INTRODUCTION: Aircrew viewing eyepiece-injected symbology on color display night vision goggles (CDNVGs) are performing a visual task involving color under highly unnatural viewing conditions. Their performance in discriminating different colors and responding to color cues is unknown.METHODS: Experimental laboratory measurements of 1) color discrimination and 2) visual search performance are reported under adaptation conditions representative of a CDNVG. Color discrimination was measured using a two-alternative forced choice (2AFC) paradigm that probes color space uniformly around a white point. Search times in the presence of different degrees of clutter (distractors in the scene) are measured for different potential symbology colors.RESULTS: The discrimination data support previous data suggesting that discrimination is best for colors close to the adapting point in color space (P43 phosphor in this case). There were highly significant effects of background adaptation (white or green) and test color. The search time data show that saturated colors with the greatest chromatic contrast with respect to the background lead to the shortest search times, associated with the greatest saliency. Search times for the green background were around 150 ms longer than for the white. Desaturated colors, along with those close to a typical CDNVG display phosphor in color space, should be avoided by CDNVG designers if the greatest conspicuity of symbology is desired.DISCUSSION: The results can be used by CDNVG symbology designers to optimize aircrew performance subject to wider constraints arising from the way color is used in the existing conventional cockpit instruments and displays.Liggins EP, Serle WP. Color vision in color display night vision goggles. Aerosp Med Hum Perform. 2017; 88(5):448–456.

BACKGROUND: The objective was to determine if short term exposure to dry immersion (DI) results in a cephalic fluid shift similar to what has been observed with spaceflight.METHODS: Data were collected from 10 individuals at rest and during the first 2 h of dry immersion. Jugular vein (JV), portal vein (PV), and thyroid volume were measured using 3D echography. Middle cerebral vein velocity (MCVv) was determined using transcranial Doppler ultrasound. The cochlear response to audio stimulation was used to derive an estimate of intracranial pressure (dICP).RESULTS: After 2 h of DI, there was a significant increase (mean ± SD) in JV (2.21 ± 1.10 mL), PV (1.05 ± 0.48 mL), and thyroid (0.428 ± 0.313 mL) volume. MCVv was also significantly increased with DI (3.90 ± 5.03 cm · s⁻¹). There was no change in dICP with DI in part due to large individual variability. The range of dICP changes appeared to be related to MCVv, with participants with the largest increase in MCVv also showing increased dICP.DISCUSSION: The results suggest that DI induces a significant cephalic fluid shift similar to what is observed with spaceflight. The increased thyroid volume suggests that cerebral tissue may also be subjected to similar fluid filtration, with implications for changes in intracranial pressure. However, despite all participants having an increase in JV and thyroid volume, only half showed an increase in dICP, suggesting that increased venous pooling alone is not sufficient to cause increased intracranial pressure.Arbeille P, Avan P, Treffel L, Zuj K, Normand H, Denise P. Jugular and portal vein volume, middle cerebral vein velocity, and intracranial pressure in dry immersion. Aerosp Med Hum Perform. 2017; 88(5):457–462.

BACKGROUND: This paper examines the subjective sense of orientation during asymmetric body rotations in normal subjects.METHODS: Self-motion perception was investigated in 10 healthy individuals during asymmetric whole-body rotation with different head orientations. Both on-vertical axis and off-vertical axis rotations were employed. Subjects tracked a remembered earth-fixed visual target while rotating in the dark for four cycles of asymmetric rotation (two half-sinusoidal cycles of the same amplitude, but of different duration).RESULTS: The rotations induced a bias in the perception of velocity (more pronounced with fast than with slow motion). At the end of rotation, a marked target position error (TPE) was present. For the on-vertical axis rotations, the TPE was no different if the rotations were performed with a 30° nose-down, a 60° nose-up, or a 90° side-down head tilt. With off-vertical axis rotations, the simultaneous activation of the semicircular canals and otolithic receptors produced a significant increase of TPE for all head positions.DISCUSSIONS: This difference between on-vertical and off-vertical axis rotation was probably partly due to the vestibular transfer function and partly due to different adaptation to the speed of rotation. Such a phenomenon might be generated in different components of the vestibular system. The adaptive process enhancing the perception of dynamic movement around the vertical axis is not related to the specific semicircular canals that are activated; the addition of an otolithic component results in a significant increase of the TPE.Panichi R, Occhigrossi C, Ferraresi A, Faralli M, Lucertini M, Pettorossi VE. Adaptive changes in the perception of fast and slow movement at different head positions. Aerosp Med Hum Perform. 2017; 88(5):463–468.

BACKGROUND: Divers try to limit risks associated with their sport, for instance by breathing enriched air nitrox (EANx) instead of air. This double blinded, randomized trial was designed to see if the use of EANx could effectively improve cognitive performance while diving.METHODS: Eight volunteers performed two no-decompression dry dives breathing air or EANx for 20 min at 0.4 MPa. Cognitive functions were assessed with a computerized test battery, including MathProc and Ptrail. Measurements were taken before the dive, upon arrival and after 15 min at depth, upon surfacing, and at 30 min postdive. After each dive subjects were asked to identify the gas they had just breathed.RESULTS: Identification of the breathing gas was not possible on subjective assessment alone, while cognitive assessments showed significantly better performance while breathing EANx. Before the dives, breathing air, mean time to complete the task was 1795 ms for MathProc and 1905 ms for Ptrail. When arriving at depth MathProc took 1616 ms on air and 1523 ms on EANx, and Ptrail took 1318 ms on air and and 1356 ms on EANx, followed 15 min later by significant performance inhibition while breathing air during the ascent and the postdive phase, supporting the concept of late dive/postdive impairment.DISCUSSION: The results suggest that EANx could protect against decreased neuro-cognitive performance induced by inert gas narcosis. It was not possible for blinded divers to identify which gas they were breathing and differences in postdive fatigue between air and EANx diving deserve further investigation.Germonpré P, Balestra C, Hemelryck W, Buzzacott P, Lafère P. Objective vs. subjective evaluation of cognitive performance during 0.4-MPa dives breathing air or nitrox. Aerosp Med Hum Perform. 2017; 88(5):469–475.

INTRODUCTION: Many countries have developed their own airborne early warning and control (AEW&C) systems for use in surveying their territorial sky in real time. However, a review of the literature suggests that no studies have been conducted to analyze the cervical spine of pilots and air-controllers of AEW&C aircraft.METHODS: The study subjects were 80 pilots and air-controllers of AEW&C aircraft with a period of service of > 1 yr and had data on physical examinations, simple radiographs and functional scores of the axial skeleton, and questionnaires about lifestyle and working conditions. Information about physical characteristics and experience of neck pain were collected. Functional scores including the neck disability index and short-form 36-item health survey were obtained. Radiological measurements were performed for the C2-7 Cobb angle and degree of forward head posture.RESULTS: Of the 80 subjects, 33 (41.3%) had experienced neck pain and 63 (78.8%) had impaired cervical lordosis. The results of functional and radiological evaluations were not significantly different between pilots and air-controllers. In multivariate analysis, only the age was significantly related to the occurrence of impaired cervical lordosis. However, there were no significant factors related to the occurrence of neck pain.DISCUSSION: The results of this study suggest that the working environment of pilots and air-controllers of AEW&C aircraft has a negative effect on their cervical spine. Age seemed to be the most significant factor affecting the occurrence of impaired cervical lordosis in these subjects.Shin YH, Yun C, Han AH. Cervical spine status of pilots and air-controllers of airborne early warning and control aircraft. Aerosp Med Hum Perform. 2017; 88(5):476–480.

BACKGROUND: The minimum flight crew on the flight deck should be established according to the workload for individual crewmembers. Typical workload measures consist of three types: subjective rating scale, task performance, and psychophysiological measures. However, all these measures have their own limitations. To reflect flight crew workload more specifically and comprehensively within the flight environment, and more directly comply with airworthiness regulations, the Workload Function Distribution Method, which combined the basic six workload functions, was proposed.METHODS: The analysis was based on the different conditions of workload function numbers. Each condition was analyzed from two aspects, which were overall proportion and effective proportion. Three types of approach tasks were used in this study and the NASA-TLX scale was implemented for comparison.RESULTS: Neither the one-function condition nor the two-function condition had the same results with NASA-TLX. However, both the three-function and the four- to six- function conditions were identical with NASA-TLX. Further, the significant differences were different on four to six conditions. The overall proportion was insignificant, while the effective proportions were significant.DISCUSSION: The results show that the conditions with one function and two functions seemed to have no influence on workload, while executing three functions and four to six functions had an impact on workload. Besides, effective proportions of workload functions were more precisely compared with the overall proportions to indicate workload, especially in the conditions with multiple functions.Zheng Y, Lu Y, Jie Y, Fu S. Flight crew workload evaluation based on the workload function distribution method. Aerosp Med Hum Perform. 2017; 88(5):481–486.

BACKGROUND: Aviation is a classic example of a high reliability organization (HRO)—an organization in which catastrophic events are expected to occur without control measures. As health care systems transition toward high reliability, aviation practices are increasingly transferred for clinical implementation.METHODS: A PubMed search using the terms aviation, crew resource management, and patient safety was undertaken. Manuscripts authored by physician pilots and accident investigation regulations were analyzed. Subject matter experts involved in adoption of aviation practices into the medical field were interviewed.RESULTS: A PubMed search yielded 621 results with 22 relevant for inclusion. Improved clinical outcomes were noted in five research trials in which aviation practices were adopted, particularly with regard to checklist usage and crew resource-management training. Effectiveness of interventions was influenced by intensity of application, leadership involvement, and provision of staff training. The usefulness of incorporating mishap investigation techniques has not been established. Whereas aviation accident investigation is highly standardized, the investigation of medical error is characterized by variation.DISCUSSION: The adoption of aviation practices into clinical medicine facilitates an evolution toward high reliability. Evidence for the efficacy of the checklist and crew resource-management training is robust. Transference of aviation accident investigation practices is preliminary. A standardized, independent investigation process could facilitate the development of a safety culture commensurate with that achieved in the aviation industry.Powell-Dunford N, McPherson MK, Pina JS, Gaydos SJ. Transferring aviation practices into clinical medicine for the promotion of high reliability. Aerosp Med Hum Perform. 2017; 88(5):487–491.

INTRODUCTION: Recent research has postulated increased cardiovascular mortality for astronauts who participated in the Apollo lunar missions. The conclusions, however, are based on small numbers of astronauts, are derived from methods with known weaknesses, and are not consistent with prior research.METHODS: Records for NASA astronauts and U.S. Air Force astronauts were analyzed to produce standardized mortality ratios. Lunar astronauts were compared to astronauts who have never flown in space (nonflight astronauts), those who have only flown missions in low Earth orbit (LEO astronauts), and the U.S. general population.RESULTS: Lunar astronauts were significantly older at cohort entry than other astronaut group and lunar astronauts alive as of the end of 2015 were significantly older than nonflight astronauts and LEO astronauts. No significant differences in cardiovascular disease (CVD) mortality rates between astronaut groups was observed, though lunar astronauts were noted to be at significantly lower risk of death by CVD than are members of the U.S. general population (SMR = 13, 95% CI = 3–39).DISCUSSION: The differences in age structure between lunar and nonlunar astronauts and the deaths of LEO astronauts from external causes at young ages lead to confounding in proportional mortality studies of astronauts. When age and follow-up time are properly taken into account using cohort-based methods, no significant difference in CVD mortality rates is observed. Care should be taken to select the correct study design, outcome definition, exposure classification, and analysis when answering questions involving rare occupational exposures.Reynolds RJ, Day SM. Mortality due to cardiovascular disease among Apollo lunar astronauts. Aerosp Med Hum Perform. 2017; 88(5):492–496.

BACKGROUND: To examine the causes and factors of airplane landings on highways and the dangers to occupants of vehicles on the ground.METHODS: The U.S. National Transportation Safety Board online database provided 133 accidents involving a highway landing dating from 2000 to 2013. Supplemental information was sought in online media archives, which reported on 53 of these accidents. Collisions with highway-related objects, other options for landing, and witness accounts were added categories extracted from the narrative statements and media reports.RESULTS: Highway landings occur mostly due to mechanical failures, ineffective preflight or in-flight planning, and fuel exhaustion, in addition to a lack of alternate landing options for a pilot of a fixed-wing aircraft. Most of the landings (N = 108) lead to minor or no injuries at all. A significant proportion of 7 out of 19 collisions with powerlines resulted in a fatality, as opposed to other types of accidents. Collisions with motor vehicles (N = 29) caused minor (N = 23) and serious (N = 2) injuries to people on the ground. Main online media archives covered less than half of all accidents (39.8%).DISCUSSION: While highway landings are not a recommended landing alternative, mitigation strategies should include a focus on avoiding powerlines and vehicles on the ground. Unfortunately, online media archives are not yet a consistent source of information for general aviation accidents.Holzman E, de Voogt A. Emergency highway landings in general aviation and the possible role of media reports. Aerosp Med Hum Perform. 2017; 88(5):497–499.

BACKGROUND: Benign episodic unilateral mydriasis is one cause of anisocoria. This phenomenon is thought to be related to an imbalance between the sympathetic and parasympathetic nervous systems. There is a documented association with migraines, but asymptomatic cases have also been reported. A challenge with all cases is the level of investigation required to exclude more sinister causes of nervous system dysfunction. In a dynamic flight environment, additional considerations need to be made, such as varying light levels and use of night vision devices.CASE REPORT: A 27-yr-old woman on deployment to Afghanistan as a flight nurse presented to the role one clinic with right-sided mydriasis. The patient denied headache or any history of migraines. A dilated right pupil that was reactive to light was found on exam. Symptoms and exam findings resolved shortly after initial presentation. We consulted an ophthalmologist who requested patient transfer for review. He made a diagnosis of benign episodic unilateral mydriasis.DISCUSSION: There are a variety of causes for anisocoria. A thorough history and examination are required to avoid unnecessary investigations that may not be locally available in the more austere deployed military settings. From an operational perspective, the decision needs to be made regarding the maintenance of flight status. Consideration needs to be given to patient care capability when treating a flight nurse. In cases of rapid resolution such as this, removal from operational status is not reasonable should a clinician be confident of the diagnosis.Schiemer A. Benign episodic unilateral mydriasis in a flight nurse. Aerosp Med Hum Perform. 2017; 88(5):500–502.

BACKGROUND: Blood-injection-injury (B-I-I) phobia is capable of producing inaccurate hypoxic challenge testing results due to anxiety-induced hyperventilation.CASE REPORT: A 69-yr-old woman with a history of hypersensitivity pneumonitis, restrictive spirometry, exercise desaturation requiring supplementary oxygen on mobilizing, reduced DLco, and B-I-I phobia was referred for hypoxic challenge testing (HCT) to assess in-flight oxygen requirements. HCT was performed by breathing a 15% F_Io₂ gas mixture, simulating the available oxygen in ambient air onboard aircraft pressurized to an equivalent altitude of 8000 ft. S_po₂ fell to a nadir value of 81% during HCT, although it rapidly increased to 89% during the first of two attempts at blood gas sampling. A resultant blood gas sample showed an acceptable Po₂ outside the criteria for recommending in-flight oxygen and a reduced Pco₂. Entering the nadir S_po₂ value into the Severinghaus equation gives an estimated arterial Po₂ of 6 kPa (45 mmHg), which was felt to be more representative of resting values during HCT, and in-flight oxygen was recommended.DISCUSSION: While hyperventilation is an expected response to hypoxia, transient rises in S_po₂ coinciding with threat of injury are likely to be attributable to emotional stress-induced hyperventilation, characteristic of B-I-I specific phobia and expected during the anticipation of exteroceptive threat, even in normal subjects. In summary, should excessive hyperventilation be detected during HCT and coincide with transient increases in S_po₂, HCT should be repeated using S_po₂ only as a guide to the level of hypoxemia, and S_po₂ maintained using supplementary oxygen in accordance with alternative methods described in guidelines.Spurling KJ, McGoldrick VP. Blood-injection-injury (B-I-I) specific phobia affects the outcome of hypoxic challenge testing. Aerosp Med Hum Perform. 2017; 88(5):503–506.

McLaughlin CM. You’re the flight surgeon: atypical hypothyroid presentation. Aerosp Med Hum Perform. 2017; 88(5):509–511.

Chumbley EM. You’re the flight surgeon: a case of bilateral leg pain and swelling in a loadmaster. Aerosp Med Hum Perform. 2017; 88(5):511–515.