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BACKGROUND: It has previously been documented by a number of nations that pilots of high-performance aircraft have reported symptoms during flight, these are have become known collectively as in-flight physiologic episodes (PHYSEPs). The NATO HFM RTG-312 group has been developing a PHYSEP 'exposure matrix'. During 2023, this matrix has been progressed to provide a more detailed description of the relevance of each 'exposure' in the potential development of PHYSEPs and the knowledge gaps that exist. This presentation will provide an overview of the exposure matrix, and detail one of the four exposure matrix categories. Broadly, the exposure matrix describes cockpit environmental conditions (detailed in this presentation), life support equipment design and function, breathing gas delivery, and underlying pilot state. The matrix consists of exposures that have been assessed for the level of available evidence in the context of PHYSEPs, the likely frequency that a pilot will be exposed to each factor, the efficacy of the mitigation, the significance for PHYSEPs, and finally, the research priority as assessed by RTG-312 panel members. For each exposure, each of these parameters have been assessed as either 'high', 'medium' or 'low'. OVERVIEW: For environmental conditions, the key categories are low ambient pressure (altitude) and high +Gz acceleration, where the exposure frequency for both is considered to be high and the significance of both, in the context of PHYSEPs, is considered high (either in terms of likelihood, severity of symptoms or both). The level of evidence and knowledge associated with both these exposures is considered to be high. The efficacy of cockpit pressurisation and increased concentrations of oxygen in breathing gas to mitigate against low altitude is considered high in a well designed and functioning life support system. In contrast, while G protection systems are usually effective, they may not always provide adequate protection, particularly when combined with variations in underlying pilot state. DISCUSSION: Taking the rating of these factors together, it is concluded that the research priority for low ambient pressure and +Gz acceleration, in the context of PHYSEPs, are low and medium respectively. Learning Objectives 1. Understand the the importance of factors relevant to high performance aircraft in the development of physiologic episodes. 2. Understand the research priority of environmental exposures in the context of physiologic episodes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Fatigue and sleepiness reduce aviator performance and safety. Past studies have supported a link to poor judgement and increased risk-taking. Our objective was to determine whether fatigue and sleepiness altered risk-taking behavior in military aviators. METHODS: This study was approved by Institutional Review Boards at Case Western Reserve University and the Air Force Research Laboratory. Fatigue and sleepiness were measured using the Multidimensional Fatigue Inventory (MFI) and the Epworth Sleepiness Scale (ESS). Risk taking behavior was measured using the Balloon Analogue Risk Task (BART). The study participants consisted of 50 military aviators (45 male 5 female). Using Mann-Whitney U-tests, group means were compared to determine whether differences existed between aviators who endorsed fatigue and/or sleepiness and those who did not. RESULTS: Two groups emerged based on reported levels of fatigue and sleepiness. Group 1 exhibited a mean MFI general fatigue score less than 9 and a mean ESS score less than 10. Group 2 had a mean MFI general fatigue score greater than 9, a mean ESS score greater than 10, or both. Group 2 (16.00 ± 0.52) popped a greater number of balloons than Group 1 (13.81 ± 0.82) when performing the BART (p=.043). Group 2 (3.99 ± 0.10) also applied a greater number of pumps per balloon than Group 1 (3.54 ± 0.18; p=.041). DISCUSSION: The study results identified a relationship between levels of fatigue, sleepiness, and risk-taking behavior in military aviators, further supporting the threat that fatigue and sleepiness pose to aviator safety. These findings provide support for the use of the BART or other risk-taking measure to evaluate the effectiveness of fatigue and sleepiness mitigation strategies. Learning Objectives 1. The audience will understand the prevalence of fatigue and sleepiness among military aviators. 2. The audience will be able to communicate the relationship between fatigue, sleepiness, and risk-taking behavior. [ABSTRACT FROM AUTHOR]

INTRODUCTION: High performance aviators require optimal lung function to counter the environmental stressors of tactical aviation. Pulmonary function tests (PFTs) are key measurements of respiratory health. We sought to characterize PFT values in US Air Force instructor pilots following successive sorties across a work week. The purpose of this study was to use pulmonary function testing to characterize respiratory performance over a two-week period of time. METHODS: This study was approved by both the Air Force Research Laboratory Institutional Review Board and Case Western Reserve University. Portable spirometry was used to assess pulmonary function at 6 time points across two weeks in T6 and T38 instructor pilots at two Air Force training bases. Frequencies and descriptive statistics (Mean ± Standard Deviation) were calculated for percent predicted PFT metrics of forced vital capacity (FVC), forced expiratory volume in one second (FEV-1), FEV-1/FVC ratio, and forced expiratory flow at 25%-75% of vital capacity (FEF 25-75%). Paired t-tests were used to determine if values changed from baseline (Sunday) to final (Thursday) across each week of the study. RESULTS: Instructor pilots (N=35; 31 male + 4 female) ranged in age from 25-48 years (M=34.7 ± 5.6) with 10.9 ± 5.2 years military pilot experience. Approximately 10% of instructor pilots had suboptimal percent predicted FEV-1 values (≤ 80%) for Week 1 and Week 2. Four pilots had 3 suboptimal FEV-1 measurements and three pilots had suboptimal FEV-1 levels at each assessment. FVC increased across the work week from the Sunday baseline (94.63 ± 9.1) to the Thursday measurement (96.37 ± 10.1) in Week 1 (p=0.47). DISCUSSION: Limitations of the cross-sectional study design and small sample size preclude the ability to determine if the suboptimal FEV-1 results in a small subset of instructor pilots represent an acute pulmonary response or unrecognized chronic condition. This suggests a need for future longitudinal research studies of pulmonary function in high performance aviators. Learning Objectives 1. The participant will describe the range of pulmonary function test values of US Air Force instructor pilots across the work week following successive training flights. 2. The participant will learn that suboptimal percent predicted FEV-1 values may exist in a subset of instructor pilots experiencing successive sorties. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1053/jada.2003.50069 Byline: Timothy W. van Wave, Michael Decker Abstract: Objective Development of a method using marketing research data to assess food purchase behavior and consequent nutrient availability for purposes of nutrition surveillance, evaluation of intervention effects, and epidemiologic studies of diet-health relationships. Design Data collected on household food purchases accrued over a 13-week period were selected by using Universal Product Code numbers and household characteristics from a marketing research database. Universal Product Code numbers for 39,408 dairy product purchases were linked to a standard reference for food composition to estimate the nutrient content of foods purchased over time. Subjects/setting Two thousand one hundred sixty-one households located in Victoria, Texas, and surrounding communities who were active members of a frequent shopper program. Analyses Demographic characteristics of sample households and the nutrient content of their dairy product purchases were analyzed using frequency distribution, cross tabulation, analysis of variance, and t test procedures. Results A method for using marketing research data was successfully used to estimate household purchases of specific foods and their nutrient content from a marketing database containing hundreds of thousands of records. Distribution of dairy product purchases and their concomitant nutrients between Hispanic and non-Hispanic households were significant (P<.01, P<.001, respectively) and sustained over time. Application/conclusions Purchase records from large, nationally representative panels of shoppers, such as those maintained by major market research companies, might be used to accomplish detailed longitudinal epidemiologic studies or surveillance of national food- and nutrient-purchasing patterns within and between countries and segments of their respective populations. J Am Diet Assoc. 2003;103:445-453. Author Affiliation: T. W. Van Wave is an associate professor, Department of Family Medicine of the University of Minnesota School of Medicine Duluth, Duluth, MN; research director for the Whiteside Institute for Clinical Research, Duluth, MN. He was an NCI post-doctoral fellow, School of Public Health of the University of Texas Health Science Center at Houston, Houston, TX, during the data collection and analysis phase of this research. M. Decker is a retired associate professor, School of Public Health of the University of Texas Health Science Center at Houston, Houston, TX. Article Note: (footnote) [star] Address correspondence to: Timothy W. Van Wave, DrPH, RD, Department of Family Medicine, University of Minnesota School of Medicine Duluth, 1035 University Drive, Duluth, MN 55812. E-mail: tvanwave@d.umn.edu.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1053/jada.2003.50069 Byline: Timothy W. van Wave, Michael Decker Abstract: Objective Development of a method using marketing research data to assess food purchase behavior and consequent nutrient availability for purposes of nutrition surveillance, evaluation of intervention effects, and epidemiologic studies of diet-health relationships. Design Data collected on household food purchases accrued over a 13-week period were selected by using Universal Product Code numbers and household characteristics from a marketing research database. Universal Product Code numbers for 39,408 dairy product purchases were linked to a standard reference for food composition to estimate the nutrient content of foods purchased over time. Subjects/setting Two thousand one hundred sixty-one households located in Victoria, Texas, and surrounding communities who were active members of a frequent shopper program. Analyses Demographic characteristics of sample households and the nutrient content of their dairy product purchases were analyzed using frequency distribution, cross tabulation, analysis of variance, and t test procedures. Results A method for using marketing research data was successfully used to estimate household purchases of specific foods and their nutrient content from a marketing database containing hundreds of thousands of records. Distribution of dairy product purchases and their concomitant nutrients between Hispanic and non-Hispanic households were significant (P<.01, P<.001, respectively) and sustained over time. Application/conclusions Purchase records from large, nationally representative panels of shoppers, such as those maintained by major market research companies, might be used to accomplish detailed longitudinal epidemiologic studies or surveillance of national food- and nutrient-purchasing patterns within and between countries and segments of their respective populations. J Am Diet Assoc. 2003;103:445-453. Author Affiliation: T. W. Van Wave is an associate professor, Department of Family Medicine of the University of Minnesota School of Medicine Duluth, Duluth, MN; research director for the Whiteside Institute for Clinical Research, Duluth, MN. He was an NCI post-doctoral fellow, School of Public Health of the University of Texas Health Science Center at Houston, Houston, TX, during the data collection and analysis phase of this research. M. Decker is a retired associate professor, School of Public Health of the University of Texas Health Science Center at Houston, Houston, TX. Article Note: (footnote) [star] Address correspondence to: Timothy W. Van Wave, DrPH, RD, Department of Family Medicine, University of Minnesota School of Medicine Duluth, 1035 University Drive, Duluth, MN 55812. E-mail: tvanwave@d.umn.edu.

Objective Development of a method using marketing research data to assess food purchase behavior and consequent nutrient availability for purposes of nutrition surveillance, evaluation of intervention effects, and epidemiologic studies of diet-health relationships. Design Data collected on household food purchases accrued over a 13-week period were selected by using Universal Product Code numbers and household characteristics from a marketing research database. Universal Product Code numbers for 39,408 dairy product purchases were linked to a standard reference for food composition to estimate the nutrient content of foods purchased over time. Subjects/setting Two thousand one hundred sixty-one households located in Victoria, Texas, and surrounding communities who were active members of a frequent shopper program. Analyses Demographic characteristics of sample households and the nutrient content of their dairy product purchases were analyzed using frequency distribution, cross tabulation, analysis of variance, and t test procedures. Results A method for using marketing research data was successfully used to estimate household purchases of specific foods and their nutrient content from a marketing database containing hundreds of thousands of records. Distribution of dairy product purchases and their concomitant nutrients between Hispanic and non-Hispanic households were significant (P Application/conclusions Purchase records from large, nationally representative panels of shoppers, such as those maintained by major market research companies, might be used to accomplish detailed longitudinal epidemiologic studies or surveillance of national food- and nutrient-purchasing patterns within and between countries and segments of their respective populations. J Am Diet Assoc. 2003; 02:445-453., Accurate longitudinal measurement of nutrient intake continues as a sought after, but elusive, goal of epidemiologists because repeated, detailed registries of food consumption are required to account for the effects [...]