INTRODUCTION: The assessment of individuals on abilities or other characteristics is based on comparison to a representative sample. General population norms provide an appropriate reference group when the distribution of scores in the sample can be expected to be similar to those for the general population (e.g., comparing high school students at a particular school to national high school norms on a college entrance test). Specialized norms are needed, however, when subsets of the population differ from the population at large. Military pilot trainees represent a special population; they are highly screened on cognitive ability and other characteristics thought to be related to job performance. Other characteristics (e.g., personality) are thought to be “self-selected,” resulting in distinctive profiles. Normative tables were developed for U.S. Air Force pilot trainees for two widely used tests, the Multidimensional Aptitude Battery-II (MAB-II) and NEO Personality Inventory-Revised (NEO PI-R).METHODS: The MAB-II and NEO PI-R were administered to large samples of USAF cadets, ROTC students, and officers selected for pilot training.RESULTS: The mean MAB-II full-scale IQ was about 1.5 SD above the adult population norm and was much less variable, supporting the need for specialized norms. Tables showing the percentile equivalents are provided for use by clinicians.DISCUSSION: Use of these tables, in addition to, or in lieu of, commercially published norms, will prove helpful when clinical psychologists perform assessments on pilots; in particular when evaluating them for return-to-duty status following a disqualifying condition that may have affected cognitive functioning or emotional stability.Carretta TR, King RE, Ree MJ, Teachout MS, Barto E. Compilation of cognitive and personality norms for military aviators. Aerosp Med Hum Perform. 2016; 87(9):764–771.

BACKGROUND: A number of space activities (e.g., extravehicular astronaut rescue, cooperation in satellite services, space station supplies, and assembly) are implemented directly or assisted by remote robotic arms. Our study aimed to reveal those individual characteristics which could positively influence or even predict teleoperation performance of such a space robotic arm.METHODS: There were 64 male volunteers without robot operation experience recruited for the study. Their individual characteristics were assessed, including spatial cognitive ability, cognitive style, and personality traits. The experimental tasks were three abstracted teleoperation tasks of a simulated space robotic arm: point aiming, line alignment, and obstacle avoidance. Teleoperation performance was measured from two aspects: task performance (completion time, extra distance moved, operation slips) and safety performance (collisions, joint limitations reached). The Pearson coefficients between individual characteristics and teleoperation performance were examined along with performance prediction models.RESULTS: It was found that the subjects with relatively high mental rotation ability or low neuroticism had both better task and safety performance (|r| = 0.212 ∼ 0.381). Subjects with relatively high perspective taking ability or high agreeableness had better task performance (r = −0.253; r = −0.249). Imagery subjects performed better than verbal subjects regarding both task and safety performance (|r| = 0.236 ∼ 0.290). Compared with analytic subjects, wholist subjects had better safety performance (r = 0.300). Additionally, extraverted subjects had better task performance (r = −0.259), but worse safety performance (r = 0.230).CONCLUSIONS: Those with high spatial cognitive ability, imagery and wholist cognitive style, low neuroticism, and high agreeableness were seen to have more advantages in working with the remote robotic arm. These results could be helpful to astronaut selection and training for space station missions.Pan D, Zhang Y, Li Z, Tian Z. Association of individual characteristics with teleoperation performance. Aerosp Med Hum Perform. 2016; 87(9):772–780.

BACKGROUND AND METHODS: Life in isolated and confined environments (ICEs) is subject to important constraints which can generate psychosociologically impaired outcomes. This study investigated psychological, social, occupational, and cultural variables which are among the most important determinants in adaptation to a one-year wintering in Antarctica for 13 international subjects.RESULTS: Our findings confirm and give further insight into the role of social (Cohesiveness, Social Support) and occupational (Implementation/Preparedness, Counterproductive Activity, Decision Latitude, and Psychological Job Demands) dimensions of adaptation to ICEs. Relationships between various social and occupational dimensions studies reflected detrimental effects ranging from decrements in cohesiveness (ICE 1, M = 4.44; ICE 7, M = 3.33), social support (ICE 2, M = 4.93; ICE 7, M = 4.28), and work performance (ICE 1, M = 4.33; ICE 6, M = 3.5), which differed across professional status and multicultural factors.DISCUSSION: These psychosocial issues have important implications for pre-mission selection and training, monitoring and support of crews during the mission, and post-mission readaptation. Operational recommendations are suggested to improve adaptation, success, and well-being for long-duration ICE missions, e.g., to Mars and beyond.Nicolas M, Bishop SL, Weiss K, Gaudino M. Social, occupational, and cultural adaptation during a 12-month wintering in Antarctica. Aerosp Med Hum Perform. 2016; 87(9):781–789.

INTRODUCTION: Prevalence of metabolic syndrome (MetS) in the Indian population varies from 31.6 to 41.1%. Indians, without being conventionally obese, but inherently insulin resistant, have higher risk of developing cardiovascular diseases and diabetes. Since military aircrew, belonging to the same ethnic pool, may reflect similar prevalence of MetS as the general Indian populace, this study was undertaken to find the prevalence of MetS among Indian military aircrew using one candidate definition.METHODS: In this cross sectional descriptive study, 210 military aircrew voluntarily participated. Besides demographic and lifestyle related details, their anthropometric measurements, including height, weight, waist circumference, hip circumference, and skin fold thickness were recorded. Body mass index and waist-to-hip ratio were deduced from the recorded measurements. Resting heart rate and blood pressure were recorded and appropriate laboratory investigations were undertaken.RESULTS: Prevalence of MetS, as per chosen definition, was 33.3% (N = 70), which had moderate, fair, and slight agreement with NCEP ATP III (k = 0.43), IDF (k = 0.27), and WHO (k = 0.15) definitions, respectively. Decadal prevalence of MetS was found to be highest in the fourth decade (46.8%), followed by the third decade (41.3%).CONCLUSION: Reported prevalence of MetS highlights an urgent need to define preventive strategies to minimize loss of trained manpower among military aircrew. Flight surgeons have an important role to play to educate aircrew about modifying their lifestyle to reduce morbidity and mortality among themselves in the future.Sharma S, Chandrashekar AM, Singh V. Metabolic syndrome in military aircrew using a candidate definition. Aerosp Med Hum Perform. 2016; 87(9):790–794.

INTRODUCTION: Lower back pain (LBP) is the most common complaint worldwide and the leading cause of disability in the workplace. In Colombia there are no epidemiological data on low back pain in aviation. This study aimed to characterize lower back pain in pilots and maintenance technicians in a Colombian commercial airline.METHODS: Information was collected from the total population in a Colombian commercial airline in Bogota during the period from 2011 to 2013 using a voluntary survey which requested demographics, occupational (LEST survey) factors, back pain, and chronic pain (chronic pain grade scale).RESULTS: The prevalence rate of LBP in pilot respondents was 71% and the factors associated previously have belonged to the military forces: occupational exposure to physical load and work time. Chronic low back pain was at a prevalence of 49%. The prevalence of LBP in maintenance technicians was 65%. Associated factors were again similar to military forces and included mental workload. Chronic pain had a prevalence of 65%. Factors associated with chronic low back pain were the technicians’ time in office and physical load.DISCUSSION: The prevalence of lower back pain in pilots is similar to that presented in the airline world population. In the case of maintenance technicians, the prevalence was higher than those found in other similar groups, but very similar to prevalences presented in different business industries, including the transport sector.Fajardo Rodriguez HA, Ortiz Mayorga VA. Characterization of low back pain in pilots and maintenance technicians on a commercial airline. Aerosp Med Hum Perform. 2016; 87(9):795–799.

BACKGROUND: Apache pilots needing refractive correction are issued modified HGU-4/P aviator spectacles. However, a recently published survey found field of view (FOV) dissatisfaction with the current spectacles when sighting in with a Helmet Display Unit (HDU). A current Air Force flight frame was modified in-lab and the purpose of this study was to evaluate the FOV with the current Apache flight frame vs. the modified flight frame.METHODS: Recruited were 21 Apache pilots to assess FOV under three conditions: 1) wearing the current Apache frame; 2) wearing the modified Apache frame; and 3) wearing no frame. The main outcome measure was total FOV of four quadrants tested: superior left (45°); superior right (135°); inferior right (225°); and inferior left (315°).RESULTS: No significant differences in FOV were seen between the two frames tested while wearing the current Apache helmet (P = 0.33) and the new Apache helmet (P = 0.64). However, there were significant differences in FOV between the no frame condition and the two frame conditions tested with both helmets (P < 0.001).DISCUSSION: No significant differences in FOV were seen between the two frames tested while wearing either Apache helmet. However, with both helmets there were significant differences in FOV between the no frame condition and the two frame conditions tested. This suggests that wearing no eyewear is still optimal in integrating the HDU device. With advances in contact lens technology, future research can study the viability of the latest generation of multifocal contact lenses with Apache aviators.Walsh DV, Jurek GM, McLean WE, Statz JK, Allen RL, Riggs DW. Assessment of a prototype Apache flight eyewear. Aerosp Med Hum Perform. 2016; 87(9):800–805.

INTRODUCTION: The first space-based fused deposition modeling (FDM) 3D printer became operational in 2014. This study evaluated whether Mars simulation crewmembers of the Hawai’i Space Exploration Analog and Simulation (HI-SEAS) II mission with no prior surgical experience could utilize acrylonitrile butadiene styrene (ABS) thermoplastic surgical instruments FDM 3D printed on Earth to complete simulated surgical tasks.METHODS: This study sought to examine the feasibility of using 3D printed surgical tools when the primary crew medical officer is incapacitated and the back-up crew medical officer must conduct a surgical procedure during a simulated extended space mission. During a 4 mo duration ground-based analog mission, five simulation crewmembers with no prior surgical experience completed 16 timed sets of simulated prepping, draping, incising, and suturing tasks to evaluate the relative speed of using four ABS thermoplastic instruments printed on Earth compared to conventional instruments.RESULTS: All four simulated surgical tasks were successfully performed using 3D printed instruments by Mars simulation crewmembers with no prior surgical experience. There was no substantial difference in time to completion of simulated tasks with control vs. 3D printed sponge stick, towel clamp, scalpel handle, and toothed forceps.DISCUSSION: These limited findings support further investigation into the creation of an onboard digital catalog of validated 3D printable surgical instrument design files to support autonomous, crew-administered healthcare on Mars missions. Future work could include addressing sterility, biocompatibility, and having astronaut crew medical officers test a wider range of surgical instruments printed in microgravity during actual surgical procedures.Wong JY, Pfahnl AC. 3D printed surgical instruments evaluated by a simulated crew of a Mars mission. Aerosp Med Hum Perform. 2016; 87(9):806–810.

BACKGROUND: Sleep and fatigue management is one of the main challenges in airline operations scheduling. Our aim was to compare the differences regarding fatigue, sleep, and labor specificities between the two most common types of flight, short/medium haul (SM-H) and long haul (L-H), in a large sample of airline pilots.METHODS: A self-report questionnaire was developed, composed of socio-economic and labor questions, and psychological assessment scales for fatigue and sleep. Associations of these variables and type of flight were tested.RESULTS: Of the total sample of Portuguese airline pilots (N = 435), 313 (72%) were from SM-H and 122 (28%) were from L-H. For SM-H, the values obtained for sleep complaints were 34.2%, daytime sleepiness 61.6%, and fatigue 93.0%. For L-H, 36.9%, 53.3%, and 84.4%, respectively. Looking at labor variables, the differences between the two types of flights were evident, with SM-H pilots’ having statistically significant higher mean values of duty and flight hours, numbers of sectors, and early mornings. Only the mean number of night periods was higher in L-H pilots. All values were reported for 28 consecutive scheduling days.CONCLUSION: Night periods and time-zone crossing may explain higher prevalence levels of sleep disturbances in L-H pilots. However, the values for daytime sleepiness were higher in SM-H pilots, which may be attributed to diminished sleep caused by a combination of frequent early starts and long duty periods. Taking into account the large differences between the two types of flights, different regulatory limits should be considered by aviation authorities.Reis C, Mestre C, Canhão H, Gradwell D, Paiva T. Sleep and fatigue differences in the two most common types of commercial flight operations. Aerosp Med Hum Perform. 2016; 87(9):811–815.

INTRODUCTION: Aviation medical specialists should be aware that commercial airline aircraft engineers may undertake a 'dive equivalent' operation while conducting maintenance activities on the ground. We present a worked example of an occupational risk assessment to determine a minimum safe preflight surface interval (PFSI) for an engineer before flying home to base after conducting an Excessive Cabin Leakage Test (ECLT) on an unserviceable aircraft overseas.METHOD: We use published dive tables to determine the minimum safe PFSI.RESULTS: The estimated maximum depth acquired during the procedure varies between 10 and 20 fsw and the typical estimated bottom time varies between 26 and 53 min for the aircraft types operated by the airline. Published dive tables suggest that no minimum PFSI is required for such a dive profile.DISCUSSION: Diving tables suggest that no minimum PFSI is required for the typical ECLT dive profile within the airline; however, having conducted a risk assessment, which considered peak altitude exposure during commercial flight, the worst-case scenario test dive profile, the variability of interindividual inert gas retention, and our existing policy among other occupational groups within the airline, we advised that, in the absence of a bespoke assessment of the particular circumstances on the day, the minimum PFSI after conducting ECLT should be 24 h.Houston S, Wilkinson E. Flying after conducting an aircraft excessive cabin leakage test. Aerosp Med Hum Perform. 2016; 87(9):816–820.

INTRODUCTION: Although harness suspension trauma has been documented since the 1960s, especially in the mountaineering setting, there is little robust medical research into the area. Helicopter hoist rescue shares similar risks and is reserved for those cases that cannot be accessed safely by other routes, where extrication may be hazardous or will take an unreasonable amount of time. The single sling or chest harness used for hoist rescue is a single harness around the upper torso and is easier and quicker to apply than a stretcher. However, the risks of a chest harness need to be balanced against the patient’s condition, the environment, aircraft performance, and the urgency of the rescue.CASE REPORT: We report an adult male falling 80 ft to his death while being hoisted into a rescue helicopter for a likely fractured ankle. A single rescue sling harness technique was used, but the patient became unconscious, slipped out of the harness, and fell. He had significant comorbidities, including cardiomyopathy, obstructive sleep apnea, morbid obesity, and diabetes.DISCUSSION: A decrease in cardiac output secondary to thoracic compression was the presumed cause for his loss of consciousness and the potential physiological mechanisms and modifying factors are discussed. Further research into harness suspension trauma is required. Stretcher, double point harnesses, or rescue baskets are likely safer methods of hoisting, especially in a medically compromised patient.Biles J, Garner AA. Loss of consciousness during single sling helicopter hoist rescue resulting in a fatal fall. Aerosp Med Hum Perform. 2016; 87(9):821–824.

BACKGROUND: The occurrence of an acute stroke syndrome during a long-distance flight demands critical decisions from the crew and attendant physicians. One in particular is whether the flight should be continued or be detoured to a nearby airport.CASE REPORT: We describe a 42-yr-old woman who suffered from a severe stroke in a commercial airplane over the Sahara. The captain, together with a physician aboard and the next of kin, decided not to detour to north African or south European airports, but to continue flying to Frankfurt, Germany (final destination; remaining flight time 4 h), where an efficient transfer infrastructure and an advanced medical standard were presumed. At the hospital, the patient was successfully treated by means of catheter-based mechanical thrombus extraction. The patient was free of neurological deficits at discharge.DISCUSSION: The geographically unbalanced availability of complex but highly effective therapies such as mechanical recanalization in acute stroke challenges decision making in aviation medicine. In selected cases it might be beneficial to continue flying to cities with advanced medical standards instead of deviating to nearby airports.Foerch C, Mayer CA, Berkefeld J, You S-J. Endovascular treatment of a severe stroke occurring in a commercial airplane over the Sahara. Aerosp Med Hum Perform. 2016; 87(9):825–829.

Carnes BG, Pavelites JJ, Grigley DT. You’re the flight surgeon: shortness of breath. Aerosp Med Hum Perform. 2016; 87(9):833–835.