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The October 2024 obituaries from the Canadian Medical Association Journal honor the lives and careers of several distinguished medical professionals from diverse backgrounds and specialties. Each obituary provides essential details such as the individual's name, location, alma mater, medical specialty, date of death, and surviving family members, along with a link to their full obituary for further information. These summaries respectfully recognize the significant contributions and legacies of these doctors within the medical field, offering a glimpse into their impactful careers and highlighting their achievements. [Extracted from the article]

Introduction Military fighter aircrew report high rates of cervical pain and injury. There is currently no consensus regarding the best training methods for this population. Eglin Air Force Base (AFB) and Luke AFB have multidisciplinary teams specializing in aircrew training, performance, and injury mitigation. All student pilots (SPs) completing Basic Course training at these locations engage in an 8-week Spine Training Program (STP). The STP originated at Luke AFB in 2020 and was expanded to Eglin AFB in 2022. The primary aim of this study was to assess whether the STP led to significant changes in the performance measure studied, Cervical Endurance Hold (CEH). Further, this study aimed to determine if the CEH training effect was independent of location of STP administration. We hypothesized that SPs would exhibit statistically significant CEH training adaptations irrespective of base location. Materials and Methods Air Force F-16 and F-35 SPs from Luke AFB and Eglin AFB were actively enrolled in the Basic Course and participated in the standardized STP from 2020 to 2023. The CEH test was administered prior to (intake) and following (exit) the 8-week STP. SPSS for Windows version 29 software (IBM, Armonk, NY) was used to retrospectively analyze the data from this study. Participants were excluded if they were unable to perform the CEH test at intake or exit. The study was approved by the Air Force Research Laboratory Institutional Review Board and was performed in accordance with the ethical standards of the Declaration of Helsinki. Results One hundred and ninety-eight SPs (Luke AFB, males n  = 170, females n  = 12; Eglin AFB, males n  = 16) completed the STP program. There was no significant difference between intake and exit concerning age, height, weight, % body fat, and fat-free mass at Luke AFB or Eglin AFB (P  < 0.05). Statistically significant improvements in CEH were observed within all groups from intake to exit (P  < 0.001). When considering all participants collectively, there was a notable 33.6% increase in CEH from intake to exit (P  < 0.001) with an overall effect size of d  = 1.14. When analyzing specific subgroups, females from Luke AFB experienced a significant 20.4% increase in CEH (P  < 0.001, d  = 1.14), males from Luke AFB exhibited a significant 34.5% increase (P  < 0.001, d  = 1.09), and males from Eglin AFB demonstrated a significant increase of 55.7% in CEH (P  < 0.001, d  = 1.97). Conclusions This retrospective analysis showed significant improvements in the CEH across all groups following the completion of the STP. Furthermore, CEH results from both bases exhibited a large effect size indicating a meaningful change was found between intake and exit regardless of training location. These preliminary study results should be interpreted with caution as a control group was unable to be established. In the future, a randomized control trial should be performed to test the STP used in this study against other STP programs. This may better inform experts on the best spine training methods for fighter aircrew. [ABSTRACT FROM AUTHOR]

Without visual references, nonpilots exposed to coordinated flight turns underestimate the bank angle, because of discordant information of the roll-angular displacement from the otoliths, consistently signaling vertical position, versus the semicircular canals, enabling detection of the displacement. Pilots may also use their ability to perceive the G load and knowledge of the relation between load and angle to assess the bank angle. Our aim was to investigate whether the perception of bank angle can be improved by spatial orientation training in a centrifuge. Sixteen pilots/pilot students assessed their roll tilt, in complete darkness, during both real coordinated flight turns and gondola centrifugation, at roll tilts of 30° and 60°. The experiments were repeated after a 3-wk period, during which eight of the subjects performed nine training sessions in the centrifuge, comprising feedback on roll angle vs. G load, and on indicating requested angles. Before training, the subjects perceived in the aircraft and centrifuge, respectively: 37 (17)°, 38 (14)° during 60° turns and 19 (12)°, 20 (10)° during 30° turns. Training improved the perception of angle during the 60° [to 60 (7)°, 55 (10)°; P ≤ 0.04] but not the 30° [21 (10)°, 15 (9)°; P ≥ 0.30] turns; the improvement disappeared within 2 yr after training. Angle assessments did not change in the untrained group. The results suggest that it is possible to, in a centrifuge, train a pilot's ability to perceive large but not discrete-to-moderate roll-angular displacements. The transient training effect is attributable to improved capacity to perceive and translate G load into roll angle and/or to increased reliance on semicircular canal signals. NEW & NOTEWORTHY: Spatial disorientation is a major problem in aviation. When performing coordinated flight turns without external visual cues (e.g., flying in clouds or darkness), the pilot underestimates the aircraft bank angle because the vestibular system provides unreliable information of roll tilt. The present study demonstrates that it is possible to, in a long-arm centrifuge, train a pilot's ability to perceive large but not discrete-to-moderate roll-angular displacements. [ABSTRACT FROM AUTHOR]

Background: The physical and cognitive demands of combat flying may influence the development and persistence of flight-related neck pain (FRNP). The aim of this pilot study was to analyse the effect of a multimodal physiotherapy program which combined supervised exercise with laser-guided feedback and interferential current therapy on psychophysiological variables in fighter pilots with FRNP. Methods: Thirty-one fighter pilots were randomly assigned to two groups (Intervention Group: n = 14; Control Group: n = 17). The intervention consisted of 8 treatment sessions (twice per week) delivered over 4 weeks. The following primary outcomes were assessed: perceived pain intensity (Numeric Pain Rating Scale–NPRS) and Heart Rate Variability (HRV; time-domain, frequency-domain and non-linear variables). A number of secondary outcomes were also assessed: myoelectric activity of the upper trapezius and sternocleidomastoid, pain catastrophizing (Pain Catastrophizing Scale–PCS) and kinesiophobia (TSK-11). Results: Statistically significant differences (p≤0.05) within and between groups were observed for all outcomes except for frequency domain and non-linear HRV variables. A significant time*group effect (one-way ANOVA) in favour of the intervention group was found for all variables (p<0.001). Effect sizes were large (d≥0.6). Conclusions: The use of a multimodal physiotherapy program consisting of supervised exercise with laser-guided feedback and interferential current appears to show clinical benefit in fighter pilots with FRNP. Trial registration: ClinicalTrials.gov: NCT05541848. [ABSTRACT FROM AUTHOR]

INTRODUCTION: While there are numerous factors that may affect pilot attentional performance, we hypothesize that an increased expiratory work of breathing experienced by fighter pilots may impose a "distraction stimulus" by creating an increased expiratory effort sensation. Therefore, the purpose of this study was to determine the extent to which increasing expiratory pressure time product or expiratory effort sensation impacts attentional performance. METHODS: Data was collected on 10 healthy participants (age: 29 ± 6 yr). Participants completed six repetitions of a modified Masked Conjunctive Continuous Performance Task protocol while breathing against four different expiratory threshold loads. Repeated measures analysis of variances and generalized additive mixed effects models were used to investigate the effects of expiratory threshold load conditions on expiratory pressure time product, expiratory effort sensation, and the influence of altered end tidal gases on Masked Conjunctive Continuous Performance Task scores. RESULTS: The overall median hit reaction times were significantly longer as the expiratory threshold loads increased. Specific shape-conjunctive and non-conjunctive median hit reaction times were longer with increased expiratory effort sensation. Additionally, increased expiratory effort sensation did not significantly change commission error rates, but did significantly increase omission error rates. DISCUSSION: The findings of our work suggest that both progressively greater expiratory threshold loads during spontaneous breathing and expiratory effort sensation may impair subjects' attentional performance due to longer reaction times and increased stimuli recognition error rates. [ABSTRACT FROM AUTHOR]

Introduction: Fighter pilots must support the effects of many stressors, including physical and psychological exertion, circadian disturbance, jet lag, and environmental stress. Despite the rigorous selection of military pilots, those factors predispose to failures in physiological compensatory mechanisms and metabolic flexibility. Objectives: We compared through NMR-based metabolomics the metabolic profile of Brazilian F5 fighter pilots with different flight experiences vs. the control group of non-pilots. We hypothesized that combat pilots have metabolic flexibility associated with combat flight time. Methods: We evaluated for the first time 34 Brazilian fighter pilots from Santa Cruz Air Base (Rio de Janeiro, RJ) allocated into three groups: pilots with lower total accumulated flight experience < 1,100 h (PC1, n = 7); pilots with higher total accumulated flight experience ≥ 1,100 h (PC2, n = 6); military non-pilots (CONT, n = 21). Data collection included anthropometric measurements, total blood count, lipidogram, markers of oxidative stress, and serum NMR-based metabolomics. Results: In comparison with controls (p < 0.05), pilots exhibited decreased levels of white blood cells (−13%), neutrophils (−15%), lymphocytes (−20%), alfa-glucose (−13%), lactate (−26%), glutamine (−11%), histidine (−20%), and tyrosine (−11%), but higher isobutyrate (+ 10%) concentrations. Significant correlations were found between lactate vs. amino acids in CONT (r = 0.55–0.68, p < 0.001), and vs. glutamine in PC2 (r = 0.94, p = 0.01). Conclusion: Fighter pilots with lower experience showed a dysregulation in immune-metabolic function in comparison with controls, which seemed to be counteracted by the accumulation of flight hours. Those findings might have implications for the health preservation and operational training of fighter pilots. [ABSTRACT FROM AUTHOR]

"The Wingmen: The Unlike, Unusual, Unbreakable Friendship Between John Glenn and Ted Williams" by Adam Lazarus is a book that explores the friendship between two Marine jet fighter pilots, John Glenn and Ted Williams, during the Korean conflict. The book highlights their shared commitment to their country and their willingness to put aside personal interests for the dangerous jobs in the service. Lazarus humanizes the narrative by including personal accounts, diary entries, and interviews, showcasing the true character and vulnerabilities of these heroes. The book serves as a reminder that loyal friends and trustworthy wingmen do exist in a complicated world. [Extracted from the article]

INTRODUCTION: There is a current belief in aviation suggesting that aerobic training may reduce G-tolerance due to potential negative impacts on arterial pressure response. Studies indicate that increasing maximal aerobic capacity (Vo2 max) through aerobic training does not hinder G-tolerance. Moreover, sustained centrifuge training programs revealed no instances where excessive aerobic exercise compromised a trainee's ability to complete target profiles. The purpose of this review article is to examine the current research in the hope of establishing the need for routine Vo2-max testing in air force pilot protocols. METHODS: A systematic search of electronic databases including Google Scholar, PubMed, the Aerospace Medical Association, and Military Medicine was conducted. Keywords related to "human performance," "Air Force fighter pilots," "aerobic function," and "maximal aerobic capacity" were used in various combinations. Articles addressing exercise physiology, G-tolerance, physical training, and fighter pilot maneuvers related to human performance were considered. No primary data collection involving human subjects was conducted; therefore, ethical approval was not required. RESULTS: The Vo2-max test provides essential information regarding a pilot's ability to handle increased Gz-load. It assists in predicting G-induced loss of consciousness by assessing anti-G straining maneuver performance and heart rate variables during increased G-load. DISCUSSION: Vo2-max testing guides tailored exercise plans, optimizes cardiovascular health, and disproves the notion that aerobic training hampers G-tolerance. Its inclusion in air force protocols could boost readiness, reduce health risks, and refine training for fighter pilots' safety and performance. This evidence-backed approach supports integrating Vo2-max testing for insights into fitness, risks, and tailored exercise. [ABSTRACT FROM AUTHOR]

Soviet pilot Lidiia Litviak was the first woman in the world to shoot down an enemy aircraft in combat and has the highest documented score of any female pilot. She achieved this in fifteen and a half months of active service before she disappeared on 1 August 1943 during a dogfight over eastern Ukraine. Her remains were identified in 1979 and in 1990 Mikhail Gorbachev named her a Hero of the Soviet Union. Yet a rumor that Litviak was not killed in the war but survived and defected to the Germans, has gained widespread acceptance. The author argues that based on accepted standards of plausibility, credibility and reliability, the preponderance of evidence shows that Lidiia Litviak died on 1 August 1943. [ABSTRACT FROM AUTHOR]

Introduction Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system. Objectives The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations. Methods The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program. Results Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex. Conclusions Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction. [ABSTRACT FROM AUTHOR]

Background: Chronic low back pain (LBP) related to flight is a prevalent health issue in military aviation, impacting pilots. The objective of this investigation was to ascertain if the application of core muscle training in conjunction with interferential current (IFC) therapy results in a reduction in pain severity and associated disability, consequently enhancing core muscle functionality in Chinese Air Force high-performance fighter pilots experiencing chronic LBP. Methods: Fifty-three fighter pilots with chronic LBP were randomized into 3 groups: a core muscle exercise combined with IFC group (CG, n = 19), a core muscle exercise group (EG, n = 19), and an IFC group (IG, n = 15). The three groups underwent therapeutic intervention 5 times a week for 12 weeks. The primary outcomes were pain intensity, Oswestry Disability Index (ODI) score and SF-12 health-related quality of life (PCS and MCS) score. Secondary outcomes included evaluations of trunk muscle strength, endurance, and range of motion (ROM) during medial/lateral rotation to assess muscle functionality. Measurements were obtained both before and after the implementation of the intervention therapy. Results: After 12 weeks of intervention therapy, all the health condition parameters significantly improved among the three groups. However, the CG had a significant improvement in pain intensity compared to the EG (MD = − 0.84 scores; 95% CI = − 1.54 to − 0.15; p = 0.013) and the IG (MD = − 1.22 scores; 95% CI = − 1.96 to − 0.48; p = 0.000). Additionally, the CG led to greater conservation of ODI and improved SF-12 PCS scores than did the IG (p < 0.05). Finally, compared with those at baseline, the core muscle function parameters in the CG and EG improved significantly at the end of the study, but no statistically significant differences were observed between the two groups (p > 0.05). Conclusion: Among participants with chronic LBP, three intervention therapies appear effective in reducing pain, diminishing disability, and enhancing quality of life. Also, combined therapy significantly improved pain and disability compared to the other two monotherapies; moreover, combined therapy and core muscle exercise provided similar benefits in terms of core muscle function after 12 weeks of intervention therapy. [ABSTRACT FROM AUTHOR]

Episode 8 of "Masters of the Air" introduces the Tuskegee Airmen, fighter pilots from the 99th Fighter Squadron in the Mediterranean Theater of Operations. The episode highlights the camaraderie and individual stories of the Tuskegee Airmen, offering a different perspective on their experiences compared to other movies. The episode also depicts the intense preparations for D-Day and the importance of airpower in the invasion. It explores the leadership transitions within the 100th Bomb Group and the role of women in covert intelligence collection. The episode accurately portrays the challenges and experiences of the Tuskegee Airmen, including their time as prisoners of war. In Episode 9, the war in Europe comes to an end, and Major Robert "Rosie" Rosenthal leads the 100th Bomb Group on a strike against Berlin. The scene showcases the scale of air operations and the mastery of the Army Air Forces. However, Rosenthal's crew is shot down, highlighting the risks and challenges faced by bomber crews. The episode also depicts Rosenthal's survival and interaction with advancing Russian soldiers. Overall, the episode provides a realistic portrayal of the air war against Nazi Germany and the experiences of the bomber crews. [Extracted from the article]

Background: Fighter aircraft pilots are regularly exposed to physiological challenges from high acceleration (Gz) forces, as well as increased breathing pressure and oxygen supply in the support systems. We studied whether effects on the lung and systemic oxidative stress were detectable after real training flights comprising of a wide variety of exposure conditions, and their combinations. Methods: Thirty-five pilots of the German Air Force performed 145 flights with the Eurofighter Typhoon. Prior to and after flight lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), alveolar volume (VA), and diffusing capacities per volume (KCO, KNO) were assessed. In addition, the fractional concentration of exhaled nitric oxide (FeNO) was determined, and urine samples for the analysis of molecular species related to 8-hydroxy-2'-deoxyguanosine (8-OHdG) were taken. For statistical analysis, mixed ANOVA models were used. Results: DLNO, DLCO, KNO, KCO and VA were reduced (p < 0.001) after flights, mean ± SD changes being 2.9 ± 5.0, 3.2 ± 5.2, 1.5 ± 3.7, 1.9 ± 3.7 and 1.4 ± 3.1%, respectively, while FeNO decreased by 11.1% and the ratio of 8-OHdG to creatinine increased by 15.7 ± 37.8%. The reductions of DLNO (DLCO) were smaller (p < 0.001) than those of KNO (KCO). In repeated flights on different days, baseline values were restored. Amongst various flight parameters comprising Gz-forces and/or being indicative of positive pressure breathing and oxygenation support, the combination of long flight duration and high altitude appeared to be linked to greater changes in DLNO and DLCO. Conclusions: The pattern of reductions in diffusing capacities suggests effects arising from atelectasis and increased diffusion barrier, without changes in capillary blood volume. The decrease in exhaled endogenous NO suggests bronchial mucosal irritation and/or local oxidative stress, and the increase in urinary oxidized guanosine species suggests systemic oxidative stress. Although changes were small and not clinically relevant, their presence demonstrated physiological effects of real training flights in a modern 4th generation fighter jet. [ABSTRACT FROM AUTHOR]

With advances in artificial intelligence, machine learning, and cognitive modelling, unmanned aircraft are expected to act as human-like wingmen in the near future. For fluent and effective manned–unmanned teaming, synthetic wingmen must be able to account for and adapt to their partners' intent with little or no communication. To enable such abilities, it becomes crucial to identify the requirements that makes intent explainable to synthetic wingmen, necessitating approaches to describe and analyse intent from a human-centric perspective. To address this issue, this paper reports on findings from using Work Domain Analysis to design and analyse models of situated intent with six levels of cognitive control (frames, effects, values, generic, implementations, and physical). Through a literature review and seven subject matter expert interviews, a synthesized model was designed to represent fighter pilots' intent in a manned–unmanned teaming scenario. Using the synthesized model as the context, a transfer of control and a link loss situation were further described and analysed. Experiences show that Work Domain Analysis can provide a practical and applicable means to model situated intent, particularly since designed models can be re-utilised to model intent in similar situations. Furthermore, the model analyses show the importance of accounting for fighter pilots' adopted frames since small variations of the framing of the situations can propagate throughout the model resulting in conflicting or inconsistent intent. The paper concludes that synthetic wingmen must be able to reason about all six levels of cognitive control, requiring a more holistic approach to make intent explainable. [ABSTRACT FROM AUTHOR]

This study investigates whether and how perceived training value varies among fighter pilots participating in a large force exercise (LFE), and whether they expect Live Virtual Constructive (LVC) training to enhance training value of future LFEs. LVC technology is maturing but its expected training value is under-investigated, especially regarding future LVC in LFEs. Fighter pilots at a Live-flying LFE answered questionnaires, 120 responses were analyzed statistically. The questions focused on whether the sortie they just flew provided training value, generally and for specific Desired Learning Objectives (DLOs), on whether the inclusion of Virtual and Constructive entities in future LFEs would contribute to training value generally and to the DLOs specifically, and on specific LVC implementation issues. Ratings of experienced training value varied across DLOs, and DLO ratings varied across Mission types. Fighter pilots were positive toward including Virtual and Constructive entities in LFEs for certain DLOs, mostly for flying a complex mission. DLOs covaried around the factors of LVC-tradeoff advantages and Live advantages, as well as temporal dimensions of planning before a mission and stages of engagement. LVC implementation lessons were extracted. Fighter pilots are generally moderately positive about LVC in LFEs. The measurement of perceived training value per DLO seems a relevant instrument for investigating perceived training value of an LFE and expected training value of future LVC training. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Gravity-induced loss of consciousness (G-LOC) is a major threat to fighter pilots and may result in fatal accidents. The brain has a period of 5-6 s from the onset of high +Gz exposure, called the functional buffer period, during which transient ischemia is tolerated without loss of consciousness. We tried to establish a method for predicting G-LOC within the functional buffer period by using machine learning. We used a support vector machine (SVM), which is a popular classification algorithm in machine learning. METHODS: The subjects were 124 flight course students. We used a linear soft-margin SVM, a nonlinear SVM Gaussian kernel function (GSVM), and a polynomial kernel function, for each of which 10 classifiers were built every 0.5 s from the onset of high +Gz exposure (Classifiers 0.5-5.0) to predict G-LOC. Explanatory variables used for each SVM were age, height, weight, with/without anti-G suit, +Gz level, cerebral oxyhemoglobin concentration, and deoxyhemoglobin concentration. RESULTS: The performance of GSVM was better than that of other SVMs. The accuracy of each classifier of GSVM was as follows: Classifier 0.5, 58.1%; 1.0, 54.8%; 1.5, 57.3%; 2.0, 58.1%; 2.5, 64.5%; 3.0, 63.7%; 3.5, 65.3%; 4.0, 64.5%; 4.5, 64.5%; and 5.0, 64.5%. CONCLUSION: We could predict G-LOC with an accuracy rate of approximately 65% from 2.5 s after the onset of high +Gz exposure by using GSVM. Analysis of a larger number of cases and factors to enhance accuracy may be needed to apply those classifiers in centrifuge training and actual flight. [ABSTRACT FROM AUTHOR]

BACKGROUND: Research has shown that excessive sugar-sweetened beverage (SSB) consumption has been associated with being overweight and obese and the military is not immune to this disorder. Being overweight/obese is one of the characteristics that comprise a condition known as Metabolic Syndrome (MetS). The global prevalence of MetS in the military population is estimated to be 21%, which varies depending upon the armed forces type and specialty. The purpose of this study is to identify the subset of the aviation population that may develop MetS at some future point and to put forth suggestions on how best to combat this and maintain operational readiness. METHODS: Data were collected by means of an anonymous 44-item survey administered and completed by 302 students enrolled in Aviation Preflight Indoctrination at the Naval Air Station Base in Pensacola, FL. RESULTS: Results indicated that 70.86% of students reported SSB consumption, with 95.3% preferring caffeinated to decaffeinated SSBs. 11.7% of personnel met the "at risk criteria" of consuming SSBs four times per week or greater (four 12-oz cans or more per week). DISCUSSION: Findings from this study indicate that approximately 11.7% of aviation pilots or flight officers are "at risk" of developing MetS. Given that it takes up to 4 yr to train a new fighter pilot, this could become a significant readiness issue on par with the impact seen with pilots leaving the services through natural attrition. [ABSTRACT FROM AUTHOR]