INTRODUCTION: Living in an isolated, confined environment (ICE) can induce conflict, stress, and depression. Computer-based behavioral health countermeasures are appealing for training and treatment in ICEs because they provide confidentiality and do not require communication with the outside environment. We evaluated the Virtual Space Station (VSS), a suite of interactive computer-delivered psychological training and treatment programs, at the Hawaii Space Exploration Analog and Simulation (HI-SEAS) III expedition.METHODS: Six subjects (3 male, 3 female) spent 8 mo in group-isolation and used the Conflict, Stress, and Depression modules in the VSS. Survey evaluations, data collected within the program, and postdeployment interviews were collected.RESULTS: This crew dealt with behavioral health issues common to ICEs. The VSS proved to be a valuable resource and was used both as intended, and in unanticipated ways, to help maintain behavioral health. The Conflict and Stress Modules were rated as highly acceptable (1.8 on a 7-point Likert scale). The crew identified a total of 13 stressors and worked on 9 problems through the VSS. Opinions about the modules were highly individualized. Crewmembers identified exercises in the VSS that were applicable and not applicable to their needs. Additional content to improve the program was identified.DISCUSSION: Autonomous, confidential training and treatment for behavioral health issues will need to be a critical component of long duration spaceflight travel. This work provides an evaluation of such a tool in a relevant ICE.Anderson AP, Fellows AM, Binsted KA, Hegel MT, Buckey JC. Autonomous, computer-based behavioral health countermeasure evaluation at HI-SEAS Mars analog. Aerosp Med Hum Perform. 2016; 87(11):912–920.

INTRODUCTION: Although there are numerous studies that demonstrate that color vision deficient (CVD) individuals perform less well than color vision normal (CVN) individuals in tasks that require discrimination or identification of colored stimuli, there remains a need to quantify the relationship between the type and severity of CVD and performance on operationally relevant tasks.METHODS: Participants were classified as CVN (N = 45) or CVD (N = 49) using the Rabin cone contrast test, which is the standard color vision screening test used by the United States Air Force. In the color condition, test images that were representative of the size, shape, and color of symbols and lines used on fifth-generation fighter aircraft displays were used to measure operational performance. In the achromatic condition, all symbols and lines had the same chromaticity but differed in luminance. Subjects were asked to locate and discriminate between friend vs. foe symbols (red vs. green, or brighter vs. dimmer) while speed and accuracy were recorded.RESULTS: Increasing color deficiency was associated with decreasing speed and accuracy for the color condition (R² > 0.2), but not for the achromatic condition. Mean differences between CVN and CVD individuals showed the same pattern.DISCUSSION: Although lower CCT scores are clearly associated with lower performance in color related tasks, the magnitude of the performance loss was relatively small and there were multiple examples of high-performing CVD individuals who had higher operational scores than low-performing CVN individuals.Gaska JP, Wright ST, Winterbottom MD, Hadley SC. Color vision and performance on color-coded cockpit displays. Aerosp Med Hum Perform. 2016; 87(11):921–927.

INTRODUCTION: Flight-induced neck pain is common in high performance jet pilots, with incidents frequently attributed to high G_z flight maneuvers. The additional load of helmet-mounted night vision goggles (NVG) is believed to increase the risk, possibly from neck muscle strain in counteracting muscles. Hence, the aim was to investigate the effect of NVG on neck muscle strain as well as on the activity level distribution through a simulated flight session in air force pilots.METHODS: In this post hoc randomized crossover trial, four senior air force pilots each completed two identical 1.5-h dynamic flight simulations in a human centrifuge: one with a standard helmet and NVG, and one with a standard helmet only. Simulations included repeated exposure to 3–7 G_z, during which neck muscle activity was recorded bilaterally from the anterior neck, the upper and lower posterior neck, and the upper shoulders. The number of muscle activities surpassing 50% of maximum voluntary electrical activity (MVE) and total time of activity at each MVE percentile were compared between NVG and control flights.RESULTS: There was no overall effect in number of neck strain activities between NVG and control flights; however, significantly more activities emerged in the anterior neck. In addition, MVE percentile data showed a tendency of higher activity in the lower posterior neck during NVG flights.CONCLUSIONS: The results showed that the additional load of helmet-mounted NVG increases neck muscle strain in anterior stabilizing muscles, indicating that the inertia of head-worn NVG elevates the risk of flight-related neck pain.Pousette MW, Lo Martire R, Linder J, Kristoffersson M, Äng BO. Neck muscle strain in air force pilots wearing night vision goggles. Aerosp Med Hum Perform. 2016; 87(11):928–932.

INTRODUCTION: This paper investigates personality traits as potential factors for success in an astronaut selection by comparing personality profiles of unsuccessful and successful astronaut candidates in different phases of the ESA selection procedure. It is further addressed whether personality traits could predict an overall assessment rating at the end of the selection.METHODS: In 2008/2009, ESA performed an astronaut selection with 902 candidates who were either psychologically recommended for mission training (N = 46) or failed in basic aptitude (N = 710) or Assessment Center and interview testing (N = 146). Candidates completed the Temperament Structure Scales (TSS) and the NEO Personality Inventory Revised (NEO-PI-R).RESULTS: Those candidates who failed in basic aptitude testing showed higher levels of Neuroticism (M = 49.8) than the candidates who passed that phase (M = 45.4 and M = 41.6). Additionally, candidates who failed in basic testing had lower levels of Agreeableness (M = 132.9) than recommended candidates (M = 138.1). TSS scales for Achievement (r = 0.19) and Vitality (r = 0.18) showed a significant correlation with the overall assessment rating given by a panel board after a final interview.DISCUSSION: Results indicate that a personality profile similar to Helmreich’s “Right Stuff” is beneficial in astronaut selection. Influences of test anxiety on performance are discussed.Mittelstädt JM, Pecena Y, Oubaid V, Maschke P. Psychometric personality differences between candidates in astronaut selection. Aerosp Med Hum Perform. 2016; 87(11):933–939.

INTRODUCTION: Long-duration space explorations will involve significant communication delays that will likely impact individual and team outcomes. However, the extent of these impacts and the appropriate countermeasures for their mitigation remain largely unknown. This study examined the feasibility and acceptability of utilizing the International Space Station (ISS) as a research platform to assess the impacts of communication delays on individual and team behavior and performance.METHODS: For this study, 3 ISS crewmembers and 18 mission support personnel performed 10 tasks identified by subject matter experts as meeting study criteria, 6 tasks without a delay in communication and 4 tasks with a 50-s one-way delay. Assessments of individual and team performance and behavior were obtained after each task. The completion rate of posttask assessments and postmission interviews with astronauts were used to assess feasibility and acceptability.RESULTS: Posttask assessments were completed in 100% of the instances where a crewmember was assigned to a task and in 83% where mission support personnel were involved. Qualitative analysis of postmission interviews found the study to be important and acceptable to the three astronauts. However, they also reported the study was limited in the number and type of tasks included, limitations in survey questions, and preference for open-ended to scaled items.DISCUSSION: Although the ISS is considered a high fidelity analog for long-duration space missions, future studies of communication delays on the ISS must take into considerations the constraints imposed by mission operations and subject preferences and priorities.Kintz KM, Palinkas LA. Communication delays impact behavior and performance aboard the International Space Station. Aerosp Med Hum Perform. 2017; 87(11):940–946.

BACKGROUND: Powered parachutes are becoming a popular form of sport flying. No previous study has reviewed injuries in this sport. The purpose of this study was to describe the injuries associated with powered parachute flying, the flight factors involved in an incident, and the impact an incident has on current sport involvement.METHODS: National Transportation Safety Board incident reports involving powered parachutes between 2004 and 2015 were reviewed. Internet searches were performed to contact involved pilots to find further information.RESULTS: There were 71 incidents reported involving 117 people. Of these, 10 incidents involved 14 fatalities (12.0%). Of the 14 fatalities, 11 (78.5%) occurred in midflight. Pilot error was the most common finding for an incident and accounted for 53/71 incidents (74.6%). The main error was misjudging the distance required for takeoff and landing. This accounted for 37/71 incidents (52.1%). Orthopedic extremity injuries were the most common severe injuries reported. Surgical intervention was needed in 43.8% of injuries and 48.0% of those involved fractures. The median return to work was 14 d (range 0–180 d). Only 4/53 (7.5%) of the pilots contacted continued to fly powered parachutes.DISCUSSION: Powered parachute participants are at risk for unique injuries compared to other forms of flight. A powered parachute injury can have a significant impact on future pilot involvement in the sport. This study provides evidence for design changes in the aircraft and helps direct pilot training. This information can improve the safety and well-being of participants so they can continue to fly powered parachutes.Skelley NW, Yarholar LM, Richardson LC. Pilot and passenger injuries associated with powered parachutes. Aerosp Med Hum Perform. 2016; 87(11):947–953.

INTRODUCTION: The Motion Sickness Assessment Questionnaire (MSAQ) was developed in order to assess the multiple dimensions of the motion sickness syndrome (gastrointestinal, central nervous system, peripheral, and sopite-related symptoms). The aim of this study was to evaluate the psychometric properties of the Greek version of the MSAQ.METHODS: The MSAQ was translated into Greek and then translated back into English. Minor differences between the two texts were corrected. The Greek version was then administered to male subjects before and after nauseogenic motion stimulation. With the use of a motor driven rotating chair, the subjects were exposed to Coriolis cross-coupling stimulation. A battery of statistical tests was used to evaluate the psychometric properties of the MSAQ.RESULTS: There were 112 subjects who participated. Internal consistency, measured with Cronbach's alpha coefficient, was excellent for the total scale and subscales. The test-retest evaluation was done with Pearson's coefficient and Bland-Altman's plot for the total score and subscales and showed statistically significant results. Mean total MSAQ score was 19.04 before the exposure and 33.46 after the exposure, which was statistically significant.CONCLUSION: Results suggest the Greek-MSAQ is a valid instrument with satisfactory internal consistency, reliability, reproducibility, validity, and responsiveness and can be used in future studies of motion sickness in Greek speaking populations.Kousoulis P, Pantes A, Alevetsovitis G, Fydanaki O. Psychometric properties of the Greek version of the Gianaros Motion Sickness Assessment Questionaire. Aerosp Med Hum Perform. 2016; 87(11):954–957.

INTRODUCTION: The Stratex Project is a high altitude balloon flight that culminated in a freefall from 41,422 m (135,890 ft), breaking the record for the highest freefall to date. Crew recovery operations required an innovative approach due to the unique nature of the event as well as the equipment involved. The parachutist donned a custom space suit similar to a NASA Extravehicular Mobility Unit (EMU), with life support system mounted to the front and a parachute on the back. This space suit had a metal structure around the torso, which, in conjunction with the parachute and life support assembly, created a significant barrier to extraction from the suit in the event of a medical emergency. For this reason the Medical Support Team coordinated with the pressure suit assembly engineer team for integration, training in suit removal, definition of a priori contingency leadership on site, creation of color-coded extraction scenarios, and extraction drills with a suit mock-up that provided insight into limitations to immediate access. This paper discusses novel extraction processes and contrasts the required medical preparation for this type of equipment with the needs of the prior record-holding jump that used a different space suit with easier immediate access.Garbino A, Nusbaum DM, Buckland DM, Menon AS, Clark JB, Antonsen EL. Emergency medical considerations in a space-suited patient. Aerosp Med Hum Perform. 2016; 87(11):958–962.

BACKGROUND: Arterial gas embolism (AGE) is a rare condition in the flying community most often only ever seen in flight while operating at high altitude or incidents involving hypobaric chambers. This article describes a severe case of AGE that occurred in a pilot of a fourth generation fighter aircraft at ground level. The environmental control system (ECS) malfunctioned, causing an overpressurized cockpit and a subsequent explosive decompression when the pilot opened the canopy to egress.CASE REPORT: The ECS onboard fourth generation fighter aircraft is composed of many computer-controlled subsystems. When these components fail, the system can potentially overpressurize the cockpit. Combined with opening the canopy without prior venting, this overpressurization can lead to a situation akin to a diver surfacing too quickly. A pilot experienced this scenario and subsequently developed symptoms of arterial gas embolization—one form of decompression illness (DCI). We reviewed the design of the environmental control system and recommend that the cockpit must be slowly depressurized to decrease risk of injury from rapid decompression.DISCUSSION: Literature review showed three similar cases of ground-based overpressurization causing AGE symptoms, although these cases were maintenance personnel intentionally testing aircraft cabin integrity and not associated with aircraft intending flight.⁷ The lessons learned from this case can be used to identify and hopefully prevent severe DCI from ground level cockpit overpressurization and to further general understanding of aircraft ECS.Zhang JX, Berry JR, Beckstrand DP. Explosive decompression with resultant air gas embolism in a fourth generation fighter at ground level. Aerosp Med Hum Perform. 2016; 87(11):963–967.

BACKGROUND: A candidate with paraplegia contacted the Institute of Aviation Medicine, Oslo, requesting a medical examination and medical certification for flying back seat on an F-16 Fighting Falcon. Thorough aeromedical examinations, including specialist evaluations, were initiated for the final decision to be made.CASE REPORT: Almost 13 yr earlier the candidate had acquired spinal cord damage at neurological level L1 after falling 4 m (13 ft) from out of a window. The CT scans showed luxation of the 12^th thoracic vertebra with fracture and dislocation of the 1^st lumbar vertebra. He went for surgery, where fixation of the 12^th thoracic vertebra to the 1^st lumbar vertebra was performed. He developed syringomyelia 1 yr postoperatively and was re-operated on twice in the following years. He was now in a wheelchair, but engaged himself in several sport activities such as sledge-hockey and sit-skiing, participating in several Paralympics.DISCUSSION: With respect to the general principles of aviation medicine, several considerations had to be taken into account before a medical certification could be given. The risks associated with an F-16 flight in relationship to the candidate's general health and the fixation of his spinal cord had to be evaluated. Also, his ability to perform required tasks during the flight and in case of an emergency was an important issue discussed. Finally, the candidate’s medical and physical condition should not present a considerable risk to flight safety. After extensive specialist consultations and in-depth discussions, the candidate was given medical certification to fly back seat in a F-16.Chahal-Kummen M, Strand T-E, Owe JO, Gulliksen E, Wagstaff AS. Aeromedical evaluation for an F-16 candidate with incomplete paraplegia. Aerosp Med Hum Perform. 2016; 87(11):968–971.

Martin BR. You’re the flight surgeon: West Nile virus neuroinvasive disease. Aerosp Med Hum Perform. 2016; 87(11):976–979.