Research on a post-competency model of civil aviation flight cadets.

The initial evaluation index system of civil aviation flight cadets' competency was established using NVivo version 11.0 through qualitative analysis. The competency evaluation index system of civil aviation flight cadets was determined using questionnaire surveys and SPSS version 26.0, and includes four dimensions - core quality, ethical discipline, psychological quality and leadership - and another 23 indexes. The competency model was constructed using AMOS version 23.0 through factor analysis and a structural equation model, and the weight coefficient of each index at all levels was finally determined. The results showed that self-confidence and optimism, attention distribution and situational awareness are the three most important indicators affecting the competency of civil aviation flight cadets. Therefore, the model can provide references for the scientific evaluation of civil aviation flight cadets' competence and provide support for airlines and colleges to train flight cadets.

CRM: Desarrollo de Aspectos Críticos Pendientes / CRM: Development of Pending Critical Aspects

La evolución de los programas de CRM ha supuesto para la aviación un enorme progreso en cuanto al estudio de los factores humanos y su relación con la reducción de los accidentes aéreos. Si bien es cierto que los programas de CRM han sufrido una exitosa evolución desde su aparición en 1979, no lo es menos, que los avances en la ciencia psicológica de las últimas décadas hacen necesario revisar y profundizar en aspectos ya abordados en etapas anteriores por dichos programas. Uno de estos aspectos es la importancia que presentan los Tripulantes de Cabina de Pasajeros (TCP) como integrantes del equipo de vuelo. Retrotrayéndose a los programas de CRM de tercera generación, el presente artículo analiza las actuaciones que han tenido los TCP en diferentes accidentes aéreos, poniendo de manifiesto la importancia que tiene su ejecución y la coordinación de la misma con la del resto de la tripulación de cara al éxito en la resolución de la emergencia aérea.(AU)

The evolution of CRM programs has meant enormous progress for aviation in terms of the study of human factors and their relationship with the reduction of air accidents. Although it is true that CRM programs have undergone a successful evolution since their appearance in 1979, it is no less true that the advances in psychological science in recent decades make it necessary to review and expand on aspects already addressed in previous stages by these programs. One of these aspects is the importance of the cabin crew members (CCM) as members of the flight team. Going back to the third generation programs, this paper analyzes the actions that the CCM have taken in different air accidents, highlighting the importance of their performance and their coordination with the rest of the crew in order to achieve success in resolving the air emergency.(AU)

Aviation Decompression Sickness in Aerospace and Hyperbaric Medicine.

INTRODUCTION: The U.S. Navy experienced a series of physiological events in aircrew involving primarily the F/A-18 airframe related to rapid decompression of cabin pressures, of which aviation decompression sickness (DCS) was felt to contribute. The underlying pathophysiology of aviation DCS is the same as that of diving-related. However, based on the innate multifactorial circumstances surrounding hypobaric DCS, in clinical practice it continues to be unpredictable and less familiar as it falls at the intersect of aerospace and hyperbaric medicine. This retrospective study aimed to review the case series diagnosed as aviation DCS in a collaborative effort between aerospace specialists and hyperbaricists to increase appropriate identification and treatment of hypobaric DCS.METHODS: We identified 18 cases involving high-performance aircraft emergently treated as aviation DCS at a civilian hyperbaric chamber. Four reviewers with dual training in aviation and hyperbaric medicine retrospectively reviewed cases and categorized presentations as "DCS" or "Alternative Diagnosis".RESULTS: Reviewers identified over half of presenting cases could be attributed to an alternative diagnosis. In events that occurred at flight altitudes below 17,000 ft (5182 m) or with rapid decompression pressure changes under 0.3 atm, DCS was less likely to be the etiology of the presenting symptoms.CONCLUSIONS: Aviation physiological events continue to be difficult to diagnose. This study aimed to better understand this phenomenon and provide additional insight and key characteristics for both flight physicians and hyperbaric physicians. As human exploration continues to challenge the limits of sustainable physiology, the incidence of aerospace DCS may increase and underscores our need to recognize and appropriately treat it.Kutz CJ, Kirby IJ, Grover IR, Tanaka HL. Aviation decompression sickness in aerospace and hyperbaric medicine. Aerosp Med Hum Perform. 2023; 94(1):11-17.

Aviation infrastructures in the Republic of China, 1920-37.

This essay investigates technical aspects of the history of aviation in the Republic of China, focusing on the period between 1920 and 1937. It suggests that Chinese authors and administrators came to see the establishment of technical infrastructure as dependent on the education of personnel who could assume responsibility for maintaining and expanding Chinese aviation ventures, rather than on specific technologies or practices. Magazines and journals in the 1920s reflected concerns with the establishment of weather observation and reporting, radio communications, and technical education in service of aviation; the last of these was critical for the first two. Provisions for technical work and training were reflected in contracts that were drawn up in the years around 1930 to establish three aviation projects in the Republic: the China National Aviation Corporation (CNAC), the Eurasia Aviation Corporation, and Southwest Airlines. Subsequent contracts and reports for CNAC and Eurasia in the years before the 1937 outbreak of war with Japan suggested a particular emphasis on the technical education of personnel as an important step in building Chinese aviation infrastructures.

Reacting and responding to rare, uncertain and unprecedented events.

This work examines how we may be able to anticipate, respond to, and train for the occurrence of rare, uncertain, and unexpected events in human-machine systems operations. In particular, it uses a foundational matrix which describes the combinations of the state-of-the-world and the state-of-the-respondent, to formulate preferred response strategies, contingent upon what is knowable and actionable in each circumstance. It employs the dichotomy of System I and System II forms of cognitive response and augments these perspectives with a further form of decision-making, namely Systems III. The latter is predicated upon reactions to novel, unprecedented, and even 'unthinkable' events. The degree to which any human operator, the associated automation and/or the autonomy of a system, or each of these acting in concert, can best deal with these 'blue swan' events is explored. Potential forms of remediation, especially featuring training, are discussed, and evaluated in light of the skills needed to respond to even prohibitive degrees of situational uncertainty.Practitioners summary: Practitioners are liable to witness a growing spectrum of unusual and, on occasion, even unprecedented events in the operation of systems for which they are responsible. They will be required to account for their response to these circumstances to a spectrum of involved constituencies to whom they answer. This work aids them in succeeding to bring clarity to such difficult and challenging processes.Abbreviations: K: Known; Unk: Unknown; AI: Artificial Intelligence; ML: Machine Learning; CHARM: Cockpit Human-Automation Resource Management; SDT: signal detection theory; ASRS: Aviation Safety Reporting System.

Pilot training and surgical education: flying towards a brighter future.

AIM: Human factors, surgery and aviation are intimately tied together by the common threads of error, risk and interpersonal relationships. A plethora of research abounds in all disciplines individually. The lessons learnt in one domain however are not unique and can be shared between all to promote best practice, further research and a greater understanding at a fundamental level. METHODS: A structured, thematic, literature review was performed. PubMed, EMBASE and Ovid MEDLINE databases were interrogated directly. The Health Foundation, National Health Service and Department of Health online databases were used through querying intrinsic search functions. RESULTS: With expanding use of technologies such as checklists, there is a gap left to better address and understand the nuances and roles of stress, communication and emotion on both learning and clinical practice. These can be prominent in the high-pressure environments shared between aviation and surgery. CONCLUSIONS: The authors explore lessons learnt from aviation, the human factors applicable to both and how they can be extrapolated to improve patient safety outcomes and promote the use of the 'Software, Hardware, Environment, Liveware' tool to aid practice.

Training in robotic surgery, replicating the airline industry. How far have we come?

INTRODUCTION: As the role of robot-assisted surgery continues to expand, development of standardised and validated training programmes is becoming increasingly important. We aim to compare current robotic training curricula with training in aviation, to evaluate current similarities and to provide insight into how healthcare can further learn from replicating initiatives in aviation training. METHODS: A systematic literature review of the current evidence was conducted online and relevant publications and information were identified. Evaluation and comparison between training in robotic surgery and the aviation industry was performed. RESULTS: There are significant similarities between modern robotic training curricula and pilot training. Both undergo basic training before proceeding to advanced training. Aviation training methods include classroom instruction, e-learning and practical training, in both the aircraft and flight simulation training devices. Both surgeon and pilot training include technical and procedural instruction as well as training in non-technical skills such as crisis management, decision making, leadership and communication. However, there is more regulation in aviation, with international standards for training curricula, simulation devices and instructors/trainers that are legally binding. Continuous learning with re-qualification with benchmarked high stakes tests are also mandatory throughout a pilot's and instructor's career. CONCLUSION: Robotic surgeons and pilots roles have many fundamental similarities. Both work with expensive and complex technology requiring high levels of skills, within working environments with high physiological and psychological stress levels. Whilst many initiatives in aviation training have already been replicated in surgical training there remain considerable differences in regulation. Adopting established and proven aviation methods of assessment and regulation could help robotic surgical training become more efficient, more effective and ultimately safer.

The effects of dynamic workload and experience on commercially available EEG cognitive state metrics in a high-fidelity air traffic control environment.

The current study evaluated the validity of commercially available electroencephalography (EEG) cognitive state metrics of workload and engagement in differentially experienced air traffic control (ATC) students. EEG and pupil diameter recordings were collected from 47 ATC students (27 more experienced and 20 less experienced) during a high-fidelity, variable workload approach-control scenario. Scenario workload was manipulated by increasing the number of aircraft released and the presence of a divided attention task. Results showed that scenario performance significantly degraded with increased aircraft and the presence of the divided attention task. No scenario performance differences were found between experience groups. The EEG engagement metric significantly differed between experience groups, with less experienced controllers exhibiting higher engagement than more experienced controllers. The EEG workload metric and pupil diameter were sensitive to workload manipulations but did not differentiate experience groups. Commercially available EEG cognitive state metrics may be a viable tool for enhancing ATC training.

Burnout among pilots: psychosocial factors related to happiness and performance at simulator training.

In this study among airline pilots, we aim to uncover the work characteristics (job demands and resources) and the outcomes (job crafting, happiness and simulator training performance) that are related to burnout for this occupational group. Using a large sample of airline pilots, we showed that 40% of the participating pilots experience high burnout. In line with Job Demands-Resources theory, job demands were detrimental for simulator training performance because they made pilots more exhausted and less able to craft their job, whereas job resources had a favourable effect because they reduced feelings of disengagement and increased job crafting. Moreover, burnout was negatively related to pilots' happiness with life. These findings highlight the importance of psychosocial factors and health for valuable outcomes for both pilots and airlines. Practitioner Summary: Using an online survey among the members of a European pilots' professional association, we examined the relationship between psychosocial factors (work characteristics, burnout) and outcomes (simulator training performance, happiness). Forty per cent of the participating pilots experience high burnout. Job demands were detrimental, whereas job resources were favourable for simulator training performance/happiness. Twitter text: 40% of airline pilots experience burnout and psychosocial work factors and burnout relate to performance at pilots' simulator training.

Psychophysiological response of different aircrew in normobaric hypoxia training.

Hypoxia remains the most important hazard in high altitude flights, but there is still a need for deeper analysis of the effect of hypoxia exposition in the psychophysiological and cognitive functions. The aim of this study was to study the effect of hypoxia training in cortical arousal, autonomic modulation, muscle strength and cognitive function. We analysed 23 male aircrew personnel of the Spanish Army and Air Force (10 Helicopter Pilots, 7 Transport Aircrew, 3 Transport Pilots and 3 F-18 Fighter Pilots) before, during and after a normobaric hypoxia exposition. Hypoxia produced an increase in perceived stress and effort, a higher Heart Rate and a decreased function of breath muscles. Working memory and pattern recognition were impaired after hypoxia exposition. Significant differences were found in cognitive tests performance among aircrew groups, suggesting differences on their previous training. These results can improve specific training for better preparation of pilots and aircrews for hypoxic threats. Practitioner summary: Distinct aircrew preparation produces a different hypoxia exposition effect on psychophysiological response and cognitive functions. Hypoxia produced an increase in Heart Rate, a decreased function of breath muscles, being more negatively affected in Transport Pilots. Cognition abilities were impaired after hypoxia exposition, independently of the aircrew group.

Eye tracking as a debriefing tool in upset prevention and recovery training (UPRT) for general aviation pilots.

Upset prevention and recovery training (UPRT) is intended to improve the ability of pilots to recognize and avoid situations that can lead to airplane upsets and to improve their ability to recover control of an airplane that has exceeded the normal flight envelope. To this end, a set of different training contents - from theoretical knowledge of aerodynamics and human factors to practice-based flight training - is necessary. In order to support the debriefing with an objective feedback, and because visual scanning is a core competence, two studies on subjective evaluation of aviation pilots - one conducted in a flight simulator and the other one in-flight - focussed on the practical application of eye tracking as a debriefing tool in UPRT. From a practitioner's perspective, eye tracking appeared to be a useful method in terms of visualising instrument scanning techniques, supporting the instructor with objective debriefing material and fostering self-awareness in human processes. The discussion recommends adjusted UPRT instructor training and further improvements to eye tracking hardware and software. Practitioner Summary: The article focuses on pilot evaluations of eye tracking as a debriefing tool in UPRT and the identification of critical elements in its use. Eye tracking is a promising debriefing tool for UPRT. The discussion points to desirable improvements of eye tracking hardware and software as well as adjustments to instructor training that are pertinent.

The training and practice of crew resource management: recommendations from an inductive in vivo study of the flight deck.

Crew resource management (CRM) is credited with saving 185 lives at Sioux City. While the theory behind CRM is well documented, there are few studies of how CRM manifests on the line. This inductive in vivo study had three objectives. First, to describe how CRM manifests. Secondly, to evaluate the efficacy of CRM vis-à-vis flight safety. Thirdly, to suggest improvements to the CRM training syllabus. The study produced five conclusions: First, CRM is durable under conditions of moderate strain. Secondly, crews embed and refine CRM through reflection and action. Thirdly, CRM facilitates and shapes social relations. Fourthly, mindlessness (Langer 1989 ) undermines CRM. Finally, the interruption of flight-deck routines by third-parties poses a threat to flight-safety. The paper recommends multi-profession CRM training as a means of improving communication and co-ordination in and around aircraft. The study's limitations include a monocultural flight-deck: flights were operated by pilots with European backgrounds. Mindful of Hofstede's ( 1980 ), Engle's ( 2000 ) and Helmreich and Merritt's ( 2001 ) examination of the relationship between culture and performance, the author suggests the study be repeated with carriers that employ pilots from a variety of cultures. Practitioner Summary: This in vivo study evaluates the efficacy of CRM vis-à-vis flight safety and supports a critique of the CRM syllabus. The author observed twenty sectors and attended a CRM training day. To improve safety and efficiency, it is recommended that airlines run multi-profession (inclusive) CRM training courses.

Evaluation of a drug and alcohol safety education program in aviation using interrupted time series and the Kirkpatrick framework.

Compliance with drug and alcohol regulations are required by 14 CFR Part 120/ and 49 CFR Part 40. These regulations affect approximately 7200 aviation-related companies and their associated services. Consequences for noncompliance can include loss of revenue from imposition of civil penalties, suspension, or revocation of the company's certificate to conduct business. Front End Analysis (FEA) was conducted to determine specific performance problems and provide five tailored educational interventions to address them. Program evaluation was conducted using Interrupted Time Series (ITS) modeling. Results showed significant (p < .05) decreases in nonconformities across all five models with small to moderate effect sizes. Based on the relative effects, values for reductions in civil penalty costs between 16% and 47%, were predicted. Actual sanction reductions from the pre-to-post-intervention periods were confirmed to be 24.21%. The study supported the efficacy of the ITS approach for implementation of level four Kirkpatrick evaluation.

Parallels in safety between aviation and healthcare.

Aviation and healthcare are complex industries and share many similarities: the cockpit and the operating theater, the captain and the surgeon. While North American commercial aviation currently enjoys a tremendous safety record, it was not always this way. A spike of accidents in 1973 caused 3214 aviation-related fatalities. Over the past 20years, the rate of fatal accidents per million flights fell by a factor of five, while air traffic increased by more than 86%. There have been no fatalities on a U.S. carrier for over 12years. Last year, there were 251,454 deaths in the United States owing to medical error. Pilots pioneered ways to address risks through crew resource management (CRM), and threat and error management (TEM). Both strategies, which are aimed at minimizing risk and optimizing safety, are applicable to surgery and the healthcare industry. These strategies as well as the Swiss Cheese Model, Checklists and the Normalization of Deviance will be reviewed in this article.

The Persistent Issue of Simulator Sickness in Naval Aviation Training.

INTRODUCTION: Virtual simulations offer nearly unlimited training potential for naval aviation due to the wide array of scenarios that can be simulated in a safe, reliable, and cost-effective environment. This versatility has created substantial interest in using existing and emerging virtual technology to enhance training scenarios. However, the virtual simulations themselves may hinder training initiatives by inducing simulator sickness among the trainees, which is a series of symptoms similar to motion sickness that can arise from simulator use. Simulator sickness has been a problem for military aviation since the first simulators were introduced. The problem has also persisted despite the increasing fidelity and sense of immersion offered by new generations of simulators. As such, it is essential to understand the various problems so that trainers can ensure the best possible use of the simulators. This review will examine simulator sickness as it pertains to naval aviation training. Topics include: the prevailing theories on why symptoms develop, methods of measurement, contributing factors, effects on training, effects when used shipboard, aftereffects, countermeasures, and recommendations for future research involving virtual simulations in an aviation training environment.Geyer DJ, Biggs AT. The persistent issue of simulator sickness in naval aviation training. Aerosp Med Hum Perform. 2018; 89(4):396-405.

You're the Flight Surgeon.

Haight SP, Sholes PC, Pokorny WB, Brandenburg LR. You're the flight surgeon: other causes of mechanical low back pain. Aerosp Med Hum Perform. 2018; 89(4):411-413.

Topological Changes in the Brain Network Induced by the Training on a Piloting Task: An EEG-Based Functional Connectome Approach.

Training is a process to improve one's capacity or performance through the acquisition of knowledge or skills specific for the trained task. Although behavioral performance would be improved monotonically and reach a plateau as the learning progresses, neurophysiological signal shows different patterns like a U-shaped curve. One possible account for the phenomenon is that the brain first works hard to learn how to use task-relevant areas, followed by improvement in the efficiency derived from disuse of irrelevant brain areas for good task performance. Here, we hypothesize that topology of the brain network would show U-shaped changes during the training on a piloting task. To test this hypothesis, graph theoretical metrics quantifying global and local characteristics of the network were investigated. Our results demonstrated that global information transfer efficiency of the functional network in a high frequency band first decreased and then increased during the training while other measures such as local information transfer efficiency and small-worldness showed opposite patterns. Additionally, the centrality of nodes changed due to the training at frontal and temporal sites. Our results suggest network metrics can be used as biomarkers for quantifying the training progress, which can be differed depending on network efficiency of the brain.

Uncoupling VOR and vestibuloautonomic retention to Coriolis acceleration training in student pilots and control subjects.

PURPOSE: Explore the different vestibular physiologic response retention patterns after Coriolis acceleration training in student pilots and extend the results for use with Chinese astronauts in the future. METHODS: Twelve healthy control male subjects were screened from males familiar with vestibular training and who physically resembled the astronauts. Fourteen student pilots were selected from 23 participants by rotational vestibular function tests. All subjects were exposed to five-day continuous or intermittent Coriolis acceleration training. Subjective motion sickness (MS) symptom scores, electrocardiography, electrogastrography (EGG), post-rotatory nystagmus and renin-angiotensin system responses were measured before, during and after rotational vestibular function tests at different times after vestibular training. RESULTS: Subjects could tolerate 10 min or 15 min of vestibular with mild MS symptoms. Retention of vestibular autonomic responses (retention of MS symptom scores, heart rate variability, power density of EGG, variations in levels of arginine vasopressin) were approximately 1 week for control subjects and approximately 5 weeks for student pilots. Decreases in slow-phase velocity of post-rotatory nystagmus were maintained for 14 weeks for control subjects and 9 weeks for student pilots. CONCLUSIONS: Retention of the vestibulo-autonomic reaction after vestibular training was different for control subjects and student pilots. All parameters related to autonomic responses could be maintained at low levels after vestibular training for approximately 1 week for control subjects and approximately 5 weeks for student pilots. Uncoupling patterns between post-rotatory nystagmus and the vestibulo-autonomic reaction may be helpful in the design of clinical rehabilitation plans for balance-disorder patients and for exploration of artificial gravity in future space missions.

Latent Presentation of Decompression Sickness After Altitude Chamber Training in an Active Duty Flier.

BACKGROUND: Decompression sickness (DCS) is a potential danger and risk for both divers and aircrew alike. DCS is also a potential side effect of altitude (hypobaric) chamber training as well and can present long after training occurs. Literature review shows that altitude chamber induced DCS has approximately a 0.25% incidence. CASE REPORT: A 32-yr-old, active duty military member developed symptoms of DCS 3 h after his hypobaric chamber training. Unfortunately, he did not seek treatment for DCS until 48 h after the exposure. His initial treatment included ground level oxygen therapy for 30 min at 12 L of oxygen per minute using a nonrebreathing mask. He achieved complete symptom resolution and was returned to duty. However, 12 d after his initial Flight Medicine evaluation, the patient returned complaining of a right temporal headache, multijoint pains, and fatigue. He was treated in the hyperbaric chamber and had complete resolution of symptoms. He was returned to flying status and 5 mo later denied any return of symptoms. DISCUSSION: Hypobaric chamber familiarity training is a requirement for all military aircrew personnel to allow them assess their ability to identify symptoms of hypoxia. This training method is not only costly to maintain, but it also places aircrew and chamber technicians at risk for potential long-term side effects from failed recompression treatment of DCS. We are presenting a case of recurrent DCS symptoms 12 d after initial ground level oxygen therapy.Gentry J, Rango J, Zhang J, Biedermann S. Latent presentation of decompression sickness after altitude chamber training in an active duty flier. Aerosp Med Hum Perform. 2017; 88(4):427-430.