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This paper is designed to introduce, propose, inform, and advocate enhanced relationships between the medical communities of special operations and space. Although each provides service support in different roles and functions, similarities in both the operational context and in medical care are notable. During a recent interaction, significant relationship potential was discovered by both communities, and recommendations for greater engagement are proposed herein. By identifying and appreciating similarities and understanding history, key actors, and authorities to analyze and realize opportunities will enable us to find synergy for the development of like efforts and goals. Collaboration in research on the limits of human performance and medical support to the most austere and challenging operational environments may benefit both communities in different but productive ways. Establishing and increasing cooperation will also meet command strategic intent, explore and advance a policy concept, initiate a relationship between unique medical communities, and provide a tangible success for the advancement of operational support.

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Preference cards are a foundation for perioperative inventory management processes; however, they can add to nurses' perceived workload, introduce variability into supply management processes, and increase costs. The purpose of this quality improvement project was to implement an automated perioperative inventory management system to decrease nurses' workload and increase their efficiency. Goals included improving preference card accuracy, decreasing add-on supplies, and decreasing the supply costs for each procedure. Using a preintervention-postintervention survey design, the project team evaluated the outcomes of workload, preference card accuracy, add-on supplies, and procedural cost. Nurses' perception of workload decreased in the supply management processes and cost of supplies categories and increased in the documenting supply use category. A four-month 7.7% improvement in preference card accuracy reduced the average procedure supply cost by $86.72 for each procedure and saved the hospital $260,467. The number of add-on supplies was reduced by 4,177 for a 20% reduction.

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Inadequate lighting will be associated with some degree of perceptual error such as sleepiness. The main purpose of this study was to investigate the interactions between mood, fatigue, mental workload, and sleepiness and their relationship with quantitative indicators of street lighting in passenger car drivers. The present study was a cross-sectional study that was performed on 270 drivers of passenger cars. The quantitative indices of lighting studied were illuminance, luminance, uniformity, and disability glare which were calculated using the Hagner device (EC1-L) and according to EN 13201 standard. Alertness and mood indices, fatigue scale (SAMN-PERELLI), mental workload (NASA-TLX), positive and negative affect schedule (PANAS) were used. Generalized structural equation modeling (GSEM) was used to investigate the relationship between mood, fatigue, mental workload, and drivers' sleepiness. Data analysis was performed in version 26 of SPSS software and version 14 of Stata software There is a significant relationship between illuminance and mood (P < 0.001). There is a significant relationship between the degree of disability glare on the streets and the mood (P = 0.006). There is a significant relationship between fatigue score and mood (P < 0.001) so that with increasing one unit in fatigue scale, mood score decreases by 0.669 units (P < 0.001). Finally, it can be assured that lighting interventions can be done as an effective way to increase alertness and reduce fatigue and the mental workload of drivers with the aim of reducing night traffic accidents.

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Background: Exposure to high-altitude conditions during flight or similar activities affects many aspects of visual function, which is critical not only for flight safety but for any altitude-related activity. We aimed to summarize the available literature pertaining to ocular changes during flight or equivalent short-term high-altitude exposure (e.g., hypobaric chamber, effortless ascent lasting ≤ 24 h) and to highlight future research priorities. Methods: Using the PubMed/MEDLINE and Web of Science/ISI Web of Knowledge databases with structured search syntax, we conducted a systematic review of the literature spanning a 40-year period (January 1, 1983, to October 10, 2023). Articles pertaining to ocular changes during flight or flight-equivalent exposure to altitude were retrieved. The reference lists of retrieved studies were also searched, and citations of these references were included in the results. Results: Of 875 relevant PubMed and ISI publications, 122 qualified for inclusion and 20 more were retrieved from the reference lists of initially selected records, for a total of 142 articles. Reported anterior segment changes included deterioration in tear film stability and increased dry eye incidence, increased corneal thickness, discomfort and bubble formation in contact lens users, refraction changes in individuals with prior refractive surgery, decreased intraocular pressure, and alterations in pupillary reaction, contrast sensitivity, and visual fields. Photoreceptor-visual pathway changes included alterations in both photoreceptors and neuro-transduction, as evidenced in dark adaptation, macular recovery time, reduction in visual field sensitivity, and optic neuritis (likely an element of decompression sickness). Retinochoroidal changes included increases in retinal vessel caliber, retinal blood flow, and choroidal thickness; central serous chorioretinopathy; and retinal vascular events (non-arteritic ischemic optic neuropathy, high-altitude retinopathy, and retinal vein occlusion). Conclusions: The effect of short-term high-altitude exposure on the eye is, in itself, a difficult area to study. Although serious impairment of visual acuity appears to be rare, ocular changes, including tear film stability, contact lens wear, central corneal thickness, intraocular pressure, contrast sensitivity, stability of refractive surgeries, retinal vessels, visual fields, and macula recovery time, should be considered in civilian aviators. Our report provides guidance to climbers and lowlanders traveling to altitude if they have pre-existing ocular conditions or if they experience visual symptoms while at altitude. However, key outcomes have been contradictory and comprehensive studies are scarce, especially those pertaining to the choroid and retina. Such studies could not only deepen our understanding of high-altitude ocular pathophysiology, but could also offer valuable information and treatment possibilities for a constellation of other vision-threatening diseases.

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The COVID-19 pandemic has greatly changed workplace management. Most workplaces have adopted the work-from-home policy to minimize the risk of community spread. Consequently, housing estates remain largely occupied during office hours. Since some housing estates are situated in the vicinity of an airport, noise pollution resulted from the takeoff and landing of aircraft is now more noticed by residents, causing annoyance. This problem would be most acute for those located directly under the flight path. Before the pandemic, such aircraft operations had lower effect on the residents because most of them were not at home but at workplaces. Evidently, it is timely that more emphasis should now be placed during urban planning to predict and minimize aircraft noise in the built environment. This article first defines the aircraft noise metrics commonly used to assess environmental impact. Preceded by an overview of how aircraft noise affects the built environment, this article reviews how various aircraft noise prediction models have been used in urban planning. Lastly, this article reviews how aircraft noise can be managed for better acoustic comfort of the residents. Anticipating the adoption of hybrid work arrangement moving forward, this article aims to provide urban planning professionals with an avenue to understand how aircraft noise can negatively affect the built environment, which, in turn, justify why prediction and management of aircraft noise should be emphasized from the outset of urban planning.

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OBJECTIVES: Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can be burdensome due to frequent interruptions and multitasking. We introduced a new role, the Triage nurse, to hold the triage pager and distribute patients. We sought to determine the effect of this Triage Nurse on the perceived workload of hospitalists and frequency of pages. METHODS: We partnered with our patient throughput department to implement the Triage Nurse role who took the responsibility of tracking and distributing admissions among three admitting physicians along with coordinating report. We used the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) to measure perceived workload and accessed pager logs of admitters for 3 months before and after implementation. RESULTS: Overall, 50 of an expected 67 NASA-TLX surveys (74.6%) were returned in the pre-intervention period and 64 of 92 (69.6%) were returned in the post-intervention period. We found a statistically significant reduction in the domains of physical demand, temporal demand, effort and frustration from pre- to post-intervention periods (p < 0.01). There was also a significant decrease in the performance domain (p = 0.01) with a lower number indicative of better perceived performance. There was a significant reduction in the mean number of pages received by admitting hospitalists over their 9-h shifts (81.3 + 17.3 vs 52.4 + 7.3; p < 0.01). CONCLUSION: The implementation of the Triage Nurse role was associated with a significant decrease in the perceived workload of admitting hospitalists. Our findings are important because workload and interruptions can contribute to errors and burnout. Future studies should test interventions to improve hospitalist workload and evaluate their effect on patient outcomes and physician wellness.

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OBJECTIVES: Coronavirus disease 2019 pandemic exercised a significant demand on healthcare workers. We aimed to characterize the toll of caring for coronavirus disease 2019 patients by registered nurses. DESIGN: An observational study of two registered nurses cohorts. SETTING: ICUs in a large academic center. SUBJECTS: Thirty-nine ICU registered nurses assigned to coronavirus disease 2019 versus noncoronavirus disease 2019 patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Skin temperature (t [°C]), galvanic skin stress response (GalvStress), blood pulse wave, energy expenditure (Energy [cal]), number of steps (hr-1), heart rate (min-1), and respiratory rate (min-1) were collected using biosensors during the shift. National Aeronautics and Space Administration Task Loading Index measured the subjective perception of an assignment load. Elevated skin temperatures during coronavirus disease 2019 shifts were recorded (ΔtCOVID vs tnon-COVID = +1.3 [°C]; 95% CI, 0.1-2.5). Registered nurses staffing coronavirus disease patients self-reported elevated effort (ΔEffortCOVID vs Effortnon-COVID = +28.6; 95% CI, 13.3-43.9) concomitant with higher energy expenditure (ΔEnergyCOVID vs Energynon-COVID = +21.5 [cal/s]; 95% CI, 4.2-38.7). Galvanic skin stress responses were more frequent among coronavirus disease registered nurse (ΔGalStressCOVID vs GalvStressnon-COVID = +10.7 [burst/hr]; 95% CI, 2.6-18.7) and correlated with self-reported increased mental burden (ΔTLXMentalCOVID vs ΔTLXMentalnon-COVID = +15.3; 95% CI, 1.0-29.6). CONCLUSIONS: There are indications that registered nurses providing care for coronavirus disease 2019 in the ICU reported increased thermal discomfort coinciding with elevated energy expenditure and a more pronounced self-perception of effort, stress, and mental demand.

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The complete lockdown due to COVID-19 pandemic has contributed to the improvement of air quality across the countries particularly in developing countries including India. This study aims to assess the air quality by monitoring major atmospheric pollutants such as AOD, CO, PM2.5, NO2, O3 and SO2 in 15 major cities of India using Air Quality Zonal Modeling. The study is based on two different data sources; (a) grid data (MODIS- Terra, MERRA-2, OMI and AIRS, Global Modeling and Assimilation Office, NASA) and (b) ground monitoring station data provided by Central Pollution Control Board (CPCB) / State Pollution Control Board (SPCB). The remotely sensed data demonstrated that the concentration of PM2.5 has declined by 14%, about 30% of NO2 in million-plus cities, 2.06% CO, SO2 within the range of 5 to 60%, whereas the concentration of O3 has increased by 1 to 3% in majority of cities compared with pre lockdown. On the other hand, CPCB/SPCB data showed more than 40% decrease in PM2.5 and 47% decrease in PM10 in north Indian cities, more than 35% decrease in NO2 in metropolitan cities, more than 85% decrease in SO2 in Chennai and Nagpur and more than 17% increase in O3 in five cities amid 43 days pandemic lockdown. The restrictions of anthropogenic activities have substantial effect on the emission of primary atmospheric pollutants.

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The COVID-19 pandemic elicited a global response to limit associated mortality, with social distancing and lockdowns being imposed. In India, human activities were restricted from late March 2020. This 'anthropogenic emissions switch-off' presented an opportunity to investigate impacts of COVID-19 mitigation measures on ambient air quality in five Indian cities (Chennai, Delhi, Hyderabad, Kolkata, and Mumbai), using in-situ measurements from 2015 to 2020. For each year, we isolated, analysed and compared fine particulate matter (PM2.5) concentration data from 25 March to 11 May, to elucidate the effects of the lockdown. Like other global cities, we observed substantial reductions in PM2.5 concentrations, from 19 to 43% (Chennai), 41-53% (Delhi), 26-54% (Hyderabad), 24-36% (Kolkata), and 10-39% (Mumbai). Generally, cities with larger traffic volumes showed greater reductions. Aerosol loading decreased by 29% (Chennai), 11% (Delhi), 4% (Kolkata), and 1% (Mumbai) against 2019 data. Health and related economic impact assessments indicated 630 prevented premature deaths during lockdown across all five cities, valued at 0.69 billion USD. Improvements in air quality may be considered a temporary lockdown benefit as revitalising the economy could reverse this trend. Regulatory bodies must closely monitor air quality levels, which currently offer a baseline for future mitigation plans.

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BACKGROUND: Patient monitoring is indispensable in any operating room to follow the patient's current health state based on measured physiological parameters. Reducing workload helps to free cognitive resources and thus influences human performance, which ultimately improves the quality of care. Among the many methods available to assess perceived workload, the National Aeronautics and Space Administration Task Load Index (NASA-TLX) provides the most widely accepted tool. However, only few studies have investigated the validity of the NASA-TLX in the health care sector. OBJECTIVE: This study aimed to validate a modified version of the raw NASA-TLX in patient monitoring tasks by investigating its correspondence with expected lower and higher workload situations and its robustness against nonworkload-related covariates. This defines criterion validity. METHODS: In this pooled analysis, we evaluated raw NASA-TLX scores collected after performing patient monitoring tasks in four different investigator-initiated, computer-based, prospective, multicenter studies. All of them were conducted in three hospitals with a high standard of care in central Europe. In these already published studies, we compared conventional patient monitoring with two newly developed situation awareness-oriented monitoring technologies called Visual Patient and Visual Clot. The participants were resident and staff anesthesia and intensive care physicians, and nurse anesthetists with completed specialization qualification. We analyzed the raw NASA-TLX scores by fitting mixed linear regression models and univariate models with different covariates. RESULTS: We assessed a total of 1160 raw NASA-TLX questionnaires after performing specific patient monitoring tasks. Good test performance and higher self-rated diagnostic confidence correlated significantly with lower raw NASA-TLX scores and the subscores (all P<.001). Staff physicians rated significantly lower workload scores than residents (P=.001), whereas nurse anesthetists did not show any difference in the same comparison (P=.83). Standardized distraction resulted in higher rated total raw NASA-TLX scores (P<.001) and subscores. There was no gender difference regarding perceived workload (P=.26). The new visualization technologies Visual Patient and Visual Clot resulted in significantly lower total raw NASA-TLX scores and all subscores, including high self-rated performance, when compared with conventional monitoring (all P<.001). CONCLUSIONS: This study validated a modified raw NASA-TLX questionnaire for patient monitoring tasks. The scores obtained correctly represented the assumed influences of the examined covariates on the perceived workload. We reported high criterion validity. The NASA-TLX questionnaire appears to be a reliable tool for measuring subjective workload. Further research should focus on its applicability in a clinical setting.

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The effects of climate change together with the projected future demand represents a huge challenge for wheat production systems worldwide. Wheat breeding can contribute to global food security through the creation of genotypes exhibiting stress tolerance and higher yield potential. The objectives of our study were to (i) estimate the annual grain yield (GY) genetic gain of High Rainfall Wheat Yield Trials (HRWYT) grown from 2007 (15th HRWYT) to 2016 (24th HRWYT) across international environments, and (ii) determine the changes in physiological traits associated with GY genetic improvement. The GY genetic gains were estimated as genetic progress per se (GYP) and in terms of local checks (GYLC). In total, 239 international locations were classified into two groups: high- and low-rainfall environments based on climate variables and trial management practices. In the high-rainfall environment, the annual genetic gains for GYP and GYLC were 3.8 and 1.17 % (160 and 65.1 kg ha-1 yr-1), respectively. In the low-rainfall environment, the genetic gains were 0.93 and 0.73 % (40 and 33.1 kg ha-1 yr-1), for GYP and GYLC respectively. The GY of the lines included in each nursery showed a significant phenotypic correlation between high- and low-rainfall environments in all the examined years and several of the five best performing lines were common in both environments. The GY progress was mainly associated with increased grain weight (R2 = 0.35 p < 0.001), days to maturity (R2 = 0.20, p < 0.001) and grain filling period (R2 = 0.06, p < 0.05). These results indicate continuous GY genetic progress and yield stability in the HRWYT germplasm developed and distributed by CIMMYT.

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On May 5, 1961, Alan B. Shepard Jr. piloted the Freedom 7 craft into a suborbital flight to become the first American man in space. His promising astronautical career was soon scuttled by spells of dizziness and tinnitus later diagnosed as Ménière's disease, until William F. House-considered the father of neurotology and a pioneer in surgery for vestibular schwannomas-intervened. In 1968 House implanted an endolymphatic-subarachnoid shunt, which at the time was a virtually experimental procedure. Shepard's debilitating Ménière's disease was cured, but not quite in time for him to pilot the doomed Apollo 13 mission; he was reassigned to Apollo 14 and as a result would step foot on the moon on February 5, 1971. This historical vignette depicts the tale of how the career trajectories of Shepard and House-two notable figures in their respective fields-fatefully intersected.

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In 1985, more than thirty geomorphologists, planetary scientists, and remote sensing specialists gathered at a conference center in Oracle, Arizona, to discuss an emerging area of research that they called "mega-geomorphology." Building on a conference of the same name held in London in 1981, they argued that new techniques of remote sensing and insights emerging from the study of extraterrestrial planets had created opportunities for geomorphology to broaden its spatial and temporal scope. This new approach was, however, neither unproblematic nor uncontested. In the discussions around mega-geomorphology that took place in the mid-1980s, the perceived conflict between the use of remote-sensing techniques to observe phenomena on vast spatial scales, on one hand, and the disciplinary centrality of fieldwork and field experience to geomorphology, on the other, was a recurrent theme. In response, mega-geomorphologists attempted to re-situate fieldwork and re-narrate disciplinary histories in such a way as to make remote sensing and planetary science not only compatible with geomorphological traditions but also means of revitalizing them. Only partially successful, these attempts reveal that the process of adopting a planetary perspective in geomorphology, as in other earth sciences, was neither straightforward nor inevitable. They also show how the field and fieldwork could remain central to geomorphology while also being extensively revised in light of new technical possibilities and theoretical frameworks.

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AIMS AND OBJECTIVES: To adapt the National Aeronautics and Space Administration Task Load Index scale into Turkish, to determine the nurses' mental workload using subjective methods and to identify the factors affecting the mental workloads of nurses. BACKGROUND: As the concept of safety gains prominence in healthcare services, the determination of employees' mental workloads using subjective methods is considered important in preventing errors caused by employees. DESIGN: Methodological and descriptive design. METHODS: The population of the study consisted of a total of 1900 nurses working at three hospitals and a dentistry faculty hospital affiliated with a public university in Istanbul. The sample of the study consisted of 1266 nurses who agreed to participate in the study (the rate of return was 66·6%). Language and content validity and reliability measurements were performed to adapt the National Aeronautics and Space Administration Task Load Index into Turkish, which was used as the data collection tool. RESULTS: It was found that the mean total mental workload score of the nurses was 80·48 (SD 11·76), and the weighted score of mental workload was 83·7. While the highest mean score was obtained on the subscale of mental demand (88·08, SD 16·12), the lowest mean score was obtained on the subscale of frustration (54·52, SD 29·96). The mean total mental workload score of the nurses showed a significant difference according to the units in which the nurses worked. CONCLUSION: The mean mental workload scores of nurses working at hospitals within the scope of the study were higher than the results of other studies. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurse managers perform mental workload measurements of nurses and compare the results with the quality indicators observed in units to determine and employ a labour force that is qualified for the profession and that may benefit more effectively from human resources.

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BACKGROUND: Mental fatigue is impaired cognitive function induced by engaging in cognitively demanding activities. Pediatric intensive care unit (PICU) rounds are demanding and may be a cause of impaired cognitive functioning. The purpose of this study is to evaluate if PICU rounds induce poorer performance on cognitive tasks after rounds compared to before rounds and assess the feasibility of cognitive testing in the PICU. METHODS: This was a prospective study of residents in the PICU. Participants were evaluated before and after rounds on a single day, consisting of two tests of cognitive function that are sensitive to mental fatigue, the cognitive estimation test (CET) and the repeatable episodic memory test (REMT). RESULTS: Thirty residents participated. The mean length of rounds was 191 min (SD 33.8 min), the mean number of patients rounded on by the team was 14.9 (SD 2.3) and the median patients presented by the participant was two (range 0-6). The average number of words recalled on the REMT was significantly lower after rounds compared to before (29.6 vs. 31.2, p < 0.05). There were significantly more falsely recalled words after rounds (1.3 vs. 0.7, p=0.02). There was a correlation between worsening performance and later time of testing in the 4-week PICU rotation (r=0.42, p < 0.02). There were no differences in performance on the CET. CONCLUSIONS: PICU rounds induced impairments on cognitive testing but the effect size is small and not consistent across tests. There is an increased susceptibility to impaired cognition induced by rounds over the course of a rotation, this finding merits further investigation.

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BACKGROUND: Musculoskeletal disorders (MSDs) are a serious problem among the nursing staff. Mental workload is the major cause of MSDs among nursing staff. The aim of this study was to investigate the mental workload dimensions and their association with MSDs among nurses of Alzahra Hospital, affiliated to Isfahan University of Medical Sciences. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted on 247 randomly selected nurses who worked in the Alzahra Hospital in Isfahan, Iran in the summer of 2013. The Persian version of National Aeronautics and Space Administration Task Load Index (NASA-TLX) (measuring mental load) specialized questionnaire and Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used for data collection. Data were collected and analyzed by Pearson correlation coefficient and Spearman correlation coefficient tests in SPSS 20. RESULTS: Pearson and Spearman correlation tests showed a significant association between the nurses' MSDs and the dimensions of workload frustration, total workload, temporal demand, effort, and physical demand (r = 0.304, 0.277, 0.277, 0.216, and 0.211, respectively). However, there was no significant association between the nurses' MSDs and the dimensions of workload performance and mental demand (P > 0.05). CONCLUSIONS: The nurses' frustration had a direct correlation with MSDs. This shows that stress is an inseparable component in hospital workplace. Thus, reduction of stress in nursing workplace should be one of the main priorities of hospital managers.

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As malaria transmission declines, it becomes increasingly important to monitor changes in malaria incidence rather than prevalence. Here, a spatio-temporal model was used to identify constituencies with high malaria incidence to guide malaria control. Malaria cases were assembled across all age groups along with several environmental covariates. A Bayesian conditional-autoregressive model was used to model the spatial and temporal variation of incidence after adjusting for test positivity rates and health facility utilisation. Of the 144,744 malaria cases recorded in Namibia in 2009, 134,851 were suspected and 9893 were parasitologically confirmed. The mean annual incidence based on the Bayesian model predictions was 13 cases per 1000 population with the highest incidence predicted for constituencies bordering Angola and Zambia. The smoothed maps of incidence highlight trends in disease incidence. For Namibia, the 2009 maps provide a baseline for monitoring the targets of pre-elimination.

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