Hands-free administration of subjective workload scales: Acceptability in a surgical training environment

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 (η_partial² = 0.138) was substantially less than that for the written version (η_partial² = 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 (η_partial² = 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.     

极小布尔不可满足子式的提取算法

研究了极小布尔不可满足子式的提取算法，它分为近似算法和精确算法两种．文中就精确算法提出了局部预先赋值的优化方案，并且在理论上证明了该算法的正确性；通过实验显示了此算法可以获得更高的效率．通过模拟实验观察到，利用完法计算法进行近似提取的一个有趣现象，即随着公式密度的增加，算法的提取误差会趋于下降．     

面向虚拟装配的混杂系统建模和控制器设计

针对装配的动态过程显著地表现出连续与离散共存的混杂特性,研究了面向虚拟装配的混杂系统建模以及控制器设计方法．提出了混杂基本结构对应于单个装配对象的建模方法,有效地避免了由于装配零部件过多给模型造成的复杂性,并在此基础上,运用最小干预安全控制器对装配过程中的不合法结构实施控制,最后以某汽车底盘总装中两个装配对象为例,给出了具体的动态描述及其建模和控制器设计。证明了该方法的可行性和有效性.     

Contact and friction between catheter and blood vessel

Therapeutic vascular catheterization techniques are sometimes hampered by the frictional forces between the blood vessel and the catheter, when contact points of the vessel are changing and deforming during the movement of the catheter. The goal of the present study was to characterize frictional interactions between the blood vessel wall and the catheter using experimental and numerical analysis. First, the frictional force was measured with an experimental apparatus that uses a ball and flattened porcine aorta to simulate frictional forces between the catheter and the vessel. Second, catheter motion was characterized by two-dimensional numerical calculations based on the experimental results. Experimental analysis demonstrated that slip occurred and that friction coefficient between the vessel and the catheter and the deformation of the specimen were small when the contact between the ball and the aorta occurred at a small angle. The compliance of the specimen in the normal direction obtained by the experiment was by far larger than that calculated according to the Hertzian contact theory. Numerical analysis shows that this difference of the parameter of the vessel, which must be determined accurately in surgical simulator, could affect the trajectory of the catheter.     

微创经皮肾鈥激光碎石术治疗上尿路结石的临床疗效

目的探讨微创经皮肾鈥激光碎石术治疗上尿路结石的重要性及临床疗效。方法 2006年3月至2010年5月应用微创经皮肾鈥激光碎石术治疗上尿路结石患者127例143侧。所有患者均行F18穿刺通道输尿管镜鈥激光碎石术。结果 127例经皮肾输尿管镜鈥激光碎石术后,结石残留24例(二期碎石2例,结合体外震波碎石9例,药物排石13例);1例感染;2例漏尿;3例出血,所有并发症经积极相应治疗后均治愈。结论微创经皮肾鈥激光碎石术治疗上尿路结石疗效确切,安全,值得临床推广。     

Feasibility of tracking laparoscopic instruments in a box trainer using a Leap Motion Controller

Motion analysis is employed to assess minimally invasive surgical psychomotor skills in box trainers. Tracking of laparoscopic instruments requires sensor-based systems that can be expensive, limit movements and modify their ergonomic properties. We evaluate the feasibility of using Leap Motion as a cheap, unobtrusive alternative. Four experiments were performed to determine its precision while tracking a laparoscopic instrument inside and outside a box trainer. Static long and short term precision of the Leap Motion was <2.5 mm. Precision between 12 different positions within the box trainer was <0.7 mm for all measured distances between neighbors. Dynamic precision when moving the instrument for 200 mm ranged between 2 and 15 mm. Leap Motion presents acceptable precision values inside a box trainer. Improvements are still required (e.g.: multiple instruments’ tracking). Once solved, a validation study should verify the usefulness of Leap Motion to objectively measure skills of novices and residents during training.     

Overview of Human Factors and Ergonomics in the OR,with an Emphasis on Minimally Invasive Surgeries

Operating rooms (OR) are where medical teams work to improve the health of a patient. However, because of the complexity of the procedures, errors and unsafe situations are likely to occur. These complications can lead to harm to the patient or medical professionals. Human factors and ergonomic professionals have been working to improve these unsafe conditions in the OR for over a century. However, with advances in technology, increased surgical complexity, as well as an increase in medical team members in the OR, there are still numerous improvements yet to be accomplished. Minimally invasive surgeries require an even more advanced approach to prevent errors due to technology, fatigue, and miscommunication. Human factors and ergonomic techniques provide the ability to greatly improve conditions for patients and surgeons alike. It is imperative that human factors and ergonomics continue to grow and facilitate technological advancements in healthcare. © 2012 Wiley Periodicals, Inc.     

不可满足公式的同态证明系统

合取范式(CNF)公式H到F的同态φ是一个从H的文字集合到F的文字集合的映射,并保持补运算和子句映到子句.同态映射保持一个公式的不可满足性.一个公式是极小不可满足的是指该公式本身不可满足,而且从中删去任意一个子句后得到的公式可满足.MU(1)是子句数与变元数的差等于1的极小不可满足公式类.一个三元组(H,φ,F)称为的一个来自H的同态证明,如果φ是一个从H到F的同态.利用基础矩阵的方法证明了:一个不可满足公式F的树消解证明,可以在多项式时间内转换成一个来自MU(1)中公式的同态证明.从而,由MU(1)中的公式构成的同态证明系统是完备的,并且由MU(1)中的公式构成的同态证明系统与树消解证明系统之间是多项式等价的.     

Properties of polyethylene films with incorporated benzoic anhydride and/or ethyl and propyl esters of 4-hydroxybenzoic acid and their suitability for food packaging

Benzoic anhydride and ethyl and propyl esters of 4-hydroxybenzoic acid (ETP and PRP, respectively, also termed parabens) incorporated into low density polyethylene (LDPE) film were studied with regard to migration into food and food simulants at 6°C and 25°C, and changes in selected properties of the film were investigated. Antimicrobials were incorporated into polymer film in concentrations of 5g/kg and 10g/kg. The addition of parabens into the polymer was more difficult than benzoic anhydride due to their volatility. For benzoic anhydride, 30-40% and 10-20% of the added amount was found to leach from the film into aqueous and olive oil food simulants, respectively. The migration into both water and olive oil followed a very similar course in the case of parabens. Migration levels over 90% and in the range of 70% to 80%, relative to the amount of agent in the film, were determined for ETP and PRP respectively. The incorporation of antimicrobials into the film significantly changed the functional characteristics of the packaging material, i.e. permeability of oxygen, carbon dioxide and water vapour, tensile strength, coefficient of friction, sealing strength and transparency. Shelf life tests with packaged cheese and toasted bread demonstrated the efficiency of the film containing 10g/kg of BA against mould growth on the food surface during storage at 6°C.