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Introduction: Strong neck muscles may decrease the risk of flight-induced neck pain and possible disability among fast jet pilots. The purpose of this study was to examine the intra- and interrater reliability of a commercial force gauge attached to a pilot's helmet for measuring isometric force production of the neck muscles., Methods: A total of 41 subjects performed maximal isometric cervical flexion, extension, and lateral flexion in two measurement sessions for intrarater reliability, and 31 of these subjects participated in a third session for measuring interrater reliability. Delayed muscle soreness and neck pain were assessed using the Visual Analog Scale before and after each measurement session. The intraclass correlation coefficient (ICC) was used to compare values between the test and retest assessments., Results: The overall interrater reliability was good (ICC 0.79-0.90), whereas the intrarater reliability varied from moderate to good (ICC 0.58-0.84). In both intra- and interrater reliability, the flexion test had good (ICC 0.84-0.89) reliability, while the lateral flexion test results had moderate to good (ICC 0.73-0.90) reliability. The extension test had the lowest reliability in both intra- (ICC 0.58) and interrater (ICC 0.79) tests. The average visual analog scale score (from 1-100 scale) prior to the second measurement session was 16 ± 18 in delayed muscle soreness and 0 ± 0 in neck pain., Discussion: The present study demonstrated that the helmet-attached force gauge is a reliable, safe, and clinically applicable method to evaluate isometric neck strength in the flexion and lateral flexion directions. Honkanen T, Mattila V, Kinnunen O, Janhunen M, Sovelius R, Vaara JP, Kyröläinen H. Reliability of a flight helmet-attached force gauge in measuring isometric neck muscle strength. Aerosp Med Hum Perform. 2024; 95(10):788-793.

This short communication highlights the US Air Force's recent success with having their aeromedical evacuation crews use the Transportation Isolation System for the first time operationally to transport patients positive for coronavirus disease 2019., (Published by Elsevier Inc.)

BACKGROUND: UK Royal Air Force fast jet aircrew use three different anti-G systems, however, little objective comparison of the G protection they provide exists. The G-protection afforded by each system and associated hemodynamic responses were investigated. METHODS: Ten subjects performed centrifuge acceleration exposures using Mk-10 (S1) and Mk-4 (S2) five-bladder anti-G trousers (AGT) and full coverage AGT plus pressure breathing for G-protection (PBG; S3). Measurements of relaxed G tolerance (RGT), eye-level blood pressure (BP eye ), lower body blood volume (LBV), stroke volume (SV) and total peripheral resistance (TPR) were made during gradual onset runs (GOR) and rapid onset runs (ROR). The subjective effort required to maintain clear vision at +7 and +8 G z provided an indication of the protection provided by the system. RESULTS: All systems moderated decreases in SV and BP eye and increases in LBV under increased +G z . S3 provided the greatest mean RGT during GOR (+6.2 G z ) and ROR (+6 G z ), reduced the effort required to maintain clear vision at up to +8 G z , prevented venous pooling and afforded the greatest rise in TPR. The majority of indices revealed no difference between S1 and S2 although RGT during the ROR was greater with S2 (+0.25 G z ). DISCUSSION: S3 effectively prevented pooling of blood in the lower limbs under +G z , despite the use of PBG, and offers an advantage over five-bladder AGT. Given the similarities of S1 and S2, it was unsurprising that the majority of indices measured were similar. The objective measurement of hemodynamic parameters provides useful information for comparing the G-protection provided by anti-G systems. Pollock RD, Firth RV, Storey JA, Phillips KE, Connolly DM, Green NDC, Stevenson AT. Hemodynamic responses and G protection afforded by three different anti-G systems. Aerosp Med Hum Perform. 2019; 90(11):925-933.

INTRODUCTION: Due to the risk of hypoglycemia-related incapacitation, diabetic pilots requiring insulin are assessed as unfit according to the International Civil Aviation Organization and most national authorities. Some authorities, such as those from Canada, the United Kingdom, and the United States, permit selected insulin-treated pilots (ITDM-pilots) to fly subject to a protocol requiring pre- and in-flight capillary glucose measurements to show safe levels (>100-<300 mg · dl -1 ). Critics of such permission question the practicability of these in-flight measurements and whether clinically desired glycemic targets can be achieved while keeping glucose levels in the safe range. Subcutaneous continuous glucose monitoring (CGM) has recently been approved by the FDA as a stand-alone method to provide accurate glucose levels and treatment decision guidance in patients. This commentary considers that use of CGM by ITDM pilots facilitates practicability and recording of in-flight glucose measurements and facilitates achievement of clinically desired glycemic targets without increasing hypoglycemia risks. Strollo F, Simons R, Mambro A, Strollo G, Gentile S. Continuous glucose monitoring for in-flight measurement of glucose levels of insulin-treated pilots . Aerosp Med Hum Perform. 2019; 90(8):735-737.

BACKGROUND: The evaluation of how air rarefaction can affect a loudspeaker performance at altitude implies the need for characterization of earphones during hypobaric conditions. The aim of this study was phonometric analysis at different altitudes of the acoustic output of a widely used earphone model, along with its consequences on audiological investigations conducted under such environmental conditions. METHODS: The transfer function of a TDH-39P earphone was analyzed with an artificial ear under nine different altitude levels, from sea level up to 35,000 ft, inside a hypobaric chamber. A specific phonometric system not sensitive to environmental pressure changes was used. Other potentially confounding factors, such as environmental temperature and humidity, were continuously monitored. RESULTS: No relevant temperature or humidity changes were detected. The sound pressure level generated by the earphone under hypobaric conditions was found considerably affected by air density changes. These data produced a correction table aiming at recalibrating the earphone's output at each audiometric octave test frequency within the 250-8000 Hz range. Quite different characteristics of response were observed at different audiometric frequencies. Such findings were particularly evident for altitudes exceeding 12,000 ft. DISCUSSION: The development of a frequency-selective and altitude-related correction factor for acoustic stimuli is an essential aspect when hearing threshold measurements in hypobaric environments are performed. Lucertini M, Botti T, Sanjust F, Cerini L, Autore A, Lucertini L, Sisto R. High altitude performance of loudspeakers and potential impact on audiometric findings . Aerosp Med Hum Perform. 2019; 90(7):655-659.

INTRODUCTION: Prior research suggests there may be gender differences with regards to hypoxia resilience. Our study was designed to determine whether there were differences between genders in neuronal electrical activity at simulated altitude and whether those changes correlated with cognitive and aviation performance decrements. METHODS: There were 60 student Naval Aviators or Flight Officers who completed this study (30 women, 30 men). Participants were exposed to increasing levels of normobaric hypoxia and monitored with dry EEG while flying a fixed-base flight simulation. Gender differences in brainwave frequency power were quantified using MATLAB. Changes in flight and cognitive performance were analyzed via simulation tasks and with a cognitive test validated under hypoxia. RESULTS: Significant decreases in theta and gamma frequency power occurred for women compared to men with insidious hypoxic exposures to 20K, with an average frequency power decrease for women of 19.4% compared to 9.3% for men in theta, and a 42.2% decrease in gamma for women compared to 21.7% for men. Beta frequency power correlated highest between genders, with an average correlation coefficient of r = 0.95 across seven channels. DISCUSSION: Results of this study suggest there is identifiable brain wave suppression for both men and women with hypoxic exposure and, moreover, there are significant differences in this suppression between genders. Beta frequency power was most sensitive for both genders and highly correlative compared to other brainwave frequencies. The implications of these findings are important considerations for next-generation aviation helmets, which may employ this technology as an early warning mechanism. Rice GM, Snider D, Drollinger S, Greil C, Bogni F, Phillips J, Raj A, Marco K, Linnville S. Gender differences in dry-EEG manifestations during acute and insidious normobaric hypoxia . Aerosp Med Hum Perform. 2019; 90(4):369-377.

Prototype low-intensity threat laser eye protection (LIT-LEP) spectacles were evaluated for US Coast Guard (USCG) cockpits and night vision goggle compatibility. The impetus for interest in aviation LIT-LEP is driven in part by the fact that easily accessible 0.5-2.0 W high-power laser pointers exceed safety standards for direct on-axis viewing. A repeated-measures experimental design was used to assess LIT-LEP performance relative to a no-LEP control for the following tasks: Near- and far contrast acuity, night vision goggle far-contrast acuity, emissive and non-emissive light source color-vision screening, and USCG multifunctional display color symbol discrimination reaction time and accuracy. Near- and far-contrast acuity results demonstrated good LIT-LEP performance for typical in- and out-of-cockpit lighting conditions. Night vision goggle performance suffered marginally at only one contrast level (85%; 20/30 acuity line). Color vision test results showed good color balance in that S-, M-, and L-cone performance did not demonstrate a clinical diagnostic color defect for emissive or non-emissive light sources when wearing LIT-LEP. Color symbol discrimination reaction-time-task results based on inverse efficiency scores revealed that some non-primary flight display colors exhibited a combination of slower speed and decreased accuracy. The findings will contribute to an acquisition decision as well as guide future LEP designs., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

Introduction: Fighter jet pilots may adopt a voluntary hypohydration strategy hours before take-off to avoid urinating in flight. This may favor sortie-induced dehydration and potentially increase flying errors. Since 2015, French pilots have used a urinary sheath (US) that appears to have resolved this problem. However, its effect has never been assessed., Methods: Urine specific gravity (USG) before and after sorties, inflight intake (water and food) and loss (sweat and urine), and changes in bodyweight were measured during 44 long (~370 minutes) sorties (22 in 2015 without a US, No-US group, and 22 in 2017 with a US, US group)., Results: The USG before sorties was lower in the US than No-US group (1.019 ± 0.008 vs 1.028 ± 0.006, p = 0.008) and the proportion of hypohydrated pilots (>1.020) was lower in the US than No-US group (29 vs 90%, p = 0.007). Total loss and intake were higher in the US group (1,793 ± 640 and 927 ± 585 g, respectively) than in the No-US group (1,337 ± 382 and 359 ± 191 g, respectively; p < 0.006). Changes in bodyweight, both absolute (-977 ± 367 g for the No-US and -866 ± 593 g for the US group) and relative (1.16 ± 0.51% for the No-US and 1.13 ± 0.77% for the US group) during sorties were not altered by wearing a US., Conclusion: The use of a US successfully mitigates preflight dehydration, as reflected by decreases in USG, showing that pilots, at least partially, abandon preflight voluntary hypohydration strategies. It also favored water and food intake during flight without enhancing inflight dehydration, shown by the parallel increases in loss (urine and sweat) when wearing a US., (© Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Long-duration space missions pose important health concerns for astronauts, especially regarding the adverse effects of microgravity and exposure to high-energy cosmic rays. The long-term maintenance of crew health and performance mainly relies on prevention, early diagnoses, condition management, and medical interventions in situ. In-flight biosensor diagnostic devices and medical procedures must use few resources and operate in a microgravity environment, which complicates the collection and management of biological samples. Moreover, the biosensors must be certified for in-flight operation according to strict design and safety regulations. Herein, we report on the state of the art and recent advances in biosensing diagnostic instrumentation for monitoring astronauts' health during long-duration space missions, including portable and wearable biosensors. We discuss perspectives on new-format biosensors in autonomous space clinics. We also describe our own work in developing biosensing devices for non-invasively diagnosing space-related diseases, and how they are used in long-duration missions. Finally, we discuss the benefits of space exploration for Earth-based medicine., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The U.S. Military no longer maintains overseas extracorporeal membrane oxygenation (ECMO) capability for patients with severe lung injury including acute respiratory distress syndrome (ARDS). The authors present a case of severe ARDS at a military hospital in Afghanistan with limited capability for rescue therapies to include presentation, treatment, transport, and use of ECMO in the deployed military environment at one Role 3 medical facility. Lack of ECMO in the overseas environment is a significant gap in U.S. Military medical capability. The authors propose a novel solution, "ECMO packs," for prepositioning at strategic Role 3 facilities for early intervention in patients with severe lung injury to close this lethal and unnecessary capability gap.

Introduction: The provision of medical care in exploration-class spaceflight is limited by mass, volume, and power constraints, as well as limitations of available skillsets of crewmembers. A quantitative means of exploring the risks and benefits of inclusion or exclusion of onboard medical capabilities may help to inform the development of an appropriate medical system. A pilot project was designed to demonstrate the utility of an early tradespace analysis tool for identifying high-priority resources geared toward properly equipping an exploration mission medical system., Methods: Physician subject matter experts identified resources, tools, and skillsets required, as well as associated criticality scores of the same, to meet terrestrial, U.S.-specific ideal medical solutions for conditions concerning for exploration-class spaceflight. A database of diagnostic and treatment actions and resources was created based on this input and weighed against the probabilities of mission-specific medical events to help identify common and critical elements needed in a future exploration medical capability., Results: Analysis of repository data demonstrates the utility of a quantitative method of comparing various medical resources and skillsets for future missions. Directed database queries can provide detailed comparative estimates concerning likelihood of resource utilization within a given mission and the weighted utility of tangible and intangible resources., Discussion: This prototype tool demonstrates one quantitative approach to the complex needs and limitations of an exploration medical system. While this early version identified areas for refinement in future version development, more robust analysis tools may help to inform the development of a comprehensive medical system for future exploration missions.Antonsen EL, Mulcahy RA, Rubin D, Blue RS, Canga MA, Shah R. Prototype development of a tradespace analysis tool for spaceflight medical resources. Aerosp Med Hum Perform. 2018; 89(2):108-114.

A revised pilot oxygen mask design was developed for better fit to the Korean Air Force pilots' faces. The present study compared an existing pilot oxygen mask and a prototype of the revised mask design with 88 Korean Air Force pilots in terms of subjective discomfort, facial contact pressure, and slip distance on the face in high gravity. The average discomfort levels, facial contact pressures, and slip distance of the revised mask were reduced by 33%-56%, 11%-33%, and 24%, respectively, compared to those of the existing oxygen mask. The mask evaluation method employed in the study can be applied to ergonomic evaluation of full- or half-face mask designs., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: With the development of the commercial space industry, growing numbers of spaceflight participants will engage in activities with a risk for pulmonary injuries, including pneumothorax, ebullism, and decompression sickness, as well as other concomitant trauma. Medical triage capabilities for mishaps involving pulmonary conditions have not been systematically reviewed. Recent studies have advocated the use of point-of-care ultrasound to screen for lung injury or illness. The operational utility of portable ultrasound systems in disaster relief and other austere settings may be relevant to commercial spaceflight., Methods: A systematic review of published literature was conducted concerning the use of point-of-care pulmonary ultrasound techniques in austere environments, including suggested examination protocols for triage and diagnosis., Results: Recent studies support the utility of pulmonary ultrasound examinations when performed by skilled operators, and comparability of the results to computed tomography and chest radiography for certain conditions, with important implications for trauma management in austere environments., Discussion: Pulmonary injury and illness are among the potential health risks facing spaceflight participants. Implementation of point-of-care ultrasound protocols could aid in the rapid diagnosis, triage, and treatment of such conditions. Though operator-dependent, ultrasound, with proper training, experience, and equipment, could be a valuable tool in the hands of a first responder supporting remote spaceflight operations.Johansen BD, Blue RS, Castleberry TL, Antonsen EL, Vanderploeg JM. Point-of-care ultrasound for pulmonary concerns in remote spaceflight triage environments. Aerosp Med Hum Perform. 2018; 89(2):122-129.

Objectives: Since hypoxia remains one of the most important physiological hazards the aviation environment poses, military aviators are trained to recognize symptoms of hypoxia in order to implement appropriate safety procedures and countermeasures when hypoxia occurs. A widely used commercial instrument for hypoxia training, demonstration, and research is the Reduced Oxygen Breathing Device (ROBD). Here we describe a novel, inexpensive method to use the ROBD's breathing loop pressure (BLP) to measure respiration rate, a critically important response parameter for hypoxia., Methods: The ROBD can be controlled by a computer to export several variables including BLP, via the ROBD's RS232 port. An archived database was reanalyzed to assess the BLP data. New instrumentation added independent measures of respiration and expired oxygen and carbon dioxide; these measures were integrated with the ROBD output., Results: Analysis of the archived data showed that the BLP reflected realistic breathing patterns. The new instrumentation integrated well with the ROBD, and independently supported the potential of the BLP as a valid measure of respiration., Discussion: The ROBD's BLP data may provide a basis for a reliable, sensitive measure of respiration that is available at no additional cost., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Introduction: Flying a helicopter is a complex psychomotor skill. Fatigue is a serious threat to operational safety, particularly for sustained helicopter operations involving high levels of cognitive information processing and sustained time on task. As part of ongoing research into this issue, the object of this study was to develop a field-deployable helicopter-specific psychomotor vigilance test (PVT) for the purpose of daily performance monitoring of pilots., Methods: The PVT consists of a laptop computer, a hand-operated joystick, and a set of rudder pedals. Screen-based compensatory tracking task software includes a tracking ball (operated by the joystick) which moves randomly in all directions, and a second tracking ball which moves horizontally (operated by the rudder pedals). The 5-min test requires the pilot to keep both tracking balls centered., Results: This helicopter-specific PVT's portability and integrated data acquisition and storage system enables daily field monitoring of the performance of individual helicopter pilots. The inclusion of a simultaneous foot-operated tracking task ensures divided attention for helicopter pilots as the movement of both tracking balls requires simultaneous inputs., Discussion: This PVT is quick, economical, easy to use, and specific to the operational flying task. It can be used for performance monitoring purposes, and as a general research tool for investigating the psychomotor demands of helicopter operations. While reliability and validity testing is warranted, data acquired from this test could help further our understanding of the effect of various factors (such as fatigue) on helicopter pilot performance, with the potential of contributing to helicopter operational safety.

The paper reports the results of testing some diagnostic video systems enabling digital rendering of TNT teeth and jaws. The authors substantiate the criteria of choosing and integration of imaging systems in future on Russian segment of the International space station kit LOR developed for examination and download of high-quality images of cosmonauts' TNT, parodentium and teeth.

Multiple trials were conducted from 2006 to 2014 in an attempt to validate aerial spray efficacy at altitudes conducive to night spray operations using night vision goggles (NVGs). Higher altitude application of pesticide (more than 400 ft (121.9 m) above ground level (AGL)) suggested that effective vector control might be possible under ideal meteorological conditions. A series of lower altitude daytime applications (300 ft (91.4 m) AGL) demonstrated effective and repeatable mortality of target sentinel insects more than 5,000 ft (1,524 m) downwind, and control of natural vector populations. From these results we believe further pursuit of aerial night applications of pesticide using NVGs at 300 ft (91.4 m) AGL by this group is warranted.

Background: A sudden loss of external visual cues during critical phases of flight results in spatial disorientation. This is due to undetected horizontal and vertical drift when there is little tolerance for error and correction delay as the helicopter is close to the ground. Three helmet-mounted symbology system concepts were investigated in the simulator as potential solutions for the legacy Griffon helicopters., Method: Thirteen Royal Canadian Air Force (RCAF) Griffon pilots were exposed to the Helmet Display Tracking System for Degraded Visual Environments (HDTS), the BrownOut Symbology System (BOSS), and the current RCAF AVS7 symbology system. For each symbology system, the pilot performed a two-stage departure and a single-stage approach. The presentation order of the symbology systems was randomized. Objective performance metrics included aircraft speed, altitude, attitude, and distance from the landing point. Subjective measurements included situation awareness, mental effort, perceived performance, perceptual cue rating, and NASA Task Load Index. Repeated measures analysis of variance and subsequent planned comparison for all the objective and subjective measurements were performed between the AVS7, HDTS, and BOSS., Results: Our results demonstrated that HDTS and BOSS showed general improvement over AVS7 in two-stage departure. However, only HDTS performed significantly better in heading error than AVS7. During the single-stage approach, BOSS performed worse than AVS7 in heading root mean square error, and only HDTS performed significantly better in distance to landing point and approach heading than the others., Discussion: Both the HDTS and BOSS possess their own limitations; however, HDTS is the pilots' preferred flight display.

Background: The most commonly cited hypotheses for motion sickness (MS) focus on inconsistent sensory inputs. Visual/vestibular conflicts may lead to MS, but visual input from retinal regions/neural pathways that are sensitive to motion might bear more weight in MS etiology. We hypothesized that inducing blurred vision in an optokinetic drum would attenuate the influence of foveal (parvocellular) input, but not peripheral (magnocellular) input that is sensitive to motion. Increased relative influence of peripheral visual input was predicted to subsequently lead to more visual/vestibular conflict and subsequently more severe MS symptoms., Methods: Through goggles that were either clear or frosted, 15 subjects (5 men, 10 women, mean age = 24.9 yr, range = 18-49) viewed the interior of a rotating (60° · s(-1)) optokinetic drum for 10 min. Subjects completed the Simulator Sickness Questionnaire (SSQ) before and after viewing. Overall subjective sickness ratings (0-10) and visually induced self-motion perception (vection) ratings (0-10) were also recorded., Results: Postexposure SSQ scores obtained in the blur condition (total - 52.9, oculomotor - 38.9, disorientation - 69.6) were significantly higher than those obtained in the control condition (total - 30.4, oculomotor - 21.7, disorientation - 37.8). Overall sickness ratings and vection ratings were also significantly higher in the blur condition., Conclusions: These results suggest that visual blur can exacerbate MS, perhaps because of differential influences of visual pathways. Although these results were obtained with an optokinetic drum, possible effects of visual blurring in motion provocative environments such aircraft, watercraft, spacecraft, and land vehicles should be considered.

MEMS (micro-electro-mechanical system)-based inertial sensors, i.e., accelerometers and angular rate sensors, are commonly used as a cost-effective solution for the purposes of navigation in a broad spectrum of terrestrial and aerospace applications. These tri-axial inertial sensors form an inertial measurement unit (IMU), which is a core unit of navigation systems. Even if MEMS sensors have an advantage in their size, cost, weight and power consumption, they suffer from bias instability, noisy output and insufficient resolution. Furthermore, the sensor's behavior can be significantly affected by strong vibration when it operates in harsh environments. All of these constitute conditions require treatment through data processing. As long as the navigation solution is primarily based on using only inertial data, this paper proposes a novel concept in adaptive data pre-processing by using a variable bandwidth filtering. This approach utilizes sinusoidal estimation to continuously adapt the filtering bandwidth of the accelerometer's data in order to reduce the effects of vibration and sensor noise before attitude estimation is processed. Low frequency vibration generally limits the conditions under which the accelerometers can be used to aid the attitude estimation process, which is primarily based on angular rate data and, thus, decreases its accuracy. In contrast, the proposed pre-processing technique enables using accelerometers as an aiding source by effective data smoothing, even when they are affected by low frequency vibration. Verification of the proposed concept is performed on simulation and real-flight data obtained on an ultra-light aircraft. The results of both types of experiments confirm the suitability of the concept for inertial data pre-processing.

On ISS missions and explorer class missions, unexpected medical and surgical emergencies could be disastrous. Lack of ability to rapidly assess and make critical decisions affects mission capability. Current imaging modalities on ISS consist only of ultrasound. There are many acute diagnoses which ultrasound alone cannot diagnose. Portable X-Ray imaging (radiography) technology has advanced far enough to where it is now small enough, cheap enough, and accurate enough to give diagnostic quality images sent wirelessly to the onboard computer and on Earth for interpretation while fitting in something the size of a briefcase. Although further research is warranted, Portable Radiography is an important addition to have on ISS and future Explorer Class Missions while maintaining a very small footprint.

Until recently, astronaut blood samples were collected in-flight, transported to earth on the Space Shuttle, and analyzed in terrestrial laboratories. If humans are to travel beyond low Earth orbit, a transition towards space-ready, point-of-care (POC) testing is required. Such testing needs to be comprehensive, easy to perform in a reduced-gravity environment, and unaffected by the stresses of launch and spaceflight. Countless POC devices have been developed to mimic laboratory scale counterparts, but most have narrow applications and few have demonstrable use in an in-flight, reduced-gravity environment. In fact, demonstrations of biomedical diagnostics in reduced gravity are limited altogether, making component choice and certain logistical challenges difficult to approach when seeking to test new technology. To help fill the void, we are presenting a modular method for the construction and operation of a prototype blood diagnostic device and its associated parabolic flight test rig that meet the standards for flight-testing onboard a parabolic flight, reduced-gravity aircraft. The method first focuses on rig assembly for in-flight, reduced-gravity testing of a flow cytometer and a companion microfluidic mixing chip. Components are adaptable to other designs and some custom components, such as a microvolume sample loader and the micromixer may be of particular interest. The method then shifts focus to flight preparation, by offering guidelines and suggestions to prepare for a successful flight test with regard to user training, development of a standard operating procedure (SOP), and other issues. Finally, in-flight experimental procedures specific to our demonstrations are described.

Background: Donepezil, an acetylcholinesterase inhibitor used in the treatment of Alzheimer's disease, has been widely cited in media and bioethics literature on cognitive enhancement (CE) as having the potential to improve the cognitive ability of healthy individuals. In both literatures, this claim has been repeatedly supported by the results of a small study published by Yesavage et al. in 2002 on non-demented pilots (30-70 years old). The factors contributing to this specific interpretation of this study's results are unclear., Methods: We examined print media and interdisciplinary bioethics coverage of this small study, aiming to provide insight into how evidence from research may be shaped within different discourses, potentially influencing important policy, ethics, and clinical decisions. Systematic qualitative content analysis was used to examine how this study was reported in 27 media and 22 bioethics articles. Articles were analyzed for content related to: (1) headlines and titles; (2) colloquialisms; and, (3) accuracy of reporting of the characteristics and results of the study., Results: In media and bioethics articles referencing this small study, strong claims were made about donepezil as a CE drug. The majority of headlines, titles, and colloquialisms used enhancement language and the majority of these suggest that donepezil could be used to enhance intellectual ability. Further, both literatures moved between reporting the results of the primary study and magnifying the perceived connection between these results and the CE debate that was alluded to in the primary study. Specific descriptions of the results overwhelmingly reported an improvement in performance on a flight simulator, while more general statements claimed donepezil enhanced cognitive performance. Further, a high level of reporting accuracy was found regarding study characteristics of the original study, but variable levels of accuracy surrounded the presentation of complex characteristics (i.e., methods) or contentious properties of the CE debate (i.e., initial health status of the study subjects)., Conclusions: Hyped claims of CE effects cannot be completely accounted for by sheer inaccuracy in reporting. A complex interaction between the primary and secondary literature, and expectations and social pressures related to CE appears to drive enthusiastic reports.

Introduction: The Red Bull Stratos Project consisted of incremental high altitude parachute jumps [maximum altitude 127,852 ft (38,969 m)] from a pressurized capsule suspended from a stratospheric helium-filled balloon. A physiological monitoring system was worn by the parachutist to provide operational medical and acceleration data and to record a unique set of data in a supersonic environment., Methods: Various physiological parameters, including heart rate (HR), respiratory rate (RR), skin temperature, and triaxial acceleration, were collected during the ascent, high altitude float, free fall, and parachute opening and descent stages of multiple low- and high altitude jumps. Physiologic data were synchronized with global positioning system (GPS) and audiovisual data for a comprehensive understanding of the environmental stressors experienced., Results: HR reached maximum during capsule egress and remained elevated throughout free fall and landing. RR reached its maximum during free fall. Temperature data were unreliable and did not provide useful results. The highest accelerations parameters were recorded during parachute opening and during landing. During each high altitude jump, immediately after capsule egress, the parachutist experienced a few seconds of microgravity during which some instability occurred. Control was regained as the parachutist entered denser atmosphere., Discussion: The high altitude environment resulted in extremely high vertical speeds due to little air resistance in comparison to lower altitude jumps with similar equipment. The risk for tumbling was highest at initial step-off. Physiological responses included elevated HR and RR throughout critical phases of free fall. The monitoring unit performed well despite the austere environment and extreme human performance activities.

Spatial orientation of pilots using a cockpit exterior surveillance system was tested in real nighttime helicopter flights. Major factors complicating adequate spatial orientation and provoking visual illusions in pilots are lack of information for spatial depth (relation) perception in two-dimensional TV images altering their position along the horizontal and vertical lines of trajectory and simultaneous piloting and target search-identification operations. Reliability of pilot's spatial orientation could be improved by displaying on the exterior imaging screen also relevant flight navigation parameters.

Objectives: Intraindividual variability (IIV) is negatively associated with cognitive test performance and is positively associated with age and some neurological disorders. We aimed to extend these findings to a real-world task, flight simulator performance. We hypothesized that IIV predicts poorer initial flight performance and increased rate of decline in performance among middle-aged and older pilots., Method: Two-hundred and thirty-six pilots (40-69 years) completed annual assessments comprising a cognitive battery and two 75-min simulated flights in a flight simulator. Basic and complex IIV composite variables were created from measures of basic reaction time and shifting and divided attention tasks. Flight simulator performance was characterized by an overall summary score and scores on communication, emergencies, approach, and traffic avoidance components., Results: Although basic IIV did not predict rate of decline in flight performance, it had a negative association with initial performance for most flight measures. After taking into account processing speed, basic IIV explained an additional 8%-12% of the negative age effect on initial flight performance., Discussion: IIV plays an important role in real-world tasks and is another aspect of cognition that underlies age-related differences in cognitive performance.

On May 5, 1961, astronaut Alan Shepard became the first American to fly in space. Although National Aeronautics and Space Administration (NASA) had discounted the need for him to urinate, Shepard did, in his spacesuit, short circuiting his electronic biosensors. With the development of the pressure suit needed for high-altitude and space flight during the 1950s, technicians had developed the means for urine collection. However, cultural mores, combined with a lack of interagency communication, and the technical difficulties of spaceflight made human waste collection a difficult task. Despite the difficulties, technicians at NASA created a successful urine collection device that John Glenn wore on the first Mercury orbital flight on February 20, 1962. With minor modifications, male astronauts used this system to collect urine until the Space Shuttle program. John Glenn's urine collection device is at the National Air and Space Museum and has been on view to the public since 1976.

The article considers the questions of development of new technologies for evaluation of health of apparently healthy people based on experience of long-term researches of cosmonauts' performed at Russian Academy of Sciences Institute of Biomedical Problems under the direction of academician A. I. Grigoriev. In 2007 in monograph "Concept of Health and Space Medicine" the principle of health estimation in apparently healthy people working in conditions of chronic stress was described. These approaches were realized the same year to produce a new hard and software "Ecosan-2007". In the following 2008 the device has been tested for inspection of bus drivers and pilots of civil aircraft and since 2009 it has been used in the international project "Mars-500". All these developments and researches were supported by the Fundamental Sciences-to-Medicine Program maintained by the Presidium of the Russian Academy of Sciences under guidance of academician A. I. Grigoriev. In the project 'Mars-500" in the "artificial confinement", simulating the interplanetary ship, 6 members of the international "Martian crew" were medically and psycho physiologically surveyed. Among set of various devices the "Ecosan-2007" was also used. With application of the same device, not less that 125 volunteers were examined, who lived usual life in natural and socially-industrial conditions. The investigation was simultaneously conducted in 12 various regions of the world. These long-term medico-ecological researches allowed to receive important experimental substantiations for preclinical approach to state of health estimation. In the frame of these researches the methodology of remote monitoring of adverse ecological factor effects on health initiated telemedical ecology, a new applied discipline. The article concludes with discussion of the issues of health conception and new preclinical diagnostic technologies adapting by the public health services.

Portable oxygen concentrators (POC) are highly desirable for patients with lung disease traveling by airplane, as these devices allow theoretically much higher travel times if additional batteries can be used. However, it is unclear whether POCs produce enough oxygen in airplanes at cruising altitude, even if complying with aviation regulations. We evaluated five frequently used POCs (XPO2 (Invacare, USA), Freestyle (AirSep C., USA), Evergo (Philipps Healthcare, Germany), Inogen One (Inogen, USA), Eclipse 3 (Sequal, USA)) at an altitude of 2650 m (as simulated airplane environment) in 11 patients with chronic obstructive lung disease (COPD) and compared theses POCs with the standard oxygen system (WS120, EMS Ltd., Germany) used by Lufthansa. Oxygen was delivered by each POC for 30 min to each patient at rest, blood gases were then drawn from the arterialized ear lobe. All POCs were able to deliver enough oxygen to increase the PaO(2) of our subjects by at least 1.40 kPa (10 mmHg). However, to achieve this increase, the two most lightweight POCs (Freestyle and Invacare XPO2) had to be run at their maximum level. This causes a significant reduction of battery life. The three other POCs (EverGo, Inogen One, Eclipse 3) and the WS120 were able to increase the PaO(2) by more than 2.55 kPa (20 mmHg), which provides extra safety for patients with more severe basal hypoxemia. When choosing the right oxygen system for air travel in patients in COPD, not only weight, but also battery life and maximum possible oxygen output must be considered carefully., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Normobaric hypoxia, which does not entail an altitude chamber, but reduces the fraction of inspired oxygen (02) by diluting air with nitrogen, is finding increased use. The reduced oxygen breathing device (ROBD-2) is one of several commercial devices for generating such normobaric hypoxia. Reported here are results of a procedure to check the calibration of the ROBD-2 using methods that may be readily available in physiology and psychophysiology facilities., Methods: The %O2 output by the ROBD-2 was measured concurrently in two ways for altitudes from mean sea level (MSL) to 34,000 ft above MSL at 2000-ft intervals five times over 2 d. One measurement method used was the one built into the ROBD-2, which reports the %O2 the device is delivering at the selected target altitude. The other method diverted a sample of the ROBD-2's output gas to the paramagnetic O2, sensor of a metabolic measuring system via its sampling line. The %O2, measured with the two techniques was compared using Bland-Altman statistical procedures., Results: The two measurement methods produced %O2 readings differing by no more than 0.18% O2 from MSL to 34,000 ft (from 20.95 to about 4.40% oxygen, respectively), the full operating range of the device. Calculating altitude from the measured %O2 showed the ROBD-2 operated within its design error margins over its whole operational range., Discussion: The purpose for which the ROBD-2 is used should determine whether the reliability of its output in normobaric equivalent altitude is adequate. Differences between devices and device stability over time and with use have yet to be assessed. Our assessment does not address the accuracy of the algorithm the ROBD-2 uses to provide an equivalent target altitude under normobaric conditions.

Accelerometer data provide useful information about subject activity in many different application scenarios. For this study, single-accelerometer data were acquired from subjects participating in field tests that mimic tasks that astronauts might encounter in reduced gravity environments. The primary goal of this effort was to apply classification algorithms that could identify these tasks based on features present in their corresponding accelerometer data, where the end goal is to establish methods to unobtrusively gauge subject well-being based on sensors that reside in their local environment. In this initial analysis, six different activities that involve leg movement are classified. The k-Nearest Neighbors (kNN) algorithm was found to be the most effective, with an overall classification success rate of 90.8%.

Research carried outby the great Russian scholar I. M. Sechenov has significantly contributed to development of aviation physiology, medicine and psychology. His fundamental works consisted of discovery of the constancy of alveolar air composition theory, study of interactions of analyzers systems in solving the problem of human spatial orientation under flight conditions, development of a nervous theory of fatigue. Creative development of ideas by I. M. Sechenov allowed enhancing the efficiency of performing and safety of aviation and space flights.

Background: The origins of telemedicine date back to the early 1970s, and combined with the concept of minimally invasive surgery, the idea of surgical robotics was born in the late 1980s based on the principle of providing active telepresence to surgeons. Many research projects were initiated, creating a set of instruments for endoscopic telesurgery, while visionary surgeons built networks for telesurgical patient care, demonstrated transcontinental surgery, and performed procedures in weightlessness. Long-distance telesurgery became the testbed for new medical support concepts of space missions., Methods: This article provides a complete review of the milestone experiments in the field, and describes a feasible concept to extend telemedicine beyond Earth orbit. With a possible foundation of an extraplanetary human outpost either on the Moon or on Mars, space agencies are carefully looking for effective and affordable solutions for life-support and medical care. The major challenges of surgery in weightlessness are also discussed., Results: Teleoperated surgical robots have the potential to shape the future of extreme health care both in space and on Earth. Besides the apparent advantages, there are some serious challenges, primarily the difficulty of latency with teleoperation over long distances. Advanced virtualization and augmented-reality techniques should help human operators to adapt better to the special conditions. To meet safety standards and requirements in space, a three-layered architecture is recommended to provide the highest quality of telepresence technically achievable for provisional exploration missions., Conclusion: Surgical robotic technology is an emerging interdisciplinary field, with a great potential impact on many areas of health care, including telemedicine. With the proposed three-layered concept-relying only on currently available technology-effective support of long-distance telesurgery and human space missions are both feasible.

Introduction: Urine collection systems for in-flight use have gradually improved over the past 50 yr; however, current management of urine evacuation remains suboptimal. This is a cross-sectional survey-based study on the current urine collection device employed in the U.S. Air Force's U-2S airframe, examining efficacy, problems with wear, device maintenance, and complaint reporting., Methods: An anonymous survey consisting of 18 questions was generated inquiring about problems with wear of the urine collection system, care of the device, and education. The survey was offered at Beale AFB and overseas U-2 locations to pilots with at least 180 h of flying experience with the airframe., Results: There were 57 subjects who completed the survey with 62.5% reporting complications, including mechanical dysfunction, pain and poor fit, skin irritation, allergic reaction, embarrassment, and urethral issues. Variation was seen in the degree of problem reporting and care of the device. Discussion and literature review is provided on in-flight and space urine collection and evacuation systems, sheath catheters, urine and contact dermatitis, urethritis, external catheter sizing methods, and psychological aspects of catheter use., Conclusions: The majority of surveyed pilots experienced various problems associated with wear of their urine collection device. Also, variation in reporting and care of the device exists. Potential improvements include standardization of fitting procedures and device maintenance, increased catheter draining capacity, use of skin barriers to urine, enhanced privacy measures, and incorporation of less injurious structural materials such as silicone.

Objective: To design and test an embedded biomedical sensor system that can monitor astronauts' comprehensive physiological parameters, and provide real-time data display during extra-vehicle activities (EVA) in the space exploration., Methods: An embedded system was developed with an array of biomedical sensors that can be integrated into the spacesuit. Wired communications were tested for physiological data acquisition and data transmission to a computer mounted on the spacesuit during task performances simulating EVA sessions., Results: The sensor integration, data collection and communication, and the real-time data monitoring were successfully validated in the NASA field tests., Conclusions: The developed system may work as an embedded system for monitoring health status during long-term space mission., (Copyright 2010 Elsevier Ltd. All rights reserved.)

It was suggested as the main compositive fractions MSS to consider the base system of automated evaluation of blood redistribution (BR) in body means of crew members protection and prophylaxis (CMPP) of unfavourable effects of flight factors to organism and also the automated circuit of CMPP' control. The advanced MSS includes 4 original measuring channels for registration of the base physiologic indices (electrocardiogram, venous-arterial pulsegram of neck vessels, reogram of head, earlap vessels pulsegram) the dynamic of which allows to determine with the help of computer the BR-integral parameter. The CMPP automated control circuit unites the separate protecting means in common system and executes the individual selection of regimes and CM PP-composition in accord with, first of all, body reactions manifestation and, secondly, individual physiologic status of spaceman. As CMPP was selected the negative pressure production around lower body part. Approlation of constructed active laboratory engineering mock-up MSS has performed investigations with participation of 29 subjects (Volunteers) under the modeling of hemodynamic shifts, developing in human body in short-term antiorthostatic hypokinesia (-10 degrees), as well as, in combined effect of antiorthostatic hypokinesia (-10 degrees), Coriolis acceleration and optokinetic stimulation. Results of investigations have showed, that the use of advanced MSS gives the indices of operator professional activity on the average of 17-32% under the decrease of hemodynamic stressful.

In article discussed physiological and methodical principles of the organization of training process and his (its) computerization during Martian flight in conditions of autonomous activity of the crew, providing interaction with onboard medical means, self-maintained by crew of the their health, performance of preventive measures, diagnostic studies and, in case of necessity, carrying out of treatment. In super long autonomous flights essentially become complicated the control of ground experts over of crew members conditions, that testifies to necessity of a computerization of control process by a state of health of crew, including carrying out of preventive actions. The situation becomes complicated impossibility of reception and transfer aboard the necessary information in real time and emergency returning of crew to the Earth. In these conditions realization of problems of physical preventive maintenance should be solved by means of the onboard automated expert system, providing management by trainings of each crew members, directed on optimization of their psychophysical condition.

Almost 2 billion people travel aboard commercial airlines every year. Health-care providers and travellers need to be aware of the potential health risks associated with air travel. Environmental and physiological changes that occur during routine commercial flights lead to mild hypoxia and gas expansion, which can exacerbate chronic medical conditions or incite acute in-flight medical events. The association between venous thromboembolism and long-haul flights, cosmic-radiation exposure, jet lag, and cabin-air quality are growing health-care issues associated with air travel. In-flight medical events are increasingly frequent because a growing number of individuals with pre-existing medical conditions travel by air. Resources including basic and advanced medical kits, automated external defibrillators, and telemedical ground support are available onboard to assist flight crew and volunteering physicians in the management of in-flight medical emergencies.

Introduction: It is presumed that pilots with abnormal color vision who pass the Farnsworth lantern test can distinguish aviation signal lights including the red and white lights of the Precision Approach Path Indicator (PAPI). The investigation of the FedEx Flight 1478 crash at Tallahassee airport in 2002 raises doubts about this presumption. It found a contributory factor was that the pilot had difficulty distinguishing the PAPI signals because of his deficient color vision (DCV) even though he had passed the Farnsworth lantern. This paper reports on the ability of subjects with DCV who pass the Farnsworth lantern to distinguish PAPI signal colors., Methods: Under a good visibility and a marginal visibility condition, 52 DCV subjects and 52 with normal color vision (NCV) named the colors of simulated PAPI signal lights observed in the dark. Subjects were tested with the Farnsworth lantern and a comprehensive battery of other color vision tests., Results: The 10 DCV subjects who passed the Farnsworth lantern made significantly more errors naming PAPI signals than the NCV subjects and 80% made more errors than the worst performing NCV subject. Some confused the red and white signals on more than 10% of occasions., Conclusions: Passing the Farnsworth lantern test does not ensure that DCV pilots can distinguish PAPI signal colors. The criterion for passing the lantern test should be made more stringent. In addition the design of PAPI signals can be improved by a better choice of the white color and by providing a redundant non-color cue., Keywords: abnormal color vision, aviation color vision standard, aviation signal lights, color vision tests, PAPI.

There are no data about supplemental oxygen in flight in our country. The objective of our study was to evaluate arranging in-flight-oxygen required by a simulated traveler, system of administration and costs, and to compare the results between Argentine-based (A) and international (I) airlines. The questionnaire used was similar to that of Stoller et al12. Data collection consisted of telephone calls placed by one of the authors to all commercial air carriers listed in our two Buenos Aires City airports during July 2007. A structured interview with questions was addressed on issues that an oxygen-using air traveler would need to arrange in-flight oxygen. Of the 25 airlines, 6 were discarded because of lack of information (24%, three A -60%- and one I -16%-). All A allowed in-flight-oxygen vs. 80% of I (p<0.05), 100% of A and 94% of I required a medical certificate (p=NS); 71% of A and 100% of I required previous notification (p<0.05); 50% of A and 87% of I provided patient interphases of oxygen administration (p=NS). Free of charge oxygen could be provided by 100% of A and 50% of I, with airline charge between 70 to 300 dollars. In conclusion, we observed different policies, rules, availability, and a pronounced lack of standardization of airline information. The cost of oxygen was very different between airlines and it was superior on I. It will be necessary to carry out actions to facilitate patient access to oxygentherapy and to standardize medical information among airlines in our country.

In 1998, the Air Transport Medicine (ATM) Committee of the Aerospace Medical Association (AsMA) made its first recommendations concerning medical kits for commercial airlines. These were updated in 2002 and the ATM has continued to monitor medical kit usage, as well as pharmaceutical developments, and a further revision is now needed. This has taken into account ongoing work of the International Civil Aviation Organization and recommendations of the International Air Transport Association in the field of passenger and crew health. Based on the above, the Committee proposes the following update to its 2002 recommendations.

The benefit from occlusive cuffs (prophylactic device Braslet) to human hemodynamics was evaluated in seven cosmonauts on long-term Mir missions using the ultrasonic technique (Echography and Doppler). Braslet had a positive effect on cosmonauts" state of health during the first month of flight. Improvement of cerebral hemodynamics was attested objectively by reduction of venous congestion. However, the device did not produce a noticeable effect on the leg vein expansibility and capacity at the beginning of long-term mission. Starting on flight month 3, cumulation of the Braslet effect on the leg large veins resulted in progressive vein expansion. Regular wearing of the Braslet device produced changes in expansibility, capacity and elasticity of the veins in lower extremities. Extent of these changes was dependent on period of Braslet application and tightness of occlusion. Though the state of leg veins of the cosmonauts who had been favourable to Braslet during mission did not appear changed after landing, still we cannot make the conclusion that the occlusive cuffs do not bring harm if worn continuously, as their delayed effects have not been evaluated and remain unknown.

In the period of 1988 - 1990 the ZVEZDA Aerospace medicine Department fulfilled comprehensive physiological investigations in order to assess the prospects for water immersion as an anti-g gear for pilots of high-maneuver aircraft. Both dry and open water immersion methods were used. More than 150 centrifuge runs were conducted to define limits for the acceleration value and time of 9-g tolerance. Volunteered subjects in the pilot's posture were inclined at 35 degrees and 55 degrees to the total inertial force vector. The obvious subjective discomfort felt during acceleration and absence of clinical aftereffect were qualified as a positive outcome. The subjects were ready for repeated runs even after a very brief repose. The main impediment to the professional anti-g use of immersion is visual disorders which in this case are not predictors of coming loss of consciousness and attributed to alterations in regional hemodynamics. The authors assert that there is a good reason to continue search for implementation of the immersion principle in g-protection of pilots to reduce the rate of professional pathologies and to intensify flights.