BACKGROUND: Chronic obstructive pulmonary disease (COPD) is highly prevalent and often associated with chronic hypoxia. Previous studies have shown alterations of cerebral oxygenation and cardiac repolarization in COPD patients (GOLD stage II–IV). Airplane travel is common in patients with COPD; however, the clinical effects of a diminished oxygen partial pressure in aircraft cabin environments at cruising altitude remain elusive. The aim of this study was to assess changes of cerebral oxygenation as well as parameters of cardiac repolarization during a hypoxia altitude simulation combined with mild physical activity in these patients.METHODS: Patients with COPD and healthy subjects (10 per group) randomly selected from the Charité outpatient clinic conducted a hypoxia altitude simulation test which consisted of three phases. The regional cerebral oxygen saturation (rSO₂) of the frontal cortex was measured at rest using near-infrared spectroscopy (NIRS). Furthermore, oxygen saturation (S_pO₂), blood pressure, and heart rate values, as well as a 12-lead-ECG, were recorded. Subsequently, a mild treadmill exercise program (25 W) was divided into 10 min of normoxia (pre-hypoxia), 30 min of mild hypoxia (F_IO₂ = 0.15), followed by a second 10-min period of normoxia (post-hypoxia). Meanwhile, mentioned parameters were recorded in 2-min intervals. P, PQ, QRS, QT, QTc, QTd, T-peak-T-end interval (TpTe), and corrected TpTe (TpTec) were measured on three ECG complexes, each at baseline, at the end of the normoxic phase, and at the end of the hypoxic phase.RESULTS: A total of 10 patients with COPD and 10 control subjects were included in this study. S_pO₂ was significantly lower in COPD patients throughout the whole test. Frontal cerebral rSO₂ was significantly lower in the left hemisphere during hypoxia altitude simulation in COPD patients (59.5 ± 8.5 vs. 67.5 ± 5.7).CONCLUSIONS: We show reduced left frontal cerebral oxygenation during hypoxia and mild exercise in patients with COPD, suggesting diminished altitude resilience and altitude capabilities. Preflight hypoxia assessment might be recommended to patients with severe COPD.Dehe L, Hohendanner F, Gültekin E, Werth G, Wutzler A, Bender TO. Hypoxia altitude simulation and reduction of cerebral oxygenation in COPD patients. Aerosp Med Hum Perform. 2023; 94(3):102–106.

INTRODUCTION: Neck pain and injury are common problems in military high-performance aircraft and helicopter aircrews. A contributing factor may be the reclined sitting position in cockpits. This study aimed to determine the effect of typical cockpit ergonomics on cervical proprioception, assessed by using the cervical joint position error (cJPE).METHODS: A total of 49 healthy male military employees (mean age 19.9 ± 2.2 yr) were examined. Measurements of the cJPE were obtained in the flexion, extension, and rotation directions in an upright and in a 30°-reclined sitting position. Each condition comprised three trials, with an additional 3-kg head load to mimic real world working conditions.RESULTS: A smaller cJPE was noted in the 30°-reclined sitting position (mean cJPE = 3.9 cm) than in the upright sitting position (mean cJPE = 4.6 cm) in the flexion direction. The cJPE decreased significantly in all movement directions across the three trials; for example, in the flexion direction in the 30°-reclined sitting position: Trial 1/2/3 mean cJPE = 5.0/3.8/3.1 cm.CONCLUSION: It seems that a reclined seating position has a positive influence on cJPE. However, the result is weak. In both sitting positions and all three directions, the first tests of the cJPE showed the highest values. Already after one or two further measurement runs, a significantly reduced cJPE was observed. This rapid improvement might indicate that an exercise similar to the cJPE test may improve the pilots' cervical proprioception and possibly reduce the risk of injury or pain.Heggli U, Swanenburg J, Hofstetter L, Häusler M, Schweinhardt P, Bron D. Typical cockpit ergonomics influence on cervical motor control in healthy young male adults. Aerosp Med Hum Perform. 2023; 94(3):107–112.

INTRODUCTION: The purpose of this study was to report the temporary loss of medical license and pilot incapacitations in the United Arab Emirates from 2018–2021.METHOD: The General Civil Aviation Authority database was searched for all reported temporary suspensions of license between 2018–2021 and the ICD-10 codes were extracted.RESULTS: A total of 1233 incapacitations was reported with a mean license suspension of 148.4 ± 276.8 d. The mean days of suspension for the various medical specialties were 115.2 ± 188.4 for musculoskeletal conditions (N = 392), 189.3 ± 324.8 for medicine (N = 335), 101.6 ± 231.4 for surgery, 109.4 ± 223.5 for urology (N = 93), 90.3 ± 128.7 for ophthalmology (N = 68), 385.6 ± 594.3 for psychiatry (N = 61), 150.4+285.9 for ENT (N = 59), 419.4 ± 382.6 for obstetrics and gynecology (N = 30), and 44.9+39 for dermatology (N = 21). Permanent suspensions were as follows: total N = 100 (8.1%), musculoskeletal N = 13 (3.3%), medicine N = 37 (11%), surgery N = 10 (5.7%), urology N = 10 (10.7%), ophthalmology N = 2 (2.9%), psychiatry N = 20 (32.8%), ENT N = 1 (1.7%), obstetrics and gynecology N = 4 (13.1%), and dermatology N = 3 (14.3%).DISCUSSION: Musculoskeletal conditions are the most common reason for temporary loss of medical license followed by medical and surgical conditions. The least common reason was dermatological conditions. The longest period of incapacitation was associated with psychiatric conditions followed by medical and ENT conditions. The annual calculated temporary incapacitation rate was 2.8% and the permanent suspension rate was 0.25%.Hohmann E, Pieterse R. Temporary incapacitation rates and permanent loss of medical license in commercial airline pilots. Aerosp Med Hum Perform. 2023; 94(3):113–121.

INTRODUCTION: Spaceflight has detrimental effects on human health, imposing significant and unique risks to crewmembers due to physiological adaptations, exposure to physical and psychological stressors, and limited capabilities to provide medical care. Previous research has proposed and evaluated several strategies to support and mitigate the risks related to astronauts' health and medical exploration capabilities. Among these, extended reality (XR) technologies, including augmented reality (AR), virtual reality (VR), and mixed reality (MR) have increasingly been adopted for training, real-time clinical, and operational support in both terrestrial and aerospace settings, and only a few studies have reported research results on the applications of XR technologies for improving space health. This study aims to systematically review the scientific literature that has explored the application of XR technologies in the space health field. We also discuss the methodological and design characteristics of the existing studies in this realm, informing future research and development efforts on applying XR technologies to improve space health and enhance crew safety and performance.Harari RE, Paladugu P, Miccile C, Park SH, Burian B, Yule S, Dias RD. Extended reality applications for space health. Aerosp Med Hum Perform. 2023; 94(3):122–130.

BACKGROUND: The geographical circumstances, such as mountains and ocean, and specific aviation operations, especially sightseeing, make the state of Hawaii stand out in aviation. These conditions support a regional approach to aviation accident analysis.METHODS:Accident reports of aviation accidents collected from the online National Transportation Safety Board database were used to study a 10-yr time period between 2008 and 2017.RESULTS: There was a significantly higher proportion of fatal accidents during night, dawn, and dusk (6 out of 13) than during daytime (13 out of 74). In addition, a significantly higher proportion of accidents occurred in diminished light conditions among fixed wing airplanes (11 out of 48) as opposed to other aircraft (2 out of 39), and among twin-engine aircraft (6 out of 12) as opposed to single-engine aircraft (7 out of 74). Out of seven weight-shift control aviation accidents, four were reported to be fatal; the latter all took place during instruction.DISCUSSION: Light conditions are the main environmental concern in Hawaiian aviation that particularly affect twin-engine fixed wing aircraft and warrant specific attention in advanced training exercises. Helicopter operations have not exhibited a diminished safety record since the 1990s, showing a lasting effect of a previous safety intervention. A relatively high number of fatal weight-shift control aircraft accidents requires further research in other parts of the United States.de Voogt AJ, Brause J. A regional approach to aviation accident analysis in Hawaii. Aerosp Med Hum Perform. 2023; 94(3):131–134.

INTRODUCTION: A study was performed to evaluate a cockpit flight simulation suite for measuring moderate altitude effects in a limited subject group. Objectives were to determine whether the apparatus can detect subtle deterioration, record physiological processes throughout hypobaric exposure, and assess recovery.METHODS: Eight subjects trained to perform precision instrument control (PICT) flight and unusual attitude recovery (UAR) and completed chamber flights dedicated to the PICT and UAR, respectively. Each flight comprised five epochs, including ground level pressure (GLP), ascent through altitude plateaus at 10,000, 14,000, and 17,500 ft (3050, 4270, and 5338 m), then postexposure recovery. PICT performance was assessed using control error (FSE) and time-out-of-bounds (TOOB) when pilots exited the flight corridor. UARs were assessed using response times needed to initiate correction and to achieve wings-level attitude. Physiological indices included S_po₂, heart rate (HR), end tidal O₂ and CO₂ pressures, and respiration metrics.RESULTS: Seven subjects completed both flights. PICT performance deteriorated at altitude: FSE increased 33% at 17,513 ft and 21% in Recovery vs. GLP. Mean TOOB increased from 11 s at GLP to 60 s in Recovery. UAR effects were less clear, with some evidence of accelerated responses during and after ascent.CONCLUSIONS: The test paradigm was shown to be effective; piloting impairment was detected during and after exposure. Physiological channels recorded a combination of hypoxia, elevated ventilation, and hypocapnia during ascent, followed by respiratory slowing in recovery. Findings indicate precision piloting and respiration are subject to changes during moderate altitude exposure and may remain altered after S_po₂ recovers, and changes may be linked to hypocapnia.Beer J, Morse B, Dart T, Adler S, Sherman P. Lingering altitude effects during piloting and navigation in a synthetic cockpit. Aerosp Med Hum Perform. 2023; 94(3):135–141.