Assessing cognitive load in navigation tasks through EEG: Spatio-temporal multi-scale analysis

Growing endoscopy demand has increased physical workload and injury risk among endoscopists, while current ergonomic solutions remain limited. We developed a newly motion-optimized endoscope-holding device (scope-holder) designed to reduce muscular burden, allowing each operator to adjust the scope position according to individual preference. This study assessed its ergonomic impacts in a simulated setting. Clinical endoscopists and nonmedical participants without any medical background were recruited to collect data. Each participant performed a simulated endoscopic marking task with and without the scope-holder. We compared the procedure time of the task, evaluated muscle efforts in the upper arm, forearm, and shoulder using wireless electromyography, as well as mental workload using NASA-TLX across the two settings. A total of 26 participants, including 17 clinical endoscopists and 9 nonmedical participants, were enrolled. In the overall cohort, the scope-holder assisted group significantly reduced activation of biceps brachii (p < 0.001), trapezius (p < 0.001), flexor carpi ulnaris (p = 0.049) muscles and NASA-TLX scores (p = 0.003). Additionally, the assisted group achieved a shorter procedure time (p = 0.018) compared with the non-assisted group. Subgroup analysis showed reduced muscle load in both clinical endoscopists and nonmedical participants (p < 0.05), with additional improvements in mental workload (p = 0.004) and the procedure time (p = 0.027) observed only in nonmedical participants, whereas clinical endoscopists showed no significant difference in mental workload (p = 0.299) and procedure time (p = 0.229). Our newly developed scope-holder, designed to accommodate the operator's natural scope motion, effectively reduced physical and mental workload. It offers a practical solution to improve ergonomics in endoscopic clinical practice.

Associations between prebriefing quality and satisfaction in simulation-based learning among nursing students: A structural equation model.

Evaluating the effect of immersive virtual reality technologies on cognitive load, situation awareness, and engagement using eye movements.

Resting-state functional connectivity correlates of emotional memory control under cognitive load in subclinical anxiety.

Embodied representations are known to influence user behavior in virtual environments through stereotypes associated with their appearance, a phenomenon known as the Proteus effect, or through perceived affordances. The latter concept refers to the suggested ways of interacting with the environment as perceived by the capabilities of the user's virtual representation. The inherent ability of virtual reality to support non-anthropomorphic avatars, enabling new interaction modalities, paves the way for a deeper understanding of affordances in virtual environments. We designed an experiment to assess the effect of embodying a chimeric hand (crab claw), compared to a regular hand, on participants' sense of embodiment, presence, character plausibility, mental workload, and behavior. Following a within-subject design, participants took part in a gamified task consisting of finding a key in a wrecked pirate ship. As the key could be hidden in containers of different durability, their strategy (opening or destroying objects) was used as an objective measure. Results indicated a high perceived usability and a low mental workload with both virtual limbs. Participants also performed hitting actions more frequently when using the biomimetic limb than when using the humanoid hand representation. A higher perceived change in the body schema was reported when embodying the crab claw, but a higher sense of body ownership and agency were observed with the anthropomorphic hand. Results revealed no significant difference in terms of plausibility.

Exploring the Relationship Between Eye Metrics and Surgical Performance: A Study on Orthopedic Surgeons in Simulated Procedures.

Self-management experience of young patients with refractory epilepsy: A qualitative study.

This manuscript proposes two novel interaction techniques for visualization-assisted exploration of urban data, namely, Layer Toggling and Visibility-Preserving Lenses. The former mitigates visual overload by organizing information into distinct layers while enabling multi-layer comparisons through controlled overlays. The technique supports focused analyses without sacrificing spatial context and enables users to quickly switch between layers through a dedicated physical button interface. Visibility-Preserving Lenses, on the other hand, dynamically adapt their size and transparency so that users can effectively examine dense spatial regions and temporal attributes in detail. Both techniques support urban data exploration and improve prediction. Exploring urban data is essential for understanding complex phenomena related to crime, mobility, and residents’ behavior and equally important is the ability to predict and explain how they evolve over time, supporting informed urban planning and policymaking. However, navigating urban data in all their complexity is challenging, often resulting in cognitive overload, loss of spatial context, and excessive visual clutter due to the many layers that must be examined simultaneously. Although layered visualizations aim to mitigate those challenges, they face limitations with occlusion and effortless comparisons across data layers. Additionally, interaction methods are typically confined to mouse-based controls, limiting the fluidity of dynamic exploration. The visualization tool was validated through a comprehensive user study that measured user performance, cognitive load, and interaction efficiency across multiple devices. Using real-world data from São Paulo, including mobility patterns, climate conditions, and crime statistics, the way the approach enhances both exploratory and analytical tasks is demonstrated. The results also show how users perform when playing with different interactive devices, providing guidelines for future developments and improvements. • Introduces a novel approach to toggle data layers for spatial crime analysis. • Proposes visibility-preserving lenses for comparisons of urban attributes with less occlusion. • Supports multi-attribute exploration in dense urban visualizations. • User study shows improved accuracy and interaction efficiency with proposed tools. • Enables better decision-making by enhancing insight into urban spatial patterns.

Beyond anxiety reduction: Psychological transformation and systemic contradictions in generative-AI-mediated language learning - A cultural-historical activity theory perspective.

Could the overarching tasks in the Glasgow Consensus Statement change teaching and practice?

Clinical alarm management is a critical patient safety challenge in intensive care units (ICUs). The high frequency of non-actionable alarms paradoxically undermines safety by contributing to alarm fatigue, increased cognitive load and delayed responses among nurses. To systematically synthesise and appraise qualitative evidence on ICU nurses' experiences, perceptions and coping behaviours regarding clinical alarms. A systematic review of qualitative evidence using meta-aggregation was conducted. A comprehensive search of eight databases (PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang, VIP and CBM) was undertaken from inception to December 2024. Included qualitative and mixed method studies were critically appraised using the Joanna Briggs Institute's Critical Appraisal Checklist. Data were synthesised using the meta-aggregation approach, and the confidence in the synthesised findings was assessed using the ConQual approach. Fourteen studies were included in the synthesis. The meta-aggregation produced four synthesised findings: (1) The Perceptual Paradox: Alarms as an Essential Safety Mechanism and a Clinical Burden; (2) Nurses' Alarm Response as an Evolving Practice of Situated Clinical judgement; (3) A Multi-level System of Nurses' Alarm Response: Individual, Contextual and organisational Factors; and (4) ICU Nurses' Expectations for Clinical Alarms: Intelligent Support, Practical Training and Sustained Autonomy. Effective alarm management is fundamentally a socio-technical challenge, rooted in a core perceptual paradox. Nurses navigate this paradox through situated clinical judgement, a process shaped by a multi-level system in which unit safety culture is pivotal. Therefore, sustainable solutions must integrate technological optimisation to reduce cognitive load, cultivate positive unit safety cultures and augment clinical expertise-thereby repositioning nurses from passive alarm responders into empowered clinical decision makers. The synthesised evidence suggests that interventions should prioritise competency-based, situational training to bridge the recognition-intervention gap, foster a non-punitive unit alarm safety culture to mitigate responder isolation and adopt a human-centred design paradigm for future technologies to reduce cognitive load and support, rather than replace, clinical expertise.

Advanced life support (ALS) competence may deteriorate within months after certification, but what supports ongoing competence in critical care remains unclear. To map factors influencing maintenance of ALS competence among critical care professionals working in critical care settings. Scoping review conducted in accordance with Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE, CINAHL and the Cochrane Library were searched (from February to March 2025). We included peer-reviewed and grey sources from hospital-based critical care settings that assessed ALS competencies over time. Data were synthesised using inductive thematic analysis. Twenty-five sources were included (19 peer-reviewed, 6 grey). Factors were mapped to three domains. Educational factors were most frequently reported and centred on simulation-based rehearsal, structured feedback and debriefing and spaced refreshers delivered in brief, frequent sessions. Institutional determinants related to protected training time, access to resources, standardised roles and content and monitoring through audit and feedback. Individual determinants included clinical exposure and experience, perceived preparedness and self-confidence, stress and cognitive load, engagement in ongoing learning and non-technical behaviours. Outcomes were largely simulation-based or self-reported, and longer-term durability was inconsistently assessed. Maintenance of ALS competence appears to require coordinated educational and organisational supports; longitudinal evaluations with explicit definitions and validated outcomes are needed. Critical care services may strengthen ALS competence maintenance by embedding recurrent, context-aligned rehearsal with feedback, supported by protected training time, accessible training infrastructure and ongoing performance monitoring. The review protocol was prospectively registered on the Open Science Framework https://doi.org/10.17605/OSF.IO/PEQJH.

Developer Experience (Dev-X) has emerged as a critical driver of software quality, developer productivity, and project success. However, the empirical literature remains fragmented, with limited understanding of how specific Dev-X interventions affect downstream software and business outcomes. This study aims to synthesize and map the current empirical evidence on Dev-X interventions, identifying how they influence software outcomes (e.g., code readability, collaboration) and propagate to organizational key performance indicators (KPIs) such as product quality and process efficiency. We conducted a systematic mapping study of 160 empirical articles published between 2006 and 2024. We identified 146 unique interventions that impacts software outcomes such as role match may impact on developers’ workload, likewise managing burnout in developer feedback may impact organizational culture. Using grounded coding, we also classified such mappings to 8 KPIs and 5 Dev-X dimensions based on the strength of empirical relationships (correlational, causal, classification-based) reported in the literature. Our analysis reveal that quality-related KPIs are more frequently impacted than productivity metrics, challenging traditional emphasis. Emotional state and values-oriented interventions dominate current practices, while cognitive load and motivation-focused strategies remain underexplored. Only a minority of studies (39 out of 160) explicitly trace full chains of intervention–outcome–KPI, highlighting persistent fragmentation; in other cases, we reconstructed these chains using cross-sectional synthesis of study data. Notably, recent years show an emergence of AI-assisted and value-centered intervention designs. This study consolidates the fragmented Dev-X landscape by offering an evidence-based, open-access Ready-Reckoner tool for navigating interventions and their effects. While not prescriptive, it enables structured, context-aware exploration of empirical findings and lays the foundation for future causal, longitudinal, and multi-channel Dev-X research. • We systematically map 160 empirical studies to trace how Developer Experience (Dev-X) interventions influence software outcomes and business-critical KPIs. • The study identifies 146 unique interventions and categorizes them by their targeted Dev-X facets, intermediate outcomes, and relationship strength (causal, correlational, qualitative). • Our results highlight a gap in empirical traceability between Dev-X practices and long-term organizational success, emphasizing the need for integrated evaluation frameworks. • The study identifies underexplored connections across Dev-X dimensions and advocates for research into their combined influence on developer performance and project outcomes. • We deliver an open-access, practitioner-oriented Dev-X Ready-Reckoner Tool that supports evidence-based selection of interventions aligned with organizational goals.

This study evaluated the TLS's effectiveness in reducing cognitive load, improving time management, and supporting academic performance. A case study design examined the TLS implementation in an online neonatal care course and two blended Human Pathophysiology and Pharmacology courses. Quantitative data were analysed using descriptive statistics and effect size (Cohen's h) to compare positive agreement across cohorts. Qualitative feedback was thematically coded to identify key perceptions of TLS usefulness. The TLS was introduced in Care of the Neonate in 2018 and in the P&P courses in 2023. Data were collected across 13 institutional survey cycles (2018-2025) using Likert-scale and open-ended responses. Cumulative feedback included 146 neonatal and 192 P&P students. Analyses highlight the first neonatal course year (2018) and the most recent P&P cycle (2025). In 2018, 85.6% of neonatal students (n = 83) rated TLS positively, with 62.7% (n = 52) strongly agreeing it supported learning. In 2025 P&P data (n = 129), 82.2% rated the TLS positively, with 56.6% (n = 73) strongly agreeing. The difference between cohorts showed a small, stable effect size (h = 0.09), confirming consistency across time and courses. Qualitative feedback revealed five themes: clearer study prioritization, improved focus, ease of use, deeper engagement, and greater satisfaction. The TLS enhances curriculum clarity, time management, and cognitive load reduction. Integration of quantitative and qualitative outcomes shows the TLS is statistically consistent and valued by students, supporting targeted, high-impact learning across diverse courses.

Objective The objective of this cross-sectional study was to compare the auditory memory scores obtained using the verbal and picture-pointing response modes in children with cochlear implants and implant-age matched typically developing children. Method The short-term auditory memory test consisting of word sequences ranging from two-word sequences to five-word sequences was developed and administered to 53 children using unilateral cochlear implants and 53 typically developing children matched in terms of implant age and gender. The implant age of the children ranged from 2 years 8 months to 7 years 9 months, and the mean age of implantation was 3 years 5 months. Each participant was tested twice, once using a verbal response task and once using a picture-pointing response task in two different sessions. Results The total auditory memory scores were significantly higher (P < 0.05) for the picture-pointing task as compared to the verbal recall task, especially when the memory task placed a high auditory demand and cognitive load on the children. The total auditory memory scores obtained using both the response tasks were lower in children using cochlear implants as compared to implant-age matched typically developing children (P < 0.05). Conclusion The present findings indicate that the type of response task affects the performance on the short-term auditory memory test in children using cochlear implants and typically developing children, with the picture-pointing response task yielding better scores than the verbal response.

Biology educators increasingly teach in classrooms shaped by digital devices, projected media, bright artificial lighting, dense visual displays, and frequent movement between lecture, laboratory, and online learning tasks. These conditions are often treated as background features rather than as factors that may affect attention, engagement, and cognitive access. Cognitive load theory has helped educators analyze how instructional design can support or overload working memory; however, science educators have fewer practical frameworks for examining the combined sensory, physical, and technological demands of the learning environment. This Perspective uses the term environmental load to describe task-irrelevant cognitive demand produced by the physical, sensory, spatial, and technological conditions of biology learning environments, including lighting, noise, temperature, visual clutter, screen exposure, device interruptions, room arrangement, and limited opportunities for movement. The article situates this concept within prior work on cognitive load, student engagement, classroom design, lighting, and educational technology. It then argues that environmental load is particularly relevant in biology and laboratory learning because students must coordinate terminology, diagrams, models, procedures, safety expectations, and abstract systems while managing the physical space around them. Practical next steps include classroom environment audits, intentional screen breaks, reduced visual complexity during cognitively demanding tasks, research on sensory conditions in science classrooms, and professional development that treats cognitive access as both an instructional and environmental concern.

A well-powered test of task difficulty effects on cardiovascular indicators of mental effort.

Exploring the integration of large language models in human-robot collaboration: Effects on performance, mental stress, and trust.

Digital twins (DTs) are becoming a transformative technology for built infrastructure management. However, their potential remains constrained by the limitations of existing human-DT interaction modes, namely graphical user interfaces (GUIs), which impose steep learning curves, rigid workflows, and high cognitive loads. This paper introduces a large language model (LLM)-driven multi-agent system (MAS) framework as a complementary human-DT interaction paradigm. Within this framework, a Leader Agent, supported by a Reasoning Agent, coordinates specialized Member Agents to decompose tasks, orchestrate workflow, and orchestrate heterogeneous DT functions. A proof-of-concept prototype, termed HighwayMAS, was developed for highway infrastructure management and evaluated through a mixed-design experiment involving 18 highway experts. Results showed that HighwayMAS significantly outperformed the traditional GUI in reducing cognitive workload, improving task performance, and improving usability and user experience. Importantly, participants without prior DT experience completed tasks successfully, signifying MAS as a promising direction for more intuitive, adaptive, and human-centered DT interaction. • Digital twins (DTs) have emerged as a promising solution for intelligent built infrastructure management. • The existing GUI-based interaction modes impose learning barriers, rigid workflows, and high cognitive loads. • An LLM-driven multi-agent system (MAS) framework is proposed as an alternative human-DT interaction mode. • A proof-of-concept prototype, HighwayMAS, was implemented for highway infrastructure management. • User study showed HighwayMAS reduced workload and improved task performance, usability, and user experience.