Physiological Equivalence of Normobaric and Hypobaric Exposures of Humans to 25,000 feet

http://www.faa.gov/library/reports/medical/oamtechreports/2010s/media/201020.pdf

Physiological Equivalence of Normobaric and Hypobaric Exposures of
Humans to 25,000 Feet

DOT/FAA/AM-10/20

Self DA, Mandella J, Prinzo OV, Forster EM, Shaffstall RM

Introduction. Skepticism exists whether normobaric and hypobaric hypoxic exposures are equivalent. We have evaluated if physiological differences between the two environments would translate into actual differences in hypoxia symptoms.
Methods. We exposed 20 subjects to 5-min 25,000 ft (7620 m) equivalent environments in an altitude chamber and then in a ground-level portable reduced-oxygen training enclosure (PROTE). Heart rate and hemoglobin oxygen saturation (SAO2) were continuously monitored. Alveolar gas samples were collected at 1-, 3-, and 4-min elapsed time. Subjects completed hypoxia symptom questionnaires at the same time points.
Results. Mean 4th min alveolar oxygen tension (PAO2 ), alveolar carbon dioxide tension (PACO2), and respiratory quotient (RQ) differed significantly between the chamber and PROTE. Declines in SAO2 appeared biphasic, with steepest declines seen in the first minute. Rates of SAO2 decline over the 5-min exposure were significantly different. Heart rate was not different, even when indexed to body surface area. Mean number of hypoxia symptoms between hypobaric and normobaric environments after 1 min were significant. However, the temporal
pattern of symptom frequencies across subjects between the chamber and PROTE were similar.
Conclusions. Alveolar gas composition, as well as arterial hemoglobin oxygen desaturation patterns, differed between a ground-level and hypobaric exposure. Differences in mean number of hypoxia symptoms between hypobaric and normobaric environments after 1 min, but not at 3 and 4 min, coupled with similar patterns in symptom frequencies, suggest that ground-level hypoxia training may be a sufficiently faithful surrogate for altitude chamber training

Air Force Personnel Issues. A Manager’s Handbook

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534240&Location=U2&doc=GetTRDoc.pdf

Air Force Personnel Issues. A Manager’s Handbook

Jacobina Skinner; Nancy Thompson; Kenneth Schwartz; Johnny
Weissmuller

AFCAPS-FR-2010-0017

Handbook is designed to provide Manager’s with convenient access to information about completed Air Force research on military personnel issues. Handbook covers topics and provides brief summaries on reseacrh related to both enlisted and officer personnel systems.

Effects of Sleep on Training Effectiveness in Soldiers at Fort Leonard Wood, Missouri

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534009&Location=U2&doc=GetTRDoc.pdf

Effects of Sleep on Training Effectiveness in Soldiers at Fort Leonard Wood, Missouri


This study examined the effect of alterations in the timing of sleep within the circadian cycle on the amount of total nightly sleep and its influence on various indicators of mood and performance of U.S. Army Soldiers attending Basic Combat Training (BCT) at Fort Leonard Wood, Missouri. The quasi-experimental study design compared Soldiers assigned to one of two training companies: a company using the standard BCT sleep regimen (8:30 p.m. to 4:30 a.m.) or a company using a phase-delayed sleep regimen (11:00 p.m. to 7:00 a.m.), the latter being more in line with the biologically driven sleep-wake patterns of adolescents. Demographic and psychophysiological measures were collected at the start of the study using standard survey instruments and methods. A random sample of approximately 24% of Soldiers wore wrist activity monitors to unobtrusively record sleep quantity and quality. Weekly assessments were made of subjective fatigue and mood throughout BCT. Data on physical fitness, marksmanship, and attrition from BCT were extracted from organizational training records.
The study sample was comprised of 392 Soldiers, 209 in the intervention group and 183 in the comparison group. Based on actigraphic data, it was shown that Soldiers on the modified sleep schedule obtained 33 more minutes of total sleep per night than those on the standard sleep schedule. Soldiers in the intervention group reported less total mood disturbance relative to baseline, but the effect size was modest and diminished over the course of BCT. Improvements in Soldier marksmanship performance over a series of record fires was positively correlated with average nightly sleep during the week preceding the record fires, when basic marksmanship tasks were being learned. By the end of BCT, Soldiers in the comparison group were 2.3 times more likely to have occupationally significant fatigue and were 5.5 times more likely to report poor sleep quality, as assessed using validated survey instruments, than those in the comparison group. There was no effect of the sleep scheduling intervention on physical fitness scores or the relative risk for attrition. Overall, increasing sleep and concomitantly decreasing fatigue had a small but measurable influence on various indicators of Soldier functioning even after controlling for a variety of factors that affect performance.

MEDICAL ASPECTS OF DISASTER PREPAREDNESS AND RESPONSE:

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534199&Location=U2&doc=GetTRDoc.pdf

MEDICAL ASPECTS OF DISASTER PREPAREDNESS AND RESPONSE:
A SYSTEM OVERVIEW OF CIVIL AND MILITARY RESOURCES
AND NEW POTENTIAL

America’s surge capacity medical infrastructure was in many respects launched in 1984, when
the National Disaster Medical System, in a partnership between and among many public and private sector organizations and four federal agencies, emerged. Although this system has provided a critical service to those with medical needs, 9/11 and recent reassessments of the current medical threat environment pointed to emerging threats that have lead to the development of other surge responders, including the Surgeon General’s MRC, reemphasis upon DoD and NG health related missions, and an incipient revival and expansion of SDF medical missions. The recent passage of the Pandemic and All-hazards Preparedness Act presents a renewed call for organized health volunteerism generally, and is a mandate for strengthening of all emergency health preparedness initiatives, as well as a strengthening of the uniformed Public Health Service and Veterans Administration to help meet emerging medical, mental health, mortuary and veterinary disaster response needs. Although the nation’s medical system has struggled with the jurisdictional changes since 9/11 - it remains evident that America’s emergency health volunteers will continue as never before to come to the aid of those with medical needs after a disaster befalls them.

In silico investigation of intracranial blast mitigation with relevance to military traumatic brain injury

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA533075&Location=U2&doc=GetTRDoc.pdf

In silico investigation of intracranial blast mitigation
with relevance to military traumatic brain injury

Michelle K. Nyeina, Amanda M. Jasona, Li Yua, Claudio M. Pitaa, John D. Joannopoulosb,
David F. Moorec, and Raul A. Radovitzkya



Blast-induced traumatic brain injury is the most prevalent military
injury in Iraq and Afghanistan, yet little is known about the mechanical
effects of blasts on the human head, and still less is known
about how personal protective equipment affects the brain’s
response to blasts. In this study we investigated the effect of the
Advanced Combat Helmet (ACH) and a conceptual face shield on
the propagation of stress waves within the brain tissue following
blast events. We used a sophisticated computational framework
for simulating coupled fluid–solid dynamic interactions and a
three-dimensional biofidelic finite element model of the human
head and intracranial contents combined with a detailed model
of the ACH and a conceptual face shield. Simulations were conducted
in which the unhelmeted head, head with helmet, and
head with helmet and face shield were exposed to a frontal blast
wave with incident overpressure of 10 atm. Direct transmission of
stress waves into the intracranial cavity was observed in the unprotected
head and head with helmet simulations. Compared to the
unhelmeted head, the head with helmet experienced slight mitigation
of intracranial stresses. This suggests that the existing ACH
does not significantly contribute to mitigating blast effects, but
does not worsen them either. By contrast, the helmet and face
shield combination impeded direct transmission of stress waves
to the face, resulting in a delay in the transmission of stresses
to the intracranial cavity and lower intracranial stresses. This
suggests a possible strategy for mitigating blast waves often associated
with military concussion

The Influence of Agility Training on Physiological and Cognitive Performance

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA533244&Location=U2&doc=GetTRDoc.pdf

The Influence of Agility Training on Physiological and Cognitive Performance

AFRL-RH-BR-TR-2010-0070

Thomas B. Walker, Lynette Lennemann, Erica Doczy, Rene Klein, Kathryn Sidrow
and Catherine Harrison


Agility training (AT) has recently been instituted in several combat athlete communities in hopes of improving combat performance as well as general fitness. AT has been demonstrated to improve performance in agility tests while traditional linear exercise does not. Further, in animal models, while exercise alone offers some neurological benefits, studies suggest a greater benefit from AT. The purpose of this study was to determine how substituting AT for traditional linear running influences physiological and cognitive performance. Forty-one subjects undergoing military technical training were divided randomly into two groups for 6 weeks of physical training (PT). One group participated in standard military PT of calisthenics and moderate linear running. A second group duplicated the volume of exercise of the first group, but used AT as their primary mode of PT. Prior to and following training, subjects completed a physical and cognitive battery of serum cortisol, VO2max, vertical jump, reaction time, Illinois Agility Test, body composition, visual vigilance, dichotic listening, and working memory tests. There were significant improvements for the agility group in VO2max, Illinois Agility Test, visual vigilance, and continuous memory. There was a significant increase in time-to-exhaustion for the traditional group. There were strong trends toward the agility group improving more than the traditional group on VO2max (p=0.12), vertical jump (p=0.06), Illinois Agility Test (p=0.07), and continuous memory (p=0.07.) We conclude that AT is as effective or more effective as linear running in enhancing physical fitness. Further, it is potentially more effective than running in enhancing specific measures of physical and cognitive performance, such as physical agility, memory, and vigilance. Consequently, we posit that AT should be a central component of military PT.

Aerial Command and Control of Unmanned Aircraft Systems

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA533728&Location=U2&doc=GetTRDoc.pdf


Aerial Command and Control of Unmanned Aircraft Systems

USAARL 2011-07

Jeremy Athy
Andreas Hitzig
Heber Jones
Stephanie Moon
Jonathan Hewett
Navdeep Saini
John Ramiccio

The benefits provided by teaming unmanned aerial systems (UAS) with active in-flight crewmembers suggest research should be conducted on the practicality of this pairing. This study was conducted to examine two issues: the flight performance of a simulated UAS flight piloted within a UH-60, and the potential for motion sickness when piloting the UAS within the UH-60. UAS flight conditions consisted of a training (lecture) session, within a grounded UH-60, within a flying UH-60 with unobstructed windows, and within a flying UH-60 with obstructed windows. Being within an in-flight UH-60 resulted in little negative UAS flight controller performance, but did lead to increased motion sickness, especially during vigorous flight conditions. Results suggest that further research is necessary concerning the issue of motion sickness prior to implementing UAS operation within an in-flight UH-60.


unmanned aerial systems, motion sickness, manned unmanned training

A Comparison of the Efficacy of Modafinil and Dextroamphetamine as Alertness Promoting Agents in Aviators Performing Extended Operations

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA533725&Location=U2&doc=GetTRDoc.pdf

USAARL 2011-05

A Comparison of the Efficacy of Modafinil and Dextroamphetamine as
Alertness Promoting Agents in Aviators Performing Extended Operations

Arthur Estrada, Amanda M. Kelley, Catherine M. Webb, Jeremy R. Athy, John S. Crowley, Lana S. Milam, Steven J. Gaydos, Heber D. Jones, Melody R. King, Bradley S. Erickson, Jim A. Chiaramonte, Stephanie M. Moon, Robert S. MacNeill, John G. Ramiccio, Patricia A. Leduc

Successful military operations depend on maintaining continuous day-night operations. Stimulants are easy to use and popular for sustaining performance because their utility is not dependent on environmental or scheduling modifications. Eighteen pilots each completed 15 helicopter flights and other evaluations during two 40 hr periods of sustained wakefulness during which they received 2 of 3 experimental conditions: 3 doses at 4 hr intervals of modafinil (100mg), dextroamphetamine (5mg), or placebo. Statistical results showed that the stimulants maintained alertness, feelings of well-being, cognitive function, judgment, risk perception, and
situation awareness of sleep-deprived aviators consistently better than placebo and without side effects of aeromedical concern. Like previous research, this study strongly suggests that these drugs can maintain acceptable levels of mood and performance during sleep deprivation. The results also confirm that modafinil is well tolerated and appears to be a good alternative to
dextroampheatmine for countering the debilitating mood and cognitive effects of sleep loss during sustained operations.

The Effect of Sleep Deprivation on Detection of Correlational and Causal Relationships and Performance on an Engagement Skills Trainer Task in Soldier

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA533230&Location=U2&doc=GetTRDoc.pdf

The Effect of Sleep Deprivation on Detection of Correlational and Causal
Relationships, and Performance on an Engagement Skills Trainer Task in
Soldiers

USAARL 2011-02

Amanda Kelley
Jeremy Athy
Catherine Webb
Melody King

Correlation detection, or rather the ability to determine whether two things are related, is an essential cognitive ability that underlies a number of other processes such as causal judgment. Under conditions of stress cognitive resources become taxed and the probability of a judgment error increases. To mitigate the risk of an error, people tend to use cognitive short-cuts. It was predicted that performance would reflect a “short-cut” technique and accuracy would be compromised during periods of sleep deprivation.
Performance by 20 US Army Soldiers was evaluated on classic laboratory measures of correlation and causal judgment, measures sensitive to fatigue, and a correlation detection task employing the weapons simulator at baseline, after 24 and 36 hours of sleep deprivation, and after 8 hours of recovery sleep. The results of this study suggest that people use “cognitive short-cuts” under as few as 24 hours sleep deprivation thus decrementing performance. By understanding these cognitive short-cuts, cues presented in information displays can be manipulated to exploit these techniques and ultimately decrease the likelihood of an error.

Cognitive Rehabilitation for Mild Traumatic Brain Injury

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA532896&Location=U2&doc=GetTRDoc.pdf

Cognitive Rehabilitation for Mild Traumatic Brain Injury


Mild traumatic brain injury (mTBI), also known as concussion, is one of the invisible injuries of the current conflicts in Afghanistan and Iraq. The true incidence of military mTBI is unknown. This is similar to the civilian sector as some individuals with mTBI do not seek medical care or are not properly diagnosed. However, of the combat exposed U.S. military personnel who have served in Afghanistan and Iraq since 2001, there is a 15%-22% mTBI incidence rate by self report (Hoge et al., 2008, Terrio et al., 2009).
In the mTBI literature, it is reported that a substantial majority of civilian patients with mTBI (75-90%) have symptoms that are transient and self-limiting, with apparent full recovery occurring within minutes to several weeks following injury (Levin et al., 1997). However, approximately 5%-15% of persons with mTBI do not show the expected rapid and uneventful recovery and have persistent symptoms and/or functional limitations (Iverson et al., 2006; Ruff et al., 1996). Given the incidence of mTBI in the military, and the suspected high frequency of repeated mTBI, this percentage may represent a substantial number of warriors.
Differences exist between military and civilian populations regarding mTBI. There is no evidence to determine if the recovery trajectory for mTBI sustained in combat replicates that of the civilian cohort. Additionally, the high incidence of blast-related mTBI as well as the psychologically traumatic component of the source of the wartime injuries further complicates comparisons to civilians. Thus, it is possible that the number of patients with persistent symptoms is greater than 5% of all those sustaining mTBI in the military population.
There is strong consensus in the literature that persistent mTBI symptoms include cognitive and
emotional sequelae that can result in significant functional impairment and disability. Cognitive
rehabilitation is a well-accepted and common component of comprehensive rehabilitation for persons with moderate and severe TBI (Cicerone et al, 2005). A parallel situation does not exist in the area of mTBI. Clinical management for patients with mTBI symptoms typically has focused on prevention of "excess disability" through education to promote expectations of rapid and complete recovery; providing a "timeout" period to permit recuperation; avoidance of dangerous activities that could lead to secondary injury; and, using aggressive medical treatment to ameliorate symptoms (e.g., headache, sleep disturbance, dizziness, etc.) that can interfere with optimal recovery (Comper et al., 2005; DVBIC/BIAA educational references). However, clinicians currently face an increasingly large population of Wounded Warriors who have sustained mTBI and go on to develop chronic symptoms and functional limitations, including cognitive impairment.

Biomarkers of fatigue: ranking mental fatigue susceptibility

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534096&Location=U2&doc=GetTRDoc.pdf

Biomarkers of fatigue: Ranking mental fatigue susceptibility

Donald L. Harbille, Scott R. Chaiken et al
ADFRL-RH-WP-TR-2010-0150

This is the mental fatigue susceptibility ranking portion of a study seeking to determine metabolic biomarkers for resistance to fatigue. A total of 23 paid subjects completed a fatigue protocol involving informed consent, medical screening, Tuesday and Wednesday evening training on cognitive tasks, providing five urine samples (beginning with a Friday morning baseline), refresher training, and an experimental session (with six, four hour long blocks) starting Friday evening.

The Effect of Spatial Disorientation on Working Memory and Mathematical Processing

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534074&Location=U2&doc=GetTRDoc.pdf

The Effect of Spatial Disorientation on Working Memory and Mathematical
Processing


Catherine M. Webb, Arthur Estrada, Amanda M. Kelley,
John G. Ramiccio, Edna Rath, Efrem R. Reeves,
Melinda E. Hill, Michael J. Crivello, Heber D. Jones


Previous research shows that participants exhibit impairments in spatial memory while experiencing various types of spatial disorientation (SD) in a laboratory environment. With regard to aviation-based SD, a pilot’s ability to think his/her way out of a dangerous situation may be impaired when disoriented. The present study assessed the effects of SD on cognitive functioning during simulated flight. Thirty-six UH-60 aviators participated in the study. Participants were asked to perform cognitive tests (presented aurally) as they performed oriented and disoriented flight conditions. Cognitive tests consisted of a digit span task as well as an addition task. Participants’ accuracy was significantly worse for the disoriented condition than the two oriented conditions for both cognitive tests. The current study provides support that SD can negatively impact cognitive performance. These results can be used to aid future cockpit display design and training techniques aimed at mitigating SD.

Outreach and Prevention: Staff Focus Guide: Building Bridges:

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA532902&Location=U2&doc=GetTRDoc.pdf

Outreach and Prevention: Staff Focus Guide: Building Bridges:
Supporting the Psychological Health and Traumatic Brain Injury Needs
of Military and Veteran Families


“Building Bridges” is a multi-agency, multi-disciplinary collaborative group whose purpose is to
support the PH and TBI needs of military and veteran families by:
 Building community partnerships and networks (e.g. meetings, LISTSERVS, VTCs)
 Enhancing community capacity (especially in National Guard and Reserve communities)
 Developing tools and resources designed to support families.(e.g. focus guides, toolkits,
information sheets)
“Building Bridges” is facilitated by the Defense Centers of Excellence for Psychological Health
and Traumatic Brain Injury (DCoE), but all group members are actively engaged and are
essential to making these projects a success. Members include representatives from:
 DoD Agencies, Services, Reserve and National Guard
 Departments of Veterans Affairs, Health and Human Services, and other federal
partners
 Non-profit organizations and veterans groups
 Academic institutions
 Family members

Symptom complaints following combat-related traumatic brain injury:

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA532921&Location=U2&doc=GetTRDoc.pdf

Symptom complaints following combat-related traumatic brain injury:
Relationship to traumatic brain injury severity and posttraumatic stress
disorder


HEATHER G. BELANGER , TRACY KRETZMER , RODNEY D. VANDERPLOEG , and
LOUIS M. FRENCH
Patients with a history of mild ( n = 134) or moderate-to-severe ( n = 91) TBI were asked to complete the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist. Consistent with prior research, signifi cantly more postconcussion symptoms were endorsed by the mild group. After controlling for age, time since injury, and mechanism of injury, TBI severity continued to be signifi cantly related to postconcussion complaints on the NSI. However after controlling for these same variables, along with posttraumatic stress disorder symptom severity, there no longer were differences between the TBI severity groups. That is, patients with mild TBI did not endorse signifi cantly more complaints (adjusted mean = 22.4) than the moderate-to-severe group (adjusted mean = 21.8). These fi ndings suggest that much
of the symptom complaints in mildly injured patients may be due to emotional distress. ( JINS , 2009, 16, 194?199.)

Assessing Neurophysiologic Markers for Training and Simulation to Develop Expertise in Complex Cognitive Tasks

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531504&Location=U2&doc=GetTRDoc.pdf

Assessing Neurophysiologic Markers for Training and
Simulation to Develop Expertise in Complex Cognitive Tasks


This work explores the theoretic basis and provides empirical support for using neurophysiologic markers to provide information on a trainee’s cognition to guide instruction. This serves as the basis for improving the design of simulation responsive to individual traits for training continuous complex cognitive tasks. Individualized instruction has been empirically proven to be vastly superior to other forms of instruction. However, current methods to design simulation that is responsive to the user have relied primarily on raw performance metrics. These metrics are often misleading and provide very little diagnostic value. For complex tasks, understanding cognitive processes is critical. Neurophysiologic markers can potentially inform instructional systems on trainees’ cognition but have yet to be validated. This research developed a sample process to identify neurophysiologic markers for informing individualized instruction. Applying the process to helicopter overland navigation, a theoretic model of eye scan behavior was developed. The process and theoretic model were validated by analyzing novices and expert navigators. Predicted eye scan metrics reliably distinguished between expert and novice behavior, providing insight not available using raw performance metrics. Also, a visualization tool was developed to explore expert scan strategies. In addition to confirming expected strategies and novice expert differences, we discovered novel, unexpected strategies of expert navigators

Where Do I Start? Decision Making in Complex Novel Environments

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531545&Location=U2&doc=GetTRDoc.pdf

Sara Katherine Diaz

Threats to our country have never been more real, nor had more potential to impact large populations of Americans. From the homeland defense perspective, some ideology-based groups have the ability and intention to attack the United States in ways that we as a nation have never imagined. As our world grows more complex and unpredictable, our first responders need tools to enable them to operate in this space.
This thesis focuses on how decisions are made in complex novel environments. Using Grounded Theory methodology, interviews were conducted with public safety personnel who had past experience managing incidents that matched the study criteria. Aspects of Complexity Theory and Recognition-Primed Decision Making were identified as core components.
Based on these findings, a descriptive process model was developed that modifies the existing Recognition-Primed Decision Making model in order to account for novel situations, in addition to those cases where the decision maker has previous experience. The Exploration and Exploitation Decision Making model (Ex2DM) is based on actual practices by both law enforcement and fire-rescue professionals. With an understanding of the unique characteristics of complex environments and how decisions are made under these conditions, public safety personnel will be better prepared to manage complex incidents.

Carrier Air Wing Mishap Reduction Using a Human Factors Classification System and Risk Management

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531422&Location=U2&doc=GetTRDoc.pdf

Carrier Air Wing Mishap Reduction Using a Human Factors
Classification System and Risk Management

Aviat Spac e Envir on Med 2010; 81: 1028 – 32 .

Kris M. Belland , Cara Olsen , and Russell Lawry

Introduction: In 1998, the Navy’s center of excellence for advanced air wing combat operations, namely the Naval Strike and Air Warfare Center (NSAWC), had a spike in Class A fl ight mishaps. The spike triggered an intense review of prior mishaps and current mishap-reduction
practices using the Human Factors Analysis and Classifi cation System (HFACS). The review resulted in NSAWC instituting a comprehensive multifactorial mishap reduction plan applying Operational Risk Management (ORM) precepts. Methods: This is a nonrandomized investigational study with use of a historical comparison population. The Class A mishap rate per fl ight hour covering 10 yr prior to the mishap reduction efforts was estimated and compared to the Class A mishap rate per fl ight hour for the 10 yr after implementation using Poisson regression. Results: Combined Fleet and NSAWC data shows a 27% reduction in mishap rate, but the 21% reduction in the Fleet alone was not statistically signifi cant. The mishap reduction at NSAWC was statistically signifi cant with an 84% reduction. Fallon carrier air wing mishap rates post-ORM mishap reduction efforts are approaching those seen in the Fleet, but are still elevated overall (3.7 vs. 2.4). Conclusion: The incidence rate ratio was 80% lower at Fallon than the rest of the Fleet, indicating a significantly greater reduction in NSAWC air wing mishaps and suggests focused aviation mishap reduction efforts in similar circumstances could result in similar reductions.

Combat-Related Mental Health Disorders: The Case for Resiliency in the Long War

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530573&Location=U2&doc=GetTRDoc.pdf

Combat-Related Mental Health Disorders: The Case for Resiliency in
The Long War


More US military service members have been deployed since 9/11 than in the previous 40 years. A greater number of these deployed service members are surviving, which has
increased the incidence of combat-related mental health disorders among veterans of “The Long War.” The societal cost of caring for veterans with such disorders is expected to surpass
that of the Global War on Terror, which is estimated at $600 billion. Because the prospect of stopping all deployment is remote, standardized prevention and treatment methods must be used to eliminate these “invisible wounds of war.” It is imperative that high-quality, evidence-based, and costeffective treatments—pharmaceutical and nonpharmaceutical— be developed. Although no approved medication currently exists for the prevention of posttraumatic stress
disorder, the blood pressure medication propranolol has shown promise in erasing the behavioral expression of fear memory and may be useful for preventing more severe emotional
disorders. In addition, a nonpharmaceutical method known as stress inoculation training is ideally suited to military populations and should be incorporated into military training programs. Furthermore, osteopathic physicians can improve resilience in the communities they serve by considering the dynamic of body, mind, and spirit in their patients. Applying these methods, teaching self-regulation traits, and removing barriers to care will build resiliency
among service personnel for The Long War.
J Am Osteopath Assoc. 2010;110(9):520-527

In-Flight Hypoxia Events in Tactical Jet Aviation: characteristics compared to normobaric training

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530631&Location=U2&doc=GetTRDoc.pdf

In-Flight Hypoxia Events in Tactical Jet Aviation:
Characteristics Compared to Normobaric Training


Deussing, Eric C., Artino, Anthony R., Jr., Folga, Richard V.


This document is the final report of the project entitled Hypoxia Symptoms: Comparing Normobaric Training to In-Flight Events. This project was sponsored by the U.S. Air Force Medical Research Program, Office of the Air Force Surgeon General, Directorate
for Modernization, SGRS. This final report discusses the project's purpose, methodology, results, and conclusions

hypoxia symptoms, reduced oxygen breathing device (ROBD), aerospace physiology, low-pressure chamber (LPC) training

Distribution of Oxycodone in Postmortem Fluids and Tissues

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531004&Location=U2&doc=GetTRDoc.pdf


Botch SR, Johnson RD, Chaturvedi AK, Lewis RL

Introduction: Oxycodone is a heavily used and abused analgesic agent. Its pharmacological effects, including euphoria, respiratory depression, nausea, and drowsiness, have the potential to adversely affect performance. The postmortem distribution of oxycodone has not been well characterized, particularly at sub-lethal levels. Therefore, an attempt was made to evaluate the distribution of oxycodone in postmortem specimens collected from aviation accidents.
Methods: A search of our database identified 4 oxycodone-positive fatalities from separate civil aviation accidents that occurred during a period of 6 years that had numerous biological tissues and fluids available (blood, urine, vitreous humor, liver, kidney, skeletal muscle, lung, spleen, heart muscle, and brain). These specimens were extracted using solid-phase extraction and were analyzed for oxycodone by GC/MS.
Results: Oxycodone concentration ranges (μg/mL, μg/g) found in the different tissues and fluids were: blood 0.027-0.742, urine 2.20 - 12.5, vitreous humor 0.048 - 0.118, liver 0.103-3.35, lung 0.047-1.35, kidney 0.045-3.12, spleen 0.115-2.43, muscle 0.017-0.400, brain 0.032-1.36, and heart 0.038-3.19.
Conclusion: The blood concentrations found indicate that the oxycodone in these cases ranged from therapeutic to above therapeutic, but all were below lethal levels. Tissue/fluid to blood distribution coefficients were found to have large coefficients of variation (ranging from 26-128%), thereby rendering them unreliable for estimating a blood oxycodone concentration from a tissue value when no blood is available for analysis.

Toxicological Findings in 889 Fatally Injured Obese Pilots Involved in Aviation Accidents

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531003&Location=U2&doc=GetTRDoc.pdf

DOT/FAA/AM-10/10

Botch SR, Davidson MS, Ricaurte EM, Chaturvedi AK

Obesity continues to be a public health concern and its impact on aviation community has not been fully evaluated. Toxicological findings in fatally injured aviation accident obese pilots were examined. The Civil Aerospace Medical Institute's (CAMI's) Scientific Information System was used to develop a dataset, entailing fatally injured obese pilots involved in aviation accidents, 1990–2005. A pilot with a body mass index (BMI) of > 30 kg·m•2 was considered obese. Toxicological results and aeromedical histories of these aviators were retrieved from the CAMI toxicology and medical certification databases, and the cause/factors in the related accidents were retrieved from the National Transportation Safety Board's aviation accident database. In 311 of the 889 pilots, carbon monoxide, cyanide, ethanol, and drugs were found, and glucose and hemoglobin A1c (HbA1c) were elevated. Many of these drugs were for treating overweight, depression, hypertension, and cardiac conditions. In a pilot (BMI: 39.33 kg·m•2) wherein phentermine was detected, vitreous and urinary glucose concentrations were 301 and 6,050 mg 11.5 dL•1, respectively; HbA1c was 12.4%. Of the 889 pilots, 107 had an obesity-related medical history. The health and/or medical condition(s) of, and/or the use of ethanol and/or drugs by, pilots were the cause/factors in 55 (18%) of the 311 accidents. Although the drugs found are
commonly used in the general population, they were primarily used for treating obesity-related medical conditions. Findings emphasize monitoring of obesity and diabetes in pilots and understanding the potential implications of these health conditions in relation to flight safety.

Heat Acclimation Improves Exercise Performance

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530499&Location=U2&doc=GetTRDoc.pdf

S. Lorenzo, J.R. Halliwil, M.N. Sawka, C.T. Minson


Thermal and Mountain Medicine Division
U.S. Research Institute of Environmental Medicine
Natick, MA 01760-5007

This study examined the impact of heat acclimation on improving exercise performance in cool and hot environments. Twelve trained cyclists performed tests of maximal aerobic power (V˙ O2max), time-trial performance, and lactate threshold, in both cool [13°C, 30% relative humidity (RH)] and hot (38°C, 30% RH) environments before and after a 10-day heat acclimation ( 50%V ˙ O2max in 40°C) program. The hot and cool condition V ˙ O2max and lactate threshold tests were both preceded by either warm (41°C) water or thermoneutral (34°C) water immersion to induce hyperthermia (0.8 –1.0°C) or sustain normothermia, respectively. Eight matched control subjects completed the same exercise tests in the same environments before and after 10 days of identical exercise in a cool (13°C) environment. Heat acclimation
increased V ˙ O2max by 5% in cool (66.8 2.1 vs. 70.2 2.3 ml·kg 1·min 1, P 0.004) and by 8% in hot (55.1 2.5 vs. 59.6 2.0 ml·kg 1·min 1, P 0.007) conditions. Heat acclimation improved time-trial performance by 6% in cool (879.8 48.5 vs. 934.7 50.9 kJ, P 0.005) and by 8% in hot (718.7 42.3 vs. 776.2 50.9 kJ, P 0.014) conditions. Heat acclimation increased power output at lactate threshold by 5% in cool (3.88 0.82 vs. 4.09 0.76 W/kg, P 0.002) and by 5% in hot (3.45 0.80 vs. 3.60 0.79 W/kg, P 0.001) conditions. Heat acclimation increased plasma volume (6.5 1.5%) and maximal cardiac output in cool and hotconditions (9.1 3.4% and 4.5 4.6%, respectively). The control group had no changes in V ˙ O2max, time-trial performance, lactate threshold, or any physiological parameters. These data demonstrate that heat acclimation improves aerobic exercise performance in temperate- cool conditions and provide the scientific basis for employing heat acclimation to augment physical training programs.

maximal oxygen uptake; time-trial performance; lactate threshold;
plasma volume; cardiac output; hot environment; cool environment