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Military aircrew of rotary-wing aircraft often report cold and dysfunctional hands during cold-weather flying. Therefore, the cold protection and manual performance of in-service gloves was quantified in a laboratory study to support cold-weather advice to aircrew and glove procurement activities. There were 8 civilian men who undertook a 60-min thermal test simulating the metabolic cost of rear crew physical tasks and wearing representative clothing on 15 occasions, where 3 main glove types (Cape leather, C; Cape + silk liner, C + S; Gunner, G) and 5 air temperatures (TA; +20, +10, 0, -10, -20°C) were assessed. Physiological (including mean finger skin temperature, TFSK), subjective thermal, and manual performance (including bare-hand and gloved finger/hand dexterity) measures were obtained. At a TA of 0°C, mean TSKF was 15.2 (C), 17.9 (C + S), and 22.4°C (G). Finger cold discomfort occurred at a TA of 0°C in C, and at -10°C in C + S and G. Gloved finger/hand dexterity was impaired relative to bare hands by 46/4 (C), 56/14 (C + S), and 73/44% (G). There was no relationship between TSKF and dexterity performance. The performance of aircrew gloves has been baselined for male aircrew. Cape leather gloves are limited to a TA of +10°C. Adding silk liners and wearing the Gunner glove extended exposure down to a TA of 0°C but imposed considerable impairment on dexterity performance. Solutions are required to enhance cold protection at a lower cost to manual performance, which must demonstrate applicability to both male and female aircrew. Weller AS, Boyd JWR. Cold protection and manual performance assessment of aircrew gloves. Aerosp Med Hum Perform. 2026; 97(3):160-168.
The flying population is diversifying, but the demographic composition of aerospace medicine specialists remains understudied. Nevertheless, comparing figures on the racial, ethnic, and gender makeup of pilots and astronauts with analog data from preventive medicine physicians and recent aerospace medicine residents reveals that certain minority groups served by aerospace medicine are likely underrepresented among aerospace medicine practitioners. Arguments regarding the potential advantages and challenges of diversity in aerospace medicine are presented, accompanied by supporting examples and research. Regardless of how its constituency ultimately decides to address the issue of diversity, an accurate collection of demographic data would provide the aerospace medicine profession with the information required for an evidence-based approach. Lam AZ. The demographic makeup of aerospace medicine specialists. Aerosp Med Hum Perform. 2026; 97(5):389-391.
Exercise has been proposed as both a preventive and therapeutic countermeasure; however, its effectiveness across different disuse conditions and timings of implementation remains uncertain. This systematic review and meta-analysis (PROSPERO: CRD42021256599) searched ClinicalTrials.gov, Cochrane Central, PubMed, SPORTDiscus, Web of Science, Scopus, CINAHL and SciELO from inception to May 2021, with an update in March 2025. Randomized and nonrandomized controlled trials examining exercise interventions during or after muscle disuse were included according to the PICOS framework. Random-effects meta-analysis evaluated effects on muscle strength, power and mass across hospitalization, bed rest and spaceflight conditions. Effect sizes (ES) are reported as standardized mean differences with 95% confidence intervals (CI). A total of 1754 participants (66% male, 34% female; mean age 49 ± 22 years) were included. Preventive exercise interventions significantly improved muscle strength and power across disuse models. During hospitalization, exercise significantly increased muscle strength (ES = 0.60, 95% CI [0.42, 0.78]; p < 0.0001; I2 = 76%). This effect remained significant in multilevel analyses accounting for within-study dependence (ES = 0.58, 95% CI [0.19, 0.96]; p = 0.003). During bed rest, conventional random-effects analyses indicated large effects (ES = 1.16, 95% CI [0.60, 1.71]; p < 0.0001; I2 = 55%); however, multilevel models incorporating correlated lower limb strength and power outcomes showed no significant pooled effect (ES = 0.06, 95% CI [-1.31, 1.43]; p = 0.93). In contrast, spaceflight studies demonstrated small, nonsignificant effects on muscle strength and power (ES = 0.10, 95% CI [-0.32, 0.51]; p = 0.65), and pooled standardized mean change analyses indicated no significant overall change in muscle mass (ES = 0.002, 95% CI [-0.077, 0.080]; p = 0.966). When exercise was applied therapeutically after disuse, a trend toward improved muscle strength and power was observed (ES = 0.23, 95% CI [-0.01, 0.47]; p = 0.06; I2 = 12%), although multilevel models showed no significant effects (ES = 0.30, 95% CI [-0.34, 0.95]; p = 0.361). Exercise significantly preserved or increased muscle mass during bed rest (ES = 0.47, 95% CI [0.19, 0.74]; p = 0.0009) and spaceflight (ES = 0.27, 95% CI [0.05, 0.48]; p = 0.02). Exercise, particularly resistance training, attenuates muscle strength loss and preserves muscle mass during hospitalization and bed rest, whereas no consistent benefits are observed during spaceflight. Exercise initiated after disuse shows modest potential for restoring muscle function. Current evidence is insufficient to determine whether preventive or therapeutic initiation provides superior outcomes. Further high-quality randomized controlled trials are required to define the optimal timing, modality and dose of exercise for clinical rehabilitation and aerospace applications.
During a half-squat parachute landing, foot-strike pattern influences joint kinematics and injury risk. This study compared forefoot and full-foot landing techniques to determine their effects on joint biomechanics, impact forces, and landing stability. A total of 17 male paratroopers performed both landing conditions. Lower-limb kinematics, ground reaction forces, and surface electromyography were synchronously recorded using infrared motion capture, a force platform, and wireless electromyography. Paired-sample t-tests or Wilcoxon signed-rank tests were applied (α = 0.05). Forefoot landing produced greater knee (96.8 ± 12.2° vs. 89.3 ± 11.2°) and ankle range of motion (12.7 ± 3.8° vs. 10.8 ± 3.1°), higher peak knee (1206.4 ± 108.7 ° · s-1 vs. 1147.8 ± 88.8 ° · s-1) and ankle flexion angular velocity (223.5 ± 60.1 ° · s-1 vs. 156.5 ± 42.5 ° · s-1), and a longer braking phase (265.0 ± 29.4 ms vs. 246.5 ± 24.7 ms). It also reduced peak vertical ground reaction forces, loading rate, and dynamic postural stability index, and increased time to peak ground reaction forces. During preactivation, electromyography amplitudes were higher for the biceps femoris (0.097 ± 0.066 vs. 0.081 ± 0.071), lateral gastrocnemius (0.304 ± 0.251 vs. 0.130 ± 0.070), and medial gastrocnemius (0.203 ± 0.144 vs. 0.111 ± 0.105). During the braking phase, amplitudes were higher in the rectus femoris, biceps femoris, semitendinosus, lateral gastrocnemius, and medial gastrocnemius. Forefoot landing enhances joint motion, muscle activation, impact attenuation, and dynamic stability during half-squat parachute landing. It may therefore represent a safer landing strategy. Findings should be interpreted cautiously due to the small, all-male sample. Ye Q, Chen H, Huang B, Wan X, Wang G. Landing technique effects on lower-limb biomechanics during half-squat parachute landing. Aerosp Med Hum Perform. 2026; 97(6):435-442.
Imaging is central to modern clinical medicine and advancing the level of care on exploration-class missions will require imaging capabilities to reduce medical risk. The NASA Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite was designed for exploration-class mission probabilistic risk assessment and trade space analysis. The associated IMPACT Conditions List includes 119 in-flight medical conditions of high likelihood and/or consequence as established by flight and terrestrial data, as well as expert opinion. This study evaluates the utility of ultrasound (US) and radiography (XR) for these conditions. For each condition, two reviewers performed a rapid review of professional society guidelines and scientific literature, supplemented with subject-matter expertise, to semiquantitatively score the utility of US and XR for both diagnosis and management. XR was diagnostically highly useful in 36 conditions and US in 38 conditions. Conversely, for 63 (52.9%) conditions, neither XR nor US had any diagnostic utility. For management, XR was highly useful for 24 conditions, while US was highly useful for 21. In over one-third of conditions, XR possesses unique capabilities either complementary or superior to US. XR possesses superior diagnostic utility for bony injuries, dental conditions, and some pulmonary conditions, and superior management capability for orthopedic reductions and device placement confirmation. This analysis suggests future missions may consider augmenting the medical system with portable radiography if resource constraints allow, and future work should quantify the risk reduction provided by this capability. Boyle MJ, Pohlen M, Lehnhardt K, Parmar P, Easter B. X-ray and ultrasound for human spaceflight using the NASA IMPACT conditions list. Aerosp Med Hum Perform. 2026; 97(3):176-184.
Understanding whether commonly available metabolic, demographic, and behavioral factors can explain variability in brain structure may support the development of accessible predictive approaches. This study aims to evaluate the ability of machine learning regression models to predict brain structural measures in young, neurologically healthy adults using clinically accessible risk factors. Data were drawn from the Human Connectome Project Young Adults dataset, including 1082 participants aged 22-37. Predictors comprised metabolic measures (systolic and diastolic blood pressure, hematocrit, body mass index, hemoglobin A1C, thyroid stimulating hormone) and demographic/behavioral variables (age, gender, race, education level, smoking history, alcohol use). Brain structural parameters from MRI included gray matter (GM) and white matter (WM) volumes, surface areas, and cortical thickness. Distance correlation (dcor) guided feature selection, followed by machine learning modeling. Model performance was evaluated using normalized mean absolute error (NMAE), normalized root-mean-squared error (NRMSE), and coefficient of determination (R²). SHAP values were used for feature interpretation. XGBoost consistently outperformed other algorithms, showing strong predictive accuracy for total brain segmentation, supratentorial, and total GM volumes (NMAE < 0.35, R² > 0.80). In contrast, cortical surface predictions (left superior frontal) showed moderate performance (NMAE > 0.50, R² < 0.60). SHAP analysis highlighted age, gender, education level, and diastolic and systolic blood pressure as the most influential predictors of brain structure. The findings highlight the methodological value of regression-based approaches for estimating brain structural variability and support their potential role as complementary tools for brain health research.
Midair collisions (MACs), while rare for air carriers, are not infrequent for general aviation, partly reflecting the limitations of the see-and-avoid method. However, considering technological advances potentially offsetting ocular limitations and little research on the subject, we sought to determine 1) whether the MAC rate has declined over time and 2) the underlying causes. MACs' (1995-2023) injury severity, mission type, and ambient conditions were per the National Transportation Safety Board database. Statistics used Poisson distributions/Chi-square tests. There were 480 aircraft (90% and 8% fixed-/rotary-wing aircraft, respectively) involved in 257 midair events. Despite an overall decline (63% reduction) in MAC rates (2020-2023), the proportion of fatal events (44-58%) was unchanged. Aircraft engaged in personal and training missions represented 61% and 24% of MACs, respectively, with the training mission MAC rate declining 70%. Although traffic density is highest surrounding aerodromes, surprisingly, only half of the MACs were within this environment. MAC rates, adjusted for arrival/departure counts, at aerodromes with a control tower were 6.5-fold lower compared with airports lacking such a facility. However, some MACs were still evident for aircraft receiving traffic deconfliction services, and for such mishaps, 78% were due to pilots not maintaining visual separation. The following recommendations are advanced. General aviation authorities and organizations should update pilot training curricula and safety programs to include training on physiological limitations, e.g. field of vision deterioration with advancing age. Further, the findings herein warrant future research to determine whether over-reliance on electronic traffic displays and panel modernization negatively impact external visual scanning. Boyd D, Anderson C. Midair collisions over a period of technological advances targeting human performance deficits. Aerosp Med Hum Perform. 2026; 97(6):443-450.
Dry immersion (DI) is a ground-based model of simulated weightlessness that reduces support and proprioceptive input. This model produces reversible sensorimotor deconditioning and allows simulation of the early acute readaptation phase after spaceflight. We aimed to determine changes in spatiotemporal gait parameters and shin muscle work resulting from 7 d of DI, and whether plantar pressure distribution shifts accompany these changes. A total of 28 healthy males (14 DI, 14 controls) completed overground walking tests twice pre-DI and 2-3 h post-DI at first standing. Spatiotemporal parameters and plantar pressure (10 zones) were recorded. Surface electromyography [tibialis anterior, gastrocnemius (caput laterale), soleus] was sampled at 2000 Hz; the root mean square of electromyography was computed over phase-relevant intervals. After DI, walking speed, step frequency, and step length decreased by 19.6%, 8.3%, and 12.3%, respectively. The stance phase increased (≈2% of gait cycle) due to longer double support. Plantar pressure showed posterior-lateral redistribution: reduced loading at the toes and medial forefoot, with increased loading at the heel; lateral forefoot changes showed trends in some subjects. Root mean square electromyography increased in all recorded muscles. The results obtained are consistent with previous findings after spaceflight and its ground-based models. At the same time, they extend existing knowledge by adding new data on changes in plantar pressure distribution. These alterations may represent both the consequence and the target of locomotor strategies that compensate for gait instability. These findings clarify locomotor risks after short spaceflights. Saveko A, Bekreneva M, Ponomarev I, Shigueva T, Rukavishnikov I, Tomilovskaya E. Reorganization of human gait and foot pressure patterns after 1-week dry immersion. Aerosp Med Hum Perform. 2026; 97(4):235-242.
In a high-stakes context like aviation, deliberate self-harm (DSH) warrants attention, as it may signal underlying psychological vulnerabilities. Understanding the psychological risk profiles of civil aviators and aspirants with DSH is therefore crucial for ensuring aviation safety. A dearth of research in this area has prompted the need for profiling psychological risk factors for DSH and high-risk behavior in civil aviation to ensure fitness to fly. The current paper is a review of six cases assigned for DSH referred to the qualified examiner. A retrospective case series of six individuals (four females and two males; five aircrew aspirants and one active aviator) with a history of DSH who were referred for psychological assessment by the civil aviation authority to ascertain fitness to fly. Clinical interviews, mental status examinations, and personality assessments were analyzed to explore their underlying traits and coping mechanisms. Psychological risk factors for DSH included adolescent onset, gender, and personality traits such as impulsivity, emotional instability, external locus of control, low compliance and trust, emotional distress, and vacillating opinions. Operational and training stressors also contributed. DSH reflects primary psychological vulnerabilities marked by impulsivity, emotional dysregulation, and maladaptive coping. Integrating demographic, personality, and defense mechanism factors with operational and training stressors in psychological screening can help flag at-risk individuals. Strengthening early assessment is crucial for excluding those unfit for piloting and ensuring flight safety. Hence it is recommended that case-by-case psychological clearance is carried out for high-risk and DSH candidates. Chaturvedula SN, Dahiya YS, Uppuluri A, Bhuvansunder M, Sonali S. Psychological profile of aviators and flight aspirants with high-risk and self-harm behavior. Aerosp Med Hum Perform. 2026; 97(5):384-388.
Human centrifuges use baseline acceleration levels between high-G exposures to optimize mechanical performance and minimize motion sickness. This trial assessed the cardiovascular changes associated with different centrifuge baselines to assess their impact on trials and training. A total of 10 subjects (1 female, median age: 35, age range: 27 yr) underwent 2-min exposures to +1.2, +1.4, +1.6, and +1.8 Gz on a human centrifuge, with 5 min at +1 Gz between runs. Cardiovascular variables were assessed via the volume-clamp method and 3-lead electrocardiogram. Blood volume change in the abdomen, thigh, knee, and calf were measured via impedance plethysmography. There was an interaction between all +Gz baseline levels and cardiac output, stroke volume, heart rate, and total peripheral resistance. There was an interaction with mean arterial and diastolic blood pressure at both heart and head level, and with systolic blood pressure at head level only. When compared to +1 Gz, the highest baseline tested of +1.8 Gz resulted in increases in heart-level diastolic pressure (14 ± 8%), total peripheral resistance (31 ± 19%), and heart rate (12 ± 8%), with decreases in cardiac output (-17 ± 9%), stroke volume (-27 ± 4%), and head-level mean arterial pressure (41 ± 9%). Decreases in impedance were greater in the abdomen and thigh at higher +Gz baselines. The measured response when transitioning from +1 Gz to +1.6 and +1.8 Gz was similar to that previously reported on transition from supine to standing. This response should be considered when selecting baselines, particularly for cardiovascular research. Britton JK, Green NDC, Harridge SDR, Peters AG, Thornton-White CG, Pollock RD. Physiological responses to four different baseline accelerations on a human centrifuge. Aerosp Med Hum Perform. 2026; 97(2):75-83.
Bistable perception, where the brain alternates between two interpretations of ambiguous stimuli, has individual-specific switching rates. Although it is related to neural activities, no prior research has investigated its correlation with external behavioral performance. This study aimed to explore the relationship between the stability of bistable perception and behavioral performance, and the corresponding application prospects in the selection of special talents, such as pilots. We chose to use simulated flight operations in this research. Two experiments were conducted on ab initio pilot cadets. In Experiment 1, 38 cadets completed a simulated flight and then observed a bistable point-light rotating sphere (with or without rhythmic information) and reported its rotation direction. Experiment 2 involved 54 cadets divided into two groups observing either rhythmic or nonrhythmic spheres, with pre- and postflight tests. The perceptual switch rate of the rotating sphere was negatively correlated with simulated flight scores (rhythmic: r = -0.547; nonrhythmic: r = -0.484). After observing three sessions of 3-min trials of rhythmic stimuli, the perceptual switch rate increased, which led to an increase in the dominant frequency of flight altitude fluctuations (t = 2.440). Bistable perception stability can predict the performance of external behaviors in simulated flight. The change of perception stability will change operational stability. This research provides support for the application of bistable rhythmic rotating spheres in assessing the perceptual stability of flight candidates in pilot selection, and for enhancing the perceptual stability of pilot cadets in flight training. Zhang X, Wei L, Li X, Luo Y, Yuan J, Tan Q, Mu H. The association between bistable perception stability and performance in simulated flight operations. Aerosp Med Hum Perform. 2026; 97(5):337-343.
With increasingly ambitious space ventures, astronauts face numerous hazards, including radiation, isolation, altered gravity fields, and hostile environments. Cataracts pose a significant challenge to astronauts' health and performance, both in space and upon returning to Earth. These concerns intensify with deep space exploration, where exposure to high-energy ionizing radiation in the form of galactic cosmic rays, solar particle events, and heavy ions accelerate cataract development. This review synthesizes research from Embase, Google Scholar, Web of Science, Grey Literature, PubMed, and NASA sources on cataracts, radiation, and spaceflight. Of 3308 articles identified, 595 duplicates were removed, 476 met inclusion criteria, and 392 were included in the analysis. Radiation-induced cataract pathophysiology consists of ionizing radiation induced oxidative stress, which increases free radicals while depleting glutathione. Glutathione is a key antioxidant that interacts with ascorbic acid to protect the lens. Once glutathione levels are compromised, oxidative damage promotes protein aggregation and opacification of the lens, resulting in cataract formation. Countermeasures include optimizing antioxidant defenses, intraocular lens placement, and implementing operational and biomedical strategies such as radiation shielding and protective eyewear. Understanding and addressing these risks is essential for ensuring astronaut visual health and mission success in prolonged space exploration. Katsev BD, Lee R, Kim JH, Leigh A, Ong J, Waisberg E, Lacy AJ, Mader TH, Gibson CR, Berdahl J, Lee AG. Space radiation effects on the glutathione redox cycle and cataract formation. Aerosp Med Hum Perform. 2026; 97(5):354-361.
Lung cancer is the leading cause of cancer-related deaths worldwide and among Singaporean males. While incidence in Singapore has declined due to reductions in smoking, patient outcomes have also improved because of advances in our understanding of cancer biology, lung cancer screening, and refinements in treatment. In the Republic of Singapore Air Force, its first diagnosed case of aircrew lung cancer was presented and deliberated at its Aeromedical Board in October 2024. A narrative review was conducted to summarize aeromedically relevant updates on the current assessment and management of lung cancer, with a focus on return-to-flying considerations as well as future implications for military aircrew. Developments in immune checkpoint inhibitors and targeted therapies has driven the requirement for molecular and immunohistochemical diagnosis in lung cancer management. Together with advances in radiation therapy and minimally invasive surgery techniques, lung cancer screening and smoking cessation have significantly improved disease mortality and morbidity. Despite this, a safe return to aviation duties may remain limited by treatment side effects and the possibility of late disease recurrence. While there is an opportunity to update current waiver policies for resectable early-stage lung cancer, additional considerations are still required to individualize aeromedical decision-making based on underlying cancer histology, treatment response, side effects of newer therapies, and risk of cancer recurrence after remission. In preserving their fitness for duty, emerging evidence and the continuously evolving treatment landscape will continue to challenge flight surgeons to keep aircrew well-informed of their management options. Low JW. Current lung cancer management and return-to-duty considerations for military aircrew. Aerosp Med Hum Perform. 2026; 97(3):185-193.
Rotary-wing (helicopter) operations expose aircrew-including pilots, flight engineers, navigators, and various operators-to significant ergonomic risks, particularly affecting their lumbar and cervical spines. This strain can impair individual well-being, workforce health, and operational effectiveness. A systematic review of five databases was performed to evaluate back and neck pain prevalence among military rotary-wing aircrew. Eligible studies included those published in English, focusing on active flying military aircrew, and providing quantitative prevalence data for back and/or neck pain. Three reviewers assessed eligibility criteria, evaluated bias using the Joanna Briggs Institute quality appraisal tool, and used Excel and SPSS analysis. The review included 3786 rotary-wing pilots and aircrew from 28 studies. The pooled prevalence of back pain was 64%, while neck pain was reported in 52% of subjects. High statistical heterogeneity (I2) indicated variability across studies. Variations in pain definitions, aircrew roles, and aircraft types were noted. Recall of pain complaints spanned from immediately postflight to several months later. Subgroup analysis revealed no difference in pooled prevalence scores based on pain duration or intensity, contributing to the observed heterogeneity. Contributing factors included unclear injury timeframes, inconsistent definitions, and a lack of data on rear crewmembers. Back and neck complaints among military rotary-wing aircrew impact operational capabilities. Further research is necessary to standardize pain definitions across all aircrew roles to improve understanding. Cooper N, Spratford W, Stone M, Newman P. Prevalence of back and neck complaints in military rotary wing aircrew: a systematic review. Aerosp Med Hum Perform. 2026; 97(6):451-463.
Neck pain is common and often persistent, especially among military pilots exposed to high physical demands during flight. These conditions may alter neuromuscular control, contributing to chronic symptoms. While surface electromyography can detect pain-related changes in muscle activity, little is known about these patterns during low-load exercises in pilots. This study identifies differences in cervical muscle activity between pilots and nonpilots with and without neck pain. A total of 18 military pilots and 23 control subjects were categorized into symptomatic and asymptomatic subgroups. All subjects performed one reference movement and seven standardized mobility exercises while surface electromyogram recorded the activity of the cervical muscles. Wavelet analysis was applied to assess frequency and intensity patterns. Across the four subgroups, mean age ranged from 25.4 ± 0.9-48.7 ± 15.0 yr, mean body mass index from 24.1 ± 2.3-27.2 ± 3.4 kg · m-2, and current Visual Analog Scale scores from 0.0 ± 0.0-1.7 ± 1.8. In symptomatic nonpilots, the left trapezius muscle showed notably lower firing intensity compared to symptomatic pilots across multiple exercises. Symptomatic pilots demonstrated predominant activity in the lower frequency bands (wavelets) compared to all other subgroups during shoulder movements. These findings suggest that neck pain may be associated with reduced firing intensity and frequency shifts, potentially reflecting a protective adaptation. In pilots, this may help preserve function under load while minimizing further strain on cervical structures. Rochelt J, Saba N, Bron D. Differences in cervical muscle activity of pilots and nonpilots with and without neck pain. Aerosp Med Hum Perform. 2026; 97(6):394-402.
Epiphora, or excessive tearing, is a commonly reported symptom among those with dry eyes in the terrestrial environment. It is therefore not surprising that a higher frequency of epiphora was demonstrated among astronauts onboard both Space Transportation Shuttle and International Space Station missions. In this review paper, we discuss the pathophysiology and mechanisms of epiphora and consider the additional risk factors due to the extreme environments of spaceflight, including microgravity and, to a lesser extent, radiation. We also discuss potential strategies to mitigate spaceflight-associated epiphora. This review utilized articles related to epiphora and the spaceflight environment from various medical literature databases including Embase, Google Scholar, Web of Science, Grey Literature, PubMed, and reliable secondary sources, such as NASA webpages. Our search strategy resulted in 94 articles, and 67 articles were relevant to our study. Spaceflight-associated epiphora has a multifactorial etiology related to both reflex tearing and obstruction of the lacrimal drainage system. Dry eyes are closely associated with epiphora in space as the result of ocular irritation causing reflex tearing. Decreased tear drainage may result from the lack of gravitational assistance and the cephalad fluid shift which may create a functional obstruction of the lacrimal drainage system. While primarily a concern with chronic exposure, radiation may irritate the cornea, cause lacrimal and Meibomian gland atrophy, and disrupt tear film stability. Potential countermeasures include maintaining the tear film, mitigating the cephalad fluid shift, and protecting from radiation. Katsev BD, Lee R, Ong J, Gibson CR, Mader TH, Waisberg E, Lipsky W, Sampige R, Berdahl J. Spaceflight-associated epiphora mechanisms and countermeasures. Aerosp Med Hum Perform. 2026; 97(4):272-278.
Military jet pilots are exposed to extreme +Gz, imposing strain on the cervical musculoskeletal system. Neck pain prevalence is well documented, but the acute effects of real flight on cervical muscles and kinematics remain unclear. This study assessed acute effects in Eurofighter pilots vs. non-pilot controls. It was hypothesized that acute high +Gz exposure during a real flight affects cervical 3D kinematics, muscle mechanical properties, and pilot-reported pain scores compared to a nonexposed control group and effects of acute high +Gz exposure persist 24 h postflight, resulting in altered cervical 3D kinematics, modified muscle mechanical properties, and increased subjective pain compared to the nonexposed control group. A controlled, longitudinal study compared 20 Eurofighter pilots with 20 matched controls. Cervical 3D kinematics, subjective neck pain, and cervical muscle stiffness were assessed preflight, immediately postflight, and 24 h postflight. Pilots executed high +Gz maneuvers during real flight following a scripted mission. Primary outcomes were group-by-time differences. Statistics included repeated-measures of variance. In pilots, cervical extension range of motion decreased postflight from 56.4 ± 6.5° to 52.4 ± 7.8°, and at 24 h to 53.3 ± 6.4°. Subjective neck pain increased postflight and persisted at 24 h [pain 0.0-10.0; medians from 0.0 (0.0)-2.1 (3.0), then 1.8 (2.9)]. Right trapezius muscle stiffness decreased postflight (241.0 ± 20.3-227.8 ± 20.7 N · m-1) and after 24 h at 234.1 ± 20.1 N · m-1. High +Gz exposure and extreme head postures reduce range of motion and increase neck pain in fighter pilots. The stiffness decrease suggests a muscular mechanical overload. Findings support the need for targeted neck conditioning and real-time monitoring to mitigate injury risk to sustain operational readiness. Lingscheid R, Nuesse R, Rein R, Goell F, Albracht K, Braunstein B. High +Gz flight reduces cervical 3D kinematics and increases neck pain in fighter pilots. Aerosp Med Hum Perform. 2026; 97(3):151-159.
Cardiac remodeling can occur during spaceflights. This research aimed to study the relationship between the ST2 plasmatic biomarker and some cardiac MRI parameters of cosmonauts after 6- or 12-mo spaceflights. Venous blood for ST2 level assessment from nine Russian cosmonauts was collected 30 d before launch and on the first and seventh days after landing. The cardiac MRI sessions with T1- and T2-mapping of the heart were conducted before launch and on the fourth day after landing. Variance analysis of the ST2 levels revealed a significant increase in all cosmonauts on the first day after spaceflight (P = 0.014). On the seventh day after landing the ST2 level decreased, approaching background values. On the fourth day after landing, the MRI mapping showed structural changes in the myocardial segments that corresponded to the g-load vectors during landing. Our findings indicate a transient myocardial over-distention upon landing, as well as an increased risk of cardiac fibrosis after spaceflight. Goncharova AG, Pastushkova LH, Luchitskaya ES, Kashirina DN, Nosovsky AM, Goncharov IN, Kireev KS, Larina IM. Protein marker ST2 and myocardial mapping of cosmonauts after spaceflight. Aerosp Med Hum Perform. 2026; 97(4):243-248.
The aircraft attitude indicator is crucial for flight safety, yet its conventional design may lead to slower responses and reversal errors. This study examined whether flickering bars at different frequencies around the indicator could improve pilot performance. Forty-five pilots completed a recovery task and a tracking task with a joystick. In both tasks, the attitude indicator was modified by adding bars flickering at five frequencies (0, 2, 4, 6, and 8 Hz). A total of 14 dependent variables were recorded, including response times, reversal error rates, accuracy, and root mean square errors. Across the 14 dependent variables, 3 showed significant main effects of flicker frequency. Of the nonzero flicker conditions, performance under the 6-Hz bars was generally higher than that of the other frequencies. In the recovery task, the roll reversal error rate at 6 Hz (3.39%) was significantly lower than at 4 Hz (4.64%) and 8 Hz (4.86%). Recovery accuracy was highest at 6 Hz (96.68%), significantly outperforming 2 Hz (95.57%). In the tracking task, initiation times were fastest at 6 Hz (875 ms), significantly shorter than at 2 Hz (1028 ms). Conversely, 2-Hz flickering bars produced the worst outcomes, with the lowest accuracy and longest initiation times. The performance of the 0-Hz (nonflickering) condition was comparable to that of the 6-Hz bars on several measures. These findings extend prior research on visual salience and redundancy in cockpit display design, offering empirical evidence that flickering frequency influences pilot performance. The results provide practical implications for cockpit instrumentation design. Jiang H, Wen M, Peng X, Yu X, Liu R. Pilot performance enhancement through flickering bars at varying frequencies in attitude indicators. Aerosp Med Hum Perform. 2026; 97(4):249-256.
Aircraft crashes are infrequent but often associated with high mortality, morbidity, and only a limited number of survivors. These events are classified as high-energy traumas as aircraft typically maintain significant vertical and horizontal speeds at impact. The forces generated can produce a wide range of injuries, from soft tissue damage to fractures, with particular concern for neurological injury. Due to the low number of survivors, few studies in the literature specifically address spinal injury patterns. We retrospectively evaluated thoracolumbar spinal injuries sustained in the aircraft accident that occurred in Istanbul on February 5, 2020. A total of 22 patients with thoracolumbar fractures were transferred to 4 different healthcare centers. Data were analyzed for age, sex, fracture level and morphology, neurological status, treatment methods, and radiological imaging findings. There were 47 spinal injuries identified in 22 patients. Multiple-level fractures were observed in 12 patients. Four had neurological deficits (all American Spinal Injury Association Impairment Scale-D). According to the Thoracolumbar Injury Classification and Severity Score system, seven injuries in six patients were unstable and required surgery. Posterior decompression and stabilization were performed in six patients and vertebroplasty in one. Of the remaining patients, 10 were treated with a brace, and 5 were managed conservatively with pain palliation and supportive care. Understanding and analyzing the data from this accident is essential for improving passenger and crew safety and may contribute to preventing morbidity and mortality in future aircraft crashes with changes and adjustments to seat and seatbelt design. Harman F, Guvenc Y, Kivrak C, Cekic E, Dalbayrak S, Aydogmus E, Korkmaz E, Sarioglu E. Management of thoracolumbar spinal fracture caused by an aircraft accident. Aerosp Med Hum Perform. 2026; 97(5):333-336.