INTRODUCTION: Hypobaric hypoxia training utilizing the environmental chamber is often preceded by prebreathing of 100% oxygen with the goal of reducing decompression illness (DCI). We aimed to study the impact of prebreathing 100% oxygen for 30 min prior to hypobaria exposure to 7600 m (25,000 ft) on the incidence rate of DCI, as well as the impact of prebreathing on hypoxia symptoms felt during training.METHODS: Records of participants who underwent hypobaric hypoxia training in the Republic of Singapore Air Force (RSAF) from 2011 to 2014 (before introduction of prebreathing) were compared to those who underwent similar training from 2014 to 2017 (after introduction of prebreathing) to determine the incidences of DCI for both groups. Participants who underwent hypobaric hypoxia training from January 2017 to July 2017 completed a survey to assess the impact of prebreathing on the presentation and severity of hypoxia symptoms.RESULTS: Two DCI events were recorded in 1530 hypobaric chamber exposures without prebreathing while two DCI events were recorded in 1729 exposures with prebreathing. There was no significant difference in the incidence of DCI between the two groups. The survey findings showed no significant difference in the presentation and severity of hypoxia symptoms with 30 min of prebreathing.DISCUSSION: Incidence of DCI remains low during hypobaric chamber training, with no statistical difference with or without prebreathing. Possible reasons were the short duration of hypobaric exposure of 10 min during hypoxia training, and that 30 min of prebreathing was insufficient to further decrease or eliminate the risk of DCI in short duration hypobaric exposures.Cheok LJ, Goh BLY, Soh FW, Chuan BTB. Decompression illness incidence and hypoxia symptoms after prebreathing in hypobaric hypoxia training. Aerosp Med Hum Perform. 2021; 92(5):289293.

INTRODUCTION: Air taxis conduct nonscheduled transport and employ aircraft in various performance categories hereafter referred to as low, medium, and high performance, respectively. No study has yet addressed fixed-wing air taxi safety by performance category. Herein, we compared accident rates/occupant injury across air taxi airplane fleets grouped by performance category and identified human factors contributing to fatal accidents for airplanes in that category with the highest mishap rate.METHODS: Accidents (20042018) in the United States were identified from the National Transportation Safety Board database. General Aviation/Part 135 Activity Surveys provided annual fleet times. Fatal accident contributing factors were per the Human Factors Classification System (HFACS). Statistics utilized Poisson distributions, Chi-Square/Fisher, and Mann-Whitney tests.RESULTS: There were 269 air taxi mishaps (53 fatal) identified. Over the 15 yr, the accident rate (1.10/million flight hours-all categories) declined 50%, largely due to a reduction in medium/high performance category airplane crashes. However, little temporal change was observed for low performance airplanes (1.5/million flight hours) and injury severity trended higher. At the aircrew/physical environment levels, HFACS revealed decision (improper choices), skill-based (stick and rudder) and perceptual (night, instrument conditions) errors contributing to > 60% of fatal accidents involving low performance airplanes. At the organizational level, failing to correct problems, time pressures, and incentive systems contributed to 16% of fatal mishaps.CONCLUSION: Safety deficits remain for the low performance category air taxi fleet warranting increased pilot instrument flight training/utilization of the mandatory 3-axis autopilot in degraded visibility. Safety culture improvements to address issues of personnel/equipment/training deficiencies, failing to correct problems, and time pressures/a safety-compromising incentive system all need to be addressed.Budde D, Hinkelbein J, Boyd DD. Analysis of air taxi accidents (20042018) and associated human factors by aircraft performance class. Aerosp Med Hum Perform. 2021; 92(5):294302.

BACKGROUND: Many workers routinely transition between day and night shiftsincluding pilots, where night flights are commonly considered more stressful. The physiological toll from this transition is not fully understood, though fatigue is a factor in many aviation accidents. This research investigated the changes in physiological markers of stress and cognitive performance as F-22 pilots transitioned from day flying to night flying.METHODS: There were 17 fully-qualified F-22 pilots who took part in a 2-wk data collection using salivary swabs, wrist-worn activity monitors, the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) inventory, and a go/no-go (GNG) test.RESULTS: No differences were found in comparing day and night flying on the GNG reaction time/accuracy, NASA-TLX scores, or sleep quantity. Cortisol levels were significantly higher than civilian levels in all experimental conditions and control days. Participants had higher than predicted cortisol levels postflight in the day-flying condition and lower than predicted cortisol levels postflight in the night-flying condition, relative to levels from control day patterns. We also found smaller changes in cortisol (pre- to postflight) in the day-flying condition for those with more F-22 experience. Finally, we found a negative correlation between Perceived Stress Scale scores and age of pilots (r 0.72).DISCUSSION: We hypothesized that the night-flying environment would be more stressful, but our results disputed this claim. Our results suggest day flying elicits more of a stress response; however, a larger sample size is required to verify results. Preliminary findings of potential stress adaptation may suggest stress adaptation in the F-22 community needs further investigation.Combs EK, Dahlman AS, Shattuck NL, Heissel JA, Whitaker LR. Physiological and cognitive performance in F-22 pilots during day and night flying. Aerosp Med Hum Perform. 2021; 92(5):303311.

BACKGROUND: This study aimed to investigate the biomechanical effects of different interventions on astronauts lumbar intervertebral discs in a microgravity environment during spaceflight and in a gravity environment when the astronaut returns.METHODS: A finite element model of the L4L5 lumbar segment was developed with eight loading schemes representing different interventions. The loading schemes included no intervention, wearing a penguin suit, sleeping in a fetal position, wearing a penguin suit combined with sleeping in the fetal position, reclining for 4 or 16 h/d, and maintaining upright posture for 4 or 16 h/d.RESULTS: Without intervention, the microgravity environment led to increased central pore pressure, radial displacement, and water content in the lumbar intervertebral disc. Wearing a penguin suit combined with sleeping in the fetal position can reduce disc pore pressure, axial stress, radial displacement, and water content to 0.156 MPa, 11.50 kPa, 0.538 mm, and 1.390%, respectively. When astronauts return to the gravity environment, staying upright for 4 h can reduce the pore pressure, axial stress, radial displacement, and water content of the intervertebral disc to 0.222 MPa, 10.72 kPa, 0.373 mm, and 0.219%, respectively.CONCLUSION: This study showed that wearing a penguin suit and sleeping in the fetal position both have the potential to protect the lumbar intervertebral disc from the negative effects caused by microgravity. Remaining in the upright posture for 4 h per day may help squeeze out the water in the intervertebral disc safely when astronauts return to the gravity environment.Zhang S, Wang K, Zhu R, Jiang C, Niu W. Penguin suit and fetal position finite element model to prevent low back pain in spaceflight. Aerosp Med Hum Perform. 2021; 92(5):312318.

INTRODUCTION: When an aircraft banks pilots will reflexively tilt their heads in the opposite direction, known as the optokinetic cervical reflex (OKCR). This is elicited by the appearance of the horizon and is an attempt to keep the moving horizon stable on the pilots retina to help maintain spatial orientation. The appearance of the horizon and the visual environment changes at higher altitudes and there is little research studying the effects of this. Our hypothesis was that increasing altitude would alter the visual cues present and decrease the OKCR.METHODS: There were 16 subjects who flew two flights in a flight simulator while their head tilt, aircraft altitude, and angle of aircraft bank were recorded. The flights were at an altitude of under 1500 ft above ground and above 15,000 ft above ground.RESULTS: Aircraft bank caused head tilt in the opposite direction at both altitudes. A two-way ANOVA with Bonferroni post hoc tests showed that 86% of aircraft bank angles from 0 to 90 in either direction had a head tilt that was statistically significantly smaller at high altitude.DISCUSSION: This study shows that there appears to be a difference between the OKCR at low and high altitude. Pilots at higher altitude seem to exhibit a smaller head tilt for the same aircraft bank angle. More research is required to fully understand why there is a decrease in the OKCR at high altitude, as well as the actual consequences of the decreased reflex on pilot orientation.Stewart MA, Pingali S, Newman DG. Increasing altitude and the optokinetic cervical reflex. Aerosp Med Hum Perform. 2021; 92(5):319325.

INTRODUCTION: Hypoxia is an ever-present threat in tactical aviation and gained recent attention due to its putative role in physiological episodes. Previous work has demonstrated that hypoxia negatively impacts a variety of sensory, cognitive, and motor systems. In particular, the visual system is one of the earliest systems affected by hypoxia. While the majority of previous studies have relied on self-report and behavioral testing, the use of event-related potentials as a novel tool to monitor responses to low oxygen in humans has recently been investigated. Specifically, ERP components that are evoked passively in response to unattended changes in background sensory stimulation have been explored.METHOD: Subjects (N 28) completed a continuous visuomotor tracking task while EEG was recorded. During the tracking task, a series of standard color checkerboard patterns were presented in the periphery while occasionally a deviant color checkerboard was presented. The visual mismatch negativity (MMN) component was assessed in response to the deviant compared to the standard stimuli. Subjects completed two sessions in counterbalanced order that only differed by the oxygen concentration breathed (10.6% vs. 20.4%).RESULTS: Results demonstrated a significant reduction in the amplitude of the visual MMN under hypoxic compared to normoxic conditions, showing a 50% reduction in amplitude during hypoxia. Our results suggest that during low-oxygen exposure the ability to detect environmental changes and process sensory information is impaired.DISCUSSION: The visual MMN may represent an early and reliable predictor of sensory and cognitive deficits during hypoxia exposure, which may be of great use to the aviation community.Blacker KJ, Seech TR, Funke ME, Kinney MJ. Deficits in visual processing during hypoxia as evidenced by visual mismatch negativity. Aerosp Med Hum Perform. 2021; 92(5):326332.

INTRODUCTION: Flight-related neck pain (FRNP) is a frequently reported musculoskeletal complaint among military helicopter aircrew. However, despite its prevalence and suspected causes, little is known of the underpinning pain mechanisms or the impact of neck pain on aircrews in-flight task performance. The biopsychosocial (BPS) approach to health, combined with the contemporary conceptualization of musculoskeletal pain, in which injury and pain are not necessarily synonymous, provides a relatively new holistic framework within which to consider the problem of FRNP in military helicopter aircrew. Combining these concepts, a new conceptual model is proposed to illustrate how biopsychosocial factors may influence pain perception, potentially affecting aircrews capacity to process information and, therefore, threatening in-flight task performance. Recommendations are made for considering the underlying pain mechanisms of FRNP to aid prognoses and guide the development of holistic evidence-based countermeasures for FRNP in military helicopter aircrew. Development of instruments able to measure psychosocial factors, such as self-efficacy and functional ability, validated in the military helicopter aircrew population, would assist this task.Vail RE, Harridge SDR, Hodkinson PD, Green NDC, Pavlou M. A novel biopsychosocial approach to neck pain in military helicopter aircrew. Aerosp Med Hum Perform. 2021; 92(5):333341.

INTRODUCTION: The effects of spaceflight on the intervertebral disc (IVD) have not been thoroughly studied, despite the knowledge that spaceflight increases the risk of herniation of IVDs in astronauts upon return to Earth. However, as long duration missions become more common, fully characterizing the mechanisms behind space-induced IVD degeneration becomes increasingly imperative for mission success. This review therefore surveys current literature to outline the results of human, animal, and cell-level studies investigating the effect of microgravity and radiation exposure on IVD health. Overall, recurring study findings include increases in IVD height in microgravity conditions, upregulation of catabolic proteases leading to a weakening extracellular matrix (ECM), and both nucleus pulposus (NP) swelling and loss of annulus fibrosus (AF) fiber alignment which are hypothesized to contribute to the increased risk of herniation when reloading is experienced. However, the limitations of current studies are also discussed. For example, human studies do not allow for invasive measures of the underpinning biochemical mechanisms, correlating animal model results to the human condition may be difficult, and cellular studies lack incorporation of ECM and other complexities that mimic the native IVD microarchitecture and environment. Moving forward, the use of three-dimensional organoid culture models that incorporate IVD-specific human cells, ECM, and signals as well as the development of cell- and ECM-level computational models may further improve our understanding of the impacts that spaceflight has on astronaut IVD health.Smith K, Mercuri J. Microgravity and radiation effects on astronaut intervertebral disc health. Aerosp Med Hum Perform. 2021; 92(5):342352.

BACKGROUND: This study examines the relationship between seat restraints and injuries of children and infants who were passengers on an aircraft and gives a detailed analysis of children whose behavior contributed to an accident.METHODS: A total of 58 accident reports from 1980 until 2015 were extracted from the NTSB online database in which children were mentioned. In at least 10 cases the childs behavior contributed to the accident.RESULTS: Violations of regulations by the Federal Aviation Authority (FAA) as well as the age and number of children and infants on board were each reported inconsistently. Violations of regulations were significantly more common when accidents occurred during the takeoff phase. Child behaviors that caused accidents included distraction of crew, not wearing a seatbelt, and running into dangerous areas.CONCLUSIONS: Pilots and crew, especially in General Aviation, need to be made aware of the need to enforce FAA regulations concerning child restraint systems. It is recommended that children both on the ground and inside an aircraft have adult supervision in addition to supervising aircraft crew to prevent distractions that harm the safe operation of an aircraft.Kalagher H, de Voogt A. Children and infants in aviation accidents. Aerosp Med Hum Perform. 2021; 92(5):353357.