Accuracy and Similarity of Team Situation Awareness in Simulated Air Combat.

BACKGROUND: Fighter pilots' Team Situation Awareness (TSA) has been studied from the perspective of TSA accuracy, which represents how closely the pilots' collective knowledge is aligned with the real world. When TSA accuracy is low, the pilots can have similarly or dissimilarly inaccurate SA. The concept of TSA similarity represents the similarity of team members' collective knowledge. This paper investigates how TSA accuracy and similarity of F/A-18 pilots are associated with performance.METHOD: Data were extracted from simulated air combat missions. Performance and TSA were investigated in 58 engagements. The accuracy and similarity of pilots' SA were elicited and performance was evaluated. TSA accuracy and similarity were analyzed with respect to the flights' performance, and the independent variables were events in which the flights initiated engagements with enemy aircraft versus events in which the flights were engaged by enemy aircraft.RESULTS: With the mentioned events as the main effect, there were statistically significant differences at all levels of TSA accuracy and similarity. With performance as the main effect, there were also significant differences at all levels of TSA accuracy and similarity. TSA accuracy and similarity were superior in offensive engagements and when engagements were successful.DISCUSSION: The main contribution of this paper is the extension of the concept of TSA similarity to air combat: both TSA similarity and accuracy were higher when the flight was engaging the enemy aircraft, compared to situations when the flight itself was being engaged. The results also suggest that low TSA accuracy and similarity have a statistically significantly negative impact on the flights' performance.Mansikka H, Harris D, Virtanen K. Accuracy and similarity of team situation awareness in simulated air combat. Aerosp Med Hum Perform. 2023; 94(6):429-436.

Pilots' Spatial Visualization Ability Assessment Based on Virtual Reality.

BACKGROUND: The aim of this study was to investigate the effectiveness of the mental rotation test (MRT) based on virtual reality (VR) in predicting pilots' spatial visualization ability (SVA).METHODS: Based on VR, 118 healthy pilots' SVA were evaluated by MRT. The pilot flight ability evaluation scale was used as the criterion of test validity. According to the scale score, pilots were divided into high, middle, or low spatial ability groups pursuant to the 27% allocation principle. Differences in reaction time (RT), correct rate (CR), and correct number per second (CNPS) of MRT between groups were compared. Correlations between scale scores and MRT scores were analyzed. RT, CR, and CNPS of MRT among different age groups and between genders were also compared.RESULTS: The RT of the high spatial ability group was remarkably slower than that of the low spatial ability group (363.4 ± 140.2 s, 458.1 ± 151.7 s). The CNPS of the high spatial ability group was dramatically higher than that of the low spatial ability group (0.111 ± 0.045 s, 0.086 ± 0.001 s). There were no significant differences in RT, CR, and CNPS between different genders. Pilots in the 29-35 yr old age group had considerably slower RT than those in the 22-28 yr old age group (330.8 ± 140.3 s, 417.2 ± 132.7 s). Pilots in the 29-35 yr old age group had conspicuously higher CNPS than pilots in the 22-28 yr old age group (0.119 ± 0.040 s, 0.096 ± 0.036 s). All pilots' scale scores were positively correlated with CNPS (r = 0.254) and negatively correlated with RT (r = -0.234).DISCUSSION: MRT based on VR has a good discrimination efficacy for SVA of pilots and is a good indicator for the SVA component measurement.Zhang M, Wang M, Feng H, Liu X, Zhai L, Xu X, Jin Z. Pilots' spatial visualization ability assessment based on virtual reality. Aerosp Med Hum Perform. 2023; 94(6):422-428.

Noise-induced hearing loss profile among Taiwan Airforce on duty pilots.

PURPOSE: Noise-induced hearing loss (NIHL) often results in impaired functional hearing and accidental injuries; thus, reducing military performance and endangering flight safety. While a few studies addressing laterality (left-right ear differences) and NIHL incidence between fixed-winged (jet-fighter) and rotary-wing (helicopter) aircrafts yielded inconsistent results, little is known about the NIHL profile among different types of jet-fighter pilots. This study aims to conduct a fine-grained examination of NIHL among Airforce jet pilots, with planned comparisons of laterality and aircraft type, along with the goal to compare the sensitivity of different hearing indices in predicting military pilot NIHL. MATERIALS AND METHODS: This cross-sectional study utilizes the health and hearing data of 1025 Taiwanese Air Force Military pilots from the 2019 Taiwanese physical examination database to assess the changes in their hearing thresholds, and evaluate their risk for NIHL. RESULTS: Our results showed that, among available military aircraft types, the trainer aircraft and M2000-5 jet-fighter had the highest risk of NIHL, in addition to a left ear inferiority found in the overall population of military pilots. Among the three hearing indices used in this study -the International Organization for Standardization (ISO) three-point hearing index, the Occupational Safety and Health Administration (OSHA) three-point hearing index, and the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) high-frequency three-point hearing index-, the OSHA the AAO-HNS were the most sensitive. CONCLUSION: Our results suggest a better noise protection for trainer and M2000-5 pilots, especially for the left ear, is warranted.

AI co-pilot: content-based image retrieval for the reading of rare diseases in chest CT.

The aim of the study was to evaluate the impact of the newly developed Similar patient search (SPS) Web Service, which supports reading complex lung diseases in computed tomography (CT), on the diagnostic accuracy of residents. SPS is an image-based search engine for pre-diagnosed cases along with related clinical reference content ( https://eref.thieme.de ). The reference database was constructed using 13,658 annotated regions of interest (ROIs) from 621 patients, comprising 69 lung diseases. For validation, 50 CT scans were evaluated by five radiology residents without SPS, and three months later with SPS. The residents could give a maximum of three diagnoses per case. A maximum of 3 points was achieved if the correct diagnosis without any additional diagnoses was provided. The residents achieved an average score of 17.6 ± 5.0 points without SPS. By using SPS, the residents increased their score by 81.8% to 32.0 ± 9.5 points. The improvement of the score per case was highly significant (p = 0.0001). The residents required an average of 205.9 ± 350.6 s per case (21.9% increase) when SPS was used. However, in the second half of the cases, after the residents became more familiar with SPS, this increase dropped to 7%. Residents' average score in reading complex chest CT scans improved by 81.8% when the AI-driven SPS with integrated clinical reference content was used. The increase in time per case due to the use of the SPS was minimal.

Traducción y adaptación transcultural de la escala AS-20 para medir la calidad de vida en adultos con estrabismo en Colombia, prueba piloto / Translation and transcultural adaptation of the AS-20 scale to measure quality of life in adults with strabismus in Colombia, a pilot study

Antecedentes El estrabismo genera un impacto psicosocial negativo en los pacientes adultos, afectando aspectos como la autopercepción y la calidad de vida. No existe en Colombia una escala que permita medir dicho impacto. Objetivo Realizar la traducción y adaptación transcultural del instrumento AS-20 al español colombiano, para medición de la calidad de vida en pacientes adultos con estrabismo en Colombia. Materiales y métodos Prueba piloto de un estudio de corte transversal de traducción, traducción inversa y adaptación del instrumento de medición tipo escala de calidad de vida AS-20 de su idioma original en pacientes adultos con estrabismo en Bogotá, Colombia. Resultados Dieciséis pacientes fueron evaluados. El rango de edad fue entre 18 y 68 años, con un promedio de 41 años. La escala fue respondida en una media de tiempo de 10,62min. Se reportó dificultad en 3 individuos para la comprensión de 2 ítems (preguntas 8 y 14), los cuales se ajustaron, resolviendo la dificultad. Conclusión Se realizó la traducción y prueba piloto de la escala AS-20 a español colombiano identificando y corrigiendo los problemas de traducción en la prueba. Este es el primer paso del proceso de adaptación transcultural. Con base en los resultados, la validación y adaptación transcultural se puede finalizar en un próximo estudio (AU)

Background Strabismus generates a negative psychosocial impact on adult patients, affecting aspects such as self-perception and quality of life. There is no scale in Colombian Spanish that measures these impacts. Objective To carry out the translation and cross-cultural adaptation of the AS-20 instrument into Colombian Spanish, for measuring the quality of life in adult patients with strabismus in Colombia. Materials and methods Pilot test of a cross-sectional study for the translation, reverse translation, and cross-cultural adaptation of the AS-20 instrument from its original language, English, to Colombian Spanish, in adult patients with strabismus in Bogotá, Colombia. Results Sixteen patients were assessed. The age range was between 18 and 68 years with a mean age of 41 years. The scale was answered in an average time of 10.62min. Difficulty was reported in 3 individuals for understanding 2 items (questions 8 and 14), which were resolved. Conclusion The translation and pilot test of AS-20 scale into Colombian Spanish was carried out, identifying and solving translational difficulties. It is the first step in the cross-cultural adaptation process. Based on the results, the validation and cross-cultural adaptation can be completed in a future study (AU)

Test Pilot and Airline Pilot Differences in Facing Unexpected Events.

BACKGROUND: Unexpected events in flight might decrease the transparency of the flying process and weaken the pilot's perception of the current state, or even erode manipulating skills. However, during the flight test of a new or modified aircraft, to verify the boundaries of aircraft aerodynamic performance and handling stability, unexpected events may be encountered that need to be handled by the test pilot. Therefore, studying the differences between test pilots and airline pilots could help improve flight safety.METHODS: Two kinds of physiological parameters, eye blink rate and average fixation duration and task-related performance of test pilots and airline pilots, were analyzed in three abnormal scenarios. A total of 16 pilots participated. The study was carried out in an A320 flight simulator.RESULTS: The differences were significant for both test pilots and airline pilots in eye blink rate and average fixation duration. Furthermore, the reaction time of test pilots (Mean = 23.38 s) was significantly shorter than airline pilots (Mean = 42.63 s) in Unreliable Airspeed condition, and the pitch angle deviations between them were significant in both Wind Shear and Unreliable Airspeed condition.DISCUSSION: The uncertainty of environmental change could create more severe pressure and mental workload influence than actual system failure. For airline pilots, compared with test pilots, the importance of practicing manual flight should still be emphasized. Improving reactions to unexpected ambient conditions and unannounced fault status could also contribute to flight safety.Zheng Y, Lu Y, Jie Y, Zhao Z, Fu S. Test pilot and airline pilot differences in facing unexpected events. Aerosp Med Hum Perform. 2023; 94(1):18-24.

Using machine learning methods and EEG to discriminate aircraft pilot cognitive workload during flight.

Pilots of aircraft face varying degrees of cognitive workload even during normal flight operations. Periods of low cognitive workload may be followed by periods of high cognitive workload and vice versa. During such changing demands, there exists potential for increased error on behalf of the pilots due to periods of boredom or excessive cognitive task demand. To further understand cognitive workload in aviation, the present study involved collection of electroencephalogram (EEG) data from ten (10) collegiate aviation students in a live-flight environment in a single-engine aircraft. Each pilot possessed a Federal Aviation Administration (FAA) commercial pilot certificate and either FAA class I or class II medical certificate. Each pilot flew a standardized flight profile representing an average instrument flight training sequence. For data analysis, we used four main sub-bands of the recorded EEG signals: delta, theta, alpha, and beta. Power spectral density (PSD) and log energy entropy of each sub-band across 20 electrodes were computed and subjected to two feature selection algorithms (recursive feature elimination (RFE) and lasso cross-validation (LassoCV), and a stacking ensemble machine learning algorithm composed of support vector machine, random forest, and logistic regression. Also, hyperparameter optimization and tenfold cross-validation were used to improve the model performance, reliability, and generalization. The feature selection step resulted in 15 features that can be considered an indicator of pilots' cognitive workload states. Then these features were applied to the stacking ensemble algorithm, and the highest results were achieved using the selected features by the RFE algorithm with an accuracy of 91.67% (± 0.11), a precision of 93.89% (± 0.09), recall of 91.67% (± 0.11), F-score of 91.22% (± 0.12), and the mean ROC-AUC of 0.93 (± 0.06). The achieved results indicated that the combination of PSD and log energy entropy, along with well-designed machine learning algorithms, suggest the potential for the use of EEG to discriminate periods of the low, medium, and high workload to augment aircraft system design, including flight automation features to improve aviation safety.

Pilot fatigue survey: A study of the mutual influence among fatigue factors in the "work" dimension.

Background: Fatigue risk management for pilots has received increasing attention. The existing fatigue management systems have detailed descriptions of the factors and the mutual influences among the factors that affect the dimension of "sleep", which is one of the most important causes of fatigue. However, the analysis of the influencing factors of the "work" dimension of fatigue causes has not been very detailed or accurate, especially the exploration of the mutual influence among many fatigue-influencing factors in the "work" dimension. Objective: The purpose of this study was to explore the mutual influence among fatigue-influencing factors related to the "work" dimension in the analysis of pilot fatigue causes. Methods: This study designed a questionnaire on the dimension of "work" in the causes of pilot fatigue and collected a total of 270 feedback data points from international flight pilots. Based on the questionnaires and data, descriptive statistical analysis, exploratory factor analysis and confirmatory factor analysis were performed to explore the influencing factors and their mutual influences on the "work" dimension of pilot fatigue. Results: There is a strong, mutual influence relationship among the fatigue causes of long-haul flight pilots - working status, working conditions and working schedules - in the dimension of "work". The workload only has a strong correlation with the working schedule, and the interaction relationships with the working status or working conditions are weak. Conclusion: This study analyses the mutual influence among the influencing factors of the "work" dimension of pilot fatigue, and we expect to provide empirical data for pilot fatigue risk management and to help improve fatigue risk management systems.

Temporary Incapacitation Rates and Permanent Loss of Medical License in Commercial Airline Pilots.

INTRODUCTION: The purpose of this study was to report the temporary loss of medical license and pilot incapacitations in the United Arab Emirates from 2018-2021.METHOD: The General Civil Aviation Authority database was searched for all reported temporary suspensions of license between 2018-2021 and the ICD-10 codes were extracted.RESULTS: A total of 1233 incapacitations was reported with a mean license suspension of 148.4 ± 276.8 d. The mean days of suspension for the various medical specialties were 115.2 ± 188.4 for musculoskeletal conditions (N = 392), 189.3 ± 324.8 for medicine (N = 335), 101.6 ± 231.4 for surgery, 109.4 ± 223.5 for urology (N = 93), 90.3 ± 128.7 for ophthalmology (N = 68), 385.6 ± 594.3 for psychiatry (N = 61), 150.4+285.9 for ENT (N = 59), 419.4 ± 382.6 for obstetrics and gynecology (N = 30), and 44.9+39 for dermatology (N = 21). Permanent suspensions were as follows: total N = 100 (8.1%), musculoskeletal N = 13 (3.3%), medicine N = 37 (11%), surgery N = 10 (5.7%), urology N = 10 (10.7%), ophthalmology N = 2 (2.9%), psychiatry N = 20 (32.8%), ENT N = 1 (1.7%), obstetrics and gynecology N = 4 (13.1%), and dermatology N = 3 (14.3%).DISCUSSION: Musculoskeletal conditions are the most common reason for temporary loss of medical license followed by medical and surgical conditions. The least common reason was dermatological conditions. The longest period of incapacitation was associated with psychiatric conditions followed by medical and ENT conditions. The annual calculated temporary incapacitation rate was 2.8% and the permanent suspension rate was 0.25%.Hohmann E, Pieterse R. Temporary incapacitation rates and permanent loss of medical license in commercial airline pilots. Aerosp Med Hum Perform. 2023; 94(3):113-121.

Design and Evaluation of Personalized Services to Foster Active Aging: The Experience of Technology Pre-Validation in Italian Pilots.

Assistive devices could promote independent living and support the active and healthy aging of an older population; however, several factors can badly influence the long-term use of new technologies. In this context, this paper presents a two-step methodology called "pre-validation" that aims to identify the factors that can bias the use of new services, thus minimizing the risk of an unsuccessful longer trial. The proposed pre-validation methodology is composed of two main phases that aim to assess the usability and the reliability of the technology assessed in a laboratory environment and the usability, acceptability, user experience, and reliability of the technology in real environments. The tested services include the socialization scenario, in which older adults are better connected to the community via technological solutions (i.e., socialization applications), and the monitoring scenario, which allows for the introduction of timely interventions (technologies involved include environmental monitoring sensors, a telepresence robot, wearable sensors, and a personalized dashboard). The obtained results underline an acceptable usability level (average System Usability Scale score > 65) for the tested technologies (i.e., socialization applications and a telepresence robot). Phase Two also underlines the good acceptability, user experience, and usability of the tested services. The statistical analysis underlines a correlation between the stress related to the use of technology, digital skills, and intention of use, among other factors. Qualitative feedback also remarks on a correlation between older adults with low digital skills and an anxiety about using technology. Positive correlation indexes were highlighted between the trust and usability scores. Eventually, future long-term trials with assistive technology should rely on motivated caregivers, be founded on a strong recruitment process, and should reassure older adults­especially the ones with low digital literacy­about the use of technology by proposing personalized training and mentoring, if necessary, to increase the trust.

PRESBYOND Laser Blended Vision LASIK in Commercial and Military Pilots Requiring Class 1 Medical Certification.

PURPOSE: To report the outcomes of PRESBYOND Laser Blended Vision LASIK (Carl Zeiss Meditec AG) in presbyopic commercial and military pilots requiring Class 1 aeromedical certification. METHODS: This was a retrospective study of 23 consecutive pilots who underwent PRESBYOND Laser Blended Vision LASIK. Postoperative visits were conducted at 1 day and 1, 3, and 12 months. Standard outcomes analysis was performed using the data at 12 months. Objective quality of vision measures including mesopic contrast sensitivity (CSV-1000; VectorVision), Ocular Scatter Index (HD Analyzer; Keeler), and straylight (C-Quant; Oculus Optikgeräte GmbH) were determined before and 3 months after surgery. A questionnaire to assess the functional vision of pilots before and after surgery was derived to record subjective outcomes. RESULTS: Of the 23 pilots treated, data were available at 12 months for 22 pilots (95.7%) and at 3 months for 1 pilot (4.3%). Median age was 55 years (range: 42 to 65 years). At 12 months, binocular uncorrected distance visual acuity was 20/20 or better in 100% and 20/16 or better in 52% of pilots. Binocular uncorrected intermediate visual acuity was J3 in 73%, J5 in 95%, and J10 in 100% of pilots. Binocular uncorrected near visual acuity was J1 or better in 78% and J2 or better in 100% of pilots. Mean postoperative spherical equivalent refraction relative to the target was -0.04 ± 0.34 diopters (D) (range: -0.63 to +0.63 D), with 93% within ±0.50 D. There was a statistically significant increase in contrast sensitivity at 3, 6, 12, and 18 cpd. C-Quant straylight was 1.07 ± 0.16 before surgery and 1.06 ± 0.16 at 1 to 3 months after surgery (P = .705). All pilots achieved Class 1 medical certification from the United Kingdom Civil Aviation Authority and resumed flying. All pilots reported improved functionality compared to the previous vision correction method. CONCLUSIONS: PRESBYOND Laser Blended Vision LASIK enabled presbyopic commercial pilots to continue to fly without the need for glasses. With consideration of the visually challenging cockpit environment, PRESBYOND Laser Blended Vision LASIK provides clear continuous vision for tasks at near, intermediate, and far distance. Class 1 pilots reported a subjective improvement in visual tasks and comfort following surgery. [J Refract Surg. 2023;39(1):6-14.].

Not just passengers, but co-pilots! Non-rhizobial nodule-associated bacteria promote cowpea growth and symbiosis with (brady)rhizobia.

AIMS: To isolate and characterize non-rhizobial nodule-associated bacteria (NAB) from cowpea root-nodules regarding their performance of plant-growth-promoting mechanisms and their ability to enhance cowpea growth and symbiosis when co-inoculated with bradyrhizobia. METHODS AND RESULTS: Sixteen NAB were isolated, identified, and in vitro evaluated for plant growth promotion traits. The ability to promote cowpea growth was analyzed when co-inoculated with Bradyrhizobium pachyrhizi BR 3262 in sterile and non-sterile substrates. The 16S rRNA gene sequences analysis revealed that NAB belonged to the genera Chryseobacterium (4), Bacillus (3), Microbacterium (3), Agrobacterium (1), Escherichia (1), Delftia (1), Pelomonas (1), Sphingomonas (1), and Staphylococcus (1). All strains produced different amounts of auxin siderophores and formed biofilms. Twelve out of the 16 strains carried the nifH, a gene associated with nitrogen fixation. Co-inoculation of NAB (ESA 424 and ESA 29) with Bradyrhizobium pachyrhizi BR 3262 significantly promoted cowpea growth, especially after simultaneous inoculation with the three strains. CONCLUSIONS: NAB are efficient cowpea growth promoters and can improve the efficiency of the symbiosis between cowpea and the N2-fixing microsymbiont B. pachyrhizi BR 3262, mainly under a specific triple microbial association.

Effects of delayed weather radar images on pilots' spatial awareness.

Data-linked Next Generation Weather Radar (NEXRAD) images can be delayed up to 20 min in the cockpit. Pilots' underappreciating or ignoring the time delay may be the major cause of two fatal accidents. No studies have connected spatial awareness with accidents. This study evaluated how delayed radar information affects the spatial awareness of pilots at three levels of analysis. Thirty-one student pilots and flight instructors completed three sequential estimation tasks (i.e., the current location of storms, the current relative distance to storms, and the future relative distance to storms). Fifty-four weather scenarios were developed for three factors (storm speeds, delays, displays) and presented to pilots. The results indicated that delays and the storm speed significantly affected the three levels of spatial awareness. Participants' estimation accuracy was the lowest under long delay and fast speed in the current location estimation, under medium delay and speed in the current distance estimation, and under short delay and slow speed in the future distance estimation. Spatial awareness could be high under the long delay and fast speed conditions if pilots had no time limits. Thus, pilots can process 20-min delayed radar information. However, there were no differences in estimation accuracy between the static and animation displays in any of the conditions. Well-designed features on displays, such as scale or distance measuring tools, can aid pilots' spatial estimation and support all levels of spatial awareness.

Cognitive Outcomes in the Pragmatic Investigation of optimaL Oxygen Targets (CO-PILOT) trial: protocol and statistical analysis plan.

INTRODUCTION: Long-term cognitive impairment is one of the most common complications of critical illness among survivors who receive mechanical ventilation. Recommended oxygen targets during mechanical ventilation vary among international guidelines. Different oxygen targets during mechanical ventilation have the potential to alter long-term cognitive function due to cerebral hypoxemia or hyperoxemia. Whether higher, intermediate or lower SpO2 targets are associated with better cognitive function at 12-month follow-up is unknown. METHODS AND ANALYSIS: The Pragmatic Investigation of optimaL Oxygen Targets (PILOT) trial is an ongoing pragmatic, cluster-randomised, cluster-crossover trial comparing the effect of a higher SpO2 target (target 98%, goal range 96%-100%), an intermediate SpO2 target (target 94%, goal range 92%-96%) and a lower SpO2 target (target 90%, goal range 88%-92%) on clinical outcomes in mechanically ventilated patients admitted to the medical intensive care unit at a single centre in the USA. For this ancillary study of long-term Cognitive Outcomes (CO-PILOT), survivors of critical illness who are in the PILOT trial and who do not meet exclusion criteria for CO-PILOT are approached for consent. The anticipated number of patients for whom assessment of long-term cognition will be performed in CO-PILOT is 612 patients over 36 months of enrolment. Cognitive, functional and quality of life assessments are assessed via telephone interview at approximately 12 months after enrolment in PILOT. The primary outcome of CO-PILOT is the telephone version of the Montreal Cognitive Assessment. A subset of patients will also complete a comprehensive neuropsychological telephone battery to better characterise the cognitive domains affected. ETHICS AND DISSEMINATION: The CO-PILOT ancillary study was approved by the Vanderbilt Institutional Review Board. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.

Innovating Student Registered Nurse Anesthetist Clinical Learning Through United States Air Force Pilot Training Practices: A Review of the Literature.

The clinical learning environment is essential for student registered nurse anesthetists (SRNAs) to develop intricate clinical knowledge and acquire proficiency in technical skills required for anesthetic care. The perioperative experience of an SRNA can differ greatly based on the program, preceptor, hospital rotation, or geographic location. This literature review synthesizes the historical and current state of certified registered nurse anesthetist (CRNA)/SRNA preceptorship in the clinical setting. Themes analyzed include the current CRNA/SRNA learning and teaching environment, student perceptions of effective CRNA preceptors, evaluation tools and feedback practices, and overall CRNA preceptor preparedness as well as the availability and effectiveness of preceptor training programs. We compare their findings to best practices seen in the United States Air Force (USAF) pilot training program because of its similar "high stakes" learning environment and utilization of a preceptor teaching model. Actionable recommendations, based on CRNA preceptorship data, preceptorship theory, and the USAF pilot training model are presented in the effort to improve preceptor transfer of knowledge and SRNA clinical competence.

Pilot Mental Health, Methodologies, and Findings: A Systematic Review.

INTRODUCTION: Pilots' mental health has received increased attention following Germanwings Flight 9525 in 2015, where the copilot intentionally crashed the aircraft into the French Alps, killing all on board. An investigation of this incident found that the pilot had a depressive disorder.METHODS: This systematic review investigated peer reviewed studies of pilot mental health published since 1980. A total of 58 papers were identified.RESULTS: Two main methodologies have been employed: questionnaires and database record searches. Anxiety, depression, and suicide were the most commonly investigated mental health conditions. There were almost an equal number of studies that found a higher prevalence of psychological symptoms in pilots as those that found a lower prevalence, relative to controls or the general population. Prevalence rates were higher in studies relying solely on questionnaires than in studies employing database record searches.DISCUSSION: Prevalence estimates are closely associated with methodology, so it is difficult to determine the true rate. Factors that might account for low prevalence estimates include under-reporting of symptoms by pilots and a reluctance to diagnose on the part of health professionals. Factors that might account for high prevalence estimates include anonymous assessment, the use of questionnaires that do not align with clinical disorders, and inconsistent cut-off scores. It is recommended that future studies on prevalence use well-validated clinical measures, and that more research be conducted on the effects of particular disorders on job performance.Ackland CA, Molesworth BRC, Grisham JR, Lovibond PF. Pilot mental health, methodologies, and findings: a systematic review. Aerosp Med Hum Perform. 2022; 93(9): 696-708.

A New Method for Combined Hyperventilation and Hypoxia Training in a Tactical Fighter Simulator.

INTRODUCTION: Physiological episodes are an issue in military aviation. Some non-pressure-related in-flight symptoms are proved to be due to hyperventilation rather than hypoxia. The aim of this study was to validate a new training method provoking hyperventilation during normobaric hypoxia (NH) training in an F/A-18 Hornet simulator.METHODS: In a double-blind setting, 26 fighter pilots from the Finnish Air Force performed 2 setups in a WTSAT simulator in randomized order with full flight gear. Without the pilot's knowledge, 6% O2 in nitrogen or 6% O2 + 4% CO2 in nitrogen was turned on. Ventilation (VE) was measured before, during, and after hypoxia. Spo2 and ECG were monitored and symptoms documented. The subjects performed a tactical identification flight until they recognized symptoms of hypoxia. Thereafter, they performed hypoxia emergency procedures with 100% O2 and returned to the base with a GPS malfunction and executed an instrument landing system (ILS) approach with the waterline HUD mode evaluated by the flight instructor on a scale of 1 to 5.RESULTS: Ventilation increased during normobaric hypoxia (NH) from 12 L · min-1 to 19 L · min-1 at Spo2 75% with 6% O2, and from 12 L · min-1 to 26 L · min-1 at Spo2 77% with 6% O2 + 4% CO2. ILS flight performance was similar 10 min after combined hyperventilation and hypoxia (3.1 with 6% O2 + 4% CO2 and 3.2 with 6% O2). No adverse effects were reported during the 24-h follow-up.DISCUSSION: Hyperventilation-provoking normobaric hypoxia training is a new and well-tolerated method to meet NATO Standardization Agreement hypoxia training requirements.Leinonen AM, Varis NO, Kokki HJ, Leino TK. A new method for combined hyperventilation and hypoxia training in a tactical fighter simulator. Aerosp Med Hum Perform. 2022; 93(9):681-687.

[Analysis of the stressors and mental status of civil aviation pilots under the background of the major infectious disease].

Objective: To study the stressors and mental status of civil aviation pilots under the background of major infectious disease. Methods: From January to March 2021, a cluster sampling method was used to select 143 airline pilots in service as the research objects. The self-made emotion and stress source questionnaire, Chinese version of stress perception scale (CPSS) , self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) were used to investigate the airline pilot population. 136 valid questionnaires were collected, with an effective recovery rate of 95.1%. The measurement data conform to the normal distribution and are expressed by (x±s) . T-test and analysis of variance are used for comparison between groups, and Pearson correlation is used for correlation analysis. The data that do not conform to the normal distribution are expressed by the median and quartile [M (Q(1), Q(3)) ], and the non parametric test is used for the comparison between groups. Multiple linear stepwise regression was used to analyze the influencing factors of pressure perception. In addition, Amos 23.0 software was used to construct structural equation models of stress perception and negative emotions. Results: Under the background of the epidemic, the main sources of stress for civil aviation pilots are: the risk of possible reduction in income, the risk of contracting COVID-19, the pressure at work, and the risk of possible slow progress of upgrading. Among them, the first co pilot was more worried about the possible reduction of income than the instructor (P=0.009) ; The first co pilot and the captain of the airline were more worried about the possible slowdown of the upgrade progress than the instructor (P<0.001, P=0.014) . The mean pressure perception of pilots was higher than that of Chinese norm (t=3.11, P=0.002) . The standard scores of anxiety and depression were slightly higher than the standard scores of the Chinese norm under the non epidemic situation (t=7.00, 4.07, all P<0.001) . The results of multiple linear stepwise regression analysis showed that stress perception was negatively correlated with good family relations (t=-8.50, P=0.000) , and positively correlated with worries about slow progress of upgrading, COVID-19 infection, lack of interpersonal communication and income reduction (t=3.31、3.86、2.88、2.06, P<0.05) . Pressure perception was positively correlated with negative emotion (all P<0.001) . The results of structural equation model show that stress perception affects pilots' negative emotions directly or indirectly, and its standardized total effects on anxiety, depression, hypochondriac, fear, compulsion and irritability are 0.719, 0.811, 0.403, 0.355, 0.295 and 0.244 respectively. Conclusion: Public health emergencies have an impact on the mental status of pilots. Should pay attention to the stressors and psychological conditions of pilots in time, and consider formulating measures to relieve the stress of pilots.

The Evaluation of Traumatic Brain Injury: A Call to Action.

INTRODUCTION: The flying status of commercial pilots with traumatic brain injury should not be based solely upon physical examination and imaging. Weaknesses exist in all neurocognitive assessment as the relationship of results to real-world performance, in this case piloting an airplane, can be best described as moderate. There is the possibility that a pilot's ability to fly safely might be better evaluated by check rides with an instructor pilot in flight and in simulators. Research in this area is needed.Hastings J. The evaluation of traumatic brain injury: a call to action. Aerosp Med Hum Perform. 2022; 93(10):758-759.

Subjective Effects of Modafinil in Military Fighter Pilots During Deployment.

INTRODUCTION: Fatigue has negative effects on flight safety, especially in military aviation, where missions are often performed under challenging conditions. Modafinil is a relatively new pharmaceutical able to counter the symptoms of fatigue, but efficacy has not yet been studied in operational military aviation. This study aims to establish effectiveness and safety of modafinil in military operations.METHODS: This field study was conducted during deployment in the Middle East by the Royal Netherlands Air Force fighter pilots. Prior to use operationally, pilots had to complete a 24-h ground test in which modafinil was administered during a nonflying period using a questionnaire to screen for duty-relevant side effects. If no side effects were reported, operational usage was allowed. In addition to registration of modafinil's effects, relevant data prior to and after administration were recorded, including caffeine consumption and sleep afterwards.RESULTS: Of the 75 pilots who completed ground testing, only one experienced duty-relevant side effects. Modafinil was used in 192 operational flights, mostly during night-time. In 128 (67%) of the flights, modafinil was used preventively, in 64 (33%) because of fatigue. In 182 (95%) of the flights, positive effects of modafinil were reported, with a maximum effect 2-3 h after administration. There was no statistical correlation between modafinil's beneficial effects and prior administration of caffeine or sleep medication, nor was sleep afterwards negatively affected.DISCUSSION: This study indicates modafinil is a suitable pharmaceutical countermeasure to minimize the effects of fatigue during real-life fighter operations, without signs of negative impact on flight safety or sleep quality afterwards.Wingelaar-Jagt YQ, Wingelaar TT, Riedel WJ, Ramaekers JG. Subjective effects of modafinil in military fighter pilots during deployment. Aerosp Med Hum Perform. 2022; 93(10):739-745.