationship between task performance and situation awareness ( SA) at different levels of automation (LOA). The conventional wisdom is that routine performance improves with level of automation but that the consequences of automation failure become more severe. This has been characterized as a routine-failure trade-off, However, recent research indicates that the trade-off is subject to unknown contextual factors in addition to the level of automation. Furthermore, it has been suggested that the human operator’s SA may impact whether the trade-off between performance under routine and failure conditions is always tenable. The current study therefore aimed to i) provide evidence to support or refute the trade-off and ii) to identify possible extenuating factors. The results generally supported the existence of the routine-failure trade-off, though the strength of this finding was tempered somewhat by operators’ apparent selective disuse of higher level automation which limited the effective range of LOA tested. We interpreted that the SA collection method made the goal of SA maintenance explicit and in doing so encouraged operators to preferentially reallocate attention away from other system goals. Thus, the functional structure of the task seems to affect whether the routine-failure trade-off occurs in a given instance.