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PubMed | Medical College of Wisconsin, Civil Aerospace Medical Institute and Milwaukee County Medical Examiners Office
Type: | Journal: Stapp car crash journal | Year: 2016

The objective of the present exploratory study is to understand occupant responses in oblique and side-facing seats in the aviation environment, which are increasingly installed in modern aircrafts. Sled tests were conducted using intact Post Mortem Human Surrogates (PMHS) seated in custom seats approximating standard aircraft geometry. End conditions were selected to represent candidate aviation seat and restraint configurations. Three-dimensional head center-of-gravity linear accelerations, head angular velocities, and linear accelerations of the T1, T6, and T12 spinous processes, and sacrum were obtained. Three-dimensional kinematics relative to the seat were obtained from retroreflective targets attached to the head, T1, T6, T12, and sacrum. All specimens sustained spinal injuries, although variations existed by vertebral level. While the tension mechanism was associated with cervical spine injuries, complex distraction-coupled with bending and tension was attributed to thoracolumbar spine injuries. Skeletal fractures to the ribcage were attributed to compression induced by the restraint from the seatbelt, the presence of the armrest, and/or severe motions of the unconstrained torso. Pelvic injuries were also attributed to restraint offered by the lap belt on the accelerating torso-pelvis complex in the absence of the armrest. Lower extremity injuries occurred due to the unconstrained motion (flailing mechanism). These results serve as an initial dataset to understand the kinematics of different body regions, injuries and patterns, and potential injury mechanisms describing PMHS responses in the aviation environment.

Kupfer D.M.,Civil Aerospace Medical Institute | White V.L.,Civil Aerospace Medical Institute | Strayer D.L.,80 S. 1530 E. BEHS 502 | Crouch D.J.,Utah Toxicology Expert Services | Burian D.,Civil Aerospace Medical Institute
BMC Medical Genomics | Year: 2013

Background: As part of the civil aviation safety program to define the adverse effects of ethanol on flying performance, we performed a DNA microarray analysis of human whole blood samples from a five-time point study of subjects administered ethanol orally, followed by breathalyzer analysis, to monitor blood alcohol concentration (BAC) to discover significant gene expression changes in response to the ethanol exposure. Methods. Subjects were administered either orange juice or orange juice with ethanol. Blood samples were taken based on BAC and total RNA was isolated from PaxGene™ blood tubes. The amplified cDNA was used in microarray and quantitative real-time polymerase chain reaction (RT-qPCR) analyses to evaluate differential gene expression. Microarray data was analyzed in a pipeline fashion to summarize and normalize and the results evaluated for relative expression across time points with multiple methods. Candidate genes showing distinctive expression patterns in response to ethanol were clustered by pattern and further analyzed for related function, pathway membership and common transcription factor binding within and across clusters. RT-qPCR was used with representative genes to confirm relative transcript levels across time to those detected in microarrays. Results: Microarray analysis of samples representing 0%, 0.04%, 0.08%, return to 0.04%, and 0.02% wt/vol BAC showed that changes in gene expression could be detected across the time course. The expression changes were verified by qRT-PCR.The candidate genes of interest (GOI) identified from the microarray analysis and clustered by expression pattern across the five BAC points showed seven coordinately expressed groups. Analysis showed function-based networks, shared transcription factor binding sites and signaling pathways for members of the clusters. These include hematological functions, innate immunity and inflammation functions, metabolic functions expected of ethanol metabolism, and pancreatic and hepatic function. Five of the seven clusters showed links to the p38 MAPK pathway. Conclusions: The results of this study provide a first look at changing gene expression patterns in human blood during an acute rise in blood ethanol concentration and its depletion because of metabolism and excretion, and demonstrate that it is possible to detect changes in gene expression using total RNA isolated from whole blood. The analysis approach for this study serves as a workflow to investigate the biology linked to expression changes across a time course and from these changes, to identify target genes that could serve as biomarkers linked to pilot performance. © 2013 Kupfer et al.; licensee BioMed Central Ltd.

Buriak S.E.,A.T. Still University | Potter J.,Harvard University | Potter J.,Beth Israel Deaconess Medical Center | Bleckley M.K.,Civil Aerospace Medical Institute
Journal of Continuing Education in the Health Professions | Year: 2015

Introduction: Cancer survivorship is a chronic disease that places patients in limbo between oncologists and primary care clinicians. Strategies have been proposed to ease the shift in coordination of care, including broad-based educational outreach to primary care providers. Methods: Guided by the theory of planned behavior (TPB), predictors of intention to provide survivorship care, including credentials, experience, perception of barriers, and personal survivorship status, were evaluated using logistic regression with a cohort of physicians, nurse practitioners, and registered nurses participating in an unprecedented online continuing medical education/continuing education survivorship care course. Results: Results showed that physicians were significantly less likely to express intent to provide survivorship care (odds ratio [OR] = .237, p = .0001) compared to the other groups. Overall, clinicians with 6-10 years of experience were 3 times more likely to express intent to provide survivorship care (OR = 2.86, p = .045) than those with less or more experience. When clinicians perceived the presence of a barrier, they were nearly twice as likely to have diminished intent (OR = 1.89, p = .035). Most participants (66%; n = 1185) selected two barriers: lack of survivorship care plans and treatment summaries (45.4%; n = 821) and lack of education (20.1%; n = 364). Discussion: Barriers to the delivery of survivorship care can influence clinicians' intention to provide survivorship care, which varied by years of experience in this study. Interdisciplinary educational strategies featuring midcareer provider champions who have successfully incorporated survivorship care and can offer specific solutions to these barriers are recommended for future interventions. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Kratchounova D.,Civil Aerospace Medical Institute
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | Year: 2016

Pilots’ awareness of the flight deck as a shared space is intrinsic and they interact with each other freely and naturally in it. However, these pilot-topilot interactions bear little resemblance to the pilot-aircraft interactions which are constrained within instrument panel areas where the majority of pilot interfaces currently reside. The inherent spatial characteristics of the flight deck afford the notion of an interspace. The interspace can be an environment where: (a) the pilots interact with technology in a multimodal fashion such that the actions in one modality complement, and collaborate the input from the others, producing a well-choreographed user experience; and (b) the spatial organization, temporal synchronization, and semantic collaboration of control input devices reflect the integration patterns characterizing people’s use of different modalities. Thus, the key to an effective design paradigm shift is contingent on successfully emulating these naturally occurring modality communication and cooperation patterns within the intended interspace. © Springer International Publishing Switzerland 2016.

Lewis R.J.,Civil Aerospace Medical Institute | Kemp P.M.,Civil Aerospace Medical Institute | Johnson R.D.,Forensic Chemistry and Toxicology Laboratory
Journal of Analytical Toxicology | Year: 2015

Paroxetine is a selective serotonin reuptake inhibitor commonly prescribed for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder. While the use of paroxetine is considered relatively safe, negative side effects, including nausea, drowsiness, insomnia and dizziness, can adversely affect a pilot's ability to safely operate an aircraft. The use of paroxetine may increase suicidal behavior and suicidal ideation. When relying on postmortem specimens for toxicological evaluation, a general understanding of drug distribution throughout postmortem specimens is important. This laboratory has determined the distribution of paroxetine in postmortem tissues and fluids from nine aviation accident fatalities. Specimens were processed using an n-butyl chloride liquid/liquid extraction followed by gas chromatographic/mass spectrometeric analysis. Blood paroxetine concentrations obtained from these cases ranged from 0.019 to 0.865 mg/mL. The distribution of paroxetine, expressed as mean specimen/blood ratio, was 1.67±1.16 urine (n = 4), 0.08±0.04 vitreous humor (n = 6), 5.77±1.37 liver (n = 8), 9.66±2.58 lung (n = 9), 1.44±0.57 kidney (n = 8), 3.80±0.69 spleen (n = 8), 0.15±0.04 muscle (n = 8), 4.27±2.64 brain (n = 7) and 1.05± 0.43 heart (n = 8). The large standard deviations associated with the paroxetine distribution coefficients suggest that paroxetine can experience significant postmortem concentration changes. © The Author 2015.

Lewis R.J.,Civil Aerospace Medical Institute | Angier M.K.,Civil Aerospace Medical Institute | Johnson R.D.,Forensic Chemistry and Toxicology Laboratory
Journal of Analytical Toxicology | Year: 2014

During the investigation of aviation accidents, postmortem specimens from accident victims are submitted to the Federal Aviation Administration's Civil Aerospace Medical Institute (CAMI) for toxicological analysis. A case recently received by CAMI screened positive for the anticonvulsant medication carbamazepine (CBZ; Tegretol®) by gas chromatography-mass spectrometry (GC-MS). The CBZ found during this routine screening procedure was subsequently confirmed using a CBZ-specific GC-MS procedure. It was later discovered that the accident victim had been prescribed oxcarbazepine (OXCBZ; Trileptal®). OXCBZ is structurally similar to CBZ and is metabolized by cytosolic enzymes in the liver to an active metabolite, 10,11-dihydro-10-hydroxycarbamazepine (DiCBZ). It was determined that the CBZ initially found in this case was present due to the thermal breakdown of DiCBZ in the GC-MS injector port. In the current study, this conversion was investigated and the percentage of CBZ formed at various injector port temperatures was determined. Additionally, these three compounds were quantified in nine fluid and tissue specimens from the case in question. Liquid chromatography-mass spectrometry was also incorporated to further demonstrate the absence/presence of CBZ in these samples. © The Author 2014. Published by Oxford University Press.

Lewis R.J.,Civil Aerospace Medical Institute | Angier M.K.,Civil Aerospace Medical Institute | Williamson K.S.,Civil Aerospace Medical Institute | Johnson R.D.,Forensic Chemistry And Toxicology Laboratory
Journal of Analytical Toxicology | Year: 2013

Sertraline (Zoloft) is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder and post-traumatic stress disorder. Although the use of sertraline is relatively safe, certain side effects may negatively affect a pilot's performance and become a factor in an aviation accident. The authors' laboratory investigated the distribution of sertraline and its primary metabolite, desmethylsertraline, in various postmortem tissues and fluids obtained from 11 fatal aviation accident cases between 2001 and 2004. Eleven specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart and bile. Human specimens were processed utilizing solid-phase extraction, followed by characterization and quantitation employing gas chromatography-mass spectrometry. Whole blood sertraline concentrations obtained from these 11 cases ranged from 0.005 to 0.392 mg/mL. The distribution coefficients of sertraline, expressed as specimen/blood ratio, were as follows: urine, 0.47±0.39 (n = 6); vitreous humor, 0.02±0.01 (n = 4); liver, 74±59 (n = 11); lung, 67±45 (n = 11); kidney, 7.4±5 (n = 11); spleen, 46±45 (n = 10); muscle, 2.1±1.3 (n = 8); brain, 22±14 (n = 10); heart, 9±7 (n = 11); and bile, 36±26 (n = 8). Postmortem distribution coefficients obtained for sertraline had coefficients of variation ranging from 47-99%. This study suggests that sertraline likely undergoes significant postmortem redistribution.

Thompson K.S.,Civil Aerospace Medical Institute | Lewis R.J.,Civil Aerospace Medical Institute | Ritter R.M.,Civil Aerospace Medical Institute
Journal of Analytical Toxicology | Year: 2014

Zolpidem is a nonbenzodiazepine sedative hypnotic drug used for the short-term treatment of insomnia. While quite effective in producing sedation, zolpidem has potentially hazardous side effects when put in the context of complex tasks. Therefore, to more fully understand the postmortem concentrations of zolpidem, our laboratory has developed a sensitive method for the quantitation of zolpidem in biological specimens. Additionally, we have evaluated the distribution of zolpidem in various postmortem tissues and fluids from 10 aviation fatalities. This method incorporated a modified acetonitrile 'crash and shoot' extraction and a Waters Xevo TQ-S with an Acquity ultra-performance liquid chromatograph. The linear dynamic range was 0.4-800 ng/mL. The extraction efficiencies ranged from 78 to 87%, depending on the concentration. Postmortem blood zolpidem concentrations in these 10 cases ranged from 7.6 to 76.5 ng/mL. The highest concentrations of zolpidem present in each victim were found in the liver, spleen, lung and kidney tissues. Distribution coefficients for zolpidem were determined for each of the specimen types analyzed. These coefficients are expressed relative to the blood concentration in each case. This method proved to be simple, accurate and robust for the identification and quantitation of zolpidem in postmortem fluids and tissues. © The Author 2014. Published by Oxford University Press.

PubMed | Civil Aerospace Medical Institute
Type: Journal Article | Journal: Aerospace medicine and human performance | Year: 2016

The issue of expanding flight privileges that do not require medical oversight is currently an important topic, especially in the United States. We compared personal flying accident rates in aircraft with special light sport aircraft (SLSA) and experimental light sport aircraft (ELSA) airworthiness certificates to accident rates for personal flying in other general aviation (GA) aircraft.To calculate accident rates, personal flying hours were obtained from the annual FAA General Aviation and Part 135 Activity Surveys, and numbers of personal flying accidents were obtained from the NTSB accident database. Overall and fatal personal flying accident rates for the SLSA and ELSA groups and other GA aircraft were calculated and accident rates were compared.The overall personal flying accident rate for SLSA and ELSA was found to be 29.8 per 100,000 flight hours and the fatal accident rate was 5.2 per 100,000 flying hours. These are both significantly greater than the overall personal flying rate of 12.7 per 100,000 h and fatal rate of 2.6 per 100,000 h for other GA aircraft.Although this study has several limitations, the significantly higher accident rates in the sport pilot aircraft suggests caution when expanding sport pilot privileges to include larger, more complex aircraft. Mills WD, DeJohn CA. Personal flying accident rates of selected light sport aircraft compared with general aviation aircraft. Aerosp Med Hum Perform. 2016; 87(7):652-654.

PubMed | Civil Aerospace Medical Institute
Type: Journal Article | Journal: Aerospace medicine and human performance | Year: 2016

Since 2004, in the United States, light sport aircraft (LSA) and some aircraft with standard airworthiness certificates can be operated for recreational purposes with a valid state drivers license rather than a Federal Aviation Administration (FAA)-issued aeromedical certificate. There have been recent efforts to allow operation of much larger, heavier, faster, and more complex aircraft without requiring a medical certificate. The primary objective of this research was to compare hazards to flight safety identified in fatally injured pilots required to possess a valid FAA third-class medical certificate to hazards in fatally injured pilots who were not required to possess a valid medical certificate.A search of all fatal U.S. aircraft accidents in the FAA Medical ANalysis and TRAcking (MANTRA) registry between January 1, 2011, and April 30, 2014, identified 1084 individuals. A review of accident pilots medical, autopsy, and toxicological data was conducted. After applying exclusion criteria, 467 pilots remained, including 403 medically certified and 64 medically uncertified pilots.A significant difference was found in a surrogate measure for risk between medically certified and uncertified pilots (25% vs. 59%). This difference remained significant after adjustment for age. No significant difference was found in the proportions of hazards identified on toxicological review.The results of this study suggest that the risk of an adverse medical event is reduced in pilots required to possess a valid medical certificate. Ricaurte EM, Mills WD, DeJohn CA, Laverde-Lopez MC, Porras-Sanchez DF. Aeromedical hazard comparison of FAA medically certified third-class and medically uncertified pilots. Aerosp Med Hum Perform. 2016; 87(7):618-621.

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