BACKGROUND: The experimental research PILOT on board the space stations aimed to assess cosmonauts expectable reliability in a mission relevant operation, the manual docking of Soyuz or Progress spacecrafts on the space stations Mir and International Space Station (ISS), respectively.METHOD: Therefore, a simulation of the docking of two space apparatuses was used for training and research. The methodological approach is described, taking into consideration the level of performance and the individual effort spent, the psychophysiological costs. In three decades altogether 32 cosmonauts took part.RESULTS: A significant increase of reliability was found from Mir (0.45 scores) to ISS missions (0.51). On ISS the reliability remained stable (0.50 0.1).DISCUSSION: Salnitskis model for the evaluation of operators reliability was further developed and tested, which turned out to be sensitive as well as robust enough for a practical application in this critical operational task.Johannes B, Bronnikov SV, Bubeev JA, Kotrovskaya TI, Shastlivtseva DV, Piechowski S, Hoermann H-J, Jordan J. Operators reliability during spacecraft docking training on board Mir and ISS. Aerosp Med Hum Perform. 2021; 92(7):541549.

OBJECTIVE: This study aimed to evaluate the effects of repeated pressure alterations on cochlear structures in rats in an attempt to understand indirectly the inner ear status of flight crew who are repeatedly exposed to pressure alterations.METHODS: There were 12 adult Wistar albino rats equally divided into 2 groups: Group 1 (controls) and Group 2 (study group). The animals in Group 2 were exposed to repeated pressure changes in a pressure cabin which is regulated by manometers. The animals in Group 1 were placed in the cabin without being exposed to pressure changes. Auditory brainstem response (ABR) testing was performed in all animals at the beginning and at the end of the study. After 12 wk the animals were sacrificed and their cochleas were investigated using scanning electron microscopy (SEM).RESULTS: In the study group, hearing decreases at 2 kHz, 4 kHz, 6 dB at 8 kHz, and 32 kHz were encountered at the end of 3 mo. On SEM evaluation of the control group, the outer hair cells (OHC) and stereocilia were normal throughout the cochlea. In the study group, there were irregularities in lateral surface connections and separations, collapse, and adhesions in the basal segment of the cochlea and partial loss of stereocilia throughout the cochlea.CONCLUSION: Repeated alterations in the atmospheric pressure can lead to damage in the inner ear with subtle or evident hearing loss. Frequent flyers like air workers may be at risk of inner ear damage, which may be considered an occupational health problem.Eroglu S, Dizdar HT, Cevizci R, Cengiz AB, Ogreden S, Bulut E, Ilgezdi S, Dilci A, Ustun S, Sirvanci S, Cilingir-Kaya OT, Bayazit D, Caki BO, Oktay MF, Bayazit Y. Repeated atmospheric pressure alteration effect on the cochlea in rats: experimental animal study. Aerosp Med Hum Perform. 2021; 92(7):550555.

BACKGROUND: During hypoxia an operators cognitive performance may decline. This decline is linked to altered brain metabolism, resulting in decreased adenosine triphosphate (ATP) production. Ketone bodies are an alternative substrate to glucose for brain metabolic requirements; previous studies have shown that the presence of elevated ketone bodies in the blood maintains brain ATP levels and reduces cerebral glycolysis during hypoxia. Thus, ketones may be a strategy to mitigate cognitive decline in hypoxia. Ketone ester (KE) consumption allows rapid elevation of blood ketone levels; therefore, we investigated the effects of consuming a KE drink on cognitive performance during hypoxia. Here, we report results of a pilot study.METHODS: There were 11 subjects who completed a cognitive performance test battery under conditions of normoxia and hypoxia following consumption of a KE drink and a placebo control drink.RESULTS: Significant hypoxia effects (O₂ saturation minimum was found to range between 63 and 88 in subjects) were found for blink duration (Ph2 0.665) and blink rate (Ph2 0.626), indicating that the hypoxia condition was associated with longer blink durations and lower blink rates. Significant hypoxia effects were likewise observed for a code substitution task (Ph2 0.487), indicating that performance on the task was significantly disrupted by the hypoxia stressor. KE consumption had a significant effect on blink duration (Ph2 0.270) and the code substitution task (Ph2 0.309).DISCUSSION: These finding suggest that some effects of acute hypoxia can be mitigated by nutritional ketosis.Coleman K, Phillips J, Sciarini M, Stubbs B, Jackson O, Kernagis D. A metabolic intervention for improving human cognitive performance during hypoxia. Aerosp Med Hum Perform. 2021; 92(7):556562.

INTRODUCTION: Helicopter Emergency Medical Service (HEMS) is a mode of transportation designed to expedite the transport of a patient. Compared to other modes of emergency transport and other areas of aviation, historically HEMS has had the highest accident-related fatality rates. Analysis of these accident data has revealed factors associated with an increased likelihood of accident-based fatalities. Here we report the results of an analysis on the likelihood of a fatality based on various factors as a result of a HEMS accident, employing a Bayesian framework.METHODS: A retrospective study was conducted using data extracted from the NTSB aviation accident database from April 31, 2005, to April 26, 2018. Evidence from Baker et al. (2006) was also used as prior information spanning from January 1, 1983, to April 30, 2005.RESULTS: A Bayesian logistic regression was implemented using the prior information and current data to calculate a posterior distribution confidence interval of possible values in predicting accident fatality. The results of the model indicate that flying at night (OR 3.06; 95 C.I 2.14, 4.48; PoD 100), flying under Instrument Flight Rules (OR 7.54; 95 C.I 3.94, 14.44; PoD 100), and post-crash fires (OR 18.73; 95 C.I 10.07, 34.12; PoD 100) significantly contributed to the higher likelihood of a fatality.CONCLUSION: Our results provide a comprehensive analysis of the most influential factors associated with an increased likelihood of a fatal accident occurring. We found that over the past 35 yr these factors were consistently associated with a higher likelihood of a fatality occurring.Simonson RJ, Keebler JR, Chaparro A. A Bayesian approach on investigating helicopter emergency medical fatal accidents. Aerosp Med Hum Perform. 2021; 92(7):563569.

INTRODUCTION: Current spacesuits are cumbersome and metabolically expensive. The use of robotic actuators could improve extravehicular activity performance. We propose a novel method to quantify the benefit of robotic actuators during planetary ambulation.METHODS: Using the OpenSim framework, we completed a biomechanical analysis of three walking conditions: unsuited, suited with the extravehicular mobility unit (EMU) spacesuit (represented as external joint torques applied to human joints), and suited with the EMU and assisted by robotic actuators capable of producing up to 10 Nm of torque. For each scenario, we calculated the inverse kinematics and inverse dynamics of the lower body joints (hip, knee, and ankle). We also determined the activation of muscles and robotic actuators (when present). Finally, from inverse dynamics and muscle activation results, the metabolic cost of one gait cycle was calculated in all three conditions.RESULTS: The moments of lower body joints increased due to the increased resistance to movement from the spacesuit. The additional torque increased the overall metabolic cost by 85 compared to the unsuited condition. The assistive robotic actuators were able to reduce the metabolic cost induced by EMU resistance by 15.DISCUSSION: Our model indicates that the majority of metabolic cost reduction can be attributed to the actuators located at the hip. The robotic actuators reduced metabolic cost similar to that of modern-day actuators used to improve walking. During a Mars mission, the actuators could save one crewmember up to 100,000 kilocal on one 539-d planetary expedition.Kluis L, Keller N, Bai H, Iyengar N, Shepherd R, Diaz-Artiles A. Reducing metabolic cost during planetary ambulation using robotic actuation. Aerosp Med Hum Perform. 2021; 92(7):570578.

INTRODUCTION: The paragliding reserve parachute system is safety-critical but underused, unstandardized, and known to fail. This study aimed to characterize reserve parachute deployment under radial acceleration to make recommendations for system design and paraglider pilot training.METHODS: There were 88 licensed amateur paraglider pilots who were filmed deploying their reserve parachutes from a centrifuge. Of those, 43 traveled forward at 4 G simulating a spiral dive, and 45 traveled backward at 3 G simulating a rotational maneuver known as SAT. Tests incorporated ecologically valid body, hand, and gaze positions, and cognitive loading and switching akin to real deployment. The footage was reviewed by subject matter experts and compared to previous work in linear acceleration.RESULTS: Of the pilots, 2.3 failed to extract the reserve container from the harness. SAT appeared more cognitively demanding than spiral, despite lower G. Participants located the reserve handle by touch not sight. The direction of travel influenced their initial contact with the harness: 82.9 searched first on their hip in spiral, 63.4 searched first on their thigh in SAT. Search patterns followed skeletal landmarks. Participants had little directional control over their throw.CONCLUSIONS: Paraglider pilots are part of the reserve system. Maladaptive behaviors observed under stress highlighted that components must work in harmony with pilots natural responses, with minimal cognitive demands or need for innovation or problem-solving. Recommendations include positioning prominent, tactile reserve handles overlying the pilots hip; deployment bags extractable with any angle of pull; deployment in a single sweeping backward action; and significantly increasing reserve deployment drills.Wilkes M, Long G, Charles R, Massey H, Eglin C, Tipton MJ. Paraglider reserve parachute deployment under radial acceleration. Aerosp Med Hum Perform. 2021; 92(7):579587.

INTRODUCTION: U.S. airlines often request a healthcare professional to volunteer to assist an ill passenger. Litigation from a Good Samaritans care of an in-flight medical emergency (IME) is considered improbable. The 1998 Aviation Medical Assistance Act (AMAA) encourages health care professionals to volunteer with indemnity for standard and good medical care. It does not offer legal or financial assistance. Our review explored the legal support malpractice companies and U.S. airlines provide if litigation is initiated for IME care. Malpractice insurance policies can differ on IME coverage. We found most private practice physicians policies include IME. Medical institutions may have policies restricting their physicians coverage to the institutions location. Those without malpractice coverage will need to retain and pay for a legal defense to demonstrate no gross negligence and no willful misconduct. The physicians, airline crews, and on-ground IME documentation support should be retained by the Good Samaritan especially for a pediatric or adolescent ill passenger. U.S. airlines consider a Good Samaritan medical volunteer as a passenger and do not extend legal assistance. This contrasts with some foreign airlines that do provide liability protection. Knowledge of the malpractice policy IME coverage is essential prior to traveling by air. After completing care for an ill passenger, physicians should generate their medical documentation and request the IME documentation generated by the airline and on-ground medical expert. We also believe U.S. airlines should assume responsibility to provide legal assistance to a Good Samaritan physician in the event of IME litigation.de Caprariis PJ, Di Maio A. Medical legal implications when providing emergency care on a commercial flight. Aerosp Med Hum Perform. 2021; 92(7):588592.

INTRODUCTION: Accidents with aircraft standing are more likely with helicopters than fixed-wing aircraft due to the common presence of off-airport landings and the possibility of the rotor system to strike objects in its immediate surroundings.METHODS: A total of 115 accidents involving helicopters characterized as standing as a broad phase of flight were selected from the NTSB online database for the period 1998 until 2018.RESULTS: Accidents reporting fatal (8.7) or serious injuries (7.8) were significantly less likely to occur when the aircraft was substantially damaged (84.3) or destroyed (5.2). The majority of the cases occurred after off-airport landings (57.4), which were reported significantly more often in Alaska (N= 15). A main rotor strike with an individual was at the basis of each of the 10 fatal accidents in the dataset and in 8 of these cases the cause of the accident was attributed to the victim. None of the accidents occurred in instrument meteorological conditions, but, in particular, high winds and gusts proved a main cause of accident (18.3).CONCLUSION: Pilot, passengers, and crew endangered themselves when they were outside the aircraft while the rotors were still turning. Helicopter operating manuals should highlight the limitations and dangers for wind and wind gusts not only during takeoff and flight, but specifically when standing.de Voogt AJ, Hummel C, Kalagher H. Fatality and operational specificity of helicopter accidents on the ground. Aerosp Med Hum Perform. 2021; 92(7):593596.

BACKGROUND: The National Aeronautics and Space Administration (NASA) Flight Crew Health Stabilization Program (HSP) was historically implemented to minimize infectious disease transmission to astronauts in the immediate prelaunch period. The first ever commercial application and adaptation of the NASA HSP was implemented during the Crew Demo-2 mission in the time of the Coronavirus disease 2019 (COVID-19) pandemic. This article details and discusses the first commercial implementation and adaptation of the HSP prior to the Crew Demo-2 launch.METHODS: This is a retrospective descriptive analysis of the application of NASA disease prevention protocols for human spaceflight during the COVID-19 pandemic. In the context of the pandemic, extra precautions added to the HSP included daily symptom surveys completed by Primary Contacts of the crew, COVID-19 RT-PCR testing, and improved quarantine protocols.RESULTS: Of the 91 SpaceX Primary Contacts who completed a total of 2720 daily symptom surveys prior to launch, 22 individuals (24.2) and 198 surveys (7.3) returned positive for potential symptoms of COVID-19. Two individuals were removed due to symptoms indistinguishable from COVID-19. Through this survey, systematic quarantine, and PCR testing, the Crew Demo-2 mission was successful with no known infectious diseases transmitted.CONCLUSIONS: Overall, the commercial implementation of the NASA Health Stabilization Program by SpaceX with adjustments required during the COVID-19 pandemic was a success, with protocols allowing identification and removal of potentially infectious persons from the program. The principles of the HSP may provide an adequate infectious disease playbook for commercial spaceflight operations going forward.Petersen E, Pattarini JM, Mulcahy RA, Beger SB, Mitchell MR, Hu YD, Middleton KN, Frazier W, Mormann B, Esparza H, Asadi A, Musk ER, Alter G, Nilles E, Menon AS. Adapting disease prevention protocols for human spaceflight during COVID-19. Aerosp Med Hum Perform. 2021; 92(7):597602.