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Background: Cardiologists will commonly assess patients who hold an aviation medical certificate and require unique assessments and communications with national civil aviation authorities (in Australia, the Civil Aviation Safety Authority [CASA] and in New Zealand, the Civil Aviation Authority of New Zealand [CAA NZ]). Cardiac conditions are the most common reason for disqualification from holding an aviation licence, and coronary artery disease is considered a high-risk condition for pilot incapacitation., Aim: To provide a contemporary update on the aeromedical approach to the evaluation, detection, and management of coronary artery disease in an Australasian context., Methods: A narrative view of current and historical practice in the area of aeromedical evaluation of coronary disease was undertaken., Results: This review highlights the aeromedical approach to risk stratification and specific challenges of the aviation environment for patients with coronary artery disease. Scenarios of coronary artery disease screening, common and rare acute coronary syndromes, and the assessment of established coronary artery disease are examined in detail. Suggestions to facilitate communications between specialists and CASA or CAA NZ to facilitate patient re-certification are also provided., Conclusion: Patients who are pilots have unique requirements in terms of their coronary assessment, management, and follow-up to maintain eligibility to fly. It is important for cardiologists to be aware of relevant occupational requirements to provide optimal care to their patients., Competing Interests: Conflicts of Interest Nil direct. Concepts discussed within this paper are accurate at time of publication and represent broad consensus only. Recommendations should not be represented as being the CASA’s or the CAA’s positions at law in the case of any individual patients., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Current cardiovascular risk screening approach in airline pilots in New Zealand (NZ) does not fully achieve the goal of identifying silent cardiovascular disease (CVD) before it causes sudden incapacitating symptoms. Moreover, approaches to investigate excessive cardiovascular risk relied heavily on exercise electrocardiography as a diagnostic test, and were sub-optimal to either detect disease, or to protect pilots from unnecessary invasive procedures. This paper recommends a new approach in assessing CVD in asymptomatic pilots in NZ. The assessment of a 5-year cardiovascular risk score using NZ cardiovascular risk charts as currently adopted will still be the first step of the screening process. The new approach is that asymptomatic pilots with 5-year CVD risk of 5-10% and 10-15% will be referred for coronary artery calcium scoring. No further cardiovascular investigations will be required if the calcium score is <400. Those with a calcium score between 100 and 399 will receive drug and/or lifestyle interventions. Pilots with a calcium score of ≥400 will proceed to a stress myocardial perfusion imaging or a coronary computed tomography angiography. Those with a normal result will not undertake further examination and will receive lifestyle and/or drug interventions. If an abnormal result is found, the pilots will undergo a coronary angiography, and a definitive treatment such as percutaneous coronary intervention might be recommended. After consideration of the risks and benefits of cardiac tests involved, the proposed new system appears to be reasonable and feasible to be implemented in the cardiovascular risk assessment of asymptomatic pilots. [ABSTRACT FROM AUTHOR]

Thirty six volunteer air force personnel were sequentially exposed in a randomized balanced order in a hypobaric chamber to 30 min of baseline (sea level) and mild hypoxia induced by a specified altitude (sea level, 8000 ft and 12,000 ft), followed immediately by breathing 100% oxygen from an oro-nasal mask. Mood and complex cognition were assessed. Analysis of variance indicated that mood (fatigue and vigour) remained the same at 8000 ft but fatigue was increased (p = 0.001) and vigour reduced (p = 0.035) at 12,000 ft and was restored by supplementary oxygen. Complex cognition was not significantly altered by the test conditions. The results of this study do not support prior evidence that mild hypoxia equivalent to either 8000 or 12,000 ft, impairs complex cognition, but suggests that some aspects of mood may be affected at 12,000 ft and can be restored by breathing 100% oxygen. [ABSTRACT FROM AUTHOR]

Abstract: Accelerating global climate change poses considerable challenges to all societies and economies. The European Union now targets a 20% reduction in CO2 emissions by 2020. Indeed, the Labour-led Norwegian government is committed to carbon neutrality across all sectors of the economy by 2030. Aviation has been identified as a rapidly growing contributor to CO2 emissions. This article reports on a research project that explored Norwegian attitudes towards climate change, particularly as they relate to extreme long-haul air travel to Aotearoa/New Zealand. It reveals that the ‘dream trip’ to New Zealand for Norwegians is still largely intact. It also finds evidence of ‘air travel with a carbon conscience’ arising from growing concern for high frequency discretionary air travel. Evidence of denial of the climate impact of air travel that recent studies have revealed was largely absent. Interviewees expressed a greater concern for short-haul air travel emissions than for the climate impact of long-haul travel. However, intentions to adapt long-haul travel behaviours were expressed, highlighting the need to monitor consumer attitudes towards the impact of air travel on climate change. We conclude that Norway is a vanguard European tourism market in terms of climate sensitivity. [ABSTRACT FROM AUTHOR]

This article will examine the involvement of the Empire Press Union, including prominent early members like Lord Northcliffe and its founder Sir Harry Brittain, in the development of imperial air services as part of a larger ongoing study involving India, Australia and New Zealand. The main focus will be on the first three decades of the organization (1909-39) and on its regular conference activity which correspond with the pioneering period of aviation in Britain and in the antipodes. The press, as will be shown, had a commercial stake in the pioneer aviation story, while the Empire Press Union, for reasons to be outlined below, had a strong interest in Imperial Airways' plans to develop the 'longest air route in the world' to that time. The focus of this analysis is inevitably limited: it does not, for example, deal with the ambitious British airship experiment which competed for funds and publicity with aviation, albeit with tragic outcomes. In contrast with the triumphalism of traditional communication and press narratives, it uncovers a complex faltering set of developments in which the Empire Press Union, both for altruistic and self-interested motives, played its part. In general terms, this involvement also serves to confirm that the Empire Press Union and its elaborate conferences paid increasing attention to new and emerging technologies like aviation and broadcasting in the interwar years. Moreover, this interest was not solely a response to the commercial challenges which such inventions posed to newspapers and print journalism; rather it reflected the willingness of the Press Union leadership, both in Britain and elsewhere, to harness such developments in the interests of speedier and cheaper imperial communications. [ABSTRACT FROM AUTHOR]

This paper uses industry wide survey data to assess employees’ perceptions of safety management and safety culture in the aviation industry. Results show that organisations, in ensuring safety, considered employees’ safety responsibilities to be more important than implementing effective safety management systems and encouraging positive safety culture. Aircraft maintenance engineers appeared to be committed to standards and operating procedures and effective organisational processes in making the maintenance system work. Interestingly, pilots regarded luck to be a significant contributing factor in safety. Overall, the findings suggest the various sectors of the aviation industry need to do much more to improve the prevailing safety culture. [Copyright &y& Elsevier]

The regulatory governance of two government-owned, commercialised, monopoly air navigation service providers in Australian and New Zealand is assessed. Economic oversight by an independent regulator in Australia is compared to self-regulation in New Zealand. The Stern and Holder (1999) evaluation framework is applied and user assessments are considered. Both models meet the attributes of sound regulatory governance in most respects. Significant changes in the industry environment indicate that regulatory governance should be reassessed, including with regard to linkages between price regulation and service delivery. • Self-regulation of air traffic management is compared to independent regulation. • Theories of regulatory governance and new governance applied to case studies. • Case studies of air traffic management provision in Australia and New Zealand. • Self-regulation and independent regulation meet good governance criteria. • Environmental changes suggest regulatory frameworks need review. [ABSTRACT FROM AUTHOR]

Introduced brushtail possums (Trichosurus vulpecula) and rat species (Rattus spp.) are major vertebrate pests in New Zealand, with impacts on conservation and agriculture being managed largely through poisoning operations. Aerial distribution of baits containing sodium fluoroacetate (1080) has been refined to maximise cost effectiveness and minimise environmental impact, but this method is strongly opposed by some as it is perceived as being indiscriminate. Although ground based control enables precise placement of baits, operations are often more than twice as costly as aerial control, mainly due to the high labour costs. We investigated a new approach to ground based control that combined aerial distribution of non-toxic 'prefeed' baits followed by sparse distribution of toxic baits at regular intervals along the GPS tracked prefeeding flight paths. This approach was tested in two field trials in which both 1080 baits and cholecalciferol baits were used in separate areas. Effectiveness of the approach, assessed primarily using 'chewcards', was compared with that of scheduled aerial 1080 operations that were conducted in outlying areas of both trials. Contractors carrying out ground based control were able to follow the GPS tracks of aerial prefeeding flight lines very accurately, and with 1080 baits achieved very high levels of kill of possums and rats similar to those achieved by aerial 1080 baiting. Cholecalciferol was less effective in the first trial, but by doubling the amount of cholecalciferol bait used in the second trial, few possums or rats survived. By measuring the time taken to complete ground baiting from GPS tracks, we predicted that the method (using 1080 baits) would be similarly cost effective to aerial 1080 operations for controlling possums and rats, and considerably less expensive than typical current costs of ground based control. The main limitations to the use of the method will be access to, and size of, the operational site, along with topography and vegetation density.

Background: This study examined the prevalence of airline pilots who have an excessive cardiovascular disease (CVD) risk score according to the New Zealand Guideline Group (NZGG) Framingham-based Risk Chart and describes their cardiovascular risk assessment and investigations., Methods: A cross-sectional study was performed among 856 pilots employed in an Oceania based airline. Pilots with elevated CVD risk that had been previously evaluated at various times over the previous 19 yr were reviewed retrospectively from the airline's medical records, and the subsequent cardiovascular investigations were then described., Results: There were 30 (3.5%) pilots who were found to have 5-yr CVD risk score of 10-15% or higher. Of the 29 pilots who had complete cardiac investigations data, 26 pilots underwent exercise electrocardiography (ECG), 2 pilots progressed directly to coronary angiograms and 1 pilot with abnormal echocardiogram was not examined further. Of the 26 pilots, 7 had positive or borderline exercise tests, all of whom subsequently had angiograms. One patient with a negative exercise test also had a coronary angiogram. Of the 9 patients who had coronary angiograms as a consequence of screening, 5 had significant disease that required treatment and 4 had either trivial disease or normal coronary arteries., Conclusion: The current approach to investigate excessive cardiovascular risk in pilots relies heavily on exercise electrocardiograms as a diagnostic test, and may not be optimal either to detect disease or to protect pilots from unnecessary invasive procedures. A more comprehensive and accurate cardiac investigation algorithm to assess excessive CVD risk in pilots is required.

Introduction: In Air Traffic Control, counterclockwise rapidly rotating shift schedules are often employed but may result in significant sleep loss. This has potential consequences for performance, particularly if a night shift is worked. As part of a large-scale field study, the pattern of sleep across a 4-d counterclockwise, rapidly rotating schedule (afternoon, day, morning, night shift) was documented and relationships between prior sleep and performance during the night shift were investigated., Methods: There were 28 controllers who completed 4 periods of data collection which included 2 d before and 2 d after a 4-d shift cycle. Sleep was recorded using an actigraph and sleep diary, and performance on each night shift was measured three times using the Psychomotor Vigilance Task., Results: Across the work week, sleep duration decreased largely due to earlier rise times associated with shift start times moving backward. In the short turn-around between the morning and night shift, 90% of controllers slept for an average of 2.2 h. Improved performance on the night shift was related only to longer periods of sleep the night prior., Discussion: This study demonstrates that a 4-d counterclockwise, rapidly rotating schedule results in a progressive reduction in sleep and consequently the rapid accumulation of a sleep debt. To help maintain their performance on the night shift, it is recommended that controllers attempt to obtain at least 6 h sleep the night before a night shift. It is also recommended that ATC providers educate their workforce about this issue.

Objective: This study assessed the effect of removing artifacts from workplace electroencephalography (EEG) recordings on power spectra and the consequent interpretation of changes in alertness., Methods: EEG was recorded for 27 air traffic controllers on the night shifts of four roster cycles. On two of the four night shifts, each controller was given a 40-minute opportunity to nap, while on the other two they remained awake (105 shifts in total). Recordings for the last hour of each night shift were screened for artifacts by an experienced viewer (who viewed the EEG in isolation from other electrophysiological recordings). The effects of the nap opportunity on the EEG power spectra were then analyzed in a mixed model analysis of variance in the presence and absence of artifact-contaminated data., Results: Overall, 89.3% of the EEG recordings contained artifacts. Removal of these data markedly altered the interpretation of how the nap opportunities affected the EEG power spectra. The spectral parameters of the artifact appeared to be different when the participants were given the opportunity to nap., Conclusions: Removal of artifacts can dramatically affect the interpretation of workplace EEG recordings. This potential source of error is often unreported.

The use of strategies to manage fatigue associated with work was investigated in a sample of 253 pilots operating Air New Zealand regional and international routes. Overall, 13% of pilots responded that they experienced fatigue from their job as a pilot three times a week or more but no differences in overall fatigue levels were found by age, rank or fleet. The use of napping by pilots prior to an overnight duty was variable and 25% of pilots responded that they napped only a little of the time or not at all before such a duty. Pilots who routinely used daytime napping prior to overnight duties reported significantly lower levels of general fatigue. The use of the cockpit napping procedure was evenly split, with 52.5% of pilots reporting the use of cockpit napping over the previous 12 months. The use of the cockpit napping procedure was associated with lower levels of reported fatigue. Hypnotic medication use in the previous 2 months was reported by 19% of pilots mostly on an occasional basis. Melatonin and alternative medicine were used less frequently than hypnotics. This study highlights fatigue as a major problem for many pilots operating regional and international routes. The strategies used by international aircrew to manage fatigue are variable and provide support for the association between napping and lower reported fatigue.

Background: The frequency and role of risk factors for venous thromboembolism related to air travel is uncertain. We aimed to establish the frequency of this disorder in a group of long distance air travellers and to investigate the role of potential risk factors., Methods: We designed a prospective study into which we recruited individuals aged between 18 and 70 years, travelling for 4 h or more by aircraft. D-dimer measurement was done before and after travel. Participants with a negative D-dimer (<500 ng/L) before travel were included in the study. Those who became D-dimer positive or developed high clinical probability symptoms during the 3 months after travel were investigated with bilateral compression ultrasonography and CT pulmonary angiography. Suspected clinical and thrombophilic risk factors, and use of prophylactic measures, were assessed., Findings: 1000 individuals were recruited, with 878 meeting inclusion criteria and completing the study. All participants travelled at least 10 h, with a mean total duration of air travel of 39 h (SD 12.5). 112 patients underwent radiological assessment on return. Frequency of venous thromboembolism associated with travel was 1.0% (9/878, 95% CI 0.5-1.9), which included four cases of pulmonary embolism and five of deep venous thrombosis. Six patients with venous thromboembolism had pre-existing clinical risk factors, two had a recognised thrombophilic risk factor, two travelled exclusively in business class, five used aspirin, and four wore compression stockings., Interpretation: Our results suggest an association between multiple long distance air flights and venous thromboembolism, even in individuals at low to moderate risk. The role of traditional risk factors and prophylactic measures in air travel-related venous thromboembolism needs further investigation.

Aviation medicine has researched many important facts on pilots, but little on direct relationships between controllers, aviation medicine and air safety. The unsuspecting flying public accepts a 'blind faith' in aircraft and pilots, unaware that aircraft are controlled within 'suspect' ATC systems. The deceptive simplicity of controlling air traffic in apparently limitless skies belies the complexity of man-machine ATC systems operated in ever-crowded airspace, sometimes with antiquated equipment and indifferent communications. The indivisible operational controller/pilot team strives to meet similar ICAO medical standards and operate within the limitations of non-standardised recorded air traffic. Despite controllers' intensive stress at air disasters and 'almost' air disasters, air traffic must continually be controlled for air safety; but, countless human lives (and insurance dollars) saved are possibly camouflaged within the smoke screen of ATC. In New Zealand aviation, the Accident Compensation Corporation is statutorily responsible for air-safety, but accident investigators need controllers' expertise. Has a climate of complacency evolved towards air safety such that New Zealand's Erebus and other air disasters could have been avoided? Controllers are that crucial link in aviation with personal medical fitness vital to the air safety of the unsuspecting flying public. Controllers' dedicated aim for complete air safety in ATC shall benefit from greater understanding within aviation medicine and in-depth medical research.