Diurnal cardio-respiratory changes in ambulatory individuals deciphered using a multi-parameter wearable device.

Background: Recent technological developments enable big data-driven insights on diurnal changes. This study aimed to describe the trajectory of multiple and advanced parameters using a medical-grade wearable remote patient monitor. Methods: Parameters were monitored for 24 h in 256 ambulatory participants who kept living their normal life. Parameters included heart rate, blood pressure, stroke volume, cardiac index, systemic vascular resistance, blood oxygen saturation, and respiratory rate. Diurnal variations were evaluated, and analyses were stratified based on sex, age, and body mass index. Results: All parameters showed diurnal changes (p < 0.001). Females demonstrated higher heart rate and cardiac index with lower systemic vascular resistance. Obese participants had a higher blood pressure, and lower stroke volume and cardiac index. Systemic vascular resistance was higher among the elderly. Diurnal changes corresponded with awake-sleep hours and differed between sex, age, and body mass index groups. Conclusion: Wearable monitoring platforms could decipher hemodynamic changes in subgroups of individuals, and might help with efforts to provide personalized medicine, pre-symptomatic diagnosis and prevention, and drug development.

Cognitive Evaluation of Israeli Air Force Pilot Cadets.

OBJECTIVE: In aviation psychology, there is a constant need for the cognitive evaluation of pilots as part of operational fitness and safety criteria. METHODS: A cross-sectional study with comparison between the performance of Israeli Air Force pilot cadets (N = 318) and U.S. Air Force pilot training candidates (N = 512) as assessed by a cognitive battery was undertaken. The data of the comparison group was collected from Callister, King, and Retzlaff, as published in 1996. RESULTS: In general, the means in the three components composing the battery-speed, accuracy, and throughput variables-indicated that the Israeli Air Force pilot cadets' scores were higher than those of the U.S. Air Force pilot candidates' scores in 50 of 53 variables. Nonsignificant differences were found in Accuracy of shifting attention-arrow color (SATAC), pathfinder-combined (PFC), and pathfinder-letter (PFL). CONCLUSIONS: The difference in performance between the two groups may be due to differences in population characteristics. However, these results need to be considered cautiously, as the groups were sampled at a sizeable time gap (1996 for the U.S. Air Force vs. 2013 for the Israeli Air Force), with each time period characterized by different cultural and technological influences.Gordon S, Goren C, Carmon E, Shelef L. Cognitive evaluation of Israeli Air Force pilot cadets. Aerosp Med Hum Perform. 2017; 88(4):392-398.

The prevalence of medical symptoms in military aircrew.

BACKGROUND: The prevalence of medical symptoms in aviators has not been described in the medical literature. METHODS: An anonymous questionnaire was handed to all Israeli Air Force aviators who went through the routine yearly examination. Because only two women filled the questionnaire, we excluded them. The questionnaire contained a list of 49 symptoms and the aviators were asked to mark symptoms that were present in the last month before the examination as well as age, estimated weekly flying hours, military service status (reserve or career) and type of aircraft (jet-fighter, helicopter or transport). A general linear model was used to determine the association between age, weekly flying hours, type of aircraft and type of service with the number of symptoms. Binary logistic regression analyses was used to assess the association of these factors with lack of symptoms, and the top five ranking symptoms. RESULTS: Data was available for 323 male aviators. 62.5% of the aviators reported at least one symptom in the previous month. 26.9% reported three or more symptoms. 25.1% reported spinal symptoms, 22% respiratory symptoms, 21.4% fatigue, 11.5% headache and 6.5% general weakness. Career service was associated with the number of symptoms, fatigue and general weakness. Age was associated with fatigue and general weakness. Aircraft type and weekly flying hours were not associated with any symptom. CONCLUSIONS: Medical symptoms are prevalent in military aviators. Career personnel report on medical symptoms, especially fatigue, more often than reserve personnel. Further study is warranted to examine this association.

Hearing Loss in Israeli Air Force Aviators: Natural History and Risk Factors.

OBJECTIVE: To investigate the natural history of hearing loss (HL) in Israeli military aviators and its risk factors. METHODS: Audiometric results of aviators with available audiometry at ages 30 and 40 years, and up to their last available audiometry were retrieved. HL DEFINITION: pure-tone threshold (PTT) of 30 dB or higher in at least one frequency in at least one ear, moderate-to-severe (M-S) HL as PTT of 45 dB or higher, and suspected noise-induced HL (NIHL) as HL at 3 to 6 kHz. Potential risk factors for HL were assessed by the χ(2) test and logistic regression models. RESULTS: 298 aviators were included. Rates of HL increased with age, up to 57.5% at age 50. All M-S HL at age 50 years had clues on previous examinations, but new HL was observed in all ages. Age was found as a statistically significant risk factor, but aircraft type was not. Total flying hours were found to be an independent risk factor for suspected NIHL only. Self-reported earplug use was not found to protect from HL, with methodological limitations. CONCLUSIONS: HL is prevalent in aviators. Age and total flying hours are risk factors, the latter probably only for NIHL, whereas aircraft type is not.

The Ecology of Medical Care Among Israeli Military Aviators.

BACKGROUND: The ecology of medical care model has been used in various populations with varying results. We aimed to apply this model in the population of Israeli Air Force (IAF) aviators. METHODS: An anonymous questionnaire was presented to all Israeli Air Force aviators during their mandatory yearly check-up over 1 yr starting on November 26th, 2012. The questionnaire contained items on demographic, personal, and military details, as well as items on the presence of clinical symptoms, and various health care contacts in the previous month. We assessed the differences between career and reserve personnel using a X2 test. RESULTS: There were 325 aviators who completed the questionnaire (2 women, 132 reserves). Clinical symptoms were reported by 62.5% of the responders. Over half (52.6%) had any health care encounter: 23.7% with a dentist, 17.9% with non-MD therapists, 12.6% with a specialist, and 11.7% with a primary physician. A significant difference between reserve and career personnel was found only in primary care visits. Out of the aviators who reported having clinical symptoms, 70.9% did not visit a physician. Of those who did not seek medical care, 42.4% reported that the symptoms were viewed as unimportant, 41% thought they would disappear by themselves, 40.3% could not find time for treatment. CONCLUSIONS: Aviators in the IAF have similar rate of clinical symptoms as in other unselected populations. Those who report symptoms usually do not visit a physician for treatment. When they do seek advice it is mostly from non-MD practitioners.Gordon B, Levy Y, Yemini T, Carmon E, Erlich Y, Hermoni D. The ecology of medical care among Israeli military aviators. Aerosp Med Hum Perform. 2016; 87(12):1036-1040.

The contribution of personal and seniority variables to the presence of stress symptoms among Israeli UAV operators.

BACKGROUND: The exposure to war scenes via screens, despite offering a degree of detachment, can be stressful for the operator. The aim of the current study is to examine the existence of anxiety, depression, and post traumatic stress disorder (PTSD) symptoms among unmanned aerial vehicle (UAV) Israeli operators. METHODS: Participants comprised 41 UAV operators (87.2% male), aged 22-38 (Mage = 26.05, SD = 3.54). Most (78.0%) reported having viewed battlefield scenes. All participants completed a total of five questionnaires: Beck Depression Inventory, State-Trait Anxiety Inventory, and three questionnaires of PTSD: Post Trauma Questionnaire (CAPS), the Post-Traumatic Cognition Inventory (CTPI), and the Post-Traumatic Symptom Scale (PSS). RESULTS: Mean scores of depression and anxiety were found significantly lower than diagnosis cut-off points (p < .001). Senior operators showed higher means for depression (5.69 vs. 2.58, p = .040), of stress level (PSS; 3.17 vs. 0.25, p = .020) and for distress intensity (3.79 vs. 0.57, p = 0.041) than less-experienced operators. CONCLUSIONS: Investigating and monitoring the impact of battlefield exposure in UAV operators are highly beneficial for preventing psychopathology.

Critical Velocity Is Associated With Combat-Specific Performance Measures in a Special Forces Unit.

The purpose of this study was to examine the relationship between critical velocity (CV) and anaerobic distance capacity (ADC) to combat-specific tasks (CST) in a special forces (SFs) unit. Eighteen male soldiers (mean ± SD; age: 19.9 ± 0.8 years; height: 177.6 ± 6.6 cm; body mass: 74.1 ± 5.8 kg; body mass index [BMI]: 23.52 ± 1.63) from an SF unit of the Israel Defense Forces volunteered to complete a 3-minute all-out run along with CST (2.5-km run, 50-m casualty carry, and 30-m repeated sprints with "rush" shooting [RPTDS]). Estimates of CV and ADC from the 3-minute all-out run were determined from data downloaded from a global position system device worn by each soldier, with CV calculated as the average velocity of the final 30 seconds of the run and ADC as the velocity-time integral above CV. Critical velocity exhibited significant negative correlations with the 2.5-km run time (r = -0.62, p < 0.01) and RPTDS time (r = -0.71, p < 0.01). In addition, CV was positively correlated with the average velocity during the 2.5-km run (r = 0.64, p < 0.01). Stepwise regression identified CV as the most significant performance measure associated with the 2.5-km run time, whereas BMI and CV measures were significant predictors of RPTDS time (R(2) = 0.67, p ≤ 0.05). Using the 3-minute all-out run as a testing measurement in combat, personnel may offer a more efficient and simpler way in assessing both aerobic and anaerobic capabilities (CV and ADC) within a relatively large sample.

An incidental suprasellar mass in a military flying cadet: implications for aircrew.

BACKGROUND: Incidental findings pose a dilemma in aviation medicine, where every finding must be carefully considered in order to ensure the well-being of the aircrew for flight and mission safety. Since suprasellar masses are not uncommon, their possible effects should be addressed. CASE REPORT: We present an incidental finding of 11.5 mm × 14.4 mm, hyper-intense on T2 and iso-intense on T1-weighted images, of a suprasellar mass in a 19-yr-old man. This finding led to the re-evaluation of his position as a military flight cadet, followed by his later disqualification. DISCUSSION: No medical waiver regarding asymptomatic suprasellar mass exists. We have carefully examined the differential diagnosis and generated a profile for each possible diagnosis consisting of risks for sudden incapacitation, progression likelihood, and the effect of an aerial environment on a brain lesion. We were able to draw up a medical waiver for some of the possible diagnoses (namely, Rathke's cyst or craniopharyngioma) for nonhigh performance aircraft.

The clinical application of spectral karyotyping (SKY) in the analysis of prenatally diagnosed extra structurally abnormal chromosomes (ESACs).

OBJECTIVE: The prenatal detection of de novo extra structurally abnormal chromosomes (ESACs) presents a challenge because the associated risk for congenital anomaly ranges from 100% to practically none, depending on the chromosomal origin. Despite the use of standard cytogenetic techniques and even fluorescence in situ hybridization (FISH), the origin of some ESACs often remains elusive. Spectral karyotyping (SKY) is a molecular cytogenetic technique based on the simultaneous analysis of all chromosomes using a unique probe mix that allows the rapid identification of all chromosomes in 24 colors. The purpose of this study was to evaluate the use of SKY in the characterization of prenatally diagnosed de novo ESACs. METHODS: This series includes five cases of de novo ESACs detected prenatally in routine amniocentesis samples performed for advanced maternal age. Cases of inherited ESACs or ESACs defined by standard cytogenetic techniques were excluded. RESULTS: SKY analysis yielded valuable information, particularly in cases of nonsatellited ESACs: a der(18) and a ring(Y). In a case of a unisatellited der(15), SKY corroborated data obtained by standard cytogenetic techniques and FISH. Finally, in two cases of small bisatellited chromosomes, SKY was noncontributory. CONCLUSIONS: While SKY may be a valuable tool in some cases, especially nonsatellited and ring ESACs, it does have limitations and should be used judiciously in conjunction with other cytogenetic techniques.