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Nawar Alotaibi,1 Brigitte M Borg,2,3 Michael J Abramson,3 Eldho Paul,3 Nicholas Zwar,4 Grant Russell,5 Sally Wilson,1,6 Anne E Holland,2,7 Billie Bonevski,8 Ajay Mahal,9 Johnson George1,3 1Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia; 2Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia; 3School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia; 4Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; 5Department of General Practice, Monash University, Melbourne, VIC, Australia; 6Department of Infrastructure Engineering, The University of Melbourne, Melbourne, VIC, Australia; 7Central Clinical School, Monash University, Melbourne, VIC, Australia; 8College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; 9The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, AustraliaCorrespondence: Johnson George, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia, Email Johnson.George@monash.eduAim: Diagnosis of COPD in primary care is hindered by underuse of spirometry. Case finding using validated symptom and health status questionnaires, and simple handheld devices in high-risk populations may improve diagnosis. This study aimed to determine the best combination of measures to optimise COPD diagnosis in the primary care setting.Methods: We recruited 335 current or ex-smokers, including those with an established diagnosis of COPD from general practices. Participants’ FEV1 and FEV6 were measured using a handheld spirometry device (COPD-6®). Each completed the COPD assessment test (CAT), a modified Medical Research Council (mMRC) dyspnoea scale, St George’s Respiratory Questionnaire (SGRQ) and smoking history questionnaire. From these data we calculated the predictive validity for spirometry-confirmed diagnosis of COPD. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for each. Kappa coefficient was used to measure the agreement between the Fixed-Ratio (FR) and Lower Limit of Normal (LLN) spirometric criteria in diagnosing COPD.Results: FEV1/FEV6 < 0.70 alone showed significant association (p< 0.0001) with COPD diagnosis and good predictive accuracy (AUROC=0.725). However, no further improvement was found after combining SGRQ, CAT and mMRC with FEV1/FEV6. FEV1/FEV6 < 0.70 using the COPD-6® handheld device had moderate sensitivity (65.7%) and high PPV (90.1%), high specificity (79.3%) and NPV (44.8%). There was good agreement between FR and LLN definitions (κ=0.70).Conclusion: Handheld micro-spirometers can facilitate case finding of COPD in smokers and ex-smokers attending general practice. The fixed ratio criterion currently recommended by COPD-X guidelines offers the simplest method for diagnosing COPD in Australian primary care.Keywords: case finding, COPD, diagnosis, primary care

Supplementary Material 1: Interview guide.

Objectives: Infection with COVID-19 presents known and unknown perioperative risks to the patient and operative staff. Pre-operative testing protocols have become widespread, yet little is known about the utility of this practice in asymptomatic patients undergoing elective surgery. We describe the impact and cost of a routine testing protocol on elective surgical procedures in a retrospective series at a single institution. Methods: Standardized pre-operative COVID-19 testing in all surgical patients was implemented in May 2020. Health system protocol required testing 3 to 5 days before all elective surgery. Data stratified by surgical specialty were collected over the initial 90-day period and disposition over a period of 6-months was assessed for all positive and indeterminate results. Results: Thirty-one (0.41%) positive results amongst 7579 pre-procedural tests, including 3 of 792 (0.38%) for urologic procedures, were noted in asymptomatic patients. Following a positive test, 20 procedures (62.5%) were delayed an average of 49 days, 8 were not performed and 3 proceeded without delay. All 3 urologic procedures were delayed a mean of 59 days. Institutional cost per test ranged from $34-$54. The number needed to test for one positive result was 244 with a cost of $11,573 for each positive result. Conclusions: Institution of a universal pre-operative COVID-19 screening protocol for asymptomatic, unvaccinated patients undergoing elective surgery identified clinically silent infection in 0.4% of cases with a significant associated cost. Risk and symptom-based testing is likely a better strategy for triaging resources.

Additional file 1.

Alzheimer’s disease (AD) is one of the looming health crises of the near future. Increasing lifespans and better medical treatment for other conditions mean that the prevalence of this disease is expected to triple by 2050. The impact of AD includes both the large toll on individuals and their families as well as a large financial cost to society. So far, we have no way to prevent, slow, or cure the disease. Current medications can only alleviate some of the symptoms temporarily. Many animal models of AD have been created, with the first transgenic mouse model in 1995. Mouse models have been beset by challenges, and no mouse model fully captures the symptomatology of AD without multiple genetic mutations and/or transgenes, some of which have never been implicated in human AD. Over 25 years later, many mouse models have been given an AD-like disease and then ‘cured’ in the lab, only for the treatments to fail in clinical trials. This review argues that small animal models are insufficient for modelling complex disorders such as AD. In order to find effective treatments for AD, we need to create large animal models with brains and lifespan that are closer to humans, and underlying genetics that already predispose them to AD-like phenotypes.

Additional file 1: Appendix 1. Additional information on the OPTIMISE intervention. Appendix 2: Table A-1. Responsibility of establishing the need for and booking an interpreter by group (Multiple responses, Baseline). Table A-2. Confidence of GPs arranging an interpreter. Table A-3. Perceived barriers related to the engagement of credentialed interpreters before and after intervention reported by GPs (Multiple responses)

Additional file 1: Table S1. Summary of targeted populations, access issues, and interventions in the IMPACT program. Table S2. Principal components factor resolution for items measuring abilities to access healthcare. Table S3. Distribution of personal and social characteristics of each study sample and tests of significant differences between the four sites. Table S4. Distribution of scores for each measure of access ability (range 1–4, except as noted) for each study sample and tests of significant differences between the four sites.

Supplemental material, Appendix_B-_Search_Strategy for Impact of Interprofessional Primary Care Practice on Patient Outcomes: A Scoping Review by Livia R. M. McCutcheon, Stuart T. Haines, Ruta Valaitis, Deborah A. Sturpe, Grant Russell, Ahlam A. Saleh, Kevin A. Clauson and Jeannie K. Lee in SAGE Open

CIHR APHCRI submission

Supplemental material, Appendix_A-Features_of_Primary_Care_Service_Delivery for Impact of Interprofessional Primary Care Practice on Patient Outcomes: A Scoping Review by Livia R. M. McCutcheon, Stuart T. Haines, Ruta Valaitis, Deborah A. Sturpe, Grant Russell, Ahlam A. Saleh, Kevin A. Clauson and Jeannie K. Lee in SAGE Open

A one page plain language summary of the Pop-Up project for project participants. The Pop-Up project was conducted in 2019 by Monash University Department of General Practice researchers and community stakeholders.

Supplemental material, Appendix_C-_Inclusion_Criteria_Screening_Form for Impact of Interprofessional Primary Care Practice on Patient Outcomes: A Scoping Review by Livia R. M. McCutcheon, Stuart T. Haines, Ruta Valaitis, Deborah A. Sturpe, Grant Russell, Ahlam A. Saleh, Kevin A. Clauson and Jeannie K. Lee in SAGE Open

Gabriel Izbicki,1,2 Valerie Teo,1,3 Jenifer Liang,4 Grant M Russell,5 Anne E Holland,6 Nicholas A Zwar,7 Billie Bonevski,8 Ajay Mahal,9 Paula Eustace,10 Eldho Paul,1 Kirsten Phillips,11 Sally Wilson,4,12 Johnson George,1,4 Michael J Abramson1 1School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; 2Shaare Zedek Medical Center and The Hebrew University Hadassah Medical School, Jerusalem, Israel; 3National Healthcare Group Polyclinics, Singapore; 4Centre For Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; 5Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Notting Hill, Australia; 6Discipline of Physiotherapy, La Trobe University and Alfred Health, Melbourne, Australia; 7Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia; 8School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; 9The Nossal Institute For Global Health, University of Melbourne, Melbourne, Australia; 10Eastern Melbourne PHN (EMPHN), Box Hill, Australia; 11Lung Foundation Australia (LFA), Milton, Australia; 12Department of Infrastructure Engineering, The University of Melbourne, Melbourne, AustraliaCorrespondence: Michael J AbramsonSchool of Public Health & Preventive Medicine, 553 St Kilda Road, Melbourne, VIC 3004, AustraliaTel +61 3 9903 0573Fax +61 3 9903 0556Email michael.abramson@monash.eduPurpose: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices.Patients and methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre- and post-bronchodilator spirometry, dyspnoea and St. George’s Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone.Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p

Background Direct oral anticoagulants (DOACs) are widely used as therapies for venous thromboembolism and other cardiovascular diseases. However, routine coagulation monitoring is not required, but may be clinically indicated in high risk populations including obese patients. Objectives The aims of this study were two fold; to validate a chromogenic assay for anti-factor Xa measurement in patients taking apixaban, and correlate it with PT/INR and PTT, and to measure anti-factor Xa levels in patients who weighed >120 kg. Patients/methods Patients who were taking apixaban had 3 blood samples drawn over a 4 h period. Apixaban levels were determined using an anti-factor Xa activity assay (STA-Liquid Anti-Xa) using STA-Apixaban Calibrator and STA-Apixaban Controls. The PT/INR was determined using standard methodology. Apix MS, using manufacturer provided apixaban standard, was performed on plasma. Results and conclusions 18 normal weight patients, 39 obese patients and 14 controls were enrolled. There was a strong correlation between apixaban anti-factor Xa activity compared to plasma Apix MS (r = 0.95). In patients >120 kg, there was a statistically significant decreased rate of change in anti-factor Xa levels after ingestion. Further, the area under the curve for apixaban anti-factor Xa levels was significantly lower in patients over 120 kg. While INR correlated with apixaban MS and apixaban anti-factor Xa activity in both normal weight and obese patients, the association was not sufficiently strong to clinically manage patients, normal weight or obese. Given these findings, research is necessary to investigate the clinical utility of apixaban anti-factor Xa activity measurement in selected populations.

Action plan template (PDF 122 kb)

Monash University Human Research Ethics Committee exemption letter regarding the use of the â Building A New Life in Australiaâ data sets. (DOCX 27 kb)

Facilitator interview guide. (DOCX 27 kb)

Baseline Refugee Healthcare Survey (PDF 475 kb)

Staff interview guide. (DOCX 29 kb)

PEP Practice Intervention - Study Outline. (DOCX 16 kb)

PEP Practice Intervention - Study Outline. (DOCX 16 kb)

Facilitator interview guide. (DOCX 27 kb)

Individual Clinical Staff Survey (PDF 419 kb)

Practice Description Survey (PDF 246 kb)

Staff interview guide. (DOCX 29 kb)

Table S1. Characteristics of patients who did and did not participate in the study. Table S2. Univariable and multivariable logistic regression for factors associated with low physical health status (SF Physical Composite Summary

contains the list of countries that were focussed on in the grey search. (DOCX 13Â kb)

contains the flow diagram for the main search. (DOC 75Â kb)

contains the flow diagram for the grey search. (DOC 69Â kb)

Four experiments tested a hypothesized function of signaling devices, namely, to communicate information about text organization. Experiments 1 and 2 compared headings that communicated the hierarchical organization of text topics with headings that did not communicate the hierarchical organization. Signaling organization led to more complete and accurate outlines of a text. Experiment 3 compared headings that communicated the sequential organization of text topics with headings than did not communicate the organization. Signaling organization led to faster text search. Experiment 4 compared headings that emphasized the sequential organization of topics with headings that emphasized their hierarchical organization. In this comparison, sequential headings led to faster search times than hierarchical headings. Together, the results of the four experiments demonstrate (a) that signals can communicate two distinct types of organizational information, and (b) those two types of organization have distinct impli...

Background: Hurricane Katrina made landfall in August 2005 and destroyed the infrastructure of New Orleans. Mass evacuation ensued. The immediate and long-lasting impact of these events on the mental health of children have been reported in survey research. This study was done to describe the nature of mental health need of children during the four years after Hurricane Katrina using clinical data from a comprehensive healthcare program. Medical and mental health services were delivered on mobile clinics that traveled to medically underserved communities on a regular schedule beginning immediately after the hurricane. Patients were self-selected residents of New Orleans. Most had incomes below the federal poverty level and were severely affected by the hurricane.Methods: Paper charts of pediatric mental health patients were reviewed for visits beginning with the establishment of the mental health program from 01 July 2007 through 30 June 2009 (n = 296). Demographics, referral sources, presenting problems, diagnoses, and qualitative data describing Katrina-related traumatic exposures were abstracted. Psychosocial data were abstracted from medical charts. Data were coded and processed for demographic, referral, and diagnostic trends.Results: Mental health service needs continued unabated throughout this period (two to nearly four years post-event). In 2008, 29% of pediatric primary care patients presented with mental health or developmental/learning problems, including the need for intensive case management. The typical presentation of pediatric mental health patients was a disruptive behavior disorder with an underlying mood or anxiety disorder. Qualitative descriptive data are presented to illustrate the traumatic post-disaster experience of many children. School referrals for mental health evaluation and services were overwhelmingly made for disruptive behavior disorders. Pediatric referrals were more nuanced, reflecting underlying mood and anxiety disorders. Histories indicated that many missed opportunities for earlier identification and intervention.Conclusions: Mental health and case management needs persisted four years after Hurricane Katrina and showed no signs of abating. Many children who received mental health services had shown signs of psychological distress prior to the hurricane, and no causal inferences are drawn between disaster experience and psychiatric disorders. Post-disaster mental health and case management services should remain available for years post-event. To ensure timely identification and intervention of child mental health needs, pediatricians and school officials may need additional training.

The idea of naturalizing metaphysics stretches back to Locke and Newton. Recently it has been revived by Ross and Ladyman et al (2007) in ‘Every Thing Must Go’. At the heart of the doctrine is the idea that metaphysics should be constrained by actual science (science which is current and institutionally valid). It is my attempt in this paper to naturalize the metaphysics of the species problem by proposing a species concept which conforms to the principles set out in Ross and Ladyman et al's book. This is a concept which conforms strictly with current work in the field of evolutionary theory, with specific reference to theories in Information theory and Thermodynamics. In the end I use as an example of non-naturalized metaphysics Matthew Slater's paper ‘The Indeterminacy Problem for Species as Individuals’

Naturalistic observations of two fifth-year surgical trainees in the OR revealed that they struggled with specific tasks during several seemingly straightforward laparoscopic surgical procedures. Retrospective think-aloud reports of the trainees and their attending surgeons on those tasks in video clips and NASA-TLX ratings further shed lights on trainees' specific challenges. Results showed that trainees' inadequate cognitive skills rather than poor technical skills could be their greatest hindrance in performing those tasks. Specifically, the trainees seemed to focus their attention on immediate urgent tasks and failed to plan strategically for action sequences or manipulations. NASA-TLX results further showed that trainees and attending surgeons differed in their perceptions of effort, performance, and frustration in performing those isolated tasks. These preliminary data suggested that a gap exists between trainees and the more experienced surgeons on their attention allocation strategies, which may indicate the need to emphasize cognitive skills training such as multitasking during the practice of surgical skills outside the OR.

This conference was arranged by the Extension Services in Pharmacy at the University of Wisconsin School of Pharmacy. The purpose of this annual 4-day conference is to provide an educational forum to discuss issues and applications associated with the analysis of xenobiotics and metabolites in biological matrices. The conference is designed to include and encourage an open exchange of scientific and methodological applications for bioanalysis. To increase the interactive nature of the conference, the program will be a mixture of lectures, poster sessions, round table discussions and workshops. This paper summarizes the presentations at the Tenth Annual Conference.

Disasters, whether resulting from terrorism or natural events, have a dramatic impact on the health and well-being of children. Studies after the terror attacks of September 11, 2001, in New York City and the 1995 Oklahoma City bombing and countless reports on the impact of natural disasters on children show that a child's mental health can suffer from direct and indirect exposure to these events. Children may react to a disaster or act of terrorism in a variety of ways. These reactions are influenced by age, developmental level, intellectual capacity, individual and family support systems, personality, and other factors. Common manifestations of psychological trauma in young children include regression, clinging behavior, inattentiveness, aggressiveness, bed-wetting, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer-lasting effects may include depression, anxiety, adjustment disorders, posttraumatic stress disorder, and interpersonal or academic difficulties. Some children are particularly vulnerable to postdisaster trauma because of preexisting psychosocial stressors (homelessness, foster care, exposure to violence, etc), low socioeconomic status, or special needs (including cognitive delays and prior mental illness). These postdisaster reactions may not manifest until well after the event and could persist for years. The National Center for Disaster Preparedness (NCDP) at Columbia's Mailman School of Public Health gathered key staff to discuss the appropriate response to the needs in the Gulf Coast region. Over the following few days, talks were held with federal, state, and local public officials to assess immediate needs and determine what resources could be offered to the affected areas. Necessary clearances to provide medical care were obtained from the Louisiana, Mississippi, and Texas departments of health. Permission was also necessary (and obtained) for access to gasoline and necessary supplies including pharmaceuticals and to travel after curfew. The Children's Health Fund and the NCDP launched Operation Assist, a collaborative effort to organize programs … Address correspondence to Paula A. Madrid, PsyD, 707A W 171st St, Ground Floor, Suite East, New York, NY 10032. E-mail: paulamadridpsyd{at}hotmail.com

Background and Objectives Rivaroxaban, a new oral anti-Xa agent, has been approved for use without routine monitoring, but the lack of a predictable drug level measurement may hinder the management of anticoagulated patients. The aims of the project were to correlate a Anti-Factor Xa assay using commercial calibrators and controls (Riva Activity) with serum drug levels analyzed by HPLC-MS/MS (Riva MS) in patients currently receiving rivaroxaban, and secondly, to correlate the PT/PTT, thrombin generation (CAT assay) and Thromboelastograph (TEG) with the Riva activity and Riva MS. Methods Recruited patients receiving rivaroxaban prospectively had a total of 3 blood samples taken at least 2 hours apart. Plasma was divided for measurement of PT/PTT, Riva activity, rivaroxaban HPCL-MS/MS, and thrombin generation. TEG activity was measured at one random time point for each patient. Correlation and linear regression evaluations were used to compare the different assays. Results The cases were 22 patients on rivaroxaban, age 56 + 12.6, and 10 healthy controls. There was a strong correlation between Riva activity compared to serum Riva MS (r = 0.99). We found a statistically significant correlation between PT/INR compared to serum measurements of Riva MS (r = 0.68) and anti-Xa activity (r = 0.69). The peak (r = -0.50) and lag time (r = 0.57) CAT correlated with Riva MS measurements. There was no correlation between Riva MS and PTT, TEG R, TEG MA, Endogenous Thrombin potential. Conclusion Riva anti-factor Xa activity assay measured with commercial calibrators and controls provides a reliable assessment of rivaroxaban serum levels for patients requiring measurement of anticoagulant activity. Correlation with other coagulation tests is not sufficiently strong to be used clinically.

Since the advent of atmospheric pressure ionization sources, liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) has become the indisputable gold standard technique for quantitative analysis for in vitro and in vivo biological samples. Dramatic improvements in throughput by LC-MS/MS have been achieved based on need and confluences of technologies over the past 20 years primarily in mass spectrometry (MS) and liquid chromatography (LC) augmented with improvements in automation and robotics. Evolutions in mass spectrometer sampling interfaces, mass analyzers, ion optics, and electronics have enabled the development of a rugged, reliable, and exquisitely sensitive platform. Instrument-to-instrument variation now is controlled such that instrument parameters can be translated in a facile manner to like platforms from the same manufacturer. Continued increases in MS instrument sensitivity have enabled reductions in sample loading needs, a key requirement for robust, hands-free operation. Instrument tuning algorithms and sample delivery workflows have been developed to automatically create acquisition methods for chosen analytes to enable streamlining of method development and sample analysis. Systematic evolutions in LC pumps and column hardware have led to better sensitivity, improved chromatographic resolution with a concomitant reduction in analysis time, and robustness. Numerous techniques that rely on robust chromatography have been developed to increase the effective data collection rate of mass spectrometers, the time spent acquiring data of value. In a single decade, we have seen evolution from the serial delivery mode of a single LC system coupled to a mass spectrometer up to commercial versions of eight-channel “true” parallel and eight-channel serial (staggered) parallel LC systems coupled to a single mass spectrometer. Before sample analysis, generic automated sample preparation techniques have been developed. Robotics capabilities have improved sample handling processes for protein and phospholipid removal along with sample pooling, through the use of 96- and 384-well-plate-based systems. Postacquisition data processing and reporting solutions have also been developed to handle the greater influx of data generated by this high throughput platform. When these developments are taken into account, we are left with the realization that quantitative MS has become an industrialized process. We now have dramatically shortened the timelines required for analytical support to the point it is not a rate-limiting step in the discovery process. This chapter discusses the evolution of high throughput LC-MS/MS and many of the approaches that have been pursued in the past decade. We also consider non-LC-based workflows that utilize alternative ionization sources. With some of these new strategies, it is conceivable that data acquisition rates will reach or exceed multiple assays per second. Keywords: liquid chromatography-mass spectrometry (LC-MS); tandem mass spectrometry (MS/MS); high throughput; triple quadrupole; electrospray; atmospheric pressure ionization; selective reaction monitoring; automation

Text signals include a wide variety of writing devices that emphasize specific content within a text, the organization of a text, or both (Lorch, 1989; Meyer, 1975). Signals presumably evolved as a means for an author to guide readers' processing of a text by making the text structure and important content more salient to the reader. Although signals share a common general purpose, they b are a seeming hodgepodge of devices that includes headings, typographical variations, topical overviews and summaries, outlines, bulleting and numbering, preview sentences, and other devices (Lorch, 1989). Despite their variety, a recent theory has provided a unifying framework for understanding the relations between signaling devices and for hypothesizing about their effects on text processing (Lemarie, Lorch, Eyrolle, & Virbel, 2008). The purpose of this study is to provide a first test of that theory by examining one of its central claims regarding the types of information communicated by signals.

We propose using an array of high efficiency, frequency-doubled, pulsed Yb fiber lasers for underwater communications. A 1036.7nm pulsed Yb laser producing over 1mJ of energy in a 30μm core fiber is demonstrated.

Introduction Subjective workload measures are usually administered in a visual–manual format, either electronically or by paper and pencil. However, vocal responses to spoken queries may sometimes be preferable, for example when experimental manipulations require continuous manual responding or when participants have certain sensory/motor impairments. In the present study, we evaluated the acceptability of the hands-free administration of two subjective workload questionnaires – the NASA Task Load Index (NASA-TLX) and the Multiple Resources Questionnaire (MRQ) – in a surgical training environment where manual responding is often constrained. Method Sixty-four undergraduates performed fifteen 90-s trials of laparoscopic training tasks (five replications of 3 tasks – cannulation, ring transfer, and rope manipulation). Half of the participants provided workload ratings using a traditional paper-and-pencil version of the NASA-TLX and MRQ; the remainder used a vocal (hands-free) version of the questionnaires. A follow-up experiment extended the evaluation of the hands-free version to actual medical students in a Minimally Invasive Surgery (MIS) training facility. Results The NASA-TLX was scored in 2 ways – (1) the traditional procedure using participant-specific weights to combine its 6 subscales, and (2) a simplified procedure – the NASA Raw Task Load Index (NASA-RTLX) – using the unweighted mean of the subscale scores. Comparison of the scores obtained from the hands-free and written administration conditions yielded coefficients of equivalence of r = 0.85 (NASA-TLX) and r = 0.81 (NASA-RTLX). Equivalence estimates for the individual subscales ranged from r = 0.78 (“mental demand”) to r = 0.31 (“effort”). Both administration formats and scoring methods were equally sensitive to task and repetition effects. For the MRQ, the coefficient of equivalence for the hands-free and written versions was r = 0.96 when tested on undergraduates. However, the sensitivity of the hands-free MRQ to task demands (ηpartial2 = 0.138) was substantially less than that for the written version (ηpartial2 = 0.252). This potential shortcoming of the hands-free MRQ did not seem to generalize to medical students who showed robust task effects when using the hands-free MRQ (ηpartial2 = 0.396). A detailed analysis of the MRQ subscales also revealed differences that may be attributable to a “spillover” effect in which participants’ judgments about the demands of completing the questionnaires contaminated their judgments about the primary surgical training tasks. Conclusion Vocal versions of the NASA-TLX are acceptable alternatives to standard written formats when researchers wish to obtain global workload estimates. However, care should be used when interpreting the individual subscales if the object is to make comparisons between studies or conditions that use different administration modalities. For the MRQ, the vocal version was less sensitive to experimental manipulations than its written counterpart; however, when medical students rather than undergraduates used the vocal version, the instrument’s sensitivity increased well beyond that obtained with any other combination of administration modality and instrument in this study. Thus, the vocal version of the MRQ may be an acceptable workload assessment technique for selected populations, and it may even be a suitable substitute for the NASA-TLX.

Consideration of the body-support interaction and the available mobile and static support systems is followed by detailed discussion of ventile incompressible cushioning. The requirements of the filler material for mattresses, cushions and pillows constructed on this principle are outlined and the economic aspects are highlighted. A call is made for filler production and marketing at more acceptable cost levels than at present.