BACKGROUND: The Swedish Air Force (SwAF) conducted a study in 2010 to harmonize portrayal of aeronautical info (AI) on SwAF charts with NATO standards. A mismatch was found concerning vertical obstructions (VO). Norway regarded Sweden’s existing symbology as a way to solve the problem of overcrowded air charts and the two countries started to cooperate. The result of this development was a new set of symbology for obstacles. The aim of this study was to test the readability of the new obstacle and power line symbols compared to the old symbols. We also wished to assess the readability in NVG illumination conditions, particularly regarding the new symbols compared to the old.METHODS: In a randomized controlled study design, 21 volunteer military pilots from the Norwegian and Swedish Air Force were asked to perform tracking and chart-reading tests. The chart-reading test scored both errors and readability using a predefined score index. Subjective scoring was also done at the end of the test day.RESULTS: Overall response time improved by approximately 20% using the new symbology and error rate decreased by approximately 30–90% where statistically significant differences were found.DISCUSSION: The tracking test turned out to be too difficult due to several factors in the experimental design. Even though some caution should be shown in drawing conclusions from this study, the general trends seem well supported with the number of aircrew subjects we were able to recruit.Wagstaff AS, Larsen T. Readability of new aviation chart symbology in day and NVG reading conditions. Aerosp Med Hum Perform. 2017; 88(11):978–984.

BACKGROUND: In previous research on motion sickness in simulated and virtual vehicles, subjects’ experience controlling the corresponding physical vehicles has been confounded with their age. During driving of virtual automobiles in a video game, we separated chronological age from experience driving physical automobiles.METHODS: Subjects drove a virtual automobile in a driving video game. Drivers were young adults with several years of experience driving physical automobiles, while nondrivers were individuals in the same age group who did not have a driver’s license and had never driven an automobile. During virtual driving, we monitored movement of the head and torso. We collected independent measures of the incidence and severity of motion sickness.RESULTS: After virtual driving, motion sickness incidence did not differ between drivers (65%) and nondrivers (60%). Game performance and the severity of symptoms also did not differ between drivers and nondrivers. However, movement differed between subjects who later became motion sick and those who did not. In addition, physical driving experience influenced patterns of postural activity that preceded motion sickness during virtual driving.CONCLUSIONS: The results are consistent with the postural instability theory of motion sickness, and help to illuminate relationships between the control of physical and virtual vehicles.Chang C-H, Chen F-C, Kung W-C, Stoffregen TA. Effects of physical driving experience on body movement and motion sickness during virtual driving. Aerosp Med Hum Perform. 2017; 88(11):985–992.

INTRODUCTION: Blindfolded subjects used a joystick to orient themselves to the direction of balance in a device programmed to exhibit inverted pendulum behavior in the roll plane; they indicated with a trigger press when they were at that location. Our goal was to determine how otolith and somatosensory information about the gravitational vertical influenced the ability to locate the direction of balance.METHODS: The subjects (N = 12) were tested in each of three orientations of the body roll plane: vertical (Upright), 45° back (45_Degree), and 90° back (Supine), which provided progressively less salient otolith and somatosensory information about roll orientation with regard to the direction of gravity. For each pitch plane, subjects were tested with three directions of balance: 0° (aligned with the gravitational vertical in the Upright condition) and 30° right or left.RESULTS: The mean achieved and indicated orientations for the Upright and 45_Degree conditions were significantly displaced away from the direction of balance in the direction of gravity, with indicated angles less displaced. In the Supine condition, the mean achieved and indicated angles were closer to the direction of balance, but their within-trial standard deviations were significantly larger than in the Upright and 45_Degree conditions, which did not differ. This greater variability resulted from the frequent side to side “drifting” behavior that was a characteristic feature of the Supine condition only.DISCUSSION: These findings indicate that in the absence of vision accurate dynamic orientation requires gravity dependent shear forces on the otolith organs and body surface.Panic AS, Panic H, DiZio P, Lackner JR. Gravitational and somatosensory influences on control and perception of roll balance. Aerosp Med Hum Perform. 2017; 88(11):993–999.

INTRODUCTION: Many fighter pilots report cervical pain during their careers. Etiology likely relates to +G_z exposure, physical positioning with maneuvers, and varying load associated with headgear. We evaluated whether selected risk factors predicted cervical pain in this population.METHODS: An Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant, controlled crossover study of the use of home cervical traction was undertaken with 20 male F-15C pilots. We recorded pilot age (mean 38 yr, range 34–49), total high-G hours (2338 h, range 1038–4645), and previous neck problems and measured cervical range of motion. For 12 wk, pilots logged pre- and postflight pain, whether the Joint Helmet Mounted Cueing System (JHMCS) was employed, maximum +G_z experienced, and sortie duration. Pain with and without JHMCS was compared using paired t-tests and correlations assessed with Pearson or Spearman coefficients.RESULTS: Mean flight-related pain increased by 0.73 on the numerical rating scale with JHMCS and 0.52 without. Neck extension coupled with JHMCS use correlated negatively with increased pain (r = −0.551). Higher numbers of previously reported neck problems correlated with pain when using JHMCS (r = 0.629). Age, maximum +G_z per sortie, total high-G_z hours flown, and hours per sortie did not correlate.DISCUSSION: To our knowledge, this is the first prospective evaluation of risk factors for fighter pilots’ cervical pain. Neck pain was significantly worse with JHMCS use and with flexed posture or history of prior neck problems combined with JHMCS use. This information will help guide countermeasure development for high-G pilots.Chumbley EM, Stolfi A, McEachen JC. Risk factors for cervical pain in F-15C pilots. Aerosp Med Hum Perform. 2017; 88(11):1000–1007.

INTRODUCTION: There are limited data on cardiac dysrhythmias in laypersons during hypergravity exposure. We report layperson electrocardiograph (ECG) findings and tolerance of dysrhythmias during centrifuge-simulated suborbital spaceflight.METHODS: Volunteers participated in varied-length centrifuge training programs of 2–7 centrifuge runs over 0.5–2 d, culminating in two simulated suborbital spaceflights of combined +G_z and +G_x (peak +4.0 G_z, +6.0 G_x, duration 5 s). Monitors recorded pre- and post-run mean arterial blood pressure (MAP), 6-s average heart rate (HR) collected at prespecified points during exposures, documented dysrhythmias observed on continuous 3-lead ECG, self-reported symptoms, and objective signs of intolerance on real-time video monitoring.RESULTS: Participating in the study were 148 subjects (43 women). Documented dysrhythmias included sinus pause (N = 5), couplet premature ventricular contractions (N = 4), bigeminy (N = 3), accelerated idioventricular rhythm (N = 1), and relative bradycardia (RB, defined as a transient HR drop of >20 bpm; N = 63). None were associated with subjective symptoms or objective signs of acceleration intolerance. Episodes of RB occurred only during +G_x exposures. Subjects had a higher post-run vs. pre-run MAP after all exposures, but demonstrated no difference in pre- and post-run HR. RB was more common in men, younger individuals, and subjects experiencing more centrifuge runs.DISCUSSION: Dysrhythmias in laypersons undergoing simulated suborbital spaceflight were well tolerated, though RB was frequently noted during short-duration +G_x exposure. No subjects demonstrated associated symptoms or objective hemodynamic sequelae from these events. Even so, heightened caution remains warranted when monitoring dysrhythmias in laypersons with significant cardiopulmonary disease or taking medications that modulate cardiac conduction.Suresh R, Blue RS, Mathers CH, Castleberry TL, Vanderploeg JM. Dysrhythmias in laypersons during centrifuge-stimulated suborbital spaceflight. Aerosp Med Hum Perform. 2017; 88(11):1008–1015.

BACKGROUND: Participation rates in extreme sports have grown exponentially in the last 40 yr, often surpassing traditional sporting activities. The purpose of this study was to examine injury rates in foot-launched flying sports, i.e., sports in which a pilot foot-launches into flight with a wing already deployed.METHODS: This paper is based on a retrospective analysis of the reports of incidents that occurred between 2000 and 2014 among the British Hang Gliding and Paragliding Association members.RESULTS: The majority of the 1411 reported injuries were in the lower limb, followed by the upper limb. The most common lower limb injury was to the ankle and included fractures, sprains, and dislocations. The distribution of injures was different in each discipline. The calculated yearly fatality rate (fatalities/100,000 participants) was 40.4 in hang gliding, 47.1 in paragliding, 61.9 in powered hang gliding and 83.4 in powered paragliding; the overall value for foot-launched flight sports was 43.9.DISCUSSION: Significant differences in injury rates and injury patterns were found among different sport disciplines that can be useful to steer research on safety, and adopt specific safety rules about flying, protective clothing and safety systems in each of these sports.Feletti F, Aliverti A, Henjum M, Tarabini M, Brymer E. Incidents and injuries in foot-launched flying extreme sports. Aerosp Med Hum Perform. 2017; 88(11):1016–1023.

INTRODUCTION: Behavioral health is essential for the safety, well-being, and performance of crewmembers in both human spaceflight and Antarctic exploration. Over the past five decades, psychiatric issues have been documented in orbital spaceflight. In Antarctica, literature suggests up to 5% of wintering crewmembers could meet criteria for a psychiatric illness, including mood disorders, stressor-related disorders, sleep-wake disorders, and substance-related disorders. Experience from these settings indicates that psychiatric disorders on deep space missions must be anticipated. An important part of planning for the psychological health of crewmembers is the onboard provision of psychotropic drugs. These medications have been available on orbital missions. A greater variety and supply of these drugs exist at Antarctic facilities. The size and diversity of a deep space psychiatric formulary will be greater than that provided on orbital missions. Drugs to be provisioned include anxiolytics, antidepressants, mood stabilizers, antipsychotics, and hypnotics. Each drug category should include different medications, providing diverse pharmacokinetic, pharmacodynamic, and side effect profiles. The formulary itself should be rigorously controlled, given the abuse potential of some medications. In-flight treatment strategies could include psychological monitoring of well-being and early intervention for significant symptoms. Psychiatric emergencies would be treated aggressively with behavioral and pharmacological interventions to de-escalate potentially hazardous situations. On long-duration space missions, a robust psychiatric formulary could provide crewmembers autonomy and flexibility in treating a range of behavioral issues from depression to acute psychosis. This will contribute to the safety, health, and performance of crewmembers, and to mission success.Friedman E, Bui B. A psychiatric formulary for long-duration spaceflight. Aerosp Med Hum Perform. 2017; 88(11):1024–1033.

BACKGROUND: Acceleration load causes several physiological changes that play important roles in pilot performance. One of the problems is determining individual factors responsible for the differences in changes in the level of central nervous system (CNS) arousal after exposure to acceleration loads. We were interested in whether the coping style and anxiety as a trait might differentiate the subjects in terms of reactions of the CNS to +G_z load-related stress.METHODS: Examined were 31 male volunteers with ages between 23 and 30 yr. Measurements were obtained under controlled conditions before, during, and every 2 min up to 12 min after centrifugation. The study was conducted using the Coping Inventory for Stressful Situations (CISS) and State Trait Anxiety Inventory. The value of Critical Flicker Fusion Threshold (CFFT) corresponded to the level of CNS arousal.RESULTS: Two significantly different trends of changes in CNS arousal were identified: class 1 (higher level of fatigue following +G_z load) and class 2 (lower level of fatigue following +G_z load). Significant differences were observed in CISS scores with Task-Oriented Coping value in class 1 (M = 65.94, SD = 5.47) being considerably greater than in class 2 (M = 62, SD = 4.37). For Emotion-Oriented and Distraction Coping, the mean value in class 1 (M = 29.53, SD = 7.72; M = 16.82, SD = 3.8) was significantly lower than in class 2 (M = 34.33, SD = 6.68; M = 19.42, SD = 3.4).DISCUSSION: The nature of the changes in CFFT values over time is associated with coping style. Coping styles are very valuable in the prediction of CNS arousal caused by exposure to +G_z stress.Biernacki MP, Lewkowicz R, Zieliński P, Wojtkowiak M. Coping and changes in arousal after exposure to +G_z load. Aerosp Med Hum Perform. 2017; 88(11):1034–1039.

BACKGROUND: Laser devices are ubiquitous in everyday operations. These devices pose a hazard to the eye and numerous injuries have been documented. However, there lies a misunderstanding in the propensity to damage aircrews’ eyes during an exposure. Patient encounters and article review is presented in hopes to raise awareness that aircrew laser exposure at altitude, outside of critical phases of flight, is a distraction and not a threat. Also, to propose a change to Air Force policy regarding such exposures and further educating flight surgeons.METHODS: An electronic medical record (EMR) search at a deployed clinic was performed from July 2016 through Jan 2017. The “reason for visit” column was perused for any reference to the eye and laser exposure. Subsequently, the patient encounters were scrutinized specifically for eye injury, optometry visit, color of laser, and suspension of flight duties. All members were military aircrew spanning loadmasters, boom operators, and pilots. No protective lenses or other forms of optics were employed at time of exposure.RESULTS: There were 21 encounters reviewed; 1 patient was seen twice due to 2 separate instances. Of the encounters, 14 were green lasers, 6 did not comment, and 1 indicated white. Zero acute injuries were discovered.DISCUSSION: Patients were needlessly sent for further examination and prohibited from performing their duties. Following military patient encounters and civilian literature regarding laser injury, the evidence highly supports the hypothesis that hand-held laser exposure in flight from a ground base does not engender eye injury. More emphasis should be placed on recognizing the laser threat as a distraction or disruption to critical phases of flight, and a policy change may be in order for the USAF laser exposure guide.Dietrich KC. Aircrew and handheld laser exposure. Aerosp Med Hum Perform. 2017; 88(11):1040–1042.

BACKGROUND: An aircraft’s orientation relative to the ground cannot be perceived via the sense of balance or the somatosensory system. When devoid of external visual references, the pilot must rely on instruments. A sudden unexpected instrument indication is a challenge to the pilot, who might have to question the instrument instead of responding with the controls. In this case report we analyze, from a human-factors perspective, how a limited instrument failure led to a fatal accident.CASE REPORT: During straight-ahead level flight in darkness, at 33,000 ft, the commander of a civil cargo airplane was suddenly confronted by an erroneous pitch-up indication on his primary flight display. He responded by pushing the control column forward, making a bunt maneuver with reduced/negative G_z during approximately 15 s. The pilots did not communicate rationally or cross-check instruments. Recordings of elevator and aileron positions suggest that the commander made intense efforts to correct for several extreme and erroneous roll and pitch indications. G_z displayed an increasing trend with rapid fluctuations and peaks of approximately 3 G. After 50 s the aircraft entered a turn with decreasing radius and finally hit the ground in an inverted attitude.DISCUSSION: A precipitate maneuvring response can, even if occurring in a large aircraft at high altitude, result in a seemingly inexorable course of events, ending with a crash. In the present case both pilots were probably incapacitated by acute psychological stress and spatial disorientation. Intense variations in G_z may have impaired the copilot’s reading of the functioning primary flight display.Tribukait A, Eiken O. Instrument failure, stress, and spatial disorientation leading to a fatal crash with a large aircraft. Aerosp Med Hum Perform. 2017; 88(11):1043–1048.

Speakman RO. You’re the flight surgeon: hypertension, when it doesn’t add up. Aerosp Med Hum Perform. 2017; 88(11):1049–1052.

Pelligra S. You’re the flight surgeon: decompression illness following altitude chamber exposure. Aerosp Med Hum Perform. 2017; 88(11):1052–1055.