INTRODUCTION: Virtual reality (VR) can provide exposure to nature for those living in isolated confined environments. We evaluated VR-presented natural settings for reducing stress and improving mood.METHODS: There were 18 participants (9 men, 9 women), ages 32 ± 12 yr, who viewed three 15-min 360° scenes (an indoor control, rural Ireland, and remote beaches). Subjects were mentally stressed with arithmetic before scenes. Electrodermal activity (EDA) and heart rate variability measured psycho-physiological arousal. The Positive and Negative Affect Schedule and the 15-question Modified Reality Judgment and Presence Questionnaire (MRJPQ) measured mood and scene quality.RESULTS: Reductions in EDA from baseline were greater at the end of the natural scenes compared to the control scene (−0.59, −0.52, and 0.32 μS, respectively). The natural scenes reduced negative affect from baseline (Δ = 1.2 and Δ = 1.1 points), but the control scene did not (Δ = 0.4 points). MRJPQ scores for the control scene were lower than both natural scenes (4.9, 6.7, and 6.5 points, respectively). Within the two natural scenes, the preferred scene reduced negative affect (Δ = 2.4 points) more than the second choice scene (Δ = 1.8 points) and scored higher on the MRJPQ (6.8 vs. 6.4 points).DISCUSSION: Natural scene VR provided relaxation both objectively and subjectively, and scene preference had a significant effect on mood and perception of scene quality. VR may enable relaxation for people living in isolated confined environments, particularly when matched to personal preferences.Anderson AP, Mayer MD, Fellows AM, Cowan DR, Hegel MT, Buckey JC. Relaxation with immersive natural scenes presented using virtual reality. Aerosp Med Hum Perform. 2017; 88(6):520526.

INTRODUCTION: Microgravity (μG) exposure and even early recovery from μG in combination with mild hypoxia may increase the alveolar-arterial oxygen (O₂) partial pressure gradient.METHODS: Four male astronauts on STS-69 (1995) and four on STS-72 (1996) were exposed on Earth to an acute sequential hypoxic challenge by breathing for 4 min 18.0%, 14.9%, 13.5%, 12.9%, and 12.2% oxygen–balance nitrogen. The 18.0% O₂ mixture at sea level resulted in an inspired O₂ partial pressure (P_Io₂) of 127 mmHg. The equivalent P_IO₂ was also achieved by breathing 26.5% O₂ at 527 mmHg that occurred for several days in μG on the Space Shuttle. A Novametrix CO₂SMO Model 7100 recorded hemoglobin (Hb) oxygen saturation through finger pulse oximetry (S_po₂, %). There were 12 in-flight measurements collected. Measurements were also taken the day of (R+0) and 2 d after (R+2) return to Earth. Linear mixed effects models assessed changes in S_po₂ during and after exposure to μG.RESULTS: Astronaut S_po₂ levels at baseline, R+0, and R+2 were not significantly different from in flight, about 97% given a P_Io₂ of 127 mmHg. There was also no difference in astronaut S_po₂ levels between baseline and R+0 or R+2 over the hypoxic challenge.CONCLUSIONS: The multitude of physiological changes associated with μG and during recovery from μG did not affect astronaut S_po₂ under hypoxic challenge.Conkin J, Wessel JH III, Norcross JR, Bekdash OS, Abercromby AFJ, Koslovsky MD, Gernhardt ML. Hemoglobin oxygen saturation with mild hypoxia and microgravity. Aerosp Med Hum Perform. 2017; 88(6):527–534.

BACKGROUND: The study of personality traits, personal values, and the emergence of conflicts within groups performing in an isolated, confined, and extreme environment (ICE) may provide insights helpful for the composition and support of space crews for long duration missions.METHODS: Studied pre/post and over the 2-yr period of the investigation were 10 Danish military personnel deployed to stations in Greenland on a 26-mo staggered rotation. Subjects completed the NEO PI-R, Triarchic Psychopathy Measure, and Portrait Values Questionnaire, and participated in structured interviews. During deployment, questionnaires were completed biweekly and a cognitive function test once a month.RESULTS: Personality findings indicated a generally well-adjusted group, above average in positive personality traits [Conscientiousness T-score = 59.4 (11.41); Agreeableness T-score = 54.4 (9.36)] and boldness. Personal values of benevolence and self-direction were highly rated. The decision when to “pick sides” and intervene during disagreements between group members was viewed as an important component of conflict resolution. There were no changes in positive/negative affect or cognitive function over the annual light/dark cycle.DISCUSSION: The personal values of group members appear highly compatible for living in a small group ICE environment for an extended period. Disagreements between group members impact the functioning of the entire group, particularly in regard to decisions whether to support one of the individuals or let the argument run its course. Extended training in strategies for conflict resolution are needed in planning for future long duration missions to avoid fault lines forming within the group.Corneliussen JG, Leon GR, Kjærgaard A, Fink BA, Venables NC. Individual traits, personal values, and conflict resolution in an isolated, confined, extreme environment. Aerosp Med Hum Perform. 2017; 88(6):535–543.

INTRODUCTION: Hypoxic environments increase the physiological demands of exercise. Inspiratory muscle training can reduce the demands of exhaustive exercise in this environment. This study examined the impact of inspiratory muscle training on moderate intensity hypoxic cycling exercise.METHODS: There were 17 healthy adult men who undertook 4 wk of inspiratory muscle training (N = 8) or 4 wk of sham inspiratory muscle training (N = 9). Subjects completed four fixed intensity (100 W) and duration (10 min) cycle ergometry tests. Two were undertaken breathing normoxic ambient air and two breathing a hypoxic gas mixture (14.6% oxygen, balance nitrogen). One normoxic and hypoxic test occurred before, and one after, inspiratory muscle training.RESULTS: Inspiratory muscle training increased maximal inspiratory mouth pressure by 21 ± 16 cmH₂O. Arterial oxygen saturation and its ratio to minute ventilation also increased after inspiratory muscle training during hypoxic exercise from 83 ± 4% to 86 ± 3% (approximately 3%) and 2.95 ± 0.48 to 3.52 ± 0.54% · L · min⁻¹(approximately 21%), respectively. In addition, minute ventilation and carbon dioxide output fell by 12–13% after inspiratory muscle training during hypoxic exercise.DISCUSSION: Inspiratory muscle training reduced the physiological demand of moderate intensity exercise during acute hypoxic, but not normoxic, exercise. It may therefore be of benefit in adults exercising in a hypoxic environment.Lomax M, Massey HC, House JR. Inspiratory muscle training effects on cycling during acute hypoxic exposure. Aerosp Med Hum Perform. 2017; 88(6):544–549.

INTRODUCTION: Exposure to sustained +G_z acceleration with inadequate G protection can result in G-induced loss of consciousness (G-LOC) or almost loss of consciousness (A-LOC). The UK Royal Air Force (RAF) last conducted a survey of G-LOC within their military aircrew in 2005 with interventions subsequently introduced. The aim of this study was to repeat the 2005 survey in order to evaluate the impact of those interventions.METHODS: An anonymous questionnaire requesting details of G-LOC and A-LOC events was mailed to all RAF pilots (N = 1878) and weapons systems operators (WSOs) (N = 473), irrespective of aircraft currently flown.RESULTS: The questionnaire was returned by 809 aircrew (34.4% response rate). There were 120 (14.8%) aircrew who reported at least one episode of G-LOC and 260 (32.2%) reported at least one episode of A-LOC. The reported prevalence of G-LOC in the previous 2005 survey was 20.1% (N = 454). There was an increased reporting of G-LOC in the Hawk, Tucano, and Grob Tutor aircraft, with 5 G-LOC and 19 A-LOC events reported in the Grob Tutor compared to none in 2005.DISCUSSION: The prevalence of reported G-LOC has decreased in the surveyed populations, which may be due to the introduction of centrifuge training, but also may be influenced by patterns of G exposure and other factors. Scope for further reduction remains through correct execution of the anti-G straining maneuver (AGSM) with centrifuge training early in flying training and use of a structured conditioning program to increase the general strength of muscles involved in the AGSM.Slungaard E, McLeod J, Green NDC, Kiran A, Newham DJ, Harridge SDR. Incidence of G-induced loss of consciousness and almost loss of consciousness in the Royal Air Force. Aerosp Med Hum Perform. 2017; 88(6):550–555.

INTRODUCTION: General aviation (GA) accidents have continued to demonstrate high fatality rates. Recently, ballistic parachute recovery systems (BPRS) have been introduced as a safety feature in some GA aircraft. This study evaluates the effectiveness and associated factors of the Cirrus Airframe Parachute System (CAPS) at reducing the odds of a fatal accident in Cirrus aircraft crashes.METHODS: Publicly available Cirrus aircraft crash reports were obtained from the National Transportation Safety Board (NTSB) database for the period of January 1, 2001–December 31, 2016. Accident metrics were evaluated through univariate and multivariate analyses regarding odds of a fatal accident and use of the parachute system.RESULTS: Included in the study were 268 accidents. For CAPS nondeployed accidents, 82 of 211 (38.9%) were fatal as compared to 8 of 57 (14.0%) for CAPS deployed accidents. After controlling for all other factors, the adjusted odds ratio for a fatal accident when CAPS was not deployed was 13.1.DISCUSSION: The substantial increased odds of a fatal accident when CAPS was not deployed demonstrated the effectiveness of CAPS at providing protection of occupants during an accident. Injuries were shifted from fatal to serious or minor with the use of CAPS and postcrash fires were significantly reduced. These results suggest that BPRS could play a significant role in the next major advance in improving GA accident survival.Alaziz M, Stolfi A, Olson DM. Cirrus Airframe Parachute System and odds of a fatal accident in Cirrus aircraft crashes. Aerosp Med Hum Perform. 2017; 88(6):556–564.

INTRODUCTION: Preparation and training for long-duration spaceflight bring with them psychosocial stressors potentially affecting the well-being and performance of astronauts, before and during spaceflight. Social support from within the workplace may mitigate behavioral health concerns arising during the preflight period and enhance resiliency before and during extended missions. The purpose of this review was to evaluate evidence addressing the viability of workplace social support as a pre-mission countermeasure, specifically addressing: 1) the observed relationships between workplace social support and behavioral health; 2) perceived need, acceptability, and format preference for workplace social support among high-achievers; 3) potential barriers to delivery/receipt of workplace social support; 4) workplace social support interventions; and 5) delivery timeframe and anticipated duration of workplace social support countermeasure benefits.METHODS: We conducted an evidence review examining workplace social support in professional contexts sharing one or more characteristics with astronauts and spaceflight. Terms included populations of interest, social support constructs, and behavioral health outcomes. Abstracts of matches were subsequently reviewed for relevance and quality.RESULTS: Research findings demonstrate clear associations between workplace social support and behavioral health, especially following exposure to stress. Further, studies indicate strong need for support and acceptability of support countermeasures, despite barriers. Our review revealed two general formats for providing support (i.e., direct provision of support and training to optimize skills in provision and receipt of support) with potential differentiation of expected duration of benefits, according to format.DISCUSSION: Workplace social support countermeasures hold promise for effective application during pre-mission phases of long-duration spaceflight. Specific recommendations are provided.Deming CA, Vasterling JJ. Workplace social support and behavioral health prior to long-duration spaceflight. Aerosp Med Hum Perform. 2017; 88(6):565–573.

BACKGROUND: Keratoconus is a progressive noninflammatory ectatic corneal dystrophy, characterized by corneal thinning and increased curvature with central or paracentral tapered protrusion. Such changes in corneal morphology induce irregular astigmatism and myopia, resulting in visual acuity impairment. This report assesses cases in which keratoconus is not an absolute disabling condition for civil aviation pilots.METHODS: Six cases of keratoconus in active pilots are presented. This report includes cases which were treated with crosslinking therapy and even corneal transplantation. In such cases, the civil aviation medical authority considered four aspects in the medical assessment: best corrected visual acuity, condition stability, risk of sudden incapacitation, and pilot category.RESULTS: Six civil pilots with ages between 19 and 45 yr of age presented with keratoconus in different stages. Using the Snellen scale, best corrected visual acuity (BCVA) was measured in 12 eyes, all of them having equal or better than 20/30 (20/20, N = 9; 20/25, N = 2; 20/30, N = 1). All of them are currently fit for aviation activity and have been given an aviation medical certificate with limitation of use of corrective lenses by the Brazilian Civil Aviation Authority (ANAC in Portuguese). Among these cases, there is a pilot who had undergone treatment with crosslinking therapy and another that had undergone corneal transplantation.DISCUSSION: These cases demonstrate that keratoconus is not always a disabling condition for civil aviation pilots. Nevertheless, it has to be analyzed on a case-by-case basis.Rebello A, Rodrigues B, Pereira M. Keratoconus in civil aviation pilots in a report of six cases. Aerosp Med Hum Perform. 2017; 88(6):574–578.

BACKGROUND: Sailors in the U.S. Navy are habitual shiftworkers, often experiencing circadian misalignment due to their irregular work/rest schedules. This study assessed the effect of sunlight exposure, work hours, and caffeinated beverage consumption on the daily sleep duration of crewmembers of a U.S. Navy ship during a 2-wk underway period.METHODS: Working in an artificially lit area with no access to sunlight during work hours, U.S. Navy crew members (N = 91) used daily logs to report their daily activity, caffeinated beverage consumption, and exposure to sunlight while off-duty; sleep was assessed by wrist-worn actigraphy.RESULTS: Hours of sunlight exposure, work duration, and the amount of coffee/tea/soft drinks were statistically significant predictors of sleep duration. On average, crewmembers who reported more than one half-hour of sunlight each day slept on average ∼40 min (10%) less than their peers working the same shifts who received less than one half-hour of sunlight (on average 6.05 ± 0.90 h vs. 6.71 ± 0.91 h, respectively).DISCUSSION: Exposure to sunlight, work hours, and consumption of caffeinated beverages are important factors when planning watchstanding schedules at sea. Even though further research is needed, our results suggest that even brief exposure to sunlight may contribute to circadian misalignment that negatively affects sleep in the operational environment. Educating crewmembers about sleep hygiene, especially the important roles played by sunlight and caffeine, could potentially improve the sleep and fatigue levels of this population of maritime shiftworkers.Shattuck NL, Matsangas P. Sunlight exposure, work hours, caffeine consumption, and sleep duration in the naval environment. Aerosp Med Hum Perform. 2017; 88(6):579–585.

INTRODUCTION: Local heat urticaria is a physical urticaria caused by the environmental stimulus of heat. Typically, the resultant lesion, a wheal, is pruritic (itches) and is sometimes accompanied by a burning sensation. It is a self-limited phenomenon that resolves after 1.5–2 h. The prevalence of local heat urticaria in the general population has been estimated as 1 in 200,000 persons.CASE REPORT: The subject, a 39-yr-old active duty man, participated in a test of a 95-GHz energy beam designed to heat the skin. He had delayed presentation of raised, erythematous, nonpruritic, nonpainful areas at five of the exposure sites where the skin temperature exceeded 54°C. All wheals resolved within 2 h of the exposures.Gibbons JA. Localized heat urticaria from 95-GHz millimeter waves. Aerosp Med Hum Perform. 2017; 88(6):586–588.

INTRODUCTION: The Mark III (MIII) space suit assembly (SSAs) implements a multibearing, hard-material hip brief assembly (HBA). We hypothesize that: 1) the MIII HBA restricts operator mobility and agility which manifests in effects to gait parameters; 2) the waist bearing provides rotational motion, partially alleviating the restrictions; and 3) there are resistive, speed-dependent torques associated with the spinning bearings which further diminish mobility and agility.METHODS: A subject (Suited and Unsuited) performed two planetary tasks—walking forward (WF) and backward (WB). An analysis of variance (ANOVA) and post hoc comparisons were performed to determine interaction effects. Motion capture data was processed to obtain gait parameters: static base (m), dynamic base (m), step length (m), stride length (m), cadence (steps/min), center of mass speed (m · s⁻¹), foot clearance (toe and heel) (m), and bearing angular velocities (° · s⁻¹).RESULTS: The static base when Suited (0.355 m) was larger than Unsuited (0.263 m). The Suited dynamic base (pooled, 0.200 m) was larger than both Unsuited WF (0.081 m) and WB (0.107 m). When Suited, the operator had lower clearance heights. The waist bearings provided about 7.2° of rotation when WB and WF. The maximum torque, while WF, in the right upper and mid bearings was 15.6 ± 1.35 Nm and 16.3 ± 1.28 Nm.DISCUSSION: This study integrated suit component properties and the emergent biomechanics of the operator to investigate how biomechanics are affected. The human hip has three collocated degrees of freedom (DOFs), whereas the HBA has a single DOF per bearing. The results can inform requirements for future SSA and other wearable system designs and evaluations.Cullinane CR, Rhodes RA, Stirling LA. Mobility and agility during locomotion in the Mark III space suit. Aerosp Med Hum Perform. 2017; 88(6):589–596.

Frayser MR. You’re the flight surgeon: Bell’s palsy. Aerop Med Hum Perform. 2017; 88(6):601–604.

Watkins-Nance SM. You’re the flight surgeon: atrial septal defect. Aerosp Med Hum Perform. 2017; 88(6):604–607.