The study of NOELs
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* Catherine Collins

*   © 2005 CMA Media Inc. or its licensors

Kenneth Rockwood and colleagues1 are to be congratulated for highlighting the problem of nodding off during scientific sessions, an unfortunate condition common among doctors and health care professionals that has until now been ignored in the medical literature. The authors have, however, overlooked 2 issues related to dress: the sex of the lecturer (and thus the location of high-risk fabrics such as tweed) and the presence of a bow tie.

In the interests of science, I attempted to test the theory of Rockwood and colleagues by creating a high risk of NOELs for undergraduate students at King's College London attending a lecture on the role of dietitians in the media. The wearing of a tweed skirt (gored panels, slimming design, midcalf length) failed to generate a NOEL response, despite postprandial timing and a warm environment. Anecdotally, therefore, the wearing of tweed below the waistband cannot be considered a high risk factor for NOELs.

The presence of a bow tie — a not-uncommon occurrence among British general surgeons, psychiatrists and the occasional rheumatologist (thankfully confined to consultant grades) — is a variable risk factor, representing either a character of whimsy (low NOEL risk) or an über-bore (high NOEL risk). As such, this easily visualized appendage requires consideration as a confounding factor (although it may be a uniquely European sartorial aberration).

## Reference

1.  1. Rockwood K, Hogan DB, Patterson CJ. Incidence of and risk factors for nodding off at scientific sessions. CMAJ 2004;171(12):1443-5.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTcxLzEyLzE0NDMiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTcyLzEyLzE1MzkuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)