Migraine History and Outcomes in Military Pilots and Flight Surgeons.

BACKGROUND: Migraine is a common disorder with significant aeromedical implications. The variability and unpredictable nature of occurrences hampers accurate assessment of future risk. This uncertainty results in a necessarily conservative approach to aeromedical recommendations, which unfortunately may lead to over-restrictive dispositions. Limited long-term follow up information is available on migraine outcomes in pilots, particularly assessing for impact of potential modifiable aggravating factors.Methods: This retrospective study reviewed 159 U.S. Air Force pilots with migraine who had been granted aeromedical waivers. As a comparison group, 44 U.S. Air Force flight surgeons with migraine who had been granted aeromedical waivers were reviewed.Results: Migraine with aura and isolated migraine aura without headache accounted for the majority of migraine subtypes in both male and female subjects. Self-identified triggering factors were identified by 62% of subjects. The most commonly reported triggers were dietary factors, sleep disturbances, stress, caffeine intake, and hormonal factors. Sleep disturbances, stress, hormonal factors, and ethanol triggers were more frequently noted in female subjects. Self-reported positive response to trigger factor modification was noted in 54% of subjects. Subjects reported an average of only 3 migraine attacks in the previous year. Long-term follow up indicated continued aeromedical waiver in 91% of subjects.Discussion: The majority of subjects had migraine with aura or isolated migraine aura. Significant salutary response to modification of commonly-reported triggering factors was noted. These findings can be incorporated into individualized aeromedically-compatible management strategies to clarify symptom impact on aviation safety, improve symptom control, and increase the possibility of safe return to fly recommendations.Hesselbrock RR, Haynes JT. Migraine history and outcomes in military pilots and flight surgeons. Aerosp Med Hum Perform. 2022; 93(1):26-31.

Migraine History and Recurrence in Military Pilot Applicants.

BACKGROUND: Migraine is a common condition with features that can adversely impact aviation activities. The diagnosis of migraine is often compatible with civil aviation training, but is much more concerning for military pilot applicants. A history of migraine headache traditionally medically excluded potential military pilot applicants due to unpredictability of occurrence and potential for operational distraction or incapacitation. Medical standards and policy applications have been quite variable, ranging from total exclusion for even one headache occurrence to as low as a 1-yr migraine-free period before consideration. In many instances, policy application has been subjective and not based on objective evidence. This presents a challenge to waiver authorities and also potentially sends a mixed message to command authorities. There is essentially no current literature evidence applicable to the aviation population on migraine occurrence risk.METHODS: This study reviewed 71 U.S. Air Force pilot applicants who were diagnosed with migraine and had been granted waivers to assess any predictive factors for migraine recurrence and its aeromedical impact.RESULTS: Only three applicants had recurrence after waiver was granted, with two of these occurring within 2 yr of their last reported migraine event, and all recurrences noted within 3 yr.DISCUSSION: Data indicated favorable risk with suitable migraine-free observation before military pilot training, which could be incorporated into aeromedical standards and policies.Hesselbrock RR, Haynes JT. Migraine history and recurrence in military pilot applicants. Aerosp Med Hum Perform. 2020; 91(1):37-40.

Relationship Between Spiritual Well-being and Post-traumatic Stress Disorder Symptoms in United States Air Force Remotely Piloted Aircraft and Intelligence Personnel.

BACKGROUND: Remotely piloted aircraft (RPA) are in frequent use by the U.S. Air Force to engage in combat operations from remote locations. RPA operations involve remote killing, which can lead to significant emotional responses. This study addresses a gap in research by examining the association of existential and spiritual health with post-traumatic stress disorder (PTSD) symptoms in RPA and intelligence personnel. METHODS: Three hundred and five U.S. Air Force RPA and intelligence personnel completed the Spiritual Well-Being Scale (SWBS) and PTSD Checklist-Military Version. Correlational analyses were used to examine the association between SWBS score and PTSD symptoms. FINDINGS: There was a negative correlation between the SWBS and PTSD Checklist-Military Version scores (Pearson correlation coefficient = -0.49, p < 0.0001). Higher spiritual and existential well-being were associated with lower PTSD symptoms. Further, spiritual and existential scores in this sample were comparable with a number of SWBS norms, suggesting that levels of existential distress may not be high among remote warfare operators. DISCUSSION: In this sample of U.S. Air Force personnel involved in remote warfare, higher spiritual and existential well-being were associated with less endorsement of mental health symptoms on a PTSD symptom measure. Additionally, levels of spiritual and existential well-being in this sample were comparable with norms used in a number of samples within the general population. Although there are ongoing concerns regarding the psychological impact remote warfare has on RPA operators, the bulk of current research has indicated that operational stressors such as workload, rotating shifts, organizational and leadership concerns, and balancing work and domestic tasks rather than the job duties themselves (i.e., involvement in killing) likely contribute more to reported emotional distress levels.

Longitudinal Outcomes of U.S. Air Force Pilot Applicants With Waivered Astigmatism.

BACKGROUND: Current U.S. Air Force medical standards allow applicants to enter pilot training with up to 1.50 D of astigmatism. However, waivers are considered for individuals with up to 3.00 D of astigmatism. Although typically a benign finding, higher levels of astigmatism may be progressive and can be associated with corneal ectasia (e.g., keratoconus or pellucid marginal degeneration) leading to reduced visual acuity with spectacles and/or soft contact lenses. The goal of this study was to evaluate the long-term outcomes of pilot applicants waivered into training with astigmatism exceeding the aeromedical standard. METHODS: Subjects were identified on the basis of their enrollment in the Excessive Astigmatism Management Group maintained by the Aeromedical Consultation Service, Ophthalmology branch at Wright-Patterson Air Force Base, Ohio. Metrics evaluated included refractive status, visual acuity, aeromedical waiver status, safety data, and the development of corneal ectasia. FINDINGS: Seventy-six subjects were tracked for up to 10 years, with an average follow-up period of 5.5 years. Mean astigmatism at initial examination was 1.91 D, although mean astigmatism on the basis of the most recent examination was 2.19 D. Subjects with excessive astigmatism who were waivered into pilot training showed an average increase in astigmatism of slightly less than 0.05 D annually, which equates to a total increase in astigmatism of approximately 0.25 D for the duration of the study. No subjects developed ectasia or were disqualified from flying for vision or refractive reasons. No mishaps were identified with vision being a causative or contributing factor. DISCUSSION/IMPACT/RECOMMENDATIONS: This study supports continuation of current Air Force waiver policy, although a longer follow-up period is required to consider modifying the aeromedical standard for astigmatism.

Asymptomatic Wolff-Parkinson-White Pattern ECG in USAF Aviators.

INTRODUCTION: Wolff-Parkinson-White (WPW) pattern is occasionally found in asymptomatic aviators during routine ECGs. Aeromedical concerns regarding WPW pattern include risk of dysrhythmia or sudden cardiac death (SCD), thus affecting the safety of flight. The purpose of this study was to determine the prevalence and outcomes of aviators with asymptomatic WPW pattern and assess for risk factors that contribute to progression to dysrhythmia or symptoms. METHODS: The U.S. Air Force (USAF) ECG library database containing over 1.2 million ECGs collected over the past 68 yr was used to identify 638 individual aviators with WPW pattern. Demographic, medical history, and outcome data were obtained by medical record review. Aviators who developed high risk features defined as symptoms, arrhythmia, or ablation of a high risk pathway, were compared to those who remained asymptomatic. RESULTS: Prevalence of WPW pattern was 0.30% among all USAF aviators. Of the 638 individuals, 64 (10%) progressed to the combined endpoint of SCD, arrhythmia, and/or ablation of a high risk pathway over 6868 patient years, with average follow-up of 10.5 yr. There were two sudden cardiac deaths (0.3%). Annual risk of possible sudden incapacitation was 0.95% and of SCD 0.03%. Those that progressed to high risk were significantly younger, had lower diastolic blood pressure, lower total cholesterol, and better physical fitness testing scores. DISCUSSION: WPW pattern on ECG found in asymptomatic aviators confers < 1% annual risk of arrhythmia or incapacitating events with the highest risk in the younger, healthier, and most fit populations.Davenport ED, Rupp KAN, Palileo E, Haynes J. Asymptomatic Wolff-Parkinson-White pattern ECG in USAF aviators. Aerosp Med Hum Perform. 2017; 88(1):56-60.

Psychological Distress and Workplace Bullying Among Registered Nurses

Workplace bullying (WPB) behaviors are pervasive in some healthcare organizations leading to difficult work environments for registered nurses. We conducted an exploratory quantitative dominant (QUANT/qual) mixed method design study to determine the differences in respondents in three Midwestern states on psychological distress symptoms using WPB exposure levels and select nurse characteristics. This article discusses background information and WPB consequences. We report on the study purpose, methods, and Phase I qualitative results, including significant differences with perceived stress, anxiety, and posttraumatic symptoms reported by persons with frequent to daily WPB behavior exposure. The discussion section considers significant differences found between respondents related to age and posttraumatic stress symptoms. Narrative analysis on strategies used after bullying also illuminates the discussion. Finally, we examine implications for nurse leaders and empowerment of their direct reports to resolve minor interpersonal conflicts and move swiftly to resolve escalating bullying.

Regurgitant valvular disease prevalence and progression found on echocardiogram in military aviators.

INTRODUCTION: The prevalence, progression rates, and outcomes affecting aviator valvular heart disease have not been extensively studied. METHODS: The U.S. Air Force (USAF) School of Aerospace Medicine's Clinical Sciences Database was used to determine prevalence and progression rates for regurgitant valvular disease. A subset of the initial population was further evaluated for risk factors that increased the likelihood of progression. Descriptive statistical analysis, analysis of variance, and t-test calculations were completed. RESULTS: There were 8475 unique aviators with some degree of valvular regurgitation for an overall prevalence of 3.0%. The mitral and aortic valves were most likely to have mild and moderate or greater regurgitation, respectively. Progression rates from mild to moderate were 8% in the aortic valve, 2% in the mitral valve, and less than 1% in the pulmonic and tricuspid valves. Progression rates from moderate to severe were over 20% for both the mitral and aortic valves. The only risk factors correlating to progression of valvular disease were lower levels of high-density lipoproteins in the mitral and aortic valves and triglycerides in the mitral valve. DISCUSSION: In USAF aviators, progression rates for mild or greater aortic valve regurgitation and moderate or greater mitral valve regurgitation are significant and should be followed closely. Classic risk factors of age, tobacco use, elevated blood pressure, and hyperlipidemia have no association with increased risk of valvular progression or rate of progression. Study outcomes validate the current USAF policy for valvular heart disease in aviators.

Pollen foraging by bumblebees: Foraging patterns and efficiency on Lupinus polyphyllus.

Bumblebees foraging on vertical inflorescences start near the bottom and work upward, behavior commonly interpreted as a response to the greater amounts of nectar available in lower flowers. Lupinus polyphyllus, which produces no nectar, has more pollen available in upper flowers. Although bees are probably unable to detect this gradient, since pollen is hidden from their view, they still start low and forage upward. Therefore, we concluded that the bees' tendency to forage upward on vertical inflorescences is not tied to a reward gradient. In addition, bees use only about 15% of the flowers per inflorescence, although they could be much more efficient by visiting and revisiting every flower systematically. In general, revisits would not be penalized because most flowers contain enough pollen for several visits. Optimal foraging theory may not offer an adequate explanation for such gross inefficiency.