ObjectiveThis work establishes a methodological framework for sources of pilot distraction and interruptions in a structured model that can be used as a tool for cockpit design/procedure assessment.BackgroundPilots must complete complex tasks, and distractions can impair performance and lead to errors that can cause aircraft accidents. Although various cockpit distractors are examined individually, there is no integrated approach.MethodDistraction and interruption sources were identified through a literature review and confirmed/extended by interviews with airline pilots. Associated weights were determined through pairwise comparisons, yielding a hierarchical model using the Analytic Hierarchy Process.Results26 sources of pilot distraction and interruptions were quantified and categorized into four categories: communication, head-down time, responding to abnormal conditions & unexpected situations, and searching for traffic.ConclusionA taxonomic structure for assessment is achieved with the top 5 sources identified as communications, technical interruptions, experience in type, environmental factors, operational irregularities, and airspace high terrain, accounting for 63.07%.ApplicationThe structured system is a flexible assessment scale that provides a taxonomic framework for airline risk management, supports future research, and cockpit design efforts.
The travel industry has a responsibility to accommodate the needs of all its customers, including those with obesity. It is not known to what extent airlines communicate accessibility policies to passengers with obesity. We sought to assess the adequacy and content of information provided by international commercial airlines regarding the carriage of passengers with obesity. A descriptive cross-sectional analysis was conducted of policies relating to passengers with obesity that were available on publicly accessible websites of the 50 busiest global commercial airlines. Variables of interest included fleet description, passenger weight-related terminology, seating information, use of seatbelt extenders, special assistance information, use of artificial intelligence chatbots for customer service, and availability of customer information in the English language. A diverse range of terms was used to describe travelers with obesity, with "customers requiring extra personal space" or "an extra seat for personal comfort" being the most frequently used descriptors. Seating information relating to larger passengers was provided by 86% (n = 43) of airlines. Passenger guidance on the use of seatbelt extenders was available on 70% (n = 35) of airline websites. Special assistance information was provided by all airlines. While leading commercial airlines provide obesity policy information on their websites, there is considerable variation between carriers in the degree of information provided. There is a need for more transparent and standardized accessibility information for airline passengers with obesity.
As indispensable members of the flight crew for passenger transport on large aircraft, flight attendants are responsible for cabin safety, security, passenger services, and emergency response during flights. As the primary interface between passengers and airlines, their delivery of high-quality service is critical to maintaining passenger loyalty and supporting airlines' sustained prosperity. Enhancing flight attendants' in-flight service performance thus represents a key focus in airline management. This cross-sectional study examined the relationships among spiritual leadership, meaningful work, work engagement, and service performance using a sample of 313 Chinese flight attendants from Tibet Airlines and its branches. Psychological questionnaire surveys and correlation analyses revealed significant positive correlations among all four variables. Bootstrap analyses demonstrated that meaningful work and work engagement not only exert independent mediating effects on the relationship between spiritual leadership and service performance, but also jointly form a sequential mediating chain. Theoretical implications of these findings and practical recommendations for enhancing flight attendants' service performance in airline management are discussed.
Dysphagia, or difficulty in swallowing, can be the result of several etiologies such as stroke, neuromuscular disorders, head and neck injuries, or extrinsic compression of the esophagus. Patients with dysphagia are at severe risk of sequelae, such as aspiration and malnutrition, which present a severe risk of mortality. There is a significant need of implementing dysphagia -appropriate menu in commercial airlines. Among the general US population, there is a prevalent increase in dysphagia, which creates a substantial accessibility gap in commercial aviation food service. We reviewed publicly available in-flight menu options from the three largest U.S. carriers (American, United, and Delta) and classified items using the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Across economy-accessible menu items identified online, 56 (American), 67 (United), and 51 (Delta) items were classified to be concentrated in thin liquids (IDDSI 0-1) and regular/easy-to-chew foods (IDDSI 6-7), with no clearly identifiable mildly/moderately thick liquid options (IDDSI 2-3) based on posted descriptions.
Jetlag affects millions of travelers daily, yet influences of flight schedules on circadian disruption remain unclear. We aimed to quantify the effects of flight itinerary on jetlag duration at the group-average level and to identify underlying physiological mechanisms. We used biophysical modeling to analyze how flight departure and duration times impacted jetlag across 55 296 simulated flights. Simulated flights spanned time zone differences, ΔT, from -12 to 12 h and departed between 00:30 and 24:00 with durations from 0.5 to 24 h. Two cases were compared: (1) free sleep and (2) forced wakefulness during daytime at the destination. In-flight sleep followed the physiological need for sleep. Flight itineraries affected jetlag duration for all ΔTs and determined the direction of circadian adaptation for a subset of ΔTs depending on behavior at the destination. The highest variability of jetlag duration was observed for ΔT >0 h, peaking at ΔT = 9 h. Overall, for 1 ≤ ΔT ≤ 9 h, jetlag was shortest for flights departing or arriving around habitual wake time and longest when departing or arriving near habitual sleep onset. When in-flight sleep was restricted, the shortest jetlag for these ΔTs was instead observed for flights arriving during the circadian day. This pattern reversed for other ΔTs. Flight departure and arrival times contribute to the variability of jetlag duration and can reverse the direction of circadian adaptation post-flight. These dynamics are mainly governed by light exposure and sleep timing during and around flights. Statement of Significance This study provides a quantitative analysis of how flight itineraries interact with circadian and sleep physiology to determine jetlag duration. By simulating over 55 000 flights across all time zone transitions, we reveal systematic patterns linking flight timing with adaptation time and the opportunities to minimize circadian disruption through itinerary design and behaviors during and around flights. These findings advance the mechanistic understanding of jetlag and offer actionable insights for travelers and airlines to reduce jetlag impact through optimized flight schedules and personalized strategies.
Travelers who fly on commercial aircraft while infectious with measles are reported to CDC by health departments. CDC contacts airlines to collect information on potentially exposed travelers. Traveler locating information is shared with health departments to facilitate aircraft contact investigations. In May 2025, CDC was notified of a traveler who flew from Europe to Colorado while infectious with measles, transited through Denver International Airport, then flew from Colorado to North Dakota. This report describes details of the subsequent contact investigations, environmental assessment, and laboratory testing results. CDC laboratories conducted testing on a majority of case samples. Data from the CDC laboratory, CDC's Port Health Activity Reporting System, and health department investigations were analyzed to describe the index case, contacts, test results, and travel details. Flight records and visual inspection were used to describe relative locations of index and secondary case-patients at Denver International Airport. The index case was in an unvaccinated adult. Aircraft contact investigations identified 135 exposed domestic travelers. Fifteen secondary cases were identified among people exposed during the international (5) and domestic (3) flights, and at the airport (7). Two tertiary case-patients were also identified. Five of the secondary case-patients had at least one documented prior measles vaccination. Measles transmission may occur during travel. Measles vaccination is recommended prior to international travel for all travelers aged 6 months or older. Travelers with fever and other overt signs of transmissible illness, such as coughing or malaise, should be strongly encouraged to delay travel while symptomatic.
This study examines how seat width, load factor, and demographics influence passenger ratings of sufficiency, acceptability, and comfort in aircraft seating. Data from a subjective seating study relates seated hip breadth and seat width to these passenger outcomes. A parametric study and Virtual Fit Trials combined anthropometric data with empirical spatial comfort models to simulate the effects of varying seat widths, load factors, and passenger demographics. This extends earlier work based only on anthropometric fit by incorporating subjective preference for space. Results show that wider seats substantially improve accommodation across all metrics, while higher load factors reduce comfort by limiting adjacent empty seats. Female passengers were disproportionately disaccommodated across all metrics due to larger seated hip breadths. A case study comparing 3:3 and wider 3:2 seating in a fixed-width fuselage showed improved accommodation but reduced capacity, highlighting the trade-off between passenger comfort and airline efficiency. Airlines must balance passenger comfort with capacity. Simulations combining body size data and passenger feedback show that narrow seats and crowded flights negatively impact comfort, especially for females. Wider seats improve comfort but reduce capacity, revealing a clear trade-off between efficiency and passenger experience.
On May 22, 2020, Pakistan International Airlines flight PK-8303 crashed in Karachi, resulting in 97 fatalities. Many victims' remains were burned, fragmented, or commingled, making visual or fingerprint identification impossible. A rapid and reliable Disaster Victim Identification (DVI) process was initiated, integrating advanced forensic genetic techniques with kinship analysis to meet urgent humanitarian, cultural, and legal needs. Biological samples, including bone fragments, teeth, and soft tissue, were collected under strict chain-of-custody procedures. DNA was extracted using optimized protocols for degraded material, quantified via real-time PCR, and profiled with a high-sensitivity autosomal STR multiplex kit (GlobalFiler™). Y-STR and mitochondrial DNA sequencing were employed for cases where nuclear DNA was insufficient. Reference samples from 92 families were analyzed, and kinship likelihood ratios were calculated using dedicated forensic software. Within 16 days, complete identifications were made for 96 victims, with partial matches supporting the remaining case. The combined application of sensitive STR systems, lineage markers, and probabilistic kinship analysis significantly improved recovery rates from compromised remains and reduced turnaround times compared to standard DVI workflows. This case demonstrates how technological advances in forensic genetics can meet the humanitarian imperative of victim identification in mass disasters while ensuring legally robust outcomes.
Aircraft engine blade maintenance relies on inspection records shared across manufacturers, airlines, maintenance organizations, and regulators. Yet current systems are fragmented, difficult to audit, and vulnerable to tampering. This paper presents BladeChain, a blockchain-based system providing immutable traceability for blade inspections throughout the component life cycle. BladeChain is the first system to integrate multi-stakeholder endorsement, automated inspection scheduling, AI model provenance, and cryptographic evidence binding, delivering auditable maintenance traceability for aerospace deployments. Built on a four-stakeholder Hyperledger Fabric network (OEM, Airline, MRO, Regulator), BladeChain captures every life cycle event in a tamper-evident ledger. A chaincode-enforced state machine governs blade status transitions and automatically triggers inspections when configurable flight hour, cycle, or calendar thresholds are exceeded, eliminating manual scheduling errors. Inspection artifacts are stored off-chain in IPFS and linked to on-chain records via SHA-256 hashes, with each inspection record capturing the AI model name and version used for defect detection. This enables regulators to audit both what defects were found and how they were found. The detection module is pluggable, allowing organizations to adopt or upgrade inspection models without modifying the ledger or workflows. We built a prototype and evaluated it on workloads of up to 100 blades, demonstrating 100% life cycle completion with consistent throughput of 26 operations per minute. A centralized SQL baseline quantifies the consensus overhead and highlights the security trade-off. Security validation confirms tamper detection within 17 ms through hash verification.
The aviation industry faces increasing pilot training demands, and reliance on conventional Full Flight Simulators (FFS) limits training capacity. Virtual Reality (VR) offers scalable, remote training opportunities, but its role as a complement to FFS requires empirical validation. In collaboration with Singapore Airlines (SIA) instructor pilots, we developed a VR training prototype for a visual approach into Gimhae International Airport, emphasizing Competency-Based Training and Assessment (CBTA)-based Threat and Error Management (TEM). An empirical study with 39 SIA Boeing 737-MAX 8 type-rated first officers evaluated VR against FFS. An equivalence analysis showed that VR achieved performance outcomes comparable to FFS in 13 of the 16 Observable Behaviors (OBs) and across 4 Competencies. In addition, a comparative analysis indicated measurable performance improvements when VR was used to supplement FFS training. Our results suggest VR can meaningfully complement FFS in targeted competency areas, with future work required to assess its broader integration across additional scenarios and performance metrics.
As more people live with cardiovascular disease, commercial flights increasingly include patients recovering from acute coronary syndrome (ACS) or living with heart failure (HF), who face unique physiological and logistical challenges due to hypobaric hypoxia, reduced pressure, prolonged immobility, and limited onboard medical resources. We reviewed current guidelines, observational studies, and registry data to synthesize evidence and define major gaps regarding air travel in patients with ACS or HF. Available data although derived from small, heterogeneous cohorts and different therapeutic eras, suggest that many clinically stable patients after ACS and those with compensated HF (New York Heart Association classes I-III) can generally fly with low short-term event rates when appropriately assessed. The risk may be higher in the very early post-discharge period, with the magnitude of this excess risk remaining poorly defined. No universally accepted waiting period after ACS or HF decompensation is recommended by guidelines although they broadly concordant in emphasizing clinical stability, euvolemia and absence of ongoing ischemia prerequisites for travel, yet these recommendations have not been validated against in-flight outcomes. Commercial air travel is likely safe for patients with ACS or HF who are clinically stable, but decisions should be individualized and incorporate both patient- and flight-specific factors. Substantial evidence gaps persist, particularly regarding optimal timing after ACS or HF decompensation and the development of aviation-specific risk models. Prospective cohorts and international registries integrating contemporary clinical, airline, and in-flight medical event data are needed to refine guidance and support patient mobility without compromising safety.
Adverse childhood experiences (ACEs) are known risk factors for mental health issues in adulthood. Shift workers, especially those in high-stress roles like aviation, are particularly vulnerable to these mental health conditions. However, limited research has explored the relationship between ACE exposure and mental health in this population. This cross-sectional study used data from the Civil Aviation Health Cohort of China (November to December 2023). Aviation personnel (aged 18-60) reported 11 ACE types, categorized by count and latent class analysis. Mental health symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and a single-item screener for depression, anxiety, and suicidal ideation, respectively. The study analyzed 19,137 aviation personnel (61.7% male, mean age 31.7 years). Latent class analysis identified three ACE patterns: low ACE (96.5%), abuse (2.8%), and family dysfunction (0.7%). Notably, 22.6% reported ≥1 ACE and 1.2% reported ≥4, showing a dose-response association with mental health risks. Family dysfunction showed the strongest associations with depression (AOR 5.22, 95% CI 3.80-7.17), anxiety (AOR 3.94, 95% CI 2.82-5.50), and suicidal ideation (AOR 4.46, 95% CI 2.55-7.82). The cross-sectional design precludes causal inference. The reliance on retrospective self-report of ACEs may be subject to recall bias. Potential residual confounding and selection bias further limit generalizability. These findings highlight the need for workplace mental health strategies to support shift workers, particularly those with a history of ACEs. Further research is needed on mechanisms linking ACEs to aviation shift workers' mental health and potential protective factors.
Designing an optimal Coverage Path Planning (CPP) framework for autonomous aircraft cabin cleaning is a critical challenge due to the time-sensitive nature of aircraft turnaround operations. Conventional domestic cleaning robots struggle to adapt to the confined and irregular cabin layouts of commercial aircraft. To address this, the paper proposes a two-stage CPP approach utilizing the reconfigurable robot. In the first stage, the robot operates in its full-size configuration to efficiently clean open regions such as aisles and galleys, skipping hard-to-access seat rows to minimize total cleaning time. In the second stage, a Genetic Algorithm (GA)-based Traveling Salesman Problem (TSP) optimization process determines the optimal visiting sequence for the skipped areas, while simultaneously accounting for the robot's reconfiguration energy model. This integrated framework explicitly models the trade-off between coverage efficiency, energy consumption, and reconfiguration cost, ensuring that the robot autonomously selects the most energy-optimal path under operational constraints. The experiments incorporating airline procedures and cabin geometry demonstrate that the proposed approach significantly outperforms conventional CPP strategies in both coverage time and energy usage. The results validate the feasibility of deploying reconfigurable robotic systems for real-world autonomous aircraft cabin cleaning during turnaround operations.
Deficits in executive functions (EFs) and impulsive decision-making are well-established cognitive mechanisms underlying gambling disorder (GD), though there are some inconsistent findings. This study investigated the relationship between changes in GD symptoms in online sports bettors and specific EFs as well as decision-making processes over time. A subsample of online sports bettors (n = 54, mean age = 33, 96% male) from a larger study underwent an in-person assessment. Initial GD symptom severity was measured online according to DSM-5 criteria and was low to mild in most participants. All other assessments took place an average of 443 days later, during the in-person assessment. We analyzed cross-sectional and longitudinal associations between three facets of EFs (response inhibition, cognitive flexibility, and working memory) and four decision-making facets (delay discounting, probability discounting for gains and losses, and loss aversion) and GD symptom severity and changes over time. Cross-sectional results showed that higher GD symptom severity was associated with poorer working memory and reduced loss aversion. Reduced loss aversion was also associated with greater symptom increase over time. However, these associations were not statistically significant after correction for multiple testing, so they should be interpreted with caution. No other significant relationships were found. These findings provide preliminary evidence that reduced loss aversion is one cognitive factor in disordered gambling among online sports bettors, a population with heterogeneous profiles of EFs and decision-making. Further longitudinal studies are needed to clarify the role of specific cognitive processes in the development and progression of GD to better inform treatment strategies.
Fear of flying, or aviophobia, is one of the most prevalent phobias, affecting approximately 3 to 5% of the population. Although air travel has become significantly safer, fear of flying continues to impact individuals' social, professional, and personal lives, often leading to avoidance behaviors and significant distress. This qualitative study explores the causes, triggers, and coping strategies associated with fear of flying, focusing on participants from Türkiye. Through semi-structured interviews with 20 individuals with self-reported fear of flying, conducted between June 2024 and February 2025, the study identifies key factors associated with the fear of flying, including psychological factors (e.g., anxiety disorders, claustrophobia), negative flight-related experiences (e.g., turbulence, media coverage of crashes), cognitive factors (e.g., catastrophic thinking), environmental and social influences (e.g., learned behaviors, media exposure), physiological responses (e.g., sweating, palpitations), and cultural contexts. Data were analyzed using thematic analysis, and data collection continued until thematic saturation was achieved. The findings reveal that turbulence, fear of enclosed spaces, and media portrayals of aviation accidents are significant triggers. Coping strategies such as Cognitive-Behavioral Therapy (CBT), relaxation techniques, and spiritual methods (e.g., praying) are commonly employed to manage flight anxiety. The study also highlights the role of social media in relation to fear of flying, as exposure to negative aviation content is associated with increased anxiety and avoidance behaviors. Despite the availability of professional support and airline-sponsored programs, many participants reported a notable underutilization of these resources. The study concludes that a multifaceted approach, combining psychological interventions, education, and culturally sensitive treatments, may be important for addressing fear of flying. These findings contribute to the growing body of literature on fear of flying and provide insights for developing targeted interventions to help individuals overcome their fear of flying.
Artificial intelligence (AI) is reshaping future work and increasing university students' concerns about career uncertainty and employability. Existing research offers limited insight into why students respond differently to the same AI-related career uncertainty. Drawing on cognitive appraisal theory, this study examines how the AI job replacement threat influences students' career goal adjustment intentions through challenge and hindrance appraisals, as well as whether proactive personality shapes these appraisal processes. Two studies were conducted. Study 1 used a scenario-based experiment with 205 university students to manipulate high versus low AI job replacement threat. Independent-samples t-tests and partial least squares structural equation modeling (PLS-SEM) were used for data analysis. Study 2 used survey data from 458 career-entry students to test the proposed moderated mediation model using PLS-SEM. Artificial intelligence job replacement threat increased both challenge and hindrance appraisals. Challenge appraisal mediated the relationship between AI job replacement threat and career goal reengagement intention, whereas hindrance appraisal mediated the relationship between AI job replacement threat and career goal disengagement intention. Proactive personality strengthened the relationship between the AI job replacement threat and challenge appraisal, as well as the indirect effect on career goal reengagement intention. However, proactive personality did not significantly weaken the hindrance appraisal pathway. The findings suggest that AI job replacement threat functions as a dual-meaning source of career uncertainty in the context of AI-driven labor market transformation. While proactive personality facilitates opportunity-oriented career adaptation, it does not eliminate perceptions of structural career threat, highlighting the limits of individual agency in navigating future work uncertainty.
High-quality evidence guiding opioid prescribing decisions for acute pain across common diagnoses is lacking. To describe pain trajectories and patterns of opioid and nonopioid treatment use among individuals who were offered opioids for the treatment of acute pain. This was a prospective cohort study of patients recruited from 5 US health systems between September 2020 and March 2023 in emergency departments (EDs), primary care clinics, dental practices, or after cesarean delivery or knee replacement. Eligible patients were opioid-naive adults aged 18 years or older at all study sites, as well as adolescents aged 15 to17 years undergoing impacted molar extraction at 1 site, who were offered an opioid prescription for acute pain. Analysis was conducted April 2023 through February 2026. Offer of a prescription for an opioid analgesic. Time to pain resolution (3 consecutive reports of no pain), patterns of opioid and nonopioid treatment use, and opioid-related adverse effects, ascertained from digital questionnaires. Among 1708 enrolled patients (median age, 38 years [IQR, 28-52 years]; 615 [36.0%] reporting race or ethnicity underrepresented in studies of acute pain management) followed up for 180 days, 915 (53.6%) were recruited in EDs, 307 (18.0%) in primary or urgent care, 263 (15.4%) in dental settings, and 223 (13.1%) in inpatient settings. Pain sources included dental (302 patients [17.7%]), trauma or injury (302 [17.7%]), obstetric (176 [10.3%]), musculoskeletal (131 [7.7%]), and low back (100 [5.9%]). Among 1502 patients reporting pain level at least once, median time to pain resolution irrespective of the treatment approach was 20 days (IQR, 8-88 days), with longer durations for surgical pain (74 days [IQR, 30 days to not reached]) and low back pain (69 days [IQR, 18 days to not reached]). The median time to opioid discontinuation among 1189 patients (69.6%) who reported any opioid use was 7 days (IQR, 2-31 days); an estimated 10.0% (95% CI, 7.7%-12.7%) of patients used opioids for at least 90 days, with higher rates in people reporting frequent pain before enrollment. Of 1482 patients (86.8%) completing at least 1 survey during the first 2 weeks of follow-up, 1153 (77.8%) reported using any opioids and 1287 (86.8%) reported using acetaminophen or ibuprofen. Among 619 (52.1%) patients with any opioid use who reported the dose of opioids taken in the first 15 days, daily doses were low (median, 10 [IQR, 5-15] morphine milligram equivalents). Most respondents reported leftover opioids (657 of 982 responding [66.9%]). In this cohort study of opioid-naive patients with acute pain, opioid use was generally low dose and of short duration, although some patients reported prolonged opioid use; most reported achieving pain resolution within 3 weeks, with longer times for surgical and low back pain. The findings suggest current guidelines for multimodal treatment and for short-duration opioid prescriptions if needed will serve many but not all patients, and treatment should be tailored to address individual patients' needs.
The COVID-19 outbreak profoundly disrupted the aviation industry and reshaped cabin crew work conditions, increasing psychological strain and altering job resources. Against this backdrop, this study investigates the antecedents of organizational citizenship behavior among cabin crew members in a Taiwanese airline, focusing on job crafting, perceived organizational support, job burnout, and organizational commitment. A purposive and quota sampling method was employed to collect data through an online questionnaire from a Taiwanese airline company. The collected data was analyzed using structural equation modeling to verify the proposed model. The study found that job burnout does not significantly affect organizational citizenship behavior or organizational commitment and that job crafting does not significantly affect job burnout. In contrast, job crafting and perceived organizational support have a positive effect on organizational commitment and organizational citizenship behavior, whereas perceived organizational support has a negative effect on job burnout. Finally, the study discusses managerial implications and suggests directions for future research.
Predicting where and when epidemics will spread is essential for guiding early public health responses, yet remains challenging when surveillance data are sparse. Mobility-based approaches offer a promising alternative by leveraging human movement patterns to predict spatial spread without requiring detailed epidemiological data. We evaluated the ability of mobility-informed effective distance to predict the relative timing of epidemic onset for three respiratory pathogens: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), seasonal influenza virus, and respiratory syncytial virus (RSV). We compared effective distances derived from county-level commuting data, airline traffic flows, and a theoretical radiation model within a metapopulation framework. Analyses were conducted at the county level across South Carolina for all three pathogens and at the state level across the United States for influenza and SARS-CoV-2. Effective distance reliably predicted the relative order of epidemic onset across pathogens and spatial scales. Across all analyses, epidemics arrived earlier in larger, more connected populations, and effective distance outperformed geographic distance as a predictor of onset timing. In metapopulation simulations of a hypothetical respiratory pathogen, radiation-model effective distance was highly correlated with simulated arrival times (Spearman's ρ = 0.95, 95% CI [0.90 to 0.98]), substantially outperforming commuting-based effective distance (ρ = 0.54, 95% CI [0.24 to 0.75]). In empirical analyses at the county level in South Carolina, radiation-model effective distance consistently outperformed commuting-based measures for the coronavirus disease 2019 (COVID-19) first wave (ρ = 0.62 vs. 0.39), the 2022-2023 influenza season (ρ = 0.57 vs. 0.44), and the 2022-2023 RSV season (ρ = 0.70 vs. 0.47). At the state level, airline-based effective distance predicted arrival timing for COVID-19 (ρ = 0.46, 95% CI [0.19 to 0.66]) and onset timing for the 2024/2025 influenza season (ρ = 0.45, 95% CI [0.14 to 0.66]). Mobility-informed models capture consistent spatiotemporal patterns of epidemic spread across pathogens and scales. These findings support their use as scalable, data-efficient tools for early outbreak preparedness.
BACKGROUND: International air border crossings are crucial for controlling the spread of respiratory pandemics like COVID-19. Effective screening at these points is vital for national health security and meeting global health obligations under the revised International Health Regulations (IHR) 2005. This qualitative study aimed to identify and analyze the challenges, barriers, and proposed solutions in COVID-19 screening and management at Iran’s air border crossings and situates these findings within the context of global health governance and pandemic response frameworks. METHODS: Using purposive sampling, twelve key stakeholders involved in border health management were interviewed between Mar and Nov 2024. Data were collected through semi-structured interviews and supplemented by a field visit to Imam Khomeini International Airport’s border health base and a review of relevant international regulations and recent scholarly literature. Content analysis combined with Fishbone root cause analysis was employed to explore underlying factors. RESULTS: Findings revealed multifaceted challenges including inconsistent implementation of screening protocols, shortage of trained personnel, inadequate technological infrastructure, poor interagency coordination, and legal ambiguities related to data privacy and quarantine enforcement. Behavioral factors such as passenger resistance and limited airline cooperation further undermined screening effectiveness. Additionally, the assessment identified significant gaps in meeting global standards and IHR core capacities (points of entry, public health emergency preparedness and surveillance) at air border points. Proposed solutions emphasized integrated digital platforms for real-time data sharing, enhanced staff training, improved quarantine facilities, legal reforms, and targeted multilingual communication campaigns. CONCLUSION: This study indicates that strengthening air border screening during pandemics requires a multisectoral approach aligned with IHR. Identified human, technical, organizational, legal, and environmental challenges may hinder full compliance with these regulations. Addressing these barriers through practical solutions could improve preparedness and response to health emergencies at both national and international levels.