Measuring aviator workload using EEG: an individualized approach to workload manipulation.

Introduction: Measuring an operator's physiological state and using that data to predict future performance decrements has been an ongoing goal in many areas of transportation. Regarding Army aviation, the realization of such an endeavor could lead to the development of an adaptive automation system which adapts to the needs of the operator. However, reaching this end state requires the use of experimental scenarios similar to real-life settings in order to induce the state of interest that are able to account for individual differences in experience, exposure, and perception to workload manipulations. In the present study, we used an individualized approach to manipulating workload in order to account for individual differences in response to workload manipulations, while still providing an operationally relevant flight experience. Methods: Eight Army aviators participated in the study, where they completed two visits to the laboratory. The first visit served the purpose of identifying individual workload thresholds, with the second visit resulting in flights with individualized workload manipulations. EEG data was collected throughout both flights, along with subjective ratings of workload and flight performance. Results: Both EEG data and workload ratings suggested a high workload. Subjective ratings were higher during the high workload flight compared to the low workload flight (p < 0.001). Regarding EEG, frontal alpha (p = 0.04) and theta (p = 0.01) values were lower and a ratio of beta/(alpha+theta) (p = 0.02) were higher in the baseline flight scenario compared to the high workload scenario. Furthermore, the data were compared to that collected in previous studies which used a group-based approach to manipulating workload. Discussion: The individualized method demonstrated higher effect sizes in both EEG and subjective ratings, suggesting the use of this method may provide a more reliable way of producing high workload in aviators.

Effects of temperature acclimation on the upper thermal tolerance of two Arctic fishes.

The thermally dynamic nearshore Beaufort Sea, Alaska, is experiencing climate change-driven temperature increases. Measuring thermal tolerance of broad whitefish (Coregonus nasus) and saffron cod (Eleginus gracilis), both important species in the Arctic ecosystem, will enhance understanding of species-specific thermal tolerances. The objectives of this study were to determine the extent that acclimating broad whitefish and saffron cod to 5°C and 15°C changed their critical thermal maximum (CTmax) and HSP70 protein and mRNA expression in brain, muscle and liver tissues. After acclimation to 5°C and 15°C, the species were exposed to a thermal ramping rate of 3.4°C · h-1 before quantifying the CTmax and HSP70 protein and transcript concentrations. Broad whitefish and saffron cod acclimated to 15°C had a significantly higher mean CTmax (27.3°C and 25.9°C, respectively) than 5°C-acclimated fish (23.7°C and 23.2°C, respectively), which is consistent with trends in CTmax between higher and lower acclimation temperatures. There were species-specific differences in thermal tolerance with 15°C-acclimated broad whitefish having higher CTmax and HSP70 protein concentrations in liver and muscle tissues than saffron cod at both acclimation temperatures. Tissue-specific differences were quantified, with brain and muscle tissues having the highest and lowest HSP70 protein concentrations, respectively, for both species and acclimation temperatures. The differences in broad whitefish CTmax between the two acclimation temperatures could be explained with brain and liver tissues from 15°C acclimation having higher HSP70a-201 and HSP70b-201 transcript concentrations than control fish that remained in lab-acclimation conditions of 8°C. The shift in CTmax and HSP70 protein and paralogous transcripts demonstrate the physiological plasticity that both species possess in responding to two different acclimation temperatures. This response is imperative to understand as aquatic temperatures continue to elevate.

Transcranial Direct Current Stimulation and Aviator Performance During Simulated Flight.

INTRODUCTION: Transcranial direct current stimulation (tDCS) is a promising method for maintaining cognitive performance. Anticipated changes in rotary-wing aircraft are expected to alter aviator performance.METHODS: A single-blind, randomized, sham-controlled study evaluated effects of 2-mA anodal tDCS to the right posterior parietal cortex on aviator performance within a Black Hawk simulator. A mixed design with one between-subjects factor was assessed: stimulation prior to flight (20 constant min) and during flight (two timepoints for 10 min each). The within-subjects factor included active vs. sham stimulation. Randomly assigned to each stimulation group were 22 aviators. Aircraft state metrics derived from the simulator were used to evaluate performance. Subjects completed two flights (active stimulation and sham stimulation) with an in-flight emergency introduced at the end to assess whether the timing of tDCS application (prior or during flight) affected the ability to maintain attention and respond to an unexpected event.RESULTS: Results found active stimulation during flight produced statistically significant improvements in performance during the approach following the in-flight emergency. Subjects maintained a more precise approach path with glideslope values closer to zero (M = 0.05) compared to the prior-to-flight group (M = 0.15). The same was found for localizer values (during flight, M = 0.07; prior to flight, M = 0.17). There were no statistically significant differences between groups on secondary outcome measures.DISCUSSION: These findings suggest stimulation during flight may assist in maintaining cognitive resources necessary to respond to an unexpected in-flight emergency. Moreover, blinding efficacy was supported with 32% of subjects correctly guessing when active stimulation was being delivered (52% correctly guessed the sham condition).Feltman KA, Kelley AM. Transcranial direct current stimulation and aviator performance during simulated flight. Aerosp Med Hum Perform. 2024; 95(1):5-15.

Preliminary Evaluation of an Osteopathic Manipulative Treatment to Prevent Motion Sickness.

INTRODUCTION: Motion sickness affecting military pilots and aircrew can impact flight safety and, if severe, can lead to disqualification from flight status. However, due to the common adverse effects of motion sickness pharmaceuticals (e.g., drowsiness), medication options are severely limited. The purpose of this study was to explore the potential utility of a nonpharmaceutical method for motion sickness prevention, specifically an osteopathic manipulative technique (OMT).METHODS:A novel OMT protocol for the reduction of motion sickness symptoms and severity was evaluated using a sham-controlled, counterbalanced, between-subjects study design. The independent variable was OMT treatment administered prior to the motion sickness-inducing procedure (rotating chair). The primary dependent measures were total and subscale scores from the Motion Sickness Assessment Questionnaire.RESULTS:The OMT treatment group experienced significantly fewer gastrointestinal (mean scores postprocedure, treatment M = 20.42, sham M = 41.67) and sopite-related (mean scores postprocedure, treatment M = 12.81, sham M = 20.68) symptoms than the sham group while controlling for motion sickness susceptibility. There were no differences between groups with respect to peripheral and central symptoms.DISCUSSION:The results suggest that the treatment may prevent gastrointestinal (nausea) and sopite-related symptoms (sleepiness). These preliminary findings support further exploration of OMT for the prevention of motion sickness. A more precise evaluation of the mechanism of action is needed. Additionally, the duration of the effects needs to be investigated to determine the usefulness of this technique in training and operational settings.Thomas VA, Kelley AM, Lee A, Fotopoulos T, Boggs J, Campbell J. Preliminary evaluation of an osteopathic manipulative treatment to prevent motion sickness. Aerosp Med Hum Perform. 2023; 94(12):934-938.

Embryonic and Early Larval Development of the Pacific Razor Clam (Siliqua patula).

AbstractThe Pacific razor clam, Siliqua patula (Sugpiaq: Cingtaataq, Dixon, 1789), is vital to commercial, recreational, and subsistence fisheries across the Pacific Northwest Coast of North America. Despite the species' status as one of the most popular shellfish species harvested in the Pacific Northwest, British Columbia, and Alaska, its larval development has never been fully characterized. Generating a developmental times series, and describing development fully, is crucial for guiding targeted management, developing a mariculture strategy for the species, and providing a more pointed avenue for studies examining the response of S. patula to ocean change. This study presents the first photographic documentation of larval development in S. patula, including the timing of key transitions during embryogenesis and early larval development. Scanning electron microscopy revealed that the larval shell forms via a concretion, a process typically documented in early gastropod development. This novel characterization is pertinent, as it conveys the need for the inclusion of alternative bivalve development processes, such as a concretion, in bivalve research. This study also compared development in S. patula to a global assortment of bivalve species, including two other members of the Pharidae family, determining that the timing to D-veliger and trochophore stages was similar to the majority of bivalves surveyed. While bivalve response to climate change is a topic of great interest, not all species of concern have undergone comprehensive developmental assessments, a requisite benchmark for designing climate change studies that examine early life history sensitivity to such changes. This research supports the use of comprehensive developmental studies as prerequisites for designing climate change experimentation, establishes the necessity of high-magnification and high-resolution scanning electron microscopy within developmental assessments, and provides information about the development of a cornerstone bivalve species.

A long-snouted and long-necked polycotylid plesiosaur from the Late Cretaceous of North America.

Plesiosaurs are a group of Mesozoic marine diapsids. Most derived plesiosaurs fall into one of two typical body forms: those with proportionately small heads, short snouts, and elongated necks, and those with large heads, elongated snouts, and short necks. Serpentisuchops pfisterae is a polycotylid plesiosaur from the Upper Cretaceous Pierre Shale that presents the trait combination of both an elongate snout and elongate neck (consisting of 32 vertebrae). Phylogenetic analysis places Serpentisuchops within the Polycotylinae, indicating that its long snout is an ancestral trait, while its long neck is secondarily derived and convergent with that of ancestral plesiosaurs, contemporaneous elasmosaurids, and some more basal members of the Polycotylidae. The conical, recurved, and narrow teeth are consistent with a piscivorous diet. The tall and anteroposteriorly broad cervical neural spines indicate large epaxial muscles, suggesting that Serpentisuchops used both its neck and snout in fast lateral strikes aimed at proportionately small prey.

Obstructive Sleep Apnea Among Army Aircrew.

INTRODUCTION: Obstructive sleep apnea (OSA) is a condition characterized by disrupted sleep and excessive daytime fatigue. Associated cognitive and psychomotor decrements pose a threat to aviators' performance and flight safety. Additionally, the longer term health effects associated with the disease can jeopardize an aviator's career and negatively impact operational outputs. This study reviews OSA prevalence, related comorbid conditions in Army aviators, and analyzes the aeromedical dispositions of affected individuals.METHODS: The U.S. Army Aeromedical Electronic Resource Office (AERO) database was interrogated for all cases of OSA from June 2005 through June 2015 using ICD-9 code 327.23. Prevalence rates for OSA and other comorbid conditions were then calculated using the total number of aviators in the AERO database.RESULTS: A total of 663 unique instances of OSA were found among the aviator population (N = 24,568), giving a point prevalence of 2.69%. Four cases affected women. Mean age of initial presentation was 42.62 yr and mean Body Mass Index was 28.69. The top five most prevalent comorbid conditions were hypertension, lumbago, degeneration of a lumbar or lumbosacral intervertebral disc, PTSD, and testicular hypofunction.DISCUSSION: Prevalence of OSA among aviators is lower than the general population but is not uncommon. A positive diagnosis requires a waiver or can result in suspension if not managed effectively, potentially leading to a reduction in aviator numbers. Aggressive health promotion and robust medical surveillance and aeromedical disposition management by the aeromedical community is essential to reduce OSA numbers, maintain aviator health, and maximize flight safety.Goldie C, Stork B, Bernhardt K, Gaydos SJ, Kelley AM. Obstructive sleep apnea among army aircrew. Aerosp Med Hum Perform. 2022; 93(5):415-420.

Characterization of the abiotic drivers of abundance of nearshore Arctic fishes.

Fish are critical ecologically and socioeconomically for subsistence economies in the Arctic, an ecosystem undergoing unprecedented environmental change. Our understanding of the responses of nearshore Arctic fishes to environmental change is inadequate because of limited research on the physicochemical drivers of abundance occurring at a fine scale. Here, high-frequency in situ measurements of pH, temperature, salinity, and dissolved oxygen were paired with daily fish catches in nearshore Alaskan waters of the Beaufort Sea. Due to the threat that climate change poses to high-latitude marine ecosystems, our main objective was to characterize the abiotic drivers of abundance and elucidate how nearshore fish communities may change in the future. We used generalized additive models (GAMs) to describe responses to the nearshore environment for 18 fish species. Relationships between abundance and the physicochemical environment were variable between species and reflected life history. Each abiotic covariate was significant in at least one GAM, exhibiting both nonlinear and linear associations with abundance. Temperature was the most important predictor of abundance and was significant in GAMs for 11 species. Notably, pH was a significant predictor of abundance for six species: Arctic cod (Boreogadus saida), broad whitefish (Coregonus nasus), Dolly Varden (Salvelinus malma), ninespine stickleback (Pungitius pungitius), saffron cod (Eleginus gracilis), and whitespotted greenling (Hexagrammos stelleri). Broad whitefish and whitespotted greenling abundance was positively associated with pH, while Arctic cod and saffron cod abundance was negatively associated with pH. These results may be a bellwether for future nearshore Arctic fish community change by providing a foundational characterization of the relationships between abundance and the abiotic environment, particularly in regard to pH, and demonstrate the importance of including a wider range of physicochemical habitat covariates in future research.

Alkalinity cycling and carbonate chemistry decoupling in seagrass mystify processes of acidification mitigation.

The adverse conditions of acidification on sensitive marine organisms have led to the investigation of bioremediation methods as a way to abate local acidification. This phytoremediation, by macrophytes, is expected to reduce the severity of acidification in nearshore habitats on short timescales. Characterizing the efficacy of phytoremediation can be challenging as residence time, tidal mixing, freshwater input, and a limited capacity to fully constrain the carbonate system can lead to erroneous conclusions. Here, we present in situ observations of carbonate chemistry relationships to seagrass habitats by comparing dense (DG), patchy (PG), and no grass (NG) Zostera marina pools in the high intertidal experiencing intermittent flooding. High-frequency measurements of pH, alkalinity (TA), and total-CO2 elucidate extreme diel cyclicity in all parameters. The DG pool displayed frequent decoupling between pH and aragonite saturation state (Ωarg) suggesting pH-based inferences of acidification remediation by seagrass can be misinterpreted as pH and Ωarg can be independent stressors for some bivalves. Estimates show the DG pool had an integrated ΔTA of 550 µmol kg-1 over a 12 h period, which is ~ 60% > the PG and NG pools. We conclude habitats with mixed photosynthesizers (i.e., PG pool) result in less decoupling between pH and Ωarg.

Detecting functional deficits following sub-concussive head impacts: the relationship between head impact kinematics and visual-vestibular balance performance.

Introduction: Mild traumatic brain injury (mTBI) continues to be a significant issue facing the US military. While TBI cases in deployed environments are of significant concern, an estimated 80% of diagnoses occur in garrison settings (e.g., military training).Objective: With the aim of improving the detection of potentially concussive exposures, the objective of this study was to evaluate the relationships between head impact kinematics and performance on a visual-vestibular balance task.Methods: Participants (n = 51) were enrolled in the Basic Airborne Training Course. Two sensors to measure head impacts sustained were worn. Performance was measured at four time points: baseline and at the end of each week of the course.Results: Visual-vestibular balance task performance tended to decrease over the course of airborne training for our participants, however, limited to the most challenging levels of the task. Also, head impact kinematic measures correlated with performance outcomes to suggest that worse performance was associated with greater number of impacts and greater linear and rotational acceleration and rotational velocity.Discussion: Our findings suggest that visual-vestibular balance task performance may be a useful measure for detection of sub-concussive impacts and that wearable sensors may provide useful data on head impact kinematics that relates directly to functionally relevant performance.

Changes to benthic community structure may impact organic matter consumption on Pacific Arctic shelves.

Changes in species composition and biomass of Arctic benthic communities are predicted to occur in response to environmental changes associated with oceanic warming and sea-ice loss. Such changes will likely impact ecosystem function, including flows of energy and organic material through the Arctic marine food web. Oxygen consumption rates can be used to quantify differences in metabolic demand among species and estimate the effects of shifting community structure on benthic carbon consumption. Closed-system respirometry using non-invasive oxygen optodes was conducted onboard the R/V Sikuliaq in June 2017 and 2018 on six dominant species of benthic macrofauna from the northern Bering and southern Chukchi Sea shelves, including five bivalve species (Macoma sp., Serripes groenlandicus, Astarte sp., Hiatella arctica and Nuculana pernula) and one amphipod species (Ampelisca macrocephala). Results revealed species-specific respiration rates with high metabolic demand for S. groenlandicus and A. macrocephala compared to that of the other species. For a hypothetical 0.1-g ash-free dry mass individual, the standard metabolic rate of S. groenlandicus would be 4.3 times higher than that of Astarte sp. Overall, carbon demand ranged from 8 to 475 µg C individual-1 day-1 for the species and sizes of individuals measured. The allometric scaling of respiration rate with biomass also varied among species. The scaling coefficient was similar for H. arctica, A. macrocephala and Astarte sp., while it was high for S. groenlandicus and low for Macoma sp. These results suggest that observed shifts in spatial distribution of the dominant macrofaunal taxa across this region will impact carbon demand of the benthic community. Hence, ecosystem models seeking to incorporate benthic system functionality may need to differentiate between communities that exhibit different oxygen demands.

Aircrew Performance and Safety While Using Protective Masks in Response to Coronavirus Disease.

INTRODUCTION: In response to the urgent need for safe aircrew respiratory protection due to the COVID-19 pandemic, three small descriptive evaluations were conducted with aircrew and air traffic controllers (ATC) that assessed the impact of mask use on safety and performance onboard rotary wing aircraft.METHODS: A series of evaluations assessed aircrew performance using the 3MTM Model 1860 N95 respiratory protection mask, two aviation-specific cloth mask prototypes, and a commercial off-the-shelf aviation-specific cloth mask. The series of evaluations included different sets of subjects consisting of up to five Black Hawk helicopter aircrew members, air traffic control (ATC), and 12 CH-47 aircrew members. The Modified Rhyme Test was used to measure speech intelligibility and was administered in the UH-60 among crewmembers of the same aircraft, between pilots of different aircraft, and between the pilots and ATC. Measures of workload, usability, comfort, and pulse oximetry were also administered.RESULTS: Results from the Modified Rhyme Test indicated that all subjects scored greater than 80% accuracy given the proper microphone positioning relative to the mask. With respect to workload, NASA-TLX total scores for the perform radio communications task was 50.83.DISCUSSION: Despite an elevated perceived degree of workload on the communications flight task, results from the speech intelligibility test indicated that performance was maintained within the acceptable range as defined by MIL-STD-1474E, Design Criteria Standard Noise Limit. This abbreviated evaluation suggests that the face masks tested are safe for use by helicopter aircrew under the conditions tested.Cave KM, Kelley AM, Feltman KA, Gerstner JA, Stewart JL, Crowley JS. Aircrew performance and safety while using protective masks in response to coronavirus disease. Aerosp Med Hum Perform. 2021; 92(4):274280.

The adaptable speaker: A theory of implicit learning in language production.

The language production system continually learns. The system adapts to recent experiences while also reflecting the experience accumulated over the lifetime. This article presents a theory that explains how speakers implicitly learn novel phonotactic patterns as they produce syllables. The learning is revealed in their speech errors. For example, if speakers produce syllable strings in which the consonant /f/ is always a syllable onset, their slips will obey this rule; /f/'s will then slip mostly to onset positions. The article reviews over 30 phenomena related to this finding. To explain phonotactic learning, the article presents four linked "mini-theories," each of which addresses components of the data. The first mini-theory, the production theory, provides an account of how speech errors arise during the assembly of word forms. The second, the learning theory, characterizes the implicit learning of phoneme distributions within the production system. The third mini-theory, the consolidation theory, augments the learning theory to explain instances in which this learning depends on a period of time, possibly a sleep period, before it is expressed. The final mini-theory, the developmental theory, addresses cases in which learning varies between children and adults, and depends on speakers' early linguistic experience. The resulting theory forges links between these diverse aspects of psychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trends in Metabolic Disorder in U.S. Army Aviators, 20162018.

INTRODUCTION: Recent epidemiological studies of U.S. Army aviators have suggested higher than anticipated rates of hyperlipidemia and metabolic disorder. The goal of this study was to determine whether this finding has persisted in 20162018 and to subsequently determine whether this trend is genuine and warrants further evaluation.METHODS: Data were requested from the U.S. Army Aeromedical Electronic Resource Office (AERO) and retrieved from the publicly available Defense Medical Surveillance System (DMSS) utilizing similar inclusion/exclusion criteria, where possible, as the earlier studies. For each year 20162018, incidence rates (per 1000 person years) for hyperlipidemia and metabolic syndrome were retrieved from DMSS, while percentages of aviators with these conditions were retrieved from AERO. The DMSS incidence rates were also age stratified. No formal analyses were conducted.RESULTS: Results from DMSS showed overall rates of hyperlipidemia ranging from 3.18 to 6.83 per 1000 person-years and for metabolic syndrome from 0.16 to 0.69 per 1000 person-years. The age stratified rates increased proportionally with age. AERO data showed a range of 0.81.5% of aviators had hyperlipidemia and for metabolic syndrome this ranged from 0.31 to 0.45%. These rates are broadly comparable to the previous studies findings.DISCUSSION: This studys findings suggest no continued increase in hyperlipidemia or metabolic disorder in aviators. While the exact cause is unknown, one could speculate a number of sources such as preferences in testing or encouragement from specific commanders or flight surgeons.Goldie C, McGhee J, Kelley AM. Trends in metabolic disorder in U.S. Army aviators, 20162018. Aerosp Med Hum Perform. 2021; 92(1):4346.

Measuring the Domain Specificity of Workload Using EEG: Auditory and Visual Domains in Rotary-Wing Simulated Flight.

OBJECTIVE: The overarching objective was to evaluate whether workload sensory-domain specificity could be identified through electroencephalogram (EEG) recordings during simulated rotary-wing operations. BACKGROUND: Rotary-wing aviators experience workload from different sensory domains, although predominantly through auditory and visual domains. Development of real-time monitoring tools using psychophysiological indices, such as EEG recordings, could enable identification of aviator overload in real time. METHOD: Two studies were completed, both of which recorded EEG, task performance, and self-report data. In Study 1, 16 individuals completed a basic auditory and a basic visual laboratory task where workload was manipulated. In Study 2, 23 Army aviators completed simulated aviation flights where workload was manipulated within auditory and visual sensory domains. RESULTS: Results from Study 1 found differences in frontal alpha activity during the auditory task, and that alpha and beta activities were associated with perceived workload. Frontal theta activity was found to differ during the visual task while frontal alpha was associated with perceived workload. Study 2 found support for frontal beta activity and the ratio of beta to alpha + theta to differentiate level of workload within the auditory domain. CONCLUSION: There is likely a role of frontal alpha and beta activities in response to workload manipulations within the auditory domain; however, this role becomes more equivocal when examined in a multifaceted flight scenario. APPLICATION: Results from this study provide a basis for understanding changes in EEG activity when workload is manipulated in sensory domains that can be used in furthering the development of real-time monitoring tools.

Selective Serotonin Reuptake Inhibitor Use Among Army Aviators.

INTRODUCTION: Mental health is an important aspect of Army aviation medicine given that it significantly impacts career longevity, readiness, and healthcare usage. One of the most commonly used classes of medications to treat mental health disorders is the selective serotonin reuptake inhibitor (SSRI). Here we present a descriptive epidemiological review of SSRI use in Army aviators over a 10-yr period.METHODS: An archival dataset retrieved from the U.S. Army Aeromedical Electronic Resource Office covering the years 2005 to 2015 was queried for cases of SSRI use. Frequencies were generated by primary diagnoses and aeromedical disposition for the SSRI subset of data.RESULTS: A total of 114 unique cases of SSRI use were identified (122 total aeromedical outcomes). These cases included 41 waiver recommendations, 59 suspension recommendations, and 22 cases of waiver continuations. The top five most common primary diagnoses were depressive disorder (N 32), anxiety state (N 21), posttraumatic stress disorder (N 16), single major depressive episode (N 13), and adjustment disorder with depressed mood (N 12).DISCUSSION: Understanding of the etiology, pathophysiology, and treatment of mental health disorders particularly within the safety-focused and unforgiving aviation environment has continued to evolve. With the application of evidence-based policy, deliberate aeromedical decision-making, and methodical risk mitigation, SSRI use does have a place within aviation. Aviators suffering in silence with deleterious impact to performance and safety or aircrew seeking services on the outside without knowledge or oversight of certification authorities must remain in the past.Kelley AM, Bernhardt K, McPherson M, Persson JL, Gaydos SJ. Selective serotonin reuptake inhibitor use among Army aviators. Aerosp Med Hum Perform. 2020; 91(11):897900.

Association of MOS-Based Blast Exposure With Medical Outcomes.

The study of effects associated with human exposure to repeated low-level blast during training or operations of select military occupational specialties (MOS) challenges medical science because acute negative effects that might follow such exposures cannot be expected to be clear or prevalent. Any gross effects from such occupational blast exposure on health or performance should be expected to have been already identified and addressed by affected military units through changes to their standard training protocols. Instead, effects, if any, should be expected to be incremental in nature and to vary among individuals of different susceptibilities and exposure histories. Despite the challenge, occupational blast-associated effects in humans are emerging in ongoing research. The purpose of the present study was to examine medical records for evidence of blast-associated effects that may have clinical significance in current standard of care. We hypothesized that populations exposed to blast by virtue of their military occupation would have poorer global medical outcomes than cohorts less likely to have been occupationally exposed. Records from a population of 50,254 service members in MOSs with a high likelihood of occupational blast exposure were compared to records from a matched cohort of 50,254 service members in MOSs with a lower likelihood of occupational blast exposure. These two groups were compared in hospitalizations, outpatient visits, pharmacy, and disability ratings. The clearest finding was higher risk among blast-exposed MOSs for ambulatory encounters for tinnitus, with adjusted risk ratios of 1.19 (CI 1.03-1.37), 1.21 (CI 1.16-1.26), and 1.31 (CI 1.18-1.45) across career time points. Other hypothesized effects (i.e., neurological outcomes) were smaller and were associated with acute exposure. This study documents that service members in occupations that likely include repeated exposure to blast are at some increased risk for neurosensory conditions that present in medical evaluations. Other hypothesized risks from occupational exposure may manifest as symptomology not visible in the medical system or current standard of care. Separate studies, observational and epidemiological, are underway to evaluate further the potential for occupational risk, but the evidence presented here may indicate near-term opportunities to guide efforts to reduce neurosensory risk among exposed service members.

Dementia Care Mapping™ to reduce agitation in care home residents with dementia: the EPIC cluster RCT.

BACKGROUND: The quality of care for people with dementia in care homes is of concern. Interventions that can improve care outcomes are required. OBJECTIVE: To investigate the clinical effectiveness and cost-effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation and improving care outcomes for people living with dementia in care homes, versus usual care. DESIGN: A pragmatic, cluster randomised controlled trial with an open-cohort design, follow-up at 6 and 16 months, integrated cost-effectiveness analysis and process evaluation. Clusters were not blinded to allocation. The primary end point was completed by staff proxy and independent assessors. SETTING: Stratified randomisation of 50 care homes to the intervention and control groups on a 3 : 2 ratio by type, size, staff exposure to dementia training and recruiting hub. PARTICIPANTS: Fifty care homes were randomised (intervention, n = 31; control, n = 19), with 726 residents recruited at baseline and a further 261 recruited after 16 months. Care homes were eligible if they recruited a minimum of 10 residents, were not subject to improvement notices, had not used DCM in the previous 18 months and were not participating in conflicting research. Residents were eligible if they lived there permanently, had a formal diagnosis of dementia or a score of 4+ on the Functional Assessment Staging Test of Alzheimer's Disease, were proficient in English and were not terminally ill or permanently cared for in bed. All homes were audited on the delivery of dementia and person-centred care awareness training. Those not reaching a minimum standard were provided training ahead of randomisation. Eighteen homes took part in the process evaluation. INTERVENTION: Two staff members from each intervention home were trained to use DCM and were asked to carry out three DCM cycles; the first was supported by an external expert. MAIN OUTCOME MEASURES: The primary outcome was agitation (Cohen-Mansfield Agitation Inventory), measured at 16 months. Secondary outcomes included resident behaviours and quality of life. RESULTS: There were 675 residents in the final analysis (intervention, n = 388; control, n = 287). There was no evidence of a difference in agitation levels between the treatment arms. The adjusted mean difference in Cohen-Mansfield Agitation Inventory score was -2.11 points, being lower in the intervention group than in the control (95% confidence interval -4.66 to 0.44; p = 0.104; adjusted intracluster correlation coefficient: control = 0, intervention = 0.001). The sensitivity analyses results supported the primary analysis. No differences were detected in any of the secondary outcomes. The health economic analyses indicated that DCM was not cost-effective. Intervention adherence was problematic; only 26% of homes completed more than their first DCM cycle. Impacts, barriers to and facilitators of DCM implementation were identified. LIMITATIONS: The primary completion of resident outcomes was by staff proxy, owing to self-report difficulties for residents with advanced dementia. Clusters were not blinded to allocation, although supportive analyses suggested that any reporting bias was not clinically important. CONCLUSIONS: There was no benefit of DCM over control for any outcomes. The implementation of DCM by care home staff was suboptimal compared with the protocol in the majority of homes. FUTURE WORK: Alternative models of DCM implementation should be considered that do not rely solely on leadership by care home staff. TRIAL REGISTRATION: Current Controlled Trials ISRCTN82288852. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 16. See the NIHR Journals Library website for further project information.

Agitation is common in care home residents and may result from care that does not meet individual needs. Dementia Care Mapping™ (DCM) is a tool used within care homes to improve the delivery of person-centred care, which may help reduce agitation. This randomised controlled trial aimed to understand whether or not DCM is better than usual care at reducing resident agitation, behaviours that staff may find difficult to support and the use of antipsychotic medicines, as well as at improving residents' quality of life and staff communication. It also assessed its value for money. We recruited 726 residents with dementia from 50 care homes. After initial data collection, care homes were randomly assigned to DCM (31/50) or told to continue with usual care (19/50) and data were collected again after 6 and 16 months. A further 261 residents were recruited after 16 months. We also interviewed staff, relatives and residents about the use of DCM after the final data collection had taken place. Two staff members in each DCM home were trained to use DCM and were helped by an expert to use it for the first time. They were asked to use it again a further two times without support. Results showed that DCM was no better than usual care in relation to any of the outcomes. It was also not shown to be value for money. Only one-quarter of care homes used DCM more than once. The care staff who were interviewed said that the benefits of using DCM included reduced resident boredom and increased staff confidence. There were also many challenges, including the time needed to complete DCM, a lack of managerial support and problems with staffing levels. Putting DCM into practice in care homes was difficult, even with expert support, and most care homes did not complete three DCM cycles. Future research should explore models of implementing DCM that do not rely on care home staff to lead them.

Viability of tDCS in Military Environments for Performance Enhancement: A Systematic Review.

INTRODUCTION: Transcranial electrical stimulation (tES) as a method of cognitive enhancement in both diseased and healthy individuals has gained popularity. Its potential for enhancing cognition in healthy individuals has gained the interest of the military. However, before it being implemented into military training or operational settings, further work is needed to determine its efficacy and safety. Although a considerable amount of literature exists, few studies have specifically evaluated its use in enhancing cognition relative to operational, military tasks. Therefore, in a first step to evaluate its efficacy, we completed a systematic literature review of studies using transcranial direct current stimulation (tDCS), a type of tES, to enhance cognitive processes in healthy individuals. METHODS: A systematic literature review was conducted to identify literature published between 2008 and 2018 that used a method of tES for cognitive enhancement. As part of a larger literature review effort, 282 articles were initially retrieved. These were then screened to identify articles meeting predetermined criteria, to include those using various methods of tES, resulting in 44 articles. Next, the articles were screened for those using tDCS or high-definition tDCS, resulting in 34 articles for review and information extraction. RESULTS: Of the 34 articles reviewed, 28 reported some degree of enhancement (eg, improved accuracy on tasks and reduced reaction times). Areas of cognitive enhancements included executive functioning, creativity/cognitive flexibility, attention/perception, decision-making, memory, and working memory. However, the precise outcomes of enhancement varied given the range in tasks that were used to assess the constructs. Additionally, the stimulation parameters in terms of intensity applied, duration of stimulation, and brain region targeted for stimulation varied. CONCLUSIONS: The conclusions to be drawn from this systematic literature review include the identification of a brain region for targeting with stimulation to enhance a broad range of cognitive constructs applicable to military tasks, as well as stimulation parameters for duration and intensity. The dorsolateral prefrontal cortex was most frequently targeted in the studies that found enhanced performance across several cognitive constructs. Stimulation intensities of 2 mA and durations of 20 minutes or longer appeared frequently as well. Although several parameters were identified, further work is required before this type of technology can be recommended for operational use.

Medical Suspension in Female Army Rotary-Wing Aviators.

INTRODUCTION: Female aviators with health conditions may face a variety of occupational impacts. Outcomes may include a waiver for continued flight or a permanent suspension, in which flight is no longer possible. The objective of this study is to determine the prevalence of medical diagnosis among female U.S. Army aviators over a ten year period and identify associations of clinical diagnoses leading to waiver or permanent suspension. MATERIALS AND METHODS: This study was a secondary data analysis; data were retrieved on 1,282 female, rated aviator patients from an Army Aviation epidemiological database. The archival dataset was composed of a total of 6,856 cases between June 2005 and June 2015. Age ranged from 19 to 58 years. The data were examined in terms of raw ICD-9 diagnostic codes, grouped system diagnoses (diagnosis categories), and occupational consequence. Spearman's rho correlations were used to determine associations between diagnosis, waiver and permanent suspension. RESULTS: The leading diagnoses were pregnancy, normal delivery, and allergic rhinitis. The systems approach yielded pregnancy, orthopedic disorders, and spinal disorders as the leading diagnosis categories. Leading waivered conditions included spinal, psychiatric, and neurological disorders. In terms of permanent suspension, the leading cause was depression, followed by migraine and post-traumatic stress disorders. In almost all diagnostic groupings, the Spearman's rho correlation coefficients between age and diagnosis were positively related. However, age was not associated with negative occupational outcome (permanent suspension), generally. CONCLUSIONS: A variety of conditions negatively impact the health and occupational status of female aviators, with disparate occupational impacts. Prevalent conditions differed from those reported previously for all aviators in a predominantly male population. The absence of cardiovascular disease is a significant change from 20-30 years ago. Among all medical diagnoses, a minority are responsible for a greater occupational burden.