Mental- and Temporal-Demand NASA-Task Load Index Scores Correlate with Decreases in Irisin Serum Levels in Healthy Individuals Subjected to 10-Day Bed Rest

As the U.S. Armed Forces shift from counterterrorism operations to peer conflict, preparing Critical Care Air Transport (CCAT) teams for high-volume patient movement is imperative. Quantifying baseline CCAT task load and its impact on team performance is essential for guiding future research aimed at mitigating task saturation during the complex transport missions anticipated in peer conflict scenarios. Individual provider task load and team performance were evaluated during a high-fidelity simulation conducted as part of the CCAT-Advanced Course. The 55-minute scenario involved the simultaneous care of 2 critically ill patients and was designed to impose a mild-to-moderate task load for mechanical ventilation management and a moderate-to-high task load for medication infusion management. Immediately following the simulation, participants completed the unweighted National Aeronautics and Space Administration Task Load Index (NASA-TLX). Team non-technical performance was assessed using the Team Emergency Assessment Measure (TEAM) instrument. Rather than aggregating NASA-TLX and TEAM subscale scores through arithmetic means (e.g., sums or averages), we applied multilevel Bayesian modeling. Specifically, we implemented a multivariate cumulative logit model-appropriate for ordinal Likert-scale data-that jointly modeled NASA-TLX and TEAM subscale responses. The model accounted for provider type as a predictor of task load (NASA-TLX) and nested observations within teams. Data from 44 CCAT teams were analyzed. Across the cohort, the NASA-TLX dimensions with the highest estimated scores were Effort (13.4, IQR = [8.12, 17.14]), Mental Demand (13.4, IQR = [8.72, 17.1]), and Temporal Demand (11.6, IQR = [6.71, 15.2]), while Frustration (7.94), Performance (5.63), and Physical Demand (5.29) were lower. This pattern-elevated cognitive and temporal demands with lower physical and emotional strain-was consistent across provider types. Among physicians (MDs), there was a significant negative correlation between individual task load (total NASA-TLX score) and team performance (total TEAM score), with Spearman's rank correlation coefficient ρ = -0.23 (95% credible interval = [-0.36 to -0.09]). In contrast, correlations for respiratory therapists (RTs) and registered nurses (RNs) were not statistically reliable, with ρ = -0.07 (95% CI = [-0.21 to 0.07]) and ρ = -0.02 (95% CI = [-0.16 to 0.13]), respectively. For MDs, higher levels of Frustration, Mental Demand, Temporal Demand, and Effort, along with lower self-rated Performance, were significantly associated with lower TEAM scores. No comparable associations were observed for RNs or RTs. Finally, all MD-RN NASA-TLX dimension pairs were significantly correlated, ρ between 0.31 and 0.44; and essentially no correlations were found between the RN-RT or MD-RT comparisons. We observed a negative association between physicians' self-rated Frustration, Mental Demand, Temporal Demand, Performance, and Effort and the total TEAM score-a pattern not observed among RNs or RTs. Physicians were the only provider type to both recognize team underperformance and attribute it to perceived shortcomings in their own performance. Although all MD and RN task load dimensions were correlated-likely reflecting task sharing between the 2 roles-only physicians' self-reported task load measures were associated with their team's non-technical skills performance.

Minimally invasive surgery (MIS) has become an essential component of modern surgical practice due to improved patient outcomes. However, these procedures impose significant cognitive and physical demands on surgeons, which remain inadequately quantified. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a validated subjective tool used to assess workload during complex tasks, including surgery. The aim of this study was to evaluate intra-operative surgeon workload during minimally invasive procedures across multiple surgical departments in a tertiary healthcare centre using NASA-TLX. This prospective observational study included surgeons performing elective minimally invasive procedures over a 3-month period at a tertiary care hospital. A total of 200 procedures performed by 27 surgeons across multiple departments were analysed. Emergency procedures, conversions to open surgery, combined procedures and abandoned surgeries were excluded. Surgeons completed the NASA-TLX questionnaire immediately after each procedure, assessing mental demand, physical demand, temporal demand, performance, effort and frustration. Workload scores were compared across procedure types and surgeon experience levels using appropriate statistical analyses, and effect sizes (η²) were calculated. NASA-TLX scores demonstrated a moderate overall workload, with higher mental and physical demand. Significant differences were observed across procedures in mental demand ( P = 0.013, η² =0.07), physical demand ( P = 0.022, η² =0.06), temporal demand ( P < 0.001, η² =0.11) and frustration ( P < 0.001, η² =0.21). The mean global NASA-TLX score was 5.77 ± 1.3. Laparoscopic gastrointestinal and cholecystectomy procedures demonstrated higher workload scores. Surgeons with < 5 years' experience reported greater temporal demand, while senior surgeons demonstrated higher mental demand, effort and frustration. Surgeon workload during MIS varies with procedure type and experience level. NASA-TLX is a practical and effective tool for assessing intra-operative workload and may help optimise surgical training, ergonomics and operative planning.

Soldering is common in electrical product manufacturing, but the task load in small units is unquantified. Therefore, this study aimed to establish the occurrence of task load due to soldering work, analyzing the effects of age and sex among workers in small manufacturing units. The task load of 102 soldering workers from four small-scale manufacturing units was assessed using the National Aeronautics and Space Administration task load index (NASA-TLX) questionnaire, covering six dimensions: physical demand, mental demand, temporal demand, effort, performance and frustration. Statistical analyses were performed using the Mann–Whitney U test, the Kruskal–Wallis test and ordinal regression, considering age, sex and work characteristics as independent variables. Age and work characteristics significantly influenced task loading, with a high prevalence of physical, mental and temporal demands and effort among soldering workers. These findings could lead to interventions in terms of the workstation design.

Understanding Cognitive Performance During Robot-Assisted Surgery

IntroductionSurgeons’ mental workload during endoscopic sinus surgery (ESS) has not been fully evaluated. The assessment was challenging due to the great diversity of each patient’s anatomy and the consequence variety of surgical difficulties. In this study, we examined the mental workload of surgeons with various surgical skill levels during ESS under the standardized condition provided by novel-designed 3D sinus models.Materials and methodsForty-seven participants performed a high-fidelity ESS simulation with 3D-printed sinus models. Surgeons’ mental workload was assessed with the national aeronautics and space administration-task load index (NASA-TLX). Associations between the total and subscales score of NASA-TLX and surgical skill index, including the board certification status, the number of experienced ESS cases, and the objective structured assessment of technical skills (OSATS), were analyzed. In addition, 10 registrars repeated the simulation surgery, and their NASA-TLX score was compared before and after the repetitive training.ResultsThe total NASA-TLX score was significantly associated with OSATS score (p = 0.0001). Primary component analysis classified the surgeons’ mental burden into three different categories: (1) the skill-level-dependent factors (temporal demand, effort, and performance), (2) the skill-level-independent factors (mental and physical demand), and (3) frustration. After the repetitive training, the skill-level-dependent factors were alleviated (temporal demand; z = −2.3664, p = 0.0091, effort; z = −2.1704, p = 0.0346, and performance; z = −2.5992, p = 0.0017), the independent factors were increased (mental demand; z = −2.5992, p = 0.0023 and physical demand; z = −2.2509, p = 0.0213), and frustration did not change (p = 0.3625).ConclusionSome of the mental workload during ESS is associated with surgical skill level and alleviated with repetitive training. However, other aspects remain a burden or could worsen even when surgeons have gained surgical experience. Routine assessment of registrars’ mental burdens would be necessary during surgical training to sustain their mental health.

Stress week was included during training of Special Forces (SF) Operators in Sweden to test their ability and limits for handling stress in different unknown situations and environments at a military training facility in Sweden. The aim of the study was to examine the effects of stress and workload experienced in various tasks during firefighting and military medicine simulation training. This pilot study was performed during the second day of stress week. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) is a validated, subjective, and multidimensional assessment tool for rating perceived workload with six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. These subscales were used as an indicator of stress experienced. The different tasks were assessed by the SF Operators by rating the NASA-TLX subscales for each task, which were then analyzed and compared using ANOVA. There was a significant difference between the two simulation exercises assessed by the participants and instructors, and both groups considered firefighting to be more demanding than medical. The participants perceived the mental and physical demands as more demanding in the firefighting exercises, as well as for the level of frustration and effort. However, no differences regarding performance or temporal demands between the simulation exercises were found. The principle "train as you fight" implies difficult and demanding situations. When exposing Swedish SF Operators to challenging situations, assessment of perceived stress and performance are possible.

This study investigates differences in difficulty using a microscope (OM) between professionals with less than 1 year of experience (Group 1 [G1]) and experienced professionals with over 5 years of practice in periodontics or implant dentistry (Group 2 [G2]). Twenty professionals were divided into two groups based on their experience. Each participant was instructed to perform three different exercises. Participants' ability to complete the exercises and the time required were evaluated. Additionally, they completed the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire. Its purpose is to assess the mental, physical, and temporal demands, the effort required, the level of frustration, as well as the participants' perception of the degree of success or failure. Both groups had an equal number of participants and completed three exercises. In Exercise 1, G1 was significantly faster than G2 (mean 0.54min vs. 6.51min). In Exercise 2, the time was similar for both groups (G1: mean 24.9min vs. G2: mean 21.3min). In Exercise 3, G2 was faster (mean 32.4min vs. mean 24.6min). In NASA-TLX, demand was significantly higher for G2. On the other hand, G1 had a higher perception of success in completing their tasks. G1 found it easier to incorporate the microscope. The level of frustration and demand (physical and mental) was higher in G2. The perception of success in using this technology was greater in G1, and the time required to complete the exercises was shorter for G1 in Exercise 1 and similar for both groups in Exercises 2 and 3. Both experienced and inexperienced professionals were able to complete all three exercises equally. Exercise 1 was completed faster by Group 1, whereas the times for Exercises 2 and 3 were similar. The level of difficulty in terms of mental demand, physical effort, time, and frustration was higher in experienced professionals. The perception of success in incorporating the OM was higher among professionals with less experience. This study compared the use of a microscope in clinical tasks between two groups of dental professionals: Group 1 (G1), with less than 1 year of experience, and Group 2 (G2), with over 5 years of experience in periodontics or implant dentistry. Twenty participants were divided equally and asked to complete three exercises using a microscope. Their performance, time taken, and perceived workload were assessed using the NASA-Task Load Index (NASA-TLX), which measures mental and physical effort, time pressure, frustration, and perceived success. In the first exercise, G1 completed the task much faster than G2. In the second, both groups had similar times, whereas in the third, G2 was quicker. However, G2 reported higher mental and physical demands and more frustration. G1, on the other hand, felt more successful in completing the tasks. In conclusion, less experienced professionals found it easier to adapt to using a microscope, with lower workload and greater confidence. These results suggest that introducing magnification early in clinical training may be beneficial.

All human activities, whether light, medium, or heavy, must have or contain a workload. Basically, every human being has a varied workload capacity, thus it's not inconceivable that the workload experienced by one worker differs from that of another, because there are a variety of elements that influence the difference in workload capacity. Sales and processing teams are under a lot of pressure to meet credit disbursement targets, which puts them under a lot of mental strain. A worker will experience work stress if he is given an excessive workload. When it comes to work, the influence of stress will result in a decline in performance, efficiency, and productivity of the work in question. To address this issue, a study based on the National Aeronautics and Space Administration Task Load Index (NASA-TLX) approach will be conducted to measure the mental strain of personnel in the Medan Balaikota consumer loan unit. NASA-TLX is a way for analyzing the mental workload of workers who must do a variety of tasks at work. Mental demand, physical demand, temporal demand, performance, effort, and frustration dimensions are among the six variables to be measured. Thirty workers of PT Bank XYZ Consumer Loan Unit Medan Balaikota Branch were surveyed. The NASA-TLX survey method is a quantitative descriptive methodology that was utilized to test in this study. According to the findings of the study, the NASA-TLX average score of PT Bank XYZ Consumer Loan Unit Medan Balaikota Branch employees obtained through research had a modest value. The result is a score of 77. Keywords: Mental Workload, NASA-TLX.

In the present study, we aimed to systematically evaluate the current evidence regarding the intraoperative workload of surgeons performing robot-assisted radical prostatectomy (RARP) for prostate cancer. A systematic search was carried out in the PubMed-MEDLINE and Web of Science databases through April 2024 using the following search terms: "workload AND robot assisted radical prostatectomy", "workload AND robotic radical prostatectomy", "task load AND robotic radical prostatectomy", "task load AND robot assisted radical prostatectomy" and "NASA-TLX AND robot assisted radical prostatectomy" by combining population, intervention, comparison, and outcome (PICO) terms, following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We therefore selected studies that included patients with prostate cancer (P) who underwent robotic radical prostatectomy (I) and reported a workload/task load questionnaire (C) to assess the intraoperative workload/task load of the surgeon performing robot-assisted radical prostatectomy (O). A total of 11 studies were identified. The surgeon's workload during RARP was assessed using the National Aeronautics and Space Administration task load index (NASA-TLX) and/or the surgery task load index (SURG-TLX) in the studies. Total NASA-TLX scores of the studies ranged from 22.7 ± 3.2 to 62.0 ± 6.4. Mental and physical demands, flow interruptions, surgeon experience, the use of single or multiple ports, and the relationship between the surgeon and other staff in the operating theater may play a role in the intraoperative workload of the console surgeon. The studies we reviewed suggest that RARP offers an acceptable workload for the console surgeon despite its mental demands.

Background:Pedicle screw placement during spine fusion is physically and mentally demanding for surgeons. Consequently, spine surgeons can become fatigued, which has implications for both patient safety and surgeon well-being.Purpose:We sought to assess the cognitive workload of surgeons placing pedicle screws using robotic-assisted navigation compared with fluoroscopic and computed tomography (CT)-assisted placement.Methods:We performed a nonrandomized prospective controlled trial to compare the cognitive workload of 3 surgeons performing single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using robotic, CT, or fluoroscopic navigation on 25 patients (15 in the robotic navigation group and 10 in the nonrobotic group). Immediately after each procedure, surgeons submitted the National Aeronautics and Space Administration–Task Load Index (NASA-TLX), which has 6 subscales: mental demands, physical demands, temporal demands, performance, effort, and frustration. Four tasks associated with pedicle screw placement were assessed independently: (1) screw planning, (2) calibrating robot/obtaining imaging/registration, (3) pedicle cannulation, and (4) screw placement. Patient demographics and surgical characteristics were obtained and reviewed.Results:Surgeons’ self-reported cognitive workload was significantly reduced when using robotic-assisted navigation versus CT/fluoroscopic navigation. Workload was reduced for screw planning, pedicle cannulation, and screw placement. In addition, there were significant reductions in each subdomain for these 3 tasks, encompassing mental demand, physical demand, temporal demand, effort, and frustration with improved task performance.Conclusions:This study found significant reductions in mental workload with improved perceived performance for robotic-assisted pedicle screw placement compared with fluoroscopic and CT-navigation techniques. Lowering the cognitive burden associated with screw placement may allow surgeons to address the remainder of the operative case with less decision fatigue, prevent complications, and increase surgeon wellness.

Traditional training metrics do not distinguish between the different components of internal training load contributing to training-induced fatigue, whereas the National Aeronautics and Space Administration Task Load Index (NASA-TLX) may offer a compelling multidimensional alternative. However, the NASA-TLX subscales have been overlooked in the context of endurance training. Therefore, this study investigated whether the NASA-TLX subscales are associated with acute performance decrement (APD) and physiological responses across different endurance training sessions. Twelve well-trained runners (10 males, 2 females; age 26.8 [6.9]y; maximal oxygen uptake [VO2max] 65.6 [6.4]mL·kg-1·min-1) completed 6 visits in the laboratory, an incremental test, a time to exhaustion (TTE) test, and 4 experimental training sessions in randomized order. A TTE test was performed at baseline and after each of 4 exercise sessions: low-intensity training, medium-intensity training, long-interval high-intensity (HITlong), and short-interval high-intensity (HITshort). APD was calculated as the percentage drop in TTE compared to baseline. The NASA-TLX questionnaire was administered between each training session and the TTE test to assess mental demand, physical demand, temporal demand, effort, frustration, and perceived performance. All sessions led to significant APD (P = .041), with HITlong producing greater APD than low-intensity training (P = .035). Subscale analysis showed lower mental, physical, temporal, and effort scores after low-intensity training compared to HIT sessions (P < .001). All subscales were significantly correlated with APD and key physiological ventilatory and metabolic parameters (P < .001). NASA-TLX subscales appear valid and may help athletes to discriminate distinct components of perceived workload.

Healthcare settings heavily rely on clinicians' abilities to interpret vital sign alarms indicating patient decompensation. Meanwhile, clinicians are bombarded with many multisensory stimuli necessary for patient care, including simultaneous visual and auditory displays. Here, we aim to assess how our modified auditory and visual alarm designs impact clinicians' perceived cognitive workload. This experimental study, conducted at Vanderbilt University Medical Center (VUMC) between March and September 2023, included 26 clinicians (nurse practitioners, residents, and fellows). Auditory trials involved 15 clinicians and non-clinicians (university students) to validate design intuitiveness. Clinicians participated in visual and auditory trials to identify simulated mean arterial pressure (MAP), utilizing standard and modified alarms. Visual modifications incorporated a line-graph display with a moving dot for MAP. Auditory modifications introduced harmonic overlays indicating severity and direction of MAP values. After each trial, participants completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to assess perceived workload across 6 domains (temporal demand, physical demand, mental demand, effort, performance, frustration) on a 1-20 Likert scale with increased scores represent greater workload. For analysis, Wilcoxon signed-rank and rank-sum tests were used. Demographics for auditory alarm trials averaged an age of 26.2 and 54% identified as male. Visual display trials included 26 clinicians with an average age of 30.1 and 59% identified as male. In visual trials, clinicians reported significantly lower temporal demand with the modified monitor (median, interquartile range (IQR)) (8.0, 4.2-11.8) compared to the conventional monitor (13.0, 6.5-16.0; p = 0.022). In auditory trials, clinicians reported significantly higher perceived performance with conventional auditory alarms as compared to non-clinicians (10.0, 5.0-13.0) vs. (4.0, 2.0-9.0; p = 0.022). Non-clinicians reported higher perceived temporal demand for conventional auditory alarms when compared to clinicians (6.0, 3.0-10.0) vs. (2.5, 1.0-5.0; p = 0.024). Our findings suggest modifications to both visual and auditory alarms can reduce elements of perceived cognitive workload, especially temporal demand, while preserving clinician performance without deterioration of other measured components.

Objective The objective of this study was to investigate the challenges associated with driving in spiral tunnels through a comprehensive analysis of both visual performance and subjective perceptions of drivers. By comparing driving behavior in spiral tunnels to that in conventional curved tunnels, the study aimed to identify specific differences in visual attention, cognitive processing, and perceived workload, ultimately informing tunnel design and safety improvements. Methods Naturalistic driving experiments were conducted in two different tunnel environments: A conventional curved tunnel and a spiral tunnel. Participating drivers were equipped with eye-tracking device to measure visual performance indicators such as average fixation duration, average pupil diameter, average saccade duration, and average saccade amplitude. Additionally, drivers’ subjective perceptions of workload were assessed using the National Aeronautics and Space Administration Task Load Index (NASA-TLX) scale, which evaluates mental, physical, temporal, and emotional demands, as well as overall performance and frustration. Results The results of the study revealed significant differences in drivers’ visual performance and subjective perceptions between spiral and curved tunnels. In spiral tunnels, drivers exhibited longer average fixation durations and larger average pupil diameters, indicating increased cognitive processing and visual attention requirements. Furthermore, drivers in spiral tunnels had longer average saccade durations and smaller average saccade amplitudes, suggesting a more cautious and focused visual scanning strategy due to the tight turns and limited visibility. Subjectively, drivers reported significantly higher workload across all dimensions of the NASA-TLX scale in spiral tunnels, indicating greater mental, physical, temporal, and emotional demands compared to curved tunnels. Conclusions This study reveals the challenges of spiral tunnels for drivers, especially regarding visual attention and cognitive load. It suggests that improving tunnel design elements like lighting, signage, and road surfaces can lower drivers’ cognitive demands and improve their visual processing. The research also emphasizes the importance of specialized driver training for navigating these tunnels safely. In summary, the findings enhance transportation safety by offering insights into driving behavior in complex tunnels and suggesting methods to reduce risks.

Drivers’ ability to capture driving related information, interpretation and timely action upon that information determines safe driving. However, the cognitive resources of the driver to perceive, interpret, and execute driving related information are limited. The limitation of cognitive resources brings the issue of cognitive workload in focus. In the light of this understanding, the current study examines in-vehicle object and spatial distractions in terms of their effect on cognitive workload experienced by drivers. 47 drivers voluntarily participated in this test-track study. Equal number of drivers were randomly assigned to in-vehicle object and spatial distraction conditions. Drivers assigned to object distraction condition had to process object appearance information whereas under spatial distraction they had to process spatial information. After the completion of the drive, each driver’s cognitive workload was assessed by using National Aeronautics and Space Administration-Task Load Index (NASA-TLX). It was observed that there is a significant difference between in-vehicle object and spatial distraction with respect to their effect on cognitive workload. The results indicate that the drivers experienced more cognitive workload during object distraction. Multiple regression analysis of cognitive workload reveals that temporal demand, effort, and performance dimensions are significant predictors of overall cognitive workload, but the other three dimensions (i.e., mental demand, physical demand and frustration level) are not. Further, the stepwise analysis of the dimensions of NASA-TLX showed that temporal demand is the most dominant factor which contributed to 85% of the cognitive workload experienced by the drivers.KeywordsIn-vehicle distractionsCognitive workloadDistracted drivingWorking memory

Air traffic controllers are under excessive stress because of their job. This has been linked to aspects of ATC work such as high job demands, time or responsibility pressure, or inadequate equipment. Types of work that require more vigilance, such as air traffic controllers at airports, are closely related to mental jobs that require high concentration. Because there is a negative impact on a company if it gives mental workload too high or too low for its employees, it is necessary to measure it to find out the right mental workload for its employees. This study aims to calculate the mental workload felt by ATC personnel in the APP unit. Measurement of mental workload in this study using the NASA-TLX (National Aeronautics and Space Administration Task Load Index). This method measures 6 (six) dimensions of workload size, namely Mental Demand, Physical Demand, Temporal Demand, Performance, Effort and Frustation Level