US Federal Travel Restrictions for Persons with Higher-Risk Exposures to Communicable Diseases of Public Health Concern.

Published guidance recommends controlled movement for persons with higher-risk exposures (HREs) to communicable diseases of public health concern; US federal public health travel restrictions (PHTRs) might be implemented to enforce these measures. We describe persons eligible for and placed on PHTRs because of HREs during 2014-2016. There were 160 persons placed on PHTRs: 142 (89%) involved exposure to Ebola virus, 16 (10%) to Lassa fever virus, and 2 (1%) to Middle East respiratory syndrome coronavirus. Most (90%) HREs were related to an epidemic. No persons attempted to travel; all persons had PHTRs lifted after completion of a maximum disease-specific incubation period or a revised exposure risk classification. PHTR enforced controlled movement and removed risk for disease transmission among travelers who had contacts who refused to comply with public health recommendations. PHTRs are mechanisms to mitigate spread of communicable diseases and might be critical in enhancing health security during epidemics.

Lilienthal's fatal glider crash in 1896: evidence regarding the cause of death.

Otto Lilienthal's pioneering work on gliders helped form the basis for development of powered aircraft. His death following a glider crash in 1896 was officially ascribed to fracture of the cervical spine. However, the clinical details assembled here make it more likely that he died from head trauma with resulting complications, possibly including intracranial hematoma.

In-flight medical events and aircraft diversions: one airline's experience.

BACKGROUND: An aging population combined with the increasing mobility of people with acute and chronic illnesses could make an increase in the frequency of in-flight medical events aboard commercial aircraft likely. OBJECTIVE: To determine the incidence of each type of in-flight medical complaint, the appropriateness of medical kit contents, which factors lead to aircraft diversion, and which factors effect the appropriateness of the decision to divert. METHOD: Medical complaints reported aboard a sample airline from July 1, 1999 through June 30, 2000 were studied. The frequency of aircraft diversion was related to complaint and medical assistance provided. The appropriateness of the decision to divert was determined as a function of hospital admission rates. RESULTS: There was an incidence of 22.6 medical complaints per million passengers and 0.1 deaths per million passengers. There were 210 diversions per million flights with one of every 12.6 incidents resulting in a diversion. When a passenger volunteer was used, they opened the medical kit 62% of the time. When a physician participated in the decision to divert the hospital admission rate was 49% versus 15% with no physician input. CONCLUSION: Variations in incidence of medical complaints cited in previous studies demonstrate the need for an industry-wide standardized reporting method of in-flight medical events. All in-flight medical complaints could likely have been adequately treated with the contents of the FM's newly mandated medical kits. Physician participation in decisions to divert aircraft should be sought as it is associated with more appropriate divert decisions.

Medical guidelines for space passengers--II.

It now appears likely that commercial entities will carry paying passengers on suborbital spaceflights in this decade. The stresses of spaceflight, the effects of microgravity, and the limited capability for medical care onboard make it advisable to develop a system of medical clearance for such space tourists. The Aerospace Medical Association, therefore, organized a Space Passenger Task Force whose first report on medical guidelines was published in 2001. That report consisted of a list of conditions that would disqualify potential passengers for relatively long orbital flights. The Task Force reconvened in 2002 to focus on less stringent medical screening appropriate for short duration suborbital flights. It was assumed that such commercial flights would involve: 1) small spacecraft carrying 4-6 passengers; 2) a cabin maintained at sea-level "shirt-sleeve" condition; 3) maximum accelerations of 2.0-4.5 G; 4) about 30 min in microgravity. The Task Force addressed specific medical problems, including space motion sickness, pregnancy, and medical conditions involving the risk of sudden incapacitation. The Task Force concluded that a medical history should be taken from potential passengers with individualized follow-up that focuses on areas of concern.