Polycythemia Prevalence and Risk Factors in Pilots.

INTRODUCTION: Pilots are frequently exposed to thrombotic risk as a result of immobility from air travel. As hypoxemia is associated with secondary polycythemia, and polycythemia increases the risk of thrombosis, intermittent exposure to high-altitude hypoxic environments could escalate the risk of thrombosis in pilots. Our objectives were to find the prevalence of polycythemia in airplane pilots (primary outcome) and to assess associated risk factors of polycythemia (secondary outcome).METHODS: This study is a cross-sectional descriptive study. Data was collected from paper-based and computerized medical records of airplane pilots who applied for Class 1 Aviation Medical Certificate renewal at the Institute of Aviation Medicine, Royal Thai Air Force, Bangkok, Thailand, in 2018. The data was sampled by a simple random sampling technique.RESULTS: A total of 386 paper-based records were sampled. Of those, 29 (7.5%) of the pilots met polycythemia criteria. Spearman's correlation analysis showed a significant positive correlation between Body Mass Index (BMI) and hemoglobin (correlation coefficient = 0.127) and between BMI and hematocrit (correlation coefficient = 0.105). In multivariate logistic regression of each variable on polycythemia as defined by hemoglobin alone, piloting a non-pressurized aircraft was found to be an independent predictor of polycythemia (odds ratio = 4.3).DISCUSSION: The prevalence of polycythemia in airplane pilots was 7.5%. Operating a non-pressurized aircraft was a significant risk factor of polycythemia, and pilots with higher BMI were more likely to have increased red blood cell parameters.Thanapaisan P, Plaingam M, Manyanont S. Polycythemia prevalence and risk factors in pilots. Aerosp Med Hum Perform. 2024; 95(9):683-687.

Performance Optimization and Injury Mitigation for Air Force Student Fighter Pilots.

INTRODUCTION: Military fighter aircrew report high rates of cervical pain and injury. There is currently no consensus regarding the best training methods for this population. Eglin Air Force Base (AFB) and Luke AFB have multidisciplinary teams specializing in aircrew training, performance, and injury mitigation. All student pilots (SPs) completing Basic Course training at these locations engage in an 8-week Spine Training Program (STP). The STP originated at Luke AFB in 2020 and was expanded to Eglin AFB in 2022. The primary aim of this study was to assess whether the STP led to significant changes in the performance measure studied, Cervical Endurance Hold (CEH). Further, this study aimed to determine if the CEH training effect was independent of location of STP administration. We hypothesized that SPs would exhibit statistically significant CEH training adaptations irrespective of base location. MATERIALS AND METHODS: Air Force F-16 and F-35 SPs from Luke AFB and Eglin AFB were actively enrolled in the Basic Course and participated in the standardized STP from 2020 to 2023. The CEH test was administered prior to (intake) and following (exit) the 8-week STP. SPSS for Windows version 29 software (IBM, Armonk, NY) was used to retrospectively analyze the data from this study. Participants were excluded if they were unable to perform the CEH test at intake or exit. The study was approved by the Air Force Research Laboratory Institutional Review Board and was performed in accordance with the ethical standards of the Declaration of Helsinki. RESULTS: One hundred and ninety-eight SPs (Luke AFB, males n = 170, females n = 12; Eglin AFB, males n = 16) completed the STP program. There was no significant difference between intake and exit concerning age, height, weight, % body fat, and fat-free mass at Luke AFB or Eglin AFB (P < 0.05). Statistically significant improvements in CEH were observed within all groups from intake to exit (P < 0.001). When considering all participants collectively, there was a notable 33.6% increase in CEH from intake to exit (P < 0.001) with an overall effect size of d = 1.14. When analyzing specific subgroups, females from Luke AFB experienced a significant 20.4% increase in CEH (P < 0.001, d = 1.14), males from Luke AFB exhibited a significant 34.5% increase (P < 0.001, d = 1.09), and males from Eglin AFB demonstrated a significant increase of 55.7% in CEH (P < 0.001, d = 1.97). CONCLUSIONS: This retrospective analysis showed significant improvements in the CEH across all groups following the completion of the STP. Furthermore, CEH results from both bases exhibited a large effect size indicating a meaningful change was found between intake and exit regardless of training location. These preliminary study results should be interpreted with caution as a control group was unable to be established. In the future, a randomized control trial should be performed to test the STP used in this study against other STP programs. This may better inform experts on the best spine training methods for fighter aircrew.

Maritime accidents in the estuary of the River Seine from 2009-2019.

BACKGROUND: In confined waters, ships run a high risk of groundings, contact, sinkings and near misses. In such waters the maritime traffic is dense, the waterway is narrow, the depth is limited, and tides and currents are constantly changing. MATERIALS AND METHODS: From 2009-2019, 75 accidents were investigated in the estuary of the Seine. Weather conditions and perceived fatigue were studied. From May to June 2020, 114 seafarers, 34 pilots and 80 captains, responded to a questionnaire focusing on the use of Pilot Portable Units (PPU) and Electronic Chart Display Information Systems (ECDIS). RESULTS: The 75 accidents corresponded to an average of 6.8 ± 3.2 accidents per year. Groundings were the most frequent accidents (35%, n = 26) followed by contact accidents with the quayside (25%, n = 19), between ships or tugs while manoeuvring (8%, n = 6) or while sailing (1%, n = 1). There was no loss of vessels nor fatalities of crew members. In poor weather conditions, there were 76% more accidents than in normal conditions (4.4 ± 2.5 accidents/10,000 movements versus 2.5 ± 1.9 accidents/10,000 movements, p < 0.03). Almost all the accidents (96%) were related to human errors of judgment (81%), or negligence (53%), or both (39). Perceived fatigue was probably in cause in 6 accidents. Only 3 accidents were related to mechanical causes. Through the questionnaires, 69% of the pilots complained of difficulties in mastering the devices and software. They felt distracted by alarms which affected their attention while navigating. They requested training on a simulator. Concerning ship captains, 83% felt comfortable with ECDIS devices yet only 20% were able to configure the ECDIS correctly. CONCLUSIONS: In the Seine estuary, 75 accidents occurred within the 11 year-study. Risk factors were poor weather conditions and human error. PPU and ECDIS were considered as useful tools in the prevention of accidents. However, pilots and captains requested more thorough training in their use.

Circadian Disruption in Civilian Airline Pilots.

INTRODUCTION: Most airline pilots reported having suffered from sleep disorders and fatigue due to circadian disruption, a potential risk to flight safety. This study attempted to uncover the actual scenario of circadian disruption and working load status among airline pilots.METHODS: In study 1, 21 pilots were invited to participate in a 14-d sleep monitoring and a dual 2-back test to monitor their sleep patterns and cognitive function level. To provide an in-depth view, data from scheduled flights, including 567 airline pilots, was analyzed in Study 2. The present study used cluster analysis to reflect the distribution of the flight scheduling characteristics, including working time and actual working hours. A simulation model was then developed to predict the pilots' 1-mo sleep-wake pattern.RESULTS: The results indicated that sleep problems were prevalent in this population, especially the night before an earlier morning shift. Regarding the cognitive test, they scored the lowest on earlier morning shifts compared with daytime and evening shifts. It was found that over 70% of the flight schedules can lead to circadian disruption, and 47.44% of the pilots worked under high-load status.DISCUSSION: Airline pilots inevitably work irregular hours and the current policies for coping with circadian disruption seem inefficient. This study thus calls for urgency in improving scheduling and fatigue management systems from the circadian rhythm perspective.Yang SX, Cheng S, Sun Y, Tang X, Huang Z. Circadian disruption in civilian airline pilots. Aerosp Med Hum Perform. 2024; 95(7):381-389.

Medical reasons for permanent and temporary disqualification of Turkish civil aviation pilots.

The aim of this study was to identify diseases that result in permanent and temporary medical disqualification for civil aviation pilots and their changes over the years. A retrospective analysis was conducted on the medical examination records performed in Turkey from 2018 to 2022, in accordance with ICAO and EASA standards. The permanent disqualification rate was 1.3%, and the temporary disqualification rate was 6.6%. The most common reasons for permanent disqualification among pilots were circulatory system diseases (24%), mental and behavioral disorders (22.9%), and nervous system diseases (11.5%). The most common reasons for temporary disqualification among pilots were circulatory system diseases (17.9%), digestive system diseases (11.8%), and health problems related to COVID-19 infection (9.5%). The data obtained from this study may be useful in developing preventive medicine approaches to prevent medical disqualifications and in-flight medical incapacitation.

Survival After Ditching in Motorized Aircraft, 1989-2022.

INTRODUCTION: Although an unintended aircraft landing on water (referred to as ditching) is a rare event, the potential for occupant injury/fatality increases immediately following the event due to adverse conditions. However, to date, few studies have addressed the subject. Herein, ditching events and post-ditching survival were investigated.METHODS: Ditchings (1982-2022) in the United States were identified from the National Transportation Safety Board database. Occupant injury severity, aircraft type, pilot experience, flight conditions, and number of occupants were extracted. Poisson distribution, the Chi-squared test (2-tailed), Mann-Whitney U test, and Kruskal-Wallis one-way analysis of variance were employed.RESULTS: A total of 96 ditchings were identified. A systematic survey was hampered by the lack of a standardized reporting matrix in the reports. In total, 77 reports were included in the analysis. Across all ditchings, 128 of 169 (76%) occupants survived ditching and were rescued. Importantly, the initial ditching event was survived by 95% of all occupants. However, 32 (19%) occupants died post-ditching by drowning (21/32 cases) or for undetermined reasons. Considering probability per ditching event, in 26 (34%) of all ditchings, one or more occupants was/were fatally injured.DISCUSSION: Initial survival of the emergency ditching is high. Drowning was the leading cause of death after ditching and reduced the overall survival to 76%. Further investigation is needed to identify risk factors for fatal outcomes and/or improve probability of survival after ditching.Schick VC, Boyd DD, Hippler C, Hinkelbein J. Survival after ditching in motorized aircraft, 1989-2022. Aerosp Med Hum Perform. 2024; 95(5):254-258.

Global Cardiovascular Risk and Associated Factors in 2792 French Military and Civilian Aircrew.

INTRODUCTION: Cardiovascular (CV) diseases are a major public health issue, the prevention of which plays a key role in promoting flight safety. However, few studies have looked at the determinants of the overall risk of CV morbidity-mortality within the various aeronautical occupations.METHODS: A monocentric, observational, cross-sectional study was based on the retrospective data collected during 6 mo at the Toulon Aeromedical Center. From October 2017 to April 2018, 2792 professional aircrew ages 18-74 were included. The overall CV risk was estimated using the European Society of Cardiology SCORE and the Framingham model, as well as a summation model.RESULTS: More than two-thirds of this mainly male population (86.2%) had no more than one CV risk factor [69.9% (68.2-71.6)]. In 82.5% of cases, this was dyslipidemia according to current European criteria [55.8% (52.4-59.1)] or smoking [26.7% (23.8-29.8)]. An overall risk level of "moderate" to "very high" concerned only one subject in five according to the SCORE model [20.1% (18.6-21.6)], one in six according to Framingham [16.3% (14.9-17.7)] and almost one in three according to the summation model [30.1% (28.4-31.9)].DISCUSSION: Multivariate analyses found no significant associations between socio-professional criteria and overall risk levels. The results have underlined the effect of dyslipidemia and smoking on early risk among applicants. Beyond the illustration of favorable cardiovascular status among aircrews related to the standards of selection and close monitoring process, areas for improvement were identified, inviting the development of prevention strategies around the "moderate" overall CV risk.Huiban N, Gehant M, Brocq F-X, Collange F, Mayet A, Monteil M. Global cardiovascular risk and associated factors in 2792 French military and civilian aircrew. Aerosp Med Hum Perform. 2024; 95(5):233-244.

Prevalence and network analysis of internet addiction, depression and their associations with sleep quality among commercial airline pilots: A national survey in China.

OBJECTIVE: Airline pilots are members of a unique occupational group that is often confronted with sleep routine disruptions, yet relatively few studies have examined their mental health status. This study assessed the prevalence and network structure of internet addiction, depression and sleep quality problems in commercial airline pilots. METHOD: A total of 7055 airline pilots were included in analyses. Internet addiction and depression were measured with the Internet Addiction Test (IAT) and 9-item Patient Health Questionnaire (PHQ-9), respectively. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). The network model was constructed based on an Ising model and its association with sleep quality was evaluated using a flow procedure. RESULTS: Internet addiction, depression and sleep quality were common among airline pilots. The prevalence of internet addiction was 8.0 % (95 % CI: 7.3-8.6 %), while the rates of depression and poor sleep quality were 23.3 % (95 % CI: 22.3-24.2 %) and 33.0 % (95 % CI: 31.9-34.1 %), respectively. In the depression and internet addiction network model, "Fatigue" (PHQ4; Expected Influence (EI): 2.04) and "Depressed/moody/nervous only while being offline" (IAT20; EI: 1.76) were most central symptoms while "Fatigue" (PHQ4; Bridge EI: 1.30) was also the most important bridge symptom. The flow network model of sleep quality with internet addiction and depression showed that "Appetite" (PHQ5) had the strongest positive association with poor sleep quality. CONCLUSION: Internet addiction, depression and sleep quality were common among airline pilots and warrant regular screening and timely treatment. Strategies to improve sleep hygiene may be useful in preventing onsets or exacerbations in depression and internet addiction among airline pilots.

Cervical Disc Displacement in Military Pilots.

INTRODUCTION: Cervical disc displacement (CDD) may disqualify pilots from flying and have a profound impact on military unit capability. The objective of this retrospective database review is to characterize the incidence and demographic predictors of symptomatic cervical spine disc displacement in pilots of fixed- and rotary-wing aircraft and ground-based controls. MATERIALS AND METHODS: The Defense Military Epidemiology Database was queried for first-occurrence ICD-9 code 722.0: CDD cases from 2007 to 2015. Injury count rates among aircraft groups and overall incidence per 1,000 person-years were calculated and standardized for age, gender, and military rank, and 95% confidence intervals (CIs) were compared to determine significance. RESULTS: There were 934 new cases of CDD among active duty U.S. Military pilots during the study period. The overall incidence of CDD in all pilots during this time frame was 2.715 per 1,000 person-years (95% CI, 2.603-2.830). Helicopter pilots had a significantly higher incidence compared to all other aircraft pilots and crew at 3.79 per 1,000 person-years (95% CI, 3.48-4.13). This finding remained statistically significant after standardizing for age, gender, and rank. Among all military officers, increasing age was a risk factor for CDD. CONCLUSIONS: The U.S. Military helicopter pilots have an increased risk compared to fixed-wing pilots and non-pilot controls. CDD remains a rare, though career-threatening, condition. Increased education and awareness training are warranted for both helicopter pilots and flight physicians to recognize signs and symptoms of cervical pathology. Continued investigations into preventive measures to minimize injury and time unfit for flight are warranted.

Flight Crew Alertness and Sleep Relative to Timing of In-Flight Rest Periods in Long-Haul Flights.

BACKGROUND: In-flight breaks are used during augmented long-haul flight operations, allowing pilots a sleep opportunity. The U.S. Federal Aviation Administration duty and rest regulations restrict the pilot flying the landing to using the third rest break. It is unclear how effective these restrictions are on pilots ability to obtain sleep. We hypothesized there would be no difference in self-reported sleep, alertness, and fatigue between pilots taking the second vs. third rest breaks.METHODS: Pilots flying augmented operations in two U.S.-based commercial airlines were eligible for the study. Volunteers completed a survey at top-of-descent (TOD), including self-reported in-flight sleep duration, and Samn-Perelli fatigue and Karolinska Sleepiness Scale ratings. We compared the second to third rest break using noninferiority analysis. The influence of time of day (home-base time; HBT) was evaluated in 4-h blocks using repeated measures ANOVA.RESULTS: From 787 flights 500 pilots provided complete data. The second rest break was noninferior to the third break for self-reported sleep duration (1.5 0.7 h vs. 1.4 0.7 h), fatigue (2.0 1.0 vs. 2.9 1.3), and sleepiness (2.6 1.4 vs. 3.8 1.8) at TOD for landing pilots. Measures of sleep duration, fatigue, and sleepiness were influenced by HBT circadian time of day.DISCUSSION: We conclude that self-reported in-flight sleep, fatigue, and sleepiness from landing pilots taking the second in-flight rest break are equivalent to or better than pilots taking the third break. Our findings support providing pilots with choice in taking the second or third in-flight rest break during augmented operations.Gregory KB, Soriano-Smith RN, Lamp ACM, Hilditch CJ, Rempe MJ, Flynn-Evans EE, Belenky GL. Flight crew alertness and sleep relative to timing of in-flight rest periods in long-haul flights. Aerosp Med Hum Perform. 2021; 92(2):8391.

Aeromedical Implications of Cerebral Cavernomas.

BACKGROUND: Cavernomas, cavernous angiomas, or cerebral cavernous malformations are clusters of endothelium-lined blood vessels usually found in the brain. With the increasing use of radiological imaging, these are being detected incidentally in asymptomatic aircrew. The UK Civil Aviation Authority (CAA) experience of cavernomas is described and the aeromedical concerns, that is, the risk of epilepsy, hemorrhage, and the development of a neurological deficit, are considered.METHODS: A search of the CAA database between 1990 and 2020 was performed for the term cavernoma. The gender, age at diagnosis, class of certification held, clinical presentation, location, and size of the lesion were noted. A PubMed literature review for papers with complications of cavernoma was performed.RESULTS: Six cases of cavernoma have been declared to the CAA: five professional pilots and one private pilot. Five were men and one was a woman. The age range was between 38 and 60 yr, with a mean of 48 yr. Two cases presented with clinical symptoms and four were asymptomatic. Complication rates for seizure and hemorrhage were extracted from the published literature together with the significance of other factors such as cavernoma size, family history, multiplicity, and the development of new lesions.DISCUSSION: A policy for the medical certification of aircrew with cavernomas that have presented with clinical symptoms and those that are detected incidentally is proposed.Jagathesan T, OBrien M. Aeromedical implications of cerebral cavernomas. Aerosp Med Hum Perform. 2021; 92(2):120123.

Health-related quality of life in pilots of a Chinese commercial airline.

Health-related quality of life (HRQOL) is currently an important issue in the medical industry. However, data on HRQOL in commercial airline pilots are lacking. This study aimed to investigate HRQOL and its related factors in a sample of commercial pilots. A purposive sample of 373 participants was recruited from a Chinese Commercial Airline. The median (IQR) score for physical health, psychological health and social relationship were 64.3 (75-53.6), 62.5 (70.8-54.2) and 75 (75-58.3), respectively. The mean (SD) score for Environment was 62.2 (16). After controlling for demographics, the multiple linear regression analyses showed that physical activity, fruit intake and vegetable intake were positively correlated with HRQOL score (p < .05), while time-zone flights, smoking, alcohol drinking and being dyslipidemic showed a negative correlation with HRQOL score (p < .05). Healthcare providers should consider time-zone flights, behavioral factors and dyslipidemia when planning related health promotion and disease prevention programs for commercial pilots in the future.

A survey of spatial disorientation incidence in Polish military pilots.

OBJECTIVES: The study aimed to establish the current incidence and severity of spatial disorientation (SD) in Polish military pilots when flying different aircraft types over their entire careers, and to determine how SD training and pilots' flight experience might benefit their recognition of situations that may cause SD. MATERIAL AND METHODS: Overall, 176 military Polish pilots (aged 33.8±7.72 years, the number of flying hours: 1194±941) flying different aircraft types, who attended the aviation medicine course, were surveyed and asked to report their episodes of SD. To collect anonymous data, a postal SD questionnaire (INFO PUB 61/117/5) was used. RESULTS: In the overall incidence rate of SD (96%), the most commonly experienced SD illusion was "loss of horizon due to atmospheric conditions" (81%). More SD incidents were reported by pilots who had received SD training. Some differences in the categories of the most commonly experienced SD illusion episodes between aircraft types were found. A severe episode adversely affecting flight safety was categorized by 10% of the respondents. CONCLUSIONS: In Polish military aviation, episodes of SD are a significant threat to aviation safety. There is evidence for the beneficial effects of SD training in the improvement of pilots' ability to recognize those factors that lead to SD. Int J Occup Med Environ Health. 2020;33(6):791-810.

Psychophysiological Response to Disorientation Training in Different Aircraft Pilots.

Disorientation is one of the most important hazards in flights, but there is a need for a deeper analysis of its effect on the psychophysiological response of pilots. This study aimed to analyse the effect of disorientation training in cortical arousal, autonomic modulation, muscle strength, and perception. We analysed 39 male pilots of the Spanish Army and Air Force (27 Helicopter Pilots, 7 Transport Pilots and 5 F-18 Fighter Pilots) before and after disorientation training. Disorientation training produced an increase in perceived stress and effort in Helicopter Pilots (HP) and Transport Pilots (TP), and lower Heart Rate Variability (RMSSD) in all pilots. Rating of Perceived Exertion (RPE) and Handgrip Strength were more negatively affected among HP than in TP. RPE was more negatively affected in HP than among Fighter Pilots (FP). Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) were significantly higher in FP (FVC 5.44 ± .407 l, FEV1 4.57 ± .407 l) than in HP (FVC 4.73 ± .547 l, FEV1 3.79 ± .712 l). Disorientation training affects the psychophysiological response of pilots, and different responses are depending on each job profile. These results could help to improve specific training for better preparation of pilots that face disorientation threats.

Pilots' Visual Scanning Behaviors During an Instrument Landing System Approach.

BACKGROUND: Since eye movement can provide a reliable index of the attention allocation, which can assist in understanding pilots' cognitive state, this study investigated the effect of pilots' experience and the autopilot mode on their attention allocation on the Primary Flight Display (PFD) and Multi-Function Display (MFD) during an approach task.METHODS: There were 16 pilots who were classified into two levels of aviation expertise depending on the flight hours, and required to fly an Instrument Landing System approach. Their visual scanning behaviors were recorded through an eye tracker and analyzed based on fixation number and dwell time.RESULTS: The results revealed that the pilot experience level, instrument panel and autopilot mode all had significant impact on the fixation time ratio and dwell time. The pilots fixated most often on the PFD and had shorter dwell time. Furthermore, they had a lower fixation number and shorter dwell time on the PFD and MFD when the autopilot was off that they should allocate visual resources to the others (e.g., out-of-the-window) and obtain more information to maintain overall situation awareness under higher time pressure. Compared to pilots with more expertise, pilots with less expertise had an increased fixation number and decreased dwell time on the airspeed after turning off the autopilot.DISCUSSION: The present study indicated that the pilots had different visual scanning modes according to the flight mode and their experience. We expect that pilots' visual scanning behaviors during tasks will help the training and the design of the human-machine interaction.Lu Y, Zheng Y, Wang Z, Fu S. Pilots' visual scanning behaviors during an instrument landing system approach. Aerosp Med Hum Perform. 2020; 91(6):511-517.

Age, aging and physiological dysregulation in safety-critical work: a retrospective longitudinal study of helicopter emergency medical services pilots.

PURPOSE: Concurrent progressive physiological dysregulation in different organ systems may be a driver of phenotypical frailty and is associated with morbidity and performance declines. In aging societies, health and performance of older workers are given increased scrutiny. However, there are few studies researching the effect of age on physiological dysregulation specifically in the working population and none for high-risk occupations with close medical supervision. Here, we aim to investigate this association cross-sectionally and longitudinally in a healthy sample of European helicopter emergency medical services pilots. METHODS: Using a retrospective cohort design, we constructed indices of (a) physiological dysregulation state (N = 52 participants) and (b) pace of change (N = 41 participants, average follow-up 7.9 years) based on measurements of 18 health risk-associated biomarkers, as documented in the participating pilots' aeromedical examination records. The relationship of these two indices with average age (range 27.9-60.6 years) and average baseline age (29.3-57.2 years), respectively, was modeled by weighted least squares regression, adjusting for region of origin, smoking, and medication. RESULTS: Longitudinally, dysregulation significantly increased over the follow-up period, but the pace of change did not increase with baseline age. Cross-sectionally, we observed a significant negative quadratic effect of age on physiological dysregulation state, with maximum estimated physiological dysregulation at ages 45-50. CONCLUSIONS: As hypothesized, progression of dysregulation over approximately 8 years is observable in a healthy occupational sample but it does not accelerate (i.e., does not increase with baseline age). Increases in dysregulation are counteracted by what appears to be a strong healthy worker survivor effect. The study shows that the development of physiological dysregulation in high-risk occupations differs from that in the general population and that physiological dysregulation indices may be helpful in reconciling safety concerns and fair treatment of aging workers in safety-critical jobs.

Work profile of maritime pilots in Germany.

Long and irregular shifts, unforeseeable operations and high responsibility are still prominent in the job of a pilot and pose high psycho-physical demands. Furthermore, there is a disturbed work-family balance. Working hours of pilots are highly variable and not bound by regulations due to irregularities of vessel traffic. The pilots have to work in a shifting rotation system. This paper demonstrates the stressors during their work routine and shows the usual working profile of a pilot during their service.

U.S. Statement of Demonstrated Ability Aeromedical Waivers.

INTRODUCTION: The Statement of Demonstrated Ability (SODA) is a type of U.S. aeromedical waiver used for disqualifying conditions that are not expected to change. About 21,000 (2%) U.S. pilots possess a SODA waiver.METHODS: We matched all pilot medical exams from the FAA's medical certification database from 2002 through 2011 to their respective accidents in the National Transportation Safety Board accident database. The association of SODA waivers and SODA conditions with the odds of an accident were explored using logistic regression techniques.RESULTS: For 3rd class flight exams, the presence of a SODA waiver was not associated with the odds of an accident. For the 1st and 2nd class exams, the accident odds ratio (OR = 1.45) was statistically significant. Crop dusting operations accounted for 17 of the 40 accidents where SODAs were present and returned a significant accident OR = 1.68. SODAs were not associated with the odds of accidents during other commercial operations. Six SODA conditions (amputation, internal eye, external eye, visual fields, bone and joint, and miscellaneous) were also found to have elevated ORs but were based on very small accident counts. NTSB investigators and the authors reviewed all accidents and none thought the SODA condition to be contributory.DISCUSSION: SODA waivers were not associated with increased accident odds except for crop dusting operations. Six specific SODA conditions also had elevated odds of an accident, but there was no evidence they contributed to the accidents. Overall, U.S. pilots with SODA waivers appear to have a satisfactory safety record.Mills WD, Davis JT. U.S. Statement of Demonstrated Ability aeromedical waivers. Aerosp Med Hum Perform. 2019; 90(12):1034-1040.

ACTN-3 Genotype, Body Composition, Fitness, and +Gz Tolerance in Senior Cadets.

BACKGROUND: This study aimed to investigate the relationships among ACTN-3, body composition, fitness, and +Gz tolerance for senior cadet training development and their safe task performance.METHODS: The subjects were all senior cadets (N = 68) at the Korea Air Force Academy. All cadets are required to pass a physical fitness test (3-km running, sit-ups, push-ups) and body composition test on a semiannual basis. Isokinetic muscle function (strength and endurance), +Gz test (+6 Gz ⋅ 30 s-1), and target gene (ACTN-3) were analyzed.RESULTS: The effects of body composition and physical fitness along with the relationship of the ACTN-3 genotype to the +6 Gz test results were determined. Consequently, no significant difference was found concerning the effect of ACTN-3 on the +6 Gz test result, body composition, and physical fitness; however, body fat (%) and isokinetic muscle strength (peak torque right leg extension and left leg flexion) showed significance between the pass and failure groups in the +Gz test.DISCUSSION: The cadets of the Korea Air Force Academy showed dominant fast genetic expression type based on their ACTN-3 genotype [RR and RX (N = 51, 75%) > XX (N = 17, 25%)]. Body fat (%) and isokinetic muscle strength (PT R EX, L FL) can be more effective predictors in the +6 Gz test for cadet training. Another speculation is that more RR- and RX-type-oriented training can promote cadets' Gz tolerance from the isokinetic factors such as high peak torque and low fatigue index.Shin S, Jee H. ACTN-3 genotype, body composition, fitness, and +Gz tolerance in senior cadets. Aerosp Med Hum Perform. 2019; 90(12):1055-1060.