Exceptional survival of an airplane stowaway, treated successfully with hyperbaric oxygen.

Survival of airplane stowaways is rare. Here we report an exceptional case of successful treatment and full recovery. After a transcontinental flight an unconscious stowaway was discovered in a wheel well of a Boeing 747-400F. Airport paramedics confirmed regular respiration and achieved 100% oxygen saturation (pulse oximetry) by high-flow oxygen. Rectal body temperature was 35.5 °C. On arrival at the emergency department, the patient's vital signs were stable. He did not respond to verbal stimuli. He localized to painful stimuli with both arms, however, there was no reaction to stimuli to both legs. We suspected his neurological deficits were caused by posthypoxic encephalopathy or altitude decompression sickness (DCS), the latter amenable to hyperbaric oxygen therapy (HBOT). HBOT was performed for 5 h (US Navy Treatment Table 6) and afterwards, full neurological recovery was documented. About 24 h after admission a new proximal paresis of the left leg was noted. Assuming recurrence of DCS, daily HBOT was scheduled for three days, after which motor function had again returned to normal. Stowaways travelling in airplane wheel wells experience extreme environmental circumstances. The presented patient survived an eight-hour exposure to calculated barometric pressures as low as 190 mmHg and ambient PO2 of 40 mmHg. Apart from creating awareness of this rare patient category, we want to stress the risk of altitude DCS in unpressurized flights. When DCS is suspected, immediate high-flow oxygen therapy should be initiated, followed by HBOT at the earliest opportunity.

Ultrafine particle levels measured on board short-haul commercial passenger jet aircraft.

BACKGROUND: Airline crew members report adverse health effects during and after inhalation exposure to engine oil fumes sourced to the air supply system onboard commercial and military aircraft. Most investigations into the causal factors of their reported symptoms focus on specific chemical contaminants in the fumes. The adverse health effects reported in aircrew exposed to the aircraft air supply, bled unfiltered off the engine or Auxiliary Power Unit (APU) may be related to particulate exposures, which are widely known to effect health. While oil contaminates the aircraft air supply, some suggest that this will only occur when there is a bearing seal failure, others document that there is low level oil contamination of the air supply during normal engine operation. This brief pilot study explores whether particulate exposure may be associated with the normal engine/APU and air supply operation and to therefore increase the understanding that UFP exposures may have on crew and passengers. METHODS: An ultrafine particle counter was utilised by an experienced airline captain in the passenger cabin of four short-haul commercial passenger aircraft. All flights were under 90 min on aircraft from two different carriers ranging from 7 months to 14 years old. RESULTS: UFP concentrations showed maximum concentrations ranging from 31,300 to 97,800 particles/cm3 when APU was selected on as a source of air on the ground and with engine bleed air and the air conditioning packs selected on during the climb. In 2 of the 4 flights the peaks were associated with an engine oil smell. Increases in UFP particle concentrations occurred with changes in engine/APU power and air supply configuration changes. CONCLUSIONS: This study identified increases in UFP concentrations associated with engine and APU power changes and changes in air supply configuration. These results correlated with times when engine and APU oil seals are known to be less effective, enabling oil leakage to occur. The concentrations reached in the passenger cabins exceeded those taken in other ground-based environments. UFP exposures in aircraft cabins during normal flight indicates there will be health consequences for long serving aircrew and some passengers.

A Novel Biopsychosocial Approach to Neck Pain in Military Helicopter Aircrew.

INTRODUCTION: Flight-related neck pain (FRNP) is a frequently reported musculoskeletal complaint among military helicopter aircrew. However, despite its prevalence and suspected causes, little is known of the underpinning pain mechanisms or the impact of neck pain on aircrews in-flight task performance. The biopsychosocial (BPS) approach to health, combined with the contemporary conceptualization of musculoskeletal pain, in which injury and pain are not necessarily synonymous, provides a relatively new holistic framework within which to consider the problem of FRNP in military helicopter aircrew. Combining these concepts, a new conceptual model is proposed to illustrate how biopsychosocial factors may influence pain perception, potentially affecting aircrews capacity to process information and, therefore, threatening in-flight task performance. Recommendations are made for considering the underlying pain mechanisms of FRNP to aid prognoses and guide the development of holistic evidence-based countermeasures for FRNP in military helicopter aircrew. Development of instruments able to measure psychosocial factors, such as self-efficacy and functional ability, validated in the military helicopter aircrew population, would assist this task.Vail RE, Harridge SDR, Hodkinson PD, Green NDC, Pavlou M. A novel biopsychosocial approach to neck pain in military helicopter aircrew. Aerosp Med Hum Perform. 2021; 92(5):333341.

Drone aerial imagery for the simulation of a neonate burial based on the geoforensic search strategy (GSS).

A woman reporting the homicide and burial of an infant in 2004 prompted the creation of an experimental simulated neonate grave shortly before the real search commenced. The real case, documented here, did not use aerial imagery, but used ground-penetrating radar (calibrated to the test site described here) to identify two locations that were probed for gas release and the deployment of victim recovery dogs. We suggest technological advances in remotely sensed aerial imagery that have developed since 2004 will demonstrate their use in focusing such searches by informing a Geoforensic Search Strategy (GSS) and suggesting locations accessible by a perpetrator to identify a burial location using the still-existent analogue site. To test this, in the spring of 2020 a DJI Mavic Pro drone was flown over the control site containing the simulated 2004 burial. Aerial image processing included the creation of orthomosaics, Normalised Difference Vegetation Index (NDVI), Visual Atmospheric Resistance Index (VARI), and photogrammetry. Conventional ground-based geophysical surveys using ground-penetrating radar, guided by this new type of information integrated into the GSS, confirmed that anomalies seen in drone data were the 16-year-old burial. We test this strategy using both the original simulated burial in Northern Ireland and further evaluate it in two recent simulated graves in the United States in more complex scenarios, but with successful results.

Emergency air evacuation of patients with acute respiratory failure due to SARS-CoV-2 from Mayotte to Reunion Island.

ABSTRACT: In February 2021, an explosion of cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia overwhelmed the only hospital in Mayotte. To report a case series of patients with acute respiratory failure (ARF) due to SARS-CoV-2 who were evacuated by air from Mayotte to Reunion Island.This retrospective observational study evaluated all consecutive patients with ARF due to SARS-CoV-2 who were evacuated by air from Mayotte Hospital to the intensive care unit (ICU) of Félix Guyon University Hospital in Reunion Island between February 2, and March 5, 2021.A total of 43 patients with SARS-CoV-2 pneumonia were evacuated by air, for a total flight time of 2 hours and a total travel time of 6 hours. Of these, 38 patients (88.4%) with a median age of 55 (46-65) years presented with ARF and were hospitalized in our ICU. Fifteen patients were screened for the SARS-CoV-2 501Y.V2 variant, all of whom tested positive. Thirteen patients (34.2%) developed an episode of severe hypoxemia during air transport, and the median paO2/FiO2 ratio was lower on ICU admission (140 [102-192] mmHg) than on departure (165 [150-200], P = .022). Factors associated with severe hypoxemia during air transport was lack of treatment with curare (P = .012) and lack of invasive mechanical ventilation (P = .003). Nine patients (23.7%) received veno-venous extracorporeal membrane oxygenation support in our ICU. Seven deaths (18.4%) occurred in hospital.Emergency air evacuation of patients with ARF due to SARS-CoV-2 was associated with severe hypoxemia but remained feasible. In cases of ARF due to SARS-CoV-2 requiring emergency air evacuation, sedated patients receiving invasive mechanical ventilation and curare should be prioritized over nonintubated patients. It is noteworthy that patients with SARS-CoV-2 pneumonia related to the 501Y.V2 variant were very severe despite their young age.

Definitive Treatment of Neurological Decompression Sickness in a Resource Limited Location.

BACKGROUND: While Fairbanks, AK, USA, is a remote location with significant constraints on medical resources and specialty care, a small U.S. Air Force clinic was able to provide a pilot with definitive care for neurological decompression sickness.CASE REPORT: A 31-yr-old female patient presented to her flight surgeon in Anchorage, AK, USA, with migrating polyarthropathy and headaches 48 h after a flight which included planned aircraft decompression for high altitude low opening (HALO) jump operations. In order to get definitive treatment in a hyperbaric chamber, the patient typically would have to be flown to Seattle, WA, USA. This transfer of care would cost the Air Force approximately 150,000 and may have led to more complicated disease. Fortunately, Eielson Air Force Base (AFB) in Fairbanks had previously procured a Hyperlite hyperbaric chamber specifically for this situation. After consultation with a hyperbaric specialist, the team decided that the most appropriate course of action was to transfer her by car 6 h north from Anchorage to Fairbanks. On initiation of the Hart treatment table, she experienced immediate reduction in joint pain with a reversal of neurological symptoms.DISCUSSION: This patients care could not have been done without the procurement of a hyperbaric chamber. This case demonstrates the utility and necessity for these capabilities at more facilities that manage significant flying operations. Military bases should ensure that hyperbaric treatment capabilities are available within a close proximity.Petruso MJ, Philbrick SM. Definitive treatment of neurological decompression sickness in a resource limited location. Aerosp Med Hum Perform. 2021; 92(1):4749.

Prediction of End-Of-Season Tuber Yield and Tuber Set in Potatoes Using In-Season UAV-Based Hyperspectral Imagery and Machine Learning.

Potato is the largest non-cereal food crop in the world. Timely estimation of end-of-season tuber production using in-season information can inform sustainable agricultural management decisions that increase productivity while reducing impacts on the environment. Recently, unmanned aerial vehicles (UAVs) have become increasingly popular in precision agriculture due to their flexibility in data acquisition and improved spatial and spectral resolutions. In addition, compared with natural color and multispectral imagery, hyperspectral data can provide higher spectral fidelity which is important for modelling crop traits. In this study, we conducted end-of-season potato tuber yield and tuber set predictions using in-season UAV-based hyperspectral images and machine learning. Specifically, six mainstream machine learning models, i.e., ordinary least square (OLS), ridge regression, partial least square regression (PLSR), support vector regression (SVR), random forest (RF), and adaptive boosting (AdaBoost), were developed and compared across potato research plots with different irrigation rates at the University of Wisconsin Hancock Agricultural Research Station. Our results showed that the tuber set could be better predicted than the tuber yield, and using the multi-temporal hyperspectral data improved the model performance. Ridge achieved the best performance for predicting tuber yield (R2 = 0.63) while Ridge and PLSR had similar performance for predicting tuber set (R2 = 0.69). Our study demonstrated that hyperspectral imagery and machine learning have good potential to help potato growers efficiently manage their irrigation practices.

THE USE OF DECONVOLUTION TECHNIQUE FOR THE ANALYSIS OF GAMMA SPECTROMETRY DATA FROM FIELD MONITORING USING UNMANNED AERIAL VEHICLES.

Airborne gamma spectrometry is an effective tool for prompt monitoring and mapping of large areas contaminated after NPP accident, radionuclides leakage cases, an impact of uranium ore mining and processing, etc. Airborne spectrometry data analysis using deconvolution technique enables to calculate air kerma rates and/or radionuclides concentrations as well as identification of radionuclides. Application of this technique on the airborne data (from manned as well as an unmanned survey using drones) is rather specific due to the requirements for short time of one scan data acquisition, a relatively long distance from the source and small detector size, due to the limited payload of the usually used drones. Application of deconvolution techniques for analysis of spectra with very poor statistics, methods and possibilities to improve the processing of such spectra are discussed.

Sherpas, Coca Leaves, and Planes: High Altitude and Airplane Headache Review with a Case of Post-LASIK Myopic Shift.

PURPOSE OF REVIEW: High altitude headache is a common neurological symptom that is associated with ascent to high altitude. It is classified by the International Classification of Headache Disorders, 3rd Edition (ICHD-3) as a disorder of homeostasis. In this article, we review recent clinical and insights into the pathophysiological mechanisms of high altitude and airplane headache. We also report a second case of post-LASIK myopic shift at high altitude exposure secondary hypoxia. Headache attributed to airplane travel is a severe typically unilateral orbital headache that usually improves after landing. This was a relative recent introduction to the ICHD-3 diagnostic criteria. Headache pain with flight travel has long been known and may have been previously considered as a part of barotrauma. Recent studies have helped identify this as a distinct headache disorder. RECENT FINDINGS: Physiologic, hematological, and biochemical biomarkers have been identified in recent high altitude studies. There have been recent advance in identification of molecular mechanisms underlying neurophysiologic changes secondary to hypoxia. Calcitonin gene-related peptide, a potent vasodilator, has been implicated in migraine pathophysiology. Recent epidemiological studies indicate that the prevalence of airplane headache may be more common than we think in the adult as well at the pediatric population. Simulated flight studies have identified potential biomarkers. Although research is limited, there have been advances in both clinical and pathophysiological mechanisms associated with high altitude and airplane headache.

The Significance of a Cooperative Medical System for Treating Decompression Illness on the Izu Peninsula in Japan.

INTRODUCTION: In 2011, our hospital on the Izu peninsula began to hold meetings to discuss how to manage patients with decompression illness (DCI) to establish a cooperative medical system. We retrospectively investigated the influence of these meetings and the changes subsequently effected. METHODS: A medical chart review was retrospectively performed to investigate all cases between January 2005 and December 2017 in which the transport of patients with DCI via a physician-staffed helicopter emergency medical service (HEMS) was attempted. The patients were divided into 2 groups: the preprogram group and the postprogram group. RESULTS: There were 63 patients in the preprogram group and 65 in the postprogram group. There were no cases in which a patient's symptoms deteriorated during transportation by the HEMS. The frequency of dispatch to the scene for direct evacuation in the postprogram group (86%) was greater than that in the preprogram group (74%), but the difference was not statistically significant (P=0.09). In the postprogram group, the duration of activities at the scene or the first aid hospital was significantly shorter in comparison to the preprogram group (P=0.01). CONCLUSIONS: This retrospective study revealed simultaneity between the introduction of the yearly meetings and a reduced duration of the HEMS staff's activity at either the scene or the first aid hospital.

Simulation Training for In-Flight Medical Emergencies Improves Provider Knowledge and Confidence.

INTRODUCTION: In-flight medical emergencies require healthcare providers to operate in confined spaces with limited resources and delayed access to definitive care. These emergencies are common, with an estimated frequency of 1 per 100 to 1000 flights. Despite this, training for medical response in these environments is limited. We hypothesize that integrating such education into a pre-existing medical student elective course would improve knowledge and ability to respond appropriately to in-flight medical emergencies.METHODS: The available literature surrounding in-flight medical emergencies was reviewed. Syncope, respiratory distress, allergic reaction, and cardiac arrest were identified as common and potentially life-threatening complaints. Simulation cases were designed for each of these complaints and a simulation room was modified to mimic an airplane cabin. These simulation cases and accompanying relevant didactic lectures were incorporated into an existing wilderness and extreme environmental medicine course, with multiple-choice tests completed by the students at the beginning and end of the 2-wk course.RESULTS: Participating in this study were 18 students. The pretest average was 76%, which improved to 87% on the posttest. Qualitative feedback regarding this type of training was overwhelmingly positive.DISCUSSION: Simulation-based training for in-flight medical emergencies can significantly improve medical students' knowledge. This training was very well received by the students. Opportunities for training to manage in-flight medical emergencies remain limited; incorporating such training into existing curricula could provide a means by which to improve provider knowledge. Such a curriculum could be adapted for use by flight crews and other populations.Padaki A, Redha W, Clark T, Nichols T, Jacoby L, Slivka R, Ranniger C, Lehnhardt K. Simulation training for in-flight medical emergencies improves provider knowledge and confidence. Aerosp Med Hum Perform. 2018; 89(12):1076-1079.

Triage and Treatment of Mass Casualty Decompression Sickness After Depressurization at 6400 m.

BACKGROUND: Decompression sickness is a condition that results from an abrupt change from a higher to a lower pressure. It is described most commonly in divers; however, it can occur in aviation incidents, which this case report will discuss.CASE REPORT: Following an acute cabin depressurization incident, 36 patients presented to a small outpatient clinic with multiple symptoms, including fatigue, headache, nausea, vomiting, and dizziness. These patients were evaluated, triaged, and some were able to be successfully treated with supplemental oxygen in clinic. Eight of the patients had symptoms that were either persistent or concerning enough that they were referred to the dive medical clinic, where the dive medical team diagnosed six of the patients with Type II decompression sickness and referred them for hyperbaric oxygen chamber therapy. All patients who received hyperbaric therapy experienced at least some relief of symptoms, with most reporting some residual fatigue after the therapy.DISCUSSION: This case provided both lessons in triage and management of multiple patients in a small outpatient clinic, as well as the challenges in making the diagnosis of decompression sickness.Mancini S, Crotty AM, Cook J. Triage and treatment of mass casualty decompression sickness after depressurization at 6400 m. Aerosp Med Hum Perform. 2018; 89(12):1085-1088.

Does effective gaze behavior lead to enhanced performance in a complex error-detection cockpit task?

The purpose of the current study was to examine the relationship between expertise, performance, and gaze behavior in a complex error-detection cockpit task. Twenty-four pilots and 26 non-pilots viewed video-clips from a pilot's viewpoint and were asked to detect malfunctions in the cockpit instrument panel. Compared to non-pilots, pilots detected more malfunctioning instruments, had shorter dwell times on the instruments, made more transitions, visited task-relevant areas more often, and dwelled longer on the areas between the instruments. These results provide evidence for three theories that explain underlying processes for expert performance: The long-term working memory theory, the information-reduction hypothesis, and the holistic model of image perception. In addition, the results for generic attentional skills indicated a higher capability to switch between global and local information processing in pilots compared to non-pilots. Taken together, the results suggest that gaze behavior as well as other generic skills may provide important information concerning underlying processes that can explain successful performance during flight in expert pilots.

The influence of trait mindfulness on incident involvement among Chinese airline pilots: The role of risk perception and flight experience.

Introduction The primary objective of this study is to investigate the relationships between trait mindfulness, risk perception, flight experience, and incident involvement among Chinese airline pilots. Method The study used a sample consisting of 295 commercial airline pilots from China Southern Airlines Ltd. Results The results show that trait mindfulness has a direct and negative effect on airline pilots' incident involvement, and an indirect effect on incident involvement through influencing risk perception. Flight experience was also found to strengthen the negative and direct effect of trait mindfulness on incident involvement. Practical applications The practical implications of the study include recommendations as to injury prevention efforts in incident involvement. Future research directions are also discussed.

Optimizing best management practices to control anthropogenic sources of atmospheric phosphorus deposition to inland lakes.

Excessive phosphorus loading to inland freshwater lakes around the globe has resulted in nuisance plant growth along the waterfronts, degraded habitat for cold-water fisheries, and impaired beaches, marinas, and waterfront property. The direct atmospheric deposition of phosphorus can be a significant contributing source to inland lakes. The atmospheric deposition monitoring program for Lake Simcoe, Ontario, indicates roughly 20% of the annual total phosphorus load (2010-2014 period) is due to direct atmospheric deposition (both wet and dry deposition) on the lake. This novel study presents a first-time application of the genetic algorithm (GA) methodology to optimize the application of best management practices (BMPs) related to agriculture and mobile sources to achieve atmospheric phosphorus reduction targets and restore the ecological health of the lake. The novel methodology takes into account the spatial distribution of the emission sources in the airshed, the complex atmospheric long-range transport and deposition processes, cost and efficiency of the popular management practices, and social constraints related to the adoption of BMPs. The optimization scenarios suggest that the optimal overall capital investment of approximately $2M, $4M, and $10M annually can achieve roughly 3, 4, and 5 tonnes reduction in atmospheric P load to the lake, respectively. The exponential trend indicates diminishing returns for the investment beyond roughly $3M per year and that focusing much of this investment in the upwind, nearshore area will significantly impact deposition to the lake. The optimization is based on a combination of the lowest cost, most beneficial and socially acceptable management practices that develops a science-informed promotion of implementation/BMP adoption strategy. The geospatial aspect to the optimization (i.e., proximity and location with respect to the lake) will help land managers to encourage the use of these targeted best practices in areas that will most benefit from the phosphorus reduction approach. IMPLICATIONS: Excessive phosphorus loading to inland freshwater lakes around the globe has resulted in nuisance plant growth along the waterfronts, degraded habitat for cold water fisheries, and impaired beaches, marinas and waterfront property. This novel study presents a first-time application of the Genetic Algorithm methodology to optimize the application of best management practices related to agriculture and mobile sources to achieve atmospheric phosphorus reduction targets and restore the ecological health of the lake. The novel methodology takes into account the spatial distribution of the emission sources in the airshed, the complex atmospheric long-range transport and deposition processes, cost and efficiency of the popular management practices and social constraints related to the adoption of BMPs.

A fully convolutional network for weed mapping of unmanned aerial vehicle (UAV) imagery.

Appropriate Site Specific Weed Management (SSWM) is crucial to ensure the crop yields. Within SSWM of large-scale area, remote sensing is a key technology to provide accurate weed distribution information. Compared with satellite and piloted aircraft remote sensing, unmanned aerial vehicle (UAV) is capable of capturing high spatial resolution imagery, which will provide more detailed information for weed mapping. The objective of this paper is to generate an accurate weed cover map based on UAV imagery. The UAV RGB imagery was collected in 2017 October over the rice field located in South China. The Fully Convolutional Network (FCN) method was proposed for weed mapping of the collected imagery. Transfer learning was used to improve generalization capability, and skip architecture was applied to increase the prediction accuracy. After that, the performance of FCN architecture was compared with Patch_based CNN algorithm and Pixel_based CNN method. Experimental results showed that our FCN method outperformed others, both in terms of accuracy and efficiency. The overall accuracy of the FCN approach was up to 0.935 and the accuracy for weed recognition was 0.883, which means that this algorithm is capable of generating accurate weed cover maps for the evaluated UAV imagery.

Long-haul flights, edema, and thrombotic events: prevention with stockings and Pycnogenol® supplementation (LONFLIT Registry Study).

BACKGROUND: This registry study evaluated the effects of Pycnogenol® on edema and thrombotic complications in long-haul flights; jet lag was also evaluated. METHODS: Four hundred and fifty subjects at different risk levels for thrombosis, flying in economy class twice a week for more than 8 hours, were included; 295 completed the registry study and were subdivided in 3 groups according to their risk level - low, moderate, or high. The high-risk group also received Aspirin®. A standard management (SM) was used in all groups. In each risk category, three groups were made according to patient management: a Pycnogenol group, a SM group (control), and a stockings group. The groups were comparable at inclusion. No side effects were observed. RESULTS: In the low risk group edema were reduced more (P<0.05) with Pycnogenol and stockings compared to control. Ankle circumference was smaller with Pycnogenol (P<0.05). No thrombosis was detected. D-dimer was negative in Pycnogenol subjects; one subject in the control group had increased values, as did two of the 36 subjects in the stockings group. In the group with moderate risk, edema and ankle circumference were lower in the Pycnogenol group (P<0.05). One deep vein thrombosis (DVT) and one minimal superficial vein thrombosis (SVT) were seen in controls. D-dimer was normal in the Pycnogenol group. In high-risk subjects, edema, and ankle circumference were significantly reduced in the Pycnogenol group (P<0.05). There were no SVT or DVT in the Pycnogenol group. One minimal DVT and one SVT were observed in controls. D-dimer was negative in all Pycnogenol subjects (P<0.05); three post-flight values increased in controls and in four of the 32 subjects in the stockings group. The jet lag score was lower in low-, medium-, and high-risk Pycnogenol subjects (P<0.05). CONCLUSIONS: This registry study indicates that Pycnogenol supplementation reduces edema and may control some thrombotic events.

Disruption in neural phase synchrony is related to identification of inattentional deafness in real-world setting.

Individuals often have reduced ability to hear alarms in real world situations (e.g., anesthesia monitoring, flying airplanes) when attention is focused on another task, sometimes with devastating consequences. This phenomenon is called inattentional deafness and usually occurs under critical high workload conditions. It is difficult to simulate the critical nature of these tasks in the laboratory. In this study, dry electroencephalography is used to investigate inattentional deafness in real flight while piloting an airplane. The pilots participating in the experiment responded to audio alarms while experiencing critical high workload situations. It was found that missed relative to detected alarms were marked by reduced stimulus evoked phase synchrony in theta and alpha frequencies (6-14 Hz) from 120 to 230 ms poststimulus onset. Correlation of alarm detection performance with intertrial coherence measures of neural phase synchrony showed different frequency and time ranges for detected and missed alarms. These results are consistent with selective attentional processes actively disrupting oscillatory coherence in sensory networks not involved with the primary task (piloting in this case) under critical high load conditions. This hypothesis is corroborated by analyses of flight parameters showing greater maneuvering associated with difficult phases of flight occurring during missed alarms. Our results suggest modulation of neural oscillation is a general mechanism of attention utilizing enhancement of phase synchrony to sharpen alarm perception during successful divided attention, and disruption of phase synchrony in brain networks when attentional demands of the primary task are great, such as in the case of inattentional deafness.

Using mindfulness to reduce the health effects of community reaction to aircraft noise.

AIM: This paper investigates whether mindfulness-based interventions might ameliorate the detrimental health effects of aircraft noise on residential communities. REVIEW: Numerous empirical studies over the past 50 years have demonstrated the increasing negative impact of aircraft noise on residents worldwide. However, extensive database searches have revealed no published studies on psychological interventions that reduce residents' reactivity to environmental noise. By contrast, there has been extensive research over several decades confirming the effectiveness of mindfulness-based stress reduction training in lowering people's stress from work and life. Considering that stress is a major component of aircraft noise reaction, it would seem worth assessing whether mindfulness-based interventions might be effective in reducing the health effects of aircraft noise. It appears that no existing conceptualization of mindfulness specifically accounts for noise as a stressor. Conceptual Analysis: A new conceptual model is presented here which explains how mindfulness can reduce noise reactivity. Two types of mindfulness are distinguished: an active form (meta-mindfulness) and a passive form (supra-mindfulness). It is posited that meta-mindfulness can facilitate "cognitive defusion" which research has confirmed as enabling people to disconnect from their own dysfunctional thoughts. In the case of aircraft noise, negative thinking associated with residents' reactive experiences can exacerbate the health effects they suffer. The present model further proposes that supra-mindfulness can enable an individual to disengage their own sense of identity from the often overwhelming negative thoughts which can define their existence when they are consumed by extreme noise annoyance. CONCLUSION: The mindfulness processes of defusion and disidentification are postulated to be the key efficacy mechanisms potentially responsible for reducing reactivity to aircraft noise. This approach can be evaluated by extending previous research on the health benefits of mindfulness training.