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1.
Aerosp Med Hum Perform ; 90(10): 901-907, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31558200

RESUMO

INTRODUCTION: Spatial disorientation (SD) remains a leading cause of Class A mishaps and fatalities in aviation. Motion-based flight simulators and other research devices provide the capacity to rigorously study SD in order to develop effective countermeasures. By applying mathematical models of human orientation perception, we propose an approach to improve control algorithms for motion-based flight simulators to study SD.METHODS: The Disorientation Research Device (DRD), or the Kraken™, is the Department of Defense's newest and most capable aerospace medicine motion-based research device. We implemented an "Observer" model for predicting aircrew spatial orientation perception within the DRD, and perceptions experienced in flight. Further, we propose a framework that uses the model output, in addition to pilot control inputs, to optimize multiaxis motion control including human-in-the-loop control capability.RESULTS: A case study was performed to demonstrate the functionality of the framework. Additionally, the case study highlights both how limitations of human perception are crucial to consider when designing motion algorithms, and the challenges of effective flight simulation with multiple motion axes.DISCUSSION: We implemented a mathematical model for spatial orientation perception to improve the design of control algorithms for motion-based flight simulators, using the DRD as an example application. We provide an example of predicting perceptions, producing quantitative information on the efficacy of motion control algorithms. This mathematical model based approach to validating motion control algorithms aims to improve the fidelity of ground-based SD research.Dixon JB, Etgan CA, Horning DS, Clark TK, Folga RV. Integration of a vestibular model for the Disorientation Research Device motion algorithm application. Aerosp Med Hum Perform. 2019; 90(10):901-907.


Assuntos
Acidentes Aeronáuticos/prevenção & controle , Medicina Aeroespacial/métodos , Confusão/fisiopatologia , Orientação Espacial/fisiologia , Pilotos/psicologia , Atitude , Aviação , Humanos , Militares , Modelos Biológicos , Movimento (Física) , Treinamento por Simulação/métodos , Vestíbulo do Labirinto/fisiologia
2.
Aerosp Med Hum Perform ; 90(9): 764-773, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31426891

RESUMO

INTRODUCTION: Physical conditioning may improve aircrew performance during exposure to high +Gz acceleration, although few studies have directly assessed this. The present study investigated the effects of a 12-wk Aircrew Conditioning Programme (ACP) on markers of G tolerance. The ACP comprises aerobic and muscle strengthening exercise performed twice weekly and targets improved fitness and reduced injury risk.METHODS: There were 36 UK Royal Air Force and Royal Navy aircrew who volunteered; 17 performed the ACP (Ex) and 19 acted as a control group (Con). Centrifuge testing was performed before and after the intervention. Relaxed G tolerance (RGT) and straining G tolerance (SGT), which had the addition of muscle tensing, were assessed. G endurance was also determined via repeated simulated air combat maneuvers (SACMs). During these centrifuge runs a number of physiological variables were recorded.RESULTS: During the G profile to determine RGT, neither RGT, HR, nor blood pressure responses were affected by the ACP. During SGT profiles, a lower HR at a given +Gz (+5.5 Gz) level following the ACP was observed (Ex: pre 146.0 ± 4.4, post 136.9 ± 5.6 bpm; Con: pre 148.0 ± 3.2, post 153.1 ± 3.3 bpm). BP was maintained and there was a tendency toward an improved SGT. The ACP increased the proportion of individuals completing the number of SACM profiles, although no meaningful differences were found between groups in other variables.CONCLUSION: Overall the ACP has no negative effect on RGT, reduced the physiological strain associated with a given level of +Gz (during SGT), and tended to improve the ability to tolerate repeated Gz exposure.Slungaard E, Pollock RD, Stevenson AT, Green NDC, Newham DJ, Harridge SDR. Aircrew conditioning programme impact on +Gz tolerance. Aerosp Med Hum Perform. 2019; 90(9):764-773.


Assuntos
Aceleração/efeitos adversos , Medicina Aeroespacial/métodos , Hipergravidade/efeitos adversos , Condicionamento Físico Humano/métodos , Adulto , Centrifugação , Humanos , Masculino , Militares , Reino Unido , Guerra , Adulto Jovem
3.
Aerosp Med Hum Perform ; 90(8): 679-680, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31331416
4.
Aerosp Med Hum Perform ; 90(8): 735-737, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31331425

RESUMO

INTRODUCTION: Due to the risk of hypoglycemia-related incapacitation, diabetic pilots requiring insulin are assessed as unfit according to the International Civil Aviation Organization and most national authorities. Some authorities, such as those from Canada, the United Kingdom, and the United States, permit selected insulin-treated pilots (ITDM-pilots) to fly subject to a protocol requiring pre- and in-flight capillary glucose measurements to show safe levels (>100-<300 mg · dl-1). Critics of such permission question the practicability of these in-flight measurements and whether clinically desired glycemic targets can be achieved while keeping glucose levels in the safe range. Subcutaneous continuous glucose monitoring (CGM) has recently been approved by the FDA as a stand-alone method to provide accurate glucose levels and treatment decision guidance in patients. This commentary considers that use of CGM by ITDM pilots facilitates practicability and recording of in-flight glucose measurements and facilitates achievement of clinically desired glycemic targets without increasing hypoglycemia risks.Strollo F, Simons R, Mambro A, Strollo G, Gentile S. Continuous glucose monitoring for in-flight measurement of glucose levels of insulin-treated pilots. Aerosp Med Hum Perform. 2019; 90(8):735-737.


Assuntos
Medicina Aeroespacial/métodos , Glicemia/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/prevenção & controle , Insulina/administração & dosagem , Medicina Aeroespacial/instrumentação , Diabetes Mellitus Tipo 2/sangue , Estudos de Viabilidade , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Insulina/efeitos adversos , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Pilotos
5.
Mil Med ; 184(3-4): e143-e147, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31222264

RESUMO

INTRODUCTION: Female aviators with health conditions may face a variety of occupational impacts. Outcomes may include a waiver for continued flight or a permanent suspension, in which flight is no longer possible. The objective of this study is to determine the prevalence of medical diagnosis among female U.S. Army aviators over a ten year period and identify associations of clinical diagnoses leading to waiver or permanent suspension. MATERIALS AND METHODS: This study was a secondary data analysis; data were retrieved on 1,282 female, rated aviator patients from an Army Aviation epidemiological database. The archival dataset was composed of a total of 6,856 cases between June 2005 and June 2015. Age ranged from 19 to 58 years. The data were examined in terms of raw ICD-9 diagnostic codes, grouped system diagnoses (diagnosis categories), and occupational consequence. Spearman's rho correlations were used to determine associations between diagnosis, waiver and permanent suspension. RESULTS: The leading diagnoses were pregnancy, normal delivery, and allergic rhinitis. The systems approach yielded pregnancy, orthopedic disorders, and spinal disorders as the leading diagnosis categories. Leading waivered conditions included spinal, psychiatric, and neurological disorders. In terms of permanent suspension, the leading cause was depression, followed by migraine and post-traumatic stress disorders. In almost all diagnostic groupings, the Spearman's rho correlation coefficients between age and diagnosis were positively related. However, age was not associated with negative occupational outcome (permanent suspension), generally. CONCLUSIONS: A variety of conditions negatively impact the health and occupational status of female aviators, with disparate occupational impacts. Prevalent conditions differed from those reported previously for all aviators in a predominantly male population. The absence of cardiovascular disease is a significant change from 20-30 years ago. Among all medical diagnoses, a minority are responsible for a greater occupational burden.


Assuntos
Militares/estatística & dados numéricos , Pilotos/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Adulto , Medicina Aeroespacial/métodos , Medicina Aeroespacial/estatística & dados numéricos , Aeronaves/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Militares/psicologia , Prevalência , Estudos Retrospectivos
6.
Aerosp Med Hum Perform ; 90(7): 618-623, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31227035

RESUMO

BACKGROUND: In order to determine the minimum flight crew number and show compliance with airworthiness regulations, the workload of flight crew should be measured in various flight scenarios both in a simulator and in flight tests demonstrating compliance. However, the complexity, environment, and safety considerations of flight tests require pilots to take more responsibility and be more careful with decisions and actions with higher stress, and it might be inappropriate to carry out flight tests in a high-risk abnormal situation. Therefore, it is necessary to assess workload measures in a simulator to predict workload experienced during a flight test.METHODS: Two subjective workload measurements and three psychophysiological measurements were compared both in a simulator and in a flight test among three flight scenarios. The scenarios were carried out in an ARJ21-700 full-flight simulator and a corresponding aircraft, and a total of 17 pilots participated.RESULTS: Both flight scenarios and flight environment had a significant influence on NASA-TLX, eye blink rate, and heart rate. Additionally, the NASA-TLX (R = 0.864) and heart rate differences (R = 0.840) presented strong correlations between the simulator and flight test.DISCUSSION: NASA-TLX and heart rate could be used in simulators and flight tests as consistent measures of workload. Furthermore, in order to reduce the quantity and risk of compliance during a flight test, the best strategy is to combine the results of the NASA-TLX scales and HR-D together in a flight simulator to predict workload experienced in a flight test.Zheng Y, Lu Y, Jie Y, Fu S. Predicting workload experienced in a flight test by measuring workload in a flight simulator. Aerosp Med Hum Perform. 2019; 90(7):618-623.


Assuntos
Medicina Aeroespacial/métodos , Pilotos/psicologia , Treinamento por Simulação , Carga de Trabalho/psicologia , Adulto , Aeronaves , Tomada de Decisões , Humanos , Masculino , Pessoa de Meia-Idade
7.
Aerosp Med Hum Perform ; 90(7): 655-659, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31227042

RESUMO

BACKGROUND: The evaluation of how air rarefaction can affect a loudspeaker performance at altitude implies the need for characterization of earphones during hypobaric conditions. The aim of this study was phonometric analysis at different altitudes of the acoustic output of a widely used earphone model, along with its consequences on audiological investigations conducted under such environmental conditions.METHODS: The transfer function of a TDH-39P earphone was analyzed with an artificial ear under nine different altitude levels, from sea level up to 35,000 ft, inside a hypobaric chamber. A specific phonometric system not sensitive to environmental pressure changes was used. Other potentially confounding factors, such as environmental temperature and humidity, were continuously monitored.RESULTS: No relevant temperature or humidity changes were detected. The sound pressure level generated by the earphone under hypobaric conditions was found considerably affected by air density changes. These data produced a correction table aiming at recalibrating the earphone's output at each audiometric octave test frequency within the 250-8000 Hz range. Quite different characteristics of response were observed at different audiometric frequencies. Such findings were particularly evident for altitudes exceeding 12,000 ft.DISCUSSION: The development of a frequency-selective and altitude-related correction factor for acoustic stimuli is an essential aspect when hearing threshold measurements in hypobaric environments are performed.Lucertini M, Botti T, Sanjust F, Cerini L, Autore A, Lucertini L, Sisto R. High altitude performance of loudspeakers and potential impact on audiometric findings. Aerosp Med Hum Perform. 2019; 90(7):655-659.


Assuntos
Medicina Aeroespacial/métodos , Audiometria/métodos , Limiar Auditivo/fisiologia , Hipóxia/fisiopatologia , Pressão/efeitos adversos , Estimulação Acústica , Medicina Aeroespacial/instrumentação , Altitude , Audiometria/instrumentação , Aviação , Humanos , Umidade , Temperatura Ambiente
8.
Aerosp Med Hum Perform ; 90(5): 480-483, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31023409

RESUMO

INTRODUCTION: Modafinil is a wakefulness-promoting stimulant that has been approved by the Republic of Singapore Air Force (RSAF) as a fatigue countermeasure medication since 2011. Each RSAF aircrew member must undergo a ground test to exclude operationally relevant adverse drug effects prior to consuming the medication for operational reasons. This study describes the RSAF's modafinil ground testing outcomes over a 7-yr period.METHODS: This is a retrospective case series of 243 RSAF aircrew members who underwent modafinil 100-mg test dosing over the 7-yr period from September 2011 to September 2018.RESULTS: The median age was 31 yr (range, 21-53 yr) and mean age was 31.7 yr ± 6.19 yr. Of the aircrew members, 234 (96.3%) were men and all were of Asian ethnicity. Of the subjects, 237 (97.5%) were medically cleared for the operational use of modafinil. Among the six (2.47%) who failed modafinil ground testing, headache (cumulative incidence, 1.65%), anxiety (cumulative incidence, 0.41%), diarrhea (cumulative incidence, 0.41%), and insomnia (cumulative incidence, 0.41%) were reported as the side effects experienced. None of the aircrew members experienced major adverse drug events.DISCUSSION: Our findings suggest a low occurrence of adverse drug effects among military aircrew members who undergo modafinil test dosing prior to using the drug operationally. To our knowledge, this is the single largest published case series of modafinil ground testing outcomes among Asian military aviators.Ooi T, Wong SH, See B. Modafinil as a stimulant for military aviators. Aerosp Med Hum Perform. 2019; 90(5):480-483.


Assuntos
Medicina Aeroespacial/métodos , Estimulantes do Sistema Nervoso Central/administração & dosagem , Militares , Modafinila/efeitos adversos , Pilotos , Acidentes Aeronáuticos/prevenção & controle , Adulto , Ansiedade/induzido quimicamente , Ansiedade/epidemiologia , Diarreia/induzido quimicamente , Diarreia/epidemiologia , Relação Dose-Resposta a Droga , Fadiga/prevenção & controle , Feminino , Cefaleia/induzido quimicamente , Cefaleia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modafinila/administração & dosagem , Estudos Retrospectivos , Singapura , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Vigília/efeitos dos fármacos , Adulto Jovem
9.
Aerosp Med Hum Perform ; 90(5): 488-491, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31023411

RESUMO

INTRODUCTION: The Federal Aviation Administration Office of Aerospace Medicine (AAM) is required by law to identify pilots who have driving under the influence (DUI) convictions. It is the responsibility of AAM to determine, based on the DUI, if the pilot has a drinking problem and needs follow-up treatment. Pilots with alcohol problems are at risk to themselves and the public and need to have treatment to reduce the extent of the risk. It has been suggested by some that a blood alcohol concentration (BAC) of 0.15 g · dL-1 is evidence of tolerance and the pilot should be placed in an alcohol treatment program.METHOD: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) Clinician's Guide considers a person at risk for a drinking problem when a man drinks 5 or more drinks or a woman drinks 4 or more drinks in a day and reaches a 0.08 g · dL-1 of ethanol in the blood. It is possible to estimate from a BAC or breath alcohol concentration (BrAC) the number of drinks consumed using the volume of distribution for ethanol and the weight of the individual. A spread sheet tool was developed to estimate the number of drinks consumed.RESULTS: It was determined that DUI/DWI concentrations could be used to determine the minimum number of drinks consumed. Overweight people reach binge drinking levels and higher Hingson levels at lower DUI/DWI concentrations than people with an average weight or lower.DISCUSSION: Using this tool there is a high probability (99.7%) of identifying a true binge drinker.Canfield DV, Forster EM, Cheong Z-I, Cowan JM. Breath/blood alcohol concentration as an indicator of alcohol use problems. Aerosp Med Hum Perform. 2019; 90(5):488-491.


Assuntos
Medicina Aeroespacial/métodos , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Concentração Alcoólica no Sangue , Dirigir sob a Influência , Pilotos , Medicina Aeroespacial/normas , Transtornos Relacionados ao Uso de Álcool/sangue , Peso Corporal , Testes Respiratórios/métodos , Etanol/sangue , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto
10.
Mil Med ; 184(Suppl 1): 593-603, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901431

RESUMO

Prototype low-intensity threat laser eye protection (LIT-LEP) spectacles were evaluated for US Coast Guard (USCG) cockpits and night vision goggle compatibility. The impetus for interest in aviation LIT-LEP is driven in part by the fact that easily accessible 0.5-2.0 W high-power laser pointers exceed safety standards for direct on-axis viewing. A repeated-measures experimental design was used to assess LIT-LEP performance relative to a no-LEP control for the following tasks: Near- and far contrast acuity, night vision goggle far-contrast acuity, emissive and non-emissive light source color-vision screening, and USCG multifunctional display color symbol discrimination reaction time and accuracy. Near- and far-contrast acuity results demonstrated good LIT-LEP performance for typical in- and out-of-cockpit lighting conditions. Night vision goggle performance suffered marginally at only one contrast level (85%; 20/30 acuity line). Color vision test results showed good color balance in that S-, M-, and L-cone performance did not demonstrate a clinical diagnostic color defect for emissive or non-emissive light sources when wearing LIT-LEP. Color symbol discrimination reaction-time-task results based on inverse efficiency scores revealed that some non-primary flight display colors exhibited a combination of slower speed and decreased accuracy. The findings will contribute to an acquisition decision as well as guide future LEP designs.


Assuntos
Medicina Aeroespacial/instrumentação , Dispositivos de Proteção dos Olhos/normas , Lasers/efeitos adversos , Visão Noturna/fisiologia , Medicina Aeroespacial/métodos , Desenho de Equipamento/normas , Humanos , Militares , Tempo de Reação/fisiologia , Acuidade Visual/fisiologia
11.
Mil Med ; 184(Suppl 1): 306-309, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901437

RESUMO

INTRODUCTION: En Route Care (ERC) is often an ad hoc mission for the USN. In a review of 428 Navy patient transports, a Flight Surgeon (FS) was the sole provider or a member of crew in 118 of the transports. Naval FSs receive approximately 4 hours of didactic ERC training during their 24-week Naval FS course. Regardless, an FS may be caring for a critically ill patient in a helicopter. We conducted a survey to evaluate FS confidence in their ability to perform ERC and to establish their understanding of the training of Search and Rescue Medical Technicians (SMT). MATERIALS AND METHODS: A convenience sample of FSs completed a needs analysis survey as part of a process improvement project. Flight Surgeons surveyed were actively assigned or had been assigned within the past year to a squadron with Search and Rescue/MEDEVAC capabilities. RESULTS: A total of 25 surveys were completed. An average of 13 (range 0-100) patient transport missions were performed by the respondents. Twenty-five percent reported feeling confident in their ability to provide ERC without senior level direction, while 41% stated they would require direction. Nearly 70% of the FSs surveyed expressed "minimal" or less understanding of the training of the SMT. CONCLUSIONS: Our survey results reveal most FSs are confident in neither their ability to perform ERC nor the ability of their hospital corpsman to provide care during patient movement.


Assuntos
Médicos/psicologia , Autoeficácia , Desempenho Profissional/normas , Adulto , Medicina Aeroespacial/métodos , Medicina Aeroespacial/normas , Resgate Aéreo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Militares/estatística & dados numéricos , Médicos/normas , Inquéritos e Questionários
12.
Mil Med ; 184(3-4): e217-e222, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30215767

RESUMO

INTRODUCTION: Fighter jet pilots may adopt a voluntary hypohydration strategy hours before take-off to avoid urinating in flight. This may favor sortie-induced dehydration and potentially increase flying errors. Since 2015, French pilots have used a urinary sheath (US) that appears to have resolved this problem. However, its effect has never been assessed. METHODS: Urine specific gravity (USG) before and after sorties, inflight intake (water and food) and loss (sweat and urine), and changes in bodyweight were measured during 44 long (~370 minutes) sorties (22 in 2015 without a US, No-US group, and 22 in 2017 with a US, US group). RESULTS: The USG before sorties was lower in the US than No-US group (1.019 ± 0.008 vs 1.028 ± 0.006, p = 0.008) and the proportion of hypohydrated pilots (>1.020) was lower in the US than No-US group (29 vs 90%, p = 0.007). Total loss and intake were higher in the US group (1,793 ± 640 and 927 ± 585 g, respectively) than in the No-US group (1,337 ± 382 and 359 ± 191 g, respectively; p < 0.006). Changes in bodyweight, both absolute (-977 ± 367 g for the No-US and -866 ± 593 g for the US group) and relative (1.16 ± 0.51% for the No-US and 1.13 ± 0.77% for the US group) during sorties were not altered by wearing a US. CONCLUSION: The use of a US successfully mitigates preflight dehydration, as reflected by decreases in USG, showing that pilots, at least partially, abandon preflight voluntary hypohydration strategies. It also favored water and food intake during flight without enhancing inflight dehydration, shown by the parallel increases in loss (urine and sweat) when wearing a US.


Assuntos
Estado de Hidratação do Organismo/fisiologia , Pilotos/estatística & dados numéricos , Fenômenos Fisiológicos do Sistema Urinário , Adulto , Medicina Aeroespacial/instrumentação , Medicina Aeroespacial/métodos , Análise de Variância , Desidratação/diagnóstico , Desidratação/fisiopatologia , França , Temperatura Alta/efeitos adversos , Humanos , Masculino , Militares/estatística & dados numéricos , Gravidade Específica , Cateteres Urinários
13.
Mil Med ; 184(1-2): 5-7, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30272203

RESUMO

Junior officers have an obligation to "lead up." They help senior officers successfully complete missions while maintaining accountability to core values and taking care of those they lead. The following case highlights one junior officer's challenge "leading up" in a very ambiguous situation.


Assuntos
Medicina Aeroespacial/métodos , Liderança , Militares/psicologia , Humanos
14.
BMJ ; 363: k5094, 2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30545967

RESUMO

OBJECTIVE: To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft. DESIGN: Randomized controlled trial. SETTING: Private or commercial aircraft between September 2017 and August 2018. PARTICIPANTS: 92 aircraft passengers aged 18 and over were screened for participation. 23 agreed to be enrolled and were randomized. INTERVENTION: Jumping from an aircraft (airplane or helicopter) with a parachute versus an empty backpack (unblinded). MAIN OUTCOME MEASURES: Composite of death or major traumatic injury (defined by an Injury Severity Score over 15) upon impact with the ground measured immediately after landing. RESULTS: Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001). CONCLUSIONS: Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.


Assuntos
Medicina Aeroespacial/métodos , Morte Súbita/prevenção & controle , Equipamentos de Proteção , Ferimentos e Lesões/prevenção & controle , Acidentes Aeronáuticos/prevenção & controle , Adulto , Aeronaves , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Senso de Humor e Humor como Assunto
15.
J Laryngol Otol ; 132(9): 790-795, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30232949

RESUMO

OBJECTIVE: The application of moisture to the ear is anecdotally claimed to relieve the pain from otic barotrauma that can arise during aircraft descent. This claim was tested in a randomised double-blind study on an aircraft with eight participants heavily predisposed to barotrauma. METHODS: On the outward flight, half the participants wore 'active' devices that applied moisture to the external ear; the remainder wore placebo devices that contained no moisture, but were otherwise identical. On the return flight, the groups were reversed. Participants wore the devices from just before descent until landing, unless they experienced symptoms of barotrauma, in which case they switched to what they knew was an active device. RESULTS: There were no significant differences between conditions regarding the appearance of the tympanic membrane on landing or the discomfort levels immediately before and after any switch. CONCLUSION: Applying moisture is ineffective for passengers heavily predisposed to otic barotrauma.


Assuntos
Barotrauma/epidemiologia , Orelha Média/lesões , Dor de Orelha/prevenção & controle , Membrana Timpânica/lesões , Testes de Impedância Acústica/métodos , Adulto , Medicina Aeroespacial/métodos , Viagem Aérea/estatística & dados numéricos , Barotrauma/tratamento farmacológico , Barotrauma/prevenção & controle , Método Duplo-Cego , Orelha Média/efeitos dos fármacos , Orelha Média/patologia , Dor de Orelha/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Placebos/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Membrana Timpânica/efeitos dos fármacos , Membrana Timpânica/patologia
16.
Ultrasound Med Biol ; 44(11): 2406-2412, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30093338

RESUMO

Echography is the most appropriate imaging modality for investigating astronauts. Unfortunately, it requires a great deal of training to perform ultrasound examinations, which can be difficult and time consuming, especially if the astronaut does not have a medical background. We designed a new echography system with motorized probes that allows for the majority of exam functions to be controlled by a ground-based sonographer. Using tele-operation, the sonographer controls the orientation of the transducer (tilt, rotation) and echograph settings (gain, depth, freeze) and triggers ultrasound functions (pulsed wave color Doppler, 3-D capture, radiofrequency data collection, elastography). With this system, astronauts are required to hold the motorized probe only at the locations indicated, with the remainder of the exam being conducted by the ground-based sonographer. During spaceflight, ultrasound imaging of the carotid artery, jugular vein, thyroid, liver, gallbladder, biliary tract and portal vein (2-D, 3-D, color, pulsed wave, radiofrequency) were successfully performed.


Assuntos
Medicina Aeroespacial/métodos , Astronautas , Telemedicina/instrumentação , Telemedicina/métodos , Transdutores , Ultrassonografia/instrumentação , Desenho de Equipamento , Humanos , Voo Espacial , Ultrassonografia/métodos
17.
Mil Med ; 183(11-12): e649-e658, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30124915

RESUMO

Introduction: The primary objective of this study was to describe the demographic, clinical, and attrition characteristics of active duty U.S. military service members who were aeromedically evacuated from Iraq and Afghanistan theaters with a psychiatric condition as the primary diagnosis. The study links the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) data with the Defense Manpower Data Center (DMDC) to conduct an examination of the long-term occupational impact of psychiatric aeromedical evacuations on military separations and discharges. Materials and Methods: Retrospective analyses were conducted on the demographic, clinical, and attrition information of active duty service members (N = 7,023) who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013 using TRAC2ES data. Additionally, TRAC2ES database was compared with DMDC data to analyze personal and service demographics, aeromedical evacuation information, and reasons for military separation with the entire 2013 active duty force. Chi-square tests of independence and standardized residuals were used to identify cells with observed frequencies or proportions significantly different than expected by chance. Additionally, OR were calculated to provide context about the nature of any significant relationships. Results: Compared with the active duty comparison sample, those with a psychiatric aeromedical evacuation tended to be younger, female, white, divorced or widowed, and less educated. They were also more likely to be junior enlisted service members in the Army serving in a Combat Arms military occupational specialty. The primary psychiatric conditions related to the aeromedical evacuation were depressive disorders (25%), adjustment disorders (18%), post-traumatic stress disorder (9%), bipolar disorders (6%), and anxiety disorders (6%). Approximately, 3% were evacuated for suicidal ideation and associated behaviors. Individuals who received a psychiatric aeromedical evacuation were almost four times as likely (53%) to have been subsequently separated from active duty at the time of the data analysis compared with other active duty service members (14%). The current study also found that peaks in the number of aeromedical evacuations coincided with significant combat operational events. These peaks almost always preceded or followed a significant operational event. An unexpected finding of the present study was that movement classification code was not predictive of subsequent reasons for separation from the military. Thus, the degree of clinical supervision and restraint of a service member during psychiatric aeromedical evacuation from deployment proved to be unrelated to subsequent service outcome. Conclusions: Psychiatric conditions are one of the leading reasons for the aeromedical evacuation of active duty military personnel from the military combat theater. For many active duty military personnel, a psychiatric aeromedical evacuation from a combat theater is the start of a military career-ending event that results in separation from active duty. This finding has important clinical and operational implications for the evaluation and treatment of psychiatric conditions during military deployments. Whenever possible, deployed military behavioral health providers should attempt to treat psychiatric patients in theater to help them remain in theater to complete their operational deployments. Improved understanding of the factors related to psychiatric aeromedical evacuations will provide important clinical and policy implications for future conflicts.


Assuntos
Medicina Aeroespacial/estatística & dados numéricos , Transtornos Mentais/terapia , Militares/estatística & dados numéricos , Guerra , Transtornos de Adaptação/epidemiologia , Transtornos de Adaptação/terapia , Adulto , Medicina Aeroespacial/métodos , Campanha Afegã de 2001- , Resgate Aéreo/estatística & dados numéricos , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/terapia , Distribuição de Qui-Quadrado , Depressão/epidemiologia , Depressão/terapia , Feminino , Humanos , Classificação Internacional de Doenças/tendências , Guerra do Iraque 2003-2011 , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Militares/psicologia , Sistemas de Identificação de Pacientes/métodos , Sistemas de Identificação de Pacientes/estatística & dados numéricos , Enfermagem Psiquiátrica/métodos , Enfermagem Psiquiátrica/estatística & dados numéricos , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Viagem/estatística & dados numéricos , Estados Unidos/epidemiologia
18.
J. vasc. bras ; 17(3)jul.-set. 2018. tab
Artigo em Português | LILACS | ID: biblio-916069

RESUMO

A aviação civil vem apresentando aumento progressivo do número de voos regulares nos últimos 10 anos e, em função disso, mais passageiros estão sendo transportados em viagens aéreas (VAs). Associado a isso, há um aumento das doenças relacionadas às VAs, especialmente naquelas de longa duração. Uma das complicações mais temidas dos voos é o tromboembolismo venoso (TEV), mas a sua real incidência é de difícil mensuração devido à falta de consenso sobre, por exemplo, quanto tempo após o pouso podemos considerar que o TEV possa estar relacionado à VA realizada ou mesmo quanto tempo de voo pode ser considerado como de longa duração. Muito tem se discutido sobre os mecanismos fisiopatológicos do TEV relacionado às VAs, quais passageiros são os de maior risco e quais medidas profiláticas podemos adotar com segurança e eficácia. O objetivo desta revisão é esclarecer esses pontos e as condutas consensuais atuais


Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. There has been much discussion of the pathophysiological mechanisms of flight-related VTE, of which passengers are at greatest risk, and of what prophylactic measures can be adopted safely and effectively. The purpose of this review is to clarify these points and describe current consensual conduct


Assuntos
Humanos , Masculino , Feminino , Viagem Aérea/tendências , Prevenção de Doenças , Tromboembolia Venosa/terapia , Trombose Venosa/terapia , Medicina Aeroespacial/métodos , Anticoagulantes , Heparina , Hipóxia/complicações , Incidência , Inibidores da Agregação de Plaquetas , Prevalência , Embolia Pulmonar/complicações , Revisão , Fatores de Risco
19.
J Spec Oper Med ; 18(2): 79-85, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29889961

RESUMO

BACKGROUND: Historically, documentation of prehospital combat casualty care has been relatively nonexistent. Without documentation, performance improvement of prehospital care and evacuation through data collection, consolidation, and scientific analyses cannot be adequately accomplished. During recent conflicts, prehospital documentation has received increased attention for point-of-injury care as well as for care provided en route on medical evacuation platforms. However, documentation on casualty evacuation (CASEVAC) platforms is still lacking. Thus, a CASEVAC dataset was developed and maintained by the 160th Special Operations Aviation Regiment (SOAR), a nonmedical, rotary-wing aviation unit, to evaluate and review CASEVAC missions conducted by their organization. METHODS: A retrospective review and descriptive analysis were performed on data from all documented CASEVAC missions conducted in Afghanistan by the 160th SOAR from January 2008 to May 2015. Documentation of care was originally performed in a narrative after-action review (AAR) format. Unclassified, nonpersonally identifiable data were extracted and transferred from these AARs into a database for detailed analysis. Data points included demographics, flight time, provider number and type, injury and outcome details, and medical interventions provided by ground forces and CASEVAC personnel. RESULTS: There were 227 patients transported during 129 CASEVAC missions conducted by the 160th SOAR. Three patients had unavailable data, four had unknown injuries or illnesses, and eight were military working dogs. Remaining were 207 trauma casualties (96%) and five medical patients (2%). The mean and median times of flight from the injury scene to hospital arrival were less than 20 minutes. Of trauma casualties, most were male US and coalition forces (n = 178; 86%). From this population, injuries to the extremities (n = 139; 67%) were seen most commonly. The primary mechanisms of injury were gunshot wound (n = 89; 43%) and blast injury (n = 82; 40%). The survival rate was 85% (n = 176) for those who incurred trauma. Of those who did not survive, most died before reaching surgical care (26 of 31; 84%). CONCLUSION: Performance improvement efforts directed toward prehospital combat casualty care can ameliorate survival on the battlefield. Because documentation of care is essential for conducting performance improvement, medical and nonmedical units must dedicate time and efforts accordingly. Capturing and analyzing data from combat missions can help refine tactics, techniques, and procedures and more accurately define wartime personnel, training, and equipment requirements. This study is an example of how performance improvement can be initiated by a nonmedical unit conducting CASEVAC missions.


Assuntos
Medicina Aeroespacial , Campanha Afegã de 2001- , Resgate Aéreo/estatística & dados numéricos , Militares , Ferimentos e Lesões/epidemiologia , Adulto , Medicina Aeroespacial/métodos , Medicina Aeroespacial/estatística & dados numéricos , Animais , Criança , Cães , Feminino , Humanos , Masculino , Medicina Militar , Estudos Retrospectivos , Transporte de Pacientes/estatística & dados numéricos , Ferimentos e Lesões/terapia , Ferimentos e Lesões/veterinária
20.
Resuscitation ; 130: 41-43, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29883678

RESUMO

INTRODUCTION: Modern automated external defibrillators (AEDs) are designed to prevent shock delivery when excessive motion produces rhythm disturbances mimicking ventricular fibrillation (VF). This has been reported as a safety issue in airline operations, where turbulent motion is commonplace. We aimed to evaluate whether all seven AEDs can deliver shock appropriately in a flight simulator under turbulent conditions. METHODS: The study was performed in a Boeing 747-400 full motion flight simulator in Hong Kong. An advanced life support manikin and arrhythmia generator were used to produce sinus rhythm (SR), asystole, and five amplitudes of VF, with a programmed change to SR in the event of an effective shock being delivered. All rhythms were tested at rest (no turbulence) and at four levels of motion (ground taxi vibration, and mild, moderate and severe in-flight turbulence). Success was defined as: 1. effective shock being delivered where the rhythm was VF successfully converted to SR; 2. no inappropriate shock being delivered for asystole or SR. RESULTS: Five AEDs produced acceptable results at all levels of turbulence. Another was satisfactory for VF except at very fine amplitudes. One model was deemed unsatisfactory for in-flight use as its motion detector inhibited shocks at all levels of turbulence. CONCLUSION: Some AEDs designed primarily for ground use may not perform well under turbulent in-flight conditions. AEDs for possible in-flight or other non-terrestrial use should be fully evaluated by manufacturers or end-users before introduction to service.


Assuntos
Desfibriladores , Cardioversão Elétrica , Fibrilação Ventricular/prevenção & controle , Medicina Aeroespacial/métodos , Aeronaves , Desfibriladores/efeitos adversos , Desfibriladores/normas , Cardioversão Elétrica/métodos , Cardioversão Elétrica/normas , Humanos , Manequins , Teste de Materiais/métodos , Projetos de Pesquisa
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