Computerized Tests of Team Performance and Crew Coordination Suitable for Military/Aviation Settings.

INTRODUCTION: The coordination of team effort on shared tasks is an area of inquiry. A number of tests of team performance in challenging environments have been developed without comparison or standardization. This article provides a systematic review of the most accessible and usable low-to-medium fidelity computerized tests of team performance and determines which are most applicable to military- and aviation-relevant research, such as studies of group command, control, communication, and crew coordination. METHODS: A search was conducted to identify computerized measures of team performance. In addition to extensive literature searches (DTIC, Psychinfo, PubMed), the authors reached out to team performance researchers at conferences and through electronic communication. RESULTS: Identified were 57 potential tests according to 6 specific selection criteria (e.g., the requirement for automated collection of team performance and coordination processes, the use of military-relevant scenarios). The following seven tests (listed alphabetically) were considered most suitable for military needs: Agent Enabled Decision Group Environment (AEDGE), C3Conflict, the C3 (Command, Control, & Communications) Interactive Task for Identifying Emerging Situations (NeoCITIES), Distributed Dynamic Decision Making (DDD), Duo Wondrous Original Method Basic Awareness/Airmanship Test (DuoWOMBAT), the Leader Development Simulator (LDS), and the Planning Task for Teams (PLATT). Strengths and weaknesses of these tests are described and recommendations offered to help researchers identify the test most suitable for their particular needs. DISCUSSION: Adoption of a few standard computerized test batteries to study team performance would facilitate the evaluation of interventions intended to enhance group performance in multiple challenging military and aerospace operational environments.Lawson BD, Britt TW, Kelley AM, Athy JR, Legan SM. Computerized tests of team performance and crew coordination suitable for military/aviation settings. Aerosp Med Hum Perform. 2017; 88(8):722-729.

Comparison of the effects of ketamine and morphine on performance of representative military tasks.

BACKGROUND: When providing care under combat or hostile conditions, it may be necessary for a casualty to remain engaged in military tasks after being wounded. Prehospital care under other remote, austere conditions may be similar, whereby an individual may be forced to continue purposeful actions despite traumatic injury. Given the adverse side-effect profile of intramuscular (i.m.) morphine, alternative analgesics and routes of administration are of interest. Ketamine may be of value in this capacity. OBJECTIVES: To delineate performance decrements in basic soldier tasks comparing the effects of the standard battlefield analgesic (10 mg i.m. morphine) with 25 mg i.m. ketamine. METHODS: Representative military skills and risk propensity were tested in 48 healthy volunteers without pain stimuli in a double-blind, placebo-controlled, crossover design. RESULTS: Overall, participants reported more symptoms associated with ketamine vs. morphine and placebo, chiefly dizziness, poor concentration, and feelings of happiness. Performance decrements on ketamine, when present, manifested as slower performance times rather than procedural errors. CONCLUSIONS: Participants were more symptomatic with ketamine, yet the soldier skills were largely resistant to performance decrements, suggesting that a trained task skill (autonomous phase) remains somewhat resilient to the drugged state at this dosage. The performance decrements with ketamine may represent the subjects' adoption of a cautious posture, as suggested by risk propensity testing whereby the subject is aware of impairment, trading speed for preservation of task accuracy. These results will help to inform the casualty care community regarding appropriate use of ketamine as an alternative or opioid-sparing battlefield analgesic.

Motion sickness prevention by an 8-Hz stroboscopic environment during air transport.

INTRODUCTION: Previous research has shown that retinal slip can be a significant factor in causing motion sickness. Stroboscopic illumination may prevent retinal slip by providing snapshots of the visual environment that are brief enough so each image is stationary on the retina. METHODS: The purpose of this study was to determine the effectiveness of an 8-Hz stroboscopic environment as a motion sickness countermeasure for passengers during a nauseogenic flight in a helicopter. The study population was comprised of 18 motion sickness susceptible subjects. Subjects completed a motion sickness symptom questionnaire, a psychomotor vigilance test, weapons utilization tasks, a time estimation task, and a sustained attention task after nauseogenic flights with and without 8-Hz stroboscopic illumination in the cabin. RESULTS: Baseline-corrected scores of self-reported nausea were significantly lower after the stroboscopic condition (M = 36.57 +/- 6.95) than the nonstroboscopic condition (M = 50.88 +/- 7.36). Furthermore, the stroboscopic condition resulted in significantly better performance on the vigilance task than the nonstroboscopic condition. However, baseline-corrected scores of oculomotor symptoms were greater after the stroboscopic condition (M = 33.27 +/- 5.52) than the nonstroboscopic condition (M = 24.85 +/- 4.10). DISCUSSION: These results support the use of stroboscopic illumination as a nonpharmacologic countermeasure for motion sickness related to retinal slip. However, due to the uncontrolled nature of the flights, the possibility that these results could have been influenced by differences in motion between flights cannot be excluded. This technology should be investigated in other forms of transportation (i.e., ground vehicles).

Mood symptoms contribute to working memory decrement in active-duty soldiers being treated for posttraumatic stress disorder.

A significant proportion of military veterans of operations in Afghanistan and Iraq have been diagnosed with posttraumatic stress disorder (PTSD). Growing evidence suggests that neuropsychological deficits are a symptom of PTSD. The current study investigated neurocognitive functioning among soldiers diagnosed with PTSD. Specifically, active-duty soldiers with and without a diagnosis of PTSD were assessed for performance on tests of attention and working memory. In addition, factors such as combat experience, depression, anxiety, PTSD symptom severity, and alcohol consumption were explored as possible mediators of group differences in neurocognitive functioning. Twenty-three active-duty soldiers diagnosed with PTSD were matched with 23 healthy Soldier controls; all were administered the Attention Network Task (ANT), Backward Digit Span (BDS) task, Beck Depression Inventory, Beck Anxiety Inventory, PTSD Checklist-Military Version, Combat Exposure Scale, and Modified Drinking Behavior Questionnaire. Soldiers diagnosed with PTSD performed significantly worse on the working memory task (BDS) than healthy controls, and reported greater levels of PTSD symptoms, combat exposure, depression, and anxiety. However, after controlling for depression and anxiety symptoms, the relationship between PTSD and working memory was no longer present. The results indicate that PTSD is accompanied by deficits in working memory, which appear to be partially attributed to anxiety and depression symptoms.

Modafinil as a replacement for dextroamphetamine for sustaining alertness in military helicopter pilots.

INTRODUCTION: Successful military aviation operations depend on maintaining continuous day-night operations. Stimulants are easy to use and popular for sustaining performance because their utility is not dependent upon environmental or scheduling modifications. Dextroamphetamine is authorized for use by the aircrews of all U.S. military services, but its potential for abuse and subsequent addiction is of aeromedical concern. Finding an alternative stimulant, such as modafinil, that displays a low affinity for dopamine uptake binding sites would prove extremely beneficial. This study sought to establish the efficacy and safety of modafinil during actual flying operations, thus providing the operational validity desired to approve the use of modafinil for helicopter flight operations. METHODS: During two, 40-h periods of sustained wakefulness, 18 helicopter pilots (17 men, 1 woman, mean years of age = 29.5) each completed 15 flights and other evaluations, during which they received 2 of 3 experimental conditions: 3 doses at 4-h intervals of modafinil (100 mg), dextroamphetamine (5 mg), or placebo. RESULTS: Statistical results showed that modafinil, like dextroamphetamine, maintained alertness, feelings of well-being, cognitive function, judgment, risk perception, and situation awareness of sleep-deprived aviators consistently better than placebo and without side effects of aeromedical concern. DISCUSSION: Like previous research, this study strongly suggests that both drugs can maintain acceptable levels of mood and performance during sleep deprivation. The results also confirm that modafinil is well tolerated and appears to be a good alternative to dextroamphetamine for countering the debilitating mood and cognitive effects of sleep loss during sustained operations.

Cognition enhancement by modafinil: a meta-analysis.

INTRODUCTION: Currently, there are a number of pharmaceuticals available that have potential to enhance cognitive functioning, some of which may ultimately be considered for such use in military operations. Some drugs with potential for cognition enhancement have already been studied for use in military operations specific to their primary effect in sleep regulation (i.e., dextroamphetamine, modafinil, caffeine). There is considerable information available on many of these drugs. However, considerations for military appropriateness must be based on proficient research (e.g., randomly controlled trial design). METHODS: A meta-analysis was conducted to summarize the current state of knowledge of these potentially cognition-enhancing drugs. The analysis only included studies which met inclusion criteria relevant to military research. RESULTS: The results of the literature review reveal a gap in research of the enhancement properties of the drugs of interest. The results yielded three studies (all of which studied modafinil) that met the criteria. The meta-analysis of these three studies revealed a relatively weak pooled effect of modafinil on some aspects of cognitive performance in normal, rested adults. DISCUSSION: While the results of this study support the efficacy of modafinil, the main finding is the large literature gap evaluating the short- and long-term effects of these drugs in healthy adults.

Risk propensity and health risk behaviors in U.S. army soldiers with and without psychological disturbances across the deployment cycle.

Anecdotal and preliminary evidence suggests that Soldiers returning from a combat deployment engage in an increased number of health risk behaviors. Three potential factors driving this change were examined in this study; posttraumatic stress disorder (PTSD), concussion and traumatic brain injury (TBI), and perceived invincibility. We studied members of a combat arms brigade one month prior to a deployment to Iraq and approximately one month after their return (N = 319). Participants anonymously completed surveys characterizing attitudes about risk, risk propensity, invincibility, engagement in health risk behaviors, and personality. Using standardized screening instruments, participants were categorized with respect to PTSD and probable TBI. Results suggest that Soldiers engage in more alcohol use and reckless driving behaviors post-deployment. These changes were exaggerated in those who screened positive for PTSD. Perception of one's invincibility and survival skills increased post-deployment thus suggesting that participants felt less susceptible to adverse consequences and more adept at surviving dangerous situations. This study provides documentation of the pattern of health behavior in Soldiers engaged in the deployment cycle. Our findings suggest increases in the number of risks Soldiers' engage in post-deployment are not limited to those with PTSD symptomtotology. This study has implications for not only adjustment to life post-deployment at the individual level but also operational readiness.