BACKGROUND: Hypoxia continues to present risks in military aviation. Hypoxia symptoms include sensory and cognitive effects; of these, it is important to identify which components of operator performance are most vulnerable to hypoxia-induced decline in order to determine which sensory modality is most effective for alerting an impaired aviator of an imminent hypoxic episode.METHODS: A study was performed in a hypobaric chamber to characterize deterioration of cognitive performance under moderate (MH) and severe (SH) hypoxia conditions, culminating in subjects’ inability to perform tasks. Subjects operated a synthetic workstation, performing multiple simultaneous tasks during hypobaric exposures equivalent to 5486 m (18,000 ft) MH and 7620 m (25,000 ft) SH ascents. Performance was compared across baseline, altitude exposure, and recovery periods within MH vs. SH altitude profiles. Ascents lasted until at least one of a list of termination criteria was met, at which point the chamber was returned to ground level pressure and the subject resumed workstation performance during recovery.RESULTS: SH conditions generated greater deficits than MH conditions, and these more severe effects hastened the termination of exposures (5 vs. 18 min mean duration, respectively). Workstation performance collapsed rapidly on SH exposure, with Mathematics and Auditory Monitoring tasks proving vulnerable to breakdown. In MH exposures, these tasks exhibited impaired accuracy (declining 11% and 9%, respectively) and speed, with declines in Auditory Monitoring lingering into recovery.DISCUSSION: The relative robustness of memory and visual monitoring vs. the vulnerability of mathematical and auditory processing suggest that care should be taken designing purely auditory cockpit hypoxia warning alerts.Beer JMA, Shender BS, Chauvin D, Dart TS, Fischer J. Cognitive deterioration in moderate and severe hypobaric hypoxia conditions. Aerosp Med Hum Perform. 2017; 88(7):617–626.

BACKGROUND: An acute bout of exercise can improve cognitive function in normoxic and hypoxic conditions. However, limited research supports the improvement of cognitive function and mood state in women. The purpose of this study was to examine the effects of hypoxia and exercise on working memory and mood state in women.METHODS: There were 15 healthy women (age = 22 ± 2 yr) who completed the Automated Neuropsychological Assessment Metrics-4^th Edition (ANAM), including the Running Memory Continuous Performance Task (RMCPT) and Total Mood Disturbance (TMD) in normoxia (21% O₂), at rest in normoxia and hypoxia (12.5% O₂), and during cycling exercise at 60% and 40% Vo_2max in hypoxia.RESULTS: RMCPT was not significantly impaired at 30 (100.3 ± 17.2) and 60 (96.6 ± 17.3) min rest in hypoxia compared to baseline in normoxia (97.0 ± 17.0). However, RMCPT was significantly improved during exercise (106.7 ± 20.8) at 60% Vo_2max compared to 60 min rest in hypoxia. Following 30 (−89.4 ± 48.3) and 60 min of exposure to hypoxia (−79.8 ± 55.9) at rest, TMD was impaired compared with baseline (−107.1 ± 46.2). TMD was significantly improved during exercise (−108.5 ± 42.7) at 40% Vo_2max compared with 30 min rest in hypoxia. Also, RMCPT was significantly improved during exercise (104.0 ± 19.1) at 60% Vo_2max compared to 60 min rest in hypoxia (96.6 ± 17.3).DISCUSSION: Hypoxia and an acute bout of exercise partially influence RMCPT and TMD. Furthermore, a moderate-intensity bout of exercise (60%) may be a more potent stimulant for improving cognitive function than low-intensity (40%) exercise. The present data should be considered by aeromedical personnel performing cognitive tasks in hypoxia.Seo Y, Gerhart HD, Stavres J, Fennell C, Draper S, Glickman EL. Normobaric hypoxia and submaximal exercise effects on running memory and mood state in women. Aerosp Med Hum Perform. 2017; 88(7):627–632.

INTRODUCTION: We evaluated ophthalmic changes in healthy individuals who underwent integrated resistance and aerobic training (iRAT) during 70-d 6° head-down tilt (HDT) bed rest (BR).METHODS: Participants were selected using NASA standard screening procedures. Standardized NASA BR conditions were implemented. Subjects were randomly assigned to the iRAT protocol or no exercise during HDTBR. Weekly ophthalmic examinations were performed in the sitting (pre/post-BR only) and HDT (BR only) positions. Mixed-effects linear models compared pre- and post-HDTBR intraocular pressure (IOP), Spectralis OCT circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and peripapillary retinal thickness observations between groups.RESULTS: Six controls and nine exercisers completed the study. There was an overall effect of BR on our outcomes. Except Goldmann IOP (mean pre/post difference in controls and exercisers: −0.47 mmHg vs. +1.14 mmHg), the magnitude of changes from baseline was not significantly different between groups. There was a +1.38 mmHg and a +1.63 mmHg iCare IOP increase during BR in controls and exercisers, respectively. Spectralis OCT detected a +1.33 μm average cpRNFL thickness increase in both groups, and a +9.77 μm and a +6.65 μm peripapillary retinal thickening post-BR in controls and exercisers, respectively. Modified Amsler grid, red dot test, confrontational visual field, color vision, and stereoscopic fundus photography were unremarkable.CONCLUSIONS: HDTBR for 70 d induced peripapillary retinal thickening and cpRNFL thickening without visible signs of optic disc edema. The magnitude of such changes was not different between controls and exercisers. A slight IOP increase during BR subsided post-BR. Further study should evaluate whether different physical exercise paradigms may prevent/mitigate the risk of space-related visual impairment.Taibbi G, Cromwell RL, Zanello SB, Yarbough PO, Ploutz-Snyder RJ, Godley BF, Vizzeri G. Ophthalmological evaluation of integrated resistance and aerobic training during 70-day bed rest. Aerosp Med Hum Perform. 2017; 88(7):633–640.

INTRODUCTION: In commercial spaceflight, anxiety could become mission-impacting, causing negative experiences or endangering the flight itself. We studied layperson response to four varied-length training programs (ranging from 1 h–2 d of preparation) prior to centrifuge simulation of launch and re-entry acceleration profiles expected during suborbital spaceflight. We examined subject task execution, evaluating performance in high-stress conditions. We sought to identify any trends in demographics, hemodynamics, or similar factors in subjects with the highest anxiety or poorest tolerance of the experience.METHODS: Volunteers participated in one of four centrifuge training programs of varied complexity and duration, culminating in two simulated suborbital spaceflights. At most, subjects underwent seven centrifuge runs over 2 d, including two +G_z runs (peak +3.5 G_z, Run 2) and two +G_x runs (peak +6.0 G_x, Run 4) followed by three runs approximating suborbital spaceflight profiles (combined +G_x and +G_z, peak +6.0 G_x and +4.0 G_z). Two cohorts also received dedicated anxiety-mitigation training. Subjects were evaluated on their performance on various tasks, including a simulated emergency.RESULTS: Participating in 2–7 centrifuge exposures were 148 subjects (105 men, 43 women, age range 19-72 yr, mean 39.4 ± 13.2 yr, body mass index range 17.3–38.1, mean 25.1 ± 3.7). There were 10 subjects who withdrew or limited their G exposure; history of motion sickness was associated with opting out. Shorter length training programs were associated with elevated hemodynamic responses. Single-directional G training did not significantly improve tolerance.DISCUSSION: Training programs appear best when high fidelity and sequential exposures may improve tolerance of physical/psychological flight stressors. The studied variables did not predict anxiety-related responses to these centrifuge profiles.Blue RS, Bonato F, Seaton K, Bubka A, Vardiman JL, Mathers C, Castleberry TL, Vanderploeg JM. The effects of training on anxiety and task performance in simulated suborbital spaceflight. Aerosp Med Hum Perform. 2017; 88(7):641–650.

INTRODUCTION: Commercial air travel is usually without health incidents. However, there is a view that cabin environments may be detrimental to health, especially flights of 8 h or more. Concerns have been raised about deep vein thrombosis, upper respiratory tract infections, altitude sickness, and toxins from the engines.METHODS: Passenger cabin simulators were used to achieve a comparative observational study with 8-h flights at pressures equivalent to terrestrial altitudes of ground, 4000, 6000, and 8000 ft. Biomarkers of thrombosis (D-Dimer), inflammation (interleukin-6), and respiratory dysfunction (FEV₁) and oxygen saturation (S_po₂) were measured, as well as pulse and blood pressure. The wellbeing of the passengers was also monitored.RESULTS: During 36 flights, 1260 healthy subjects [626 women (F) and 634 men (M) (mean age = 43, SD = 16)] were assessed. Additionally, 72 subjects with chronic obstructive pulmonary disease (F = 32, M = 40, mean age = 48, SD = 17) and 74 with heart failure (F = 50, M = 24, mean age = 54, SD = 14) contributed to 11 flights. Additionally, 76 normal controls were observed while engaged in a usual day’s work (F = 38, M = 38, mean age = 39, SD = 15). There were no health-significant changes in D-Dimer, interleukin-6, or FEV₁. S_po₂ varied as expected, with lowest values at 8000 ft and in patients with cardiopulmonary disease. The only differences from the controls were the loss of the normal diurnal variations in interleukin-6 and D-Dimer.DISCUSSION: This very large, comparative, controlled study provides much reassurance for the traveling public, who use airline flights of up to 8 h. We did not show evidence of the development of venous thrombosis, inflammation, respiratory embarrassment, nor passenger distress. No significant symptoms or adverse effects were reported.Ideal Cabin Environment (ICE) Research Consortium of the European Community 6^th Framework Programme. Health effects of airline cabin environments in simulated 8-hour flights. Aerosp Med Hum Perform. 2017; 88(7):651–656.

INTRODUCTION: General aviation includes all civilian aviation apart from operations involving paid passenger transport. Unfortunately, this category of aviation holds a lackluster safety record, accounting for 94% of civil aviation fatalities. In 2014, of 1143 general aviation accidents, 20% were fatal compared with 0 of 29 airline mishaps in the United States. Herein, research findings over the past 30 yr will be reviewed. Accident risk factors (e.g., adverse weather, geographical region, post-impact fire, gender differences) will be discussed. The review will also summarize the development and implementation of stringent crashworthiness designs with multi-axis dynamic testing and head-injury protection and its impact on mitigating occupant injury severity. The benefits and drawbacks of new technology and human factor considerations associated with increased general aviation automation will be debated. Data on the safety of the aging general aviation population and increased drug usage will also be described. Finally, areas in which general aviation occupant survival could be improved and injury severity mitigated will be discussed with the view of equipping aircraft with 1) crash-resistant fuel tanks to reduce post-impact conflagration; 2) after-market ballistic parachutes for older aircraft; and 3) current generation electronic locator beacons to hasten site access by first responders.Boyd DD. A review of general aviation safety (1984–2017). Aerosp Med Hum Perform. 2017; 88(7):657–664.

BACKGROUND: In the space environment, the traditional radioprotective principles of time, distance, and shielding become difficult to implement. Additionally, the complex radiation environment inherent in space, the chronic exposure timeframe, and the presence of numerous confounding variables complicate the process of creating appropriate risk models for astronaut exposure. Pharmaceutical options hold tremendous promise to attenuate acute and late effects of radiation exposure in the astronaut population. Pharmaceuticals currently approved for other indications may also offer radiation protection, modulation, or mitigation properties along with a well-established safety profile. Currently there are only three agents which have been clinically approved to be employed for radiation exposure, and these only for very narrow indications. This review identifies a number of agents currently approved by the U.S. Food and Drug Administration (FDA) which could warrant further investigation for use in astronauts. Specifically, we examine preclinical and clinical evidence for statins, nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), metformin, calcium channel blockers, β adrenergic receptor blockers, fingolimod, N-acetylcysteine, and pentoxifylline as potential radiation countermeasures.McLaughlin MF, Donoviel DB, Jones JA. Novel indications for commonly used medications as radiation protectants in spaceflight. Aerosp Med Hum Perform. 2017; 88(7):665–676.

BACKGROUND: The few prior studies of time perception underwater have reached contradictory conclusions as to how, and if, time perception becomes distorted when submerged. The current paper expands upon this limited data by describing two studies of prospective time production in scuba divers.METHODS: Study 1 (N = 32) compared performance on a 30-s interval time production task in deep water (35 m–42 m/∼115–138 ft) with a shallow water control (3–12 m/∼10–39 ft). Using the same task, study 2 (N = 31) tested performance at the surface and at a range of depths underwater (1 m/3 ft; 11 m/36 ft; 20 m/66 ft; 30 m/98 ft; 40 m/131 ft).RESULTS: Study 1 revealed time production to be significantly longer in deep water compared to shallow water. In study 2 time production at the surface was not significantly different from that at 1 m, but productions at 11–40 m were significantly longer than at both 1 m and on the surface. Time productions between 11–40 m did not differ significantly.DISCUSSION: It was concluded that divers judge less time to have passed underwater than is objectively the case from a depth of 11 m, but that this effect does not deteriorate significantly once past 11 m. The cause of this distortion of time perception underwater was suggested to be the action of gas narcosis.Hobbs MB, Kneller W. Distortion of prospective time production underwater. Aerosp Med Hum Perform. 2017; 88(7):677–681.

BACKGROUND: Increased gravito-inertial acceleration, or hypergravity, such as produced in a centrifuge or in an aircraft coordinated turn, causes humans to systematically overestimate their roll tilt in the dark. This is known as the “G-excess” illusion. We have previously modified a mathematical observer model of dynamic orientation perception to replicate these illusory tilt perceptions. This modified model also made a novel, previously untested, prediction that humans would underestimate acute roll tilt in reduced gravitational environments (hypogravity).CASE REPORT: In the current study, we used aircraft parabolic flight to test this prediction in a single subject. Roll tilt perception was reported using a subjective visual vertical task in which the subject aligned an illuminated line, presented in a head mounted display, with their perceived direction of down. The same subject made reports during hypogravity parabolas (0.165 G and 0.38 G, corresponding to lunar and Martian gravity, respectively), hypergravity maneuvers (1.6 G during a pull out maneuver and 1.2 G during a coordinated turn), and 1-G control conditions (both on the ground and in straight and level flight). As hypothesized, the subject significantly underestimated roll tilt in the hypogravity environments by approximately 40% compared to 1-G reports while overestimating roll tilt in the hypergravity environments.DISCUSSION: The amount of underestimation observed was quantitatively consistent with that predicted a priori by the modified observer model. We propose the term “G-shortage” illusion for the underestimation of roll tilt in hypogravity. This illusion may have implications for aircraft pilots and astronauts.Clark TK, Young LR. A case study of human roll tilt perception in hypogravity. Aerosp Med Hum Perform. 2017; 88(7):682–687.

INTRODUCTION: Transport operators seeking to operate outside prescriptive fatigue management regulations are typically required to present a safety case justifying how they will manage the associated risk. This paper details a method for constructing a successful safety case.METHODS: The method includes four elements: 1) scope (prescriptive rules and operations affected); 2) risk assessment; 3) risk mitigation strategies; and 4) monitoring ongoing risk. A successful safety case illustrates this method. It enables landing pilots in 3-pilot crews to choose the second or third in-flight rest break, rather than the regulatory requirement to take the third break. Scope was defined using a month of scheduled flights that would be covered (N = 4151). These were analyzed in the risk assessment using existing literature on factors affecting fatigue to estimate the maximum time awake at top of descent and sleep opportunities in each break. Additionally, limited data collected before the new regulations showed that pilots flying at landing chose the third break on only 6% of flights.RESULTS: A prospective survey comparing subjective reports (N = 280) of sleep in the second vs. third break and fatigue and sleepiness ratings at top of descent confirmed that the third break is not consistently superior. The safety case also summarized established systems for fatigue monitoring, risk assessment and hazard identification, and multiple fatigue mitigation strategies that are in place.DISCUSSION: Other successful safety cases have used this method. The evidence required depends on the expected level of risk and should evolve as experience with fatigue risk management systems builds.Gander P, Mangie J, Wu L, van den Berg M, Signal L, Phillips A. Preparing safety cases for operating outside prescriptive fatigue risk management regulations. Aerosp Med Hum Perform. 2017; 88(7):688–696.

Mitchell AL. You’re the flight surgeon: aviator with myocardial ischemia. Aerosp Med Hum Perform. 2017; 88(7):697–700.

Solana NM. You’re the flight surgeon: black spot poison ivy. Aerosp Med Hum Perform. 2017; 88(7):700–702.