Travel restrictions and SARS-CoV-2 transmission: an effective distance approach to estimate impact.

OBJECTIVE: To estimate the effect of airline travel restrictions on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) importation. METHODS: We extracted passenger volume data for the entire global airline network, as well as the dates of the implementation of travel restrictions and the observation of the first case of coronavirus disease (COVID-19) in each country or territory, from publicly available sources. We calculated effective distance between every airport and the city of Wuhan, China. We modelled the risk of SARS-CoV-2 importation by estimating survival probability, expressing median time of importation as a function of effective distance. We calculated the relative change in importation risk under three different hypothetical scenarios that all resulted in different passenger volumes. FINDINGS: We identified 28 countries with imported cases of COVID-19 as at 26 February 2020. The arrival time of the virus at these countries ranged from 39 to 80 days since identification of the first case in Wuhan. Our analysis of relative change in risk indicated that strategies of reducing global passenger volume and imposing travel restrictions at a further 10 hub airports would be equally effective in reducing the risk of importation of SARS-CoV-2; however, this reduction is very limited with a close-to-zero median relative change in risk. CONCLUSION: The hypothetical variations in observed travel restrictions were not sufficient to prevent the global spread of SARS-CoV-2; further research should also consider travel by land and sea. Our study highlights the importance of strengthening local capacities for disease monitoring and control.

Comparing public concern and support for drone regulation to the current legal framework.

In this study we assess the extent to which the regulations governing the use of drones in the United States address the concerns held by the public they are meant to protect. In general, respondents were most supportive of those regulations that could be categorized as limiting one's exposure to an unwanted drone. The most popular policies were those that protected personal privacy, while the least popular were those that hampered drones used for public safety. The largest discrepancy was found to be respondents' preference for laws protecting personal privacy compared with the lack of regulatory constraints currently in place. Federal regulators have only begun to introduce regulations on how drones can be used in our national airspace, with additional regulations for other types and sizes of drones likely to be introduced in the future. The results of this study may be utilized by regulators and lawmakers to create a regulatory structure that effectively mitigates risk and supports the public interest.

Drones in medicine-The rise of the machines.

This is a medical kitty hawk moment. Drones are pilotless aircrafts that were initially used exclusively by the military but are now also used for various scientific purposes, public safety, and in commercial industries. The healthcare industry in particular can benefit from their technical capabilities and ease of use. Common drone applications in medicine include the provision disaster assessments when other means of access are severely restricted; delivering aid packages, medicines, vaccines, blood and other medical supplies to remote areas; providing safe transport of disease test samples and test kits in areas with high contagion; and potential for providing rapid access to automated external defibrillators for patients in cardiac arrest. Drones are also showing early potential to benefit geriatric medicine by providing mobility assistance to elderly populations using robot-like technology. Looking further to the future, drones with diagnostic imaging capabilities may have a role in assessing health in remote communities using telemedicine technology. The Federal Aviation Administration (FAA) in the United States and the European Aviation Safety Agency (EASA) in the European Union are some examples of legislative bodies with regulatory authority over drone usage. These agencies oversee all technical, safety, security and administrative issues related to drones. It is important that drones continue to meet or exceed the requirements specified in each of these regulatory areas. The FAA is challenged with keeping pace legislatively with the rapid advances in drone technology. This relative lag has been perceived as slowing the proliferation of drone use. Despite these regulatory limitations, drones are showing significant potential for transforming healthcare and medicine in the 21st century.

Control of Communicable Diseases. Final rule.

The Centers for Disease Control and Prevention (CDC), within the Department of Health and Human Services (HHS), is issuing this final rule (FR) to amend its regulations governing its domestic (interstate) and foreign quarantine regulations to best protect the public health of the United States. These amendments have been made to aid public health responses to outbreaks of new or re-emerging communicable diseases and to accord due process to individuals subject to Federal public health orders. In response to public comment received, the updated provisions in this final rule clarify various safeguards to prevent the importation and spread of communicable diseases affecting human health into the United States and interstate.

Aircraft noise, health, and residential sorting: evidence from two quasi-experiments.

We explore two unexpected changes in flight regulations to estimate the causal effect of aircraft noise on health. Detailed measures of noise are linked with longitudinal data on individual health outcomes based on the exact address information. Controlling for individual heterogeneity and spatial sorting into different neighborhoods, we find that aircraft noise significantly increases sleeping problems and headaches. Models that do not control for such heterogeneity and sorting substantially underestimate the negative health effects, which suggests that individuals self-select into residence based on their unobserved sensitivity to noise. Our study demonstrates that the combination of quasi-experimental variation and panel data is very powerful for identifying causal effects in epidemiological field studies.

Aircraft noise: accounting for changes in air traffic with time of day.

Aircraft noise contours are estimated using model calculations and, due to their impact on land use planning, they need to be highly accurate. During night time, not only the number and dominant types of aircraft may differ from daytime but also the flight paths flown may differ. To determine to which detail these variations in flight paths need to be considered, calculations were performed exemplarily for two airports using all available radar data over 1 year, taking into account their changes over the day. The results of this approach were compared with results of a simpler approach which does not consider such changes. While both calculations yielded similar results for the day and close to the airport, differences increased with distance as well as with the period of day (day

Venous thromboembolism during air travel: does the existing evidence raise legal implications?

Venous thromboembolism associated with prolonged sitting during air travel has been reported in the medical literature. The aim of this article was to review whether the existing evidence can raise ethical concerns and grounds for legal implications. Review of the pertinent literature. Long duration air travel is linked with venous thromboembolism in susceptible individuals. However, the jurisdictions in countries that have adopted the Warsaw Convention 1929 and its amendment at Hague in 1955 have invariably based their approach on whether venous thromboembolism developed after air travel is an ''accident'' under the provision of article 17. Not only this has failed to be proven under various jurisdictions but also inaction, including not warning of the risk and not giving advice on the precautions that would minimise that risk have not been considered sufficient to rank venous thromboembolism as an ''accident''. While there is scientific evidence to support that long-haul flights may predispose to the development of venous thromboembolism in susceptible individuals, there is a clear trend in various jurisdictions that the airline carrier does not incur liability under the Warsaw convention. Nevertheless, the existing scientific evidence raises ethical concerns on the need for information and advice on prevention to those passengers at risk from the airline companies.

Crashes of sightseeing helicopter tours in Hawaii.

INTRODUCTION: Crashes of sightseeing helicopter flights in Hawaii and the resulting tourist deaths prompted the FAA to issue regulations in 1994 specific to air tours in Hawaii. Research was undertaken to examine the effect of the 1994 Rule and to describe the circumstances of such crashes. METHOD: From National Transportation Safety Board data, 59 crashes of helicopter air tour flights in Hawaii during 1981-2008 were identified; crash investigation reports were read and coded. Crashes in 1995-2008 were compared with those in 1981-1994. RESULTS: The 1994 Rule was followed by a 47% decrease in the crash rate, from 3.4 to 1.8/100,000 flight hours. The number of crashes into the ocean decreased from eight before the Rule to one afterwards. VFR-IMC crashes increased from 5 to 32% of crashes. There were 46 tourists and 9 pilots who died in 16 fatal crashes. Aircraft malfunctions, primarily due to poor maintenance, precipitated 34 (58%) of the crashes and persisted throughout the 28-yr period. Pilot errors were apparent in 23 crashes (39%). Flight from visual to instrument conditions occurred in two cases before the Rule and seven cases after. Terrain unsuitable for landing was cited in 37 crashes (63%). CONCLUSION: Decreases occurred in the overall number and rate of crashes and in ocean crash landings. The increase in VFR-IMC crashes may be related to the requirement that tour helicopters fly at least 1500 ft. above terrain. Attention is still needed to maintenance, pilot training, and restricting flights to operating areas and conditions that enable safe emergency landings.

Leisure pilot license proposed for Europe: do you want such pilots crossing your flight path?

In a Notice of Proposed Amendment, the European Aviation Safety Agency proposes to introduce a Leisure Pilot License (LPL). Holders of a LPL for airplanes will be allowed to fly single-engine piston airplanes with a maximum takeoff mass of 2000 kg or less, carrying a maximum of three passengers. In this commentary paper, we express significant concern about the flight safety consequences of the proposed aeromedical requirements of the LPL. We argue that the proposed minimum age, validity period of the medical certificate, and issuance of certificates by general practitioners may increase the flight safety risk. Major revision of the proposed LPL regulation is recommended.