Cardiac autonomic responses in relation to cognitive workload during simulated military flight.

Understanding the operator's cognitive workload is crucial for efficiency and safety in human-machine systems. This study investigated how cognitive workload modulates cardiac autonomic regulation during a standardized military simulator flight. Military student pilots completed simulated flight tasks in a Hawk flight simulator. Continuous electrocardiography was recorded to analyze time and frequency domain heart rate variability (HRV). After the simulation, a flight instructor used a standardized method to evaluate student pilot's individual cognitive workload from video-recorded flight simulator data. Results indicated that HRV was able to differentiate flight phases that induced varying levels of cognitive workload; an increasing level of cognitive workload caused significant decreases in many HRV variables, mainly reflecting parasympathetic deactivation of cardiac autonomic regulation. In conclusion, autonomic physiological responses can be used to examine reactions to increased cognitive workload during simulated military flights. HRV could be beneficial in assessing individual responses to cognitive workload and pilot performance during simulator training.

How to modernize without compromising history: a case study of the Franzello Aeromedical Library's journey in updating collections, capabilities, and facilities.

Background: Academic libraries play a significant role in the student learning process. However, student needs and preferences as well as new paradigms of learning are driving libraries to transition from quiet book repositories to places of collaboration and open information. This descriptive, mixed methods case presentation explores the transition of one library, the United States Air Force School of Aerospace Medicine Franzello Aeromedical Library, in three key areas: collection, capability, and facility. Due to the niche subject matter and audience the library serves, this case also describes how the Franzello Aeromedical Library's distinct collection and capability remained intact throughout modernization. Case Presentation: The Franzello Aeromedical Library's modernization project aimed to augment the library as a cutting-edge resource supporting USAFSAM's education, consultation, and research mission to equip Aerospace Medicine Airmen with the skills and knowledge for healthcare delivery in austere environments. This project was approached using five phases: 1) best practices baseline, 2) baseline evaluation of library visitor needs, 3) collection weeding, 4) capability, and 5) space design and construction. Conclusion: As a result of this complex two-year project, several recommendations were gleaned. Use the effort as an opportunity to market library services to new audiences. Ensure all stakeholders are at the table from day one and in perpetuity to save time, and consider using purposeful decision-making models, such as Courses of Action, to make tough calls. Be prepared for delays by padding your timeline and compromise where necessary to keep the project alive. Finally, the authors recommend using in-project discovery and findings to plan for future need justification.

The U.S. Army Aeromedical Research Laboratory Virtual Reality Vection System.

INTRODUCTION: Vection is a stationary individual's illusory experience of self-motion. This illusory self-motion is operationally important for aviation, particularly military aviation, since vection is a dramatic example of spatial disorientation (SD), which is an individual's failure to correctly sense the aircraft's position, motion, and/or attitude with respect to the fixed coordinate system of the Earth's surface and its gravitational vertical. Notably, SD is a major cause of fatal aviation mishaps, and the visual system is particularly prone to provoking vection. This article describes the Virtual Reality Vection System (VRVS), which uses computer-controlled virtual reality technology to induce vection under controlled conditions for training, demonstration, testing, and research. MATERIALS AND METHODS: The VRVS enables the precise specification of the number and appearance of visual stimulus elements intended to generate vection, including photorealistic images. The VRVS can present visual stimuli on any OpenXR-capable virtual reality headset. The VRVS currently records 2 types of behavioral responses, button presses to indicate the presence and duration of vection and the voltage of a handheld linear potentiometer to indicate the presence, duration, and magnitude of vection. RESULTS: An approved test plan helped guide, organize, document, and validate the VRVS during its development. Under this plan, a pair of tests guided hardware and software development of the VRVS system. Although the first test verified the ability of the VRVS to generate and measure vection, it also demonstrated that the VRVS can quickly manipulate the visual stimuli from one trial to the next so that the VRVS can support complex experimental designs. The second test used these capabilities to verify that the VRVS can characterize vection in a more analytic fashion using a masking paradigm. Specifically, the test assessed whether random stimulus elements injected into the vection-inducing stimulus disrupted vection in a quantifiable fashion. This work opens the door to studies that characterize the necessary and sufficient visual elements for vection-based SD. DISCUSSION: The VRVS is currently used to research, develop, test, and evaluate mitigation strategies targeting vection-related SD in degraded visual environments. Similarly, the VRVS is supporting research to develop methods to predict individual differences in visually induced motion sickness susceptibilities. The VRVS is currently being integrated with a precision motor-controlled rotating Barany chair for multisensory studies. It should be noted that since the VRVS was developed to support United States Army Aeromedical Research Laboratory projects, it is an Army product representing government intellectual property and may be freely available to other government institutions.

Lessons for Flying Astronauts with Disabilities Drawn from Experience in Aviation.

INTRODUCTION: Accessible spaceflight may seem a distant concept. As part of a diverse European Space Agency funded Topical Team, we are working on the physiological feasibility of space missions being undertaken by people with physical disabilities. Here, the first activity of this team is presented in the form of key lessons learned from aviation to inform new work on space missions.DISCUSSION: The first lesson is agreeing on realistic expectations about impairments, their severity, and the possibility of flying independently. This is important in terms of astronaut recruitment and societal expectations. The second lesson relates to training and adjustments for people with disabilities. Flexibility is important while maintaining safety for everyone involved. The third lesson is about managing unconscious bias from the different stakeholders. We conclude by arguing that engagement with people from different backgrounds is essential for the success of the first space mission with people with physical disabilities.Miller-Smith MJ, Tucker N, Anderton R, Caplin N, Harridge SDR, Hodkinson P, Narici MV, Pollock RD, Possnig C, Rittweger J, Smith TG, Di Giulio I. Lessons for flying astronauts with disabilities drawn from experience in aviation. Aerosp Med Hum Perform. 2024; 95(9):716-719.

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.

The First Use of a Defibrillator on a U.S. Commercial Airline.

Use of onboard commercial airline defibrillators began in 1997. At first, it was met with resistance but is now present on all planes. The first in-flight resuscitation of a passenger occurred in 1998 and is described here.

Human Evolution, Microgravity, and Challenges Colonizing Mars.

INTRODUCTION: Human colonization of Mars has captured the imagination of many. However, the challenges posed are immense. In microgravity, changes in human physiology, immune dysregulation, alterations of our microbiome, and enhanced virulence of various microbes are some of the barriers that stand in the way of a successful endeavor. Countermeasures can be brought to bear, but it remains unclear if success of such a mission in the foreseeable future is realistic or fanciful.Mermel L. Human evolution, microgravity, and challenges colonizing Mars. Aerosp Med Hum Perform. 2024; 95(9):720-721.

Pilots' Reactions to Different Types of Alerts When Using Head-Up Displays.

INTRODUCTION: The benefits of using head-up displays (HUDs) include reducing head-down time during critical flight phases, enhancing awareness of the external environment, and improving in-flight crew performance. However, the monochromatic nature of HUDs, increased head rotation, and longer gaze movement paths might affect pilots' reactions to different types of alerts.METHODS: Pilot workload and behavior differences were examined between HUD and head-down display (HDD) configurations in three alert scenarios. The study was carried out in an A320 flight simulator and 12 pilots participated.RESULTS: Except for one engine-on-fire scenario, pilot workload when using a HUD was significantly lower than using an HDD. In one engine-on-fire (3.98 s vs. 3.57 s) and one gear-disagree (5.42 s vs. 4.69 s) scenario, pilot response time to alerts using HUD was significantly longer than using an HDD. The angle deviations were significantly smaller when using HUDs in both go-around-under-crosswind (2.67° vs. 3.37°) and one engine-on-fire scenario (1.22° vs. 1.89°).DISCUSSION: The HUD is suitable for a lengthy process of manual flight control inputs, which not only reduces workload but also promotes control accuracy. For tasks that rely on automation, the benefits for workload become less obvious. In addition, head rotation and reorientation of attention adversely affected the response time to non-time-critical warnings and cautions. For instantaneous control with high precision requirements, HUDs did not demonstrate a significant advantage.Zheng Y, Lu Y, Jie Y, Fu S. Pilots' reactions to different types of alerts when using head-up displays. Aerosp Med Hum Perform. 2024; 95(9):688-694.

Cross-National Strategic Aeromedical Evacuation at the European Air Transport Command.

INTRODUCTION: The European Air Transport Command (EATC) is a seven-nation integrated command. One of its core capabilities is strategic aeromedical evacuation (AE). During the global COVID-19 pandemic and Ukrainian crisis, EATC proved that acting in concert is a valuable, effective, and reliable option.METHODS: By pooling and sharing aircraft and personnel, EATC has privileged access to a diverse fleet and pool of experts. Cooperation is based on a common set of rules and regulations, which ensures that EATC can address any problem with expertise.RESULTS: During the COVID-19 pandemic, 1060 COVID-19-positive patients were transported in 198 missions, with neither death nor disease transmission reported during those strategic AE flights. EATC transferred 986 military cases, mostly routine priority (91.4%); the other 74 cases were civilians, who were transported in 17 missions, with 81.1% categorized as urgent. During the Ukrainian crisis, 251 patients were transported, 112 military and 139 civilians, including 30 children. Among the recorded injuries were cerebrocranial, abdominal, and chest injuries, as well as fractures (180) and amputations (48) of the extremities.DISCUSSION: EATC is recognized as a center of expertise within the AE community, where interoperability and harmonization of concepts are key to safety and success. Cross-national missions, where a patient is evacuated by an aircraft and medical crew provided by another nation, offer maximum flexibility. Complex situations, such as the COVID-19 pandemic and the Ukrainian crisis, have shown that multinational cooperation is not only achievable but also provides robust, effective, and reliable solutions for AE in particular.Fiorini A, Vermeltfoort R, Dulaurent E, Hove MG, Borsch M. Cross-national strategic aeromedical evacuation at the European Air Transport Command. Aerosp Med Hum Perform. 2024; 95(9):709-715.

Maternal and Fetal Health Risks Among Female Military Aviation Officers.

INTRODUCTION: Military aviation poses unique occupational risks, including exposures to intermittent hypoxia, high gravitational force, and toxic materials, in addition to circadian disruption, cosmic radiation, and ergonomic stressors also present in commercial flight. We sought to investigate whether a military aviation officer's career is associated with adverse maternal or fetal health outcomes.METHODS: We conducted a retrospective cohort study of female aviation and nonaviation officers in the Military Health System from October 2002 to December 2019. Exposure was identified as assignment of an aviation occupation code. Maternal and fetal health outcomes were identified by International Classification of Diseases codes from medical records. Regression analysis was used to estimate adjusted relative risks (aRR).RESULTS: Included in the study were 25,929 active-duty female officers, with 46,323 recorded pregnancies and 32,853 recorded deliveries; 2131 pregnancies were diagnosed in aviation officers. Pregnant aviation officers had a decreased risk of composite adverse pregnancy outcomes [aRR 0.82 (0.73-0.92)], including gestational diabetes [aRR 0.69 (0.57-0.85)] and gestational hypertension [aRR 0.84 (0.71-0.99)]. Pregnant aviation officers had a decreased risk of depression prior to delivery [aRR 0.43 (0.35-0.53)] and hyperemesis gravidarum [aRR 0.74 (0.57-0.96)], but an increased risk of placental complications [aRR 1.15 (1.02-1.30)] and fetal growth restriction [aRR 1.36 (1.16-1.60)].DISCUSSION: Pregnant military aviation officers have an increased risk of placental complications and fetal growth restriction in spite of a lower risk of gestational diabetes and gestational hypertension. Further research is needed to determine how flight-related occupations impact pregnancy.Stark CM, Sorensen IS, Royall M, Dorr M, Brown J, Dobson N, Salzman S, Susi A, Hisle-Gorman E, Huggins BH, Nylund CM. Maternal and fetal health risks among female military aviation officers. Aerosp Med Hum Perform. 2024; 95(9):675-682.

Space surgery: a SAGES' white paper.

BACKGROUND: Space travel is experiencing a renaissance with expanding commercial and international efforts. Space surgery will have growing relevance as mission frequency and distances increase beyond low Earth orbit. METHODS: This white paper from the SAGES Space Surgery Task Force raises awareness among the SAGES membership regarding the challenges and opportunities surrounding this emerging field that anticipates surgical care in the most extreme, austere environments. RESULTS: Innovation in technology and preventive medicine principles will enhance the effectiveness of space surgical care when the need arises. The impact of advancements in space and terrestrial medicine to support space exploration indicates the need for a surgeon to oversee medical/surgical invasive treatment to ensure astronaut health and mission success. Advanced technology, including semi- and autonomous robotic systems, may be a preferred way to deliver this care in the foreseeable future. There is currently a need to develop training curricula and flight-compatible supplies and technology for physicians that deliver surgical care to this special patient population. The protocols and technology developed to address the unique challenges of space travel will provide value for care in space as well as in extreme, austere terrestrial environments on Earth. CONCLUSION: Space surgery will continue to evolve as commercial and government programs explore further into space. The SAGES Space Surgery Task Force is favorably positioned to significantly contribute to addressing some capability gaps in delivering surgical care in space.