Letter: Benjamin Rush and the birth of american aviation medicine.
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Sixteen students were given flight training according to a highly standardized and rigidly controlled 35-h syllabus. Eight of the group (TG) recieved 10 h of their training in a Link GAT-1 ground trainer and 25 h in a Cherokee 140B. the other eight (AG) recieved all of their training in the airplane. The resting heart rate (HR) of group TG was significantly lower when the ground trainer was to be used than was the resting HR of group AG on equivalent lessons. The difference disappeared when group TG was to fly the airpland. In flight, group AG'S HR was significantly higher than group TG's in the ground trainer. Again the difference disappeared when group TG flew the airpland. Physcial work, as indicated by O2 consumption, was greater in the airplane than in the ground trainer. Urine chemistry indicated only a few and inconsistent points of significant differece between the groups. However, pre- and post-flight differences showed highly significant differences for both TG and AG. Objective flight tests administered four times during the syllabus indicated insignigicant differences between TG and AG, likewise, a check pilot who did not know to which group a student belonged could not differentiate between groups TG and AG. It was concluded that 10 h training in the GAT-1 did not compromise the flying skill as judged by the check pilot.
A re-evaluation of EEGs of more than 1,000 applicants for flying training is presented. All EEG abnormalities were reevaluated by three EEG specialists. Out of 1,630 EEG records, 5.4% were classified as abnormal and, of these, 24 were found to have a bearing on flying qualification. SW-variants and paroxysms were cause for elimination in any case. This study led to the adoption of the following policy: Any subject showing EEG abnormalities, possibly requiring a permanent elimination, will undergo a second EEG by another examiner. In cases with EEG anomalies, a followup EEG is done with a concurrent sensory-motor performance test. This is supplemented by an evaluation of collateral cerebral circulation, using uni-and bilateral compression of the vertebral and carotid arteries. In cases without noticeable performance deficiencies another EEG is done a year later in order to exclude a progression of the EEG anomalies.
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An experienced helicopter pilot with hypertension, hyper-triglyceridemia, elevated cholesterol, obesity, and diabetes is treated with a high-protein, low-carbohydrate diet. In 3 months, he loses 35 lbs, is normotensive without medication, cholesterol and triglycerides show significant reduction, fasting blood glucose and 2-h post glucose load are normal. At follow-up 1 yr later he has maintained hemoglobin A1C in the low 5 range. The protein diet is discussed and compared with the traditional dietary approach for type 2 diabetes.
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An Air Force F-15 pilot develops the sudden onset of incapacitating dizziness with nausea and vomiting not associated with flight. Presentation, diagnosis, treatment, and aeromedical issues surrounding the symptom complex of acute onset vertigo is discussed.
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A 44-yr-old male pilot was diagnosed with non-ischemic cardiomyopathy, possibly as a complication of hereditary hemochromatosis, 8 yr after an acquired left bundle branch block was discovered on a routine ECG. Biochemical testing returned high levels of iron and percentage transferrin saturation, and genetic testing for hemochromatosis was remarkable for a heterozygous H63D mutation in the HFE gene on chromosome 6. Hereditary hemochromatosis should be considered in the differential diagnosis when a patient presents with cardiomyopathy and genetic testing for HFE gene variants influencing iron overload is now available as a clinical adjunct for diagnosis and patient management issues. Cardiomyopathy and symptomatic hemochromatosis are aeromedically disqualifying conditions in the U.S. Air Force; however, early identification of hereditary hemochromatosis susceptibility with biochemical or genetic diagnostic tests, followed by education in primary and secondary prevention, will prevent a significant proportion of the possible sequelae.
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The article includes excerpts from The Bioethic Rules of Research With Humans and Animals that have established on analysis of national and international bioethic guidelines for biomedical research with the use of humans and animals and are a part of the ISS human use guidelines.