Repetitive Manual Tasks Research Articles

Assessment of Lateral Epicondylitis in Butchers in Islamabad

Background: Lateral epicondylitis, or tennis elbow, is a common overuse injury affecting the extensor muscles of the forearm, particularly in professions requiring repetitive manual tasks, such as butchery.Objective: To assess the prevalence of lateral epicondylitis among butchers in Islamabad and its association with occupational risk factors.Methods: A correlational study was conducted between February and July 2022, involving 205 butchers selected through convenience sampling. Participants with at least one year of work experience were included, while those with pre-existing injuries or diabetes were excluded. Data were collected using the Pain Rating Scale, DASH questionnaire, and Cozen’s test. Descriptive and inferential statistics were performed using SPSS version 25, with a significance level of 0.05.Results: The prevalence of lateral epicondylitis was 23.41% (n=48). Butchers working more than 9 hours daily had a significantly higher prevalence (p=0.001). Mild to moderate pain was reported by 26.3% to 21.5% of participants, particularly in the arm and shoulder.Conclusion: The study found a high prevalence of lateral epicondylitis among butchers, linked to prolonged working hours and repetitive tasks. Ergonomic interventions and work modifications are recommended to reduce risk.

A holonic approach to clinical pathway data analysis

BackgroundHealthcare faces challenges due to the advancements of Industry 4.0 as large volumes of data are generated within healthcare facilities that, combined with the complex nature of healthcare environments, make it difficult to utilise and interpret this data effectively. PurposeA novel holonic approach to clinical pathway data analysis is presented and implemented as a clinical pathway digital twin. A holon is here taken to be an autonomous and co-operative building block of a software system for transforming, transporting, storing and/or validating information. The digital twin's aim is to ingest, structure and analyse the information associated with a clinical pathway to support healthcare professionals in making informed decisions, for example monitoring and predicting the duration from admission to discharge for individual patients. MethodReal world observations and a review of literature led to the identification of a generic set of clinical pathway analysis needs and, derived therefrom, a set of design requirements. A proof-of-concept clinical pathway analysis digital twin was implemented using a holonic approach derived from the ARTI reference architecture. The holonic approach is evaluated in a hip and knee replacement pathway case study. The evaluation includes automated statistical analyses and machine learning predictions. ResultsThe evaluation demonstrates that the holonic approach provides an intuitive and extensible means to aggregate and disaggregate information tactically, and to derive context-tailored analysis features. The holonic approach enhances checking for data completion and handling data anomalies. The evaluation also demonstrates on-demand report generation, which reduces repetitive manual tasks for healthcare professionals. ConclusionThe novel holonic data analysis approach facilitates context-rich analyses tailored to specific clinical pathway activities, with effective tailoring of data ingestion and analysis. Healthcare professionals can use the data analysis approach to extract valuable insights for decision-making related to clinical pathways.

Analysis and study on biomarkers of local muscle fatigue caused by repetitive lifting task

BackgroundWork-related musculoskeletal disorders (WMSDs) show a rapid growth trend. It has brought a huge economic burden to the society and become a serious occupational health problem that needs to be solved urgently. This study aimed to analyze the local muscle response under continuous ergonomic load, screen sensitive fatigue-related biomarkers and provide data support for the early prevention of local muscle damage and the exploration of early warning indicators.MethodsThirteen male college student volunteers were recruited to perform simulated repetitive manual lifting tasks in the laboratory. The lifting task was designed for 4 periods which lasted for 12 min in each, and then paused for 3 min for sampling. Local muscle fatigue is assesed by the Rating of perceived exertion (RPE) and the Joint analysis of sEMG spectrum and amplitude (JASA). Elbow venous blood was collected and 14 kinds of biomarkers were analyzed, which included Metabolic markers Ammonia (AMM), Lactic acid (LAC), Creatine kinase (CK), Lactate dehydrogenase (LDH), Cartilage oligomeric matrix protein (COMP), C-telopeptide of collagen I and II (CTX-I, CTX-II) and Calcium ion (Ca2+); Oxidative stress marker Glutathione (GSH); Inflammatory markers C-reaction protein (CRP), Prostaglandin E2 (PG-E2), Interleukin-6 (IL-6) and Tumor necrosis factor α (TNF-α); Pain marker Neuropeptide Y (NPY). Repeated measures analysis of variance (Repeated ANOVA), linear regression analysis, t-test and spearman correlation analysis were used to analyze the data.ResultsBoth subjective and objective fatigue appeared at the same period. Serum AMM, LAC, CK, LDH, COMP, CTX-II, Ca2+ and NPY after fatigue were significantly higher than those before fatigue (p < 0.05). There was a certain degree of correlation between the markers with statistical differences before and after fatigue.ConclusionsMetabolic markers (serum AMM, LAC, CK, LDH, COMP, CTX-II, Ca2+) and pain markers (serum NPY) can reflect local muscle fatigue to a certain extent in repetitive manual lifting tasks. It is necessary to further expand the research on fatigue-related biomarkers in different types of subjects and jobs in the future.

Development of soft wearable robotic gloves to prevent muscle fatigue and enhance work efficiency

This study aimed to develop wearable robotic gloves that can provide comfort to logistics and transportation workers while providing hand assistance and addressing accumulated muscle fatigue caused by repetitive manual handling tasks. Two types of gloves, rivet-type and pouch-type were developed and evaluated using the nine-hole peg test (NHPT) and grip strength tests. Results showed rivet-type gloves had better dexterity, with an 8.14% faster NHPT time, and maintained 85% grip strength compared to 80% for pouch-type gloves, even after fatigue exercises. Wearability tests were conducted by measuring clothing pressure and brainwaves. In contrast to the functional experimental results, the pouch-type gloves exhibited significant decreases in clothing pressure during actuation. According to the difference in brain waves in the frontal lobe region, the beta and gamma waves observed when wearing pouch-type gloves were lower than those of rivet-type gloves, and pouch-type gloves exhibited higher alpha-wave results than rivet-type gloves. These results imply that participants were in a comparatively relaxed state when wearing pouch-type gloves. A wearer’s evaluation survey on the overall design, function, comfort, safety, ease of use, usefulness, and use intention was conducted. In summary, the rivet-type gloves exhibited better results in hand performance while the pouch-type gloves showed advantages in wearability, suggesting a tradeoff relationship between force transmission and wearer comfort. The results of this study aimed to improve the work efficiency at logistics and transportation industry sites and help improve the welfare of workers.

A facility-level self-assessment of Autonomous Pharmacy Framework levels.

The objective of this study was to understand at what level of the Autonomous Pharmacy Framework facilities are operating, in terms of the current state of data collection and analysis in the medication-use process, and to gather insights about systems integration and automation use. The Autonomous Pharmacy Advisory Board, a group of chief pharmacy officers and operational leaders, developed a self-assessment instrument based on the previously published Autonomous Pharmacy Framework, made the self-assessment instrument available via the internet, and reviewed respondents' self-reported results. The data collection period for the survey started in March of 2021 and ended in January of 2023. A total of 119 facility-level self-assessments were completed and analyzed. On a scale of 1 to 5, where 1 represented little or no data-driven automation with lots of manual tasks and 5 represented the utmost data-driven automation with few manual tasks, the average overall facility-level score was 2.77 (range, 1.38-4.41). Results revealed slight variance by facility bed capacity. Much more variation was found in the degrees to which individual facilities have automated core processes like inventory management, intravenous medication preparation, and financial reporting. As a baseline, this automation-focused facility self-assessment suggests that for essentially all health-system pharmacy facilities and their larger organizations, a substantial body of work needs to be done to further develop and upgrade technology and practice in tandem, greatly expand data collection and analysis, and thereby achieve better operational, financial, and clinical outcomes. Significant advancements are needed to arrive at the highly reliable, highly automated, data-driven medication-use process involving few repetitive manual tasks envisioned in the Autonomous Pharmacy Framework.

A Workflow for Accelerating Multimodal Data Collection for Electrodeposited Films

Future machine learning strategies for materials process optimization will likely replace human capital-intensive artisan research with autonomous and/or accelerated approaches. Such automation enables accelerated multimodal characterization that simultaneously minimizes human errors, lowers costs, enhances statistical sampling, and allows scientists to allocate their time to critical thinking instead of repetitive manual tasks. Previous acceleration efforts to synthesize and evaluate materials have often employed elaborate robotic self-driving laboratories or used specialized strategies that are difficult to generalize. Herein we describe an implemented workflow for accelerating the multimodal characterization of a combinatorial set of 915 electroplated Ni and Ni–Fe thin films resulting in a data cube with over 160,000 individual data files. Our acceleration strategies do not require manufacturing-scale resources and are thus amenable to typical materials research facilities in academic, government, or commercial laboratories. The workflow demonstrated the acceleration of six characterization modalities: optical microscopy, laser profilometry, X-ray diffraction, X-ray fluorescence, nanoindentation, and tribological (friction and wear) testing, each with speedup factors ranging from 13–46x. In addition, automated data upload to a repository using FAIR data principles was accelerated by 64x.

Pengembangan Sistem Informasi Laboratorium Untuk Meningkatkan Efisiensi dan Akurasi

The development of laboratory information systems has become a primary focus in efforts to enhance efficiency and accuracy in laboratory operations. This article discusses the need for system development and evaluates the existing systems, which may be inefficient or inaccurate. Through analysis, it is found that repetitive manual tasks, such as data entry, inventory tracking, and report generation, result in time wastage and increased human errors. Furthermore, fragmented and non-integrated systems in laboratories impede smooth information flow, reduce operational efficiency, and increase the risk of errors. Reporting is also limited and time-consuming. Based on this background, this journal aims to develop an efficient and accurate laboratory information system. The development methodology includes user requirement gathering, needs analysis, system design, development, and implementation. In the development process, tools and technologies such as RFID are employed to improve operational efficiency and data accuracy. Integration among system components is also enhanced to facilitate smoother information flow. The evaluation results demonstrate significant benefits of the laboratory information system development. Manual tasks can be reduced, operational efficiency is enhanced, and the risk of human errors is decreased. Tracking and monitoring become easier, while reporting becomes faster and more accurate. With the adoption of an integrated laboratory information system, laboratories can improve their efficiency and accuracy in operations. In conclusion, the development of a laboratory information system is a crucial step in enhancing efficiency and accuracy. Through appropriate approaches and the implementation of information technology, laboratories can reduce reliance on manual work, improve data accuracy, and facilitate smooth information flow. The implementation of an efficient laboratory information system will have a positive impact on productivity and service quality in laboratories.

Exploring the role of task on kinematic variability and assessing consistency in individual responses across repetitive manual tasks

To gain a greater understanding of motor variability (MV) as an individual trait, the effect of task type on MV and individual consistency in MV across three tasks was investigated. Twenty participants performed repetitive carrying, lifting, and simulated sawing tasks. MV was assessed using the linear measure of mean point-by-point standard deviation in three-dimensional upper body joint angles. Task type affected MV, where carrying showed higher MV compared to sawing (23–29%) and lifting (12–19%). Furthermore, MV was higher in lifting compared to sawing (12–25%). Poor to moderate individual consistency (ICC = 0.42–0.63) was found across tasks. Task type determined MV and only some support for MV as an individual trait across tasks was found. Based on this work, differences in degrees of freedom afforded by the task influence the opportunity to exploit MV, and possibly individual consistency in MV magnitude is specific to the degrees of freedom afforded by the task. Practitioner summary: In repetitive tasks, movement variability has been proposed as an individual characteristic independent of task characteristics, where repeaters show consistently low variability, while replacers show consistently high variability. In the current study, only moderate support was demonstrated for variability as a consistent individual characteristic across different manual tasks. Abbreviation MV: Motor variability; WRMSDs: Work-related musculoskeletal disorders; DOF: Degrees of freedom; meanSD: Mean standard deviation; SD: Standard deviation; H: Handle (of simulated sawing setup); T: Track (of simulated sawing setup); F: Frame (of simulated sawing setup); ICC: Intraclass correlation; UE: Upper extremity; MMH: Manual material handling; EMG: Electromyography

The use of a three-dimensional dynamic arm support prevents the development of muscle fatigue during repetitive manual tasks in healthy individuals.

Work-related upper extremity disorders are costly to society due to resulting medical costs, presenteeism and absenteeism. Although their aetiology is likely multifactorial, physical workplace factors are known to play an important role in their development. Promising options for preventing work-related upper extremity disorders include assistive technologies such as dynamic arm supports designed to follow the movement of the arm while compensating for its weight. The objective of this study was to assess the effects of a dynamic arm support on perceived exertion, muscle activity and movement patterns of the upper limb during repetitive manual tasks in healthy individuals. Thirty healthy right-handed individuals were allocated either a static or a dynamic task to perform with and without a dynamic arm support. During the task, surface electromyographic activity (anterior and middle deltoid, upper trapezius) and upper limb kinematics (elbow, shoulder, sternoclavicular) were measured using surface EMG and inertial sensors. Results showed that the dynamic arm support significantly reduced perceived exertion during the tasks and limited the development of muscular fatigue of the anterior and middle deltoid as demonstrated by EMG signal mean epoch amplitudes and median frequency of the EMG power spectrum. The dynamic arm support also prevented a decrease in shoulder elevation and an increase in total shoulder joint excursion during static and dynamic task, respectively. These results denote the potential benefits of dynamic arm supports in work environments. Further studies should focus on their efficacy, acceptability and implementability in work settings.

Automated firmware generation and continuous testing for the CMS HGCAL trigger primitive generator

The prototype version of the trigger primitive generator firmware for the Phase-2 CMS endcap calorimeter upgrade is being implemented in order to assess the FPGA resource requirements and dimension the system. For the development of some of these blocks, a data-driven design flow based on VHDL and HLS C/C++ templates is used to automate the production of multiple firmware variants. In addition, the design steps are integrated into Gitlab Continuous Integration tools to automatically test and validate every change, and as much as possible avoid repetitive manual tasks and the associated errors.

Rest period and object load effects on upper limb muscle strength recovery for manual load transfer

This study examined the rest period and object load influence on upper limb muscle strength recovery after a simulated 9 min intermittent repetitive manual work. Eight task conditions consisting of four rest periods (2.25, 4.5, 9, 13.5 min) and two object loads (1 and 2 Kg) were studied. Twelve male subjects were recruited to participate. Four muscles in the right upper limb were tested using surface electromyography. Heart rate and rating of fatigue were measured during the experiment. The experimental results showed that the rest period of 4.5 min, which was not the largest, could be the most efficient recovery level that might result in obtaining better muscle strength recovery and larger heart rate reduction with a shorter rest time. The study results provided fundamental work/rest pattern data that could be considered in early intervention strategies for muscle fatigue prevention at worksites. Limitations and recommendations regarding the current study were highlighted. Relevance to industryUpper limb repetitive manual load transfer tasks are common at worksites, and can result in work-related musculoskeletal disorders. The results from this study should be useful in work/rest scheduling for repetitive manual load transfer tasks.

Addressing big data variety using an automated approach for data characterization

The creation of new knowledge from manipulating and analysing existing knowledge is one of the primary objectives of any cognitive system. Most of the effort on Big Data research has been focussed upon Volume and Velocity, while Variety, “the ugly duckling” of Big Data, is often neglected and difficult to solve. A principal challenge with Variety is being able to understand and comprehend the data. This paper proposes and evaluates an automated approach for metadata identification and enrichment in describing Big Data. The paper focuses on the use of self-learning systems that will enable automatic compliance of data against regulatory requirements along with the capability of generating valuable and readily usable metadata towards data classification. Two experiments towards data confidentiality and data identification were conducted in evaluating the feasibility of the approach. The focus of the experiments was to confirm that repetitive manual tasks can be automated, thus reducing the focus of a Data Scientist on data identification and thereby providing more focus towards the extraction and analysis of the data itself. The origin of the datasets used were Private/Business and Public/Governmental and exhibited diverse characteristics in relation to the number of files and size of the files. The experimental work confirmed that: (a) the use of algorithmic techniques attributed to the substantial decrease in false positives regarding the identification of confidential information; (b) evidence that the use of a fraction of a data set along with statistical analysis and supervised learning is sufficient in identifying the structure of information within it. With this approach, the issues of understanding the nature of data can be mitigated, enabling a greater focus on meaningful interpretation of the heterogeneous data.

RESEARCH OF THE GLOBAL MARKET OF AUDIT SERVICES IN THE CONTEXT OF TODAY’S CHALLENGES

Purpose. The purpose of the research is to define the size of the global audit market in 2020, define the revenue of the Big Four for 2014–2020 and predict the amount of income for 2021; to determine how the crisis caused by Covid-19 has affected on the activities of the Big Four companies; perform a SWOT analysis of the audit market in terms of Deloitte, EY, KPMG and PwC; identify trends in the field of audit in 2021, knowledge of which will allow the Big Four to maintain their market position. Design/methodology/approach. The study examines the hypothesis of the effectiveness of global trends in the global audit market, with their possible implementation in the activities of the Big Four companies. The methodological basis of this study are general scientific, theoretical and special research methods that allow analyze all phenomena and processes in the field of auditing in interdependence. To solve the tasks in this study the following methods has been used: statistical and economic analysis, synthesis, logical generalization, comparison, forecasting, SWOT analysis, graphical and expert method. Findings. The study examines the activities of the Big Four companies in the context of today’s challenges. The dynamics of changes in the revenues of the Big Four companies for 2015–2020 and forecasts the total income of the surveyed companies for 2021 have been showed at the study. The authors determined the share of revenues from auditing in the overall revenue structure of each of the companies and graphically presented the revenue structure of the Big Four companies for 2019–2020. The authors developed a SWOT-analysis, which describes the strengths and weaknesses of each of the companies, as well as opportunities and threats to the environment. The authors also summarized the main trends in the global audit market, which were formed as a result of the crisis caused by Covid-19. Practical implications. The research could be used to adapt the experience of large companies in the recommendations for Ukrainian companies in the field of audit. Originality/value. Considering current crisis situation around the world, the results of this study are valuable for international audit companies and for Ukrainian as well, as it shows the main trends in the field of auditing. As organizations experience difficult economic times due to the effects of the Covid-19 pandemic, audit firms will need to prioritize their resources and demonstrate their value effectively in line with these new expectations in 2021. Covering automation and digital technologies such as research analytics, automated control testing, robotic process automation, and continuous risk assessment, auditing can forget about repetitive manual tasks and free up time for more value-added activities. As long as the Covid-19 pandemic continues, the changes caused by the pandemic will be felt for a long time. The experience of auditors in the field of risk management will continue to grow, as all companies will adapt to this new rule. However, despite budget cuts, new audit processes, and custom work, auditors will continue to be reliable business consultants and help companies thrive even in the face of growing threats and an uncertain future.

Artificial Intelligence in magnetic Resonance guided Radiotherapy: Medical and physical considerations on state of art and future perspectives.

Over the last years, technological innovation in Radiotherapy (RT) led to the introduction of Magnetic Resonance-guided RT (MRgRT) systems. Due to the higher soft tissue contrast compared to on-board CT-based systems, MRgRT is expected to significantly improve the treatment in many situations. MRgRT systems may extend the management of inter- and intra-fraction anatomical changes, offering the possibility of online adaptation of the dose distribution according to daily patient anatomy and to directly monitor tumor motion during treatment delivery by means of a continuous cine MR acquisition. Online adaptive treatments require a multidisciplinary and well-trained team, able to perform a series of operations in a safe, precise and fast manner while the patient is waiting on the treatment couch. Artificial Intelligence (AI) is expected to rapidly contribute to MRgRT, primarily by safely and efficiently automatising the various manual operations characterizing online adaptive treatments. Furthermore, AI is finding relevant applications in MRgRT in the fields of image segmentation, synthetic CT reconstruction, automatic (on-line) planning and the development of predictive models based on daily MRI. This review provides a comprehensive overview of the current AI integration in MRgRT from a medical physicist's perspective. Medical physicists are expected to be major actors in solving new tasks and in taking new responsibilities: their traditional role of guardians of the new technology implementation will change with increasing emphasis on the managing of AI tools, processes and advanced systems for imaging and data analysis, gradually replacing many repetitive manual tasks.

Frequency of examination and perceived contribution of factors relating to work-related musculoskeletal disorders of physiotherapists

Objective. Literature confirms that many physiotherapists suffer from work-related musculoskeletal disorders (WMSDs), but studies mention different, complementary and contradictory findings regarding risk factors. This scoping review aimed at revealing the most frequently examined and contributory WMSD factors mentioned in recent studies about physiotherapists. Methods. Based on specific inclusion/exclusion and appraisal criteria, 11 studies published between 2012 and 2018 were included in the analysis. The factors recorded per publication were grouped into 18 categories, the frequency of their appearance across the sources was counted and the median ranks of their relative reported contribution were calculated. Results. Excessive workload was found to be the most contributory factor, followed by the application of manual orthopaedic techniques. However, demanding and repetitive manual tasks were the most common factors investigated in the publications reviewed. A medium-strength correlation was found between the frequency of examination and reported contribution of factors but with a noticeable range of the confidence interval possibly due to the diversity of the approaches in the studies reviewed. Conclusions. The findings indicate a relative discordance between the level of contribution of each factor to the development of WMSDs and the types of factors most frequently addressed by studies.

Management of tennis elbow

Background and aim Tennis elbow is an abuse condition that out comes in pain over lateral side of elbow, provoked by activities involving gripping and manipulating objects by hand. It is frequently a consequence of participation in activities requiring repetitive manual tasks with awkward wrist positions. Tennis elbow has a variety of treatment options, starting from nonoperative treatment, including conservative treatment, bracing, and physiotherapy, to the last line of treatment being surgical intervention. Materials and methods A systemic review was performed using Google, PubMed, and Medline for a period from 2015 to 2019 comparing three methods of tennis elbow treatment: steroid injection, open surgery, and arthroscopic surgery. Results A total of 21 studies included 2055 patients treated by arthroscopic surgery. Overall, 3638 patients were treated by open surgery and 633 patients were treated by steroid injection. Conclusion This systematic review looked at high-level evidence to compare arthroscopic technique, open surgical technique, and steroid injection. There were no clinically significant differences among the three techniques (open, arthroscopic, and steroid injection) according to postoperative pain intensity (visual analog scale). Steroid injection had the least complication rate, with early return to work, but had higher recurrence rate.

Biomechanical analysis of upper trapezius, erector spinae and brachioradialis fatigue in repetitive manual packaging tasks: Evidence from Chinese express industry workers

This study aims to assess the effects of repetitive motion-induced fatigue during manual packaging on kinematics and muscle activity of the arm, back and shoulder. Eighteen participants performed a 60-min manual packaging task. Electromyography median frequency of RUT, RES, LES and RB decreased by 13.2% (p < 0.05), 12.8% (p < 0.05), 11.3% (p < 0.05) and 21% (p < 0.001), respectively over time. The head flexion and the right upper arm flexion angles significantly (p < 0.001) differed among different packaging sizes, and similar results were observed for left upper arm flexion and rotation. The trunk and pelvis angles significantly (p < 0.05) differed over time under three kinds of packaging. The results showed there was an increase in the rating of perceived exertion from 8.56 to 16.94 (p<0.01) during the task. The outcomes of this study indicate repetitive movements in the manual packaging task resulted in elevated prevalence of muscle discomfort in packaging workers, especially the right brachioradialis. Interventions such as specific work: rest ratios, workplace redesign should be explored to relieve muscle fatigue and discomfort. Relevance to industryFor workers performing repetitive manual packaging tasks, biomechanical analysis of different muscles groups can help in developing appropriate ergonomic interventions.

Resolution of Thumb Pain following Adoption of Mathieu Needle Holder: An Ergonomic Analysis.

Background:As surveys reveal the prevalence of musculoskeletal pain among surgeons, it is important to have an appreciation and understanding of surgical ergonomics to protect against long-term injuries and mitigate the symptoms of existing conditions. Surgeons diagnosed with thumb carpometacarpal (CMC) joint osteoarthritis, a progressive and debilitating condition, can be especially vulnerable to the pain caused by the repetitive manual tasks of operating.Methods:In this article, the authors describe a case of occupational thumb CMC arthritis in a right-hand dominant plastic surgeon and provide an ergonomic analysis of the different needle holders.Results:Following diagnosis, the simple switch from the traditional Hegar needle holder to the Mathieu needle driver with its palm grip and rotating ratchet lock mechanism stalled the progression of the disease, allowing the surgeon to continue operating pain free.Conclusions:This is the first report of utilization of an alternative needle holder leading to the resolution of thumb pain. In sharing this case, the authors hope to bring awareness to the importance of hand ergonomics in the operating room and offer a practical tip to surgeons with CMC arthritis.

The bilaterality of idiopathic carpal tunnel syndrome among manual workers.

To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61.

Algorithmically detectable directional changes in upper extremity motion indicate substantial myoelectric shoulder muscle fatigue during a repetitive manual task

Repetitive workplace tasks are associated with fatigue-induced changes to shoulder muscular strategies, potentially altering kinematics and elevating susceptibility to tissue overexposures. Accessible and reliable methods to detect shoulder muscle fatigue in the workplace are therefore valuable. Detectable changes in joint motion may provide a plausible fatigue identification method. In this investigation, the onset of the first kinematic changes, as identified by a symbolic motion representation (SMSR) algorithm, and the onset of substantial surface electromyography (sEMG) mean power frequency (MPF) fatigue were not significantly different, both occurring around 10% of task duration. This highlights the potential utility of SMSR identified directional changes in joint motion during repetitive tasks as a cue of substantial muscle fatigue, enabling ergonomics responses that can mitigate shoulder muscular fatigue accumulation and its associated deleterious physical effects.Practitioner Summary: The onset of substantial muscle fatigue during a repetitive dynamic task was assessed using kinematics and myoelectric-based techniques. Algorithmically detectable directional changes in upper extremity joint motion occurred with the onset of substantial muscle fatigue, highlighting the potential of this as a useful approach for workplace fatigue identification.