Aerospace medicine and human performance最新文献

Introduction: A suite of human health and performance metrics can be used to provide a holistic cognitive, physical, and emotional view of an individual and assess how well they are integrated with the overall system during spaceflight missions. The combination of such individual metrics as defined here is notionally termed "crewmember operational state."

Methods: This work identifies and defines the contributing components that comprise the proposed crewmember operational state.

Results: Considerations of how to measure the components in a spaceflight environment are summarized and the steps required to analyze and integrate these measurements into an operational framework are outlined. Use of the measurements and integration steps are then extended into several applications relevant to human spaceflight mission design and operations.

Discussion: For the framework and applications defined here to become operationally feasible, several limitations and gaps that remain to be addressed are presented with recommended future research and enabling technology advancement needs. Zero M, Klaus D, Arquilla K, Fanchiang C. Defining and measuring crewmember operational state for spaceflight operations. Aerosp Med Hum Perform. 2024; 95(12):919-929.

Background: Swimming-induced pulmonary edema (SIPE), also called immersion pulmonary edema, is a form of exertional pulmonary edema associated with swimming and/or water immersion without aspiration. Most case reports on SIPE feature young, healthy patients who were scuba-diving, surface swimming, snorkeling, or breath-hold diving before experiencing symptoms of dyspnea, chest pain/tightness, cough, and hemoptysis. The incidence of SIPE is thought to be between 0.4-5%. Although symptoms typically resolve with oxygenation and ventilation, SIPE can be fatal, making recognition of SIPE crucial, especially for operational medical providers overseeing water training events and exercises.

Case report: A 28-yr-old healthy man began experiencing severe shortness of breath during early morning pool training. Oxygen saturation was in the low 80s and the patient was put on 15-L supplemental oxygen via nonrebreathing mask. Rales were present bilaterally on lung auscultation. He denied aspiration of water. Due to his persistent hypoxia, the patient was transported to an emergency department. He received a two-view chest X-ray, showing only bibasilar pulmonary opacities. He maintained 100% saturation once oxygen was removed and was able to be discharged to continue in the selection course.

Discussion: Although SIPE may affect a small percentage of swimmers, military training in extreme conditions such as cold, lack of sleep, and profound exertion increases the risk for SIPE. Additionally, a patient who develops SIPE in the water is at risk for drowning. As SIPE may be fatal, military providers, especially those working with Special Operations, must be aware of how to diagnose and treat SIPE. O'Keefe CL, Clemente Fuentes RW, Salinas E. Swimming-induced pulmonary edema in a member participating in a special tactics selection course. Aerosp Med Hum Perform. 2024; 95(12):937-939.

Introduction: As next-generation space exploration missions require increased autonomy from crews, real-time diagnostics of astronaut health and performance are essential for mission operations, especially for determining extravehicular activity readiness. An augmented reality (AR) system may be a viable tool allowing holographic visual cueing to replace physical objects used in traditional assessments.

Methods: In this study, 20 healthy adults were compared in an Ingress and Egress Task and Obstacle Weave Task with holographic and physical objects to determine the effect of AR on performance. Subjects performed each task three times within each modality.

Results: AR exhibited increased task completion times with greater head pitch angles across the two tasks. The head and torso angular velocity showed a reduction in magnitude in both tasks within AR, while decreased magnitudes of head and torso acceleration were observed for the Obstacle Weave Task. The subjects were more deliberate and careful in their task completion during the Ingress and Egress Task within AR, stepping higher and lowering their heads further.

Discussion: Subjects successfully completed both tasks using AR and meaningful assessments of their performance were obtained. The increased head pitch observed supported the hologram visualization with the reduced AR field of view. The increased task time and reduced torso angular velocity were compared to strategies used by astronauts postflight while experiencing sensorimotor impairments. AR may be a useful instrumentation solution for assessing in-flight performance, providing embedded sensors and onboard computations; however, thresholds for assessing extravehicular activity readiness must be developed. Weiss H, Stirling L. Augmented reality assessments to support human spaceflight performance evaluation. Aerosp Med Hum Perform. 2024; 95(11):831-840.

Introduction: Hypoxia recognition training (HRT) is a requirement for many nations' military aircrew. The aim of HRT is to enhance the ability of aircrew to recognize and recover from an unexpected in-flight hypoxic exposure; however, there is a paucity of research evaluating the efficacy of HRT and whether current training approaches are optimal. Rather, the benefits of HRT are routinely promulgated based on opinions and anecdotes. Here, we raise some of our concerns with HRT practices in order to stimulate further discussion and research. Our aim is to ensure aircrew are provided with effective training to mitigate the risks associated with hypoxia-and other physiological threats-to promote flight safety. Shaw DM, Harrell JW, Gant N, Peacock DS. Clearing the air on the efficacy of hypoxia recognition training. Aerosp Med Hum Perform. 2024; 95(11):871-872.

Background: Ejection seats are designed to be a lifesaving device for aircrew in emergencies. Modern ejection seats are widely prevalent in fighter and bomber aircraft and are occasionally associated with acceleration injury from axial loading (Gz) during the catapult phase of ejection, limb flail injury due to windblast, or parachute landing fall, especially if the ejection is outside of the seat's performance envelope.

Case report: We present the first known case in the medical literature of a military pilot who survived a low-altitude, high-angulation (>90° of bank angle) ejection where the pilot's ejection seat parachute did not deploy due to contact with the ground before completion of the ejection sequence. The patient's initial exam upon arrival at a trauma center was significant for a Glasgow Coma Scale of 3T, with evidence of cranial and extremity trauma. The patient presented with respiratory acidosis and required upsizing of his endotracheal tube placed in the field. The patient's injury list included bilateral subdural and subarachnoid hemorrhages, a Hangman's fracture, spinal burst fractures, and extensive extremity fractures. After a prolonged hospital stay, the patient was discharged to rehabilitation. The patient made a functional and neurological recovery, including return to independent completion of his activities of daily living.

Discussion: This case provides evidence of favorable outcome after a low-altitude, high-angulation ejection without parachute deployment. This case details the medical and traumatic pathology medical personnel should expect from an ejection that occurs outside of the seat's performance envelope. Zivkovic MM, Inman BL, Figlewicz MR, Burchett JA, Nowadly CD. Polytrauma in a jet pilot after low-altitude ejection without parachute deployment. Aerosp Med Hum Perform. 2024; 95(11):862-866.

Introduction: Aviation safety sensitive personnel (SSP) function in highly complex environments. SSP mental health is thought to support safety, efficiency, and overall health. Research is needed to identify how to optimize and screen mental health across aviation SSP, but no consensus exists on the research priorities that need to be met.

Methods: The Aerospace Medical Association established the Mental Health Research Subgroup within the Mental Health Working Group comprising 53 aviation and aerospace medicine professionals representing 9 countries. A five-round Delphi method was employed to generate research priorities.

Results: Research priorities were identified under the following six topic areas: 1) Safety and Performance; 2) Mental Health Initiatives, Education, and Peer Support Programs; 3) Clinical Care, Pharmacology, and Return to Duty; 4) Epidemiology and Natural History; 5) Screening, Monitoring, and Emerging Technology; and 6) Special Considerations and Underrepresented Populations [Aerospace Medical Association Mental Health Research Subgroup Research Priorities Version 1.0 (current as of January 1, 2024)].

Discussion: Research is needed to identify how to optimize and screen mental health across aviation SSP. This effort identified six key research priorities to achieve that aim. Hoffman WR, Tvaryanas A, Snyder Q, Spyropoulos BP, Garcia D, Schroeder D, Fahnenbruck G, Trottier K, Overbo S, Santilhano W, Brinks E, Ndoye A, Bongers H, O'Shaughnessy R, Miranda E; Aerospace Medical Association Mental Health Research Subgroup. Aerospace Medical Association proposed research priorities for mental health and safety in aviation. Aerosp Med Hum Perform. 2024; 95(11):845-850.

Introduction: Flight attendants are constantly exposed to high-stress environments that could lead to the development of depression. The COVID-19 pandemic brought out new risk factors that could affect flight attendants' mental health, such as reduced flight hours and fear of the disease itself, which other studies have shown was associated with depression. We aimed to find out whether reduced flight hours, fear of COVID-19, and other factors were associated with depression in flight attendants during the COVID-19 pandemic.

Methods: This cross-sectional study was conducted at the Directorate General Civil Aviation Medical Center Indonesia and Garuda Sentra Medika in 2022. We included flight attendants who were still employed before and after the start of the pandemic. Data were collected using several questionnaires, including the General Health Questionnaire-12 to screen for depression and Fear of COVID-19 for fear levels.

Results: We obtained data from 159 respondents, of whom 25.2% of them had depression. Multivariate analysis showed that the reduction of flight hours 1 yr after the start of the pandemic and fear of COVID-19 were found to significantly increase the likelihood of depression by 2.3 times and 3.9 times, respectively.

Discussion: During the pandemic, depression was found to be highly prevalent among flight attendants and was associated with the reduction of flight hours and fear of COVID-19. Sutrisno AB, Agustina A, Sosrosumihardjo D, Sugiharto A, Zulaecha SI, Khoe LC. Flight hours and depression in flight attendants during the COVID-19 pandemic. Aerosp Med Hum Perform. 2024; 95(11):826-830.

Introduction: The aviation occupational environment may expose a developing fetus to intermittent hypoxia, high gravitational force, toxic materials, loud noise, high frequency vibrations, and galactic cosmic radiation. These exposures in animal models are associated with adverse neonatal outcomes. We sought to investigate whether a maternal military aviation career was associated with adverse neonatal health outcomes.

Methods: We performed a retrospective cohort study of female officer's children born in the Military Health System from October 2002 to December 2019. Female fixed-wing aviation officers were identified by the presence of an aviation occupation code prior to birth. Adverse neonatal outcomes were identified by International Classification of Diseases codes in in-patient medical records. Binomial regression was used to estimate the adjusted relative risk (aRR) of neonatal health outcomes.

Results: We identified 27,033 eligible births, with 1144 children born to female fixed-wing aviation officers and 25,889 to female nonaviation officers. Children of fixed-wing aviation officers had a significantly lower adjusted risk of overall neonatal growth abnormalities compared to children of nonaviation officers [aRR 0.74 (95% Confidence Interval 0.57-0.99)], but did not have significant differences in low birth weight [aRR 0.78 (0.56-1.10)] or small for gestational age [aRR 0.72 (0.46-1.10)] diagnoses. There were no statistically significant adverse neonatal outcomes.

Discussion: Children of female military fixed-wing aviation officers were at decreased risk of neonatal growth abnormalities compared to children of nonaviation officers and had no significant adverse neonatal health outcomes. Further research is needed to determine how flight impacts neonatal health outcomes. Stark CM, Sorensen IS, Royall M, Dorr M, Brown J, Dobson N, Salzman S, Susi A, Hisle-Gorman E, Huggins BH, Nylund CM. Neonatal health risks among children of female military aviation officers. Aerosp Med Hum Perform. 2024; 95(11):815-820.