Recent Reports from the Web

Report on the accident to Eurocopter EC225 LP Super Puma, G-REDU near the Eastern Trough Area Project (ETAP) Central Production Facility Platform in t

2012-01-18T16:24:00.001Z

http://www.aaib.gov.uk/cms_resources.cfm?file=/1-2011%20G-REDU.pdf

Report on the accident to Eurocopter EC225 LP Super Puma, G-REDU near the Eastern Trough Area Project (ETAP) Central Production Facility Platform in the North Sea on 18 February 2009

The Aeronautical Rescue Co-ordination Centre (ARCC) notified the Air Accidents Investigation Branch (AAIB) of the accident at 1912 hrs on 18 February 2009 and the investigation commenced the following day.
In accordance with established international arrangements, the Bureau d’Enquêtes et d’Analyses pour la sécurité de l’aviation civile (BEA) of France, representing the State of Design and Manufacture of the aircraft, appointed an Accredited Representative and was supported by additional investigators from Eurocopter. The operator co?operated with the investigation and provided expertise as required.

Prior to this Final Report, the AAIB published Special Bulletins on 24 March 2009 and 23 June 2009.

Twenty-seven Safety Recommendations have been made.

The helicopter departed Aberdeen Airport at 1742 hrs on a scheduled flight to the Eastern Trough Area Project (ETAP). The flight consisted of three sectors, with the first landing being made, at night, on the ETAP Central Production Facility Platform. Weather conditions at the platform deteriorated after the aircraft departed Aberdeen; the visibility and cloud base were estimated as being 0.5 nm and 500 ft respectively. At 1835 hrs the flight crew made a visual approach to the platform during which the helicopter descended and impacted the surface of the sea. The helicopter remained upright, supported by its flotation equipment which had inflated automatically. All those onboard were able to evacuate the helicopter into its liferafts and they were successfully rescued by air and maritime Search and Rescue (SAR) assets.

The investigation identified the following causal factors:

1. The crew’s perception of the position and orientation of the helicopter relative to the platform during the final approach was erroneous. Neither crew member was aware that the helicopter was descending towards the surface of the sea. This was probably due to the effects of oculogravic[1] and somatogravic[2] illusions combined with both pilots being focussed on the platform and not monitoring the flight instruments.

2. The approach was conducted in reduced visibility, probably due to fog or low cloud. This degraded the visual cues provided by the platform lighting, adding to the strength of the visual illusions during the final approach.

3. The two radio altimeter-based audio-voice height alert warnings did not activate. The fixed 100 ft audio-voice alert failed to activate, due to a likely malfunction of the Terrain Awareness Warning System (TAWS), and the audio-voice element of the selectable 150 ft alert had been suspended by the crew. Had the latter not been suspended, it would also have failed to activate. The pilots were not aware of the inoperative state of the TAWS.

The investigation identified the following contributory factors:

1. There was no specified night visual approach profile on which the crew could base their approach and minimum heights, and stabilised approach criteria were not specified.

2. The visual picture on final approach was possibly confused by a reflection of the platform on the surface of the sea.

An oculogravic illusion is a visual illusion that affects the apparent position of an object in the visual field. A full explanation is provided in Appendix A and B to this report.

[2] A somatogravic illusion is a non-visual illusion that produces a false sensation of helicopter attitude. A full explanation is provided in Appendix A and B to this report.

Report on the accident to Grob 115E Tutor

2012-01-18T16:09:00.002Z

http://www.aaib.gov.uk/cms_resources.cfm?file=/6-2010%20G-BYUT%20G-BYVN.pdf

Report No: 6/2010:
Report on the accident to Grob 115E Tutor, G-BYUT and Grob 115E Tutor, G-BYVN near Porthcawl, South Wales on 11 February 2009

Alternating Days of Intermittent Hypoxic Exposure (IHE) on Physical and Cognitive Performance

2012-01-05T14:18:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA543164&Location=U2&doc=GetTRDoc.pdf

Alternating Days of Intermittent Hypoxic Exposure (IHE) on Physical and Cognitive Performance
Zupan, Michael F. ; Lennemann, Lynette M. ; Herrera, Monica ; Walker, Thomas B.

Rapid deployments do not allow our airmen to slowly progress to high altitudes, so predeployment strategies for the optimal use of hypoxic tents need to be developed. The primary objective of this study was to determine if alternating days of intermittent normobaric hypoxic exposures (IHE) for previously unacclimatized, sea-level residents (SLR) would work as a training strategy to minimize physical and cognitive impairments, and possibly reduce acute mountain sickness (AMS) incidence in our battlefield airmen during deployment. A secondary objective was to compare the physical and cognitive performance results between normobaric hypoxic and hypobaric hypoxic conditions. We conducted a crossover style, randomized study to assess the efficacy of IHE on physical and cognitive performance decrements. Baseline physical tests were conducted at SL, normobaric hypoxic (NH), and hypobaric hypoxic (HH) environments. Subjects were randomly assigned to either five consecutive (C-IHE) or five alternating (A-IHE) days of IHE. All tests were repeated post-IHE exposure. Following a four-week washout interval, all subjects repeated the process again under the opposite IHE exposure schedule. Intra-subject differences between training regimens (C-IHE vs. A-IHE) and the three environments (SL vs. NH vs. HH) were analyzed. Seven well-conditioned (average VO2 max = 57 mL-1.Kg-1.min) male subjects (30.4 ? 8.7 yrs) completed the study. Significant physiological differences in VO2 max (p<0.001) and oxygen saturation (p<0.01) between SL and NH or HH were observed. There were no significant differences in the HH environment for any performance variables following C-IHE and A-IHE training regimens. A-IHE produces the same altitude adaptations as C-IHE, which may allow our battlefield airmen to better prepare themselves for moderate altitude (MA) deployments.
Descriptors : *HYPOXIA, STRATEGY, PERFORMANCE(HUMAN), COGNITION, ALTITUDE SICKNESS, OXYGEN, EXPOSURE(PHYSIOLOGY), DEPLOYMENT, AIR FORCE PERSONNEL

A 2011 Risk/Benefit Analysis of the Anthrax Vaccine Immunization Program

2012-01-05T14:10:00.002Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA550246&Location=U2&doc=GetTRDoc.pdf
A 2011 Risk/Benefit Analysis of the Anthrax Vaccine Immunization Program
Master's thesis

Davis, Karla L

Safety, efficacy, and legal concerns surrounded the Department of Defense (DoD) Anthrax Vaccine Immunization Program (AVIP) in the early and mid-2000s. Production capacity, patient refusals, and legal injunctions limited vaccine delivery during this time period. Since 2007, the Anthrax Vaccine Adsorbed (AVA) has been administered to all service members deploying to high-risk areas except those medically or administratively exempt. This thesis evaluates the current AVIP in terms of associated risks and benefits. Aggregate data from long-term studies and review by multiple scientific organizations, both within and external to the DoD, suggest that the AVA is both safe and efficacious. The DoD has tailored the current AVIP policy to protect forces with anticipated high exposure risk. This tailored vaccination policy minimizes vaccine-associated risk for individuals and for the force. Current AVIP benefits for individuals and for force protection outweigh the risks. As risks and benefits change over time, ongoing assessment is essential to ensure that individual and force health promotion are optimized. Continuing long-term scientific safety and efficacy research, ongoing educational efforts, and recognition of patient concerns are essential for the continued success of the AVIP and other force protection programs. Descriptors : *BACILLUS ANTHRACIS, *BIOLOGICAL WARFARE AGENTS, *DEPARTMENT OF DEFENSE, *IMMUNIZATION, *POLICIES, *RISK ANALYSIS, *VACCINES, ADSORPTION, ANTHRAX, COSTS, EPIDEMIOLOGY, HEALTH, HISTORY, MILITARY PERSONNEL, SAFETY, THESES

The United States Army Medical Department Journal. July - September 2011

2012-01-05T13:58:00.003Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA548321&Location=U2&doc=GetTRDoc.pdf

The United States Army Medical Department Journal. July - September 2011

The articles in this issue cover the gamut of force health protection concerns, from extensive research studies and surveillance, to solutions for potential threats. As you read this AMEDD Journal, you will be impressed and educated by the breadth and depth of this vital work and vigilance that are never-ending, mostly behind the scenes. Their success is reflected in an absence of disease and injury, and the improved health of us all. For this these medical professionals have truly earned our respect and gratitude, both for what they have done, and what they will do to protect our most valuable asset, the Warriors who defend our nation and our way of life.
Descriptors : *ARMY, *MILITARY MEDICINE, *PUBLIC HEALTH, ARMY PERSONNEL, CULICIDAE, ENTOMOLOGY, EXERCISE(PHYSIOLOGY), HEALTH, MOSQUITO BORNE DISEASES, PHYSICAL FITNESS, WATER SUPPLIES

Predicting Individual Differences in Response to Sleep Loss

2012-01-05T13:53:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA549152&Location=U2&doc=GetTRDoc.pdf
Research Information Bulletin (3 pages)

Predicting Individual Differences in Response to Sleep Loss

Fatigue resulting from poor or insufficient sleep is commonplace in the modern military. Previous work at this laboratory sought to validate the use of noninvasive eye-tracking (PMI FIT 2000) and cognitive (FlightFit) performance tests to detect individual impairment due to fatigue in a military population (see technical report: DTIC ADA522106). Over the course of 25 hours of continual wakefulness in a laboratory setting, eye-tracking measures of saccadic velocity (eye movement speed) and cognitive performance (attention shifting) were highly sensitive to the effects of fatigue. A recent study further validated eye-tracking and cognitive performance measures for detecting individual differences in fatigue resistance under chronic, cumulative sleep loss conditions. The study employed a chronic sleep restriction protocol, in which 4 hours of sleep were allowed each 24-hour period. Significant fatigue effects were observed on multiple components of the eye-tracker and on a flight simulator task (cognitive performance data analyses are ongoing). Analyses also revealed significant individual differences across time for saccadic velocity and flight simulator performance. Studying realistic, chronic fatigue conditions on an individual level is a step in the right direction for operational research. The ultimate goal of this line of research is the development and transition of individualized predictive fatigue models which improve upon the predictive accuracy of current tools, increasing the safety and efficiency of crew scheduling.
Descriptors : *ATTENTION, *COGNITION, *EYE MOVEMENTS, *FATIGUE(PHYSIOLOGY), *FLIGHT SIMULATORS, *PERFORMANCE(HUMAN), *SLEEP DEPRIVATION, FLIGHT CREWS, NAVAL PERSONNEL, PERFORMANCE TESTS, PHYSIOLOGICAL EFFECTS, PREDICTIONS, REACTION TIME, SCHEDULING, TRACKING

Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update

2011-12-12T13:00:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA552009&Location=U2&doc=GetTRDoc.pdf

Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update

Hospenthal, Duane R ; Murray, Clinton K ; Andersen, Romney C ; Bell, R B ; Calhoun, Jason H ; Cancio, Leopoldo C ; Cho, John M ; Chung, Kevin K ; Clasper, Jon C ; Colyer, Marcus H

Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. 'This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of hlgh-dose cefazolin with or without metronidazole tor most postinjury indications, and recommendations tor redosing of antimicrobial agents, for use of negative pressure wound therapy, and tor oxygen supplementation in flight.
Descriptors : *INFECTIOUS DISEASES, *SURGERY, ANTIMICROBIAL AGENTS, CIVILIAN POPULATION, CLINICAL TRIALS, COMBAT AREAS, IN VITRO ANALYSIS, MILITARY PERSONNEL, OXYGEN, PRESSURE, PREVENTIVE MEDICINE, RESUSCITATION, THERAPY, TRAUMA, VETERANS(MILITARY PERSONNEL), WOUNDS AND INJURIES

Optical Filter Effects on Night Vision Goggle Acuity and Preservation of Dark Adaptation

2011-12-12T12:53:00.001Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a529412.pdf

Optical Filter Effects on Night Vision Goggle Acuity and Preservation of Dark Adaptation

Thomas, Roger S. ; Wright, Steve T. ; Clark, Patrick J. ; Thompson, William T. ; Gooch, John M.

The high output of night vision goggles (NVGs) can cause a loss of dark adaptation, resulting in suboptimal unaided vision. Optical filters have been designed to mitigate this problem by changing the overall output characteristics of the NVGs. Methods: Several aspects of visual performance related to NVG use were studied in a repeated measures design, filters versus no filters. NVG acuity was assessed using a 25% contrast chart, while preservation of dark adaptation after NVG use was measured with a scotopic sensitivity tester (SST) and a low luminance acuity chart. Testing was accomplished at two light levels, roughly corresponding to starlight and quarter moon conditions. Results: Use of the filters resulted in a statistically significant loss of acuity of about a 1/2 line (approximately 2.5 letters) at both light levels. The second part of the study identified a 47% improvement in preservation of dark adaptation under simulated starlight conditions and a 31% improvement under simulated quarter moon conditions with filter use; however, only the starlight finding was statistically significant. No significant differences in performance were seen with the low luminance chart. Discussion: Despite a small loss of visual acuity with filter use, the improvement in retention of dark adaptation may be beneficial in certain operational environments. Aviators, airmen, and commanders should evaluate how the potential for slightly poorer visual acuity and improved recovery of dark adapted vision relates to their mission specific requirements prior to implementing use of NVG filters.
Descriptors : *DARK ADAPTATION, *NIGHT VISION DEVICES, VISUAL ACUITY, OPTICAL FILTERS, EXPERIMENTAL DESIGN, REPRINTS, NIGHT VISION

Acceleration Tolerance After Ingestion of a Commercial Energy Drink

2011-12-12T12:51:00.001Z

http://www.dtic.mil/docs/citations/ADA534177

Acceleration Tolerance After Ingestion of a Commercial Energy Drink

Walker, Thomas B. ; Balldin, Ulf ; Fischer, Joseph ; Storm, William ; Warren, Gordon L.

This study examined the ability of a commercial energy drink to enhance acceleration tolerance, strength under G-load, and cognitive performance immediately prior to and following acceleration exposure. Eight experienced centrifuge subjects completed three separate experimental acceleration exposures following ingestion of 11.5 ml/kg body weight of a)a commercial energy drink, providing 5.0 mg caffeine/kg body weight, b) a commercial energy drink without caffeine or c) placebo. The acceleration exposures consisted of a relaxed gradual onset run to peripheral light loss, a rapid onset run to 6.0 G for 15 s, and a simulated air combat maneuver (SACM) run of repeated alternations between 4.5 G for 15 seconds and 7G for 15 seconds until volitional exhaustion. Cognitive tests were performed prior to and after the acceleration profiles. Relaxed G-tolerance was significantly higher under the caffeine session, whereas SACM duration did not differ among the drink conditions. Hip adductor muscle strength was lower during the placebo session than during the other two sessions. Cognitive reaction time was faster post-acceleration than pre-acceleration, and faster under the caffeine condition than the placebo condition. We conclude that consumption of a caffeine-based energy drink enhances relaxed G-tolerance and may increase strength, but does not impact acceleration duration. We further conclude that cognitive reaction time is improved by the caffeinated drink, as well as by the physical exertion during the acceleration exposure.
Descriptors : *CAFFEINE, SIMULATION, REPRINTS, PERFORMANCE(HUMAN), COGNITION, STRENGTH(PHYSIOLOGY), ACCELERATION TOLERANCE, ENERGY, CENTRIFUGES, MUSCLES, EXPOSURE(PHYSIOLOGY), PLACEBOS, TEST AND EVALUATION, REACTION TIME

A Snack-based Ration Containing Caffeine Increases Caloric Intake and Improves Cognitive Performance

2011-12-12T12:40:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA545299&Location=U2&doc=GetTRDoc.pdf

A Snack-based Ration Containing Caffeine Increases Caloric Intake and Improves Cognitive Performance
ARMY RESEARCH INST OF ENVIRONMENTAL MEDICINE NATICK MA
McClung, Holly L. ; Ely, Matthew R. ; Lieberman, Harris R. ; Smith, Julie E. ; McGraw, Susan M. ; Niro, Phil J. ; Davis, Betty A. ; Young, Andrew J. ; Montain, Scott J.

Warfighter cognitive performance degrades during sustained operations in part due to difficulty consuming adequate calories and limited access to stimulants such as caffeine. This investigation tested the effectiveness of a snack-based ration, containing caffeinated components, to increase energy and preserve cognitive performance during sustained operations. Eighty-nine Marines consumed either an entree-based (MRE) or a snack-based (FSR) ration during a four-day field exercise with limited sleep. Outcome measures included visual reaction time, logical reasoning, mood state (POMS), and energy intake. Total calories, CHO and caffeine intake was greater (P<0 .05) for FSR compared to MRE in part due to a significant increase in the number of daily eating episodes in those consuming the FSR (P<0.05). Reaction time was faster and fewer lapses in attention occurred in Marines consuming the FSR compared to MRE (P<0.05). There was no difference in logical reasoning between groups. Overall mood deteriorated over the course of the exercise with no difference between ration groups.
Descriptors : *CAFFEINE, *MILITARY RATIONS, REASONING, MEALS, COGNITION, PERFORMANCE(HUMAN), REACTION TIME

Conservative Management of Uncomplicated Mechanical Neck Pain in a Military Aviator

2011-12-12T12:29:00.005Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA522718&Location=U2&doc=GetTRDoc.pdf

Conservative Management of Uncomplicated Mechanical Neck Pain in a Military Aviator

Green, Bart N. ; Dunn, Andrew S. ; Pearce, Solomon M. ; Johnson, Claire D.
2010

Non-radicular neck pain arising from local musculoskeletal structures, known as mechanical neck pain or somatic dysfunction, is highly prevalent in the fighter jet aviator population. The management of this problem includes both therapeutic and aeromedical decisions. In addition to non-steroidal anti-inflammatory medications, waiver guides recommend therapeutic exercise and manipulative therapy as treatments for somatic spine pain in aviators, and such treatments are employed in many military locations. However, there are currently no published studies that describe the use of manipulative therapy for fighter jet aviators. We report the case of an F/A-18 instructor pilot who experienced long-term relief of uncomplicated mechanical neck pain following interdisciplinary management that included manipulation and a home exercise program. Diagnostic considerations, conservative treatment options, and aeromedical concerns are discussed.
Descriptors : *AVIATION PERSONNEL, *NECK(ANATOMY), *PHYSICAL THERAPY, *PAIN, EXERCISE(PHYSIOLOGY), SPINAL COLUMN, JET FIGHTERS,

Beryllium

2011-12-01T12:12:00.000Z

http://www.hse.gov.uk/research/rrpdf/rr873.pdf

RR873

Beryllium
A review of the health effects and the evidence for screening or surveillance in workers exposed to beryllium

Dr Anthony Darby & Dr David Fishwick

As exposure limits for beryllium have decreased, so has the incidence and severity of chronic beryllium disease.
There are however an emerging number of cases of subclinical disease and beryllium sensitization (BeS) that are being detected with new immunological tests, namely the beryllium lymphocyte proliferation test (BeLPT). Almost all the recent data on screening beryllium workers relates to the BeLPT, and more traditional screening programmes such as spirometry and chest x-rays that have been in use since the 1950s have only been evaluated as secondary endpoints.
Whilst the BeLPT has revolutionised the diagnosis of chronic beryllium disease (CBD), concerns have been raised about its inter- and intra-laboratory variability, possible reversibility in patients and uncertain sensitivity and specificity. There is also debate about the natural history of BeS and subclinical CBD and the ethical aspects of identifying disease early when there is no treatment, and subsequent employment implications. Another issue for the UK is the fact that only one laboratory offers BeLPT testing, although certain evidence supports double sampling of tests across laboratories to improve sensitivity and specificity. All these factors have led to certain US based groups advocating the use of BeLPT for screening and others not.
Therefore, in the US, a definitive stance on the content of a health surveillance programme has not been possible from the current evidence base. This is supported by the fact, for example, that the National Institute for Occupational Safety and Health (NIOSH), whilst citing many articles on beryllium on its website, does not offer any specific advice on health surveillance in beryllium workers, as it does for other industries.
This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

Optimum test conditions and variability of otoacoustic emission testing in individuals with normal hearing

2011-12-01T12:05:00.000Z

http://www.hse.gov.uk/research/rrpdf/rr840.pdf

RR840

Optimum test conditions and variability of otoacoustic emission testing in individuals with normal hearing

Kerry Poole

This study investigates issues important for the potential usefulness and practical application of OAE testing within an occupational health surveillance programme. Before this technique can be used within health surveillance, it is important to understand how reliable the measurements are and the level of change that could be detected over time within individuals. As any test of hearing function is potentially susceptible to background noise levels, it was also important to establish whether a soundproof room or audio booth would be required if this were to be used within health surveillance. We also wished to compare the reliability of OAE to that of standard puretone audiometry.
This report and the work it describes were funded by the Health and Safety Executive (HSE).

KEY MESSAGES
Otoacoustic emission testing (OAE) has good reliability and repeatability in individuals with normal hearing. It should be borne in mind that this study did not investigate the impact of noise exposure or hearing difficulties on OAE, both of which would be important factors in occupational health surveillance.
The smallest difference that can be detected using the technique appears to be small enough to be able to pickup changes that may be expected with noise-induced hearing loss over time, but this would need to be verified by future research work.
The room in which the measurements are performed (quiet room versus audio booth) has little influence on the reliability of the technique. Thus, a soundproof room may not be necessary to obtain good quality information.

Effect of Acceleration Frequency on Spatial Orientation Mechanisms

2011-11-28T17:22:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA529816&Location=U2&doc=GetTRDoc.pdf

Effect of Acceleration Frequency on Spatial Orientation Mechanisms
Patterson, Frederick R. ; Chandler, Joseph F.

Extreme motion environments can induce loss of visual acuity, motion sickness, and spatial disorientation. Understanding how human sensory integration of acceleration stimuli affects spatial awareness will improve models of spatial disorientation and mishap analysis. Vestibular gaze reflex data were successfully collected from 10 subjects, each of whom completed three separate trials at sequences of low, medium, and high off-vertical axis rotation (OVAR) spin rates. The results of these tests revealed no significant change in horizontal and torsional eye movements between the low OVAR spin frequency of 0.03 Hz and the predicted crossover point of 0.25 Hz; however, there did appear to be a trend toward reduction of horizontal eye movement when the high OVAR rate of 0.55 Hz was compared with the low (0.03 Hz) and medium (0.25 Hz) rates. Based upon the collected data, a revised crossover rate of 0.42 Hz was extrapolated as the most probable spin frequency for inducing gaze reflex changes with the potential for triggering motion sickness. The results of this study have identified a potential range of circular motion with potential implications for designing future flight simulators used for training or assessment of cockpit designs.

ACCELERATION, *PHYSIOLOGICAL DISORIENTATION, REFLEXES, MOTION SICKNESS, VISUAL ACUITY, ROTATION

Effect of Repeated Normobaric Hypoxia Exposures During Sleep on AcuteMountain Sickness, Exercise Performance, and Sleep During Exposure toTerrestrial

2011-11-28T17:02:00.003Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a545957.pdf

Effect of Repeated Normobaric Hypoxia Exposures During Sleep on Acute
Mountain Sickness, Exercise Performance, and Sleep During Exposure to
Terrestrial Altitude
C.S. Fulco, S.R. Muza, B.A. Beidleman, R. Demes, J.E. Staab, J.E. Jones, A.
Cymerman

There is an expectation that repeated daily exposures to normobaric hypoxia (NH) will induce ventilatory acclimatization (VEacc) and be effective for lessening acute mountain sickness (AMS) and the exercise performance decrement during subsequent hypobaric hypoxia (HH) exposure. However, this notion has not been tested objectively. Healthy, unacclimatized sea level (SL) residents slept for 7.5 hrs each night for 7 consecutive nights in hypoxia rooms under either NH (n=14, 24±5 yr; mean±SD) or “sham” (n=9, 25±6 yr) conditions. The ambient %O2 for the NH group was progressively reduced by 0.3%O2 (150 meters equivalent) each night
from 16.2%O2 (2200 m eq) on the 1st night to 14.4%O2 (3100 m eq) on the 7th night, while that for the ventilatory and exercise-matched sham group remained at 20.9%O2. Beginning 25 hrs post-sham or NH treatment all ascended and lived for 5 days at HH (4300 m). Partial pressure of end-tidal CO2 (PetCO2), oxygen saturation (SaO2), AMS, and heart rate (HR) were measured repeatedly during daytime rest, sleep or exercise (11.3 km treadmill time trial (TT)). From pre-to post-treatment at SL, resting PetCO2 decreased (p<0.01) for the NH group (39±3 to 35±3 mmHg) but not for the sham group (39±2 to 38±3 mmHg). Throughout HH, only sleep SaO2 was higher (80±1% vs 76±1%, P<0.05) and only AMS upon awakening was lower (0.34±0.12 vs 0.83±0.14,
Ventilatory acclimatization, AMS, physical performance, hypobaric hypoxia, arterial oxygen saturation, SaO2
Charles S. Fulco, Stephen R. Muza, Beth A. Beidleman, Robby Demes, Janet E. Staab, Juli E. Jones, and Allen Cymerman

Corrective Lens Use and Refractive Error Among United States Air Force Aircrew

2011-11-28T16:55:00.002Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA516040&Location=U2&doc=GetTRDoc.pdf

Corrective Lens Use and Refractive Error Among United States Air Force Aircrew

Wright, Steve T. ; Ivan, Douglas J. ; Clark, Patirck J. ; Gooch, John M. ; Thompson, William

Corrective lens use by military aviators is an important consideration in the design of head-mounted equipment. The United States Air Force (USAF) has periodically monitored lens use by aviators; however, it has been over a decade since the last study. We provide an update on the prevalence of corrective lenses and refractive error among-USAF aircrew based on eyeglass orders processed through the Spectacle-Request-Transmission-System (SRTS). Currently, 41% of active duty USAF pilots and 54% of other aircrew require corrective lenses to perform flight duties. Refractive errors are characterized by low to moderate levels of myopia with a mean spherical equivalent power of -1.01 diopters (D) for pilots and -1.68 D for others. Contact lenses, and more recently refractive surgery, reduce the number of aircrew that must rely on spectacles when flying; however, spectacle compatibility remains an important consideration in the cockpit.
From Military Medicine
EYEGLASSES, *FLIGHT CREWS, EYE DISEASES, AIR FORCE PERSONNEL

ADA516040

The Effects of Life-Stress on Pilot Performance

2011-11-28T11:54:00.000Z

http://humansystems.arc.nasa.gov/flightcognition/Publications/Young_TM2008_215375_final.pdf

The Effects of Life-Stress on Pilot Performance

James A. Young

NASA/TM–2008-215375

The effects of acute stress, due to immediate threat, on skilled performance of pilots and other human operators are fairly well documented, but much less research has been conducted on the effects of stress from difficult life situations (life stress). Clinical research has focused more on the effects of life stressors on an individual's mood and coping than on skilled performance of demanding tasks such as military aviation. Pilots are reluctant to reveal information that
might cause them to be removed from flight status, which makes study of this issue difficult. This paper reviews existing research on the effects of life stress on pilots' performance. Although this research has substantial methodological limitations, it does suggest that life stress can impair performance, and probably does so more than pilots realize. Performance may be impaired through mechanisms such as disturbed sleep, altered mood, decreased motivation, and preemption of attention and working memory by worry. A wide range of questions that require further research, carefully designed, is discussed

Acute stress, Cognition, Skilled performance, Pilot performance, Life-stress, Attention, Working memory

Checklists and Monitoring in the Cockpit: Why Crucial Defenses Sometimes Fail

2011-11-28T10:50:00.001Z

http://human-factors.arc.nasa.gov/publications/NASA-TM-2010-216396.pdf

NASA/TM—2010-216396

Checklists and Monitoring in the Cockpit: Why Crucial
Defenses Sometimes Fail

R. Key Dismukes
Ben Berman

Checklists and monitoring are two essential defenses against equipment failures and pilot errors. Problems with checklist use and pilots’ failures to monitor adequately have a long history in aviation accidents. This study was conducted to explore why checklists and monitoring sometimes fail to catch errors and equipment malfunctions as intended. Flight crew procedures were observed from the cockpit jumpseat during normal airline operations in order to: 1) collect data on monitoring and checklist use in cockpit operations in typical flight conditions; 2) provide a plausible cognitive account of why deviations from formal checklist and monitoring procedures sometimes occur; 3) lay a foundation for identifying ways to reduce vulnerability to inadvertent checklist and monitoring errors; 4) compare checklist and monitoring execution in normal flights with performance issues uncovered in accident investigations; and 5) suggest ways to improve the effectiveness of checklists and monitoring. Cognitive explanations for deviations from prescribed procedures are provided, along with suggestions for countermeasures for vulnerability to error.

The Effect of Spatial Disorientation on Working Memory and Mathematical Processing

2011-11-23T11:13:00.000Z

http://www.usaarl.army.mil/TechReports/2011-08.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

USAARL 2011-08
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.

spatial disorientation, workload, cognition

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

2011-11-23T11:03:00.000Z

http://www.usaarl.army.mil/TechReports/2011-05.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.

modafinil, dextroamphetamine, stimulants, extended wakefulness, sustained operations, fatigue

Fatigue Risk Management in Aviation Maintenance: Current Best Practices and Potential Future Countermeasures

2011-11-23T10:53:00.000Z

http://www.faa.gov/library/reports/medical/oamtechreports/2010s/media/201110.pdf

DOT/FAA/AM-11/10

Fatigue Risk Management in Aviation Maintenance: Current Best
Practices and Potential Future Countermeasures

Hobbs A, Avers KB, Hiles JJ

The unregulated hours and frequent night work characteristic of maintenance can produce significant levels of employee fatigue, with a resultant risk of maintenance error. Fatigue Risk Management Systems (FRMS) are widely used to manage fatigue among flight crew and drivers of commercial vehicles, but comprehensive approaches to fatigue risk management are still uncommon within maintenance organizations. In the wider transport industry, the objective of most FRMS has been to reduce fatigue to an acceptable level. Two additional objectives can be identified for FRMS in the maintenance environment: reducing or capturing fatigue-related
errors, and minimizing the harm caused by fatigue-related errors. A range of countermeasures can help to achieve these three objectives in aviation maintenance. Some of these countermeasures are currently being applied within the industry, while others may become feasible in the future. The data available on best practices for fatigue risk management in aviation maintenance are continually evolving. This should be considered an interim report

Maintenance, Human Fatigue, Alertness, Fatigue Risk
Management, FRMS, Countermeasures, Hours-of-Service

Flying Blind: Aeromedical Certification and Undiagnosed Age-Related Macular Degeneration

2011-11-23T10:17:00.000Z

http://www.faa.gov/library/reports/medical/oamtechreports/2010s/media/201114.pdf

Flying Blind: Aeromedical Certification and Undiagnosed Age-Related
Macular Degeneration

Nakagawara VB, Montgomery RW

DOT/FAA/AM-11/14

Background: The love of flying seldom diminishes throughout a pilot’s career. It is often the primary motivation for investing the time and expense necessary to attain and maintain a valid pilot license and medical certificate. However, a pilot’s ability to meet the physical requirements for aeromedical certification may become compromised by advancing age or impairments. Individuals with physical limitations or the elderly in a number of states must pass a vision test to renew their driver’s license. These individuals may resort to extraordinary measures to avoid losing the privilege of operating a motor vehicle and maintain a sense of independence. Similarly, pilots with physical limitations may attempt to circumvent the Federal Aviation Administration’s
aeromedical certification process in order to retain a valid medical certificate.
Case Report: In an investigation of a fatal accident the National Transportation Safety Board (NTSB) concluded that the aviation medical examiner who issued an airman medical certificate to a visually impaired pilot failed to perform the appropriate procedures to verify the validity of medical information provided by the pilot. The airman subsequently crashed his aircraft, resulting in his death and the deaths of five others onboard.
Conclusions: The NTSB report stated the pilot's “failure to maintain airplane control for an undetermined reason resulted in an inadvertent stall.” The report also stated that “either the pilot's macular degeneration or his unrecognized coronary artery disease could have contributed to his failure to maintain control of the airplane.” The potential debilitating effects associated with these and other serious health issues are discussed.

Aviation, Medical Certification, Vision, Aviation Accident,
Macular Degeneration, Coronary Artery Disease

Flight Attendant Fatigue: A Quantitative Review of Flight Attendant Comments

2011-11-23T10:06:00.000Z

http://www.faa.gov/library/reports/medical/oamtechreports/2010s/media/201116.pdf

Flight Attendant Fatigue: A Quantitative Review of Flight
Attendant Comments

Avers KB, Nei D, King JS, Thomas S, Roberts C, Banks JO,
Nesthus TE

DOT/FAA/AM-11/16

Today’s aviation industry is a 24/7 operation that produces a variety of challenges for cabin crew members including extended duty periods, highly variable schedules, frequent time zone changes, and increased passenger loads. The present content analysis study was conducted to provide a quantitative review of flight attendant comments provided on the congressionally mandated survey of flight attendant field operations that was conducted in 2008. This report can be used as a supplement to interpret the published survey results (Avers et al., 2009b). Two hundred surveys were randomly selected for each type of operation and level of seniority. A
total of 1,800 surveys with comments were content analyzed (936 paper, 864 online). Eight broad comment categories were identified, including: scheduling, health, airline and airline policy, job performance and satisfaction, meals, survey, workload, and break facilities. Each category consisted of multiple positive and negative issues identified by flight attendants. This report outlines the most frequently reported categories and issues, summarizes the key issues by type of operation (low-cost, regional, network carrier) and seniority level (junior – bottom one-third, mid – middle one-third, senior – top one-third), and provides examples of actual respondent comments for the most commonly identified topics.

Fatigue, Flight Attendant, Survey, Duty Time, Workload,
Scheduling,

Development, Validation, and Deployment of an Occupational Test of Color Vision for Air Traffic Control Specialists

2011-11-23T09:53:00.000Z

http://www.faa.gov/library/reports/medical/oamtechreports/2010s/media/201108.pdf

Development, Validation, and Deployment of an Occupational Test of Color Vision for Air Traffic Control Specialists

DOT/FAA/AM-11/8

Chidester T, Milburn N, Lomangino N, Baxter N, Hughes S,
Peterson L

Air Traffic Control Specialists (ATCSs) are responsible for the safe, efficient, and orderly flow of traffic in the U.S. National Airspace System. Color has become an integral element of the air traffic control environment. It is used to communicate information to ATCSs about various modes of air traffic functions including conflict alerts, aircraft control status, and weather. The Federal Air Surgeon (AAM-1) and Human Factors Research, Engineering, and Development office (AJP-61) tasked the Civil Aerospace Medical Institute (CAMI) to develop, validate, and implement an occupational test for ATCS job candidates who fail clinical instruments during the
pre-employment medical examination. The Aerospace Human Factors Research Division (AAM-500) of CAMI developed the Air Traffic Color Vision Test (ATCOV) to determine whether individuals with color vision disorders (CVDs) have adequate color vision to perform critical color-related tasks involved in air traffic control.The research team conducted two studies to validate ATCOV testing. The results of Study One provided evidence of the reliability of the subtests, established performance norms for subjects with normal color vision (NCV) on each subtest, determined cut scores to apply in occupational testing, and examined the impact of testing upon a sample of CVD subjects. The results of Study Two provided evidence of the reliability of second operational ATCOV subtests, established performance norms for NCV subjects on each subtest, determined cut scores to be applied in occupational testing, and examined the impact of testing upon a sample of CVD subjects. Color vision ability sufficient to perform duties safely remains critical to provision of air traffic services in the National Airspace System. ATCOV complies with Uniform Guidelines reporting requirements for both content and construct-oriented validity.
Evidence of content validity for ATCS duties is provided through direct sampling of form and content of critical display data. Evidence of construct validity is provided by correlation with Colour Assessment and Diagnosis Test and Cone Contrast Test threshold scores, which precisely measure color vision ability. This resulted in a job sample test closely tied to critical tasks communicated using color on air traffic displays. ATCOV makes use of display formats and color chromaticities deployed for critical information on critical displays as defined by
published analyses of ATCS tasks. Its items are isomorphic with datablocks and weather depictions deployed on ARTS, STARS, and DSR displays in terminal and en route facilities. Future challenges will surround the stability of color use on new systems and displays.

Air Traffic Control, Color Vision, Personnel Selection,

Laser Illumination of Flight Crew Personnel by Month, Day of Week, and Time of Day for a 5 year study period: 2004-2008

2011-11-23T09:43:00.000Z

http://www.faa.gov/library/reports/medical/oamtechreports/2010s/media/201107.pdf

Laser Illumination of Flight Crew Personnel by Month, Day of Week, and
Time of Day for a 5-Year Study Period: 2004-2008

DOT/FAA/AM-11/7

Nakagawara VB, Montgomery RW, Wood KJ

Illumination of civilian and military aircraft by laser beams in the National Airspace System (NAS) has concerned the aviation community for nearly two decades. The principal concern is the affect laser exposure may have on flight crew personnel during landing and departure maneuvers when operational requirements are critical. This study examines the frequency of aviation-related laser event reports by month, day of the week, and time of day.
METHODS: Reports of aircraft illuminated by high-intensity light sources have been consolidated from multiple information sources into a database maintained by the Civil Aerospace Medical Institute’s Vision Research Team. Laser illumination event data involving civilian aircraft in the United States for a 5-year period (January 1, 2004 to December 31, 2008) were examined for this study.
RESULTS: There were a total of 2,492 laser events in the U.S. during the study period. In 1,676 (67.3%) of these, the cockpit environment was illuminated by a laser light. August through December were the most active months with 51% of all reports, while May through July were the least active with only 19% of all reported incidents. Sunday was the most likely day of the week for an aircraft to be illuminated by a laser (15.4%), with a relatively high number of aircraft illuminations occurring on Friday and Saturday. Weekdays exhibited the fewest laser illumination events. Time of day was provided in 2,429 (97.5%) aircraft laser illumination reports. Approximately 69.8% (1,696) of the aircraft illuminations occurred between 7 p.m.(1900 hours) and 11 p.m. (2300 hours) during the study period.
CONCLUSIONS: Laser illumination events are most likely to occur from late summer to early winter monthsand on weekends between 7:00 p.m. and 11:00 p.m. Both weather conditions and daylight savings time may play important roles in determining an opportune time frame for laser activity in a particular locale.Knowledge of these findings may assist the aviation community and law enforcement officials in allocating their limited resources to increase the likelihood of apprehending those responsible for these criminal acts.

Benzodiazepine Use in Pilots of Civil Aviation Accidents: 1990-2008 Toxicology and Autopsy Findings

2011-11-23T09:36:00.001Z

http://www.faa.gov/library/reports/medical/oamtechreports/2010s/media/201102.pdf

Benzodiazepine Use in Pilots of Civil Aviation Accidents:
1990-2008 Toxicology and Autopsy Findings

DOT/FAA/AM-11/2

Botch S, Johnson R, Ricaurte E, Selensky M

Introduction: Benzodiazepine medications have a long history of abuse. They are categorized as central nervous system depressants, and there are currently 15 different benzodiazepines prescribed in the United States and an additional 20 in other countries. The side effects of these medications include drowsiness, dizziness, decreased alertness, and/or memory loss, which can lead to impairment and a decreased ability to properly control an aircraft. The presence of these medications in postmortem specimens of aviation accident victims can help determine the cause of the accident and, potentially, result in serious legal consequences. Our laboratory is in a unique position because a medical history is available to investigators for most certified pilots. With this in mind, we compared benzodiazepine compounds found following postmortem analysis with the available medical history for each victim. This evaluation was conducted to determine if these records supported the use of such medications or if the aviators were taking the compounds without the approval of their aviation medical examiners or possibly abusing the substances. In addition, a medical review of the autopsy records was also conducted. Method: Toxicological information from analyses was retrieved from the Civil Aerospace Medical Institute’s (CAMI’s) Forensic Toxicology Research Laboratory database. Case histories and accident information were obtained from the National Transportation Safety Board. Medical histories were obtained from the FAA’s medical certification database and CAMI’s autopsy team database. Results and Discussion: Over the examined time period (1990-2008), there were 6,062 fatal aviation accident cases received at CAMI, and 96 (~1.6%) pilots were found positive for a benzodiazepine. In ~74% of pilots found positive for benzodiazepine(s), it was determined that another compound was detected and more than one additional compound was often present. Fatal aviation accidents involving pilots who had taken a benzodiazepine compound prior to the flight are an infrequent event; however, concomitant use of more than one compound with benzodiazepines is common. This study highlights the use of benzodiazepine over the examined time period in the pilot community and presents a variety of demographic information about the pilots involved in such accidents.

The Scope of Back Pain in Navy Helicopter Pilots

2011-11-22T15:06:00.001Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a543155.pdf

The Scope of Back Pain in Navy Helicopter Pilots

Andrea S. Phillips
March 2011
Thesis

This thesis investigates issues such as long hours in the cockpit, ineffective seat padding, Night Vision Goggle (NVG) use, and the constant vibrations involved in flying rotary wing aircraft. Pain is subjective and severity is difficult to compare between individuals. Does back pain affect safety of flight? In the military helicopter aviator community, 60-80% of helicopter pilots are estimated to be suffering from back pain (Sargent & Bachmann, 2010). The Sargent and Bachmann article, written by flight surgeons, suggests that back pain is an issue in the helicopter community. This article also suggests that back pain may be affecting safety of flight but did not have data to support that claim. This thesis provides an analysis of the scope, incidence and severity of back pain in the Naval Aviation helicopter pilot community. Of the helicopter pilots who responded to the survey, 88.1% are experiencing back pain during at least 50% of
their flights and 34.4% admit this pain is affecting their situational awareness. This thesis gives the Navy information to decide whether to invest R&D funds in anti-vibration seat technology and whether flight safety is affected.

Leading a Culture of Fitness

2011-11-22T14:29:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a542909.pdf

Leading a Culture of Fitness

Lieutenant Colonel J.D. McCune

Airplanes require proper fuel and maintenance—so do Airmen. Lack of physical fitness in the military has profound strategic implications for a nation at war. Poor fitness carries with it significant repercussions while even moderate fitness yields considerable benefits. The United States Air Force (USAF) is improving after decades of disturbing trajectories, but a force wide fitness ethos remains unrealized. Organizational culture and inertia remain the crux of the issue. USAF priorities must reflect the importance of fitness in order to finally achieve a culture of fitness. Leadership provides the example, communicates the message, supplies the incentive, and motivates the behavior that will ultimately succeed.

This SRP is submitted in partial fulfillment of the requirements of the Master of Strategic Studies Degree. The views expressed in this student academic research paper are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government

Subject: Military Uniforms: Issues Related to the Supply of Flame Resistant Fibers

2011-11-22T14:15:00.001Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a545056.pdf

Subject: Military Uniforms: Issues Related to the Supply of Flame Resistant Fibers
for the Production of Military Uniforms

Prior to Operation Enduring Freedom and Operation Iraqi Freedom, Department of Defense (DOD) personnel with flame resistant (FR) uniforms were mainly aviators, fuel handlers, and tank crews. With the growing prevalence of the improvised explosive device (IED) threat, all ground forces serving in Iraq and Afghanistan have been exposed to the possibility of fire-related injuries. The Ike Skelton National Defense Authorization Act for Fiscal Year 2011 extended to 2015 the authority to procure fire resistant1 rayon fiber for the production of uniforms from certain foreign countries, provided by section 829 of the National Defense Authorization Act for Fiscal Year 2008 and originally set to expire in 2013.2 This letter formally transmits the enclosed briefing developed in response to the requirement in the Ike Skelton National Defense Authorization Act for Fiscal Year 2011 to report on the supply chain for FR fiber for the production of military uniforms

Case Report: Arterial Gas Embolism Induced Ageusia

2011-11-22T14:11:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a550194.pdf

Case Report: Arterial Gas Embolism Induced Ageusia

Blake D. Lollis, Robert Johnson, Harlan M. Walker

This article details a previously unreported arterial gas embolism (AGE) clinical presentation. A military aircrew candidate water survival course trainee lost his sense of taste (“ageusia”) after only a few compressed air breaths and ascending from the shallow depth of 4 ft. Ageusia was his only AGE sign or symptom. Rapidly diagnosing and treating AGE and other decompression illnesses is essential for positive patient outcomes and requires understanding the anatomic and physiologic effects of atmospheric pressure changes.

Published in the Journal of the Society of United States Naval Flight Surgeons, Contact, Vol. 33, No. 2, July 2011

NEO PI-R Normative Personality Data that Distinguish U.S. Air Force MQ-1 Predator

2011-11-22T13:51:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a548330.pdf

AFRL-SA-WP-TR-2011-0004

NEO PI-R NORMATIVE PERSONALITY DATA THAT DISTINGUISH U.S. AIR FORCE
MQ-1 PREDATOR AND MQ-9 REAPER SENSOR OPERATORS FROM AC-130 GUNSHIP SENSOR OPERATORS AND PEERS IN THE GENERAL POPULATION

Robert Craig-Gray, Wayne L. Chappelle, John Heaton, Amber Salinas

June 2011
final report

The U.S. Air Force remotely piloted aircraft MQ-1 Predator and MQ-9 Reaper sensor operators (SOs) represent a group of enlisted airmen in a high-demand, high-precision, aviation-related position where they have a pivotal role in precision-strike aerial operations. This study evaluated psychological baseline test scores from the NEO Personality Inventory-Revised (NEO PI-R) on enlisted airmen who became operational Predator/Reaper SOs in an effort to assess how key personality traits (e.g., neuroticism, extraversion, openness, agreeableness, conscientiousness) distinguished them from peers in the civilian, general population as well as AC-130 gunship SOs. This study also developed occupationally specific normative data and distribution of personality scores for use in aeromedical evaluations of Predator/Reaper SO training applicants and incumbents. The results of the study shed light on objective personality traits and differences and assist military psychologists and flight surgeons with the interpretation of NEO PI-R test scores when evaluating the suitability and fitness for duty of training applicants and incumbents for such a unique and demanding career field. A case study and clinical vignette are provided to illustrate the practical application of study findings.

Noise Attenuation Performance of the Joint Service Aircrew Mask

2011-11-22T13:48:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a550649.pdf

AFRL-RH-WP-TP-2011-0028

Noise Attenuation Performance of the Joint
Service Aircrew Mask (JSAM) Type I (MPU-5) Rotor Wing (RW) with Flight
Helmets
Hilary L. Gallagher
Richard L. McKinley
Warfighter Interface Division
JANUARY 2011

Noise attenuation performance tests were performed on the Joint Service Aircrew Mask (JSAM) Type I (MPU-5) Rotor Wing (RW) with the HGU-56/P and HGU-84/P helmets at the Air Force Research Laboratory’s (AFRL) Acoustics facilities at Wright-Patterson Air Force Base September 2009. The MPU-5 was tested and compared to legacy masks (M-45, AERP, and AR-5). An American National Standards Institute (ANSI) method ANSI S- 12.42-1995(R2004) was used to measure the passive attenuation. Passive insertion loss was comparable for all
systems in combination with HGU-56/P. The AR-5 did outperform the MPU-5 across all frequencies when tested in combination with HGU-84/P. In addition, the MPU-5 causes significant degradation of the helmet attenuation when comparing the helmet with and without the MPU-5.

Neck Torque Study Induced by Head-Borne Visual Augmentation Systems (VAS) in Ground-Based Applications

2011-11-22T13:23:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA519127&Location=U2&doc=GetTRDoc.pdf

The Johns Hopkins University
Applied Physics Laboratory

NSTD-09-1057
Final Report
Contributors:
Emily Ward
Quang Luong

Neck Torque Study Induced by Head-Borne Visual Augmentation Systems (VAS)
in Ground-Based Applications

While providing a critical capability to conduct missions under the cover of darkness, Night
Vision Goggles (NVG) are a recognized source of acute and chronic neck injuries. US Army
Night Vision & Electronic Sensors Directorate and the Naval Surface Warfare Center needed to
characterize the mass, Center of Gravity (CG) and neck torque generated by existing NVG and
Visual Augmentation Systems (VAS) in order to understand the potential for neck pain and
injury created by existing systems, and provide insight on the mass and CG properties needed for future systems. NVG use light intensifier tubes to amplify existing light while VAS incorporate both light intensifiers and infra-red thermal imagers. (For the purposes of this report, NVG systems are a sub-set of VAS.) This project had three tasks:
1. Develop a method to measure the mass and CG of VAS.
2. Measure the mass and CG of seven (7) VAS and their associated mounts: AN/PVS-7D,
AN/PVS-14, AN/PVS-15A, AN/PVS-23, Fusion Goggles, AN/PEQ-20, Advanced
Digital Multispectral (ADM)-NVG. Calculate the neck torque generated by these
systems.
3. Develop computational models of the VAS, mounts and helmets with appropriate mass
properties to allow virtual measurement of mass, CG and neck torque. Additionally, a
virtual model was built of the FGS-PI system.
Each VAS and mount was tested on three (3) sizes of Advanced Combat Helmets (ACHs):
Medium, Large and Extra-Large. Additionally, the AMD-NVG was tested on the SOCOM
Lightweight Helmet. Each helmet system combination was tested in 4 positions:
 Lowered – Maximum distance
 Lowered – Minimum distance
 Stowed – Maximum distance
 Stowed – Minimum distance
Using the mass and CG measurements collected for the VAS, the neck torques about the atlantooccipital joint of the neck were calculated. The atlanto-occipital joint is located at the top of the neck where the skull rests. The neck torques for the different systems and configurations ranged from 0.44 N-m to 1.51 N-m (which excluded the effects of the helmet). The helmet imposes a negative torque on the neck ranging from -0.43 N-m (medium ACH) to -0.52 N-m (extra-large ACH). This negative torque of the helmet reduces the neck torque effects of the VAS and mount.
When the US Army Aeromedical Research Laboratory’s (USAARL’s) neck torque criteria for
rotary-wing aviators is applied to the data collected, there were only 3 test conditions which
exceeded their criteria1F1F1F
2. These were with the AN/PVS-15 and Wilcox mounts in the stowed
position on the large and extra-large ACHs

An Assessment of the Relationship Between Safety Climate and Mishap Risk in U.S. Naval Aviation

2011-11-22T13:14:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a550201.pdf

NPS-OR-11-004

An Assessment of the Relationship Between Safety Climate and
Mishap Risk in U.S. Naval Aviation

Paul O’Connor, Samuel E. Buttrey, Angela O’Dea, and
Quinn Kennedy
October 2011

This study used a prospective design to assess whether 12 items from the Command Safety Assessment Survey (CSAS) can be used to differentiate between U.S. Naval aviation squadrons who have had a mishap within a recent period of time, and those that have not. Logistic regression modeling was carried out using the survey responses of U.S. Naval aircrew (n = 23,442) and mishap data. The models that were used to attempt to predict severe and moderately severe mishaps together, performed better than the models that used subsets of the mishaps data. It was found that three of the CSAS items had some limited value in predicting mishap risk. Personnel in squadrons with a low probability of mishap more strongly agree with the need to monitor personnel and integrate safety and operations, than aircrew in squadrons with a higher probability of mishap. However, the aircrew in squadrons with a higher probability
of mishap also more strongly agrees that persistent rule violators will jeopardize their career, compared to personnel in squadrons with a low probability of mishaps. This finding suggests that blame and punishment are not constructive in efforts to promote safety at work. This study would seem to support the premise that safety climate and safety performance are weakly related. It is recommended that researchers would be better advised to attempt to establish the discriminate validity of their questionnaire through self-reported safety attitudes and behaviors, rather than mishap data.

Establishment of Maximum Voluntary Compressive Neck Tolerance Levels

2011-11-22T12:45:00.001Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a548465.pdf

AFRL-RH-WP-TR-2011-0090

Establishment of Maximum Voluntary Compressive Neck Tolerance Levels

Michael Cote, John Buhrman, Nathaniel Bridges, Casey Pirnstill, Chris Burneka, John Plaga, Grant Roush

July 2011
Interim Report

The primary objective of this study was to establish maximum human voluntary static tolerance levels of neck compressive loading to ensure the safe operation of a proposed Joint Strike Fighter (JSF) Head/Neck Restraint System (HNRS). A laboratory helmet-load apparatus was designed and used to safely apply compressive forces to the head/neck of 46 subjects’ (26 female; 20 male). Nearly all subjects were able to sustain maximum forces of at least 120 lbs for 5 seconds, with several subjects tolerating maximum sustained forces of over 200 lbs. Neck circumference was the most significant variable across gender with larger neck circumferences correlating to higher sustained forces. Regression models, however, demonstrated low R2 values due to high maximum voluntary load variability among subjects of similar weights. Such findings suggest that while compressive neck forces of 100 lbs could be safely tolerated by potential users of the HNRS, no single force setting will likely be ideal for all users.

The Role of Sleep in the Military: Implications for Training and Operational Effectiveness

2011-11-22T12:40:00.001Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a550390.pdf

The Role of Sleep in the Military:
Implications for Training and Operational Effectiveness

Book Chapter in The Oxford Handbook of Military Psychology. New York: Oxford University Press

Nita Lewis Miller, Panagiotis Matsangas and Aileen Kenney

This chapter addresses the role of sleep in a variety of military settings, ranging from military education and training regimes and extending to military missions and combat operations. It first overviews the scientific literature related to sleep and performance. It then describes a 10-year series of studies conducted at the Naval Postgraduate School that addresses fatigue and sleep restriction in military settings. These studies examine sleep patterns of Sailors aboard warships and submarines; shift the timing of sleep during training in Navy Recruits and Army Basic Combat Trainees; follow Cadets at the United States Military Academy at West Point in a 4-year longitudinal study; and assess sleep in operational environments including surveys of warfighters while deployed and recently returned from combat in Southwest Asia.
Results of many of these studies are reviewed concluding with recommendations advocating the inclusion of sleep as a factor when calculating military effectiveness.

Important and Critical Psychological Attributes of USAF MQ-1 Predator and MQ-9 Reaper Pilots According to Subject Matter Experts

2011-11-22T12:27:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a545552.pdf

AFRL-SA-WP-TR-2011-0002

Important and Critical Psychological Attributes of USAF MQ-1 Predator and
MQ-9 Reaper Pilots According to Subject Matter Experts

Wayne Chappelle, Psy.D.
Kent McDonald, Lt Col, USAF
Katharine McMillan, Ph.D.
May 2011
Final Report

Among U.S. Air Force remotely piloted aircraft, the MQ-1 Predator and MQ-9 Reaper have emerged as critical assets to intelligence, surveillance, reconnaissance, and close air support operations. The effective selection of Predator/Reaper pilot training candidates for such aircraft is essential to successful training and operational performance. However, a profile of "the right stuff" (i.e., cognitive aptitudes, personality traits, and motivation) guiding aeromedical flight screening and selection processes for such pilots does not exist. This study addresses the gap in the literature by formulating such a profile based upon the input of line commanders and subject matter experts (SMEs). A total of 82 SMEs provided input on the psychological attributes perceived as critical to acquisition of Predator/Reaper pilot skills, as well as adaptation to the operational environment. The researchers analyzed, organized, and integrated the results of SME interviews in to a theoretical, multidimensional profile, which serves as a communication tool between aeromedical leadership and line commanders regarding psychological attributes that should be considered prior to a Predator/Reaper pilot training applicant entering the career field. The profile may also guide aeromedical and personnel assessment and selection procedures, as well as waiver evaluations to reduce attrition, and improve retention in such a high-demand, high-operational aviation career field.

Collaborative Biomechanics Data Network (CBDN): Promoting Human Protection and Performance in Hazardous Environments Through Modeling and Data Mining

2011-11-22T12:20:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a549620.pdf

AFRL-RH-WP-TR-2011-0097

Collaborative Biomechanics Data Network (CBDN): Promoting Human Protection and Performance in Hazardous Environments Through Modeling and Data Mining of Human Centric Data Bases

John R. Buhrman
Huaining Cheng
Scott R. Chaiken

SEPT 2011
Final Report

This report is a comprehensive but synoptic overview of the 711 HPW/RHPA Collaborative Biomechanics Data Network (CBDN). The CBDN is a working (i.e. operational) concept for how the collective wisdom of years of systematic DoD research into human response and tolerance should be archived and made accessible for future investigations and for principled operational safety policy. The intent of this report is to give a guided-tour of the CBDN contents, along with its data archiving methods and philosophy. This is done mainly through extended quotes from important source materials from the major contributors to the CBDN

Facets of Occupational Burnout among U.S. Air Force Active Duty and National Guard/Reserve MQ-1 Predator and MQ-9 Reaper Operators

2011-11-22T12:11:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a548103.pdf

AFRL-SA-WP-TR-2011-0003

FACETS OF OCCUPATIONAL BURNOUT AMONG U.S. AIR FORCE ACTIVE DUTY AND
NATIONAL GUARD/RESERVE MQ-1 PREDATOR AND MQ-9 REAPER OPERATORS

Joseph A. Ouma, Lt Col, USAF, MC, FS
Wayne L. Chappelle, Psy.D., ABPP
Amber Salinas, M.A.
June 2011
Final Report

The increasing operational demand for MQ-1 Predator and MQ-9 Reaper remotely piloted aircraft (RPA) in support of intelligence, surveillance, and reconnaissance missions as well as precision-strike operations in theaters of conflict has led to a substantial rise in operational hours, shift work, and exposure to combat-related events (e.g., destruction of enemy assets and combatants) for operators. As a result of the continual need to sustain a high operational tempo, there are concerns among line commanders and aeromedical leadership regarding the prevalence of occupational burnout. There is also concern that there are differences across units for risk of occupational burnout and that active duty crew members are at higher risk when compared with National Guard/Reserve operators.
This study surveyed 426 officer and enlisted operators (pilots and sensor operators). Although a wide range of stressors may contribute to elevated levels of burnout, the majority of occupational stress was reported to stem from operational stress and not exposure to combat (e.g., live video feed regarding the destruction or death of enemy combatants and ground forces). In general, the
results revealed that active duty operators are more than twice as likely to suffer from the facets of occupational burnout involving emotional exhaustion and cynicism. Active duty as well as National Guard/Reserve operators attributed shift work, shift changes, hours worked, and simultaneously serving as a warfighter in theater while returning home and managing domestic roles and responsibilities at home to their burnout levels. Aeromedical recommendations include reducing operational hours, reducing frequency of shift changes, reducing the length of assignments, providing clear guidance and opportunities for competitive careerprogression,
improving human-machine interfacing within the ground control station, marital and family enrichment opportunities, as well as periodic psychological health assessments to mitigate the risk of burnout among RPA operators.

HANDBOOK OF AEROSPACE AND OPERATIONAL PHYSIOLOGY

2011-11-22T12:02:00.000Z

http://www.dtic.mil/dtic/tr/fulltext/u2/a548404.pdf

HANDBOOK OF AEROSPACE AND OPERATIONAL PHYSIOLOGY

AFRL-SA-WP-SR-2011-0003

Andrew D. Woodrow
James T. Webb
July 2011
Final Report

This handbook is designed to be a reference for aerospace physiologists and technicians in the U.S. Air Force. It contains information about physiologic principles and application of those principles to Air Force flight operations. While it is not designed to be a clinical resource, references to clinical materials are provided to allow further study. The first two sections contain information on basic human physiology and Earth’s atmosphere pertinent to the field of aerospace physiology. Section 3 reviews the environmental effects of the atmosphere, and Section 4 addresses human performance. Sections 5-7 address aircraft systems, crewmembers’ personal equipment, and the mission-imposed effects on performance and survivability. Section 8 reviews training, activities, and resources needed for aerospace physiologists to accomplish their duties. The appendices provide reference tables and procedures related to the career field and short biographies of the contributing authors/subject matter experts.

Initial Consideration of the Feasibility and Optimal Application of Tactile Sway Cueing to Improve Balance Among Persons Suffering from Disequilibrium

2011-02-24T10:21:00.000Z

http://www.usaarl.army.mil/TechReports/2011-01.pdf
Initial Consideration of the Feasibility and Optimal Application of Tactile Sway Cueing to Improve Balance Among Persons Suffering from Disequilibrium

Angus H. RupertBenton D. Lawson

USAARL 2011-01
This report explores the use of tactual sway cueing as a compensatory strategy for patients suffering disequilibrium. Sway feedback systems have the potential to aid Soldiers with traumatic brain injury (TBI) and other patients whose balance has been disrupted by concussions, labyrinthine diseases, or aging. Several sway feedback approaches are considered and recommendations are made concerning the steps necessary for the successful transition of promising approaches.

Cognition-Enhancing Drugs and Their Appropriateness for Aviation and Ground Troops: A Meta-Analysis

2011-02-24T10:17:00.001Z

Cognition-Enhancing Drugs and Their Appropriateness for Aviation and Ground Troops: A Meta-Analysis
http://www.usaarl.army.mil/TechReports/2011-06.pdf
Amanda Kelley, Catherine Webb, Jeremy, Athy Sanita Ley, Steven Gaydos
USAARL 2011-06

Currently, there are a number of pharmaceuticals available that have potential to enhance cognitive functioning which will inevitably be considered for use in military operations for enhancement purposes. Some drugs such as modafinil and caffeine have already been tested for use in military operations and some drugs used for cognition enhancement are already included in Army policy in terms of their approved use. There is considerable research available on these drugs. However, military policy regarding use must be based on high-quality research studies. The goal of this study was to review the literature and conduct a meta-analysis to determine quality of the research available and to synthesize the current state of knowledge of these potentially cognition enhancing drugs. A meta-analysis of the 3 studies that met all inclusion criteria revealed a relatively weak pooled effect of modafinil on some aspects of cognitive performance in normal, rested adults. While the results of this study support the efficacy of modafinil, the main finding is the large literature gap evaluating the short and long term effects of these drugs in healthy adults.

Decision Making Under Uncertainty

2011-02-14T10:38:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534878&Location=U2&doc=GetTRDoc.pdf

Decision Making Under Uncertainty

This report introduces concepts, principles, and approaches for addressing uncertainty in decision making. The sources of uncertainty in decision making are discussed, emphasizing the distinction between uncertainty and risk, and the characterization of uncertainty and
risk. The report provides a brief overview of decision theory and presents a practical method for modeling decisions under uncertainty and selecting decision alternatives that optimize the decision maker’s objectives. The decision modeling methods introduced in this paper are suitable for both data rich and data poor decision environments. This report describes how to analyze the sensitivity of a decision model to improve understanding of the decision problem and build confidence in the conclusions of an analysis. Principles of adaptive management and adaptive engineering are discussed from a decision analysis perspective. Examples are provided to
demonstrate how these methods could be applied within the U.S. Army Corps of Engineers.

Standardizing Data Collection in Traumatic Brain Injury

2011-02-14T10:26:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534620&Location=U2&doc=GetTRDoc.pdf

Standardizing Data Collection in Traumatic Brain Injury

Walter Reed Army Institute of Research,Washington,DC,20307

Andrew I.R. Maas M.D., Cynthia L. Harrison-Felix PhD, David Menon, M.D., P. David Adelson,
M.D., Tom Balkin, PhD., Ross Bullock, M.D., Doortje C. Engel, M.D., PhD, Wayne Gordon,
PhD., Jean Langlois-Orman, ScD., Henry L. Lew, M.D., PhD.1, Claudia Robertson, M.D.,
Nancy Temkin,PhD., Alex Valadka M.D., Mieke Verfaellie,PhD., Mark Wainwright, M.D., David W. Wright, M.D. and Karen Schwab, PhD

Collaboration among investigators, centers, countries and disciplines is essential to advancing the care for traumatic brain injury (TBI). It is then important that we ?speak the same language?. Great variability, however exists in data collection and coding of variables in TBI studies, confounding comparisons between and analysis across different studies. Randomized controlled trials can never address the many uncertainties around treatment approaches in TBI. Pooling data from different clinical studies and high-quality observational studies combined with Comparative Effectiveness Research may provide excellent alternatives in a cost-efficient way. Standardization of data collection and coding is essential to this purpose. Common Data Elements are presented for demographics and clinical variables applicable across the broad spectrum of TBI. Most recommendations represent a consensus, derived from clinical practice. Some recommendations concern novel approaches, for example towards assessing the intensity of
therapy in severely injured patients. Up to three levels of detail for coding data elements were developed: basic, intermediate, and advanced, with the greatest level of detail in the advanced version. More detailed codings can be collapsed into the basic version. Templates were produced to summarize coding formats explanation of choices and recommendations for procedures. Endorsement of the recommendations has been obtained from many authoritative organisations. The development of Common Data Elements for TBI should be viewed as a continuing process: As more experience is gained, refinement and amendments will be required. This proposed process of standardization will facilitate Comparative Effectiveness Research and encourage high-quality meta-analysis of individual patient data.

Management of Circadian Desynchrony (Jetlag and Shiftlag) in CF Air Operations

2011-02-14T09:58:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534917&Location=U2&doc=GetTRDoc.pdf

Management of Circadian Desynchrony
(Jetlag and Shiftlag) in CF Air Operations

Background: In response to operational difficulties resulting from the effects of fatigue
(secondary to jetlag and shiftlag) on performance of Air Force personnel, the Air Force funded a
4-year project to optimize Canadian Forces (CF) ability to manipulate circadian rhythms forwards or backwards to counter jetlag and shiftlag. This report presents the highlights of that work and offers recommendation for exploitation of this new capability to sustain operational readiness.
Methods: The project consisted of 7 studies. Four studies involved light treatment, 2 studies
involved efficacy comparisons of 3 melatonin formulations to produce a phase advance and a
phase delay, and the final study involved a combination of melatonin and light treatment.
Results: We identified the best 2 of 4 light treatment devices, confirmed optimal melatonin doses
and determined the correct treatment times with light and melatonin for circadian phase advance and phase delay. Discussion: We can now develop circadian treatments using light and melatonin along with shifting sleep/wake times and avoidance of light at key times across a broad range of operational scenarios. We are therefore in a position to exploit circadian phase shifting to counterjetlag and shiftlag. Recommendations: 1. That this knowledge-base be translated into an operational implementation plan through an interface with Air Force operational personnel. This should include the development of appropriate directives, and training of squadron personnel on the use of scheduling tools such as FAST™ (Fatigue Avoidance Scheduling Tool) for fatigue management. 2. That the Air Force aerospace medical community develop medical doctrine in the utilization of circadian interventions to improve and sustain operational readiness. This should include training Bioscience Officers in circadian physiology and how to generate circadian phaseshift protocols, and Flight Surgeons in the pharmaceutical management of circadian phase shifting with melatonin, light therapy, and sleep medications. 3. That the Surgeon General acquires several different melatonin dose sizes and formulations for the CF formulary, along with light treatment devices for use at squadron/wing level.

management of jetlag and shiftlag; melatonin; light treatment; circadian phase shifting;
circadian phase advance; circadian phase delayme

Sleep and Fatigue Issues in Continuous Operations: A Survey of U.S Army Officers

2011-02-08T15:32:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA534777&Location=U2&doc=GetTRDoc.pdf

Sleep and Fatigue Issues in Continuous Operations: A Survey of U.S.
Army Officers

A group of 49 US Army Officers recently returned from combat and attending the Infantry Officers Advanced Course at FT Benning, GA were surveyed to assess the sleep hygiene of their units and to determine the tactics, techniques, and procedures (TTPs) they used to reduce the effects of sleep deprivation in their units. Results indicate that despite Army policy, nearly 80% of the study participants had not received a sleep management plan during their most recent deployment. Over half (55%) of respondents reported that fatigue was a problem in their unit. The majority of respondents who received a sleep plan briefing indicated that their unit had done a good job of managing sleep routines (66% with vs. 25% without sleep plan briefing). Attention to the importance of sleep and fatigue management, manifested by sleep plan briefings, seems to be an important means by which units can mitigate fatigue in continuous combat operations. Respondents reported that during their most recent combat deployment,
they spent nearly half (46.7%) of their time at high operational tempo (OPTEMPO). This factor becomes especially important when considering that survey respondents report receiving only four hours of sleep per day during periods when their units are at high OPTEMPO, just over half the amount the report when at low OPTEMPO (4.0 vs. 7.8 hours). The vast majority of respondents (82.6%) report feeling sleep-deprived occasionally, sometimes or all the time while they are at high OPTEMPO.

Workplace Clinics: A Sign of Growing Employer Interest in Wellness

2011-02-08T10:41:00.000Z

http://www.rwjf.org/files/research/71564.pdf

Workplace Clinics: A Sign of Growing Employer Interest in Wellness

BY HA T. TU, ELLYN R. BOUKUS AND GENNA R. COHEN

Findings From HSC NO. 17, DECEMBER 2010
Workplace Clinics: A Sign of Growing Employer Interest in Wellness
BY HA T. TU, ELLYN R. BOUKUS AND GENNA R. COHEN
Interest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services. Employers view workplace clinics as a tool to contain medical costs, boost productivity and enhance companies’ reputations as employers of choice. The potential for clinics to transform primary care delivery through the trusted clinician model holds promise, according to experts interviewed for a new qualitative research study from the Center for Studying Health System Change (HSC). Achieving that model is dependent on gaining employee trust in the clinic, as well as the ability to recruit and retain clinicians with the right qualities—a particular challenge in communities with provider shortages. Even when clinic operations are outsourced to vendors, initial employer involvement—including the identification of the appropriate scope and scale of clinic services—and sustained employer attention over time are critical to clinic success. Measuring the impact of clinics is difficult, and credible evidence on return on investment (ROI) varies widely, with very high ROI claims made by some vendors lacking credibility. While well-designed, well-implemented workplace clinics are likely to achieve positive returns over the long term, expecting clinics to be a game changer in bending the overall health care cost curve may be unrealistic.

The Economics of Air Force Medical Service Readiness

2011-02-08T10:07:00.000Z

http://www.rand.org/content/dam/rand/pubs/technical_reports/2010/RAND_TR859.pdf

The Economics of Air Force Medical Service Readiness

John C. Graser, Daniel Blum, Kevin Brancato,
James J. Burks, Edward W. Chan, Nancy Nicosia,
Michael J. Neumann, Hans V. Ritschard,
Benjamin F. Mundell

Prepared for the United States Air Force

The Air Force Medical Service (AFMS) has three major missions: keeping the Air Force active duty population healthy and deployable for their wartime mission; maintaining the readiness
of AFMS personnel to perform their wartime health-care mission; and providing health-care
services for Air Force and other Department of Defense (DoD) retirees, dependents, and other
categories of eligible beneficiaries. To accomplish these missions, AFMS has a full-time force
of about 40,000 military and civilian personnel who operate 74 military treatment facilities
(MTFs) throughout the world and provide health care to about 2.6 million eligible beneficiaries.
In addition, the Air National Guard and Air Force Reserve have about 20,000 medical
personnel.
Since 2001, as part of the global war on terror, AFMS and the medical departments of the
Army and Navy have been tasked with supporting combat operations in Afghanistan and Iraq.
Specialists providing critical care, specifically surgeons and operating room nurses and technicians,as well as mental health professionals, have been in high demand. In addition to the
problem of filling these in-theater requirements with highly trained specialists, deployments
present another problem to AFMS: how to provide for the home-station health care these specialists would normally accomplish if they were not deployed. Their absence means that some
beneficiaries must find alternative sources of medical care. In addition, current funding methodologies mean that the resulting decreases in workloads (number of medical procedures performed) at the home station can adversely affect the portions of the AFMS budget that depend on these workloads to generate that funding. A final complication in the AFMS operating
environment is the reduction in the number of inpatient facilities and overall inpatient workload,
which has decreased opportunities for training critical-care specialists for wartime duties.
Under a project entitled “Economics of Air Force Medical Service Readiness,” the project
sponsor, then–Deputy Surgeon of the Air Force, Maj Gen C. Bruce Green, asked RAND
Project AIR FORCE to assess the AFMS operation by
• evaluating how AFMS functions as a health plan, a health-care provider, and a payer for
services, as well as how it relates to other DoD organizations
• examining how resource decisions are made and how the Medical Expense and Performance
Reporting System and other systems and processes affect resource allocation
within the U.S. Military Health System
• analyzing the effects of resource decisions on system incentives and medical readiness
• examining alternative methodologies for solving problems that are discovered.
iv The Economics of Air Force Medical Service Readiness
The research was conducted within the Resource Management Program of RAND Project
AIR FORCE. Data collection and analysis were performed between January 2008 and
September 2008, and a final project update was provided to the sponsor in September 2008,
with frequent updates in between.
This report should be of interest to government personnel with a stake in military healthcare
operations and resourcing issues. Related documents include the following:
• Christine Eibner, Maintaining Military Medical Skills During Peacetime: Outlining and
Assessing a New Approach, Santa Monica, Calif.: RAND Corporation, MG-638-OSD,
2008.
• Edward G. Keating, Marygail K. Brauner, Lionel A. Galway, Judith D. Mele, James J.
Burks, and Brendan Saloner, Air Force Physician and Dentist Multiyear Special Pay: Current
Status and Potential Reforms, Santa Monica, Calif.: RAND Corporation, MG-866-AF,
2009.
• Edward G. Keating, Hugh G. Massey, Judith D. Mele, and Benjamin F. Mundell, An
Analysis of the Populations of the Air Force’s Medical and Professional Officer Corps, Santa
Monica, Calif.: RAND Corporation, TR-782-AF, 2010.
• Don Snyder, Edward W. Chan, James J. Burks, Mahyar A. Amouzegar, and Adam C.
Resnick, How Should Air Force Expeditionary Medical Capabilities Be Expressed? Santa
Monica, Calif.: RAND Corporation, MG-785-AF, 2009.

Visual Dysfunction Following Blast-Related Traumatic Brain Injury form the Battlefield

2011-02-08T09:31:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA533219&Location=U2&doc=GetTRDoc.pdf
Visual Dysfunction Following Blast-Related Traumatic Brain Injury
From The Battlefield

To assess the occurrence of ocular and visual disorders following blast-related traumatic brain injury (TBI) in Operation Iraqi Freedom.

Research design: Retrospective cohort study.
Methods and procedures: A total of 2254 US service members with blast-related combat injuries were identified for analysis from the Expeditionary Medical Encounter Database. Medical record information near the point of injury was used to assess factors associated with the diagnosis of ocular/visual disorder within 12 months after injury, including severity of TBI.
Main outcomes and results: Of 2254 service members, 837 (37.1%) suffered a blast-related TBI and 1417 (62.9%) had other blast-related injuries. Two-hundred and one (8.9%) were diagnosed with an ocular or visual disorder within 12 months after blast injury. Compared with service members with other injuries, odds of ocular/visual disorder were significantly higher for
service members with moderate TBI (odds ratio (OR)¼1.58, 95% confidence interval (CI)¼1.02–2.45) and serious to critical TBI (OR¼14.26, 95% CI¼7.00–29.07).
Conclusions: Blast-related TBI is strongly associated with visual dysfunction within 1 year after injury and the odds of disorder appears to increase with severity of brain injury. Comprehensive vision examinations following TBI in theatre may be necessary.

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

2011-01-28T14:42:00.000Z

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

2011-01-28T14:21:00.000Z

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

2011-01-28T14:02:00.000Z

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:

2011-01-28T13:32:00.000Z

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

2011-01-28T13:18:00.000Z

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

2011-01-28T13:15:00.000Z

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

2011-01-28T13:01:00.000Z

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

2011-01-28T12:05:00.003Z

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

2011-01-28T11:16:00.001Z

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

2011-01-28T11:12:00.000Z

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

2011-01-27T14:54:00.003Z

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

2011-01-25T15:14:00.000Z

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:

2011-01-20T16:55:00.001Z

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:

2011-01-20T15:27:00.000Z

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

2011-01-20T15:23:00.000Z

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

2011-01-20T12:57:00.000Z

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

2011-01-20T11:16:00.001Z

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

2011-01-11T11:57:00.000Z

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

2011-01-11T11:39:00.000Z

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

2011-01-11T11:36:00.000Z

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

2011-01-11T11:22:00.000Z

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

2011-01-11T11:08:00.000Z

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

The Future Configuration of NHS Occupational Health Services

2010-12-15T12:14:00.001Z

http://www.nhsplus.nhs.uk/providers/images/library/files/The_Future_Configuration_of_NHS_Occupational_Health_Services_Final_September_2010_+_appendices.pdf

The Future Configuration of NHS Occupational Health Services

This report was commissioned by NHS Plus from
Helen Kirk MA BSc(Hons) BA RGN RM SCPHN(OH)
September 2010

Introduction
The 452 statutory NHS organisations in England are currently served by 175 NHS Occupational
Health services. A range of reviews and reports over the past 10 years have pointed to wide
variations in the quality of service delivery. Recent developments in terms of the Boorman Review and introduction of national Accreditation standards for occupational health providers have prompted renewed thinking about the configuration of NHS Occupational Health services. The purpose of this paper is to draw upon the available evidence and identify options for the future configuration of services. NHS Plus commissioned this work in summer 2010 to contribute to the debate about service configuration. It is based upon a range of evidence, although worldwide published literature on the configuration of occupational health services is disappointingly limited

Across the wire

2010-12-15T11:46:00.001Z

http://www.centreformentalhealth.org.uk/pdfs/Across_the_wire.pdf

Across the wire: Veterans, mental health and vulnerability
Matt Fossey

The mental health of veterans of the armed forces and its link to offending has been a subject of considerable concern in recent years. This paper reviews the available evidence and suggests ways of tackling the issues that emerge. Various social and psychological factors affect the lives of veterans. These may have been caused by events before people entered military service, during service or soon after discharge. They could be a result of previous family, education or social experiences or be a combination of all. Some of these elements have been discussed at length in the media, and have stimulated widespread debate, most of which has focused on the risk of post-traumatic stress disorder (PTSD) among veterans of recent or current active service in Iraq and Afghanistan. Most people who serve in Her Majesty’s Forces do not suffer with mental health difficulties evenafter serving in highly challenging environments. The majority of those who return from highthreat locations say that they have had a rounded and fulfilling experience (Greenberg,2010). The armed forces aim to equip service personnel with training, respect, sense of purpose and belonging as well as life skills for successful transition back to civilian life. However, no system is able to eliminate all risk. There is a vast, and growing, academic interest
in the health and well-being of service personnel and veterans. Particularly notable is the work
of the King’s Centre for Military Health Research (KCMHR, 2010a; KCMHR, 2010b).
This paper explores what we know from published literature about the mental health of people who have served in the armed forces, about the links between mental health and alcohol use in service personnel, and about veterans in the criminal justice system.

Army Physical Readiness Training

2010-12-08T16:19:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531081&Location=U2&doc=GetTRDoc.pdf

Army Physical Readiness Training

TC 3-22.20

The Army assesses, plans, prepares and executes training and leader development through training based on tasks,
conditions and standards. Knowing the task, assessing the level of proficiency against the standard and developing a
sustained or improved training plan is the essence of all Army training.
Army training overall prepares Soldiers, leaders and units to fight in the full spectrum of operations. Combat
readiness is the Army’s primary focus as it transitions to a more agile, versatile, lethal and survivable force.
Physical Readiness Training (PRT) prepares Soldiers and units for the physical challenges of fulfilling this mission
in the face of a wide range of threats, in complex operational environments and with emerging technologies.
 Part I, Philosophy, covers approach, system and leadership.
 Part II, Strategy, covers types of programs, planning considerations and special conditioning
programs.
 Part III, Activities, covers execution of training, preparation and recovery, strength and mobility and
endurance and mobility.
 Appendix A is the Army Physical Fitness Test.
 Appendix B discusses climbing bars.
 Appendix C discusses posture and body mechanics.
 Appendix D discusses environmental considerations.
 Appendix E discusses obstacle negotiation.
This manual—
 Provides Soldiers and leaders with the doctrine of Army Physical Readiness Training.
 Reflects lessons learned in battles past and present, time-tested theories and principles and emerging
trends in physical culture.
 Helps ensure the continuity of our nation’s strength and security.
 Prepares Soldiers physically for full spectrum operations.
 Explains training requirements and objectives.
 Provides instructions, required resources and reasons why physical fitness is a directed mandatory
training requirement as specified in AR 350-1, Army Training and Leader Development.
 Allows leaders to adapt PRT to unit missions and individual capabilities.
 Guides leaders in the progressive conditioning of Soldier strength, endurance and mobility.
 Provides a variety of PRT activities that enhance military skills needed for effective combat and duty performance

Demographic, Physical, and Mental Health Factors Associated with Deployment of U.S. Army Soldiers to the Persian Gulf

2010-12-08T15:39:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530640&Location=U2&doc=GetTRDoc.pdf

Demographic, Physical, and Mental Health Factors Associated
With Deployment of U.S. Army Soldiers to the Persian Gulf

Nicole S. Bell, ScD, MPH*; LTC Paul J. Amoroso, MC USAf; Jeffrey O. Williams, BS*;
Michelle M. Yore, MSPHf, LTC Charles C. Engel, Jr., MC USAf; Laura Senier, BA*;
Annette C. DeMattos, BS*; David H. Wegman, MD§

MILITARY MEDICINE, 175,4:227, 2010

A total of 675,626 active duty Army soldiers who were known to be at risk for deployment to the Persian Gulf were followed from 1980 through the Persian Gulf War. Hospitalization histories for the entire cohort and Health Risk Appraisal surveys for a subset of 374 soldiers were used to evaluate prewar distress, health, and behaviors. Deployers were less likely to have had any prewar hospitalizations or hospitalization for a condition commonly reported among Gulf War veterans or to report experiences of" depression/suicidal ideation. Deployers reported greater satisfaction with life and relationships but displayed greater tendencies toward risk taking, such as drunk driving, speeding, arid failure to wear safety belts. Deployed veterans were more likely to receive hazardous duty pay and to be hospitalized for an injury than nondeployed Gulf War-era veterans. If distress is a predictor of postwar morbidity, it is likely attributable to experiences occurring during or after the war and not related to prewar exposures or health status. Postwar excess injury risk may be explained in part by a propensity for greater risk taking, which was evident before and persisted throughout the war.

Air Break During Preoxygenation and Risk of Altitude Decompression Sickness

2010-12-08T15:22:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530698&Location=U2&doc=GetTRDoc.pdf

Air Break During Preoxygenation and Risk of Altitude Decompression Sickness

P ILMANIS AA, W EBB JT, B ALLDIN UI, C ONKIN J, F ISCHER JR. Air break
during preoxygenation and risk of altitude decompression sickness.
Aviat Space Environ Med 2010; 81: 944 – 50 .
Introduction: To reduce the risk of decompression sickness (DCS),
current USAF U-2 operations require a 1-h preoxygenation (PreOx). An
interruption of oxygen breathing with air breathing currently requires
signifi cant extension of the PreOx time. The purpose of this study was to
evaluate the relationship between air breaks during PreOx and subsequent
DCS and venous gas emboli (VGE) incidence, and to determine
safe air break limits for operational activities. Methods: Volunteers
performed 30 min of PreOx, followed by either a 10-min, 20-min, or
60-min air break, then completed another 30 min of PreOx, and began
a 4-h altitude chamber exposure to 9144 m (30,000 ft). Subjects were
monitored for VGE using echocardiography. Altitude exposure was
terminated if DCS symptoms developed. Control data (uninterrupted
60-min PreOx) to compare against air break data were taken from the
AFRL DCS database. Results: At 1 h of altitude exposure, DCS rates were
signifi cantly higher in all three break in prebreathe (BiP) profiles compared
to control (40%, 45%, and 47% vs. 24%). At 2 h, the 20-min and
60-min BiP DCS rates remained higher than control (70% and 69% vs.
52%), but no differences were found at 4 h. No differences in VGE rates
were found between the BiP profiles and control. Discussion: Increased
DCS risk in the BiP profi les is likely due to tissue renitrogenation during
air breaks not totally compensated for by the remaining PreOx following
the air breaks. Air breaks of 10 min or more occurring in the middle of
1 h of PreOx may signifi cantly increase DCS risk during the first 2 h
of exposure to 9144 m when compared to uninterrupted PreOx
exposures.

Bridging the Gap: Developing a Tool to Support Local Civilian and Military Disaster Preparedness

2010-11-26T13:27:00.002Z

http://www.rand.org/pubs/technical_reports/2010/RAND_TR764.pdf

Bridging the Gap Developing a Tool to Support Local Civilian and Military Disaster Preparedness
Melinda Moore, Michael A. Wermuth,
Laura Werber Castaneda, Anita Chandra,
Darcy Noricks, Adam C. Resnick, Carolyn Chu,
James J. Burks
Prepared for the Office of the Secretary of Defense

This is an interim report for the first phase of a larger study that aims to develop a disaster preparedness support tool for local military and civilian planners. It reflects the formative research carried out from October 2006 through May 2009. It describes the current policy context for domestic emergency preparedness, risk analysis, and capabilities-based planning— the starting points for local planning—as well as results from interviews with local military and civilian planners at five selected sites. All of this information forms the basis for the proposed tool that is described in the final chapter of the report. The next phase of the study will
include development and field testing of a proof-of-concept prototype of the tool, which will be supported by funding from the Department of Veterans Affairs.

Law Enforcement Head-Borne Personal Protective Equipment Hearing Attenuation

2010-11-12T14:20:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA498436&Location=U2&doc=GetTRDoc.pdf

Law Enforcement Head-Borne Personal Protective
Equipment Hearing Attenuation

Li, Qi; Haijeck, Joshua; and Burchfield, Tom (Li Creative Technologies)

Test methods were developed to quantify and assess the effects of personal protection equipment (PPE) on hearing. The tests use a head and torso simulator that is able to don PPE and employs advanced acoustic, signal processing, and measurement techniques. The tests measure localization and speech intelligibility effects of PPE. The methods also assess the effects of noise generated by PPE fabric and/or electro/mechanical noise. Localization effects are evaluated in terms of the Head-Related Transfer Function (HRTF). Speech intelligibility is
evaluated using the Speech Transmission Index (STI). Results show that HRTF and STI scores are significantly altered with various PPE and PPE-created noise.

Assessment and Classification of Cognitive Decrements Associated with High Workload and Extended Work Periods in a UAV Setting

2010-11-12T14:16:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA515591&Location=U2&doc=GetTRDoc.pdf

Assessment and Classification of Cognitive Decrements Associated with High Workload and Extended Work Periods in a UAV Setting

AFRL-RH-WP-TP-2010-0015

Regina Schmidt, Glenn Wilson, Margaret Funke
Iris Davis
John A. Caldwell

The present study investigated high workload and time-on-task effects through the assessment of performance and physiological measures during the continuous performance of a complex uninhabited air vehicle UAV task. This study systematically explored the effects of time-on-task, while also incorporating a variety of workload conditions designed to simulate an actual UAV operation. Subjective sleepiness and workload were monitored, as well as performance, on a psychomotor vigilance task. Electroencephalographic data were collected in order to establish physiological evidence of fatigue due to time-on-task. The results of this study demonstrated that performance remained stable throughout the 4-hour continuous mission on all workload conditions. In addition, no physiological evidence of fatigue was identified.

Attentional Drift: An Exploratory Study Into the Development of an Attention Monitoring System Based on Human Eye Fixation

2010-11-12T14:12:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA518630&Location=U2&doc=GetTRDoc.pdf
Attentional Drift: An Exploratory Study Into the Development of an Attention Monitoring System Based on Human Eye Fixation

LCDR Douglas M. Magedman

This study was designed to determine if future research into the development of an attention monitoring device based on eye fixation duration is both feasible and warranted. Attentional Drift is an insidious form of distraction where primary task attention is slowly eroded by secondary tasking. It most often occurs in very low or very high cognitive demand situations. Recent studies have shown that eye fixation duration and glance duration measures are related to attentional demand in visual tasks. In this study, participants completed two 20-minute driving periods in a STISIMTM simulator wearing a head-mounted eye-tracking system. Eye fixation measures recorded in a single-task low mental demand test did not show an expected increase in eye fixation duration over time in all but a few participants. A second test incorporating dual tasking through conversation did show that eye fixation duration values were affected by the added cognitive workload. Eye fixation measures showed statistically significant changes in duration as a direct result of varying secondary cognitive demand. It is concluded that further experimentation with significantly lengthened test runs incorporating an eye blink rate factor, a gaze dwell time function, and a fixed-base eye-tracking system is both feasible and warranted.

An Improved Methodology for Individualized Performance Prediction of Sleep-Deprived Individuals with the two-process model

2010-11-12T14:06:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA518396&Location=U2&doc=GetTRDoc.pdf

An Improved Methodology for Individualized Performance Prediction of Sleep-
Deprived Individuals with the Two-Process Model

Srinivasan Rajaraman, PhD; Andrei V. Gribok, PhD; Nancy J. Wesensten, PhD; Thomas J. Balkin, PhD; Jaques Reifman, PhD

We present a method based on the two-process model of sleep regulation for developing individualized biomathematical models that predict performance impairment for individuals subjected to total sleep loss. This new method advances our previous work in two important ways. First, it enables model customization to start as soon as the first performance
measurement from an individual becomes available. This was achieved by optimally combining the performance information obtained from the individual’s performance measurements with a priori performance information using a Bayesian framework, while retaining the strategy of transforming the nonlinear optimization problem of finding the optimal estimates of the two-process model parameters into a series of linear optimization problems. Second, by taking advantage of the linear representation of the two-process model, this new method enables the analytical computation of statistically based measures of reliability for the model predictions in the form of prediction intervals. Two distinct data sets were used to evaluate the proposed method

Citation: Rajaraman S; Gribok AV; Wesensten NJ; Balkin TJ; Reifman
J. An improved methodology for individualized performance prediction
of sleep-deprived individuals with the two-process model. SLEEP
2009;32(10):1377-1392.

PAYING DOWN THE SLEEP DEBT: REALIZATION OF BENEFITS DURING Subsequent sleep restriction and recovery

2010-11-12T14:03:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA505715&Location=U2&doc=GetTRDoc.pdf

PAYING DOWN THE SLEEP DEBT: REALIZATION OF BENEFITS DURING
SUBSEQUENT SLEEP RESTRICTION AND RECOVERY

T. L. Rupp, N. J. Wesensten, P. D. Bliese, and T. J. Balkin

The study objective was to determine whether sleep
extension (a) improves alertness and performance during
subsequent sleep restriction and (b) mediates the rate at
which alertness and performance are restored by postrestriction
recovery sleep. Twenty-four healthy adult
participants (ages 18-39) were randomly assigned to an
Extended [10 hours time in bed (TIB)] or Habitual [mean
(SD) = 7.09 (0.7)] sleep group for one week, followed by
one Baseline (10 hours or habitual TIB), seven Sleep
Restriction (3 hours TIB), and five Recovery Sleep
nights (8 hours TIB) with performance [Psychomotor
Vigilance Task (PVT)] and alertness [Maintenance of
Wakefulness Test (MWT); Stanford Sleepiness Scale
(SSS)] tests administered hourly throughout. We
conclude that the extent to which sleep restriction
impairs alertness and performance, and the rate at which
these impairments are subsequently reversed by recovery
sleep, varies as a function of the amount of nightly sleep
obtained prior to the sleep restriction period

Sleep and Performance Measures in Soldiers Undergoing Military Relevant Training

2010-11-12T14:00:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA505791&Location=U2&doc=GetTRDoc.pdf

Sleep and Performance Measures in Soldiers Undergoing Military Relevant Training
W.D. Killgore
A. Estrada
R.M. Wildzunas
T.J. Balkin

Inadequate sleep is known to impair a variety of
cognitive capacities, including attention, vigilance,
concentration. memory encoding, and some aspects of
higher order reasoning and judgment. The ability to
unobtrusively measure fatigue and predict its effects on
cognitive performance is vital to successful military
operations. Wrist actigraphy is one such method, but its
ability to accurately measure and predict performance in
militarily relevant activities is not well validated.
Healthy military volunteers (N = 108) were fitted with
wrist actigraphs (Actiwatch; Minimitter Inc.) while
undergoing one ofsix military education programs
lasting between 4 to 6 weeks. Sixty-four Actiwatches
were worn consistently and yielded valid data.
Actigraphic sleep data were analyzed with Actiware 3.41
using automated scoring algorithms. Indices ofsleep
duration, latency, and quality were used to predict
academic success in these courses. Averaging across all
courses and volunteers, Soldiers obtained 5.8 hours of
sleep per night (SD = 0.5). Sleep duration was typically
reduced to 4.6 (SD = 1.5) hours the night preceding an
exam. Regardless of course type or test content,
academic performance was significantly predicted by
total sleep time (48 hours before, r =.60, p < .00 I; 24
hours before, r = .54,P < .00 I), sleep latency (48 hours
before, r = -.46, p = .002; 24 hours before, r = -.46, p =
.002), number of immobile minutes (48 hours before, r=
.58, p < .00 I; 24 hours before, r = .52, p = .00 I), and
fragmentation index (48 hours before, r = .29, p = .05; 24
hours before, r = .28, p =.05), but not total activity level
(48 hours before, r = .06, ns; 24 hours before, r = .07,
ns). Regardless ofcourse or exam content, academic
performance was significantly related to the amount and
quality of sleep obtained within the 48-hour period
preceding the exams. Actigraphy appears to be a valid
and unobtrusive method for predicting academic
performance in military courses, although issues of
participant compliance and detection of off-wrist periods
need to be improved.

HEAT ACCLIMATISATION AND ACTIVE BODY COOLING STRATEGIES TO MITIGATE HEAT STRESS for operations involving bullet proof vests

2010-11-12T13:28:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA505760&Location=U2&doc=GetTRDoc.pdf

HEAT ACCLIMATISATION AND ACTIVE BODY COOLING STRATEGIES TO MITIGATE HEAT STRESS FOR OPERATIONS INVOLVING BULLET PROOF VESTS

L. Law and C. L. Lim
Defence Medical & Environmental Research Institute, DSO National Laboratories,
Singapore

Heat acclimatization (HA) and personal body-cooling are
effective methods of heat stress mitigation. HA involves
conditioning the body to function under hot conditions by
exposing the individual to an incremental level of heat stress
daily over 10 to 14 days. Although HA improves
thermoregulation during heat exposure, effective physical
heat exchange between the body and environment must still
take place. Operating with body armour may limit the
benefits of HA due to the increased physical workload and
greater coverage of body surface. In terms of personal
cooling, substantial amount of research has shown that a
significant amount of body heat can be removed with the
use of a personal body cooling system

HUMAN SYSTEMS INTEGRATION DOMAIN TRADE-OFFS IN OPTIMIZED MANNING: The task effectiveness scheduling tool

2010-11-12T13:22:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA529246&Location=U2&doc=GetTRDoc.pdf
HUMAN SYSTEMS INTEGRATION DOMAIN TRADE-OFFS IN OPTIMIZED MANNING:
THE TASK EFFECTIVENESS SCHEDULING TOOL

Anthony P. Tvaryanas and Nita Lewis Miller
Naval Postgraduate School
NPS-OR-10-006

The Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model is a biomathematical model that uses information about sleep history, duration of wakefulness, and circadian phase to forecast an individual’s future task effectiveness. It has seen practical application in the Defense Department within the Fatigue Avoidance Scheduling Tool (FAST). At present, given a personnel duty schedule with work and sleep periods, it is possible to obtain future predicted task effectiveness using FAST. It is not possible, however, to directly address the inverse question: given a task effectiveness threshold, what is the optimal schedule in terms of the time of sleep-wake periods and the assignment of performance sensitive duties? Such questions can now be addressed by importing data generated from FAST simulations into the Task Effectiveness Scheduling Tool (TEST). TEST is a mixed integer program that assigns persons to wake-sleep cycles and variable duty periods to provide coverage of a system function using the minimum quantity of personnel, while simultaneously ensuring individuals exceed a specified task effectiveness criterion during duty periods. The program then ensures that the temporal scheduling of duty periods maximizes averaged predicted task effectiveness over a 24-hour period. Accordingly, TEST allows analysts to mathematically determine optimal staffing and shift scheduling solutions via a deterministic model.

Using the Mean Shift Algorithm to Make Post Hoc Improvements to the Accuracy of Eye-Tracking Data Based on Probable Fixation Locations

2010-11-12T13:13:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528607&Location=U2&doc=GetTRDoc.pdf

Using the Mean Shift Algorithm to Make Post Hoc Improvements to the
Accuracy of Eye Tracking Data Based on Probable Fixation Locations

University of Oregon,Department of Computer and Information
Science,Eugene,OR,97403-1202

In eye tracking research, there is almost always a disparity between a participant?s actual gaze location and the location recorded by the eye tracker. In this paper, we propose a mean shift error correction method that can reliably reduce the systematic error?which tends to stay constant over time?and restore the fixations to their true locations. We show that the method is reliable when the visual objects of the experiment are arranged in an irregular manner, such as not on a grid in which all fixations could be shifted to adjacent locations using the same directional adjustment. Using the mean shift method, the disparity between fixations and their nearest objects are calculated and plotted on a graph in terms of their x and y deviations. The highest density point in this graph, calculated using the mean shift algorithm, is shown to correctly capture the magnitude and direction of the systematic error. This paper presents the
method, an extended demonstration, and a validation of the efficacy of the error correction technique.

Contingency Pest Management Guide. 2010 Edition

2010-11-12T12:52:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528966&Location=U2&doc=GetTRDoc.pdf

Contingency Pest Management Guide. 2010 Edition

Technical Guide No. 24

The purpose of the Contingency Pest Management Guide is to provide basic information on using pesticides to control insects that transmit disease and other pests during deployment situations worldwide. Use pesticides only as part of an integrated pest management (IPM) program. IPM is an approach that combines a variety of pest management methods-- including physical, mechanical, educational, biological and chemical--to prevent medical injury or economic damage from pests and disease vectors. This Guide is not intended to be a substitute for the instructions found on all pesticide labels. Remember, when applying pesticides around U.S. personnel or as part of a U.S. operation, the pesticide label is the law.
This guide is intended to assist DoD service members, civilians and contract personnel plan for and perform best pest management practices during contingency operations in the absence of a formalized Theater or an installation/base camp approved IPM Plan. When such a plan exists, that document takes precedence over this technical guide. Commanders are responsible for implementing a pest management program to include a pest management plan, and a plan should be written and implemented for any operation that is expected to endure for an extended period.
See the AFPMB web site at http://www.afpmb.org for contingency-related entomological information.

American College of Sports Medicine Roundtable on Exertional Heat Stroke V Return to Duty/Return to Play

2010-11-12T12:45:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA529041&Location=U2&doc=GetTRDoc.pdf

American College of Sports Medicine Roundtable on
Exertional Heat Stroke V Return to Duty/Return
to Play: Conference Proceedings

O’CONNOR, F.G., D.J. CASA, M.F. BERGERON, R. CARTER, P. DEUSTER, Y. HELED, J. KARK, L. LEON,
B. MCDERMOTT, K. O’BRIEN, W.O. ROBERTS, and M. SAWKA. American college of sports medicine roundtable on exertional heat stroke V return to duty/return to play: conference proceedings. Curr. Sports Med. Rep., Vol. 9, No. 5, pp. 314-321, 2010. On October 22-23, 2008, an ACSM Roundtable was convened at the Uniformed Services University (Bethesda, MD)
to discuss return-to-play or return-to-duty for people who have experienced exertional heat illness (EHI) and to develop consensus-based recommendations. The conference assembled experts from the civilian sports medicine community and the Department of Defense to
discuss relevant EHI issues, such as potential long-term consequences, the concept of thermotolerance, and the role of thermal tolerance testing in return-to-play decisions. Although the group was unable to move forward with new consensus recommendations, they clearly
documented critical clinical concerns and scientific questions, including the following: 1) no uniform core definitions of EHI; 2) limited validated criteria to assess recovery from exertional heat stroke (EHS); and 3) inadequate ability to predict who may be predisposed to a subsequent heat injury after EHS. Areas of potential future research are identified.

Effect of Acceleration Frequency on Spatial Orientation Mechanisms

2010-11-12T12:35:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA529816&Location=U2&doc=GetTRDoc.pdf

Effect of Acceleration Frequency on Spatial Orientation Mechanisms

NAMRL-10-55

Frederick R. Patterson; Joseph F. Chandler

Extreme motion environments can induce loss of visual acuity, motion sickness, and spatial disorientation. Understanding how human sensory integration of acceleration stimuli affects spatial awareness will improve models of spatial disorientation and mishap analysis. Vestibular gaze reflex data were successfully collected from 10 subjects, each of whom completed three separate trials at sequences of low, medium, and high off-vertical axis rotation (OVAR) spin rates. The results of these tests revealed no significant change in horizontal and torsional eye movements between the low OVAR spin frequency of 0.03 Hz and the predicted crossover point of 0.25 Hz; however, there did appear to be a trend toward reduction of horizontal eye movement when the high OVAR rate of 0.55 Hz was compared with the low (0.03 Hz) and medium (0.25 Hz) rates. Based upon the collected data, a revised crossover rate of 0.42 Hz was extrapolated as the most probable spin frequency for inducing gaze reflex changes with the potential for triggering motion sickness. The results of this study have identified a potential range of circular motion with potential implications for designing future flight simulators used for
training or assessment of cockpit designs.

Medical Attrition of Battlefield Airmen Trainees

2010-11-12T12:28:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530133&Location=U2&doc=GetTRDoc.pdf
Medical Attrition of Battlefield Airmen Trainees

Brett R. Nishikawa, Maj, USAF, MC, FS
Paul A. Sjoberg, Col, USAF, BSC
Gen M. Maupin, MPH

The Air Education and Training Command (AETC), tasked to identify methods to provide preventive medicine oversight and reduce injury risk related to physical training of Battlefield Airmen trainees, requested the U.S. Air Force School of Aerospace Medicine/Epidemiology Consult Service to identify types of injuries and illnesses that occurred in each course by week of training and location of training, to identify the injuries/illnesses to determine cost of treatment, to identify the training cost linked to injuries/illnesses (e.g., lost training days), and to provide recommendations for preventive medicine countermeasures. We queried the Technical Training Production Analysis (TTPA) section of the AETC Decision Support System (ADSS) for all training-related events from 1 January 2004 to 20 April 2010 and obtained medical encounter and cost data from the Military Health System Mart for all inpatient and outpatient military treatment facility care and all inpatient care rendered in a civilian hospital. There were 38 unique course identifiers in ADSS for Battlefield Airmen representing 7,953 different individuals. The attrition rate since 2004 for all courses combined was 51%. Medical-related training events accounted for 15% of all attrition. The highest rates were found for Special Operaton Weathermen Slection [sic], Tactical Air Command and Control Apprentice, Pararescue Indoctrination, Tactical Air Control Party Apprentice, Pararescue Indoctrination Course (Enlisted), and Combat Control Apprentice. For most courses, the most frequent types of medical encounters were for either musculoskeletal diagnoses or respiratory illnesses. We recommend the following: expand the current ADSS/TTPA surveillance to include all training sites, including non-Air Force installations; allow for better capture of medical events occurring during training; enable specific medical oversight of Battlefield Airmen pipeline training; and provide more detailed evaluation of events and attrition for the courses that carry a disproportionately high burden of cost mentioned above.

Society of U.S. Air Force Surgeons’ 2010 State of the Flight Surgeon Survey: The Medical Treatment Facility Commander’s Perspective

2010-11-12T10:55:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA529986&Location=U2&doc=GetTRDoc.pdf

Society of U.S. Air Force Surgeons’ 2010 State of the Flight Surgeon Survey: The Medical Treatment Facility Command

AFRL-SA-BR-SR-2010-0003

Theresa B. Goodman, Maj, USAF, MC, FS er’s Perspective

In May 2003, the U.S. Air Force (USAF) Surgeon General (SG) called upon the Society of USAF Flight Surgeons to report on the state of the flight surgeon from a perspective external to the traditional chain of command. This survey is the third inquiry aimed at garnering the opinion of medical treatment facility (MTF) commanders on the quality of today’s flight surgeons, the level of training of new flight surgeons, and the level of preparation of aerospace medicine specialists who graduate from the Residency in Aerospace Medicine. Overall, MTF commanders appear to approve of flight surgeon oversight of aerospace medicine programs, the Aerospace Medicine Primary (AMP) Course, and the Residency in Aerospace Medicine training program. Negative opinions about the level of training or satisfaction with flight surgeons in general were overwhelmingly due to lack of experience, inadequate manning, and/or lack of base-level mentorship. These results may indicate a frustration with the level of manning and an inability to resource time to provide necessary "on-the-job" training in the first years out of the AMP. Caution should be used in making large-scale curriculum changes based on the results of one study, as it is only sampling one of the three main stakeholders (the others being flight surgeons and the line units that the flight surgeons support). Per USAF Surgeon General’s direction, future "State of the Flight Surgeon" surveys will be a consolidation of all three stakeholders and presented once every SG cycle. This new format of the survey may give a more complete picture of the state of the flight surgeon.

Flight surgeon, aerospace medicine, training programs, survey

Combat Fitness a Concept Vital to National Defense

2010-11-12T09:28:00.000Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530226&Location=U2&doc=GetTRDoc.pdf
Combat Fitness a Concept Vital to National Defense
Major Christopher P. Larkin, U.S. Air Force
Masters Thesis

Current combat operations have uncovered some disturbing issues in the ground combatant‘s mental and physical ability to withstand the extreme demands of continuous combat operations in the harsh environmental conditions, such as those seen in Iraq and Afghanistan. These issues are creating significant problems in the American military‘s ability to sustain a healthy force able to handle the country‘s most difficult tasks. This research paper takes a critical look at the Service level physical fitness programs to determine if the fitness training currently being conducted is sufficient to train and sustain the ground combatants throughout their military careers. In today‘s environment of a tightening budget, reduced manpower and rising healthcare costs, it is imperative that the DoD take the appropriate actions to prepare and maintain its most vital weapons system, the human. Therefore, the DoD must embrace and incorporate modern physical fitness training systems, techniques, technology, and testing to better train and prepare ground combatants for the rigors of combat, including improved battlefield effectiveness and prolonged individual operational longevity, while minimizing the rash of short- and long-term injuries currently plaguing the force.

The Effects of Visual Degradation on Attended Objects and the Ability to Process Unattended Objects within the Visual Array

2010-11-02T16:39:00.002Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA529361&Location=U2&doc=GetTRDoc.pdf

The Effects of Visual Degradation on Attended Objects and the Ability to
Process Unattended Objects within the Visual Array

USAARL Report No. 2010-19

Jeremy R. Athy
Dr. Dale S. Klopfer
Stephanie M. Moon
Gina M. Jurek

Previous studies have demonstrated different levels of processing for visual stimuli dependent upon whether the objects were attended to or not. This study consisted of two manipulations to further diagnose the processing of unattended objects. First, the attended object was visually degraded on some trials to determine if this would negatively influence the processing of unattended images. Second, the number of unattended objects within a trial was varied. Previous studies used one unattended object, while this study will use both one and three unattended objects within a trial. Although the degradation of the attended object did result in
significantly longer reaction times in their naming, both degradation of the attended object and the amount of unattended objects did not influence the processing of unattended objects.

Visual Processing, Visual Attention, Object Processing

Optical Filter Effects on Night Vision Goggle Acuity and Preservation of Dark Adaptation

2010-11-02T16:33:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA529412&Location=U2&doc=GetTRDoc.pdf

Optical filter effects on night vision goggle acuity and preservation of ark adaptation.
Aviat Space Environ Med 2010; 81: 869 – 72 .

Roger S. Thomas , Steve T. Wright , Patrick J. Clark ,
William T. Thompson , and John M. Gooch

The high output of night vision goggles (NVGs) can cause a loss of dark adaptation, resulting in suboptimal unaided vision. Optical filters have been designed to mitigate this problem by changing the overall output characteristics of the NVGs. Methods: Several aspects of visual performance related to NVG use were studied in a repeated measures design, fi lters versus no fi lters. NVG acuity was assessed using a 25% contrast chart, while preservation of dark adaptation after NVG use was measured with a scotopic sensitivity tester (SST) and a low luminance acuity chart. Testing was accomplished at two light levels, roughly corresponding to starlight and quarter moon conditions. Results: Use of the filters resulted in a statistically signifi cant loss of acuity of about a 1/2 line (approximately 2.5 letters) at both light levels. The second part of the study identified a 47% improvement in preservation of dark adaptation under simulated starlight conditions and a 31% improvement under simulated quarter moon conditions with fi lter use; however, only the starlight finding was statistically signifi cant. No significant differences in performance were seen with the low luminance chart.
Discussion:
Despite a small loss of visual acuity with filter use, the improvement in retention of dark adaptation may be benefi cial in certain operational environments. Aviators, airmen, and commanders should evaluate how the potential for slightly poorer visual acuity and improved recovery of dark adapted vision relates to their mission specifi c requirements prior to implementing use of NVG filters.

A Review of Central Nervous System (CNS)/Cognitive Effects Due to Blast

2010-11-02T16:17:00.003Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528766&Location=U2&doc=GetTRDoc.pdf

A Review of Central Nervous System (CNS)/Cognitive Effects Due to Blast
Rigby, Paul, H.: Chan, Philemon, C.

AFRL-RH-BR-TR-2007-0072

An extensive literature review of central nervous system (CNS)/cognitive effects due to blast overpressure has been performed to support the assessment of human effects due to flashbang devices. Epidemiology and laboratory data have shown evidence that correlates CNS injuries to blast, but the primary mechanism of injury on the gross and molecular level is not understood. Laboratory data have suggested blast induced brain injuries have similarities to traumatic brain injuries (TBI). Full body blast test animals have shown an increase in certain molecules linked with nerve cell apoptosis and cognition dysfunction. Data also suggest blast overpressure can cause adverse cognitive effects resulting in executive deficit similar to that produced in other TBI models. Long term cognitive effects of blast include disturbances in attention and memory, and a delayed reaction time in problem solving. Veterans returning with blast injury also exhibit post concussion symptoms similar to those seen in other forms of TBI. Since the mechanism relating blast and cognitive deficit is not known, the authors recommend that an effort should characterize of CNS/cognitive effects due to blast since potential CNS injuries must be taken seriously, and data suggest a correlation between blast and cognitive effects.

Inhalation Exposure to let Fuel (JPS) Among U.S. Ai r Forcc Personnel

2010-11-02T15:59:00.002Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528449&Location=U2&doc=GetTRDoc.pdf

Inhalation Exposure to let Fuel (JPS) Among U.S. Ai r Forcc Personnel

Kristen W. Smith. Susan P. Proctor, Al Ownoff, Michael D. McClean

As jet fuel is a common occupational exposure among military and civilian populations, this study was conducted to characterize jet fuel (JP8) exposure among active duty US Air Force Personnel. Personnel (n=24) were divided a priori into high, moderate, and low exposurc groups. Questionnaires and personal air samples (breathing zone) were collected from each worker ovcr 3 consecutive days (72 worker-days) and analYLed for total hydrocarbons (THC), benzene, toluence, ethylbenzene. xylenes, and napthalene. Air Samples wcre collected from inside the fuel tank and analyzed for the same analytes. Linear mixed-effects models were used to evaluate the exposure data. Our results show that the correlation ofTHC (a measure of overall JP8
inhalation exposure) with all other analytes was moderate to strong in the a priori high and moderate exposure groups combined. Inhalation exposure to all analytes varied significantly by self-reported JP8 exposure (THC levels higher among workersreporting JP8 exposure), a priori exposure group (THC levels in high group > moderate group > low group), and more specific job
task groupings.

Toward an Operational Definition of Workload: A Workload Assessment of Aviation Maneuvers

2010-11-02T15:51:00.002Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528341&Location=U2&doc=GetTRDoc.pdf

Toward an Operational Definition of Workload: A Workload Assessment of
Aviation Maneuvers

USAARL Repo rt No. 2010-15

Catherine M. Webb
Steven J. Gaydos
Arthur Estrada
Lana S. Milam

As there is no one agreed upon definition of workload, there is no one accepted way to measure the construct. However, workload is an important variable in nearly every aviation-related research protocol. The primary objective of the study was to explore a new measure of workload assessment in an effort to move towards an operational definition of workload. Using this new workload assessment and definition, the present study characterized aviators’ retrospective assessments of the workload involved in base and mission tasks related to the UH-60 A/L aircraft. A secondary objective was to examine the role of experience in workload
assessments. Eligible participants were UH-60 Black Hawk instructor pilots or pilots enrolled in the UH-60 instructor pilot course at Fort Rucker. The present study demonstrated the new workload assessment was sensitive to various tasks and various workload dimensions. The results of this study also have applications for return-to-duty assessments for H-60 model aviators.

Validation of the Aggregate Wakefulness And Readiness Estimator(AWARE) using On-the-Job Security Forces Personnel

2010-11-02T15:45:00.001Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528182&Location=U2&doc=GetTRDoc.pdf

Validation of the Aggregate Wakefulness And Readiness Estimator(AWARE) using On-the-Job Security Forces Personnel

AFRL-RH-WP-TR-2010-0110

J. Lynn Caldwell, Christienne Ruth
Margaret Funke, Lindsey McIntire
William F. Storm
Julia Sundstrom
Tom Beltran

The present study sought to document the work/rest schedule as well as subjective and objective fatigue levels of Air Force security forces personnel and apply these data to a performance prediction model. Participants were asked to complete a sleep diary each morning and mood and performance tests every 2 hours during their work days, and upon rising, 10 hours into the day, and then prior to bedtime on days off. Due to the participation variability among shifts and bases, the results from the study do not allow direct comparison of shift schedules nor time on shift as hoped. However, the data were able to show that as time on shift increased, both subjective and objective fatigue generally increased, particularly on the 12-hr shifts.

Military Medicine. Volume 175, August 2010, Supplement. Total Force Fitness for the 21st Century: a new paradigm

2010-11-02T14:40:00.003Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528391&Location=U2&doc=GetTRDoc.pdf

Military Medicine. Volume 175, August 2010, Supplement. Total Force
Fitness for the 21st Century A New Paradigm

TOTAL FORCE FITNESS FOR THE 21st CENTURY
A NEW PARADIGM
Guest Editors:
Wayne B. Jonas, Francis G. O’Connor, Patricia Deuster, and Christian Macedonia

The Charge: Humans Are the Most Important Asset

On Total Force Fitness in War and Peace
ADM Michael Mullen, Chairman of the Joint Chiefs of Staff

Current Department of Defense Guidance for Total Force Fitness
COL Beverly C. Land, MC USA

Why Total Force Fitness?
LTC Wayne B. Jonas, MC USA (Ret.); COL Francis G. O’Connor, MC USA; Patricia Deuster, PhD, MPH;
Jonathan Peck, PhD; CAPT Caron Shake, MSC USN (Ret.); CAPT Stephen S. Frost, MC USN (Ret.)
The Domains of Total Force Fitness

Physical Fitness
MAJ Tanja C. Roy, SP USA; COL Barbara A. Springer, SP USA; MAJ Vancil McNulty, SP USA;
LTC Nikki L. Butler, SP USA

Psychological Fitness
Mark J. Bates, PhD; COL Stephen Bowles, MS USA; Jon Hammermeister, PhD; Charlene Stokes, PhD; Evette Pinder, MPH; Monique Moore, PhD; Matthew Fritts, MPH; CDR Meena Vythilingam, USPHS; MAJ Todd Yosick, MS USA; Jeffrey Rhodes, DMin; LTC Craig Myatt, MS USA; CAPT Richard Westphal, NC USN; David Fautua, PhD; CAPT Paul Hammer, MC USN; LTC Greg Burbelo, MS USA

Behavioral and Occupational Fitness
Robert M. Bray, PhD; James L. Spira, PhD; Kristine Rae Olmsted, MSPH; CPT Joseph J. Hout, MS USA

Medical and Environmental Fitness
COL Francis G. O’Connor, USA MC; Patricia A. Deuster, PhD, MPH; David W. DeGroot, PhD;
MAJ Duvell W. White, MS USA

Nutritional Fitness
Scott J. Montain, PhD; Christina E. Carvey, MS, RD; CAPT Mark B. Stephens, MC USN

Spiritual Fitness
David J. Hufford, PhD; Matthew J. Fritts, MPH; Jeffrey E. Rhodes, DMin

Social Fitness
Ian Coulter, PhD; CPT Paul Lester, USA; LTC Jeffrey Yarvis, USA

Family Fitness
CAPT Richard J. Westphal, NC USN; Kirsten R. Woodward, MSW

Evaluating Total Force Fitness

Program Evaluation of Total Force Fitness in the Military
Joan A. Walter, PA; Ian Coulter, PhD; Lara Hilton, MPH; Amy B. Adler, PhD; LTC Paul D. Bliese, MSC USA; Maj Rena A. Nicholas, USAF BSC

A Survey of Multidimensional Health and Fitness Indexes
Kimberly M. Firth, PhD; Katherine Smith, MPH

Looking Back and Looking Forward

Lessons Unlearned, Education Forfeited: Military Hygiene Enters the 21st Century
COL Stephen C. Craig, MC USA (Ret.)

The Principal Challenge of Realizing Total Force Fitness: Changing Our Readiness Culture
BG Michael Rounds, USA (Ret.)

The Effect of Blast Exposure on Sleep and Daytime Sleepiness in U.S. Marine Corps Breachers

2010-11-02T14:32:00.002Z

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA528334&Location=U2&doc=GetTRDoc.pdf

The Effect of Blast Exposure on Sleep and Daytime Sleepiness in U.S. Marine
Corps Breachers

Amanda Kelley
Jeremy Athy
Melinda Vasbinder
Jim Chiaramonte
Edna Rat

USAARL Report No. 2010-16

Traumatic brain injury resulting from blast exposure is an increasingly common problem among Soldiers returning from combat deployment. In order to understand the extent of damage resulting from blast exposure, this study examined students and instructors at the United States Marine Corps Methods of Dynamic Entry School during a two week training period. The results of the study suggest that actigraphy and subjective sleep measures are sensitive to changes in sleep quality/quantity as well as daytime sleepiness over the training session. The extent to which these changes are associated with blast exposure rather than other factors related to the
training period will be explored further in a large scale study of breacher crewmen.