Prevalence and risk factors of occupational neck pain in Chinese male fighter pilots: a cross-sectional study based on questionnaire and cervical sagittal alignment.

Background: Neck pain (NP) is a common musculoskeletal disorder among fighter pilots and has become a rising concern due to its detrimental impact on military combat effectiveness. The occurrence of NP is influenced by a variety of factors, but less attention has been paid to the association of NP with demographic, occupational, and cervical sagittal characteristics in this group. This study aimed to investigate the prevalence and risk factors of NP in Chinese male fighter pilots using a questionnaire and cervical sagittal measurements. Methods: Demographic and flight-related data, as well as musculoskeletal pain information, were gathered from Chinese male fighter pilots via a self-report questionnaire. Cervical sagittal parameters were measured and subtypes were classified using standardized lateral cervical radiographs. Differences in various factors between the case and control groups were analyzed using t-tests or chi-square tests. Binary logistic regressions were conducted to explore potential risk factors contributing to NP. Predictors were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), along with their respective 95% confidence intervals (CIs). Results: A total of 185 male fighter pilots were included in this cross-sectional study. Among them, 96 (51.9%) reported experiencing NP within the previous 12 months. The multivariate regression analysis revealed that continuous flight training (AOR: 4.695, 95% CI: 2.226-9.901, p < 0.001), shoulder pain (AOR: 11.891, 95% CI: 4.671-30.268, p < 0.001), and low back pain (AOR: 3.452, 95% CI: 1.600-7.446, p = 0.002) were significantly associated with NP. Conclusion: The high 12-month prevalence of NP among Chinese male fighter pilots confirms the existence of this growing problem. Continuous flight training, shoulder pain, and low back pain have significant negative effects on pilots' neck health. Effective strategies are necessary to establish appropriate training schedules to reduce NP, and a more holistic perspective on musculoskeletal protection is needed. Given that spinal integrated balance and compensatory mechanisms may maintain individuals in a subclinical state, predicting the incidence of NP in fighter pilots based solely on sagittal characteristics in the cervical region may be inadequate.

Quick coherence technique facilitating commercial pilots' psychophysiological resilience to the impact of COVID-19.

This study investigates the effect of quick coherence technique (QCT) on commercial pilots' resilience to the unprecedented impact of a pandemic. Eighteen commercial pilots voluntarily participated in a 2-day training course on QCT followed by 2 months of self-regulated QCT practicing during controlled rest in the flight deck and day-to day life. There are subjective and objective assessments to evaluate the effects of QCT on commercial pilots' psychophysiological resilience. Results demonstrated that QCT training can significantly increase pilots' psychophysiological resilience thereby improving their mental/physical health, cognitive functions, emotional stability and wellness on both subjective (PSS & AWSA) and objective measures (coherence scores). Moreover, pilots who continued practicing self-regulated QCT gained the maximum benefits. Current research has identified great potential to enhance pilots' mental/physical health via QCT training. Operators can develop peer support programs for pilots to increase resilience and maintain mental and physical health using the QCT technique. Practitioner summary: QCT breathing has been proven to increase commercial pilots' resilience by moderating psychophysiological coherence, strengthening mental/physical capacity and sustaining positive emotions to deal with the challenges both on the flight deck and in everyday life.HIGHLIGHTSPilots have suffered from the impact of the Covid-19 pandemic across many factors including social, economic, mental, physical, emotional, and operational issuesBiofeedback training can increase commercial pilots' resilience by moderating psychophysiological coherence, strengthening mental and physical capacitySelf-regulated practicing QCT to form a habitual behaviour is required to sustain the maximum benefits either in the flight or day-to-day lifeQCT is an effective intervention for aviation authorities and airline operators to develop peer support programs to increase pilots' fatigue resilience.

Cognitive Style and Flight Experience Influence on Confirmation Bias in Lost Procedures.

BACKGROUND: Accident analysis and empirical research have shown that the decision-making process of pilots after becoming lost is adversely affected by confirmation bias; this constitutes a serious threat to aviation safety. However, the underlying mechanism of confirmation bias in the context of lost procedures are still unclear.METHODS: This study used scenario-based map-reading tasks to conduct two experiments to explore the mechanism of confirmation bias in the lost procedures. In Experiment 1, 34 undergraduate students and 28 flying cadets were enrolled in a formal experiment to examine the effects of verbal-imagery cognitive style, experience level, and their interaction on confirmation bias. In Experiment 2, we further explored the influence of strategy as a core component of experience on confirmation bias with 26 flying cadets.RESULTS: The study found that individuals were subject to confirmation bias in lost procedures. Visualizers (M = 0.78, SD = 0.75) were almost twice as likely to select the disconfirmatory features than verbalizers (M = 0.37, SD = 0.49). Visualizers exhibited a lower degree of confirmation bias than verbalizers, and experience helps verbalizers to reduce their degree of confirmation bias. The protective effect of experience mainly lies in individuals' choice of strategy.DISCUSSION: Future aviation safety campaigns could be aimed at adopting a candidate selection process that focuses more on psychological attributes by testing for cognitive style, and enriching individual experience through adequate training. Such measures would reduce confirmation bias.Xu Q, Wang M, Wang H, Liu B, You X, Ji M. Cognitive style and flight experience influence on confirmation bias in lost procedures. Aerosp Med Hum Perform. 2022; 93(8):618-626.

The Prevalence of Dietary Supplement Usage in Military Aviators.

BACKGROUND: The prevalence of dietary supplement (DS) and energy drink (ED) usage in military personnel differs from branch to branch and is between 55% and 76% (higher values in special operations forces). Aviators with highly demanding tasks might be especially interested in using dietary supplements. To date, there are only limited data available for this special profession inside the military. METHODS: An internet-based survey was conducted on the prevalence of DS and ED usage, the reasons for their usage and the place of purchase for all wings of the German Armed Forces. RESULTS: Of the 181 pilots who participated in the survey, 34% used DSs and 16% EDs. Usage was linked to sports activities but not to the type of aircraft. DSs were purchased on the internet by 50% of the respondents; mostly protein supplements, magnesium and omega-3fatty acids. Only 42% said they would feel an effect from taking DSs. CONCLUSIONS: Although the present study showed that the prevalence of usage was comparable to that of the civilian population, the sources of supply and the range of the substances taken give cause for concern. This calls for education and information campaigns to make the pilots aware of the possible risks to their health.

Effect of a Nutritional Intervention on the Intestinal Microbiota of Vertically HIV-Infected Children: The Pediabiota Study.

AIMS: The gut microbiota exerts a critical influence in the immune system. The gut microbiota of human virus immunodeficiency (HIV)-infected children remains barely explored. We aimed to characterize the fecal microbiota in vertically HIV-infected children and to explore the effects of its modulation with a symbiotic nutritional intervention. METHODS: a pilot, double blind, randomized placebo-controlled study including HIV-infected children who were randomized to receive a nutritional supplementation including prebiotics and probiotics or placebo for four weeks. HIV-uninfected siblings were recruited as controls. The V3-V4 region of the 16S rRNA gene was sequenced in fecal samples. RESULTS: 22 HIV-infected children on antiretroviral therapy (ART) and with viral load (VL) <50/mL completed the follow-up period. Mean age was 11.4 ± 3.4 years, eight (32%) were male. Their microbiota showed reduced alpha diversity compared to controls and distinct beta diversity at the genus level (Adonis p = 0.042). Patients showed decreased abundance of commensals Faecalibacterium and an increase in Prevotella, Akkermansia and Escherichia. The nutritional intervention shaped the microbiota towards the control group, without a clear directionality. CONCLUSIONS: Vertical HIV infection is characterized by changes in gut microbiota structure, distinct at the compositional level from the findings reported in adults. A short nutritional intervention attenuated bacterial dysbiosis, without clear changes at the community level. SUMMARY: In a group of 24 vertically HIV-infected children, in comparison to 11 uninfected controls, intestinal dysbiosis was observed despite effective ART. Although not fully effective to restore the microbiota, a short intervention with pre/probiotics attenuated bacterial dysbiosis.

High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation.

BACKGROUND: High-altitude decompression sickness (HADCS) is a rare condition that has been associated with aircraft accidents. To the best of our knowledge, the present paper is the first case report of a patient treated for severe HADCS using recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO) with a complete recovery.CASE REPORT: After depressurization of a cabin, the 51-yr-old jet pilot was admitted to the Military Institute of Medicine with a life-threatening HADCS approximately 6 h after landing from a high-altitude flight, in a dynamically deteriorating condition, with progressing dyspnea and edema, reporting increasing limb paresthesia, fluctuating consciousness, and right-sided paresis. Hyperbaric oxygen therapy in the intensive care mode was initiated. A therapeutic recompression with U.S. Navy Treatment Table 6 was performed with neurological improvement. Due to cardiovascular collapse, sedation, mechanical ventilation, and significant doses of catecholamines were started, followed by continuous veno-venous hemodialysis. In the face of disturbances in oxygenation, during the second day of treatment the patient was commenced on veno-venous extracorporeal oxygenation. Over the next 6 d, the patient's condition slowly improved. On day 7, VV-ECMO was discontinued. On day 19, the patient was discharged with no neurological deficits.DISCUSSION: We observed two distinct stages during the acute phase of the disease. During the first stage, signs of hypoperfusion, neurological symptoms, and marbled skin were observed. During the second stage, multiple organ dysfunction dominated, including heart failure, pulmonary edema, acute kidney injury, and fluid overload, all of which can be attributed to extensive endothelial damage.Siewiera J, Szalanski P, Tomaszewski D, Kot J. High-altitude decompression sickness treated with hyperbaric therapy and extracorporeal oxygenation. Aerosp Med Hum Perform. 2020; 91(2):106-109.

Auditory Verbal Working Memory Load Effects on a Simulator-Induced Spatial Disorientation Event.

INTRODUCTION: Working memory is an essential executive function for flying an aircraft and its limitations may jeopardize flight safety. This function is particularly critical when pilots have to struggle with spatial disorientation (SD) cues. This research aimed to assess the combined effect of the auditory N-back task (NBT) and simulator-induced SD cues on pilots' flight performance.METHODS: Using an SD simulator, 39 male military pilots (control N = 20; age M = 31.6; SD = 8.22, experimental N = 19; age M = 26.9; SD = 8.67) were exposed to 12 flight sequences, where 6 contained an SD conflict-3 with vestibular illusions and 3 with visual illusions. Additionally, the pilots from the experimental group were asked to perform an auditory NBT involving sound stimuli (the sequential letter memory task) as they performed during oriented and disoriented flight conditions.RESULTS: Pilots' flight performance from the NBT group were significantly worse than the control group in the approach and landing profiles involving visual illusions (for both nonconflict and conflict flight), and in the profile involving the false horizon illusion (only for the conflict flight). No increase in a pilot's susceptibility to SD was observed with any other profiles.DISCUSSION: The current study provides support that pilots' cognitive workload can negatively impact flight performance. Pilots are not always aware of altered flight parameters, which may indicate that they have lost spatial orientation, mainly as a result of visual illusion. If problems occur in maintaining proper flight parameters, pilots should direct all available mental resources to regain their orientation and withdraw from any other parallel tasks.Lewkowicz R, Strózak P, Balaj B, Francuz P. Auditory verbal working memory load effects on a simulator-induced spatial disorientation event. Aerosp Med Hum Perform. 2019; 90(6):531-539.

The Effect of Intravenous Selenium on Oxidative Stress in Critically Ill Patients with Acute Respiratory Distress Syndrome.

OBJECTIVE: To modulate the inflammatory response in respiratory distress syndrome (ARDS) with selenium. BACKGROUND: Selenium replenishes the glutathione peroxidase proteins that are the first line of defense for an oxidative injury to the lungs. METHODS: Forty patients with ARDS were randomized into two groups: the SEL+ group being administered sodium selenite and the SEL- group receiving normal saline for 10 days. Blood samples were taken on Day-0, DAY-7, and Day-14 for assessment of IL-1 beta, IL-6, C-reactive protein, GPx-3, and selenium. Ferric reducing antioxidant power (FRAP) was measured in the bronchial wash fluids. Pearson correlation and repeated measure analysis were performed to examine the effects of selenium on the inflammatory markers. RESULTS: Sodium selenite replenished selenium levels in the SEL+ group. Selenium concentrations were linearly correlated to serum concentrations of GPx3 (R value: 0.631; P < 0.001), and FRAP (R value: -0.785; P < 0.001). Serum concentrations of both IL 1-beta (R value: -0.624; P < 0.001) and IL-6 (R value: -0.642; P < 0.001) were inversely correlated to the serum concentrations of selenium. There was a meaningful difference between two groups in airway resistance and pulmonary compliance changes (P values 0.008 and 0.028, respectively). CONCLUSION: Selenium restored the antioxidant capacity of the lungs, moderated the inflammatory responses, and meaningfully improved the respiratory mechanics. Despite these changes, it had no effect on the overall survival, the duration of mechanical ventilation, and ICU stay. Selenium can be used safely; however, more trials are essential to examine its clinical effectiveness.

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.

Cardiovascular Tests for Risk Assessment in Asymptomatic Adults and Implications for Pilots.

BACKGROUND: This study aims to examine which marker or testing protocols have been suggested for cardiovascular disease (CVD) risk assessment in asymptomatic populations, at which CVD risk level, and how this can be implemented for CVD risk assessment in pilot populations. METHODS: A systematic search was performed using Systematic Reviews Subset on PubMed; the OvidSP interface, including all EBM reviews and EMBASE databases; and the G-I-N International Guideline Library. From each recommendation, we extracted data on consideration of the use of a marker or test for cardiovascular risk assessment in asymptomatic populations. RESULTS: Included were 45 guidelines, systematic reviews, or meta-analyses relevant to cardiovascular risk assessment in asymptomatic populations. The majority (9/12) of the citations recommend coronary artery calcium score (CACS) for CVD risk assessment in intermediate-risk (10-yr CVD risk score of 10-20%) asymptomatic adults. Other cardiac and vascular tests that may also be considered include the measurements of carotid-intima media thickness, supplemented by carotid plaque, and the ankle brachial index for prevention of peripheral artery disease and stroke. Stress myocardial perfusion scan is the potential cardiac functional test to be used with pilots with 5-yr risk of ≥15%. Among laboratory markers, only hs-CRP has a potency to be used in CVD risk assessment in intermediate-risk asymptomatic adults; however, the strength of the recommendation is not adequate. DISCUSSION: Among the cardiac and vascular testing available, CACS is the most frequently suggested test. The implications of findings for CVD risk assessment in airline pilots are highlighted in this paper.Wirawan IMA, Griffiths RF, Larsen PD. Cardiovascular tests for risk assessment in asymptomatic adults and implications for pilots. Aerosp Med Hum Perform. 2018; 89(7):648-656.

Hydrogel Contact Lens Water Content is Dependent on Tearfilm pH.

Introduction: Based on clinical inferences, investigators theorized in situ soft lens hydration was linked to the precorneal tearfilm pH. Methods: Forty-one myopic subjects at Fort Rucker, AL, USA were fitted with one of two types of extended-wear soft contact lenses, and were followed quarterly for a period of 33 mo. The anterior soft contact lens surface pH was measured in situ, while the in vitro lens water content was measured immediately after lens removal, using a hand-held refractometer on one lens, and a gravimetric means of hydration measurement on the other lens. Results: The in situ pH increased logarithmically across extended wearing time, reaching an asymptote at approximately 5 d' wearing time at a pH of 7.45 ± 0.03. Lens water content was shown to similarly decrease at an inversely logarithmic rate, leveling off at 4-5 d' extended wearing time. Both means of hydration assessment correlated well with each other across days' extended wearing time (R = 0.98; p < 0.0001). Discussion: A log-log dual conversion yielded significantly different linear slopes (p < 0.001), based on a multifactorial analysis of both lens types, by the pH, and by their water content. The differing ionic status of each material accentuated their varied polar attraction characteristics. Two soft lenses, identical in all patient-based parameters, could provide differing oxygen availability, as well as differing physical fits in patients of identical physical characteristics, as a result of their unique tearfilm pH differences. Conclusion: The in situ hydrogel lens water content is directly dependent on the precorneal tearfilm pH.

Decompression Sickness in the F/A-18C After Atypical Cabin Pressure Fluctuations.

BACKGROUND: The spectrum of altitude decompression sickness (DCS) is evolving as more cases of atypical pressure fluctuations occur. This ongoing change makes it a difficult condition to diagnose and even more difficult to identify. Both Flight Surgeons and Undersea Medical Officers (UMOs) must keep DCS on the differential. These two cases describe altitude DCS after unique pressure patterns, with one at a markedly lower than expected altitude for DCS. CASE REPORT: Both cases occurred in the F/A-18C and resulted in DCS requiring hyperbaric chamber treatment. The aviator in case 1 experienced an over-pressurization to an unknown depth with a subsequent rapid decompression during a carrier approach at 600 ft (182.9 m) above sea level. The aviator in case 2 experienced cabin pressure fluctuations between 9000 ft (2743.2 m) and 18,000 ft (5486.4 m). Both cases demonstrate the progression of DCS after partial treatment on ground-level oxygen therapy, and the case sequence illustrates how evaluations and protocols changed with experience. DISCUSSION: Decompression sickness is difficult to identify since it does not have a diagnostic test. These cases were even more difficult because of subtle exam findings, reliance on subjective symptoms, and atypical pressure profiles. Environmental, physiological, and psychosocial factors specific to the aviation community can delay the diagnosis and treatment. Descending in altitude and using in-flight emergency oxygen or ground-level oxygen partially treats and masks symptoms for both the aviator and the physician. The Flight Surgeons' integration within the squadron and collaboration with UMOs is important to identify the first signs of DCS and decrease time to treatment.Lee KJ, Sanou AZ. Decompression sickness in the F/A-18C after atypical cabin pressure fluctuations. Aerosp Med Hum Perform. 2018; 89(5):478-482.

Effect of exogenous inoculants on enhancing oil recovery and indigenous bacterial community dynamics in long-term field pilot of low permeability reservoir.

Pseudomonas aeruginosa DN1 strain and Bacillus subtilis QHQ110 strain were chosen as rhamnolipid and lipopeptide producer respectively, to evaluate the efficiency of exogenous inoculants on enhancing oil recovery (EOR) and to explore the relationship between injected bacteria and indigenous bacterial community dynamics in long-term filed pilot of Hujianshan low permeability water-flooded reservoir for 26 months. Core-flooding tests showed that the oil displacement efficiency increased by 18.46% with addition of exogenous consortia. Bacterial community dynamics using quantitative PCR and high-throughput sequencing revealed that the exogenous inoculants survived and could live together with indigenous bacterial populations. They gradually became the dominant community after the initial activation, while their comparative advantage weakened continually after 3 months of the first injection. The bacterial populations did not exert an observable change in the process of the second injection of exogenous inoculants. On account of facilitating oil emulsification and accelerating bacterial growth with oil as the carbon source by the injection of exogenous consortia, γ-proteobacteria was finally the prominent bacterial community at class level varying from 25.55 to 32.67%, and the dominant bacterial populations were increased by 2-3 orders of magnitude during the whole processes. The content of organic acids and rhamnolipids in reservoir were promoted with the change of bacterial community diversity, respectively. Cumulative oil increments reached 26,190 barrels for 13 months after the first injection, and 55,947 barrels of oil had been accumulated in all of A20 wells block through two rounds of bacterial consortia injection. The performance of EOR has a cumulative improvement by the injection of exogenous inoculants without observable inhibitory effect on the indigenous bacterial populations, demonstrating the application potential in low permeability water-flooded reservoirs.

The Renoprotective Effects of Docosahexaenoic Acid as an Add-on Therapy in Patients Receiving Eicosapentaenoic Acid as Treatment for IgA Nephropathy: A Pilot Uncontrolled Trial.

Objective Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been reported to have beneficial effects in patients with IgA nephropathy (IgAN). Although DHA and EPA have different mechanisms of action, no study to date has assessed their individual actions in patients with IgAN. This study therefore analyzed the effects administering DHA in addition to EPA for the treatment of IgAN. Methods Twenty-one IgAN patients who were being treated with EPA (1,800 mg/day) were switched to EPA (1,860 mg/day) and DHA (1,500 mg/day). The changes in their clinical parameters from 6 months before to 6 months after switching treatment were analyzed. Results The triglyceride levels did not change during treatment with EPA alone, but tended to decrease-although not to a statistically significant extent-after the switch. The patients' low-density-lipoprotein cholesterol, blood pressure, proteinuria, and hematuria levels were similar before and after switching. The estimated glomerular filtration rate (eGFR) tended to decrease during EPA therapy, but became stable after switching and the median %⊿eGFR changed from -7.354% during EPA therapy to +1.26% during the 6 months after switching to EPA and DHA therapy (p=0.00132), and renal the function remained stable for another 6 months. Moreover, the median %⊿eGFR during the 6 months after switching was significantly higher in comparison to IgAN patients who were treated with EPA alone as a control (-3.26%, p=0.0361). No clinical parameters were independently associated with a stable renal function without switching to DHA/EPA. Conclusion The addition of DHA to EPA stabilized the renal function of IgAN patients, and it seemed that there were pleiotropic effects beyond the improvement of the clinical parameters.

Pilot Certification, Age of Pilot, and Drug Use in Fatal Civil Aviation Accidents.

INTRODUCTION: This study examined the association between mean age of pilot, pilot license, pilot medical certificate and drug use trends in pilots fatally injured in aircraft accidents. The prevalence of prescription drugs, OTC drugs, controlled drugs and drugs that may be potentially impairing was also examined. METHODS: This study was a descriptive observational study in which the NTSB Aviation Accident Database was searched from the period beginning January 1, 2012 to December 31, 2014. RESULTS: During the study period a total of 706 accidents involving 711 fatalities were investigated by the NTSB. This study included 633 of these accidents, involving 646 fatalities. Of these pilots, 42.1% had drugs in their biological samples. The prevalence of prescription drugs, controlled drugs, OTC drugs, opioids, and potentially impairing drugs in the fatally injured pilot population over the study period was 28.9%, 15.0%, 20.1%, 5.1%, and 25.5%, respectively. Pilots with any drugs in their samples were significantly older than those without drugs. Medical certificate held was associated with drug use; pilots who held third class certificates had the highest prevalence at 54.1%. Pilot license was not associated with drug use. In 3.8% of the accidents, drugs were a contributing factor in the cause. DISCUSSION: Despite current FAA medical regulations, potentially impairing drugs are frequently found in biological samples of fatally injured pilots in the U.S. More education of airmen by aviation medical examiners is needed on the safety of drug use.Akparibo IY, Stolfi A. Pilot certification, age of pilot, and drug use in fatal civil aviation accidents. Aerosp Med Hum Perform. 2017; 88(10):931-936.

Recurrence of Neurological Deficits in an F/A-18D Pilot Following Loss of Cabin Pressure at Altitude.

INTRODUCTION: Supersonic, high altitude aviation places its pilots and aircrew in complex environments, which may lead to injury that is not easily diagnosed or simply treated. Decompression illness (either venous or arterial) and environmental conditions (e.g., abnormal gases and pressure) are the most likely adverse effects aircrew often face. Though symptomatic aircrew personnel may occasionally require hyperbaric oxygen treatment, it is rare to require more than one treatment before returning to baseline function. CASE REPORT: This challenging aviation case details the clinical course and discusses the salient physiological factors of an F/A-18D pilot who presented with neurological symptoms following loss of cabin pressure at altitude. DISCUSSION: Most crucial to this discussion was the requirement for multiple hyperbaric oxygen treatments over several days due to recurrence of symptoms. The likelihood of recurrence during and after future flights cannot be estimated with accuracy. This case illustrates a degree of recurrences for neurological symptoms in aviation (hypobaric exposure to hyperbaric baseline environment) that has not previously been described. Robinson T, Evangelista JS III, Latham E, Mukherjee ST, Pilmanis A. Recurrence of neurological deficits in an F/A-18D pilot following loss of cabin pressure at altitude. Aerosp Med Hum Perform. 2016; 87(8):740-744.

Neurobiological differences in mental rotation and instrument interpretation in airline pilots.

Airline pilots and similar professions require reliable spatial cognition abilities, such as mental imagery of static and moving three-dimensional objects in space. A well-known task to investigate these skills is the Shepard and Metzler mental rotation task (SMT), which is also frequently used during pre-assessment of pilot candidates. Despite the intuitive relationship between real-life spatial cognition and SMT, several studies have challenged its predictive value. Here we report on a novel instrument interpretation task (IIT) based on a realistic attitude indicator used in modern aircrafts that was designed to bridge the gap between the abstract SMT and a cockpit environment. We investigated 18 professional airline pilots using fMRI. No significant correlation was found between SMT and IIT task accuracies. Contrasting both tasks revealed higher activation in the fusiform gyrus, angular gyrus, and medial precuneus for IIT, whereas SMT elicited significantly stronger activation in pre- and supplementary motor areas, as well as lateral precuneus and superior parietal lobe. Our results show that SMT skills per se are not sufficient to predict task accuracy during (close to) real-life instrument interpretation. While there is a substantial overlap of activation across the task conditions, we found that there are important differences between instrument interpretation and non-aviation based mental rotation.

You're the Flight Surgeon.

DeFlorio PT. You're the flight surgeon: supraventricular tachycardia. Aerosp Med Hum Perfom. 2016; 87(12):1051-1053.